The effects of sandplay therapy on the limbic system and prefrontal cortex in women with generalized anxiety disorder

Abstract

Generalized Anxiety Disorder (GAD) is a common disorder characterized by psychological and neurophysiological impairments. Previous studies show that Jungian Sandplay Therapy (SPT) effectively improves anxiety symptoms in individuals with GAD. This study explores whether clinical symptom improvement from using SPT also involves changes in brain functioning. The study focused on the brain regions implicated in GAD, including the hippocampus, amygdala, thalamus, and prefrontal cortex (PFC). Magnetic resonance spectroscopy was used to target these brain regions to measure metabolite changes, specifically in the N-Acetylaspartate to creatine (NAA/Cr) ratio—a measure of neuronal viability. A within-subject pre-post design was utilized with adult females from Indonesia diagnosed with GAD (n = 6, ages 21 to 40). Thirty sessions of SPT were provided weekly. Results from both clinical measures of anxiety (HAM-A and GAD-7) indicated mean pretest scores in the clinical range, with average posttest scores below the clinical range for GAD. Likewise, the NAA/Cr ratio mean scores for the hippocampus, amygdala, and PFC were outside the healthy range before and trended toward or into the healthy range after treatment. The NAA/Cr ratio mean scores in the thalamus were in the healthy range before treatment and remained in the healthy range after treatment. This study concludes that SPT effectively improves clinical anxiety symptoms in individuals with GAD and may also improve metabolic brain functioning in the limbic system and PFC. Limitations, implications, and further research are discussed.