How should we measure body awareness?

Here at BiM, we do a bit of research that investigates what we call ‘bodily awareness’. We have incorporated some of that research into a recent review paper on bodily illusions in health and disease. Humbly speaking, that is worth a read if you are interested in the bodily illusions stuff like the rubber hand illusion and the use of vision to distort bodily awareness. That is not the point of this post however. The point of this post is to highlight a very decent systematic review from a couple of years ago. The paper looks at how we measure body awareness and whether the available measures (there are many of them) interrogate the same thing and how many related domains can justifiably be fit under the body awareness umbrella.  I will return to what they think is good in a moment. What was surprising about this paper for me was the exhaustive nature of the introduction. The authors have given what I think is a lovely multidisciplinary narrative view of bodily awareness.  Here are some things I think are relevant to us now:

Body awareness and body image are different: Body awareness is argued to be interoceptive – concerning our internal state (see also Bud Craig’s writing on this, which focusses on the neuroanatomical perspectives), whereas body image includes to some extent information on what our body looks like when observed from without.  Body image is the common term in psychiatry literature on eating disorders primarily, and in feminist psychology – the objectification of women type work. I think our own work is less about body image and, for the sake of avoiding confusion, we would do well to not use the same label when we are not talking about those things.

From a physiological perspective, body awareness INCLUDES proprioception in addition to interoception. However, there are aspects of proprioception and interoception that do not reach awareness, so they fall outside of it.

body awareness vs body image

Body awareness can be adaptive or maladaptive, in much the same way that pain can be adaptive or maladaptive. Indeed, the authors base their argument to a large part on the pain literature, but we could equally think about this when we think of nausea, which emerges into consciousness perhaps to warn us to make available the big porcelain bus in case we need a drive. Sometimes that is helpful because we have a tummy bug, sometimes it is not because we are overly attending to tummy-related input.

They spend some time on the philosophical angle of embodiment and the disquiet at modern Western society and its disembodying tendencies.  Finally, they spend a good deal of time on mindfulness and the overlap between mindfulness and common therapeutic approaches, many of them targeting pain.

So, as you can see, by the time we get to the actual systematic review, we have waded through a very nice broad-based review of body awareness. I strongly recommend you read it if you are interested in this stuff (link to paper here).

This post is long, so i will cut to the chase with the recommendations from the review: They identified 12 satisfactory questionnaires. Two have documented reliability and only four have documented validity. There were 11 subdomains but no one questionnaire got all the subdomains covered. From a quality perspective, the Body Awareness Questionnaire, or BAQ, the Private Body Consciousness Sub-Scale (PBCS) of the Body Consciousness Questionnaire (BCQ), the Body Vigilance Scale. and the Scale of Body Connection. Rather than continue on here, if you are interested in the four key dimensions of body awareness identified by the review, and which questionnaires measure which, then you should check out the article itself here it is freely available for download as a PDF.  The review does not conclude by saying ‘use this one’ because you really have to pick the questionnaire to fit your requirements. There is not doubt though, that the PBCS is the most studied and established. For now, I would recommend that one.

To conclude, it would be very interesting for us here at BiM to know how people are assessing body awareness, if you are at all. So, drop a comment in to tell us, particularly if you have any interested data to share. Does anyone assess it formally? If you assess it informally, how do you do it?  Do you treat body awareness? If so, how do you measure your treatment?

About Lorimer Moseley

Lorimer is NHMRC Senior Research Fellow with twenty years clinical experience working with people in pain. After spending some time as a Nuffield Medical Research Fellow at Oxford University he returned to Australia in 2009 to take up an NHMRC Senior Research Fellowship at Neuroscience Research Australia (NeuRA). In 2011, he was appointed Professor of Clinical Neurosciences & the Inaugural Chair in Physiotherapy at the University of South Australia, Adelaide. He runs the Body in Mind research groups. He is the only Clinical Scientist to have knocked over a water tank tower in Outback Australia.

Link to Lorimer’s published research hereDownloadable PDFs here.

Reference

ResearchBlogging.org

Mehling WE, Gopisetty V, Daubenmier J, Price CJ, Hecht FM, & Stewart A (2009). Body awareness: construct and self-report measures. PloS one, 4 (5) e5614. doi:10.1371/journal.pone.0005614

Moseley GL, Gallace A, & Spence C (2011). Bodily illusions in health and disease: Physiological and clinical perspectives and the concept of a cortical ‘body matrix’ Neuroscience and biobehavioral reviews PMID: 21477616

Comments

  1. Lia van der Maas says:

    A possible more objective way of measuring body awareness could be found in the following article: Terhaar et al., 2012 Heartbeat evoked potentials mirror altered body perception in depressed patients, clinical neurophysiology 123; 1950-1957. I found it very interesting how they used EEG and ECG next to the perception of the heartbeat of the patient. More ways of measuring body awareness apart from questionnaires would be usefull. Because I am always struggeling with the question “don’t you make people aware of their body if you ask them if they are aware”?

  2. Jill Wigmore-Welsh says:

    Yey great to find this posting. Having just run a course for Physios here in the UK introducing elements of NLP and Feldenkrais work its great to get back into the science of measuring body awareness. Attended and excellent presentation at the RSM in London the other week all about the placebo / activated self healing in pain. Great to be hearing so many folk from differing scientific backgrounds coming together to discuss the mind, body, pain, neuroscience. Love this paper !

  3. Hi guys – the ‘Neil error’ has been fixed. All comments should be properly related to the right Neil!

  4. Hello – seems wordpress must regard all Neils as O’Connells.
    Certainly being able to measure body awareness would help us and our patients, since we believe it can be a huge problem for people in pain. Measuring pain is a great idea too. The vast number of pain questionnaires and disagreement about which is best demonstrates how important we believe it is. I think it also should be perceived as a humourously lunatic attempt to quantify a human experience. We give it a valiant effort, and it might help to step away from how serious this issue is to observe the ridiculously simple tool we are using to measure an infinitely complex experience.
    Compassion can be essential for some people to recover. I expect that similarly to pain and body awareness tools, a tool to measure it would always fall short of adequately measuring compassion, simply because the experience has so many facets. Additionally, like pain and compassion, body awareness is a perception (output)and will not be measurable on an interval or ratio scale. In pain, the best we can do is create ordinal scales with intra-patient reliability. Likely the same for body awareness.
    By the way, I absolutley mean no disrespect to the great people who have worked on and are working on measurement tools. There is an apparent need for them.
    Defining the constructs, is a seperate issue. Important again, yet troublesome, since body awareness is by definition a personal experience. Defining it is a lot like defining equanimity, love or pain. To suit everyone’s perspective of it the definition of the construct loses power and precision. Reading the definition will give us some idea of the construct. Yet to truly understand we need to experience it. And then there are the levels of experience. The more experience of pain I have, and themore experiences of love and equanimity I have, the more my view of it is changed. I like to think my view is becoming better, more circumpsect, and wise – then again maybe it is a nominal change rather than ordinal.
    Maybe the point of all of this is…if we are going to measure it, let’s start by making it clear to all those who would use the scale what we are really doing.
    Neil Pearson

  5. Steve Kamper says:

    To be honest I was a little surprised!

  6. Hayley Cafarella says:

    I’ve had CRPS for five years and been through the ringer of pharmaceutical options. Nothing has helped my quality of life more than increasing my capacity for body awareness. Mostly this has been through Feldenkrais sessions, both awareness through movement and functional integration. I also read just about anything that I can find about the brain and the amazing things it can do. I have made a lot of progress through the combination of increasing my body awareness and education; I no longer use walking aids and my quality of life has bee greatly improved. One of the most valuable aspects of increasing my body awareness has been the development of the ability to separate my mind from the physical pain. Perceiving a burning, swollen hand as just that and not “MY incredibly sore hand” has helped me to categorise these sensations (burning, stinging, etc.) in their own right, rather than just under the umbrella of “pain” in my perception. The result has been that I suffer much less stress and anxiety. I am also able to cope much more effectively during a flare and I’ve found that I can actually reduce the severity and duration of these by being aware of the sensations that indicate the flare happening before the pain becomes intense and having the presence of mind to employ pain management techniques before things get out of control. I would be very interested to see if anybody ever does find a way to formally assess body awareness, it has been such a fluctuating combination of things that has led to me understanding my body and condition that I don’t even always consciously understand the processes that are going on within myself. Thankfully this hasn’t stopped me from improving, however I have no idea how anybody outside of me could really have a hope at understanding the complicated layers of my (or anyone’s) self awareness. For now, I’ll just keep following the leads that arise in my little n=1 experiment, perhaps my awareness will expand far enough for me to understand it a little better myself!

    Neil Pearson Reply:

    Hello Hayley
    thank you so much for taking the time to write this. It won’t stop people from trying to satisfy the western science mythology that things are really only real if one can measure them objectively.
    Working with people with chronic pain, including many with CRPS, and having a long history of practising yoga and meditation, my initial reaction to Lorimer’s question was one of surprise that anyone would try to quantify such a complex human experience. You wrote it perfectly – ” I have no idea how anybody outside of me could really have a hope at understanding the complicated layers of my (or anyone’s) self awareness.” I hope people listen.
    By the way – a couple of interesting books are – The Invisible Gorilla, and Stumbling on Happiness, and The Brain has a Mind of its Own. Each delve into different aspects of how we perceive ourselves and the world.
    all the best
    neil

    Steve Kamper Reply:

    Hi Neil,
    I understand the difficulties in measuring complex and apparently idiosyncratic constructs, but from your response it appears as if you suggest there is no good reason to even try. Leaving aside for a moment the unhelpful dichotomy of objective vs. subjective measures, surely there is something to be gained by trying to define and measure these types of constructs.
    Do we not need some measure or quantification of a construct (self awareness in this case) in order to sensibly investigate it, and it’s role in whatever condition we are interested?
    Then again, this is not really my area so there is a fair chance I’m missing something important here, forgive me if I have misinterpreted what you are saying.
    Cheers,
    Steve

    Neil O'Connell Reply:

    Whoa! I didn’t write that last comment. No sir – not from me! Hey Heidi has wordpress been a bit naughty?

    For the record I am an inveterate quantifier.

  7. Are there ways to assess Body Awareness outside of simple a questionnaire that are both reliable and valid for the clinician?

    What are some not yet validated forms of tests (i.e. a special test in physio) that clinicians now use for assessing body awareness?

    As an aside I just read this interesting personal account of the repeated trauma of American Football can distort body awareness. See link here: http://www.nytimes.com/2011/11/20/sports/football/kris-jenkinss-view-of-life-in-the-nfl-trenches.html

    I wonder how Rugby stacks up in its effect on Body Awareness.

    Eric Kruger

  8. Neil Pearson says:

    Hey there Lorimer – I like the picture you included of BOdy image, awareness, proprioception and interoception. It is strikingly better than the one I have been using in teaching. Can ou tell me to whom I should give credit if I am able to use it in teaching slides?
    thanks

    Anonymous Reply:

    claim it yourself i reckon. or read and cite the paper perhaps…..
    best to you neil!
    L

  9. Undoubtedly a fascinating area and clinically very relevant. My understanding is that the sense of self is an output from the brain having scrutinised a mass of information from body systems and tissues—mmm, that sounds familiar. Tied with this is the sense of who we are, e.g. our gender, role, position in life, and a loss of this is really the realm of suffering. Of course pain can lead to suffering but they are clearly not the same. The Dalai Lama describes pain as normal and suffering as optional, suggesting that we have a choice as to how we interpret the situation.
    The sense of our bodies can clearly change in situations of pain and anxiety. Classic examples are CRPS of course and low back pain, when the person experiences a loss of acuity and definition. Many people who suffer anxiety and panic attacks talk about the feeling of detachment from their body, like it is not theirs. Extreme detachment can occur under extreme stress.
    Helping a patient to develop their sense of mental and physical self is part of my treatment programming using focused education, sensorimotor training, feedback (touch, vision and integrating both), general exercise with awareness and mindfulness to name a few methods. As the sense improves so does the quality of movement.
    I find the topic utterly intriguing. Seeing many chronic and complex cases, this is a frequent encounter.

  10. Los,

    thanks for the summary version of the intorduction (to what is undoubtedly an interesting paper) for those of us with short attention spans.

  11. Melita Giummarra says:

    haha… drive that bus! Great post. I can’t believe this paper slipped my radar. I will read it with great interest. On a related note, I am currently trying to develop a new scale to assess awareness of somatic information/experiences in others. I figure this is an important process that feeds into how we attend to/experience somatic/pain information in our own bodies. I’t pretty early days with this study, though, as I’m only just collecting pilot data at the moment and plan to roll it out to clinical/healthy populations early next year.