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.

Abstract

Generalized anxiety disorder (GAD) is a chronic psychological disorder that involves impairments in brain functioning. Sandplay therapy (SPT) has been shown to be successful in treating GAD symptoms, but few studies have been performed to investigate the efficacy of SPT in the treatment of GAD patients with childhood trauma (CT) using neuroimaging. This study investigated the efficacy of SPT in treating GAD symptoms using the Hamilton Anxiety Rating Scale (HAM-A) and the Generalized Anxiety Disorder Scale-7 (GAD-7) as clinical indicators of anxiety and also measured choline levels (a brain metabolite) in the dorsolateral prefrontal cortex (DLPFC) and centrum semiovale (CSO) using Magnetic Resonance Spectroscopy. Participants in this study were GAD patients with CT (n = 7) and healthy controls (n = 2) ages 21-40 years old. Treatment involved 30 sessions of SPT. Using a pre-post design, clinical assessments and neuroimaging measurements were conducted with a comparison of means statistical analysis. The findings showed significant improvement in symptoms of anxiety and choline levels moving into the healthy range or trending toward the healthy range in both the DLPFC and CSO. This research concludes that SPT is effective in treating symptoms of GAD with CT, and may also enhance brain metabolites. Limitations will be addressed, along with suggestions for further research.

A meta-analysis of sandplay therapy treatment outcomes.

“…This meta-analysis did not study the cognitive dimensions of treatment outcomes. Several studies assessed in the process of this meta-analysis indicated that research subjects also demonstrated improvements in cognition, academic achievement, and/or brain functioning after sandplay therapy treatment (Foo et al, 2020; Foo & Pratiwi, 2021; Lee & Jang, 2013; Lee et al, 2018; Lee & Jang, 2015; Unnsteinsdóttir, 2012). Cognitive and related dimensions might be addressed in further research.…”

“…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).…”

Psychological Counseling during the COVID-19 Pandemic: Clinical Thoughts and Implications Arisen from an Experience in Italian Schools

“…Moreover, it might be advantageous for pre-adolescents and adolescents (who used expressive and artistic techniques spontaneously) and immigrant people (including college students and adults, who might have difficulties with the psychologist’s mother tongue). Even if I did not apply sandplay therapy during my experience in these schools, a vast scientific literature supports its efficacy, including its use through group sessions [ 26 , 27 , 28 ]. Regarding the cost of implementing sandplay therapy in school counseling services, there should be a room that is not used for other school activities.…”