Deep brain stimulation (DBS) for treatment-resistant obsessive-compulsive disorder (OCD) produces profound changes beyond symptom reduction, altering patients' entire way of being in the world. Standard psychiatric scales fail to capture these global effects. The authors propose an enactive, affordance-based model describing four aspects of the person-world interaction: the perceived field of affordances (width, depth, and height); self-experience including mood and feelings; the mode of relating to the world; and the existential stance—the second-order evaluation of these changes. This model aims to specify the phenomenological effects of DBS treatment.
The biopsychosocial model holds that physiological, psychological, and social processes each uniquely contribute to psychiatric disorders, but it fails to explain how such different kinds of processes can causally interact. An enactive approach resolves this by viewing cognition as embodied and embedded in the world, with living itself involving basic sense-making. Adopting an organizational rather than linear notion of causality allows understanding of how biopsychosocial processes interrelate in the development of psychiatric disorders.
Verbalizing body awareness during Mindfulness-Based Stress Reduction (MBSR) training is difficult; participants often talked about emotions or made rational judgments instead of expressing bodily sensations. Analyzing a full MBSR course transcript with interpretative phenomenological analysis and applying Wittgenstein's concept of language-games and Austin's speech acts, the authors suggest that learning to verbalize body awareness involves learning a language-game of 'reporting sense perceptions.' The findings align with emotion regulation therapy, where the first step is feeling bodily sensations rather than making rational judgments. The authors hypothesize that mindfulness apps and recorded body scans, lacking live trainer-participant dialogue, may hinder this learning process.