12 (2005): 345, doi:10.1080/08035250510036778.
In other words, the child identifies with his or her parent’s loss of hope, and internalizes their trauma, slowly withdrawing from the world. Thus, these refugee children may not have directly experienced this trauma, but when their parents project their trauma onto them, they subsequently identify with this sense of hopelessness, slowly recognizing the trauma as their own. Accordingly, the refugee child gradually “takes up the position of devitalized infant…as a form of protection against this emotional toxicity… surviving together [as a family] in their current life circumstances”[15]
This hypothesis is supported by one of the narratives in Life Overtakes Me. a young russian girl named Dasha gradually became afflicted with Resignation Syndrome after her family fled to Sweden. Her mother had been raped in the woods of Siberia but hadn’t told her children. Inpportunly, Dasha heard the story of her mother’s rape when the asylum-seeking family had an interview with the Swedish Immigration Center. Upon this news, Dasha immediately began crying, slowly rejecting her food and stopped talking altogether after a few months (Life Overtakes Me, 2019). It was only until her family was granted Swedish residency did Dasha finally recover after 8 months of being unresponsive. It is important to highlight that this change in atmosphere, greater security, and positive news was transmitted to Dasha by her mother. To Dasha, “this profound change in the reality of their situation was accepted as a truth” only when her mother, sensing greater security in her life, was able to move past her trauma and overcome her hopelessness.[16] In doing so, the mother’s sense of hopelessness is no longer projected upon Dasha, thereby, “reawakening [her] lust for life”.[17]
Accordingly, this hypothesis may, in circumstances when the child has not personally experienced the trauma, explain why Resignation Systems occurs. To reiterate, it has been demonstrated that in the projection of the mother or father’s trauma onto their child, the son or daughter gradually recognizes the trauma as his or her own. Thus, while this may be one of several causes of Resignation Syndrome, it does not explain the regional distribution of the illness. Many refugee children’s parents, who have fled to countries other than Sweden, have also faced similar trauma and have subsequently projected this sense of hopelessness onto their sons or daughters. Accordingly, there should be evidence of other refugee children, who are living outside of Sweden, that suffer from Resignation Syndrome. Yet, as previously mentioned, no reported cases have been reported past Swedish national boundaries; therefore, the psychodynamic hypothesis falls short of explaining this bizarre phenomenon.
Mental Health Hypothesis:
a final contributing factor frequently cited by medical researchers for why Resignation Syndrome exists is a theory of mental health. This theory is more preventative as it stipulates that had these refugee children received proper mental health treatment upon experiencing this trauma, they may have never fallen ill. In more precise words, the hypothesis suggests that Resignation Syndrome could have been avoided if parents or other family members had provided sufficient mental health treatment for their children who had suffered from past trauma. To be more specific, with proper treatment of past traumatic experiences, these refugee children are not forced to suppress their trauma or have it resurface when there is a threat of deportation. Accordingly, the theory argues that in the treatment of trauma, the children never run the risk of falling into this comatose state; and so, Resignation Syndrome can be prevented. Nevertheless, this theory fails to account for the fact that usually, these families lack the economic capital to gain access to these treatments for their children. Even if they did have the economic capital, these refugee families are frequently in life-threatening circumstances; therefore, they do not have time to provide their child with this treatment. Moreover, in certain circumstances, parents may not take notice of the trauma experienced by the child if they are still in shock or if they deny having experienced the trauma in the first place. In this scenario, the parents would not find mental health treatment necessary.
Furthermore, while mental health treatment may help the child move past their personally experienced trauma, the trauma of their parents may still be projected onto them. The trauma of the migrant journey is another unavoidable stress factor for refugee children. Accordingly, further treatment would be necessary as a consequence of this added stress. In light of these weaknesses, the mental hypothesis arguably is not a compelling explanation for why Resignation Syndrome exists.cycles in biology essay In that it is not a compelling contributing factor, this theory does not go far enough to explain why the condition exists only in Sweden.
Recent Swedish Immigration Policy:
Until recently, Sweden was known for its generous immigration laws and in particular, its lenient asylum granting policies. Accordingly, many asylum-seeking families and individuals fled to Sweden under the impression that they had a high chance of being granted asylum and correspondingly, a secure future living condition. Yet, in 2015, “a record-breaking 162,877 asylum seekers entered Sweden, which along with Germany was the preferred destination for a wave of Syrians, Afghans, Russians, and others who reached European soil in search of protection and better lives”.[18] In light of this influx of immigrants, anti-immigrant sentiments began to grow in Sweden, causing the Swedish government to institute border controls. Subsequently, in late 2016, a restrictive family reunification and asylum law came into force. The law introduced “new restrictions on asylum seekers, including rules that would limit the number of people granted permanent residency and make it more difficult for parents to reunite with their children.”[19] This law may be correlated to the increase in the number of Resignation Syndrome cases starting in 2017. Of course, it is important to note that this could also be a coincidence as there is no proven correlation between the two.
Culture-Based Hypothesis:
As a result of these recent restrictive immigration laws passed in Sweden, it is plausible to argue that the recent cultural change in Swedish society serves as both a contributing factor of Resignation Syndrome as well as a sufficient explanation for why the illness exists only in Sweden. To reiterate, asylum-seeking families and their traumatized children were operating under the assumption that they had a high chance of being granted asylum in Sweden. However, as a consequence of this restrictive asylum law, their chances of receiving asylum were greatly diminished. Accordingly, these refugee children who are assimilating into Swedish society and know the language well, have both their expectations and hopes of securely staying in the country, shattered. Either their families’ request for asylum is denied, they are not granted permanent residency, or they receive a notice of imminent deportation. In comparison, countries like Greece, Hungary, and Romania have always been known to have stricter immigration laws; therefore, refugees fleeing to those countries are aware that the chances of their asylum being granted is less.[20] While there is not enough research to argue that this cultural policy shift in Sweden definitively explains why Resignation Syndrome exists solely in Sweden, it is more probable than the other hypotheses put forth. In other words, this culturally-based hypothesis has enough credible support to suggest it plays both a contributing factor for the condition and explain why the illness exists only in the Swedish state.
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To further this hypothesis, the surprising denial of asylum due to stricter immigration laws is coupled with the refugee child’s manifesting fear of returning to his or her place of trauma. This fear, according to Bodegård, is a “perpetuating retraumatization [that] possibly explains the endemic distribution” of Resignation Syndrome.[21] As previously mentioned, refugee families flee their home country as it tends to be the place in which they experience their trauma. Therefore, if a child is faced with the uncertainty of being deported back to the place of their suppressed trauma, then that trauma has the possibility of resurfacing. This refugee child’s traumatic resurface risks transforming into Resignation Syndrome.
Conclusion:
As exemplified in this paper, there are many potential contributing factors for why Resignation Syndrome exists primarily amongst refugee children. Nonetheless, unique to this illness is the fact that all reported case has been within the national boundaries of Sweden. While many contributing factors explain why the Syndrome exists, only the cultural hypothesis can fully explain its regional distribution. To reiterate, this hypothesis argues that the recently more restrictive changes to Sweden’s immigration laws, including a stricter asylum policy, explains Resignation Syndrome’s regional distribution. This fear of being deported back to the child’s place of trauma frequently manifests itself into the symptoms of the syndrome.
It is important to highlight that these are simply theoretical hypotheses, as there is not enough research on Resignation Syndrome to garner a definitive answer. As a society, we need to further study this bizarre illness and more generally, we need to research the trauma both directly and indirectly faced by refugee children. These children’s toolbox for coping with such trauma is much less than their parents; thus, they run the greatest of falling victims to conditions like Resignation Syndrome.
Bibliography
[1]“Sweden’s Mystery Illness: Resignation Syndrome,” Doctors of the World, last modified February 20, 2018, https://doctorsoftheworld.org/blog/swedens-mystery-illness-resignation-syndrome.
[2] Ibid.
[3] Karl Sallin et al., “Resignation Syndrome: Catatonia? Culture-Bound?,” Frontiers in Behavioral Neuroscience 10 (2016):doi:10.3389/fnbeh.2016.00007.
[4] “Sweden’s Mystery Illness: Resignation Syndrome,” Doctors of the World, last modified February 20, 2018, https://doctorsoftheworld.org/blog/swedens-mystery-illness-resignation-syndrome/.
[5] “Catatonia: Symptoms, Causes, and Treatment,” WebMD, last modified January 30, 2019, https://www.webmd.com/schizophrenia/what-is-catatonia#1.
[6] Bodegård in Karl Sallin et al., “Resignation Syndrome: Catatonia? Culture-Bound?,” Frontiers in Behavioral Neuroscience 10 (2016): doi:10.3389/fnbeh.2016.00007.
[7] Hultcrantz inJoselito Dias and Iago Santiago, “Resignation Syndrome in Hidden Tears and Silences,” SAGE Journals, last modified August 3, 2018,
[8] Life Overtakes Me, directed by Kristine Samuelson. (2019; Sweden: Netflix, 2019), Film.
[9] Karl Sallin et al., “Resignation Syndrome: Catatonia? Culture-Bound?,” Frontiers in Behavioral Neuroscience 10 (2016): doi:10.3389/fnbeh.2016.00007.
[10] “Sweden’s Mystery Illness: Resignation Syndrome,” Doctors of the World, last modified February 20, 2018, https://doctorsoftheworld.org/blog/swedens-mystery-illness-resignation-syndrome/.
[11]Ibid.
[12]Life Overtakes Me, directed by Kristine Samuelson. (2019; Sweden: Netflix, 2019), Film.
[13] “Child Trauma on Nauru – The Facts,” Asylum Seeker Resource Centre, last modified November 16, 2018, https://www.asrc.org.au/2018/08/28/child-trauma-on-nauru-the-facts/.
[14] Göran Bodegård, “Pervasive loss of function in asylum-seeking children in Sweden,” Acta Paediatrica 94, no. 12 (2005): 344, doi:10.1080/08035250510036778.
[15] Göran Bodegård, “Pervasive loss of function in asylum-seeking children in Sweden,” Acta Paediatrica 94, no. 12 (2005): 345, doi:10.1080/08035250510036778.
[16] Göran Bodegård, “Pervasive loss of function in asylum-seeking children in Sweden,” Acta Paediatrica 94, no. 12 (2005): 347, doi:10.1080/08035250510036778.
[17]Ibid.
[18] Admir Skodo, “Sweden: By Turns Welcoming and Restrictive in Its Immigration Policy,” Migrationpolicy.org, last modified May 26, 2019, https://www.migrationpolicy.org/article/sweden-turns-welcoming-and-restrictive-its-immigration-policy.
[19] Dan Bilefsky, “Sweden Toughens Rules for Refugees Seeking Asylum,” The New York Times – Breaking News, World News & Multimedia, last modified June 21, 2016, https://www.nytimes.com/2016/06/22/world/europe/sweden-immigrant-restrictions.html.
[20] Senay Boztas, “These Are the Toughest Places for Asylum Seekers to Enter Europe,” Telegraph.co.uk, last modified February 5, 2016, https://www.telegraph.co.uk/news/worldnews/europe/12140900/These-are-the-toughest-places-for-asylum-seekers-to-enter-Europe.html.
[21]Bodegård in Kenneth P. Nunn et al.”Pervasive refusal syndrome (PRS) 21 years on: a re-conceptualisation and a renaming,” European Child & Adolescent Psychiatry 23, no. 3 (2013): xx, doi:10.1007/s00787-013-0433-7.
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Carpal Tunnel Syndrome was first described by Sir James Paget in 1854 but the term was coined by Moeirisch. It is a syndrome of compression neuropathy of median nerve at the wrist. Carpal Tunnel Syndrome results in considerable discomfort and pain, limitation of activities of daily living, loss of sleep and work disability. (Levine et al., 1993). Twenty percent of symptomatic subjects with symptoms of pain, numbness, nocturnal parasthesia and tingling sensation in the hand would be expected to have Carpal tunnel syndrome based on the clinical examination and electro physiologic testing.
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Carpal tunnel Syndrome is more frequent in pregnancy because the systemic process increases the extra capsular fluid retention by the hormone Prolactin and produce soft tissue swelling in the later stages (third trimester) of their pregnancies. The Carpal Tunnel Syndrome can thus be produced by compression or swelling of the median nerve in its synovial sheath (Gelberman et al., 1981; Snell, 2000; Szabo, 1989; Primal Pictures, 2001; Rempel et al., 1999).
Many therapies have been advocated for treating the carpal tunnel syndrome including Mobilizations, nerve gliding, tendon gliding, etc. Therefore the presence study was focused on the Effect of Nerve and Tendon gliding Exercises in the functional recovery of the carpal tunnel syndrome during pregnancy.
Tendon gliding Exercises were mostly performed at the end range of motion at small amplitude are performed at the limit of available motion and stressed into the tissue resistance. These exercises are thought to relieve pressure on the median nerve and stretch the carpal ligaments, which also helps decrease pressure. They are also thought to help blood flow out of the carpal tunnel, which can help decrease fluid pressure.
Pregnant Women with pain and swelling in the wrist for at least 1 month.
Pregnant women with both unilateral and bilateral carpal tunnel syndrome.
Pregnant women with age group between 25years and 32years.
Non-pregnant women with carpal tunnel syndrome.
Pregnant women having other complications like hypothyroidism, diabetes that may lead to carpal tunnel syndrome.
Any other trauma related injuries in hand.
Males.
Nerve and Tendon Gliding Exercises.
Functional Status Scale for measuring functional activity.
Nerve and Tendon Gliding Exercise programme will be effective in the treatment of carpal tunnel syndrome during pregnancy.
There may not be any significance between the nerve and tendon gliding exercise programme and carpal tunnel syndrome during pregnancy.
The aim of this study is to determine from the available evidence the effectiveness of Nerve and Tendon gliding exercises programme in carpal tunnel syndrome during pregnancy using Functional Status Scale for performance and Symptom Severity Scale for wrist pain.
A total of 20 patients having carpal tunnel syndrome during pregnancy are selected to find out the effectiveness of nerve and tendon gliding exercises on them.
The duration of study per patient – 4 weeks
Treatment session – 10 minutes per session / 2settings
Treatment per week – 7 days
OUTCOME
Relief of pain and swelling in hand.
An improvement in the functional ability of hand.
Awareness is created for the working pregnant women especially with computers, typewriters, cake decorators, postal workers, dentists, and dental technicians virtually, who use their hands and wrists repetitively.
Avoiding the severity of median nerve injury, which may lead to claw hand if unnoticed.
INTRODUCTION
Sir James Paget first described carpal Tunnel Syndrome in 1854 but Moeirisch coined the term. It is a syndrome of compression neuropathy of median nerve at the wrist. INTRODUCTION:
Carpal Tunnel Syndrome results in considerable discomfort and pain, limitation of activities of daily living, loss of sleep and work disability. (Levine et al., 1993).
The Carpal Tunnel’s floor is made up of the 8 tiny wrist bones. Its roof is a thick ligament called the transverse carpal ligament. 9 tendons pass through this tunnel. 4 of the 9 tendons bend the tips of the finger, another 4 of the 9 tendons bend the middle joints of the finger, and the 9th tendon bends the thumb tip.
The median nerve passes through this tunnel. When there is swelling or if there is thickening of the ligament the nerve gets pinched or compresses. With enough compression carpal tunnel symptoms occur. If the compression is severe or occurs over a longer period of time the nerve may change shape and flatten causing some permanent damage.
Carpal Tunnel Syndrome occurs due to many causes like
Wrist injury
Carpal tunnel Syndrome (CTS) is more frequent in pregnancy because the systemic process increases the extra capsular fluid retention by the hormone Prolactin and produce soft tissue swelling in the later stages (third trimester) of their pregnancies. The Carpal Tunnel Syndrome can thus be produced by compression or swelling of the median nerve in its synovial sheath (Gelberman et al., 1981; Snell, 2000; Szabo, 1989; Primal Pictures, 2001; Rempel et al., 1999).
CTS have been recognized as a common complication of pregnancy (Heckman&Sassard, 1994). The pathophysiology of pregnancy related CTS (PRCTS) has been mostly attributed to redistribution of fluids (Ekman-Ordeberg et al., 1987; Wand, 1990; Pauda et al.,2001).
1.Pain that shoots from the hand up the arm as far as the shoulder.
2.Tingling in the hands during the day or the night that disrupts sleep and limits the ability to grasp objects with the hands.
3.Weak feeling in the hands, and the inability to pick up small objects.
4. The feeling that the hands are swollen, even if they do not appear to be so.
5.Burning numbness and tingling sensation in the thumb and first three fingers.
6.Weakness in the muscle at the base of the thumb, near the palm.
Motor weakness will be seen in abductor pollicis brevis, flexor polices brevis and opponens policis brevis. Passive flexion or hyperextension of the affected hand at the wrist for more than one minute may worsaen symptoms.(Phalen.G.S.,1966). Percussion of the median nerve at the wrist causes paresthesis of the digits (Steward.J.D.,1978).
1.Splinting the wrist in a neutral position.
2.Avoiding the activities which causes pain if possible
3.Tendon and nerve gliding exercises.
4.Massaging
5.Elevating the arm or flicking
6.Neural mobilization
7.Ultrasound, icing, as pain relieving modality etc.
Non operative treatment s is more effective in early stageas such as NSAIDS and local corticosteroids injections.If the probl;em is severe surgery is made to release the carpal tunnel.
Harrington etal suggested surveillance criteria for carpal tunnel syndrome should be pain or parasthesia or sensory losss in the median nerve distribution and one of the following:
Tinel’s sign positive
Phalens test positive
Nocturnal exacerbation of symptoms
Motor loss with wasting of the abductor pollicis brevis
Abnormal nerve conduction studies.
Nocturnal and exertonal dyesthesias in the radial half of the palm occur in 10% to 25% of pregnant women. When the carpal tunnel syndrome occurs, the symptoms area more often bilateral. Onset of symptoms is typical during the third trimester. Because of itas trnsient nature carpal tunnel syndrome during pregnancy is best treated by using conservative measures, such as tendon and nerve gliding exercises. That subsequent pregnanciesaraae frequently associated with repeated episodes of carpal tunnel syndrome confirms the association of carpal tunnel syndrome and pregnancy.
Tendon gliding and median nerve-gliding exercises are two types of exercises that may help with carpal tunnel syndrome. These exercises are thought to relieve pressure on the median nerve and stretch the carpal ligaments, which also helps decrease pressure. They are aolso thought to help blood fow out of the carpal tunnel, which can help decrease fluid pressure.
Fist Flexion Exercises(also known as tendon gliding exercises) move your fingers through five positions while your wrist stays in a neutral position(meaning it is not bend). To perform this exercise, do the following:
1.Start with your fingers straight.
2.Make a hook fist and then return to a straight hand.
3.Make a straight fist and then return to a straight hand.
4.Make a full fist andthen return to a straight hand.
Hold each positons for seven seconds amd do 10 repetitions. Repeat three times to five timeas a day.
For median nerve gliding exercises ou move yout thumb through 6 positi0nswhile your wrist stays a neutral position. To perform this exercise, do the following:
1.Begin by making a fist with your wrisat in the neutral position.
2.Straigthen your fingers anad thumb.
3.Bend your wrist back and move your thumb away from your palm
4.Turn your wrist palm up
5.Use your other hand to gently pull uyout thumb farther away from your palm.
Hold each position for seven seconds, and do five repetitions. Repeat three ti five times a day.
Effectiveness of the Tendon and nerve gliding exercises used as conservative treatment approachesd in relieving the symptoms of the carpal tunnel syndrome during pregnancy.(Lamia Pinar, Asgel Enhos et al.,)
Carpal tunnel syndrome is a condition caused by compression of median nerve within the carpal tunnel leads to sensory changesover the lateral side of the hand and muscle weakness in thenar eminence, results in pain, numbness and tingling of fingers. It usually occurs in the third trimester of pregnancy.
“A STUDY OF EFFECTIVENESS OF NERVE AND TENDON GLIDING EXERCISES AS TREATMENT APPROACH TO CARPAL TUNNEL SYNDROME DURING PREGNANCY.”
The aim of this study is to determine from the available evidence the effectiveness of Nerve and Tendon gliding exercises programme in carpal tunnel syndrome during pregnancy using Functional Status Scale for performance and Visual Analogue scale for wrist pain.
There may not be no significance between the nerve and tendon gliding exercise programme and carpal tunnel syndrome during pregnancy.
Nerve and Tendon Gliding Exercise programme will be effective in the treatment of carpal tunnel syndrome during pregnancy.
1.Lamia Pinar, Asgel Enhos et.al
Conducted an experiment study on total of 26 patients with caroal tunnel syndrome were divided into two groups. In one group the volar splint were applied and trained to modify their functional activities in accordance witrh conservative treatment. In group two tendon gliding exercises were continued for 4 weeks with numeric rating scale and Gonuiometry. It comcluded that group two reported excellent results in pain reduction and functional improvement than gropup one.
2.Akaline.E.,et.al.,(2002)
Conducted an experimental study on carpal tunnel syndrome with a total of 28 patients with 36 hands of CTS, which were divided into two groups, with 14 patients each. One group was treated with nerve and tendon gliding exercises along with custom made neutral volar splint, and another group was treataed with only neutral volar splint for 4 weeks continuously. Patientas satisfaction was invesatigated during the follow up ranging from 5-11 month, with a mean of 8 month. The study explained that, of those patients who performed nerve and tendon gliding exercise with wearing custom made neutral volar splint, 93% reported good results, and of those patients who have only wearing neutral volar splint, 72% reported good results. American Journal of Physical Medicine Rehabilitation, 2002, Feb;81(2), Pp:108-13).
3.Rosemaryn .L.M., et.al.,(1998)
Conducted an experimental study on carpal tunnel syndrome with 240 hands, from 197 patients. They were divided into two groups. Patients in both groups were treated with standard conservative methods, and those in one group were also treated with a program of nerve and tendon gliding exercise of those who did not perform the nerve and tendon gliding exercise, 71.2% underwent surgery compared with only 43.0% of patients who did perform them. Patient in experimental group, who did not undergo surgery were interviewed at an average follow-up time of 23 months (range, 14-38 months), of these 53 patients, 47(89%) responded to this detailed interview of those 47, who responded, 70.2% reported good or excellent results, 19.2% remained symptomatic, and 10.6% were non-complaint.(Journal of Hand Therapy, 1998, Jul-Sep:11(3),171-9).
4.Dakowick.A.,(2005)
the purpose of the study was to evaluate the usefulness in conservative treatment of carpal tunnel syndrome. 40 Patients aged 30-72 years, with unilateral CTS cofirmed by EMG examination were included. The patients were divided into 3 groups based on clinical symptoms according to Whitley. The character of pain, its frequency and intensity (VAS Scale) were determined using parameter. Decrease in pain was observed by the usae of VAS. (Rock Akad Med Bialmyst, 2005:50-suppi:196-8).
5.Bonebrake.A.R.,et.al.,(1990)
the study was designed to assess the efficacy of a proposed new and unique programme relative to treatment. The patients diagnosed as CTS were compared to control to a control population showing no symptoms. Prior to undergoing treatment and following completion of the treatment programme. Results indicate that individuals with CTS had significantly lower values in strength, ROM, and slower task performance than did the control;ratings of pain anad distress were also significantly higher than the control groups. Analysis of the post treatmaent cases revealed statistically significant improvements in several measures of up to statistically significant improvements in several measure of up to 25% over post treatment values. Significant improvement was also shown to several ROM measures of upto 22%. Finally, a significant reduction of 15% pain and distress ratings was demonstrated in the post treatment cases. (Journal of Manipulative Physical Therapy, 1994 (May);17(4):246-249).
6.Scrimsha.S.R.,et.al.,(2001)
Conducted a comparative study between the responsiveness of Visual analogue scale and McGill pain questionnaire. Measures in 75% patients and concluded that the VAS was a better tool than the McGill pain questionnaire for measuring pain in clinical practise.
7.O.Baysal, Z.Altay et.al
Conducted a study in 28 female patient with clinical and electrophysiologic evidence of bilateral carapal tunnel syndrome. They were divided into two groups. Group 1 received tendon gliding exercise with splinting. Group 2 received splinting with ultrasound for a period of 4 weeks with Visual analogue scale and Functional status scale.
8.Bringer TL.,Roger IC et.al
conducted a randomized trial in totoal of 61 patients with carpal tunnel syndrome. They were divided into four groups. Group 1 received neutral wrist and MCP exercise group. Group 2 received neutral wrist MCP exercise along with splint. Group 3 received wrist cock-up exercise and Group 4 received wrist cock-up exercise and tendon gliding exercise along with splintas perfoarmed 3 times a day. The tool used to asses the function is functional Status Scale and Symptom Severity Scale. There was significant effect in Group4.
9. Sonodyn, Sieman(2000)