Research ArticleValidation of the grounding assessment tool for identifying emotional awareness and emotion regulation
Introduction
The concept of grounding was developed by Alexander Lowen (1958/1979), one of the first body psychotherapists, and has since been in widespread and accepted clinical use among therapists who combine the body aspect in emotional therapy (e.g. body psychotherapy, dance movement therapy, mind-body therapy). Grounding expresses psycho-physical aspects of stability, which are embodied in a physical and emotional sense of support by the ground (the ability to be “down to earth,” or to have your “feet on the ground”) (Guest, Parker, & Williams, 2019; Hilton, 2000; Lowen, 2004; Meekums, 2002). The theory assumes that physical and emotional processes are intertwined, and that movement interventions for grounding improvement may facilitate both a change in breathing and stability and will also improve emotional awareness and emotion regulation (Lowen & Lowen, 1977; Mahr, 2003). Several studies, despite their small sample size and application of different interventions besides grounding techniques, indicate that strengthening the sense of support of the individual from the ground through physical sensory activities had a positive effect on emotional awareness, emotional expression, and emotion regulation in the following conditions: depression and anxiety (Pylvänäinen, Muotka, & Lappalainen, 2015; Röhricht, Papadopoulos, & Priebe, 2013), post-traumatic disorders (Ko, 2017), and somatoform disorders (Nickel et al., 2006). Among all of these conditions, the patients suffered from varying levels of alexithymia, impaired emotional awareness and emotional expression (Nickel et al., 2006; Pylvänäinen et al., 2015; Röhricht et al., 2013).
Physical sensory activities for grounding improvement are focused on raising awareness of the psycho-physical experience. The experiences are focused on the proprioceptive sense (perception of the position of the limbs and organs in space), the equilibrium system and the tactile system. The patient is invited to experience the body's sense of physical force in the space by engaging in strenuous movement against gravity, breathing, movement in common rhythm with others, and by raising self-awareness of the sense of body boundaries (de Tord & Bräuninger, 2015; Stromsted, 2007).
Recently, a reliable and valid tool was developed to assess one's ability to experience a sense of physical support from the ground (Grounding Assessment Tool [GAT]; Shuper Engelhard, Pitluk, & Elboim-Gabyzon., 2021). The tool is based on a comprehensive literature review of theory (Helfaer, 2011), movement analysis methods (Amigi, Loman, Lewis, & Sossin, 1999; Laban, 1975; Levy & Duke, 2003), practice (Clauer, 2011; de Tord & Bräuninger, 2015; Havsteen-Franklin, Haeyen, Grant, & Karkou, 2018; Karampoula & Panhofer, 2018; Koch & Harvey, 2012; Stromsted, 2007), and research in the field (Nickel et al., 2006; Pylvänäinen et al., 2015; Röhricht et al., 2013). GAT incorporates parameters related to grounding based on commonly used analysis methods - Laban movement analysis, Kestenberg movement profile, and bioenergetic analysis (Shuper Engelhard et al., 2021). To date, no other reliable and valid tool has been created exclusively for empirical assessment of grounding quality. GAT has been proven to have high reliability and content validity.
Analysis showed that the tool assessed four different factors: fluid and rhythmic movement, emotional expression in movement, pattern of foot placement, and lack of stability and weightiness. The goal of the present study was to demonstrate the convergent validity of the tool by comparison with a questionnaire that measure the level of alexithymia (difficulty in emotional awareness and emotional expression) and one which measures the level of emotion regulation. This could confirm the assumption that the physical expression of grounding also embodies emotional aspects of the individual. This research is necessary in order to validate essential theoretical and clinical assumptions of body psychotherapy.
Section snippets
Emotional awareness, Alexithymia, and the body
Emotional awareness is the individual's ability to recognize and describe emotions that arise in himself and others (Lane & Schwartz, 1987). It includes awareness of physical sensations, action tendencies, single emotions, blends of emotions, and blends of blends of emotional experience (Lane, Weihs, Herring, Hishaw, & Smith, 2015). It also includes awareness of sensorimotor expressions, awareness of the conscious and unconscious choices of actions in the body, and awareness of various
Emotion regulation and the body
Emotion regulation expresses the attempts individuals make to influence which emotions they have, when they have them, and how these emotions are experienced or expressed (Carthy, Horesh, Apter, & Gross, 2010). Emotion regulation may be automatic or controlled, conscious or unconscious (Koole, 2009; Young, Sandman, & Craske, 2019). Skills such as controlling attention, delaying or changing dominant responses, self-calming, and impulse control are all strategies for emotion regulation (
The present study
From the literature presented it is clear that the concept of grounding has been in theoretical and clinical use for decades. However, an experimental examination of the concept and its uniformity in theoretical and clinical use is lacking. In particular, the lack of quantitative research on the existence of connections between the physical and emotional aspects of grounding is prominent. This novel study examined, for the first time, the existence of a connection between the physical
The purposes of the research
To test the convergent validity of an empirical observation assessment tool for assessing grounding quality (GAT) by examining the correlation between valid emotion questionnaires which examine alexithymia and emotion regulation: Toronto Alexithymia Scale-26 (TAS-26) and Emotion Regulation Questionnaire (ERQ).
The research hypotheses
Grounding expresses physical and emotional stability. Previous studies have showed that grounding, as one of the therapeutic elements, enhances abilities of emotional awareness and emotion regulation (Nickel et al., 2006; Pylvänäinen et al., 2015; Röhricht et al., 2013). Therefore, we hypothesize that high grounding quality will be positively correlated with these abilities. Also, because there is a difference between regulation strategies since one is not adaptive and reflects low emotional
Study design
The research is a quantitative, intra-participant correlative research, for a convergent validity test of the Grounding Assessment Tool- GAT. This study design includes a continuous independent variable: The participants’ grounding quality score assessed by the GAT; and three continuous dependent variables: an emotional awareness impairment score as measured by an alexithymia questionnaire (TAS-26), use of a reappraisal emotion regulation strategy score as measured by an emotion regulation
Results
Descriptive analysis results (mean, SD) of the GAT, TAS-26 and ERQ questionnaires scores are presented in Table 2. The results of the Pearson analysis correlations between the GAT and the TAS-26 and ERQ questionnaires are presented in Table 2. They showed a significant moderate negative correlation (r = −.35) between the total score on the GAT and the TAS-26 score (Fig. 1). With respect to the four factors assessed by the tool, only factor 2, emotional expression in movement, demonstrated an
Discussion
Over the years, extensive literature has addressed the theoretical concept of grounding and its clinical application. To date, however, no valid observation tool has been developed for empirical and quantitative assessment of grounding quality for the purpose of examining the embodiment of emotional awareness and emotion regulation. To bridge this gap, the present study included the convergent validation of the Grounding Assessment Tool (GAT). Consistent with the hypotheses, a positive
Einat Shuper Engelhard (PH.D) is the head of the dance-movement therapy training and research associate in Haifa university’s school of creative art therapies and a senior lecturer in Kibbutzim college. Prior to that she served as the Head of the dance movement therapy training at Kibbutzim college (2013–2017). She is a psychotherapist and a dance-movement therapist (supervisor). She worked as a therapist with Holocaust survivors and in various kindergartens and high-schools in Israel, with
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Cited by (1)
Einat Shuper Engelhard (PH.D) is the head of the dance-movement therapy training and research associate in Haifa university’s school of creative art therapies and a senior lecturer in Kibbutzim college. Prior to that she served as the Head of the dance movement therapy training at Kibbutzim college (2013–2017). She is a psychotherapist and a dance-movement therapist (supervisor). She worked as a therapist with Holocaust survivors and in various kindergartens and high-schools in Israel, with children who suffer from emotional difficulties and developmental problems.
Michal Elboim-Gabyzon is a full-time lecturer and faculty member at the physical therapy department of the University of Haifa (UOH). She has a bachelor’s degree (1999, TAU, with honors), master’s degree (2005, TAU), and PhD (2011, UOH) in physical therapy. She completed her postdoctoral studies at the Biorobotics & Biomechanics Lab at the Mechanical Engineering Faculty at the Technion, Israel (2012), and at the Neuromuscular Research Laboratory, Schulthess Clinic, Zurich, Switzerland (2014–2015). Her primary research areas include application of physical agent modalities in rehabilitation, balance and gait capabilities of elderly individuals and age-related fragility. She is in the steering committee of the Israeli Special Interest Group in Electrophysical Agents (ISIG-EAP) and is currently the secretary of the group. Dr. Elboim-Gabyzon is a member of the Editorial Board of the Journal of the Israel Physiotherapy Society. She has multiple publications in international refereed journals, and has presented her work in numerous international conferences.
Michal Pitluk, M.A., Dance Movement Therapy, Graduate School of Creative Art Therapies, University of Haifa, Israel. B.A., Cognitive and brain Science and Psychology, Ben-Gurion University of the Negev, Israel.