In this section, descriptions of the four major categories – ‘mobilizing’, ‘regaining control’, ‘facilitating factors’ and ‘resilience/therapy outcomes’, and their properties are given with supporting quotations.
5.6.4.1 Mobilizing. The major category ‘mobilizing’ was recognized by participants as a central element or a catalyst that facilitated the various dimensions of therapeutic effects of DMT to take place. When probed to explain which aspect of DMT had contributed to some of the changes they had experienced, the majority of the participants answered that it was ‘the
movement itself’. The codes related to the movement and mobilizing formed two categories namely, ‘physical benefits’ and ‘loosening up and breaking free’.
5.6.4.1.1 Physical benefits. The first category under mobilizing was ‘physical benefits’.
There were numerous comments related to the ‘physical benefits’ category. All participants described that they had experienced some level of physical outcomes from participating in the DMT treatment. These included ‘invigoration’, ‘reduced fatigue’, ‘increased flexibility’, ‘bigger range of motion’, ‘better coordination’, ‘improved balance’, and ‘feeling stronger’ as well as
‘pain reduction’.
“I felt very energized and healthier at the end of our session . . . . I felt stronger and more vibrant. . . . I was much more invigorated and felt so much happier so the drive to home was not as nearly as hard. I didn’t go faster but I made it home happier.” (C3, i.e., Participant from group C, number 3)
“With me, it’s not just the migraine but there is also arthritis and osteoporosis and a lot of stuff going on, and you feel stiff and don’t feel like moving. And doing something like this, you actually realize that moving actually makes you feel better because it helped with some of my pain. So that’s what you need to do, to move more not less.” (D1)
Participants explained that the kind of movements they experienced in DMT and the way they performed these movements were distinct from those in other physical exercises or mind-body based practices. They attributed the difference of DMT to the fact that they got to participate in physical activities at free will and felt free to do as much as they could:
“Sometimes I pop in Pilates tape or yoga . . . some things I can do but if I can’t do certain things, I can get so frustrated and angry. But when I came here . . . we focus about what we ‘can’ do. Instead of beating myself about what I couldn’t do, I just think about what I can do and I just do it.” (B4)
“I go to physical therapy and even tried yoga class, but that was too much on my body so is all the exercises at thy gym. I can’t do it like regular people. I think it’s more physical when you go to the gym, tightening up your muscle or losing weight, things like that whereas yours was more an activity, it’s fun and not a job.” (A4)
People recognized that the physical benefits they experienced in DMT were connected to and influenced by the changes in other domains – cognitive, emotional, and social. One
participant spoke about his understanding of how DMT works at the mind-body level as well as incorporates social experiences and positive emotion:
“It’s [DMT] different in a bunch of reasons. Physical therapy you are trying to get your arm and hand working again, but the therapy we do here I think is more about your mind to try to teach you that there are different and better ways to cope with your pain. You don’t have to depend on the medicine because you can do your breathing, relax and meditate… knowing that you can get your mind right to help get the rest of your body right. Even though the pain is always going to be there, there is definitely something you can do to cope with it. It was also fun!” (B6)
One woman illustrated an example of how she experienced a physical movement connecting to a particular imagery, which, in turn, brought about awareness of her thoughts and emotions related to a current life circumstance she was struggling with. This helped her to gain insights into the situation and experience a sense of peace:
“So it was a physical thing that you can connect to mentally. It was when we were doing the air and water and everything and moving with that imagery. It sparked that whole train of thought of how life is an ocean with ups and downs. I physically have swam in the ocean and felt the power of all that, and applying it to the mental or emotional side of life . . . . it was very similar. So that was like ‘oh I can relate all aspects!’ That was a big lesson, because the more I think about it, everything fits for me . . . . I feel like I am under a huge amount of stress and the whole house is in turmoil. I am just such a fragile mass.
But the imagery that we went through that time was like … ‘well, just like those big waves, it will pass!’ One way or the other it will pass and it has to. So it was comforting to experience that.” (D2)
The above example demonstrates how movement may help an individual not only to connect with his/her thoughts, feelings, and memories but also impact or transformation experiences or thoughts within these domains.
5.6.4.1.2 Loosening up and breaking free. The second category under mobilizing was
‘loosening up and breaking free’. The ideas of ‘loosening up’ and ‘breaking free’ were implied in participants’ accounts when participants were describing the impact of the DMT treatment.
‘Loosening up’ is related to the releasing of physical and psychological tension and rigidity toward mobilizing body, activating life energy and discharging negative emotions. ‘Breaking
free’ refers to the experience of a meaningful insight, sense of freedom from a negative state, or transformation that people had reported.
Even though these concepts were used to describe the effect people had experienced at all levels - physical, emotional, cognitive and social, participants’ narratives suggested that the process started first and foremost at the bodily level. People felt that movement allowed them to loosen up the physical stiffness toward being ‘relaxed’, ‘flexible’, ‘invigorated’, and opening up to new ways of moving.
“I think the movement itself actually helped whether it was stretching or flowing…. the physical aspect of it . . . . the slow, flowy, soothing and therapeutic movement that we did here. . . . It felt like it was loosening up or it was moving in a different way that it hasn’t before.”(D3)
“Dance helped me to free the body from stiffness. Movement broke the ice to move more” (B1)
Some people described this state of increased mobility and vigor with expressions that imply both physical and psychological meaning such as ‘freeing’ (C1), ‘a release’ (B5),
‘unblocking’ (C4) or ‘flowing’ (B1).
“It’s like it flows. It’s like I get this big knot back here, so I still have some pain but energy is not blocked in one place. There is a flow . . . . It’s almost like having your car lubricated or oiled. It’s like a soothing fluid. It’s like blocked and clots but when you do the movement it makes everything flow. Your thought flows . . . .” (C4)
“Coming to this research group and exercising, was just keeping my mind free because it was a release. You are releasing the pain out of your body, releasing the negative
emotions . . . . with the movement, you release it and let it go.” (B5)
Another concept that was often identified in the data was ‘breaking free’ from a negative state toward a sense of freedom or moving forward. Participants often portrayed the overall experience of living with chronic pain with metaphors that implied a state of confinement or restriction such as, being ‘stuck’ (B6), ‘trapped’ (D2) or ‘bottled up’ (A3). This state was also described as not having a proper perspective on the situation one is in. The DMT experience allowed them break off/out of this state an to move toward a more open, free and insightful state
of being, such as having a ‘freedom’, ‘new/proper perspective’, ‘sense of control’, ‘growth’,
‘healing’, and readiness to move forward in life. The following quotes illustrate how this was experienced:
“The movement gives you hope. It helps you to get out of the ‘stuck-ness’ or the state of not having a proper perspective about your situation, giving you an opportunity to have a different perspective.” (C4)
“. . . . that’s all part of kind of seeing yourself in a different way, and to break out of that mold that you’ve been in, it’s the very thing that can be very healing for you.” (D3)
“It was like a baby chick bursting out of the shell. Like you are in this egg and you don’t even know that you are in there until certain point of time you are realizing that you are growing and then you burst out of that shell. That’s how the body and movement was. I was in a shell and didn’t want to do anything but once I came out of the shell life was more clear. (B2)
There were two people who did not mention the loosening up or breaking free factor.
Both of them had never had an experience of engaging in physical activity that is loosely structured and expressive. Another factor they both agreed on was the limitation of therapy dose and length:
“It got better but I can’t say that I was 100% comfortable with that because I am not a dancer or naturally athletic or graceful any of that. So I was always klutzy. I think you will become better with more time.” (D1)
“I think It’ll have to be more than once a week and more than 10 weeks for me to see any more significant changes.” (D2)
In summary, the data indicate that the participants in this study recognized the
‘movement/mobilizing’ act as a primary condition and force for various therapeutic processes to occur. Three aspects of mobilization were identified. First, people experienced various physical benefits from participating in the DMT treatment such as invigoration, relaxation, flexibility and pain reduction. Second, DMT enabled people to ‘loosen up’ the rigidity and confined state of mind and body to feel a sense of flow and release at all levels. Third, this led them to experience a sense of ‘breaking free’ from feeling ‘stuck’ toward a sense of freedom and hope to ‘move on’
with their lives.
5.6.4.2 Regaining control. ‘Regaining control’ was identified as the core therapeutic process of DMT. There were four patterns through which individuals regained control over pain and their life, namely ‘activating self-agency’, ‘connecting to self’, ‘connecting to others’,
‘reframing’ and ‘enhancing emotional intelligence’.
5.6.4.2.1 Activating self-agency. The data indicated that the experience of participating in DMT had a significant impact on activating a person’s sense of agency, a perception that one is initiating, executing, and controlling one's own actions in the world (Jeannerod, 2003). Almost all participants agreed at some level that DMT helped them to feel an increased sense of agency.
Four categories were identified as related to an individual’s process of activating self-agency namely, 1) practicing spontaneity 2) increasing self-efficacy 3) separating self from pain, 4) and self-fulfilling action.
Practicing spontaneity. The first category in activating self-agency was ‘practicing spontaneity’. The participants attributed the experience of engaging in the session activities ‘at free will’ (C1) as the main reason for their improvement in self-agency. They perceived that there was freedom and openness within the session structure in which they felt in charge about making decisions on type of movement, movement intensity, and when to stop to take a break if needed.
Many people commented on how this ‘non-forceful’ (B5) or ‘not being pressured’ (B1) condition motivated them to spontaneously engage in the activities:
“I’m motivated because I didn't have someone saying, “You didn't do that one right, or do it a little longer, or reach it a little higher. Push it, do it harder!” in this class. Well it's nice to have someone encouraging, but then my mind tells me I'm being forced. I know it sounds strange, but that makes me to be self-motivated, and feel like I’m in charge.” (B2)
“You gave us guidance as to what you wanted us to do but we had freedom to express ourselves in our own way. It was better cause not everybody could do all the movements in yoga or things like that . . . . with yoga, I felt like I couldn't really keep up and I didn’t really get much out of it. So I gave up.” (D1)
Because DMT respects individuals’ personal limits and encourages them to practice their autonomy, participants felt more in charge of monitoring their own energy and pain level and regulating the quality and intensity of their movement. Moreover, ‘moving at free will’ inspired
them to spontaneously challenge themselves and push their own limits by trying to move more, bigger or in different ways.
“Because there was no forcefulness. You do what you can. I guess it’s a different mindset and being more in control with your body . . . . wanting to do better, wanting to work a little harder, wanting to feel better . . . . I learned that I can set a limitation about what I’m going to do and how long I can do it.” (B5)
Participants’ frequent comments and emphasis on this theme indicated how being driven by intrinsic motivation as opposed to feeling demanded by external pressure can be particularly important for someone living with chronic pain when it comes to the willingness to engage in physical activity and its impact. The following quotation by participant C1 provides an example of how one might experience the self-agency during a movement exercise:
“. . . . the power to make it [making different shapes in movement] the way I wanted to… whatever shape the way I wanted it to be, that’s the way I can make it to be. That took power for me to do that, and took my mind to work with it to see what I wanted to do . . . . to make my pain smaller, or larger. . . . So it was a power for me to be able to touch and make my own shapes . . . . I am in control. I might have to take a pill a day, but in my mind I am going to keep it to the small thing so it doesn’t get out of control. That’s the type of things I was thinking during that exercise.It was the power you’ve given me over the pain.”
Self-efficacy. Increasing self-efficacy was the second theme in the larger category
‘Activating self-agency’ and it was frequently implied in participants’ descriptions. Self-efficacy is strongly linked to the process of activating self-agency. People expressed that their experience of participating in the study helped them to feel more confident about their ability to manage pain and to believe that they can ‘make it’ (B1) or have ‘power over pain’ (C1). There are some factors related to the increased sense of self-efficacy such as sense of ‘accomplishment’ and
‘mastery’, and ‘recognizing personal efficacy for physical activity’.
Throughout their participation in the intervention, individuals felt a sense that they ‘have accomplished something’, which allowed them to positively evaluate their capacity and
strengthen personal belief on their ability to manage pain and related symptoms. The following quotations illustrate the participants’ experience of feeling accomplished:
“It’s the feeling that ‘I did this today, I accomplished something!’ I am also proud of myself because I got up and did this in front of the group.” (C3)
“At the end of the class you feel good. ‘Oh, I just did that!’ So then I start telling myself
‘You see, you can do anything you want to if you try. Don’t be scared.’”(C2) For some, the sense of accomplishment was experienced as a result of being able to achieve a particular goal or simply being able to complete the entire 10-week intervention.
“ I learned that if I put my mind to it, I could do anything. Even at my age. I am 68. Just coming here every week from my house. I said, ‘Well if I can walk from my house to catch the bus for 10 weeks, I can do anything.’ And the more I came here the more I walked to that corner without having to stop so many times like I did before. I am so proud of myself even for that” (A2)
“I feel very good about myself because I’ve accomplished something. I accomplished the way I feel now because before I didn’t know how I was feeling because I was in so much pain. Now that I can express myself in movement I can actually feel myself. . . . I just feel much better now that I can express myself.” (A3)
Some exercises gave them an opportunity to reflect on the accomplishment they had made in the past and draw a sense of hope from that:
“It also made me think that if I put my mind to it, I can do anything . . . . realizing what I've done, how far I have come along, and what I have accomplished…it made me think about what my body can do still and to think that I can do it” (B4)
It appeared that one of the conditions that supported people to feel a sense of
accomplishment was the ‘optimal level of challenge’ perceived about the movement tasks by the participants. Because the movements were considered as ‘gentle’, ‘easy enough’ and ‘not too strenuous’, they did not feel intimidated to participate and were willing to try different activities offered without reservation throughout the intervention period.
“Physical therapy or other workout classes are more strenuous because you just are doing exercises but dance and movement is easy and fun to do. It’s active but relaxing.”
(B5)
One particular activity participants mentioned frequently related to this theme was the
‘connection dance’ which was a choreographed set of movements they were taught as a part of warm-up routine. Learning the movement sequence and repeating it throughout the overall study
period gave them a chance to practice and master the sequence, allowing them to feel a sense of mastery and accomplishment.
Another important factor related to the increase in self-efficacy was ‘recognizing
personal efficacy for physical activity’, which was mentioned by every participant to some degree.
While engaging in the movement activities, they were often surprised by their own physical capacity. People repeatedly spoke about their realization on how much more movement they could do than they had thought.
“. . . . Cause I didn’t know I could raise my legs this high because my hips hurt real bad.
So I didn’t think I could do that, but I realized I actually can raise my legs, and when I did it, it actually made me feel much better, and I enjoyed myself.” (A5)
“Because I used my body and tried out different moves and I could see that I was still very capable of dancing and moving and doing things that I may not have thought I was before. . . . it made me to realize I still have flexibility and I can still do a lot.” (C3) There was also a strong link between recognizing one’s efficacy for physical activity and the process of reappraisal, which will be, discussed more in detail in section 5.6.4.2.5.
There were three people who did not report self-efficacy. Table 15 shows the 6 common
There were three people who did not report self-efficacy. Table 15 shows the 6 common