BodyMind Approach

1. Introduction

Version followed: The BodyMind Approach (TBMA, a registered trademark) as Helen Payne and Susan Brooks (University of Hertfordshire) describe it for NHS primary care in Payne & Brooks 2018 and 2020 and Payne 2019. That version has an individual pre-course meeting, 12 two-hour group workshops, an individual exit meeting and a 6-month non-face-to-face follow-up. Session-level detail is filled in from the 2004–07 pilot of the "bodymind approach (BMA)" (Payne 2009a, 2009b) and from later adaptations in Taiwan (2021) and for UK students (Lixenberg, Payne & Annett 2022). The TBMA facilitator manual is restricted to certified facilitators and is not drawn on. Its authors say it is a set of practices, session themes and theory, not a session-by-session script. [source: Payne & Brooks 2018; Payne 2009a] [uncertain: manual]

What it is. TBMA is a facilitated group programme for adults with medically unexplained symptoms (MUS), also called persistent bodily symptoms or somatic symptom disorder. Examples are IBS, chronic pain, fatigue and fibromyalgia-type presentations, often with anxiety or depression. Its authors frame it on purpose as a health-education or self-management "learning course", not as psychotherapy. Sessions are called "workshops", attendees are "participants" and groups meet in community venues. The aim is to help people live well with symptoms, not to cure them. The method combines dance movement psychotherapy and Authentic Movement practice with mindfulness ("bodymindfulness"), breathing and relaxation, arts-based work with the symptom, group sharing and behaviour-change planning. It is a manualised programme, not an open therapy, so this guide is written for a clinician who delivers it, or adapts its procedures, after training. [source: Payne & Brooks 2018; Payne & Brooks 2020; Payne 2019]

How change happens. TBMA works "bottom up", from felt bodily experience to meaning. The symptom is accepted as real and explored rather than fought or distracted from. Through movement, art and metaphor it becomes a source of meaning: it may link to emotions and life events, and it can be reframed as an "early warning system" that signals when to rebalance. Better body awareness, emotional self-regulation, kind attention to the body and peer belonging are meant to break the downward spiral of symptom distress, anxiety and depression. They also move the locus of control inward, towards self-management and away from repeated GP visits. The pilot paper puts the premise as "The symptom is seen as a metaphor for connections between body, self and mind." [source: Payne 2009a; Payne & Brooks 2018; Payne 2019; Payne PESI blog 2019]

2. Framework

TBMA runs in four stages. The within-session phases are described further below. [source: Payne & Brooks 2018; Payne 2019; Payne & Brooks 2020]

Stage A: Referral, screening and preparation (about 1–2 weeks before the group).

Goals: confirm suitability, reduce stigma and fear, gain informed consent and take baseline measures.
Format: GP referral or self-referral, then a telephone assessment the week before the course and an individual intake meeting at the venue. That meeting covers fears and questions, ground rules and confidentiality. The 2018 primary-care version also had a short meeting with a clinical psychologist.
Inclusion, 2018 version: age 18 or over; MUS for at least 6 months; frequent attender, meaning more than 4 GP visits a year; co-morbid anxiety or depression; fluent English.
Exclusion, 2018 version: a current relevant physical illness or disability; trauma or complex bereavement in the last 6 months; a primary psychiatric diagnosis in the last 6 months; learning disability; current substance misuse; diagnosed eating disorder.
The 2004–07 pilot required symptoms for more than 2 years and asked referrers to say why the problem was thought not to be due to physical illness. [source: Payne & Brooks 2018; Payne & Brooks 2020; Payne 2009a] [uncertain: inclusion duration differs between versions]

Stage B: Group workshops (12 sessions × 2 hours, about 27 facilitator hours in total).

Format: closed groups of about 4–10 people with mixed symptoms. The pilot groups had 4–7 people.
Schedule, 2018 version: the first 4 sessions run twice weekly to build safety and cohesion, then 8 sessions follow. In the 2020 report, the first 2 weeks were twice weekly and the course lasted about 10 weeks. In the pilot, all 12 sessions were weekly.
Commitment: participants commit to 6 sessions, then re-commit to the next 6.
Delivery: one facilitator, with a journal for each participant. [source: Payne & Brooks 2018; Payne & Brooks 2020; Payne 2009a] [uncertain: the timetable varies by version]

Within each session (pilot structure; later reports give the same order). [source: Payne 2009a; Taiwan 2021]

Phase 1: verbal check-in and brief psychoeducation. The aim is to begin noticing bodily experience together with feeling, thought and imagination.
Phase 2: warm-up, breathing and relaxation, and massage. Bodily sensation is linked to movement, symptoms and imagery.
Phase 3: deeper work linking inner and outer experience. This includes Authentic Movement as mover and witness, metaphors arising from bodily experience and arts-based work with the symptom. Phases 2 and 3 may be swapped to suit the group.
Phase 4: verbal reflection, journal, check-out and preparation for ending. The Taiwan version also ends each session with advice for daily-life practice.

Arc across the course.

Sources: weeks 1–3 focus on safety, getting comfortable, eyes-open work and graded body attention. Eyes-closed moving and witnessing begin after 2–3 weeks of preparation. Values work and the action plan come towards the end. [source: Payne 2009a; Payne 2009b; Payne 2019]
Middle sessions: no fixed week-by-week plan was found. The manual lets facilitators tailor content to each group. [uncertain]

Stage C: Individual exit meeting. The facilitator meets each participant to say goodbye, finalise a realistic individual action plan of small achievable changes and repeat assessment. [source: Payne & Brooks 2018]

Stage D: Six-month embedding phase (no face-to-face sessions). [source: Payne & Brooks 2018]

At 6 weeks, a letter the participant wrote to themselves, restating the plan, is sent.
At 12 weeks, the facilitator sends a reminder letter.
At 18 weeks, the facilitator sends a text or email.
At 6 months, follow-up assessment.

Measures. Taken before the course, after it and at 6 months, analysed for reliable change. [source: Payne & Brooks 2018; Payne 2019]

MYMOP2: the participant names their own symptoms and an activity.
PHQ-9, GAD-7 and GAF.
A service-use questionnaire.
The pilot used CORE and MYMOP instead.

Criteria for moving on. No formal criteria were found. [uncertain]

Sources: eyes-closed and witnessing work begins only after the facilitator has judged safety, trust and self-consciousness. [source: Payne 2009a]
Practical guide [synthesis]: introduce eyes-closed or dyad work when most members can describe sensations without distress, show some ease being seen, and have practised a self-calming skill. Move to action planning once members can name at least one symptom trigger and one coping strategy that works for them.

Facilitator requirements. [source: Payne & Brooks 2018; Payne 2009a]

A master's degree in an embodied psychotherapy, such as dance movement psychotherapy or body psychotherapy, plus at least 5 years of adult group work.
4-day TBMA training, then assessment and certification.
Regular clinical supervision. The pilot had weekly supervision plus a fortnightly debrief with the principal investigator.

3. Guiding principles

[source: Payne & Brooks 2018; Payne 2019; Payne 2009a; Payne 2009b; Payne & Brooks 2020 unless marked]

Symptoms are real. Never imply "all in the head". Say plainly that the pain or fatigue is real and that the body and mind are working together.
Learning, not therapy. Use workshop and course language and avoid mental-health labels. The programme is presented as education in self-management.
Start where the patient is. Begin with the bodily distress itself. Payne calls TBMA a kind of "pre-therapy" for people who reject talking therapies.
Work with the symptom, not against it. Invite curiosity about the symptom (its shape, movement, message) rather than distraction or elimination, so that people do not dissociate further from the body.
Bottom up, then reflect. Do the non-verbal, sensory, movement or art work first, then put it into words. Do not open with interpretation.
The symptom as metaphor and ally. Help participants find images for the symptom and reframe it as an early warning signal that tells them when to rebalance.
Live well, not cure. Goals are self-management, wellbeing, activity and fewer crises, not removing the symptom. Correct cure expectations early.
Participants are experts on themselves. Collaborate. Any interpretation is offered as your view, which the person may accept or reject.
Kind attention to the body. Model and teach compassionate noticing and caring for the body, in place of self-criticism or hypervigilance.
Graded, safe exposure to the body. Pace body focus gently, offer eyes-open or active alternatives, and never push people beyond their readiness. Physical and emotional safety come first.
No search for a cause. One generic mechanism, failed self-regulation, is assumed across diagnoses, so groups are mixed. Do not dig for a single hidden cause.
The group as healing context. Belonging, normalising and peer-shared coping reduce isolation and catastrophising. Use pairs, threes and whole-group work.
Locus of control inward. Steer responsibility for practice and change towards the participant, not a "fix" from the facilitator.
Reflection-in-action. Choose exercises from the repertoire in the moment, according to group needs and dynamics. The manual is not a recipe book.
A holding, attachment-informed presence. Be a reliable, kind presence. Expect to be leaned on early, then hand over gradually.
Benign witnessing. Look and reflect without judgement or interpretation, and teach participants to do the same for each other.
Recovery-model values. Foster hope, sense of self, supportive relationships, empowerment, coping and meaning-making.
Bridge to medical care, not a replacement. TBMA does not override GP judgement about investigations. New or changed symptoms go back to the GP. [source: Payne & Brooks 2018]

4. Intervention inventory

How to read this section. The sources name the practices below and give their purpose and place in the session. They rarely give step-by-step instructions, because these are in the restricted TBMA manual. So, unless a step is tagged [source], the steps are my own reconstruction from the practice's standard form in dance movement psychotherapy or mindfulness, kept within what the TBMA sources describe [synthesis]. All example wording is illustrative. Using the TBMA name requires TBMA training and certification. [source: Payne & Brooks 2018]

Screening and safety for all body work. The sources screen out:

relevant physical illness;
recent trauma or complex bereavement (last 6 months);
recent primary psychiatric diagnosis or psychiatric care;
substance misuse;
eating disorder;
learning disability.

[source: Payne & Brooks 2018; Payne 2009a]

Added checks [synthesis]:

Ask about balance, falls, dizziness, epilepsy, pregnancy, recent injury or surgery, joint restrictions, and cardiac or respiratory illness. Adapt eyes-closed, floor and breath work to these.
Ask about dissociation, panic, and any history of abuse or touch-related distress.
Screen current suicidality with your usual risk assessment. Active risk means individual care first, not this group.
New, changing or alarming symptoms go to the GP before or alongside the group.
Never present TBMA as a treatment for physical disease.

Touch. TBMA sources mention massage (pilot) and drawing around each other's bodies, but they give no consent procedure. [uncertain] Any touch below needs the consent steps given there, specific training and supervision, and a check that your licence and jurisdiction allow it [synthesis].

4.1 Telephone screening and individual intake meeting

Purpose: check eligibility and fit, hear fears, explain the format, gain informed consent, agree ground rules and confidentiality, and lower the stigma barrier. [source: Payne 2009a; Payne & Brooks 2020; Payne & Brooks 2018]
Steps:
1. Telephone screen against the inclusion and exclusion criteria in section 2. [source]
2. Meet individually at the venue the week before session 1. Ask about the symptom story, what they have tried, what they fear, and what they want from the course. [source: Payne & Brooks 2020]
3. Describe the course in learning language: workshops, gentle movement, breathing, art and writing, and no dance skill needed. [source: Payne & Brooks 2018; Taiwan 2021]
4. Explain that symptoms are accepted as real and that the aim is to live well with them. [source]
5. Agree the 6 + 6 session commitment, ground rules and confidentiality. [source: Payne & Brooks 2020]
6. Take baseline measures. [source]
7. Note physical limits and preferences, including touch and eyes-closed work, on a private safety note. [synthesis]
Example language (illustrative): "Nobody here will tell you it's in your head. This is a course for learning new ways of listening to and looking after your body, so the symptoms take up less of your life."
Watch for: "mental health" alarm; hope for a cure; fear of a missed serious diagnosis; inability to commit to the schedule. Each is addressed in section 5.

4.2 Baseline and outcome measurement (MYMOP2, PHQ-9, GAD-7, GAF, service use)

Purpose: track symptom distress, wellbeing, activity, mood and anxiety. Through MYMOP2 it also gives the participant ownership: they name their own main symptoms and one activity the symptoms limit. [source: Payne & Brooks 2018; Payne 2019]
Steps:
1. Give the measures before the course, after it and at 6 months. [source]
2. Help the participant choose the symptoms and the activity in their own words. [source]
3. Feed the participant's own targets back into the action plan. [synthesis]
- Do not reproduce items; use licensed or official copies.
Example language (illustrative): "Which two symptoms bother you most, and what's one thing you'd like to be able to do more of?"
Watch for: reliable change in MYMOP2 profile scores. The authors warn that MYMOP improves relatively easily, so read it with the other measures. [source: Payne & Brooks 2018]

4.3 Verbal check-in

Purpose: open each session, gauge state and symptoms today, and keep continuity. [source: Payne 2009a; Taiwan 2021]
Steps:
1. Sit in a circle. [source: Lixenberg et al. 2022]
2. Each person briefly names how body and mood are today, plus anything from home practice or the journal. [synthesis on content]
3. Some sessions open with sharing personal stories. [source: Payne 2009a]
4. Keep each turn short and allow people to pass. [synthesis]
Example language (illustrative): "One or two sentences each: where is your body at today, and anything you noticed since last time?"
Watch for: one member dominating with symptom detail (see section 5). Whether people refer more to coping than to symptom catalogues over the weeks is a sign of progress. [synthesis]

4.4 Brief psychoeducation

Purpose: give a non-blaming explanation linking stress, emotion and bodily symptoms. Content includes the self-regulation spiral of symptom, anxiety and low mood; the symptom as an early warning signal; and the value of practice. [source: Payne 2009a; Payne 2019; Payne & Brooks 2018]
Steps:
1. Give 5–10 minutes on one idea per session. [synthesis on timing]
2. Use a picture or a group example.
3. Invite members to say whether it fits their experience. Never insist.
4. Later sessions cover communication and assertiveness and activity regulation. [source: Payne 2019]
Example language (illustrative): "When we're stressed for a long time, the body's alarm system can stay switched on. Symptoms can be part of that alarm, real signals, not imagined ones. Today we'll practise noticing the early signals."
Watch for: hearing "stress" as blame. Reaffirm that the symptoms are real.

4.5 Arrival, grounding and centring

Purpose: shift attention from talk into the body and settle the nervous system before movement. [source: Lixenberg et al. 2022; Payne & Brooks 2020 names grounding and centring]
Steps:
1. Seated in the circle, feet flat on the floor. [source: Lixenberg et al. 2022]
2. Invite noticing of the contact of feet, seat and back, then the breath, without changing it. [source: Lixenberg et al. 2022 on noticing body and breath]
3. Invite a sense of the body's centre, for example a hand resting on the belly or the sternum. Keep eyes open or lowered by choice. [synthesis]
4. Spend 2–5 minutes. [synthesis]
5. Each person names one word for what they noticed.
Example language (illustrative): "Let your feet find the floor. Notice where the chair holds you. You don't have to change anything, just notice."
Watch for: rising anxiety when attention turns inward. Offer eyes open, an outward focus (sounds, the room) or a move to active warm-up. [source: Payne 2009a on graded options]

4.6 Warm-up: surfaces, skin, joints, muscles

Purpose: build a gentle bridge into bodily focus, raise playfulness and share leadership. [source: Payne 2009a]
Steps:
1. Standing or seated as able. [synthesis]
2. Bring attention to the body's surfaces: brushing or tapping one's own arms, legs and torso; rolling joints from the extremities inward; gentle stretches. [source names surfaces, skin, joints and muscles; actions are synthesis]
3. Use games and shared leadership: members take turns to lead a movement that others follow. [source]
4. Use music and props such as scarves or balls as bridges. [source]
5. Spend 10–15 minutes. [synthesis]
6. Anyone can stay seated or do a smaller version.
Example language (illustrative): "Only move as far as is comfortable for your body today. Smaller is fine. Who'd like to lead the next movement?"
Watch for: pain flare-ups, which should be reduced in range and never pushed; self-consciousness, which can be eased by facing outward or keeping movements small; signs of enjoyment and laughter. [synthesis]

4.7 Mindful walking

Purpose: bring bodymindfulness into ordinary movement, link movement to internal rhythms and give a practice that is easy to repeat at home. [source: Payne & Brooks 2018; Lixenberg et al. 2022]
Steps:
1. Shoes off if comfortable. [source: Lixenberg et al. 2022]
2. Walk slowly around the room.
3. Attend to the floor under the feet, then weight shifting, then breath. [source: Lixenberg et al. 2022 on floor underfoot]
4. Optionally pause and notice the heartbeat, with a hand on the chest if wanted. [source: Lixenberg et al. 2022 on heartbeat; hand is synthesis]
5. Vary the pace (slower, faster), then return to the circle. [synthesis]
6. Spend 5–10 minutes. [synthesis]
Example language (illustrative): "Notice the floor meeting your feet. Is it cool or warm, hard or soft? Then notice your breath as you walk."
Watch for: dizziness or balance problems. Offer a chair, a wall or seated foot-awareness. Heartbeat focus can raise panic in some people, so make it optional. [synthesis]

4.8 Controlled abdominal (diaphragmatic) breathing

Purpose: provide a portable self-regulation skill for stress and symptom moments. A case participant reported eased abdominal pain, and another near-complete relief, with regular use. [source: Payne & Brooks 2018; Payne 2019]
Steps:
1. Sit or lie supported. One hand on the belly, one on the chest. [synthesis]
2. Breathe in gently through the nose, letting the belly rise more than the chest.
3. Make the out-breath slightly longer than the in-breath, unforced, for 3–5 minutes. [synthesis]
4. Practise in each session early in the course, then assign daily practice. [source: Payne 2009a puts breath work in phase 1 or 2]
- A "unique breathing method" taught in the student study is not described. [uncertain]
Example language (illustrative): "Let the breath drop low, as if into your belly. No need to breathe deeper, just a little slower out than in."
Watch for: over-breathing, with light-headedness or tingling. If it happens, stop, return to natural breathing and open the eyes. Use caution, and keep breaths natural rather than deep, in respiratory or cardiac illness and panic disorder. Progress shows as members using the skill outside sessions. [synthesis]

4.9 Progressive muscle relaxation, or stretch-release relaxation

Purpose: teach the difference between tension and release and give a coping strategy. The stretch-release option is an active alternative for people who cannot tolerate stillness with closed eyes. [source: Payne 2019; Payne 2009a]
Steps:
1. Seated or lying.
2. Go through the body region by region: gently tense or stretch for a few seconds, then release and notice the contrast for longer. [standard PMR form; synthesis]
3. Use about half effort and skip any painful or injured area, imagining or simply noticing the release there instead. [synthesis]
4. Spend 10–15 minutes.
5. Close by wiggling fingers and toes and opening the eyes.
Example language (illustrative): "Gently draw your shoulders up, about half your strength. Hold. And let them drop. Notice what changes."
Watch for: pain or cramp, so reduce or skip tension; rising anxiety or dissociation in stillness, so switch to stretch-release or eyes open. [source: Payne 2009a on alternatives; rest synthesis]

4.10 Massage (pilot version)

Purpose: relaxation and linking sensation with feeling and imagery. [source: Payne 2009a]
- The pilot lists massage among phase 2 relaxation methods, but does not say whether it is self-massage, partner massage or facilitator-given. It is not named in the later TBMA descriptions. [uncertain]
Steps [synthesis]:
1. Default to self-massage, for example of hands, forearms, face, neck or feet, using slow strokes or gentle pressure, guided for 5 minutes.
2. Partner work only on clothed, non-intimate areas: hands, forearms, shoulders, upper back.
3. Consent steps for partner touch [synthesis]: explain what will happen and where touch will go; ask each person individually; give self-massage as an equal no-touch alternative; agree a stop signal such as "stop" or raising a hand; check in midway; debrief afterwards.
4. No deep-tissue pressure. Avoid recent injuries and painful areas.
Example language (illustrative): "You can do this on yourself, or with a partner on hands and shoulders only. Either is equally useful. Say 'stop' at any time and it stops."
Watch for: freezing, compliance without real consent, startle or tearfulness. Stop and offer the self-massage alternative. Touch requires specific training, supervision and a check of what your licence allows. [synthesis]

4.11 Guided imagery and inner journeying

Purpose: reduce bodily tension, give a different experience of the body and find inner resources, for example a helper or inner guide. [source: Payne 2009a; Payne 2019]
Steps:
1. After relaxation, guide a short image journey, for example to a safe place or towards a symptom region.
2. Invite a helper figure or inner guide to appear. [source: Payne 2009a]
3. Let people find their own images rather than prescribing them.
4. Spend 5–10 minutes.
5. Return gradually and draw or write the image afterwards. [synthesis on structure]
Example language (illustrative): "If a helper or guide could appear for you here, what might they look like? What do they want you to know about your body?"
Watch for: intrusive or frightening images, so open the eyes, ground and talk it through (see section 5); helper images that participants recall again at home. [synthesis]

4.12 Bodymindfulness and self-monitoring of early stress signals

Purpose: build somatic and emotional awareness so that participants catch early stress-response signals and act on them. This puts the reframe of the symptom as an early warning system into practice. [source: Payne & Brooks 2018; Payne 2019]
Steps:
1. In session, after a movement or breath practice, invite a scan of the body. Ask: where is there tightness, heat or holding? What emotion or thought goes with it? [synthesis]
2. Teach a home log with three entries: signal noticed, situation, what I did. Keep it in the journal. [synthesis; the journal itself is source]
3. Review the logs at check-in for patterns linking triggers, emotions and symptoms. [source: Payne 2009b, where participants noticed triggers and the feelings linked to symptoms]
Example language (illustrative): "Before the symptom gets loud, what's the whisper? A clenched jaw, shallow breath, a knot somewhere?"
Watch for: hypervigilance and symptom-checking. Frame noticing as kind and brief, then followed by an action such as breathing or pacing, not as monitoring for danger. Signs of progress are participants reporting earlier detection and an early response. [synthesis]

4.13 Moving with the symptom in mind (spontaneous movement)

Purpose: explore the symptom from within through natural, non-stylised movement, to find its quality, meaning and associated feelings, and to make it more familiar and less frightening. [source: Payne 2009a; Payne 2009b]
Steps:
1. After a warm-up, each person brings attention to their symptom area. [synthesis]
2. Let the body move as the symptom feels or wants to move: its rhythm, weight, speed, shape. This can be standing, seated or lying, eyes open or lowered. [source: Payne 2009a names "with the particular symptom in mind"; detail synthesis]
3. Give 3–8 minutes, then let the movement slow to stillness. [synthesis]
4. Draw or write straight afterwards, then share in pairs. [source: Payne 2009b, speaking, drawing and writing as reflection tools]
Example language (illustrative): "If the ache in your back could move, how would it move? Slow, jagged, heavy? Let your body try it out, as small as you like."
Watch for: pain increase, so reduce range or switch to imagined or seated movement; flooding of emotion, so slow down and ground (see section 5); new words or images for the symptom, and reports of feeling less at war with it. [synthesis]

4.14 Authentic Movement: mover and witness (dyads and group)

Purpose: deepen inner listening and non-judgmental self-observation through spontaneous movement, usually with eyes closed, while being seen by a benign witness. Verbal processing then turns the experience into meaning. This is the core embodied method in TBMA. [source: Payne 2009a; Payne & Brooks 2018; Payne & Brooks 2020; Taiwan 2021]
Steps:
1. Introduce it only after 2–3 weeks of preparation and a safety check. [source: Payne 2009a]
2. Pair up: one mover, one witness. The witness sits at the edge of the space. [source: Taiwan 2021 notes at least one witness]
3. The mover closes or lowers the eyes, waits for an impulse and moves spontaneously for a set time. The source gives no length; 5–10 minutes is a reasonable start. [source on eyes closed and set duration; times synthesis]
4. The witness watches attentively and without judgement and also keeps the mover physically safe, saying "stop" near walls or objects. [synthesis on safety]
5. The facilitator signals the end, for example with a bell or soft voice. The mover opens their eyes slowly.
6. The mover speaks or draws first.
7. The witness then reflects only their own experience in first person, without interpretation, and only if the mover wants it. The 2009 paper describes requesting "benign witnessing from another". [source: Payne 2009b; detail synthesis]
8. Swap roles.
9. Later the whole group can work as movers and witnesses. [source: Payne 2009a]
- TBMA uses an "adapted" form of witnessing. Exactly how it is adapted is not described. [source: Payne & Brooks 2020] [uncertain]
Example language (illustrative): "Movers, close or lower your eyes and wait. Let movement come from the inside, or stay still. Witnesses, simply watch with kindness. You are not judging or interpreting."
Watch for:
- Falls, collisions, dizziness: clear the floor and allow eyes open. Floor or seated movement suits people with balance issues. [synthesis]
- Self-consciousness: graded options, for example eyes open while turning inward. [source: Payne 2009a]
- Dissociation or emerging traumatic memory (see section 5). [synthesis]
- Signs it is working: participants describe a meditative quality and greater body awareness. [source: Payne 2009b]

4.15 Mirroring in dyads

Purpose: non-verbal attunement and experiencing being seen and followed. It works on relational patterns such as how one feels seen compared with how one is actually seen. [source: Payne & Brooks 2020; Lixenberg et al. 2022; Payne 2009a]
Steps [synthesis on detail]:
1. Pairs face each other at a comfortable distance. No touch.
2. A leads slow movements and B mirrors them. Then swap.
3. Then try no designated leader.
4. Each round lasts 2–3 minutes.
5. Pairs talk briefly afterwards: what was it like to lead, to follow, to be seen?
Example language (illustrative): "Go slowly enough that your partner can stay with you. Notice what it's like to be followed, and to follow."
Watch for: giggling or avoiding eye contact (offer a soft gaze at shoulders); one partner always leading or always following, which can be useful material for reflection on assertiveness. [synthesis]

4.16 Synchronous group movement (Chace-adapted circle)

Purpose: group cohesion, belonging and shared rhythm. Payne has presented synchronous group rhythms for reducing chronic pain. [source: Payne & Brooks 2020; conference title, Payne 2019; the paper itself is not drawn on]
Steps [synthesis based on standard Chace circle practice]:
1. Stand or sit in a circle.
2. The facilitator picks up and amplifies a movement a member makes, and everyone joins.
3. Leadership passes around.
4. Find a shared rhythm, for example swaying, stepping or clapping, with and without music.
5. Spend 10–15 minutes.
6. Slow to stillness and name one word each.
Example language (illustrative): "Sam's doing a lovely side-to-side sway. Let's all try Sam's sway. Who wants to change it next?"
Watch for: mixed physical abilities, so offer seated versions and make sure everyone's movement is included; whether the group's energy and connection build over the course. [synthesis]

4.17 Partner-movement themes: resistance, support, trust, being seen

Purpose: explore interpersonal themes bodily. For example: how I give or take support, how I resist, how I trust, how I feel seen versus how I am seen. [source: Payne 2009a]
Steps:
- The sources name the themes but not the exercises. [uncertain]
- No-touch default [synthesis]: lead-follow walking with eyes open; pushing against an imagined wall then a real wall; pairs moving a shared scarf or stick to explore give and take.
- Contact versions such as palm-to-palm pushing or leaning only with the full consent steps in 4.10, gentle pressure, and no weight-bearing for people with pain or joint conditions. [synthesis]
Example language (illustrative): "Try pushing into the wall. Notice how much effort feels right. What's it like to push back against something?"
Watch for: shutting down when pushing (link to assertiveness work in 4.25); pain flare-ups. [synthesis]

4.18 Symptom embodiment and dialogue: role play in pairs

Purpose: create distance from the symptom and get to know it by giving it a body, voice and posture. This reveals emotional triggers. [source: Payne & Brooks 2020; Payne & Brooks 2018 on dialoguing with the symptom through drawing and speaking]
- Example from the sources: a participant sensed her symptom as a lion and came to see anger as a trigger. [source: Payne & Brooks 2018; Payne & Brooks 2020]
Steps:
1. In pairs, A shows how the symptom might move or what posture it takes. [source]
2. B gives feedback on what they saw. [source]
3. A speaks as the symptom ("I am…, I want…") or writes or draws a dialogue: questions to the symptom, then answers from it. [source names dialogue; format synthesis]
4. Step out of the role physically, for example by shaking off and returning to one's own seat. Then reflect. [synthesis]
Example language (illustrative): "Let the symptom speak for a moment: 'I am the fatigue, and I'm here because…' Then step out and be yourself again."
Watch for: strong emotion, which should be welcomed but contained, with de-roling always done; a shift from fear to curiosity, or the symptom being named as a messenger. [synthesis]

4.19 Arts-based symptom work: mark-making, clay, finger painting, collage

Purpose: represent the symptom symbolically, externalise it, change its meaning and the interpretations of self and world that go with it (such as overwhelm or catastrophising), and access non-verbal material. [source: Payne 2019; Payne & Brooks 2018; Payne & Brooks 2020; Taiwan 2021]
- Theme names in the sources include "meeting the symptom", "symptom as symbol" and "mapping the symptom". No instructions were found for them. [source: Taiwan 2021] [uncertain]
Steps:
1. After movement, each person chooses materials: paper and pastels, clay, finger paint, collage. [source: Taiwan 2021; Payne & Brooks 2020]
2. Make the symptom: its colour, shape, texture or size. Optionally use the non-writing hand to loosen control. [source: Payne & Brooks 2020 on fingers or non-writing hand]
3. Optionally make a second image of how it would be if the symptom were a little easier, or of one's resources. [synthesis]
4. Share in pairs. [source]
5. Title the work and note it in the journal. [synthesis]
6. Spend 15–20 minutes making and 10 minutes sharing. [synthesis]
Example language (illustrative): "No art skill needed. Let your hands find the shape or colour of the symptom today. It can be messy."
Watch for: "I can't draw" (reassure: marks, not art); images changing over the weeks, which is a sign the relationship with the symptom is shifting. [synthesis]

4.20 Body-outline drawing (pilot)

Purpose: map sensations and feelings onto the whole body. [source: Payne 2009a]
Steps:
1. On large paper, partners draw around each other's bodies. [source]
2. Each person then decorates their own outline with the sensations, symptoms and feelings they notice. [source]
3. Consent and proximity [synthesis]: drawing around a lying body involves closeness. Ask first, and offer alternatives: drawing around oneself seated, or using a pre-drawn generic outline. Agree a stop signal and debrief.
4. Reflect in pairs. [synthesis]
Example language (illustrative): "Would you like a partner to trace you, or would you prefer the printed outline? Both work equally well."
Watch for: body-image distress (note the eating-disorder exclusion); discomfort lying down being traced, so use the alternative. [synthesis]

4.21 Expressive writing and the personal journal

Purpose: reflect and consolidate after each session, keep continuity between sessions, and allow expressive writing about the symptom and emotions. [source: Payne 2009a; Payne 2009b; Payne & Brooks 2018; Payne & Brooks 2020]
Steps:
1. Give out a journal at the start of the course. [source]
2. Near the end of each session, give 5–10 minutes to write or draw about what was noticed. [source on timing in session; minutes synthesis]
3. Encourage entries between sessions as well. [source: Payne 2009b]
4. The journal is private and sharing is voluntary. [synthesis]
5. Optional prompts: what my body told me today; what I'll try this week. [synthesis]
- A separate reflective learning journal is also mentioned. [source: Payne & Brooks 2018]
Example language (illustrative): "Take a few minutes with your journal, words, doodles, anything. It's yours. You don't need to show anyone."
Watch for: rumination about symptoms. Steer prompts towards noticing and coping. [synthesis]

4.22 Pair sharing, group reflection and verbal check-out

Purpose: put non-verbal experience into words, give peer support and shared coping, normalise, and close the session safely. [source: Payne 2009a; Payne & Brooks 2018; Payne & Brooks 2020]
Steps:
1. Share in pairs or threes after the art and movement tasks. [source]
2. Then a whole-group reflection. [source]
3. Check-out: each person gives one word or sentence, plus a practice to take home. [source: Taiwan 2021 on daily-life advice; format synthesis]
4. Make sure everyone leaves grounded. If needed, end with a short breath or foot-awareness practice. [synthesis]
Example language (illustrative): "One word for how you're leaving, and one small thing you'll practise this week."
Watch for: someone leaving activated. Check in with them individually before they go. [synthesis]

4.23 Kind attention to the body and body compassion

Purpose: replace self-criticism and fighting the body with caring attention. The sources describe this as a core aim and coping strategy. In the 2019 case (Ms G), reduced self-criticism and increased self-compassion went together with eased pain. [source: Payne 2019; Payne & Brooks 2020 on self-acceptance and compassion; Lixenberg et al. 2022 on body compassion]
Steps [synthesis]:
1. After a breath practice, invite each person to place a hand where it is comforting, for example on the symptom area or the heart, if they want to. This is self-touch only.
2. Silently offer the body a kind phrase in their own words.
3. Ask: what does this part of me need today? Note one caring action, such as rest, warmth, a walk, or asking for help.
4. Spend 3–5 minutes.
Example language (illustrative): "Instead of asking 'what's wrong with you?', try asking your body 'what do you need?'"
Watch for: "I don't deserve it" or tearfulness, which you can acknowledge gently and keep brief. Watch for self-critical language softening at check-ins. [synthesis]

4.24 Inventory of coping resources

Purpose: recognise existing emotional, spiritual, social and physical coping strategies and build personal responsibility for using them. [source: Payne 2009a]
Steps:
1. Each person lists or draws their resources in four areas. The format, for example four quadrants on paper, is [synthesis].
2. Share in threes so others can borrow ideas. [source: Payne & Brooks 2018 on peer-shared coping]
3. Mark one resource to strengthen this week. [synthesis]
Example language (illustrative): "What already helps, even a little? People, places, activities, beliefs, anything."
Watch for: "nothing helps". Prompt with what got them through the past week. [synthesis]

4.25 Narrative work, communication and assertiveness

Purpose: help participants build narratives that link symptoms with psychosocial factors, past experiences and cultural beliefs, and practise communication and assertiveness. [source: Payne 2019]
- The sources describe safe exploration that can touch trauma and attachment. [source: Payne 2019; Payne 2009a on optional psychodynamic interpretation]
Steps:
1. Build on images and movement material by asking: when does the symptom get louder? What was happening in your life when it started? [synthesis]
2. Offer any link as your view, which the person can reject. [source: Payne 2009a]
3. Practise assertiveness through movement, for example a clear "no" gesture or a pushing exercise (4.17), and through words in pairs, for example rehearsing saying no to an extra demand. [synthesis]
Example language (illustrative): "I wonder, and you may see it differently, whether your stomach tightens most when you're holding back what you want to say?"
Watch for: rejection of any psychological link, so return to bodily description and do not argue; trauma material, so contain it and refer for individual therapy (see section 5). [synthesis]

4.26 Activity regulation and problem-solving

Purpose: replace avoidance and withdrawal with paced activity and problem-solving. [source: Payne 2019]
Steps [synthesis]:
1. Use the MYMOP2 activity (4.2) or the journal log to name one avoided activity.
2. Break it into small, paced steps. Plan rest before exhaustion, not after.
3. Problem-solve one obstacle with a partner.
4. Review at the next check-in.
- Set no fixed exercise or activity targets; steps are chosen by the participant.
Example language (illustrative): "What's the smallest piece of that you could try this week, so small it feels almost too easy?"
Watch for: boom-and-bust patterns of overdoing on good days and crashing afterwards. Use the early-signal practice (4.12) to pace. [synthesis]

4.27 Values exploration and goal-setting

Purpose: identify what matters to the participant so that goals and practices serve living well, not only symptom reduction. [source: Payne 2019]
Steps [synthesis]:
1. Use an art or writing prompt: "What would I do more of if symptoms took up less space?"
2. Name 2–3 values, for example family, creativity, work, nature.
3. Turn each into one concrete goal. These goals feed into the action plan.
Example language (illustrative): "Let's look past the symptom for a moment. What's it all for? What do you care about?"
Watch for: goals that are only about symptoms ("no pain"). Reframe them towards activity and meaning. [synthesis]

4.28 Home practice and daily-life practice advice

Purpose: test the strategies in everyday situations between sessions. [source: Payne & Brooks 2018; Taiwan 2021]
Steps:
1. At the end of each session, suggest a specific practice from the session, for example abdominal breathing, mindful walking, relaxation or a journal entry. [source: Taiwan 2021]
2. Agree when and where the participant will do it. [synthesis]
3. Review it at check-in. [synthesis]
Example language (illustrative): "Which one practice from today could fit into your normal day? When exactly will you try it?"
Watch for: non-adherence (see section 5). Practices sticking shows as spontaneous reports such as "I did the breathing on the bus". [synthesis]

4.29 Individual action plan and exit meeting

Purpose: carry learning into everyday life through a realistic, individual plan of small, achievable changes, and close the relationship with the facilitator well. [source: Payne & Brooks 2018; Payne 2019]
Steps:
1. Begin drafting in the final sessions. [source]
2. In the individual exit meeting, finalise the plan with the facilitator, say goodbye and complete the measures. [source: Payne & Brooks 2018]
3. A suggested format [synthesis]: my early warning signs; my go-to practices; values and goals with small steps; people and resources; what I'll do if symptoms flare; when to see my GP.
4. The participant then writes a letter to themselves restating the plan, which is posted to them later (4.30). [source]
Example language (illustrative): "Let's make this plan small enough to actually happen. What will you do on a bad day, and what on a good one?"
Watch for: over-ambitious plans, so scale them down; anxiety about ending, so name the follow-up contacts. [synthesis]

4.30 Six-month post-course embedding contacts

Purpose: keep participants on track with their action plan without face-to-face sessions. [source: Payne & Brooks 2018]
Steps: [source: Payne & Brooks 2018]
1. At 6 weeks, post the participant's self-written letter to them.
2. At 12 weeks, the facilitator sends a reminder letter about the plan's steps.
3. At 18 weeks, send a text or email.
4. At 6 months, complete the follow-up assessment.
Example language (illustrative), for the 12-week letter: "I'm thinking of the plan you made, especially the evening walks and your breathing practice. How are they going?"
Watch for: no response. Make one gentle follow-up and leave the door open. In some areas, participants kept meeting voluntarily after the course. [source: Payne & Brooks 2020 on continued meeting; rest synthesis]

4.31 Optional adjunct methods named in sources

Purpose: the sources list other methods without describing them. These are: Gestalt methods, meditation and mindfulness (pilot); qigong, yoga and meditation (Taiwan, at the facilitator's discretion); improvisation, movement play and collage. [source: Payne 2009a; Taiwan 2021]
Steps: use these only within your own training. The sources do not say how they fit into TBMA. [uncertain]
Watch for: keeping the TBMA framing of curiosity about the symptom, self-management and a non-medical tone when adding them. [synthesis]

5. Handling problems

The sources say little about how facilitators handle difficulties. Responses are tagged by origin.

Stigma, and "this is mental health" alarm. One participant warned that if the group was about mental health, she would leave immediately. Fear of being thought "mad", or of hearing "all in the mind", deters people from coming. [source: Payne & Brooks 2020; Payne 2009a]

Response [source: Payne & Brooks 2018; Payne 2009a]: use learning-course naming ("workshops", "participants", "learning group"), community venues and non-medical language, and say explicitly that symptoms are real.
Response [synthesis]: if alarm arises in the room, do not debate diagnosis. Return to the body ("Let's just see what your body notices today") and offer the course as a set of practical skills.

Hoping for a cure, or a "fix" from the facilitator.

Response [source: Payne & Brooks 2018; Payne 2019]: from the intake meeting onwards, frame the aim as living well with symptoms and self-management. Keep moving the locus of control back to the participant.
Response [synthesis]: acknowledge the disappointment, then ask what living well would look like. Link back to the values work (4.27).

Fear of a missed serious diagnosis, or new or changed symptoms. [source: Payne & Brooks 2020 on fear of serious diagnosis; Payne & Brooks 2018 on not replacing GP judgement]

Response [synthesis]: take it seriously. Advise a GP review for any new, changed or alarming symptom, and do not reassure medically yourself. Keep a referral route to the GP agreed with the referring practice.

Self-consciousness and shyness about moving or being watched. Participants felt "exposed in front of the group"; this eased over time. [source: Payne 2009b]

Response [source: Payne 2009a; Payne 2009b]: graded options, such as eyes open while turning inward, or active stretch-release instead of eyes-closed stillness. Introduce witnessing only after 2–3 weeks. Never push beyond readiness.
Response [synthesis]: begin with seated and small movements, facing outward. Have everyone move at once, so nobody is watched alone, before using dyads. The facilitator can move too.

"I can't dance", or a mismatch with expectations. One dropout expected dance and was put off when asked simply to "move". [source: Taiwan 2021]

Response [synthesis]: at intake, describe accurately what happens: ordinary, gentle movement with no steps to learn. Show a short example.

Pain or fatigue limiting participation, and missed sessions because of pain. The 2019 case missed two sessions because of pain and found some exercises challenging. [source: Payne 2019]

Response [synthesis]:
- Every practice has a seated, lying or imagined version. Resting while watching counts as participating.
- Contact a participant who misses sessions, warmly and without pressure.
- Use the flare itself as material: what does the body need right now?

Sessions feeling too long, or fatigue. The facilitator found two hours too long. Adding breaks and rest helped, and the group used them productively. [source: Payne 2009b]

Response: schedule breaks and rest as part of the session. [source: Payne 2009b]

Dropout and inability to commit (illness, moving house, being too busy). [source: Payne 2009a; Taiwan 2021]

Response [source: Payne & Brooks 2020]: a 6 + 6 session commitment, and twice-weekly early sessions to build cohesion fast.
Response [synthesis]: discuss practical barriers such as transport and work at intake. Where possible, have a person who is "not the right time" join a later group.

Emotional instability, or someone not ready for a group. One woman withdrew because her emotions felt unstable. [source: Taiwan 2021] Payne & Brooks note group work can be hard for vulnerable or highly anxious people, and groups can occasionally be destructive. [source: Payne & Brooks 2020]

Response [synthesis]: screen carefully, as the sources do (section 2). Offer individual support or a later group. Keep an individual review route open during the course.

Overwhelm, dissociation, panic or traumatic memory surfacing in Authentic Movement, imagery or breath work. This is not addressed in the sources beyond safety-first pacing and the trauma exclusion. [synthesis]

Stop the exercise for that person.
Eyes open. Orient them to the room: name 5 things they see, feet on the floor, slow exhalation.
Sit with them at the edge of the space while the group continues, or pause the group.
Do not explore the content in the group. Speak with them individually before they leave.
Consider referral for individual trauma-focused therapy.
Afterwards, adjust: eyes-open versions, and shorter and more structured exercises.

Over-breathing in breath work. [synthesis]

Return to natural breathing with a slower, unforced out-breath, and open the eyes.
Never coach deep or rapid breathing.

Distress about touch or closeness (massage, body outline, partner contact). [synthesis]

Always offer the no-touch alternative as equal.
Stop at once on the stop signal or any sign of freezing, and debrief privately.
Consider whether the person needs individual support.

Scepticism about any psychological link, and rejection of interpretation.

Response [source: Payne 2009a]: interpretations are offered tentatively as the facilitator's view, to be accepted or rejected.
Response [synthesis]: stay with bodily description and the person's own metaphors. Meaning often emerges from their images, as with the lion becoming anger, rather than from being told.

Non-adherence to home practice. [synthesis]

Shrink the practice: one minute of breathing tied to an existing routine.
Ask what got in the way, without judgement.
Use peer examples from the group.
Link the practice to the person's MYMOP2 activity or their values.

One member dominating with symptom detail, or the group sliding into a symptom-complaint culture. [synthesis]

Use time-limited rounds and steer towards what was noticed or tried.
Shift to non-verbal work.
Speak with the person privately if needed.

Conflict or ruptures in the group, or with the facilitator. [synthesis, apart from the supervision point]

Name the tension calmly. Return to the ground rules agreed at intake.
Invite each person to say what they need, using "I" statements.
Repair a facilitator rupture openly: acknowledge your part, then check in individually.
Use supervision. The pilot facilitator relied on self-reflection and clinical supervision for harder dynamics. [source: Payne 2009b]

Absences shrinking a small group. [source: Payne & Brooks 2020]

Response [synthesis]: run groups at the larger end of the range, about 8–10 members. Plan dyad exercises that also work with odd numbers.

Dependence on the facilitator, and difficulty ending. The sources say the facilitator may act as an attachment figure early on. [source: Payne & Brooks 2018]

Response [source: Payne & Brooks 2018]: individual exit meeting, the action plan and the staged 6-month contacts.
Response [synthesis]: hand leadership to members progressively, for example through shared leadership in warm-ups. Support peer meeting after the course where wanted.

Suicidal thoughts or self-harm disclosed. [synthesis]

Follow your service's standard risk assessment and safety-planning procedure the same day. Include lethal-means counselling, meaning safe storage or removal.
Liaise with the GP.
Decide individually whether the person continues in the group.

Adapting TBMA procedures to individual therapy or online work. Not described in the sources. [uncertain] [synthesis]

The arts, breathing, mindful-walking, symptom-dialogue and action-plan components translate most easily.
Witnessing is done by the therapist.
Online work needs a cleared, safe space at home, eyes-open movement and a plan for what happens if the connection drops during an emotional moment.
Without TBMA certification, describe this as "informed by" TBMA.

Sources

Sources: