Prozessorientierte Begleitung von Menschen im Koma
Ammann, P (2014). Prozessorientierte Begleitung von Menschen im Koma. Spiritual Care, Bd. 4, Nr. 1, 38-50.
Ist ein Mensch im Koma wirklich ohne Bewusstsein oder befindet er sich in einem stark veränderten Bewusstseinszustand (VBZ)? Es gilt, nicht nur diese Frage zu beantworten, sondern auch zu reflektieren, was dies für die Haltung eines Gegenübers und sein therapeutisches Vorgehen bedeutet. Gegenstand dieser Pilotstudie auf einer neurologischen Intensivstation ist die Annahme der Prozessorientierten Psychologie, dass sich Menschen im Koma in einem VBZ befinden und dass wir Möglichkeiten haben, uns auf den Weg zu ihnen zu begeben. Die prozessorientierten Interventionen an sieben Komapatienten ergaben signifikante und hochsignifikante Reaktionen der gemessenen Hautleitfähigkeit als ein Bewusstseinskorrelat.
Keyword: Prozessorientierte Psychologie, Koma, Bewusstsein, veränderte Bewusstseinszustände, Rehabilitationsmaßnahmen
Reaching out to people in comatose states
Is coma a state of unconsciousness or a deep altered state of consciousness? Not only is it necessary to resolve this question, but, even more important, to reflect upon the impact it has on the counterpart’s attitude and her therapeutic approach. The reason behind this pilot study is to test the conclusion, drawn by Process Oriented Psychology, that people in comatose states are in a deep altered state of consciousness and that we are able to reach out to them. Process oriented interventions on seven comatose people revealed significant and highly significant reactions measured by skin conductivity as a correlate of consciousness.
Keywords: Processwork, coma, consciousness, altered states of consciousness, rehabilitation methods
Reaching out to People in Comatose States - Contact and Communication
This research is an extensive survey and the first explorative empirical study of awareness in comatose states and the possibility of contact and communication with comatose patients in a neurological intensive care unit setting using Process-oriented Coma Work methods developed by Arnold Mindell. Practical and ethical consequences will be discussed.
ISBN 978-3-8448-1407-1, Price: 14,90 € / e-book: ISBN: 9783844821734, Price 11,99 €
"In “Reaching out to People in Comatose States” Peter Ammann creates a balanced and many sided approach to working with people in reduced states of consciousness. He demonstrates empirical results of Process-oriented Coma Work with comatose people in the ICU, making this work important both for medical and psychological communities."
Drs. Amy and Arnold Mindell, authors of “Coma, a Healing Journey”, and “Coma, Key to Awakening.”
"Peter Ammann shows incredible courage to break new ground in bringing quantitative research to Process Oriented Coma Work. He offers research to validate what Process Oriented coma therapists have experienced in their work for years, and the validation will help open many doors for this work and make it easier for those who can benefit from this form of coma work to have access to it.
His book is an exciting combination of scientific theory, clinical research, and Process oriented psychology, and it is written in a way that is accessible to a broad based audience."
Dr. Gary Reiss, co-author of "Inside Coma. A New View of Awareness, Healing, and Hope."
This research is an extensive survey and the first explorative empirical study of awareness in comatose states and the possibility of contact and communication with comatose patients in a neurological intensive care unit setting using Process-oriented Coma Work methods developed by Arnold Mindell.
The study provides present-day definitions and comparisons of terms such as coma, vegetative state, minimally conscious state, locked-in syndrome and psychogenic unresponsiveness in the field of neuroscience. Standard definitions of consciousness and its assessment by coma scales, coma scoring systems and neurological correlates are be presented. Findings of comatose and vegetative state patients’ ability not only to hear (sensation) but also to understand meaning (perception) are presented. A survey of studies on patients’ reports after a period of unconsciousness shows evidence for awareness in so-called unconscious states. Studies which have surveyed diagnostic accuracy in respect of vegetative state and minimally conscious state in recent years show up to 43% of misdiagnosis and reveal the challenge of assessing disorders of consciousness. A survey of most relevant recent findings of evidence of consciousness in coma, vegetative state and minimally conscious state and also reports on late improvement from vegetative state and minimally conscious state are reported. A further investigation of consciousness revisiting the definitions, basic assumptions and current basic questions are shared. Wilber’s integral theory of consciousness, Tart’s concept of altered states of consciousness and Mindell’s dreambody and field concepts are explained to come to a deeper understanding and wider concept of consciousness and to the Process-oriented approach to people in comatose states. A short overview of rehabilitation methods is followed by a description of Process-oriented Coma Work and its basic assumptions, methods and application. All strands presented lead to an integral Process-oriented approach to people in comatose states: different approaches to consciousness are set in a wider context, philosophical, cultural and ethical aspects and their consequences are discussed and finally the Process-oriented approach to comatose people is explored from a personal, relationship, environmental and field point of view.
Effects of Process-oriented Coma Work interventions and Arnold Mindell’s assumptions on which they are based were tested. Mindell assumes that coma is not a state of absence of consciousness as defined in neuroscience but an extremely deep altered state of consciousness in which there is potential for awareness. Contact and communication can be established by radically related Process-oriented Coma Work interventions.
It was assumed that Process-oriented interventions will lead to an increase in skin conductance level and skin conductance responses compared to a baseline measurement and that these interventions will lead to a higher increase than during the coma depth assessment. Coma depth was assessed by the Glasgow Coma Scale (score of <8). From the 16 patients who took part in the research 7 were included in the study.
The results confirm the four hypotheses: 1. Skin conductance level (SCL) significantly increased in the intervention compared to the baseline. 2. The increase in SCL during Process-oriented Coma Work intervention was greater than during Glasgow Coma Scale assessment. 3. Skin conductance responses (SCR) showed highly significant results during Process-oriented intervention compared to the baseline. 4. The increase in SCR during Process-oriented Coma Work intervention was greater than during Glasgow Coma Scale assessment.
This dynamic mirrors an increase of chronological integration of processes in different compartments of neuronal activity which is a neurological correlate, a presupposition of consciousness and a precursor of overt behavior. The results show evidence for awareness in comatose patients and for Process-oriented coma interventions as a valid coma rehabilitation method.
Finally limitations, strengths, implications and recommendations for further research are discussed.
Appendix I comprises a translated verbatim transcription of a Process-oriented Coma Work session with a non-sedated but comatose patient (Glasgow Coma Score: 4 points) which could not be included in the evaluation of the study. The transcript documents the patient’s behavior during the baseline phase, the interaction in the Glasgow Coma Scale assessment phase and the interaction and the awakening of the patient during the Process-oriented Coma Work intervention phase.
Appendix II presents a counterpart and complement to the empirical research including reflections, personal experiences, processes and developments during the preparation and realization of this project.