Promoting Self-Regulatory Management of Chronic Pain Through Dohsa-hou: Single-Case Series of Low-Functioning Hemodialysis Patients

Yutaka Haramaki, Russell Sarwar Kabir, Kazuaki Abe, Takashi Yoshitake, Yutaka Haramaki, Russell Sarwar Kabir, Kazuaki Abe, Takashi Yoshitake

Abstract

Hemodialysis patients suffer from long-term pain that drains their energy and contributes to behavioral interference and other negative effects on their daily lives that result in or exacerbate functional limitations. In addition, they deal with dietary restrictions, symptoms such as itching, lack of energy, and psychological stressors like the loss of self-concept and self-esteem. Self-regulation involves the capacity to notice, inform, and modulate responses and behavior, and research indicates that it promotes rehabilitation in chronic pain patients. Research on the aspects of self-regulation afforded by the Japanese psychotherapy Dohsa-hou correspond to psychological processes tied to the sense of self-control that clients realize over their body movements. This study pilot tested a hospital-integrated implementation of Dohsa-hou relaxation tasks as a chronic pain management behavioral intervention for five female hemodialysis patients between the ages of 59-62 years. We conducted an ABABABA single-case design to compare baseline A-phases (treatment-as-usual: TAU) taken at recurring 1 week intervals (three sessions per week for a total of 4 weeks, 12 total recordings) with an intervention of Dohsa-hou B-phases every 4 weeks (three sessions per week for 12 weeks, 36 total recordings) over the span of 4 months to compare effectiveness. Visual Analogue Scale (VAS) pain scores between phases were taken and self-regulatory progress was tracked and summarized from a series of semi-structured interviews. Visual analysis of scores for each participant as single cases indicated decreases for the Dohsa-hou phase compared to baseline treatment-as-usual. As a result, participants reported using Dohsa-hou to reduce pain and experienced improvements in quality of life associated with greater self-regulatory capacity to attend to personal care and domestic activities. These preliminary findings suggest that Dohsa-hou body movement relaxation tasks were feasible as a coping skill in a hospital-integrated setting and at home and show promise for promoting quality of life vis-a-vis the management of severe and chronic bodily pain associated with end-stage renal disease and its treatment, particularly by improving aspects of pain-mediated self-regulatory fatigue.

Keywords: Dohsa-hou; chronic conditions; chronic pain; hemodialysis patients; pain management; quality of life; self-regulation; single-case design.

Figures

Figure 1
Figure 1
Demonstration of Dohsa movement tasks. (A) Dohsa tasks involved the clenching and opening of fists for the hands and bending back and forth for wrists. (B) Dohsa tasks also involved repeatedly raising and lowering the arms and shoulders along the body axis. All tasks were planned, and staff were given supervision for the psychological intervention by a licensed clinical psychologist certified by the Japanese Association of Rehabilitation Psychology.
Figure 2
Figure 2
Effectiveness of Dohsa-hou hand movements. (A) Dohsa tasks conducted by a participant and supervised by medical staff during HD therapy. The staff clenched and opened their fists and bent their wrists back and forth repeatedly. (B) After the Dohsa-hou implementation, participants could move their hands and wrists by themselves. As a result, patients reported being able to bring and wash dishes in the kitchen and proactively perform housekeeping and daily activities at home.
Figure 3
Figure 3
Implementation procedure and interview schedule. This figure displays the schedule of interviews and flow of data collection points for outcome measures. There were three total terms, and each term included 1 week of baseline TAU and 3 weeks of Dohsa-hou intervention, totaling 4 weeks per term. All participants received Dohsa-hou from medical staff when they complained about their pain at its peak. All participants reported their pain intensity along the Visual Analog Scale of pain (0–10) before dialysis treatment, pre-intervention, post-intervention (1 h after Dohsa-hou intervention) and at follow-up (1 month after research period). TAU, Treatment as usual; VAS, Visual Analogue Scale (for pain).
Figure 4
Figure 4
Single-case data plots of the ABABABA design for each participant. VAS pain scores, measured five times during HD therapy, were averaged from hourly scores obtained at TAU and intervention phases. The VAS pain scores ranged from 0 to 10. Case A and C reported higher scores indicating severe pain which remained throughout the study period. Pain intensity for Case B, D, and E gradually reduced after 19 sessions. Case A and B had shunt occlusion issues at session 46 that kept them from receiving sufficient HD therapy for the final two sessions.

References

    1. Barlow J., Wright C., Sheasby J., Turner A., Hainsworth J. (2002). Self-management approaches for people with chronic conditions: a review. Patient Educ. Couns. 48, 177–187. 10.1016/S0738-3991(02)00032-0
    1. Brkovic T., Burilovic E., Puljak L. (2016). Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis: a systematic review. Patient Prefer. Adherence 10, 1131–1150. 10.2147/PPA.S103927
    1. Bulté I., Onghena P. (2013). The single-case data analysis package: analysing single-case experiments with R software. J. Modern Appl. Stat. Methods 12:28 10.22237/jmasm/1383280020
    1. Carlson C. R., Bertrand P., Ehrlich A., Maxwell A., Burton R. (2001). Physical self-regulation training for management of temporomandibular disorders. J. Orofac. Pain 15, 47–55.
    1. Carver C. S., Sheier M. F. (1982). Control theory: a useful conceptual framework for personality- social, clinical, and health psychology. Psychol. Bull. 92, 111–135. 10.1037/0033-2909.92.1.111
    1. Carver C. S., Sheier M. F. (1998). On the Self-Regulation of Behavior. New York, NY: Cambridge University Press.
    1. Chervenkova V. (2017). Japanese Psychotherapies: Silence and Body-Mind Interconnectedness in Morita, Naikan and Dohsa-hou. Singapore: Springer.
    1. Dadkhah A. (1998). Body consciousness in Dohsa-hou, a Japanese psychorehabilitative program. Percept. Mot. Skills 86, 411–417. 10.2466/pms.1998.86.2.411
    1. Davey E. S. (2016). Psychology and chronic pain. Anaesth. Intensive Care Med. 17, 568–570. 10.1016/j.mpaic.2016.08.004
    1. de Jong J. R., Vlaeyen J. W., Onghena P., Cuypers C., den Hollander M., Ruijgrok J. (2005). Reduction of pain-related fear in complex regional pain syndrome type I: the application of graded exposure in vivo. Pain 116, 264–275. 10.1016/j.pain.2005.04.019
    1. Engel G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science 196, 129–136. 10.1126/science.847460
    1. Feng L., Yap K. B., Ng T. P. (2013). Depressive symptoms in older adults with chronic kidney disease: mortality, quality of life outcomes, and correlates. Am. J. Geriatr. Psychiatry 21, 570–579. 10.1016/j.jagp.2012.12.020
    1. Friedberg F., Williams D. A., Collinge W. (2012). Lifestyle-oriented non-pharmacological treatments for fibromyalgia: a clinical overview and applications with home-based technologies. J. Pain Res. 5, 425–435. 10.2147/JPR.S35199
    1. Fujino H. (2012). Effects of Dohsa-hou relaxation on body awareness and psychological distress. Jpn. Psychol. Res. 54, 388–399. 10.1111/j.1468-5884.2012.00517.x
    1. Fujino H. (2017). Psychological support for young adults with down syndrome: Dohsa-hou program for maladaptive behaviors and internalizing problems. Front. Psychol. 8:1504. 10.3389/fpsyg.2017.01504
    1. Gewandter J. S., Dworkin R. H., Turk D. C., Farrar J. T., Fillingim R. B., Gilron I., et al. . (2015). Research design considerations for chronic pain prevention clinical trials: IMMPACT recommendations. Pain 156:1184. 10.1097/j.pain.0000000000000191
    1. Gordon R., Bloxham S. (2016). A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain. Healthcare 4:22. 10.3390/healthcare4020022
    1. Grassmann A., Gioberge S., Moeller S., Brown G. (2005). ESRD patients in 2004: global overview of patient numbers, treatment modalities and associated trends. Nephrol. Dial. Transplant. 20, 2587–2593. 10.1093/ndt/gfi159
    1. Griffith J. L., Gaby L. (2005). Brief psychotherapy at the bedside: countering demoralization from medical illness. Psychosomatics 46, 109–116. 10.1176/appi.psy.46.2.109
    1. Gross J. J., Thompson R. A. (2007). Emotion regulation: conceptual foundations, in Handbook of Emotion Regulation, ed Gross J. J. (New York, NY: Guilford Press, 3–24.
    1. Haramaki Y. (2011). Psychological support for a long period dialysis patient suffering from whole body pain. J. Jpn. Clin. Psychol. 29, 27–38. [In Japanese]
    1. Haramaki Y., Nishi Y. (2012). The application of Dohsa-hou for long-period dialysis patients with chronic pain. Jpn. J. Rehabil. Psychol. 38, 47–58. [In Japanese]
    1. Hayes S. C., Levin M. E., Plumb-Vilardaga J., Villatte J. L., Pistorello J. (2013). Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behav. Ther. 44, 180–198. 10.1016/j.beth.2009.08.002
    1. Hoshikawa T. (1998). Effect of body control and attention on body sway induced by a tilting room. Shinrigaku Kenkyu 69, 310–316. 10.4992/jjpsy.69.310
    1. Imura O., Furukawa T., Fujino H., Sugano S., Chervenkova V., Teruta E., et al. (2016). Introduction to Dohsa-hou: An Integrated Japanese Body-Mind Therapy. Available online at:
    1. Jane S. W., Chen S. L., Wilkie D. J., Lin Y. C., Foreman S. W., Beaton R. D., et al. . (2011). Effects of massage on pain, mood status, relaxation, and sleep in Taiwanese patients with metastatic bone pain: a randomized clinical trial. Pain 152, 2432–2442. 10.1016/j.pain.2011.06.021
    1. Japan Organ Transplant Network (JOTNW) (2019). Donors and Transplants Data (1 January – 31 December, 2017). Available online at:
    1. Kabir R. S., Haramaki Y., Ki H., Ohno H. (2018). Self-active relaxation therapy (SART) and self-regulation: a comprehensive review and comparison of the Japanese body movement approach. Front. Hum. Neurosci. 12:21. 10.3389/fnhum.2018.00021
    1. Kaptein A. A., Dijk S., Broadbent E., Falzon L., Thong M., Dekker F. W. (2010). Behavioural research in patients with end-stage renal disease: a review and research agenda. Patient Educ. Couns. 81, 23–29. 10.1016/j.pec.2009.10.031
    1. Keefe F. J., Beaupre P. M., Rumble M. E., Kelleher S. A., Van Denburg A. N. (2018). Group therapy for patients with chronic pain, in Psychological Approaches to Pain Management-A Practitioner's Handbook, 3rd Edn., eds Turk D. C., Gatchel R. J. (New York and London: The Guilford Press, 205–229.
    1. Koechlin H., Coakley R., Schechter N., Werner C., Kossowsky J. (2018). The role of emotion regulation in chronic pain: a systematic literature review. J. Psychosom. Res. 107, 38–45. 10.1016/j.jpsychores.2018.02.002
    1. Konno Y., Ohno K. (1987). A factor analytic study of the acceptance of relaxation through Dohsa Training (psychological rehabilitation training). Shinrigaku Kenkyu 58, 57–61. 10.4992/jjpsy.58.57
    1. Lillie E. O., Patay B., Diamant J., Issell B., Topol E. J., Schork N. J. (2011). The n-of-1 clinical trial: the ultimate strategy for individualizing medicine? Per. Med. 8, 161–173. 10.2217/pme.11.7
    1. McCracken L. M., Velleman S. C. (2010). Psychological flexibility in adults with chronic pain: a study of acceptance, mindfulness, and values-based action in primary care. Pain 148, 141–147. 10.1016/j.pain.2009.10.034
    1. Morley S. (2018). Single-Case Methods in Clinical Psychology-A Practical Guide. London and New York: Routledge; .
    1. Morley S., Williams A. (2015). New developments in the psychological management of chronic pain. Can. J. Psychiatry 60, 168–175. 10.1177/070674371506000403
    1. Naruse G. (1973). Shinri Rehabilitation [Psychological Rehabilitation]. Tokyo: Seishin-Shobo.
    1. Naruse G. (1988). JIKO-Control hou [Self-Control Method]. Tokyo: Seishin-Shobo.
    1. Naruse G. (1995). Rinsho Dohsa Gaku Kiso [Foundation of Dohsa-hou]. Tokyo: Gakuensha.
    1. Naruse G. (1997). The clinical Dohsa-hou as psychotherapy. Jpn. J. Rehabil. Psychol. 25, 9–16. [In Japanese]
    1. Nijs J., Almond F., De Becker P., Truijen S., Paul L. (2008). Can exercise limits prevent post-exertional malaise in chronic fatigue syndrome? An uncontrolled clinical trial. Clin. Rehabil. 22, 426–435. 10.1177/0269215507084410
    1. Nitta K., Masakane S., Hanafusa N., Taniguchi M., Hasegawa T., Nakai S., et al. (2018). Current situation for dialysis therapy in Japan – 1 January-31 December 2017. J. Jpn. Soc. Dial. Ther. 51, 699–766. 10.4009/jsdt.51.699
    1. Okumi M., Kakuta Y., Unagami K., Maenosono R., Miyake K., Iizuka J., et al. . (2018). Cardiovascular disease in kidney transplant recipients: Japan Academic Consortium of Kidney Transplantation (JACK) cohort study. Clin. Exp. Nephrol. 22, 702–709. 10.1007/s10157-017-1500-z
    1. Peterson R. A. (2010). Improving hemodialysis in patient care: critical areas. Patient Educ. Couns. 81, 3–4. 10.1016/j.pec.2010.07.023
    1. Redondo J. R., Justo C. M., Moraleda F. V., Velayos Y. G., Puche J. J., Zubero J. R., et al. . (2004). Long-term efficacy of therapy in patients with fibromyalgia: a physical exercise-based program and a cognitive-behavioral approach. Arth. Rheumatol. 51, 184–192. 10.1002/art.20252
    1. Ricka R., Vanrenterghem Y., Evers G. C. M. (2002). Adequate self-care of dialysed patients: a review of the literature. Int. J. Nurs. Stud. 39, 329–339. 10.1016/S0020-7489(01)00024-4
    1. Sauer S. E., Burris J. L., Carlson C. R. (2010). New directions in the management of chronic pain: self-regulation theory as a model for integrative clinical psychology practice. Clin. Psychol. Rev. 30, 805–814. 10.1016/j.cpr.2010.06.008
    1. Shirouzu T., Koshikawa F. (2011). The effects of attention to body sensations and muscular relaxation on mood and decentering. Shinrigaku Kenkyu 82, 115–122. 10.4992/jjpsy.82.115
    1. Solberg Nes L. S., Carlson C. R., Crofford I. J., de Leeuw R., Segerstrom S. C. (2010). Self-regulatory deficits in fibromyalgia and temporomandibular disorders. Pain 151, 37–44. 10.1016/j.pain.2010.05.009
    1. Solberg Nes L. S., Roach A. R., Segerstrom S. C. (2009). Executive functions, self-regulation, and chronic pain: a review. Ann. Behav. Med. 37, 173–183. 10.1007/s12160-009-9096-5
    1. Tate R. L., Perdices M., McDonald S., Togher L., Rosenkoetter U. (2014). The design, conduct and report of single-case research: resources to improve the quality of the neurorehabilitation literature. Neuropsychol. Rehabil. 24, 315–331. 10.1080/09602011.2013.875043
    1. Tate R. L., Perdices M., Rosenkoetter U., McDonald S., Togher L., Shadish W., et al. (2016). The single-case reporting guideline in behavioural interventions (SCRIBE) 2016: explanation and elaboration. Arch. Sci. Psychol. 4:10 10.1037/arc0000027
    1. Tseng C. N., Chen C. C. H., Wu S. C., Lin L. C. (2007). Effects of a range-of-motion exercise programme. J. Adv. Nurs. 57, 181–191. 10.1111/j.1365-2648.2006.04078.x
    1. Veehof M. M., Oskam M. J., Schreurs K. M., Bohlmeijer E. T. (2011). Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. Pain 152, 533–542. 10.1016/j.pain.2010.11.002
    1. Vlaeyen J. W. S., Morley S. J., Linton S. J., Boersma K., de Jong J. (2012). Pain-Related Fear: Exposure-Based Treatment for Chronic Pain. Seattle, WA: IASP Press.
    1. Von Korff M., Gruman J., Schaefer J., Curry S. J., Wagner E. H. (1997). Collaborative management of chronic illness. Ann. Intern. Med. 127, 1097–1102. 10.7326/0003-4819-127-12-199712150-00008
    1. Wetherell J. L., Afari N., Rutledge T., Sorrell J. T., Stoddard J. A., Petkus A. J., et al. . (2011). A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain 152, 2098–2107. 10.1016/j.pain.2011.05.016
    1. Wicksell R. K., Olsson G. L., Hayes S. C. (2011). Mediators of change in Acceptance and Commitment Therapy for pediatric chronic pain. Pain 152, 2792–2801. 10.1016/j.pain.2011.09.003
    1. Williams A., Morley S. (2018). Conducting and evaluating treatment outcome studies, in Psychological Approaches to Pain Management-A Practitioner's Handbook, 3rd Edn., eds Turk D. C., Gatchel R. J. (New York and London: The Guilford Press, 51–67.

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