The study results indicated, as hypothesized, an incremental decrease in dissociation across time for both the body therapy interventions, suggesting that dissociation reduction in body therapy as an adjunct to psychotherapy is an unfolding process that builds on itself step by step. Participants each had a minimum of 2 years in psychotherapy at the outset of study, and yet significant change in dissociation experiences occurred during the course of the intervention and the follow-up period. The overall similar rate of change for both groups suggests that dissociation responds to a variety of bodywork approaches; in this study these approaches included a standardized massage, massage with body literacy, body awareness work, and delving – a practice of inner body mindfulness.
The hypothesis that dissociation reduction would be positively associated with change on all outcome variables was upheld, suggesting a link between dissociation reduction and positive health outcomes with this population. This link was supported by correlation results demonstrating that change between any two points on dissociation was associated with change between the same two points on all outcome variables across time for participants in both intervention groups.
The results also indicated that dissociation at baseline does not interfere with the ability to change. Participants in both groups with higher dissociation experiences prior to study participation had the greatest decrease in psychological symptoms, PTSD, physical symptoms, and the greatest increase in body awareness across time. Twelve (50%) of the participants in this study had baseline dissociation in the moderate range with frequent symptoms of depersonalization; this dropped to 4 at post-intervention and only 1 at three-month follow-up. Thus, the significantly greater decrease on outcomes for participants with moderate compared to low dissociation at baseline suggests that bodywork improves health outcomes among individuals with moderate dissociation; and points to the importance of recognizing moderate dissociation as a psychological indicator of psychological and physical distress22
Change in physical symptom discomfort, body association and body investment, unlike the other outcome variables, was not linked to baseline dissociation. Likewise, participants with moderate baseline dissociation did not experience significantly greater decreases on these variables across time compared to those with lower dissociation at baseline. The reason for this distinctly different pattern in relationship to baseline dissociation is unclear. However, one possible explanation involves the impact of receiving touch through bodywork, and a focus on the body among participants who were engaged in the study primarily to seek increased body connection14
. Both body association and body investment represent the emotional connection and cognitive appraisal of the relationship to bodily self. It is possible that, in response to a body therapy intervention, change in these areas is equally likely to happen for individuals in this population regardless of baseline dissociation. Decrease in physical symptom discomfort may be associated with these aspects of increased body connection, and therefore also unlinked from baseline dissociation.
The importance of dissociation reduction in this population is not surprising given its prevalence and the role it plays to protect a survivor from the pain of her abuse. The therapeutic work of sexual abuse recovery is intimately related to the work of integration of psyche and soma that are frequently fragmented through the dissociative process of living with trauma. Reassociation with the body through body therapy may be a key to unlocking patterns of dissociation so common in this population, most likely explained by the process of (re)connection with a core sense of self through increased awareness of, and identification with bodily experience, as demonstrated by the strong association between increased body connection and dissociation reduction.
There are study limitations to be considered. The small sample size limits generalization of the study findings. Also, this study examined body therapy as an adjunct to psychotherapy – and lacked a control group - both limitations of the study design that restrict result interpretation. Despite these limitations, this study is an important first step in the study of dissociation and the role of body therapy for women in sexual abuse recovery. Future research in this area will ideally include larger samples to capture a broader range of dissociation at baseline, allowing for study of dissociation reduction in body therapy with individuals who have more frequent and severe dissociation experiences. Needed also are study designs that test dissociation reduction as a mediator of health outcomes in body therapy, and further explore the association between body connection and dissociation reduction to elucidate possible mechanisms underlying this association. To do so, it is important that there be further exploration of the measurement and conceptualization of dissociation experiences, specifically the relationship of body connection as a dimension of dissociation experience. Meanwhile, the general Dissociative Experiences Scale needs to be used judiciously in intervention research.
In summary, the study results indicate that dissociation follows a declining pattern for women in body therapy during sexual abuse recovery, and supports future research examining dissociation reduction as a mediator of health outcomes in body therapy. The positive association between dissociation reduction and health outcomes in this sample—in which there were symptoms of moderate dissociation and depersonalization with no indication of dissociative disorder—suggests that depersonalization experiences may be associated with important health concerns and barriers to sexual abuse recovery for this population. Re-association with the bodily self may be a key to healing problematic dissociation and improving mental and physical health in this population. This is a unique perspective offered by body therapy in trauma recovery, an untapped resource for the study of dissociation—its presentation and its treatment.