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.

中文翻译：

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沙盘游戏疗法对广泛性焦虑症女性边缘系统和前额皮质的影响

广泛性焦虑症（GAD）是一种以心理和神经生理障碍为特征的常见疾病。先前的研究表明，荣格沙盘游戏疗法（SPT）可以有效改善广泛性焦虑症患者的焦虑症状。本研究探讨使用 SPT 带来的临床症状改善是否也涉及大脑功能的变化。该研究重点关注与广泛性焦虑症有关的大脑区域，包括海马体、杏仁核、丘脑和前额皮质 (PFC)。使用磁共振波谱仪瞄准这些大脑区域来测量代谢物的变化，特别是 N-乙酰天冬氨酸与肌酸 (NAA/Cr) 的比率（神经元活力的衡量标准）。对来自印度尼西亚的诊断患有广泛性焦虑症的成年女性（n = 6，年龄 21 至 40 岁）采用了受试者内前后设计。每周提供三十次 SPT。两项焦虑临床测量（HAM-A 和 GAD-7）的结果表明，平均前测分数在临床范围内，平均后测分数低于 GAD 的临床范围。同样，海马、杏仁核和 PFC 的 NAA/Cr 比率平均得分在治疗前超出健康范围，但在治疗后趋于或进入健康范围。丘脑 NAA/Cr 比值平均评分在治疗前处于健康范围，治疗后仍保持在健康范围。这项研究的结论是，SPT 有效改善了 GAD 患者的临床焦虑症状，还可能改善边缘系统和前额叶皮层的代谢脑功能。讨论了局限性、影响和进一步的研究。