Date Published: February 2, 2017
Publisher: Public Library of Science
Author(s): Juliette Gueguen, Marie-Aude Piot, Massimiliano Orri, Andrea Gutierre, Jocelyne Le Moan, Sylvie Berthoz, Bruno Falissard, Nathalie Godart, Jacobus P. van Wouwe.
Qigong is a mind-body intervention focusing on interoceptive awareness that appears to be a promising approach in anorexia nervosa (AN). In 2008, as part of our multidimensional treatment program for adolescent inpatients with AN, we began a weekly qigong workshop that turned out to be popular among our adolescent patients. Moreover psychiatrists perceived clinical benefits that deserved further exploration.
A qualitative study therefore sought to obtain a deeper understanding of how young patients with severe AN experience qigong and to determine the incentives and barriers to adherence to qigong, to understanding its meaning, and to applying it in other contexts. Data were collected through 16 individual semi-structured face-to-face interviews and analyzed with the interpretative phenomenological analysis method. Eleven themes emerged from the analysis, categorized in 3 superordinate themes describing the incentives and barriers related to the patients themselves (individual dimension), to others (relational dimension), and to the setting (organizational dimension). Individual dimensions associated with AN (such as excessive exercise and mind-body cleavage) may curb adherence, whereas relational and organizational dimensions appear to provide incentives to join the activity in the first place but may also limit its post-discharge continuation. Once barriers are overcome, patients reported positive effects: satisfaction associated with relaxation and with the experience of mind-body integration.
Qigong appears to be an interesting therapeutic tool that may potentiate psychotherapy and contribute to the recovery process of patients with AN. Further analysis of the best time window for initiating qigong and of its place in overall management might help to overcome some of the barriers, limit the risks, and maximize its benefits.
Mind-body interventions, which encompass a large range of approaches, including qigong, tai chi, yoga, and meditation, combine body movements with mental focus . They are practiced both to reduce psychological distress and boost well-being . Because of their high potential for both the prevention  and management of anorexia nervosa (AN) , they have been progressively implemented in multidimensional treatment programs for eating disorders. Instructors of these techniques contend that they contribute to the recovery process in a wide variety of ways: through relaxation, enhancing body awareness and acceptance, and modifying perceptions of life events .
Eleven themes describing the incentives and barriers to adherence to, understanding the meaning of, and the application of qigong were identified and organized into three superordinate themes: individual, relational, and organizational dimensions. The first superordinate theme, the individual dimensions, comprises the attitudes and explanations that the adolescents saw as related to themselves; it includes the themes: (1) attitude towards movement: from hyperactivity to ability to relax, (2) attitude towards a new cultural frame: from Cartesian rationalism to an opening to Eastern philosophy, (3) mind-body attitude: from dualism to integration, and (4) time-related effects. The second superordinate theme, relational dimensions, involved issues with others and were categorized into three subthemes: (5) perceptions of the group, (6) role of the instructor, and (7) family attitude towards qigong. The third superordinate theme covered organizational dimensions, that is, issues related to (8) qigong access policy, (9) setting and degree of compartmentalization of the activity in the overall patient program, (10) focus of the activity, and (11) the activity’s schedule. Within each dimension and even within each theme, we identified drivers and barriers to adherence to qigong, to understanding its meaning, and to applying it outside the workshop. The barriers, in particular, could be specific to the experience of AN or involve the experience of adolescence more generally. Table 3 summarizes the themes and notes the barriers exacerbated by AN. Overall, the participants described a great variety of experiences (S1 File).
Our study aimed to (I) investigate the experience of qigong from the perspectives of adolescents practicing it as part of an multidisciplinary inpatient treatment program; and (ii) describe the incentives and barriers to adherence to qigong, to understanding its meaning, and to its application outside the program. The experience of our participants was described by 11 main themes, belonging to 3 superordinate themes or dimensions: individual, relational, and organizational.
Qigong appears to be an interesting therapeutic tool that can potentiate psychotherapy and contribute to the recovery process in patients with AN. Individual dimensions associated with AN may curb adherence, whereas relational dimensions appear to provide incentives to join the activity. Further analysis of the best time window for initiating qigong and of its place in overall management might help to overcome some of these barriers, limit the risks, and maximize its benefits. Systematic debriefing with a psychiatrist after 1 to 3 sessions should be considered, and scheduled time to discuss the activity could be included in the workshop.