The effect of sandplay therapy on the thalamus in the treatment of generalized anxiety disorder: A case report.

Abstract

Generalized anxiety disorder (GAD), a common, debilitating condition, involves psychological and physiological dysfunction. Sandplay therapy (SPT), a multisensory treatment modality, has been successfully used to reduce anxiety ratings for individuals suffering from GAD using the Hamilton Anxiety Rating Scale (HAM-A) and the General Anxiety-7 (GAD-7). Because GAD involves sensory processing alterations in the thalamus, which may also be implicated in SPT, it would be beneficial to accompany evaluation with a physiological measurement targeting the thalamus. Using an A-B single-subject design, this case study explores whether clinical improvement in a GAD patient treated with SPT is associated with brain metabolite changes, specifically the N-acetylaspartate to creatine (NAA/Cr) ratio (a measure of neuronal viability) in both thalami using proton magnetic resonance spectroscopy. With no improvement during the waiting period, after 18 sessions of SPT, the participant (female, age 23) showed clinically significant improvement in symptoms of anxiety as measured by the HAM-A and GAD-7, and also showed improved NAA/Cr ratio to the healthy range in the right and left thalamus. The effectiveness of SPT in reducing symptoms of anxiety in this study is consistent with previous findings. The results also suggest an association between clinical improvement and metabolite changes in the thalamus and may underscore the multisensory aspects of SPT as an essential mechanism of change. Future studies regarding interpretation of the NAA/Cr ratio are recommended. Limitations are discussed.

The effectiveness of sandplay therapy in treating generalized anxiety disorder patients with childhood trauma using magnetic resonance spectroscopy to examine choline level in the dorsolateral prefrontal cortex and centrum semiovale.

“…These results were accompanied by significant improvement in their symptoms of anxiety as measured by clinical assessments (HAM-A and GAD-7). The findings support the results of previous studies (Foo et al, 2017, 2020; Moon et al, 2015).…”

“…A complex pairing of the prefrontal and temporal regions (fronto-temporal network) showed the most noteworthy result, showing how sandplay enables the recovery and reprocessing of memories with an optimum amount of cognitive control. Another single-case neuroimaging study (Foo et al, 2020) showed improvement in the NAA/Cr ratio in the thalamus following SPT. However, SPT has not been studied with a focus on GAD patients experiencing CT, nor has a study been conducted that examines the effects of SPT on choline levels in the brain.…”

“…Commonly used psychotherapy such as cognitive-behavioral therapy (CBT), family therapy, psychodynamic, eye movement desensitization and reprocessing (EMDR), narrative therapy, exposure therapy, psychoeducation, and supportive therapy are used to treat trauma and GAD (Bandelow et al, 2013; Crits-Christoph et al, 2004; Gillies et al, 2016). In addition to these methods, Jungian Sandplay Therapy (SPT), a psychodynamic method, has also been found to be effective in treating a range of mental health problems in children and adults, including anxiety disorders (Chen et al, 2006; Foo et al, 2017, 2020; Freedle et al, 2020; Roesler, 2019; Song et al, 2016). Researches showed SPT is not only effective in dealing with anxiety but also trauma for both children and adults (Freedle, 2017; Freedle et al, 2020; Ramos & da Matta, 2018; Yeh et al, 2015).…”

Inter-Brain Synchronization During Sandplay Therapy: Individual Analyses

“…In a recent study examining the intra-brain hemodynamics of a sandplayer during therapy, near-infrared spectrocopy (NIRS) signals from various prefrontal and superior temporal channels were found to be temporarily correlated ( Akimoto et al, 2018 ). Moreover, Foo et al (2020) assessed the metabolic changes in the bilateral thalami of an individual with generalized anxiety disorder. Using magnetic resonance spectroscopy, the N-acetyl aspartate to creatine (NAA/Cr) ratio (i.e., a measure of neuronal viability) was found to have improved after 18 sessions of ST.…”

A meta-analysis of sandplay therapy treatment outcomes.

“…Emerging neuroimaging studies have found that sandplay therapy improved synchrony in frontotemporal networks of the brain, potentially facilitating the retrieval and reprocessing of memories with an optimal amount of cognitive control (Akimoto et al, 2018). Moreover, sandplay therapy effected symptom improvement in patients with generalized anxiety that was associated with improved brain functioning in the limbic system and prefrontal cortex (Foo et al, 2020; Foo & Pratiwi, 2021).…”