Elsevier

The Arts in Psychotherapy

Volume 75, September 2021, 101821
The Arts in Psychotherapy

Research Article
Validation of the grounding assessment tool for identifying emotional awareness and emotion regulation

https://doi.org/10.1016/j.aip.2021.101821Get rights and content

Highlights

  • The frequency of suppression of emotional expression can be assessed by the GAT.

  • GAT is a rapid assessment, and does not require special or expensive equipment.

  • Different movement qualities, indicate a low-level use of emotion regulation.

Abstract

Grounding is an accepted concept in the field of dance movement therapy and expresses an aware and regulated physical and emotional experience. Previous studies have shown that movement interventions to improve the physical sensation of grounding contribute to an increase in emotional awareness and regulation. The aim of the current study is to explore the convergent validity of the Grounding Assessment Tool (GAT) with emotional awareness and regulation. A convenience sample of 43 participants (age, M = 28.5, SD = 8.6) were assessed in an observation of walking and free movement for 10 min, recorded on video, and filled out the Toronto Alexithymia Scale-26 [TAS-26] and the Emotion Regulation Questionnaire [ERQ]. Emotional awareness was measured by the TAS- 26 refer to the ability to recognize emotions that arise in himself and others.

The results indicated a significant negative correlation between the GAT score and the level of alexithymia (r = −.36, p =  .02), and between the GAT factor which examines fluid and rhythmic movement and suppression strategy in the ERQ (r = −.336, p < .05). No relationship was found between the GAT score and the reappraisal strategy as reported in the ERQ. The fact that no associations were found between the grounding score and the reappraisal regulation strategy can be explained by the difference between emotion regulation strategies. These strategies are: avoiding the expression of emotion versus expressing emotions in the body. The findings contribute to the theoretical understanding of the physical expression of processes related to 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

References (96)

  • F. Röhricht et al.

    An exploratory randomized controlled trial of body psychotherapy for patients with chronic depression

    Journal of Affective Disorders

    (2013)
  • A.N. Tibubos et al.

    Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms

    Journal of Affective Disorders

    (2018)
  • J.A. Turkus et al.

    Therapeutic interventions in the treatment of dissociative disorders

    Psychiatric Clinics

    (2006)
  • A. Aldao et al.

    Emotion regulation flexibility

    Cognitive Therapy and Research

    (2015)
  • H.K. Altinyelken

    Promoting the psycho-social well-being of international students through mindfulness: A focus on regulating difficult emotions

    Contemporary Buddhism

    (2018)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2013)
  • K.J. Amigi et al.

    The meaning of movement: Developmental and clinical perspectives of the Kestenberg Movement Profile

    (1999)
  • S. Blasczyk-Schiep et al.

    Subclinical eating disorder symptoms and positive vs. negative affect in high school students: The mediating role of self-regulation

    Current Issues in Personality Psychology

    (2019)
  • G.A. Bonanno et al.

    Regulatory flexibility: An individual differences perspective on coping and emotion regulation

    Perspectives on Psychological Science

    (2013)
  • K. Cameron et al.

    Changes in alexithymia following psychological intervention: A review

    Harvard Review of Psychiatry

    (2014)
  • T. Carthy et al.

    Patterns of emotional reactivity and regulation in children with anxiety disorders

    Journal of Psychopathology and Behavioral Assessment

    (2010)
  • R. Cerutti et al.

    Alexithymic traits and somatic symptoms in children and adolescents: A screening approach to explore the mediation role of depression

    The Psychiatric Quarterly

    (2020)
  • E. Chervonsky et al.

    Emotion regulation, mental health, and social wellbeing in a young adolescent sample: A concurrent and longitudinal investigation

    Emotion

    (2019)
  • J. Clauer

    Neurobiology and psychological development of grounding and embodiment. Applications in the treatment of clients with early disorders

    Bioenergetic Analysis. The Clinical Journal of the International Institute for Bioenergetic Analysis

    (2011)
  • P. Duquette

    More than words can say: A multi-disciplinary consideration of the psychotherapeutic evaluation and treatment of alexithymia

    Frontiers in Psychiatry

    (2020)
  • B.M. Elzinga et al.

    The relationship between dissociative proneness and alexithymia

    Psychotherapy and Psychosomatics

    (2002)
  • A. Fogel

    The psychophysiology of self-awareness: Rediscovering the lost art of body sense

    (2009)
  • B.Q. Ford et al.

    Reappraisal reconsidered: A closer look at the costs of an acclaimed emotion-regulation strategy

    Current Directions in Psychological Science

    (2019)
  • P.A. Frewen et al.

    Toward a psychobiology of posttraumatic self-dysregulation: Reexperiencing, hyperarousal, dissociation, and emotional numbing

    Annals of the New York Academy of Sciences

    (2006)
  • P.A. Frewen et al.

    Alexithymia in PTSD: Psychometric and FMRI studies

    Annals of the New York Academy of Sciences

    (2006)
  • G. Gard et al.

    Are emotions important for good interaction in treatment situations?

    Physiotherapy Theory and Practice

    (2004)
  • E.T. Gendlin

    Focusing-oriented psychotherapy: A manual of the experiential method

    (2012)
  • U. Geuter

    Body psychotherapy: Experiencing the body, experiencing the self

    International Body Psychotherapy Journal

    (2016)
  • J.J. Gross et al.

    Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being

    Journal of Personality and Social Psychology

    (2003)
  • D. Guest et al.

    Development of modern bioenergetic analysis

    Body, Movement and Dance in Psychotherapy: Music and Movement in Therapy

    (2019)
  • S. Halfon et al.

    Mentalization, session-to-Session negative emotion expression, symbolic play, and affect regulation in psychodynamic child psychotherapy

    Psychotherapy

    (2019)
  • D. Havsteen-Franklin et al.

    A thematic synthesis of therapeutic actions in arts therapies and their perceived effects in the treatment of people with a diagnosis of Cluster B personality disorder

    The Arts in Psychotherapy

    (2018)
  • P. Helfaer

    Foundations of bioenergetic analysis

  • S. Henschel et al.

    Emotion regulation processes and psychoform and somatoform dissociation in adolescents and young adults with cumulative maltreatment

    Journal of Trauma & Dissociation

    (2019)
  • R. Hilton

    Bioenergetics and modes of therapeutic action (Conference presentation)

  • K. Hoemann et al.

    Concepts dissolve artificial boundaries in the study of emotion and cognition, uniting body, brain, and mind

    Cognition & Emotion

    (2019)
  • M.J. Horowitz

    Stress response syndromes

    (1986)
  • I. Iancu et al.

    Alexithymia affect intensity and emotional range in suicidal patients

    Psychotherapy and Psychosomatics

    (1999)
  • H.J. Irwin et al.

    Alexithymia and dissociative tendencies

    Journal of Clinical Psychology

    (1997)
  • M. Kano et al.

    The alexithymic brain: The neural pathways linkingalexithymia to physical disorders

    BioPsychoSocial Medicine

    (2013)
  • E. Kennedy-Moore et al.

    Expressing emotion: Myths, realities, and therapeutic strategies

    (1999)
  • E. Kennedy-Moore et al.

    How and when does emotional expression help?

    Review of General Psychology

    (2001)
  • H.S. Kim et al.

    "Express yourself": culture and the effect of self-expression on choice

    Journal of Personality and Social Psychology

    (2007)
  • 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.

    View full text