Pilot Study About the Effects of the Soma Experiencing Motion (Soma e-Motion) Program on Interoceptive Awareness and Self-Compassion

Objective@#The purpose of this study was to examine the effects of the Soma experiencing motion (Soma e-motion) program on interoceptive awareness and self-compassion among novices. @*Methods@#A total of 19 adults (clinical group=9, non-clinical group=10) participated in the intervention. Psychological and physical changes after program were qualitatively analyzed using in-depth interviews. The Korean Multidimensional Assessment of Interoceptive Awareness (K-MAIA) and the Korean version of the Self-Compassion Scale (K-SCS) were used as quantitative measures. @*Results@#The non-clinical group showed statistically significant differences in the K-MAIA scores (z=-2.805, p0.05; K-SCS: z=-0.178, p>0.05). According to the in-depth interviews, the results of the qualitative analysis were categorized into five dimensions (psychological and emotional, physical, cognitive, behavioral, and aspects participants found challenging and needs improvement). @*Conclusion@#The Soma e-motion program was feasible for improving interoceptive awareness and self-compassion in the non-clinical group. However, further research is needed to investigate the clinical efficacy of the Soma e-motion program for clinical group.

Body Awareness in Patients With Depression and/or Anxiety Disorder / 신경정신의학

Objectives@#The objective of the present study was to examine whether patients with severe depression and/or anxiety show a difference in the level of body awareness compared with that of healthy controls. @*Methods@#Outpatients (n=100) with a diagnosis of moderate to severe depression and/or anxiety and 42 healthy controls were included in the study. Body awareness was assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA) scale, and other clinical characteristics like anxiety and depression were measured using the State-Trait Anxiety Inventory and Patient Health Questionnaire, respectively. The data were analyzed using ANCOVA, and statistically significant differences between the two groups in both the overall MAIA score and subscale scores were documented. @*Results@#The overall MAIA scores of patients with depression and/or anxiety were significantly lower than that of healthy subjects. Specifically, the differences found in the subscales of trust, acceptance, attention-regulation, and return-to-body were significant, whereas the differences found in the subscales of notice and mind-to-body awareness were not. @*Conclusion@#These findings imply that the ability to monitor one’s own bodily sensations and to be aware of their connection with emotional states cannot serve as a marker for psychological well-being. Rather, it may be the aspects of attentional styles and attitudes toward bodily states that play a critical role in mental health. Further analyses examining the relationships between the subscales of body awareness and other psychological variables are deemed necessary.

Comparative Analysis of the Psychosocial Symptoms and Experiences of Bereaved Parents and Parents of Children Who Survived the Sewol Ferry Accident After 5 Years: A Qualitative Interview Study

Background@#This study aimed to investigate the psychosocial symptoms and experiences of bereaved parents of victims and parents of survivors of the Sewol Ferry accident five years after the accident. @*Methods@#In-depth interviews of 186 bereaved parents of victims or survivors of the Sewol Ferry accident were conducted. We elicited and categorized meaning units relevant to the psychological, cognitive, and physical traits of the participants from these interviews.Differences in responses between bereaved parents and survivors’ parents and between genders were examined using frequency analyses and χ 2 tests. @*Results@#Data were organized under seven headings: observed attitude and impression of participants, difficulties due to mental health problems, difficulties due to physical pain, difficulties in relationships, negative changes following the incident, positive changes following the incident, and help needed. Within these headings, 27 themes, 60 sub-themes, and 80 meaning units were elicited. @*Conclusion@#This study explored the psychiatric, physical, and relational problems reported by bereaved parents and those of survivors as well as major changes in their personal and social lives after the Sewol Ferry accident. Differences in responses according to gender were also identified. The results from this study could inform and facilitate the implementation of intervention measures, such as long-term psychological evaluation, to bereaved parents of victims or survivors of disasters.

A Network Model of Positive Resources, Temperament, Childhood Trauma, and Comorbid Symptoms for Patient with Depressive Disorders

Objective@#Temperament, positive resources, childhood trauma, and other clinical comorbid symptoms are related to depressive symptom severity. Here, we used network analysis to examine the interrelations between these clinical factors in patients with depressive disorders. @*Methods@#Patients with depressive disorders (n=454) completed self-report questionnaires evaluating clinical symptoms, childhood trauma, temperament, and positive resources. To identify network pattern and the most central aspect, we performed network analysis and centrality analyses. First, we analyzed the network pattern in total participants. Second, we established two groups of those with severe depressive symptoms and those with mild depressive symptoms and compared their network patterns. @*Results@#Deficient optimism and depression were the central factors in the network of total participants. In the group with severe depressive symptoms, lack of social support and childhood emotional trauma showed high centrality. Deficient social support and other positive resources played central roles in the group with mild depressive symptoms. @*Conclusion@#Network pattern of psychological factors was different between those with mild or severe depression. Lack of positive resources is an important factor in psychological processes in both mild and severe depression. However, childhood emotional trauma may play a relatively important role in patients with severe depressive symptoms.

A Mixed-Methods Study Protocol for Soma Experiencing Motion Program (Soma e-motion Program): The Effectiveness of Contemplative Movement for Emotion Regulation

Somatics refers to body work and movement study that emphasize internal perception and experience. Recently, a new perspective has emerged that views somatics-based techniques as a kind of mindful movement. Somatic techniques as contemplative movement can improve emotional regulation ability through improvement of body awareness or interoception. Based on this background, the present study attempts to develop a somatics based program suitable for a group of clinical patients suffering from emotional dysregulation. This study plans to collect quantitative and qualitative data in order to clarify how interoception and the related emotional regulation ability change after the program. These findings will help to explore whether the somatics technique has potential as an emotion regulation program in the future. In addition, the results are expected to contribute to finding an alternative treatment modality for patients who have not achieved a sufficient effect with conventional psychotherapy.

A Network Model of Positive Resources, Temperament, Childhood Trauma, and Comorbid Symptoms for Patient with Depressive Disorders

Objective@#Temperament, positive resources, childhood trauma, and other clinical comorbid symptoms are related to depressive symptom severity. Here, we used network analysis to examine the interrelations between these clinical factors in patients with depressive disorders. @*Methods@#Patients with depressive disorders (n=454) completed self-report questionnaires evaluating clinical symptoms, childhood trauma, temperament, and positive resources. To identify network pattern and the most central aspect, we performed network analysis and centrality analyses. First, we analyzed the network pattern in total participants. Second, we established two groups of those with severe depressive symptoms and those with mild depressive symptoms and compared their network patterns. @*Results@#Deficient optimism and depression were the central factors in the network of total participants. In the group with severe depressive symptoms, lack of social support and childhood emotional trauma showed high centrality. Deficient social support and other positive resources played central roles in the group with mild depressive symptoms. @*Conclusion@#Network pattern of psychological factors was different between those with mild or severe depression. Lack of positive resources is an important factor in psychological processes in both mild and severe depression. However, childhood emotional trauma may play a relatively important role in patients with severe depressive symptoms.

A Mixed-Methods Study Protocol for Soma Experiencing Motion Program (Soma e-motion Program): The Effectiveness of Contemplative Movement for Emotion Regulation

Somatics refers to body work and movement study that emphasize internal perception and experience. Recently, a new perspective has emerged that views somatics-based techniques as a kind of mindful movement. Somatic techniques as contemplative movement can improve emotional regulation ability through improvement of body awareness or interoception. Based on this background, the present study attempts to develop a somatics based program suitable for a group of clinical patients suffering from emotional dysregulation. This study plans to collect quantitative and qualitative data in order to clarify how interoception and the related emotional regulation ability change after the program. These findings will help to explore whether the somatics technique has potential as an emotion regulation program in the future. In addition, the results are expected to contribute to finding an alternative treatment modality for patients who have not achieved a sufficient effect with conventional psychotherapy.

Perceived Stress, Positive Resources and Their Interactions as Possible Related Factors for Depressive Symptoms

Objective@#The present study aimed to explore how the patterns of interaction between stress and positive resources differ according to the severity of depression and which resources play the most important role among the various positive resources. @*Methods@#The study included 1,806 people who had visited a health screening center for a mental health check-up to evaluate the levels of perceived stress, positive resources, and depressive symptoms. The participants were divided into a depressive group (n=1,642, mean age 50.60, female 68%) and a non-depressive group (n=164, mean age 48.42, female 66.6%). We conducted hierarchical regression analyses and simple slope analyses to examine the interaction between perceived stress and positive resources. @*Results@#The interaction between perceived stress and optimism was significantly associated with depression in non-depressive groups. In depressive groups, the interactions between five types of positive resources (optimism, purpose in life, self-control, social support and care) and perceived stress were all significantly related to depression. @*Conclusion@#Interventions that promote optimism can be helpful for preventing inevitable stress from leading to depression. A deficiency in positive resources may be a factor in aggravating depression in stressful situations for people reporting moderate to severe depressive symptoms.

Attachment Style, Complicated Grief and Post-Traumatic Growth in Traumatic Loss: The Role of Intrusive and Deliberate Rumination

Objective@#The present study examines the effects of attachment styles on the grief response and the indirect effect of rumination in parents who lost a child in the Sewol Ferry accident. @*Methods@#Bereaved parents (n=81) completed self-report questionnaires evaluating their attachment style (Experience in Close Relationship-Short form), traumatic loss related rumination (Event-Related Rumination Inventory), degree of complicated grief (Inventory of Complicated Grief), and post-traumatic growth (Post-Traumatic Growth Inventory). Data were analyzed using correlation analysis, structural equation modeling, and bootstrapping. @*Results@#The indirect effect of event-related intrusive rumination was significant in the relationship between attachment avoidance and complicated grief. The path from attachment avoidance to post-traumatic growth via deliberate rumination was not significant. With respect toattachment anxiety and post-traumatic growth, the indirect effect of deliberate rumination was significant. But the indirect effect of intrusive rumination was not significant in the relationships among attachment anxiety, complicated grief, and post-traumatic growth. @*Conclusion@#Individuals with attachment anxiety could obtain post-traumatic growth via deliberate rumination. By contrast, attachment avoidance was associated with the risk of maladaptive grief. Grief interventions should account for individual differences in attachment styles through interventions that manage intrusive rumination and strengthen deliberate rumination.

High Behavioral Inhibition System/Behavioral Activation System Sensitivity, Childhood Emotional Neglect and Their Interaction as Possible Related Factors for Adult Attachment Style in Depression

Objective@#Individual differences in attachment insecurity are important in a broad range of mental health problems. However, few empirical studies have examined the clinical factors that contribute to individual differences in attachment style. This study examines the nature of interrelationships among adult attachment styles, sensitivities of behavioral activation system/behavioral inhibition system (BIS/BAS), and childhood trauma in patients with depressive disorders. @*Methods@#Patients with depressive disorders (n=294) completed self-report questionnaires evaluating adult attachment style, childhood trauma, and BIS/BAS sensitivity. We performed multiple regression analyses to examine the associations between attachment style and other clinical factors, including childhood trauma and BIS/BAS sensitivity. We also conducted hierarchical regression analyses and simple slope analyses to examine the interaction between BIS/BAS sensitivity and childhood trauma. @*Results@#The BAS sensitivity was negatively associated with attachment avoidance. The higher was the BIS/BAS sensitivity, the higher was the level of attachment anxiety. Among childhood trauma, emotional neglect contributed to both dimensions of insecure attachment. The interaction between BAS sensitivity and emotional neglect is significantly associated with attachment anxiety. @*Conclusion@#This study used data regarding the interrelationship of childhood trauma and basic motivational systems to contribute to the understanding of adult insecure attachment behaviors, a risk factor for depression.

Posttraumatic Symptoms and Change of Complicated Grief among Bereaved Families of the Sewol Ferry Disaster: One Year Follow-up Study

BACKGROUND: The objective of this study was to determine whether severity and severity change of coexisting psychiatric symptoms might affect change of complicated grief (CG) regarding the Sewol ferry disaster. METHODS: Data from a cross-sectional survey were obtained 18 months (Time 1) and 30 months (Time 2) after the disaster. We ascertained sociodemographic variables and variables obtained from self-reporting questionnaires (i.e., CG, depression, anxiety, post-traumatic stress disorder [PTSD], insomnia, embitterment, and suicidal risk) among 56 bereaved family members. RESULTS: Severity of other psychiatric symptoms at Time 1 had no effect on change of CG at Time 2. However, changes in severity of PTSD over a year affected change of CG. CONCLUSION: It is important to evaluate changes in severity of PTSD and its treatment during management of CG, especially when it involves bereaved families experiencing a traumatic accident.

Effects of Mental Health Support on the Grief of Bereaved People Caused by Sewol Ferry Accident

Few studies have assessed the overall effects of multi-centered, complicated mental health support on the grief process. This study investigated the broader influence of mental health support provided practically to the bereaved family on the severity of complicated grief. Ninety-three bereaved family members of the Sewol ferry accident were recruited. Severity of complicated grief, post-traumatic stress disorder (PTSD) and depressive disorder was assessed through self-reporting questionnaire, inventory of complicated grief (ICG), PTSD Check List-5 (PCL-5) and Patient Health Questionnaire-9 (PHQ-9). We also included demographic, socioeconomic, health-related variables, and Functional Social Support Questionnaire (FSSQ), which affect the ICG score. Participants were divided into 4 groups based on the experience of psychotherapy or psychiatry clinic service before the accident and mental health support after the disaster. In univariate analysis, these 4 groups showed a significant difference in the mean ICG score (P = 0.020). Participants who received mental health support only after the Sewol ferry accident (group 2) showed a lower mean ICG score than those who received neither psychotherapy or psychiatry clinic service before the disaster nor mental health support after the accident (group 4). There was no significant correlation between the ICG score and other variables except for subjective health status measured 1 month after the disaster (P = 0.005). There was no significant difference in PCL-5 (P = 0.140) and PHQ-9 scores (P = 0.603) among groups, respectively. In conclusion, mental health support significantly reduced the severity of grief only in those participants who had not received any psychotherapy or psychiatry clinic service before the accident.

Unresolved Bereavement and Other Mental Health Problems in Parents of the Sewol Ferry Accident after 18 Months

OBJECTIVE: This study examined the overall mental health consequences of the bereaved parents after the Sewol ferry accident. METHODS: Eighty-four bereaved parents participated in the study. Self-report scales assessing the severity of psychiatric symptoms and other related psychosomatic problems were used at 18 months following the accident. Univariate descriptive statistics and regression analyses were performed to report the prevalence, severity, and correlates of psychiatric symptoms. RESULTS: 94% of the participants appeared to suffer from complicated grief based on scores on the Inventory of Complicated Grief (ICG). Half of the participants were categorized as having severe depression and 70.2% reported clinically significant post-traumatic symptoms according to scores on the Patient Health Questionnaire-9 (PHQ-9) and PTSD Check List-5 (PCL-5). No significant differences by gender were observed in the severity of psychiatric symptoms. A higher educational level was associated with more severe psychiatric symptoms in fathers. CONCLUSION: The loss of a child due to a disaster caused by human error may continue to have a substantial impact on parental mental health at 18 months after the event. A longitudinal study following parents' mental health state would be necessary to investigate the long-term effects of the traumatic experience in the future.

Impact of Obesity on Health-Related Quality of Life among Children

OBJECTIVES: To examine the relationship between health-related quality of life (HRQoL) and body mass index (BMI) of obese children. METHODS: This cross-sectional study included 387 children. HRQoL was measured with the PedsQLTM 4.0 Generic Core Scale. BMI was classified according to the World Health Organization Asia-Pacific obesity guidelines. Psychosocial factors (body image, self-esteem, and depression/anxiety) were also measured. Data were analyzed using one-way analysis of variance, Pearson's correlation and Path analysis. RESULTS: Obese participants reported lower score for physical evaluation, self-esteem, appearance evaluation component of body image, total HRQoL score, and physical/emotional/social function components of HRQoL ; they reported higher score for depression/anxiety. In addition, results indicated that as BMI increased, appearance evaluation, total HRQoL score, and social function component of HRQoL dropped. Path analysis revealed that BMI did not directly affect HRQoL ; however, BMI directly affects body image and self-esteem, indirectly mediates depression/anxiety, and thereby impacts on an individual's HRQoL. CONCLUSIONS: Body image and self-esteem, rather than BMI itself, have more influence on HRQoL. This reinforces the importance of therapeutic intervention to enhance body image and self-esteem among obese children.

Clinical Implication of Meditation in Psychiatry : Focused on Mindfulness Meditation / 신경정신의학

There is a considerable body of literature describing the trials of meditation as adjunctive treatment of psychiatry. Although meditation has included various concepts and activity through a long history, meditation used as a therapeutic intervention in psychiatry has usually been accepted as a kind of emotion and attention regulation training. The aim of this article was to review historical origin, clinical effectiveness, and neurobiological mechanism of meditation as treatment for psychiatric disorders. Meditation is originated from various types of religious tradition. In general, meditation is divided by the consciousness meditation and the awareness meditation. Concept of mindfulness-based therapy is mainly based on awareness meditation. In addition to two types of meditation, loving kindness meditation is developed and exercised in compassion-focused therapy. Neurobiological evidence suggests that meditation reduces stress-related autonomic and endocrine change. In addition, research using neuroimaging has provided biological evidence that a specific region of brain activity and connectivity is related to subjective experience of meditation. Clinical trials support the effectiveness of meditation for the treatment of anxiety, depression, and any other stress-related disorders. In the future, profound understanding of the neurobiological mechanism, clinical effectiveness, and side effects of meditation as treatment intervention of for psychiatric disorders would be provided for evidence based meditative practice.

The Effect of Depression in Decision Making Process : Based on Quantitative Methodology / 신경정신의학

The increasing number of patients with depression is a serious social issue in contemporary Korean society. To fully understand the pathophysiology of depression, this paper reviewed how depression affects the decision making process of humans. Various recent studies in behavioral economics, mathematics, medicine, and neurobiology have shown how humans make decisions and how emotional disturbances, such as depressive disorder, affect this process. There has been great progress in behavioral economics during this decade, and numerous experiments have been designed to evaluate decision making process in humans. In general, economic decision making is evaluated using the Iowa Gambling Task, and social decision making is assessed using the ultimatum game. Numerous research studies have analyzed the performance and reaction of patients with depression in these games. As a result of the advancement of neurophysiology, research has successfully identified the part of the brain that causes the specific results of tests being conducted on patients with depression. Meanwhile, computational neuroscientists have established decision making models based on bayesian framework. These models also match with the neuroanatomy. Although a large part remains unclear, researchers look forward to achieving a better understanding in depression by analyzing the distinct patterns of responses that patients under depression show in the experiment of behavioral economics.

The Sewol Ferry Accident and Early Mental Health Care Response by Volunteer Activities of Korean Disaster Mental Health Committee and Members of Korean Neuropsychiatric Association / 신경정신의학

On 16 April 2014, the Sewol ferry, carrying 476 people, sank in the ocean off the south coast of South Korea. Two hundred and ninety five are confirmed dead and 9 remain missing. The Korean Neuropsychiatric Association (KNPA) set up a Disaster Mental Health Committee (KDMHC) for out-reach services and to provide general strategies for promoting mental health and resilience. Mem bers of KDMHC and Volunteering Psychiatrists of the KNPA had participated in disaster mental health services organized by Gyeonggi-Ansan disaster mental health support team. Their activities were composed of psychoeducation, supportive individual and familial counseling and referring service to professional institutes. This report has described the outline of the initial and acute mental health care responses by KDMHC and volunteers among KNPA members.

The Effect of Depression, Impulsivity, and Resilience on Smartphone Addiction in University Students / 신경정신의학

OBJECTIVES: The aim of this study was to examine the effect of depression, impulsivity, and resilience on smartphone addiction in university students. METHODS: A total of 322 students from two universities in Seoul were enrolled in this study. Participants were divided into a risk user group and normal user group according to results using the Korean smartphone addiction scale. We additionally surveyed smartphone use patterns of the participants. The Beck Depression Inventory (BDI), Barratt Impulsiveness Scale (BIS), and Conner-Davidson Resilience Scale (CD-RS) were also used for measurement of the participants' severity of depression, impulsivity, and resilience. RESULTS: The risk user group spent more time using a smartphone on weekdays than the normal user group. The risk user group showed significantly higher scores on BDI, BIS than the normal user group. The risk user group showed significantly lower scores on CD-RS than the normal user group. Results of multiple regression analysis showed that impulsivity was a significant factor affecting smartphone addiction in university students. CONCLUSION: These results suggest that smartphone addiction is influenced by impulsivity. Students with high impulsivity may be vulnerable to smartphone addiction. Further research regarding the underlying mechanisms of these associations is needed.

Point Prevalence of Anxiety and Depression among Cancer Inpatients in a General Hospital: A Preliminary Study for the Development of Distress Management Strategies in Cancer Patients / 정신신체의학

OBJECTIVES: This study aimed to examine the point prevalence of anxiety, depression and the associated risk factors in hospitalized patients with cancer. METHODS: A total of 114 patients with cancer who admitted to the Cancer Center in St. Mary's Hospital were enrolled for a day. The patients were asked to complete Hospital Anxiety and Depression Scale(HADS). Sociodemographic and cancer related clinical variables were also evaluated. RESULTS: The point prevalence of anxiety and depression was 10.5% and 34.2%, respectively, as assessed with HADS. Logistic regression models revealed that distant metastasis was significantly associated with anxiety in patients with cancer and previous chemotherapy and Low socioeconomic status were significantly associated with depression. CONCLUSIONS: Our results indicate that more than one third of patients with cancer suffer from either anxiety or depression. In addition, previous chemotherapy as well as low socioeconomic status and distant metastasis were associated risk factors of anxiety and depression, respectively. These findings suggest the need for screening and systematized psychosocial intervention for psychological distress in hospitalized patients with cancer.

Clinical Characteristics of Vascular Depression in Korean Elderly People / 신경정신의학

OBJECTIVES: This study was done in Korean elderly people in order to examine the relationship of white matter hyperintensity with clinical neuropsychological function and depression symptom severity. METHODS: A total of 148 subjects diagnosed first major depressive episode after age of 60 years were included. Brain magnetic resonance imaging scan was rated with the modified Fazekas White Matter Rating Scale by researcher blinded to clinical information. Cognitive function was evaluated with a comprehensive neurological battery and depression severity was assessed by Hamilton Depression Scale. Subjects were divided into vascular depression group and non vascular group according to the degree of white matter hyperintensity. Independent t-test was used to compare clinical difference between two groups and correlation analysis was used to identify whether white matter hyperintensity severity is correlated with neuropsychological function and depressive symptom. RESULTS: Vascular depression group was significantly poorer performance in verbal fluency, Boston naming test, Mini-Mental State Examination, trail making test B and stroop test (p<0.05). Furthermore, trail making test B and stroop test performance was correlated with white matter hyperintensity severity. However, Hamilton Depression Scale score was not significantly different between two groups. CONCLUSION: Several findings from our study suggest that white matter hyperintensity is associated with neuropsychological performance, especially executive function. Moreover, executive dysfunction might contribute to poor treatment outcome of vascular depression group.