Systematic Review or Meta Analysis & DMT

Systematic Review or Meta Analysis & DMT

(compiled by Iris Bräuninger 2019-02-28)

Abraha, I., Rimland, J. M., Trotta, F. M., Dell'Aquila, G., Cruz-Jentoft, A., Petrovic, M., ... & Cherubini, A. (2017). Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ open, 7(3), e012759.

Abstract. Objective: To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD).

Design Systematic overview of reviews:

Data sources. PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009–March 2015).

Eligibility criteria. Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD.

Data extraction. Eligible studies were selected and data extracted independently by 2 reviewers. The AMSTAR checklist was used to assess the quality of the SRs.

Data analysis. Extracted data were synthesised using a narrative approach.

Results. 38 SRs and 142 primary studies were identified, comprising the following categories of non- pharmacological interventions: (1) sensory stimulation interventions (12 SRs, 27 primary studies) that encompassed: acupressure, aromatherapy, massage/touch therapy, light therapy and sensory garden; (2) cognitive/emotion-oriented interventions (33 SRs; 70 primary studies) that included cognitive stimulation, music/dance therapy, dance therapy, snoezelen, transcutaneous electrical nerve stimulation, reminiscence therapy, validation therapy, simulated presence therapy; (3) behaviour management techniques (6 SRs; 32 primary studies) and (4) other therapies (5 SRs, 12 primary studies) comprising exercise therapy, animal-assisted therapy, special care unit and dining room environment-based interventions. Music therapy was effective in reducing agitation (SMD, −0.49; 95% CI −0.82 to −0.17; ), and anxiety (SMD, −0.64; 95% CI −1.05 to −0.24; ). Home-based behavioural management techniques, caregiver-based interventions or staff training in communication skills, person- centred care or dementia care mapping with supervision during implementation were found to be effective for symptomatic and severe agitation.

Conclusions. A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy and behavioural management techniques were effective for reducing BPSD.

Archer, S., Buxton, S., & Sheffield, D. (2015). The effect of creative psychological interventions on psychological outcomes for adult cancer patients: a systematic review of randomised controlled trials. Psycho‐Oncology, 24(1), 1-10.

Abstract. Objective. This systematic review examined the effectiveness of creative psychological interventions (CPIs) for adult cancer patients. In particular, the findings of randomised controlled trials of art, drama, dance/movement and music therapies on psychological outcomes were examined. Methods. The review yielded 10 original studies analysing data from a total of 488 patients. Data extraction and quality assessment were conducted by two independent reviewers.

Results. Four of the papers focused on the use of art therapy, three studies used music therapy, one paper utilised dance therapy, one study used dance/movement therapy and the remaining paper used creative arts therapies, which was a combination of different art‐based therapy approaches. Eight papers focused solely on breast cancer patients, and the remaining studies included mixed cancer sites/stages. The studies reported improvements in anxiety and depression, quality of life, coping, stress, anger and mood. However, few physical benefits of CPIs were reported; there was no significant impact of a CPI on physical aspects of quality of life, vigour‐activity or fatigue‐inertia or physical functioning. One study was assessed as high quality, seven studies were assessed as satisfactory and two studies were assessed to be of poorer quality.

Conclusions. There is initial evidence that CPIs benefit adult cancer patients with respect to anxiety and depression, quality of life, coping, stress, anger and mood; there was no evidence to suggest that any one type of CPI was especially beneficial. However, more and better quality research needs to be conducted, particularly in the areas of drama and dance/movement therapies.

Baker, F. A., Metcalf, O., Varker, T., & O'Donnell, M. (2018). A systematic review of the efficacy of creative arts therapies in the treatment of adults with PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 10(6), 643-651.

Abstract. Objective: There is a growing body of literature supporting the use of creative arts therapies; however, the efficacy of creative arts therapies in the treatment of posttraumatic stress disorder (PTSD) has not been systematically evaluated. The aim of this systematic review was to examine the efficacy of creative arts therapy including music therapy, art therapy, dance/movement therapy, and drama therapy, in the treatment of PTSD. Method: Ten databases were searched for peer-reviewed literature published from inception to December 2016. Studies were included in the review if they used a randomized controlled trial (RCT), a pseudo RCT, or a controlled study design; tested the efficacy of one of the creative arts therapies described above; and reported changes to PTSD diagnosis or symptomatology.

Results: From an initial yield of 1,918 records, 1,653 records were screened on title and abstract and 125 were screened at full-text. Seven studies met the inclusion criteria for review, with four studies investigating art therapy, two studies investigating music therapy, and a final study investigating drama therapy. Individual studies were initially rated on a standardized quality and bias checklist, and then GRADE was used to rate the overall evidence for each intervention. The evidence for music therapy, art therapy, and drama therapy was ranked as low to very low, with no studies found for dance/movement therapy. Generally, the quality of the trials was very poor. Future directions for this field of research are to improve the scientific quality of the research trials in this area.

Beard, R. L. (2012). Art therapies and dementia care: A systematic review. Dementia, 11(5), 633-656.

Abstract. Despite steadfast interest in the use of arts therapies (ATs) with individuals who have dementia of the Alzheimer's type (DAT), a systematic review of the literature has not been conducted. This paper aims to critique this evidence base, including music, visual arts, drama, and dance/movement therapies between the years 1990 and 2010, and make suggestions on how it can be strengthened. The review addresses four questions: (1) What is the focus of the empirical base on using AT with persons who have DAT? (2) (How) have these studies been designed and evaluated? (3) What findings are reported? (4) What does this tell us about the potential of AT for enriching the lives of people with dementia? This analysis reveals that systematically designed, documented, and evaluated AT studies are scarce.

Information on research design, operational concepts, measurement tools, and methods of evaluation/analysis are vague, if provided. Disagreement exists about the utilization of theoretical concepts and measurement/evaluation tools. The evidence base is further divided between studies focusing on the ‘product’ versus the ‘process’ of art. Shortcomings in dementia-specific research include a paucity of accounts from participants, failure to extend therapies to individuals in the early stages, a lack of application to those living at home, and often superficial attention to the meaningful aspects of doing art. Models investigating subjective well-being, or ‘enrichment,’ rather than objectively measured biomedical approaches privileging the management of deficits, would expand the evidence base and help ensure that those with dementia receive the services they want, since strictly allopathic methodologies will continue to fall short of adequately evaluating what are deeply idiosyncratic psychosocial issues.

Keywords. Alzheimer's disease, art therapy, dementia, quality of life

Bidonde, J., Boden, C., Kim, S., Busch, A. J., Goes, S. M., & Knight, E. (2018). Scoping review of dance for adults with fibromyalgia: what do we know about it?. JMIR rehabilitation and assistive technologies, 5, e10033.

Abstract. Background. Fibromyalgia is a chronic disorder characterized by widespread muscular tenderness, pain, fatigue, and cognitive difficulties. Nonpharmacological treatment options, such as physical activity, are important for people with fibromyalgia. There are strong recommendations to support engagement in physical activity for symptom management among adults with fibromyalgia. Dance is a mode of physical activity that may allow individuals with fibromyalgia to improve their physical function, health, and well-being. Dance has the potential to promote improved pain processing while simultaneously providing the health and social benefits of engaging in physical activity that contributes to symptom management and overall function rehabilitation. However, we are unaware of current evidence on dance as a nonpharmacological/physical activity intervention for adults with fibromyalgia.

Objective. The aims of this study were to understand how dance is used therapeutically by individuals with fibromyalgia; to examine the extent, range and nature of research activity in the area; and to determine the value of undertaking a systematic review of interventions.

Methods. We used and adapted the Arksey and O’Malley scoping framework. The search strategy involved a comprehensive search of main health and electronic social databases, trial registries and grey literature without language limits. Pairs of reviewers independently screened and extracted data and evaluated the methodological quality of randomized control trials.

Results. Twenty-one unique records for 13 studies met inclusion criteria; the studies included mostly middle-aged women. Types of dance included were aerobic dance, belly dance, dance movement therapy, biodanza and Zumba. Intervention parameters were different among studies. Frequency varied between one to three times a week; all were done in small group settings. Studies evaluated a variety of outcomes in the symptoms, wellness, psychosocial, physical functioning, balance and fitness categories; no studies evaluated the safety or adverse events systematically which is a major weakness of the literature.

Conclusions. There are few studies in the field of dance and fibromyalgia, suggesting research is in its infancy but slowly growing. They are of European and South American origin, focusing on female participants and a limited number of dance modes. Because the body of literature is small, of low quality and highly heterogeneous, we concluded that a systematic review of interventions on dance is not warranted at this time.

Keywords: fibromyalgia, exercise, dancing, scoping review, adult

Boehm, K., Cramer, H., Staroszynski, T., & Ostermann, T. (2014). Arts therapies for anxiety, depression, and quality of life in breast cancer patients: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2014.

Abstract. Background. Breast cancer is one of the most common types of cancer. However, only a few trials assess the effects of arts therapies. Material and Methods. We searched the Cochrane Central Register of Controlled Trials, PubMed, and Google Scholar from their start date to January 2012. We handsearched reference lists and contacted experts. All randomized controlled trials, quasi-randomized trials, and controlled clinical trials of art interventions in breast cancer patients were included. Data were extracted and risk of bias was assessed. Meta-analyses were performed using standardized mean differences. Results. Thirteen trials with a total of 606 patients were included. Arts therapies comprised music therapy interventions, various types of art therapy, and dance/movement therapies. The methodological quality ranged from poor to high quality with the majority scoring 3 of 4 points on the Jadad scale. Results suggest that arts therapies seem to positively affect patients’ anxiety (standardized mean difference: −1.10; 95%, confidence interval: −1.40 to −0.80) but not depression or quality of life. No conclusion could be drawn regarding the effects of arts therapy on pain, functional assessment, coping, and mood states. Discussion. Our review indicates that arts interventions may have beneficial effects on anxiety in patients with breast cancer.

Bradt, J., Shim, M., & Goodill, S. W. (2015). Dance/movement therapy for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, (1).

Abstract. Background. Current cancer care increasingly incorporates psychosocial interventions. Cancer patients use dance/movement therapy to learn to accept and reconnect with their bodies, build new self‐ confidence, enhance self‐expression, address feelings of isolation, depression, anger and fear and to strengthen personal resources.

Objectives. To update the previously published review that examined the effects of dance/movement therapy and standard care versus standard care alone or standard care and other interventions on psychological and physical outcomes in patients with cancer.

Search methods. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 6), MEDLINE (OvidSP, 1950 to June week 4, 2014), EMBASE (OvidSP, 1980 to 2014 week 26), CINAHL (EBSCOhost, 1982 to July 15 2014), PsycINFO (EBSCOhost, 1806 to July 15 2014), LILACS (Virual Health Library, 1982 to July 15 2014), Science Citation Index (ISI, 1974 to July 15 2014), CancerLit (1983 to 2003), International Bibliography of Theatre and Dance (1989 to July 15 2014), the National Research Register (2000 to September 2007), Proquest Digital Dissertations, ClinicalTrials.gov, and Current Controlled Trials (all to July 15 2014). We handsearched dance/movement therapy and related topics journals, reviewed reference lists and contacted experts.

There was no language restriction.

Selection criteria. We included all randomized and quasi‐randomized controlled trials of dance/movement therapy interventions for improving psychological and physical outcomes in patients with cancer. We considered studies only if dance/movement therapy was provided by a formally trained dance/movement therapist or by trainees in a formal dance/movement therapy program.

Data collection and analysis. Two review authors independently extracted the data and assessed the methodological quality, seeking additional information from the trial researchers when necessary. Results were presented using standardized mean differences.

Main results. We identified one new trial for inclusion in this update. In total, the evidence for this review rests on three studies with a total of 207 participants.

We found no evidence for an effect of dance/movement therapy on depression (standardized mean difference (SMD) = 0.02, 95% confidence interval (CI) ‐0.28 to 0.32, , %) (two studies, N = 170), stress (SMD = ‐0.18, 95% CI ‐0.48 to 0.12, , %) (two studies, ), anxiety (, 95% CI ‐0.09 to 0.51 , %) (two studies, ), fatigue (SMD = ‐0.36, 95% ‐1.26 to 0.55, , I² = 80%) (two studies, ) and body image (SMD = ‐0.13, 95% CI ‐ 0.61 to 0.34, , %) (two studies, ) in women with breast cancer. The data of one study with moderate risk of bias suggested that dance/movement therapy had a large beneficial effect on 37 participants' quality of life (QoL) (, 95% CI 0.21 to 1.57). One study with a high risk of bias reported greater improvements in vigor and greater reduction in somatization in the dance/movement therapy group compared to a standard care control group (). The individual studies did not find support for an effect of dance/movement therapy on mood, mental health, and pain. It is unclear whether this was due to ineffectiveness of the treatment, inappropriate outcome measures or limited power of the trials. Finally, the results of one study did not find evidence for an effect of dance/movement therapy on shoulder range of motion (ROM) or arm circumference in 37 women who underwent a lumpectomy or breast surgery. However, this was likely due to large within‐group variability for shoulder ROM and a limited number of participants with lymphedema. Two studies presented moderate risk of bias and one study high risk of bias. Therefore, overall, the quality of the evidence is very low.

Authors' conclusions. We did not find support for an effect of dance/movement therapy on depression, stress, anxiety, fatigue and body image . The findings of individual studies suggest that dance/movement therapy may have a beneficial effect on QoL, somatization, and vigor. However, the limited number of studies prevents us from drawing conclusions concerning the effects of dance/movement therapy on psychological and physical outcomes in cancer patients.

Bräuninger, I. (2017). Tanztherapie in der Krebsbehandlung: Forschungsstand und Anwendung bei Erwachsenen, Kindern und Jugendlichen [Dance therapy in cancer treatment: Research and application in adults, children, and adolescents]. Zeitschrift für Sportpsychologie, 24(2), 54-64.

Zusammenfassung. Dieser Artikel bietet eine Übersicht zum Forschungsstand zu Tanztherapie bei Krebs. Der erste Teil widmet sich der theoretischen Fundierung der Tanztherapie im onkologischen Setting. Der zweite Teil fasst wissenschaftliche Erkenntnisse aus Tanztherapie Studien in der onkologischen Behandlung zusammen. Abschließend werden Einsatzmöglichkeiten während verschiedener Phasen der Behandlung mit entsprechenden tanztherapeutischen Behandlungszielen aus den Studienergebnissen abgeleitet. Die Literaturrecherche ergab, dass Tanztherapie in allen Phasen der Krebsbehandlung eingesetzt wird mit dem Ziel, den emotionalen, sozialen, physischen und spirituellen Zustand der Patientinnen und Patienten zu verbessern. Zukünftige randomisierte kontrollierte Trials könnten die Wirksamkeit spezifischer tanztherapeutischer Interventionen während unterschiedlicher Behandlungsphasen auf Symptome und bei Männern und Kindern untersuchen. Schlüsselwörter:Tanztherapie, Krebs, Forschungsstand, Embodiment

Abstract. This article provides an overview of the research and application of dance movement therapy in cancer treatment. The first part is devoted to the theoretical foundation of dance movement therapy in the oncological setting. The second part summarizes scientific findings from dance movement therapy studies in oncological treatment. The last part highlights the application during different treatment phases and corresponding treatment goals. One finding from the literature review was that dance movement therapy was provided in all phases of treatment to improve emotional, social, physical, and spiritual outcomes of cancer patients. Further randomized controlled trials could evaluate the efficacy of specific dance movement therapy interventions in different treatment phases on various symptoms and on men and children.

Key words:dance movement therapy, cancer, research, embodiment) (not a systematic review but current overview of literature)

Caldwell, C., & Victoria, H. K. (2011). Breathwork in body psychotherapy: Towards a more unified theory and practice. Body, Movement and Dance in Psychotherapy, 6(2), 89-101.

Abstract: The use of conscious breathing practices for the purpose of physical, psychological, emotional, and spiritual healing has a long and extremely varied history, yet little work has been done to see if these practices can be brought into a coherent and unified form that contributes to the field of body psychotherapy. This article attempts to meta-analyse the literature and research on breathwork in psychotherapy, with an emphasis on body psychotherapy, and to find common themes so that a general theory of breathwork and guidelines for practice might be developed. This paper provides an overview of the physiology of breathing, a review of the literature on breathwork.

Keywords: breath, breathwork, body psychotherapy, conscious breathing, breathing therapy

Conceição, L. S. R., Neto, M. G., do Amaral, M. A. S., Martins-Filho, P. R. S., & Carvalho, V. O. (2016). Effect of dance therapy on blood pressure and exercise capacity of individuals with hypertension: A systematic review and meta-analysis. International journal of cardiology, 220, 553-557.

Abstract. Background. Dance therapy is a less conventional modality of physical activity in cardiovascular rehabilitation. We performed a systematic review and meta-analysis to investigate the effects of dance therapy in hypertensive patients.

Methods. Pubmed, Scopus, LILACS, IBECS, MEDLINE and SciELO via Virtual Health Library (Bireme) (from the earliest data available to February 2016) for controlled trials that investigated the effects of dance therapy on exercise capacity, systolic (SBP) and diastolic (DBP) blood pressure in hypertensive patients. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test.

Results. Four studies met the eligibility criteria. Dance therapy resulted in a significant reduction in systolic blood pressure (WMD − 12.01 mm Hg; 95% CI: − 16.08, − 7.94 mm Hg; P < 0.0001) when compared with control subjects. Significant reduction in diastolic blood pressure were also found (WMD − 3.38 mm Hg; 95% CI: − 4.81, − 1.94 mm Hg; P < 0.0001), compared with control group. Exercise capacity showed a significant improvement (WMD 1.31; 95% CI: 0.16, 2.47; P < 0.03). A moderate to high heterogeneity was observed in our analysis: % to SBP, % to DBP, and % to exercise capacity. Conclusions. Our meta-analysis showed a positive effect of dance therapy on exercise capacity and reduction of SBP and DBP in individuals with hypertension. However, the moderate to high heterogeneity found in our analysis limits a pragmatic recommendation of dance therapy in individuals with hypertension.

Cruz, R. F., & Sabers, D. L. (1998). Dance/movement therapy is more effective than previously reported (Response to Ritter & Low). Arts in Psychotherapy, 25(2), 105-107.

The meta-analysis of dance/movement therapy research findings by Ritter and Low (1996) (in this issue) addressed a critical need to support the effectiveness of this treatment modality. As managed-care companies invade clinical settings, dance therapists are being asked to provide empirical support for the effectiveness of their treatment. Quantitative research and quantitative integration of research findings are widely accepted as empirical evidence across many disciplines. Correspondingly, a meta-analytic aggregation of dance therapy research enhances the professional acceptance of this form of treatment by providing recognized empirical validation. A meta-analytic study, even in an area with a limited body of research, is extremely labor intensive. Unfortunately, errors of calculation and interpretation of the data were made that should be corrected in order for Ritter and Low’s (1996) work to document accurately the effectiveness of dance/movement therapy.

Dirmaier, J., Krattenmacher, T., Watzke, B., Koch, U., Schulz, H., & Barghaan, D. (2010). Evidenzbasierte Behandlungselemente in der Rehabilitation von Patienten mit Depression–Eine Literaturübersicht [Evidence-Based Treatments in the Rehabilitation of Patients with Depression – A Literature Review]. PPmP-Psychotherapie· Psychosomatik· Medizinische Psychologie, 60(03/04), 83-97.

Zusammenfassung. Hintergrund: Leitlinien gewinnen in den letzten Jahren eine immer größer werdende Bedeutung, auch im Bereich der rehabilitativen Versorgung. Auch für den Bereich der Rehabilitation depressiver Störungen wird derzeit eine Prozessleitlinie in einem mehrstufigen Verfahren entwickelt.

Ziel: Ziel dieser Arbeit ist es, im Rahmen der ersten Entwicklungsphase einer Prozessleitlinie eine graduierte Bewertung der aktuellen Evidenzlage zu verschiedenen Behandlungsmöglichkeiten bei depressiven Störungen durchzuführen.

Methode: Hierfür wurde zunächst eine umfassende Recherche nationaler und internationaler Leitlinien durchgeführt. Dreizehn selektierte Leitlinien wurden dann hinsichtlich ihrer methodischen Qualität bewertet und als Grundlage für die Identifikation evidenter Behandlungsverfahren verwendet. In einem weiteren Schritt wurden spezifische Literaturrecherchen für verbleibende, durch die Klassifikation therapeutischer Leistungen (KTL) 2007 definierte rehabilitationsrelevante Behandlungselemente, durchgeführt. Im Rahmen eines hierarchischen Vorgehens erfolgte zunächst eine Sichtung von Metaanalysen und systematischen Reviews, für weiterhin ohne Evidenz verbleibende Behandlungsbereiche wurde auf Einzelstudienebene recherchiert. Die extrahierten Übersichtsarbeiten und Primärstudien wurden dann hinsichtlich ihrer methodischen Qualität bewertet und Evidenzgrade für die Behandlungsverfahren abgeleitet.

Ergebnisse: Folgende Behandlungselemente konnten im Rahmen der Leitlinienrecherche extrahiert werden: Psychotherapeutische Verfahren, Paar-, Familien- u. Angehörigengespräch bzw. Paar- u. Familientherapie, Psychoedukation, Sport und Bewegungstherapie, Problemlösetraining, Anleitung zur Selbsthilfe und Rekreationstherapie. Auf Basis der Ergebnisse der anschließenden Literaturrecherchen wurden innerhalb der folgenden übergeordneten Therapiebereiche weitere verschiedene evidente Verfahren identifiziert werden: Entspannungsverfahren, Verbesserung der sozialen Kompetenz, Ergotherapie, künstlerische Therapien (Musiktherapie, Kunsttherapie, Tanz- und Bewegungstherapie), körperpsychotherapeutische Verfahren und Massage.

Fazit: Durch das beschriebene Vorgehen konnten verschiedene Behandlungselemente mit unterschiedlichen Evidenzgraden für die Behandlung von Patienten mit Depression identifiziert werden. Die hier dargestellten Ergebnisse sollen in einem nächsten Schritt im Rahmen einer systematischen Beteiligung von Experten für die Entwicklung einer Prozessleitlinie verwendet werden.

Abstract. Background: In recent years, the importance of guidelines has increased continuously. This development also occurs in the field of rehabilitative health care, where process guidelines are being designed for various indicational groups to ensure quality standards and improvements.

Aim: The primary goal of this paper is to collect and evaluate the evidence for various treatment options for depressive disorders in order to establish a basis for the current development of a process guideline for the rehabilitation of patients with depressive disorders.

Method: In order to identify evidence based treatment elements, first a comprehensive investigation of national and international guidelines was conducted. Thirteen selected guidelines were then assessed with regard to aspects of methodological quality and evidence-based treatment elements. In a further step, literature searches were conducted for residual treatment elements, which were identified on the basis of the Classification of Therapeutic Services (KTL) 2007. For the literature search, a hierarchical approach was chosen: At first, meta-analyses and systematic reviews were viewed. In case when there was still a lack of evidence for specific, potentially relevant treatment elements, the search was expanded to the level of primary studies. All selected reviews and primary studies then underwent a standardized assessment especially regarding methodological quality and evidence grades were allocated to treatments. Results: Thereby, the following treatment elements with an adequate level of evidence were identified: Psycho-therapeutic interventions, marital/couples/family therapy and counselling, inclusion of family members, psycho education and exercise, problem solving therapy, guided self-help, and behavioral activation treatments. On the basis of this complementary literature search, various other evident interventions could be identified within the following areas: relaxation techniques, improvement of social competence, occupational therapy, art therapies (music, movement/dance therapies), body-oriented therapies and massage therapy.

Conclusion: In summary, using this hierarchical approach, it was possible to assign different levels of evidence to the various treatment elements for depression. Based on the results of this literature search, a next step in the development of a process guideline for the rehabilitative treatment of patients with depression will be the integration of experts in the field of rehabilitation.

Key words. depression - evidence-based treatment - literature review – guidelines

Fernández-Argüelles, E. L., Rodriguez-Mansilla, J., Antunez, L. E., Garrido-Ardila, E. M., & Muñoz, R. P. (2015). Effects of dancing on the risk of falling related factors of healthy older adults: a systematic review. Archives of gerontology and geriatrics, 60(1), 1-8.

Abstract. Introduction: Deficits of balance or postural control in persons of advanced age are one of the factors that influence the risk of falling. The most appropriate treatment approaches and their benefits are still unknown. Objective. The aim of this article is to systematically review the scientific literature to identify the therapeutic effects of dancing as a physical exercise modality on balance, flexibility, gait, muscle strength and physical performance in older adults.

Methods. A systematic search of Pubmed, Cochrane Library Plus, PEDro, Science Direct, Dialnet and Academic Search Complete using the search terms “dance”, “older”, “dance therapy”, “elderly”, “balance”, “gait” and “motor skills”. The eligibility criteria were: studies written in English and Spanish, published from January 2000 to January 2013, studies which analyzed the effects of dance (ballroom dance and/or dance based exercise) in older adults over 60 years of age with no disabling disease and included the following variables of study: balance, gait, risk of falls, strength, functionality, flexibility and quality of life.

Results. 123 articles were found in the literature. A final selection of seven articles was used for the present manuscript. Although the selected studies showed positive effects on the risk of falling related to factors (balance, gait and dynamic mobility, strength and physical performance), there were some aspects of the studies such as the methodological quality, the small sample size, the lack of homogeneity in relation to the variables and the measurement tools, and the existing diversity regarding the study design and the type of dance, that do not enable us to confirm that dance has significant benefits on these factors based on the scientific evidence.

Subjects. Aging physiology; Dancing physiology; Gait physiology; Motor Skills physiology; Muscle Strength physiology; Postural Balance physiology; Adult: 19-44 years; Aged: 65+ years; Middle Aged: 45-64 years; All Adult: 19+ years; Female

Keywords. Dance therapy; Elderly; Balance; Gait; Older adults

Gomes Neto, M., Menezes, M. A., & Carvalho, V. O. (2014). Dance therapy in patients with chronic heart failure: a systematic review and a meta-analysis. Clinical rehabilitation, 28(12), 1172-1179.

Abstract. Objective: To see whether dance therapy was more effective than conventional exercise in exercise capacity and health-related quality of life (HRQOL) in patients with chronic heart failure. Design and methods: Systematic review and meta-analysis. We searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, SPORT Scielo, CINAHL (from the earliest date available to August 2013) for randomized controlled trials (RCTs), examining effects of dance therapy versus exercise and/or dance therapy versus control on exercise capacity (VO2peak), and quality-of-life (QOL) in chronic heart failure. Two reviewers selected studies independently. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I(2) test.

Results: Two studies met the study criteria (62 dance therapy patients, 60 exercise patients and 61 controls patients). The results suggested that dance therapy compared with control had a positive impact on peak VO2 and HRQOL. Dance therapy resulted in improvement in: peak VO2 peak weighted mean difference (4.86 95% CI: 2.81 to 6.91) and global HRQOL standardized mean differences (2.09 95% CI:

1.65 to 2.54). Non-significant difference in VO2 peak and HRQOL for participants in the exercise group compared with dance therapy. No serious adverse events were reported.

Conclusions: Dance therapy may improve peak VO2 and HRQOL in patients with chronic heart failure (CHF) and could be considered for inclusion in cardiac rehabilitation programmes.

Keywords: Exercise tolerance, quality of life, cardiac failure, dance

Guzmán‐García, A. H. J. C., Hughes, J. C., James, I. A., & Rochester, L.    (2013). Dancing as a psychosocial intervention in care homes: a systematic review of the literature. International journal of geriatric psychiatry, 28(9), 914-924.

Abstract. Background. There is a need to find meaningful and engaging interventions to improve mood and behaviour for residents of care homes. The demand on care staff might diminish opportunities for them to encourage these activities. Staff anecdotal information attests that dancing as an activity improves mood in residents and staff. Hence, the importance of investigating what dancing brings to the care home social environment.

Aims. To provide a systematic review of the evidence from studies related to dancing interventions for older people with dementia living in care homes.

Method. Electronic databases were searched. Previous reviews were also included, and recognised experts were consulted up to January 2012. Inclusion criteria considered study methodology and evidence that the impact of the dance intervention had been measured.

Results. Ten studies were identified that satisfied the inclusion criteria: seven qualitative and three quantitative. Studies used different approaches such as therapeutic dance, dance movement therapy, dance therapy, social dancing and psychomotor dance‐based exercise. There was evidence that problematic behaviours decreased; social interaction and enjoyment in both residents and care staff improved. A few adverse effects were also acknowledged.

Conclusion. The evidence on the efficacy of dancing in care homes is limited in part owing to the methodological challenges facing such research. This review aims to raise awareness of the possibility of implementing dance work as an engaging activity in care homes. We shall also consider options for future dance work research as a means to encourage relationships and sensory stimulation for both residents and staff.

Hertrampf, R. S., & Wärja, M. (2017). The effect of creative arts therapy and arts medicine on psychological outcomes in women with breast or gynecological cancer: a systematic review of arts-based interventions. The Arts in Psychotherapy, 56, 93-110.

Abstract. Breast cancer and gynaecological cancer are two major diagnoses affecting women worldwide. Clinical research on arts-based approaches for these populations has gained a growing interest in the last decade with promising results. The purpose of this study was (a) to review evidence of arts-based approaches involving creative arts therapy (CAT) and arts medicine (AM) on psychological outcomes in women of both populations and (b) to evaluate the reporting of arts-based interventions. This systematic review examined randomized controlled trials and quasirandomized controlled studies with repeated measures. Researchers assessed each study for risk of bias using GRADE. A checklist called Reporting on Arts-Based Interventions was developed and applied to all studies included in this review. Researchers computed effect sizes for relevant outcomes. Searches identified 294 items producing 104 nonduplicate titles. Twenty-one items met inclusion criteria. These included a total of 1,703 participants (83.1% breast cancer, 16.9% gynecological cancer). CAT was applied in 10 papers (); AM in 11 (,057). For gynecological cancer, only two AM studies were found and no CAT studies were identified. Anxiety and depression were the most prevalent outcomes for both approaches across all studies. Overall, small to large effect sizes were found for AM studies and null to large effect sizes for CAT studies. Body image and sexuality were scarcely addressed. Intervention reporting was inadequate. The results suggest that arts-based interventions may be effective for improving psychological outcomes for targeted population. Research for gynecological cancer patients is recommended, as are trials aimed at improving body image and addressing sexual function and related concerns. Enhanced quality of methodology and intervention reporting are critical.

Highlights. • Lack of findings for body image and sexuality. • No trials in creative arts therapy on gynaecological cancer. • Insufficient quality in arts-based intervention reporting. • Diversity of interventions in different phases of trajectory.

Keywords. Systematic review; Psychological outcomes; Creative arts therapy; Arts medicine; Breast cancer; Gynecological cancer

Hervey, L., & Kornblum, R. (2006). An evaluation of Kornblum's body-based violence prevention curriculum for children. The Arts in Psychotherapy, 33(2), 113-129.

Abstract. This article describes an evaluation of the effectiveness of Disarming the Playground (2002), a school-based violence prevention curriculum. The program was developed and implemented by Rena Kornblum, a dance/movement therapist working in the Madison, WI public schools. Disarming the Playground is unique among such programs in its body-based approach. A review of the literature focuses on recent evaluations and reviews of other school-based violence prevention programs, as well as large-scale meta-analyses of and guides to such program evaluations. A mixed method evaluation of the Kornblum curriculum's effectiveness was conducted with second grade students. Statistical findings indicated significant positive outcomes, and qualitative findings pointed toward reasons for its effectiveness, as well as methods of improving evaluation and delivery of the curriculum.

Jiménez, J., Bräuninger, I., & Meekums, B. (2018). Dance movement therapy with older people with a psychiatric condition: A systematic review. The Arts in Psychotherapy. Doi: 10.1016/j.aip.2018.11.008 Highlights. • Dance/Movement Therapy (DMT) may improve social interaction, communication and cognitive functions. • DMT seems to increase quality of life and expressiveness. • Methodological quality varies from low to high. • Insufficient evidence exists that DMT improves mental health disorders. • More high quality studies on the efficacy of DMT in older age psychiatry are needed.

Abstract. This systematic review assessed the published literature on dance movement therapy interventions with adults aged 60 years and older with a mental health disorder. Our objective was to identify published studies of the effects of DMT in older age psychiatry and to critically appraise methodological quality of the included studies. We searched the databases CINAHL, MEDLINE, PsycINFO, and PSYNDEX, and Google Scholar. We also searched the reference list of relevant papers in order to identify publications that were not found through the initial database search. The reviewers independently critically appraised all full text articles that met our inclusion criteria. A final 16 studies met the inclusion criteria: nine were primary studies (one randomized controlled trial, three quasi- experimental studies, and five qualitative studies) and seven were secondary studies (systematic reviews). Dementia was the subject in 15 studies, and depression in one, reflecting a possible bias in the literature. The methodological quality of the primary studies was lower than for the secondary studies.

Keywords. Dance movement therapy; Older adults; Older age psychiatry; Mental disorders; Systematic review

Karkou, V., & Meekums, B. (2017). Dance movement therapy for dementia. Cochrane Database of Systematic Reviews, Vol. 2; Cochrane AN: CD011022; PMID: 28155990,  Abstract. Background. Dementia is a collective name for different degenerative brain syndromes which, according to Alzheimer's Disease International, affects approximately 35.6 million people worldwide. The latest NICE guideline for dementia highlights the value of diverse treatment options for the different stages and symptoms of dementia including non‐pharmacological treatments. Relevant literature also argues for the value of interventions that acknowledge the complexity of the condition and address the person as a whole, including their physical, emotional, social and cognitive processes. At the same time, there is growing literature that highlights the capacity of the arts and embodied practices to address this complexity. Dance movement therapy is an embodied psychological intervention that can address complexity and thus, may be useful for people with dementia, but its effectiveness remains unclear.

Objectives. To assess the effects of dance movement therapy on behavioural, social, cognitive and emotional symptoms of people with dementia in comparison to no treatment, standard care or any other treatment. Also, to compare different forms of dance movement therapy (e.g. Laban‐based dance movement therapy, Chacian dance movement therapy or Authentic Movement).

Search methods. Searches took place up to March 2016 through ALOIS, Cochrane Dementia and Cognitive Improvement’s Specialized Register, which covers CENTRAL, a number of major healthcare databases and trial registers, and grey literature sources. We checked bibliographies of relevant studies and reviews, and contacted professional associations, educational programmes and experts from around the world.

Selection criteria. We considered randomised controlled trials (RCTs) in any language, including cross‐ over design and cluster‐RCTs for inclusion. Studies considered had to include people with dementia, in any age group and in any setting, with interventions delivered by a dance movement therapy practitioner who (i) had received formal training (ii) was a dance movement therapist in training or (iii) was otherwise recognised as a dance movement therapist in the country in which the study was conducted.

Data collection and analysis. The two review authors independently reviewed studies on an abstract/title level and again after reading the full paper, and we independently evaluated methodological quality.

Main results. Of the 102 studies identified through electronic searches and personal communication, after de‐duplication we screened 80 at title/abstract level. We then reviewed 19 full papers, none of which met the inclusion criteria. Although three studies mentioned dance movement therapy as their intervention, they were excluded because they were not delivered by a qualified dance movement therapy practitioner. As a result, no studies were included in this review.

Authors' conclusions. Trials of high methodological quality, large sample sizes and clarity in the way the intervention is put together and delivered are needed to assess whether dance movement therapy is an effective intervention for dementia.

Kiepe, M. S., Stöckigt, B., & Keil, T. (2012). Effects of dance therapy and ballroom dances on physical and mental illnesses: A systematic review. The Arts in Psychotherapy, 39 (5), 404-411.

Abstract. This systematic review aims to evaluate the effects of dance (movement) therapy and ballroom dances as therapeutic interventions for adults with physical and mental illnesses in comparison to other interventions or care as usual. A systematic literature search for randomized controlled trials examining dance therapy and ballroom dances published between 1995 and 2011 was carried out in the electronic databases MEDLINE and PsycINFO. 13 publications reporting results from 11 randomized trials (predominantly from USA and Scandinavia) were identified with mostly small samples. They examined breast cancer (), dementia (), Parkinson's disease (), heart failure (), diabetes type 2 (), depression () and fibromyalgia (). Dance (movement) therapy had a positive impact for patients with breast cancer, improving quality of life, shoulder range of motion and body image. In patients with depression psychological distress was reduced by dance therapy. Ballroom dances improved balance and coordination in patients with Parkinson's disease and disease-specific quality of life in patients with heart failure. Dance (movement) therapy and ballroom dances seem beneficial for patients with breast cancer, depression, Parkinson's disease, diabetes and heart failure. However, further good quality research is needed to gain more profound insight into the efficacy of these treatment options.

Highlights. ► Systematic review of dance (movement) therapy and ballroom dances as a therapeutic intervention for adults. ► 13 RCTs were identified with mostly small samples. ► Dance (movement) therapy had a positive impact for patients with breast cancer, improving quality of life as well as for patients with depression, decreasing psychological distress. ► Ballroom dances such as Tango improved balance and coordination in patients with Parkinson and cardiopulmonary training in patients with heart failure grades I and II.

Keywords. Ballroom dances; Dance; Dance (movement) therapy; Randomized controlled trials; Systematic review

Koch, S., Kunz, T., Lykou, S., & Cruz, R. (2014). Effects of dance movement therapy and dance on health- related psychological outcomes: A meta-analysis. The Arts in Psychotherapy, 41(1), 46-64. [Effekte von Tanztherapie und Tanzen auf gesundheitsbezogene psychologische Ergebnisse: Eine Metaanalyse Highlights. • Meta-analysis of DMT interventions and the therapeutic use of dance. • Provides a systematic summary of the last 20 years of research findings. • Includes effects of 23 evidence-based primary studies for 15 populations (). • Shows moderate effects for quality of life and clinical outcomes (depression, anxiety). • Yields small but consistent effects for improvement of well-being, mood, affect, and body image.

Abstract. In this meta-analysis, we evaluated the effectiveness of dance movement therapy (DMT) and the therapeutic use of dance for the treatment of health-related psychological problems. Research in the field of DMT is growing, and 17 years have passed since the last and only general meta-analysis on DMT (Ritter & Low, 1996) was conducted. This study examines the current state of knowledge regarding the effectiveness of DMT and dance from 23 primary trials () on the variables of quality of life, body image, well-being, and clinical outcomes, with sub-analysis of depression, anxiety, and interpersonal competence. Results suggest that DMT and dance are effective for increasing quality of life and decreasing clinical symptoms such as depression and anxiety. Positive effects were also found on the increase of subjective well-being, positive mood, affect, and body image. Effects for interpersonal competence were encouraging, but due to the heterogenity of the data remained inconclusive.

Methodological shortcomings of many primary studies limit these encouraging results and, therefore, further investigations to strengthen and expand upon evidence-based research in DMT are necessary. Implications of the findings for health care, research, and practice are discussed.

Keywords: Dance movement therapy; Therapeutic use of dance; Meta-analysis; Review of evidence- based research; Randomized controlled trials; Integrative medicine Langhorst J; Häuser W; Bernardy K; Lucius H; Settan M; Winkelmann A; Musial F. (2012). [Complementary and alternative therapies for fibromyalgia syndrome. Systematic review, meta-analysis and guideline].Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Schmerz. ISSN: 1432- 2129, Jun; Vol. 26 (3), pp. 311-7.Abstract. The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften

Subjects: Germany; Complementary Therapies methods; Fibromyalgia rehabilitation

Mala, A., Karkou, V., & Meekums, B. (2012). Dance/Movement Therapy (D/MT) for depression: A scoping review. The Arts in Psychotherapy, 39(4), 287-295.

Abstract. Depression affects 121 million people worldwide (WHO, 2010). The socio-economic repercussions of depression are putting an enormous strain on UK and US governmental health budgets. Regarding treatment interventions, D/MT and other arts therapies are widely practiced around the world as a treatment of choice for depression. Research evidence suggests that exercise has positive effects on mood. Similarly, it has been argued that dance has a positive social-cultural influence on a person's wellbeing. However there are no systematic reviews that support the effectiveness of D/MT for people with a diagnosis of depression. It is therefore important to map the field of existing research studies of D/MT for depression. In this paper a scoping review is presented that engaged with an extensive search to best answer the question: is there good quality research evidence available regarding the effectiveness of D/MT and related fields for the treatment of depression? A search strategy was developed to locate publications from electronic databases, websites, arts therapies organizations and associations using specified criteria for including and excluding studies. All studies meeting the inclusion criteria were then evaluated for their quality, using broad criteria of quality such as type of methodology followed, number of participants, relevance of interventions and specific comparisons made and outcome measures. A total of nine studies were found. Six studies followed a randomized controlled trial design, and three adopted a non randomized design. At least one study met most criteria of quality. We concluded that there was a need to undertake a full systematic review of the literature and to follow a Cochrane Review protocol and procedures.

Highlights. ► Scoping review of literature for dance movement psychotherapy and depression. ► The growth of depression as a global burden. ► Extensive search strategy across publications and databases.

    • Nine studies found; six studies followed a randomized controlled trial design, and three adopted a non randomized design. ► We conclude the absence of full randomization and the need for a full systematic review of the literature through completing a Cochrane Review (title accepted).

Keywords: Dance/Movement Therapy, Dance movement psychotherapy, Depression, Effectiveness, Systematic review, Randomized controlled trials

Mansfield, L., Kay, T., Meads, C., Grigsby-Duffy, L., Lane, J., John, A., & Payne, A. (2018). Sport and dance interventions for healthy young people (15–24 years) to promote subjective well-being: a systematic review. BMJ open, 8(7), e020959.

Abstract. Objective To review and assess effectiveness of sport and dance participation on subjective well-being outcomes among healthy young people aged 15–24 years.

Design Systematic review.

Methods We searched for studies published in any language between January 2006 and September 2016 on PsychINFO, Ovid MEDLINE, Eric, Web of Science (Arts and Humanities Citation Index, Social Science and Science Citation Index), Scopus, PILOTS, CINAHL, SPORTDiscus and International Index to Performing Arts. Additionally, we searched for unpublished (grey) literature via an online call for evidence, expert contribution, searches of key organisation websites and the British Library EThOS database, and a keyword Google search. Published studies of sport or dance interventions for healthy young people aged 15–24 years where subjective well-being was measured were included. Studies were excluded if participants were paid professionals or elite athletes, or if the intervention was clinical sport/dance therapy. Two researchers extracted data and assessed strength and quality of evidence using criteria in the What Works Centre for Wellbeing methods guide and GRADE, and using standardised reporting forms. Due to clinical heterogeneity between studies, meta-analysis was not appropriate. Grey literature in the form of final evaluation reports on empirical data relating to sport or dance interventions were included.

Results Eleven out of 6587 articles were included (7 randomised controlled trials and 1 cohort study, and 3 unpublished grey evaluation reports). Published literature suggests meditative physical activity (yoga and Baduanjin Qigong) and group-based or peer-supported sport and dance has some potential to improve subjective well-being. Grey literature suggests sport and dance improve subjective well-being but identify negative feelings of competency and capability. The amount and quality of published evidence on sport and dance interventions to enhance subjective well-being is low.

Conclusions Meditative activities, group and peer-supported sport and dance may promote subjective well-being enhancement in youth. Evidence is limited. Better designed studies are needed.

Martin, L., Oepen, R., Bauer, K., Nottensteiner, A., Mergheim, K., Gruber, H., & Koch, S. (2018). Creative arts interventions for stress management and prevention—a systematic review. Behavioral Sciences, 8(2), 28. Abstract. Stress is one of the world’s largest health problems, leading to exhaustion, burnout, anxiety, a weak immune system, or even organ damage. In Germany, stress-induced work absenteeism costs about 20 billion Euros per year. Therefore, it is not surprising that the Central Federal Association of the public Health Insurance Funds in Germany ascribes particular importance to stress prevention and stress management as well as health enhancing measures. Building on current integrative and embodied stress theories, Creative Arts Therapies (CATs) or arts interventions are an innovative way to prevent stress and improve stress management. CATs encompass art, music, dance/movement, and drama therapy as their four major modalities. In order to obtain an overview of CATs and arts interventions’ efficacy in the context of stress reduction and management, we conducted a systematic review with a search in the following data bases: Academic Search Complete, ERIC, Medline, Psyndex, PsycINFO and SocINDEX. Studies were included employing the PICOS principle and rated according to their evidence level. We included 37 studies, 73% of which were randomized controlled trials. 81.1% of the included studies reported a significant reduction of stress in the participants due to interventions of one of the four arts modalities. View Full-Text

Keywords: creative arts therapies; arts interventions; art; music; dance; drama; stress management; prevention; systematic review

Meekums, B. (2010). Moving towards evidence for dance movement therapy: Robin Hood in dialogue with the King. The Arts in Psychotherapy, 37(1), 35-41.

Abstract. The myth of Robin Hood is used to explore the possible dynamics between arts therapies researchers, and in particular dance movement therapy researchers, and the world of science. As professions positioned in relation to science, arts therapists are in danger of splitting and denigration on the one hand, or appeasement on the other. The case is made for a new way forward that includes making use of what arts therapists do well in terms of creativity and embodied knowing, whilst reaching out into multidisciplinary and international research partnerships. The imperative to evidence arts therapies practice has never been more urgent. Three forms of evidence are explored: Randomised Controlled Trials and systematic reviews of these; process research; and practice-based evidence from more than one practitioner using a core data set of outcome measurement. A case study is offered to demonstrate how routine outcome measures can be used to gather evidence that links outcome to process.

Subjects: Dance Therapy; Evidence Based Practice; Movement Therapy

Keywords. Dance movement therapy; research; Science; Embodied knowing; Practice based evidence; Process

Meekums, B., Karkou, V., & Nelson, E. A. (2015). Dance movement therapy for depression. Cochrane Database of Systematic Reviews, Vol. 2). Cochrane AN: CD009895; PMID: 25695871.

Abstract. Background. Depression is a debilitating condition affecting more than 350 million people worldwide (WHO 2012) with a limited number of evidence‐based treatments. Drug treatments may be inappropriate due to side effects and cost, and not everyone can use talking therapies.There is a need for evidence‐based treatments that can be applied across cultures and with people who find it difficult to verbally articulate thoughts and feelings. Dance movement therapy (DMT) is used with people from a range of cultural and intellectual backgrounds, but effectiveness remains unclear.

Objectives. To examine the effects of DMT for depression with or without standard care, compared to no treatment or standard care alone, psychological therapies, drug treatment, or other physical interventions. Also, to compare the effectiveness of different DMT approaches.

Search methods. The Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR‐Studies and CCDANCTR‐References) and CINAHL were searched (to 2 Oct 2014) together with the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. The review authors also searched the Allied and Complementary Medicine Database (AMED), the Education Resources Information Center (ERIC) and Dissertation Abstracts (to August 2013), handsearched bibliographies, contacted professional associations, educational programmes and dance therapy experts worldwide.

Selection criteria. Inclusion criteria were: randomised controlled trials (RCTs) studying outcomes for people of any age with depression as defined by the trialist, with at least one group being DMT. DMT was defined as: participatory dance movement with clear psychotherapeutic intent, facilitated by an individual with a level of training that could be reasonably expected within the country in which the trial was conducted. For example, in the USA this would either be a trainee, or qualified and credentialed by the American Dance Therapy Association (ADTA). In the UK, the therapist would either be in training with, or accredited by, the Association for Dance Movement Psychotherapy (ADMP, UK). Similar professional bodies exist in Europe, but in some countries (e.g. China) where the profession is in development, a lower level of qualification would mirror the situation some decades previously in the USA or UK. Hence, the review authors accepted a relevant professional qualification (e.g. nursing or psychodynamic therapies) plus a clear description of the treatment that would indicate its adherence to published guidelines including Levy 1992, ADMP UK 2015, Meekums 2002, and Karkou 2006.

Data collection and analysis. Study methodological quality was evaluated and data were extracted independently by the first two review authors using a data extraction form, the third author acting as an arbitrator.

Main results. Three studies totalling 147 participants (107 adults and 40 adolescents) met the inclusion criteria. Seventy‐four participants took part in DMT treatment, while 73 comprised the control groups. Two studies included male and female adults with depression. One of these studies included outpatient participants; the other study was conducted with inpatients at an urban hospital. The third study reported findings with female adolescents in a middle‐school setting. All included studies collected continuous data using two different depression measures: the clinician‐completed Hamilton Depression Rating Scale (HAM‐D); and the Symptom Checklist‐90‐R (SCL‐90‐R) (self‐rating scale). Statistical heterogeneity was identified between the three studies. There was no reliable effect of DMT on depression (SMD ‐0.67 95% CI ‐1.40 to 0.05; very low quality evidence). A planned subgroup analysis indicated a positive effect in adults, across two studies, 107 participants, but this failed to meet clinical significance (SMD ‐7.33 95% CI ‐9.92 to ‐4.73). One adult study reported drop‐out rates, found to be non‐significant with an odds ratio of 1.82 [95% CI 0.35 to 9.45]; low quality evidence. One study measured social functioning, demonstrating a large positive effect (MD ‐6.80 95 % CI ‐11.44 to ‐2.16; very low quality evidence), but this result was imprecise. One study showed no effect in either direction for quality of life (0.30 95% CI ‐0.60 to 1.20; low quality evidence) or self esteem (1.70 95% CI ‐2.36 to 5.76; low quality evidence). Authors' conclusions. The low‐quality evidence from three small trials with 147 participants does not allow any firm conclusions to be drawn regarding the effectiveness of DMT for depression. Larger trials of high methodological quality are needed to assess DMT for depression, with economic analyses and acceptability measures and for all age groups.

Rabadán, J., Chamarro, A., & Álvarez, M. (2017). Terapias artísticas y creativas en la mejora del malestar psicológico en mujeres con cáncer de mama. [Artistic and creative therapies in improving psychological distress in women with breast cancer. Systematic review]. Revisión sistemática. Revista de Psicooncologia. Investigación y Clínica Biopsicosocial en Oncología, 14(2-3), 0187-202.

Resumen: Objetivo: Conocer el estado actual de la eficacia de las terapias artísticas y creativas (TAC) en las variables de malestar psicológico de mujeres con cáncer de mama y delimitarla en función del tipo de TAC y momento terapéutico del paciente. Método: La búsqueda se realizó mediante las bases de datos Pubmed, Web of Science, Psychinfo y Google Academic para el periodo 2010-2016. Resultados: Se obtienen 9 estudios RTC y cuasi-experimentales controlados (2 de Danza movimiento terapia, 1 de Arte Terapia, 1 de Musicoterapia y 5 de Escucha musical) que incluyen 680 participantes. Se discute la calidad metodológica, el riesgo de sesgo y las medidas de eficacia terapéutica. Conclusiones: Las TAC parecen ser una ayuda complementaria a corto plazo durante la fase de tratamiento en cáncer de mama. Sin embargo, son necesarios más ensayos para aclarar los mecanismos subyacentes a la mejora, así com