Randomised Controlled Trial & DMT

S1 AND S3: Randomised Controlled Trial & DMT

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Allet, L., Müller-Pinget, S., Punt, I., Edelsten, C., Ballif, A., Golay, A., & Pataky, Z. (2017). Dance therapy combined with patient education improves quality of life of persons with obesity: A pilot feasibility study for a randomised controlled trial. Obesity research & clinical practice, 11(1), 79-87.

Highlights. • Dance therapy combined with patient education improve quality of life of obese people. • Mainly females adhere to dance therapy. • Dance therapy is appreciated by patient • Dance therapy shows no added value compared to an educational program alone.

Summary. Objective. To assess the effect of dance therapy combined with patient education on quality of life, functional capacity (lower limb power and endurance) and physical activity level in obese individuals.

Methods. Thirty-three obese patients were randomised to a control group (structured patient education ambulatory program), and 34 to an intervention group (structured patient education ambulatory program combined with weekly sessions of dance therapy). Patients’ quality of life, physical function and physical activity level were assessed at baseline and after 16 weeks.

Results. Almost only women were willing to enrol in the study. Participants of the intervention group significantly improved their quality of life (), and particularly self-esteem (). However, dance therapy added to a patient educational program did not produce statistically significant higher effects than a patient education program alone on functional capacities and patients’ physical activity level.

Conclusion. A 16 week structured patient educational program combined with dance therapy seems to have a positive effect on the quality of life of obese people, but no effect on functional capacities and physical activity.

Practice implication. Dance therapy combined with structured patient education is an interesting approach to improve quality of life of obese people.

Keywords. Obesity; Dance therapy; Functional capacities; Quality of life; Physical activity

Bräuninger, I. (2012). The efficacy of dance movement therapy group on improvement of quality of life: A randomized controlled trial. The Arts in Psychotherapy, 39(4), 296-303.

Abstract. This study examines the treatment outcome of a ten weeks dance movement therapy intervention on quality of life (QOL). The multicentred study used a subject-design with pre-test, post- test, and six months follow-up test. 162 participants who suffered from stress were randomly assigned to the dance movement therapy treatment group (TG) () and the wait-listed control group (WG) (65). The World Health Organization Quality of Life Questionnaire 100 (WHOQOL-100) and Munich Life Dimension List were used in both groups at all three measurement points. Repeated measures ANOVA revealed that dance movement therapy participants in all QOL dimensions always more than the WG. In the short term, they significantly improved in the Psychological domain (p > .001, WHOQOL; p > .01, Munich Life Dimension List), Social relations/life (p > .10, WHOQOL; p > .10, Munich Life Dimension List), Global value (p > .05, WHOQOL), Physical health (p > .05, Munich Life Dimension List), and General life (p > .10, Munich Life Dimension List). In the long term, dance movement therapy significantly enhanced the psychological domain (p > .05, WHOQOL; p > .05, Munich Life Dimension List), Spirituality (p > .10, WHOQOL), and General life (p > .05, Munich Life Dimension List). Dance movement therapy is effective in the short- and long-term to improve QOL.

Highlights. ► Efficacy of a 10 week dance movement therapy (DMT) group intervention on quality of life was tested. ► This randomized controlled trial examined changes in the short- and long-term (N =162) on people suffering from stress. ► DMT significantly improved QOL, especially psychological well-being and general life in the short and long term. ► Social relations, Global value, and Physical health improved significantly in the short term. ► Spirituality and general life improved in the long term as an effect of dance therapy.

Keywords. Dance therapy; Dance movement therapy; Research; Quality of life (QOL); Randomized controlled trial; Treatment outcome and efficacy

Bräuninger, I. (2012). Dance movement therapy group intervention in stress treatment: A randomized controlled trial (RCT). The Arts in Psychotherapy, 39(5), 443-450.

Abstract. This randomized controlled trial compares the effect of a dance movement therapy (DMT) group intervention on stress management improvement and stress reduction with a wait-listed control group (WG). 162 self-selected clients suffering from stress were randomly assigned to a WG or a DMT intervention that received 10 group therapy sessions. Stress management [Stressverarbeitungsfragebogen/SVF 120], psychopathology and overall distress (Brief Symptom Inventory/BSI) were evaluated at baseline (t1: pre-test), immediately after completion of the ten sessions DMT group intervention (t2: post-test), and 6 months after the DMT treatment (t3: follow-up test).

Analysis of variance was calculated to evaluate the between-group (time × condition) and within-group (time) effect of the DMT intervention. Negative stress management strategies decreased significantly in the short-term at t2 (p < .005) and long-term at t3 (p < .05), Positive Strategy Distraction improved significantly in the short-term (p < .10), as well as Relaxation (p < .10). Significant short-term improvements were observed in the BSI psychological distress scales Obsessive-Compulsive (p < .05), Interpersonal Sensitivity (p < .10), Depression (p < .05), Anxiety (p < .005), Phobic Anxiety (p < .01), Psychoticism (p < .05), and in Positive Symptom Distress (p < .02). Significant long-term improvement in psychological distress through DMT existed in Interpersonal Sensitivity (p < .05), Depression (p<.000), Phobic Anxiety (p < .05), Paranoid Thinking (p < .005), Psychoticism (p < .05), and Global Severity Index (p < .01). 

Results indicate that DMT group treatment is more effective to improve stress management and reduce psychological distress than non-treatment. DMT effects last over time.

Highlights. ► Dance movement therapy's effect on stress management improvement and stress reduction was examined. ► This RCT compared short- and long-term effect of 10 sessions’ DMT group intervention (). ► Negative strategies decreased and distraction improved significantly through DMT. ► Psychological distress and psychopathology decreased significantly at t2 (after treatment) and t3 (6-months’ follow-up) in DMT group. ► DMT effects on stress management improvement and stress reduction last over time and DMT is more effective than non-treatment.

Keywords. Dance movement therapy (DMT); research; Stress management; stress reduction; Randomized controlled trial (RCT); Treatment effectiveness; Group therapy

Dibbell-Hope, S. (2000). The use of dance/movement therapy in psychological adaptation to breast cancer-A randomized prospective outcome study. The Arts in Psychotherapy, 1(27), 51-68.

Hildebrandt, M., Koch, S., & Fuchs, T. (2016). “We Dance and Find Each Other” 1: Effects of Dance/Movement Therapy on Negative Symptoms in Autism Spectrum Disorder. Behavioral Sciences, 6(4), 24.

Abstract. The treatment of deficits in social interaction, a shared symptom cluster in persons with schizophrenia (negative symptoms) and autism spectrum disorder (DSM-5 A-criterion), has so far remained widely unsuccessful in common approaches of psychotherapy. The alternative approach of embodiment brings to focus body-oriented intervention methods based on a theoretic framework that explains the disorders on a more basic level than common theory of mind approaches. The randomized controlled trial at hand investigated the effects of a 10-week manualized dance and movement therapy intervention on negative symptoms in participants with autism spectrum disorder. Although the observed effects failed to reach significance at the conventional 0.05 threshold, possibly due to an undersized sample, an encouraging trend towards stronger symptom reduction in the treatment group for overall negative symptoms and for almost all subtypes was found at the 0.10-level. Effect sizes were small but clinically meaningful, and the resulting patterns were in accordance with theoretical expectations. The study at hand contributes to finding an effective treatment approach for autism spectrum disorder in accordance with the notion of embodiment. View Full-Text

Keywords: autism spectrum disorder; embodiment; negative symptoms; dance movement therapy; randomized control trial; intervention methods

Ho, R. T. H., Cheung, J. K. K., Chan, W. C., Cheung, I. K. M., & Lam, L. C. W. (2015). A 3-arm randomized controlled trial on the effects of dance movement intervention and exercises on elderly with early dementia. BMC geriatrics, 15(1), 127.

Abstract. Background. Dementia is characterized by a progressive decline and deterioration of brain regions such as memory, spatial navigation and language, along with disturbances in daily functioning. Non-pharmacological interventions that offer a holistic approach by targeting cognitive functioning, prognosis and the psychological and social effects of dementia require rigorous investigation. The well- established benefits of physical activity for cognitive functioning and psychological support in dementia have been observed with dance-movement intervention. There is substantial evidence that dance- movement interventions provide emotional and social advantages. Thus, a randomized controlled trial (RCT) is planned to investigate the positive effects of a dance movement intervention, compared with mild physical exercise, on the physical and psychological well-being of elderly Chinese individuals with early dementia.

Methods/Design. A 3-arm RCT with waitlist control design will be used in this study. Two hundred and one elderly participants with very mild to mild dementia will be screened and randomized into the following groups: (i) dance movement based intervention, (ii) stretching and exercise intervention and (iii) no intervention waitlist-control group. The two intervention groups will receive a 1-h intervention, twice a week, for 12 weeks. The participants will be assessed four times over the course of 12 months: baseline before randomization, post-intervention (3 months), 6 months from baseline and 12 months from baseline. The primary outcomes will be compared between assessment points and between groups on neuropsychiatric symptoms, psychosocial well-being and cognitive and daily functioning. Secondary outcomes will assess the changes in salivary cortisol levels and their relationships with the primary outcome measures.

Discussion. This study will provide substantial evidence of the efficacy of a dance-movement-based intervention in slowing down dementia progression, due to its ability to act as a buffer against decline and improve areas affected by dementia. We also anticipate an association between cortisol levels and the outcome measures. The further development of this intervention into a structural program may be warranted for early psychosocial support among elderly populations.

Ho, R. T., Fong, T. C., Chan, W. C., Kwan, J. S., Chiu, P. K., Yau, J. C., & Lam, L. C. (2018). Psychophysiological Effects of Dance Movement Therapy and Physical Exercise on Older Adults With Mild Dementia: A Randomized Controlled Trial, The Journals of Gerontology: Series B, , gby145.

Abstract. Objectives. Dementia interferes with older adults’ functioning in cognitive, daily, psychosocial, and neuroendocrine domains. The present study examined the psychophysiological effects of dance movement therapy (DMT) and physical exercise for older adults with dementia.

Methods. This randomized controlled trial recruited 204 older adults diagnosed with mild dementia into the DMT, exercise, or waitlist control group. Both DMT and exercise interventions had similar intensity and comprised 24 hr of intervention that spanned over 12 weeks. All participants completed self-report questionnaires on psychosocial well-being, daily functioning, neurocognitive assessments, and salivary cortisol measures at baseline and 3 follow-up measurements more than 1 year.

Results. The DMT group showed significant decreases in depression, loneliness, and negative mood (–0.42, p < .05) and improved daily functioning (, p < .01) and diurnal cortisol slope (, p < .01). The effects on daily functioning and cortisol slope remained at 1-year follow-up. The exercise group of matched intensity showed no significant effects on the outcomes.

Discussion. The study findings support the potential utility of DMT as a multifaceted intervention for improving various aspects of functioning in older adults with declining cognitive abilities. The lack of beneficial effects for our exercise intervention and long-term DMT effects highlights the need to maintain persistent levels of exercise with adequate intensity and duration.

Key words: Biomarkers, Longitudinal change, Memory, Mild cognitive impairment, Psychophysiology Topic: hydrocortisone dementia exercise biological markers dancing depressive disorders neurosecretory systems waiting lists loneliness memory mood elderly movement therapy cognitive ability

Ho, R. T., Fong, T. C., Cheung, I. K., Yip, P. S., & Luk, M. Y. (2016). Effects of a short-term dance movement therapy program on symptoms and stress in patients with breast cancer undergoing radiotherapy: a randomized, controlled, single-blind trial. Journal of pain and symptom management, 51(5), 824-831.

Abstract. Context. Integrated interventions with combined elements of body movement and psychotherapy on treatment-related symptoms in cancer patients are relatively scarce.

Objectives. The aim of the present study is to investigate the effectiveness of dance movement therapy (DMT) on improving treatment-related symptoms in a randomized controlled trial.

Methods. A total of 139 Chinese patients with breast cancer awaiting adjuvant radiotherapy were randomized to DMT or control group. The intervention included six 1.5-hour DMT sessions provided twice a week over the course of radiotherapy. Self-report measures on perceived stress, anxiety, depression, fatigue, pain, sleep disturbance, and quality of life were completed before and after the three- week program.

Results. DMT showed significant effects on buffering the deterioration in perceived stress, pain severity, and pain interference (Cohen –0.36, P < 0.05). No significant intervention effects were found on anxiety, depression, fatigue, sleep disturbance, and quality of life (Cohen –0.20, P > 0.05).

Conclusion. The short-term DMT program can counter the anticipated worsening of stress and pain in women with breast cancer during radiotherapy.

Key Words. Breast cancer; dance/movement therapy; pain; perceived stress; randomized controlled trials

Ho, R. T., Fong, T. C., & Yip, P. S. (2018). Perceived stress moderates the effects of a randomized trial of dance movement therapy on diurnal cortisol slopes in breast cancer patients. Psychoneuroendocrinology, 87, 119-126.

Highlights

  • Moderated mediation analysis evaluated the effect of DMT on diurnal cortisol slopes.
  • Overall, DMT did not show an significant effect on diurnal cortisol slope.
  • Baseline perceived stress significantly moderated the intervention effect of DMT on diurnal cortisol slope.
  • DMT could help in modulating the neuroendocrine response of the distressed patients.

Abstract. Women with breast cancer are at risk of psychosocial distress and may suffer from aberrant diurnal cortisol rhythms. Dance movement therapy (DMT), a movement-based psychotherapy that incorporates exercise and artistic components, has demonstrated stress reduction effects. This study examined the effects of DMT on the diurnal cortisol rhythms of breast cancer patients undergoing radiotherapy treatment and the role of perceived stress in producing such effects. The study sample comprised 121 Chinese breast cancer patients randomized to the DMT () and control () groups. The intervention consisted of six 1.5-h group sessions held twice weekly over the course of radiotherapy. Participants completed validated self-report measures of perceived stress, fatigue, pain, and sleep disturbance and provided five salivary cortisol samples at baseline (Time 1) and post-intervention (Time 2). Moderated mediation analysis was used to evaluate the intervention effect on Time 2 diurnal cortisol slopes. Despite the absence of a significant DMT effect on diurnal cortisol slopes (B = −0.55, 95% CI = −1.20 to 0.08, β = −0.14), baseline perceived stress significantly moderated the intervention effect (B = −0.18, 95% CI = −0.32 to −0.05, β = −0.30). At high levels of baseline perceived stress (1 SD above the mean), the DMT group showed a steeper cortisol slope (M = –7.14) than the control group (M= −5.80) at Time 2. The present findings suggest that DMT might have a beneficial effect on diurnal cortisol slopes in breast cancer patients with high levels of distress.

Keywords. Salivary cortisol; Perceived stress; Randomized controlled trial; Moderation; Breast cancer; DMT

Ho, R. T., Lo, P. H., & Luk, M. Y. (2016). A good time to dance? A mixed-methods approach of the effects of dance movement therapy for breast cancer patients during and after radiotherapy. Cancer nursing, 39(1), 32-41.

Background: Dance movement therapy (DMT) is premised on an interconnected body and mind. It has known benefits for cancer patients’ physical and psychological health and quality of life.

Objective: To offer greater insight into a previous randomized controlled trial, the present study qualitatively explored the beneficial elements of DMT over the course of radiotherapy. To better understand the uniqueness of DMT intervention for patients receiving radiotherapy, the study statistically compared them with patients who received DMT after treatment completion.

Methods: Participants were randomized into radiotherapy and postradiotherapy control groups. The radiotherapy group received DMT (6 sessions at 90 minutes each) as they were undergoing radiotherapy.

The postradiotherapy group was provided with the same DMT intervention at 1 to 2 months after completing radiotherapy.

Results: One hundred and four participants identified 5 main benefit categories. Dance movement therapy helped them (1) cope with cancer, treatment, and physical symptoms; (2) improve mental well-being, attention, and appreciation for the self and body; (3) improve total functioning; (4) bridge back to a normal and better life; and (5) participate in shared positive experiences. The radiotherapy group reported categories 1 and 2 more prominent

Hokkanen, L., Rantala, L., Remes, A. M., Härkönen, B., Viramo, P., & Winblad, I. (2003). Dance/movement therapeutic methods in management of dementia. Journal of the American Geriatrics Society, 51(4), 576- 577.

Jeong, Y. J., Hong, S. C., Lee, M. S., Park, M. C., Kim, Y. K., & Suh, C. M. (2005). Dance movement therapy improves emotional responses and modulates neurohormones in adolescents with mild depression. International journal of neuroscience, 115(12), 1711-1720.

Abstract. This study assessed the profiles of psychological health and changes in neurohormones of adolescents with mild depression after 12 weeks of dance movement therapy (DMT). Forty middle school seniors (mean age: 16 years old) volunteered to participate in this study and were randomly assigned into either a dance movement group () or a control group (). All subscale scores of psychological distress and global scores decreased significantly after the 12 weeks in the DMT group. Plasma serotonin concentration increased and dopamine concentration decreased in the DMT group. These results suggest that DMT may stabilize the sympathetic nervous system. In conclusion, DMT may be effective in beneficially modulating concentrations of serotonin and dopamine, and in improving psychological distress in adolescents with mild depression.

Key Words: adolescent, dance movement therapy, depression, emotion, neurohormone

Jongen, P. J., Heerings, M., Ruimschotel, R., Hussaarts, A., Evers, S., Duyverman, L., ... & Lemmens, W. A. (2016). An intensive social cognitive program (can do treatment) in people with relapsing remitting multiple sclerosis and low disability: a randomized controlled trial protocol. BMC neurology, 16(1), 81. 

Abstract. Background. In people with multiple sclerosis (MS) disabilities and limitations may negatively affect self-efficacy. Lowered self-efficacy has been associated with decreases in health-related quality of life, physical activity and cognitive performance. In an explorative observational study we found that a 3- day intensive social cognitive program (Can Do Treatment [CDT]) with the participation of support partners was followed by substantial increases in self-efficacy control and health-related quality of life 6 months after treatment in those people with MS who had relapsing remitting disease and low disability. 

Methods/Design. CDT is a sociologically oriented approach, its goal is to uncover and promote existing capabilities, and the notion “stressor” is the central concept. CDT’s components are plenary group sessions, small group sessions, consultations, a theatre evening, and start of the day with a joint activity. The small group sessions form the actual training. Depending on their individual goals the participants join the training groups ‘Body’, ‘Feeling’ or ‘Life’, to work out their aims and to reduce their stressors. The multidisciplinary team includes a psychiatrist, psychiatric nurse, neurologist, specialized MS nurse, physiotherapist, dance therapist, and a person with MS. To evaluate the (cost)effectiveness of CDT in persons with relapsing remitting MS and low disability we perform a single-centre, randomized controlled trial in 140 patients, with or without support partners. The primary outcome is self-efficacy control. The secondary outcomes are self-efficacy function, health-related quality of life, autonomy and participation, anxiety, depression, cost effectiveness and cost utility. The tertiary outcome is care-related strain to support partners. Outcomes are assessed at baseline and at 1, 3 and 6 months after CDT. Discussion. This randomized controlled trial will adequately evaluate the clinical and cost effectiveness of a 3-day intensive social cognitive program in people with relapsing remitting MS and low disability, with self-efficacy control as primary outcome.

Koch, S. C., Mehl, L., Sobanski, E., Sieber, M., & Fuchs, T. (2015). Fixing the mirrors: A feasibility study of the effects of dance movement therapy on young adults with autism spectrum disorder. Autism, 19(3), 338- 350.

Abstract. From the 1970s on, case studies reported the effectiveness of therapeutic mirroring in movement with children with autism spectrum disorder. In this feasibility study, we tested a dance movement therapy intervention based on mirroring in movement in a population of 31 young adults with autism spectrum disorder (mainly high-functioning and Asperger’s syndrome) with the aim to increase body awareness, social skills, self–other distinction, empathy, and well-being. We employed a manualized dance movement therapy intervention implemented in hourly sessions once a week for 7 weeks. The treatment group () and the no-intervention control group () were matched by sex, age, and symptom severity. Participants did not participate in any other therapies for the duration of the study. After the treatment, participants in the intervention group reported improved well-being, improved body awareness, improved self–other distinction, and increased social skills. The dance movement therapy–based mirroring approach seemed to address more primary developmental aspects of autism than the presently prevailing theory-of-mind approach. Results suggest that dance movement therapy can be an effective and feasible therapy approach for autism spectrum disorder, while future randomized control trials with bigger samples are needed.

Madden, J. R., Mowry, P., Gao, D., McGuire Cullen, P., & Foreman, N. K. (2010). Creative arts therapy improves quality of life for pediatric brain tumor patients receiving outpatient chemotherapy. Journal of Pediatric Oncology Nursing, 27(3), 133-145.

Abstract. This mixed methods pilot study evaluated the effects of the creative arts therapy (CAT) on the quality of life (QOL) of children receiving chemotherapy. A 2-group, repeated measures randomized design compared CAT with a volunteer’s attention (). Statistical analysis of the randomized controlled phase of the study suggested an improvement in the following areas after the CAT: parent report of child’s hurt () and parent report of child’s nausea (). A nonrandomized phase, using a different instrument showed improved mood with statistical significance on the Faces Scale (P <.01), and patients were more excited (P < .05), happier (P < .02), and less nervous (P < .02). Provider focus groups revealed positive experiences. Case studies are included to exemplify the therapeutic process. With heightened interest in complementary therapy for children with cancer, future research with a larger sample size is needed to document the impact of incorporating creative arts into the healing process.

Keywords creative arts therapy, pediatric cancer, brain tumors, quality of life

Martin, L. A., Koch, S. C., Hirjak, D., & Fuchs, T. (2016). Overcoming disembodiment: The effect of movement therapy on negative symptoms in schizophrenia—A multi-center randomized controlled trial [Die Entkörperlichung bezwingen: Effekt von Bewegungstherapie auf negative Schizophrenie-Symptome in einer multizentrischen randomisiert-kontrollierten Studie]. Frontiers in psychology, 7, 483.

Objective: Negative symptoms of patients with Schizophrenia are resistant to medical treatment or conventional group therapy. Understanding schizophrenia as a form of disembodiment of the self, a number of scientists have argued that the approach of embodiment and associated embodied therapies, such as Dance and Movement Therapy (DMT) or Body Psychotherapy (BPT), may be more suitable to explain the psychopathology underlying the mental illness and to address its symptoms. Hence the present randomized controlled trial (DRKS00009828, http://apps.who.int/trialsearch/) aimed to examine the effectiveness of manualized movement therapy (BPT/DMT) on the negative symptoms of patients with schizophrenia.

Method:A total of 68 out-patients with a diagnosis of a schizophrenia spectrum disorder were randomly allocated to either the treatment (, 20 sessions of BPT/DMT) or the control condition [, treatment as usual (TAU)]. Changes in negative symptom scores on the Scale for the Assessment of Negative Symptoms (SANS) were analyzed using Analysis of Covariance (ANCOVA) with Simpson- Angus Scale (SAS) scores as covariates in order to control for side effects of antipsychotic medication. Results:After 20 sessions of treatment (BPT/DMT or TAU), patients receiving movement therapy had significantly lower negative symptom scores (SANS total score, blunted affect, attention). Effect sizes were moderate and mean symptom reduction in the treatment group was 20.65%.

Conclusion:The study demonstrates that embodied therapies, such as BPT/DMT, are highly effective in the treatment of patients with schizophrenia. Results strongly suggest that BPT/DMT should be embedded in the daily clinical routine.

Mastrominico, A., Fuchs, T., Manders, E., Steffinger, L., Hirjak, D., Sieber, M., ... & Koch, S. (2018). Effects of Dance Movement Therapy on Adult Patients with Autism Spectrum Disorder: A Randomized Controlled Trial. Behavioral Sciences, 8(7), 61.

Abstract. This study examines the effects of dance movement therapy (DMT) on empathy for adults with autism spectrum disorder (ASD). DMT based on the embodiment approach offers body-centered interventions, such as mirroring techniques, to address the needs of ASD patients. Accordingly, findings of a feasibility study suggest that DMT may be an effective approach for clients on the ASD spectrum. The present study is a randomized controlled trial that was conducted as a multicenter study within the framework of the EU-funded research project TESIS (Toward an Embodied Science of Intersubjectivity), and employed a two-factorial between-subject design. The treatment group () participated in a 10- week manualized DMT intervention, whereas the control group () received treatment only after a waiting period. Empathy, measured with the Cognitive and Emotional Empathy Questionnaire (CEEQ), was the main variable of interest, analyzed by a repeated measures analysis of variance. In order to also include incomplete data cases, we used the expectation-maximization algorithm for missing data estimation. Results suggest no significant changes in overall empathy between groups. We discuss the results and limitations, as well as future research options. 

Keywords: dance movement therapy; DMT; autism spectrum disorder (ASD); randomized controlled

trial; embodiment; empathy; mirroring

Papadopoulos, N. L., & Röhricht, F. (2014). An investigation into the application and processes of manualised group body psychotherapy for depressive disorder in a clinical trial. Body, Movement and Dance in Psychotherapy, 9(3), 167-180.

Abstract. Background: Body-oriented psychological therapy (BOPT) has been described as effective in addressing depressive symptoms. There is, however, a paucity of research into the processes leading to change and the actual experience of the patients and the therapist in delivering BOPT interventions.

Method: Secondary qualitative analysis of data obtained within an exploratory randomised controlled trial of manualised body psychotherapy (BPT) for patients with chronic depression, analysing qualitative aspects of change processes during therapy, was conducted. Results: At the beginning of therapy, most patients presented with a restricted, emotionally dissociated and inwardly directed range of expressive behaviours, associated with isolation of emotions from self-awareness. Clinically relevant changes in body postures and gestures were associated with feelings of empowerment; connecting repressed anger with feelings of sadness appears to have resulted in enhanced levels of self-confidence and improvements of depressed mood. Body satisfaction scores improved slightly. Conclusion: Patients with chronic depression may benefit from specific BPT interventions. These interventions appear to be particularly effective in assisting patients to identify and express a wide range of feelings.

Keywords: body psychotherapy, depression, embodiment

Priebe, S., Savill, M., Reininghaus, U., Wykes, T., Bentall, R., Lauber, C., ... & Eldridge, S. (2013).

Effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia–a multi-centre randomised controlled trial. BMC psychiatry, 13(1), 26.

Abstract. Background. Negative symptoms of schizophrenia are frequently associated with poor long term outcomes. Established interventions have little, if any, positive effects on negative symptoms. Arts Therapies such as Body Psychotherapy (BPT) have been suggested to reduce negative symptoms, but the existing evidence is limited. In a small exploratory trial a manualised form of group BPT led to significantly lower negative symptom levels both at the end of treatment and at 4 months follow-up as compared to supportive counseling. We designed a large multi-site trial to assess the effectiveness of a manualised BPT intervention in reducing negative symptoms, compared to an active control.

Methods/Design. In a randomised controlled trial, 256 schizophrenic outpatients with negative symptoms will be randomly allocated either to BPT or Pilates groups. In both conditions, patients will be offered two 90 minutes sessions per week in groups of about 8 patients over a period of 10 weeks. Outcomes are assessed at the end of treatment and at six months follow-up. The primary outcome is severity of negative symptoms, as measured by the Positive and Negative Symptom Scale (PANSS), whilst a range of secondary outcome measures include general psychopathology, social contacts, and quality of life. We will also assess the cost-effectiveness of the intervention.

Discussion. The study aims to evaluate the effectiveness of a promising form of group therapy which may help alleviate negative symptoms that are associated with unfavourable long-term outcomes and have so far been difficult to treat. If the trial is successful, it will add a new and effective option in the treatment of negative symptoms. Group BPT is manualised, might be attractive to many patients because of its unusual approach, and could potentially be rolled out to services at relatively little additional cost.

Key words: Schizophrenia; National Health Service; Negative Symptom; Exploratory Trial; Physical Activity Group

Priebe, S., Savill, M., Wykes, T., Bentall, R., Lauber, C., Reininghaus, U., ... & Roehricht, F. (2016). Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial. Health technology assessment (Winchester, England), 20(11), 1.

(English) ; Abstract available. By: Priebe S; Savill M; Wykes T; Bentall R; Lauber C; Reininghaus U; McCrone P; Mosweu I; Bremner S; Eldridge S; Röhricht F; NESS team, Health Technology Assessment (Winchester, England) [Health Technol Assess], ISSN: 2046-4924, 2016 Feb; Vol. 20 (11), 1-100.

Abstract. BACKGROUND: The negative symptoms of schizophrenia significantly impact on quality of life and social functioning, and current treatment options are limited. In this study the clinical effectiveness and cost-effectiveness of group body psychotherapy as a treatment for negative symptoms were compared with an active control.

DESIGN: A parallel-arm, multisite randomised controlled trial. Randomisation was conducted independently of the research team, using a 1 : 1 computer-generated sequence. Assessors and statisticians were blinded to treatment allocation. Analysis was conducted following the intention-to-treat principle. In the cost-effectiveness analysis, a health and social care perspective was adopted.

PARTICIPANTS:

ELIGIBILITY CRITERIA: age 18-65 years; diagnosis of schizophrenia with symptoms present at > 6 months; score of ≥ 18 on Positive and Negative Syndrome Scale (PANSS) negative symptoms subscale; no change in medication type in past 6 weeks; willingness to participate; ability to give informed consent; and community outpatient.

EXCLUSION CRITERIA: inability to participate in the groups and insufficient command of English. SETTINGS: Participants were recruited from NHS mental health community services in five different Trusts. All groups took place in local community spaces.

INTERVENTIONS: Control intervention: a 10-week, 90-minute, 20-session group beginners' Pilates class, run by a qualified Pilates instructor. Treatment intervention: a 10-week, 90-minute, 20-session manualised group body psychotherapy group, run by a qualified dance movement psychotherapist. OUTCOMES: The primary outcome was the PANSS negative symptoms subscale score at end of treatment. Secondary outcomes included measures of psychopathology, functional, social, service use and treatment satisfaction outcomes, both at treatment end and at 6-month follow-up.

RESULTS: A total of 275 participants were randomised (140 body psychotherapy group, 135 Pilates group). At the end of treatment, 264 participants were assessed (137 body psychotherapy group, 127 Pilates group). The adjusted difference in means of the PANSS negative subscale at the end of treatment was 0.03 [95% confidence interval (CI) -1.11 to 1.17], showing no advantage of the intervention. In the secondary outcomes, the mean difference in the Clinical Assessment Interview for negative symptoms expression subscale at the end of treatment was 0.62 (95% CI -1.23 to 0.00), and in extrapyramidal movement disorder symptoms -0.65 (95% CI -1.13 to -0.16) at the end of treatment and -0.58 (95% CI -1.07 to -0.09) at 6 months' follow-up, showing a small significant advantage of body psychotherapy. No serious adverse events related to the interventions were reported. The total costs of the intervention were comparable with the control, with no clear evidence of cost-effectiveness for either condition. LIMITATIONS: Owing to the absence of a treatment-as-usual arm, it is difficult to determine whether or not both arms are an improvement over routine care.

CONCLUSIONS: In comparison with an active control, group body psychotherapy does not have a clinically relevant beneficial effect in the treatment of patients with negative symptoms of schizophrenia.

These findings conflict with the review that led to the current National Institute for Health and Care Excellence guidelines suggesting that arts therapies may be an effective treatment for negative symptoms. FUTURE WORK: Determining whether or not this lack of effectiveness extends to all types of art therapies would be informative.

Priebe, S., Savill, M., Wykes, T., Bentall, R. P., Reininghaus, U., Lauber, C., ... & Röhricht, F. (2016). Effectiveness of group body psychotherapy for negative symptoms of schizophrenia: multicentre randomised controlled trial. The British Journal of Psychiatry, 209(1), 54-61.

Abstract. Background. Negative symptoms of schizophrenia have a severe impact on functional outcomes and treatment options are limited. Arts therapies are currently recommended but more evidence is required.

Aims. To assess body psychotherapy as a treatment for negative symptoms compared with an active control (trial registration: ISRCTN84216587).

Method. Schizophrenia out-patients were randomised into a 20-session body psychotherapy or Pilates group. The primary outcome was negative symptoms at end of treatment. Secondary outcomes included psychopathology, functional, social and treatment satisfaction outcomes at treatment end and 6-months later.

Results. In total, 275 participants were randomised. The adjusted difference in negative symptoms was 0.03 (95% CI –1.11 to 1.17), indicating no benefit from body psychotherapy. Small improvements in expressive deficits and movement disorder symptoms were detected in favour of body psychotherapy. No other outcomes were significantly different.

Conclusions. Body psychotherapy does not have a clinically relevant beneficial effect in the treatment of patients with negative symptoms of schizophrenia.

Röhricht, F., Papadopoulos, N., Holden, S., Clarke, T., & Priebe, S. (2011). Therapeutic processes and clinical outcomes of body psychotherapy in chronic schizophrenia–An open clinical trial. The Arts in Psychotherapy, 38(3), 196-203.

Persistent negative symptoms are an ongoing challenge in the treatment of chronic schizophrenia. Evidence from randomised controlled trials suggests that arts/non-verbal therapies may be effective in treating negative symptoms of schizophrenia. These treatments have not yet been evaluated in open clinical settings. The present uncontrolled clinical trial examines the therapeutic processes and clinical outcomes of group body psychotherapy (BPT) on marked negative symptoms in patients with chronic schizophrenia. Changes in symptom scores, subjective quality of life, social functioning and emotional processing between baseline and post-treatment were assessed. The ratings from clinical assessments of independent researchers were compared with the post-therapy summary assessment of the therapists.

A total of 39 eligible patients were referred, out of which 18 patients agreed to participate and received BPT in addition to treatment as usual within three therapy groups run by different therapists. Patients had high symptom levels and low psychosocial functioning at baseline. Negative symptoms and general psychopathology significantly reduced during treatment. Positive symptoms and other outcomes did not change. Researcher ratings of psychopathology were in line with the assessment of clinical outcome by therapists and qualitative observations on changes in movement behaviour during therapy.

The results of this study are consistent with findings from a RCT (Röhricht & Priebe, 2006), indicating that BPT is associated with reduced negative symptoms even when administered in routine clinical settings. Therapists’ qualitative judgements may be considered as a valid source for assessing treatment outcomes. Future studies should explore effects of longer term treatments on other outcomes.

Keywords: Body psychotherapy; Dance/movement therapy; Schizophrenia; Negative symptoms; Therapeutic processes

Röhricht, F., Papadopoulos, N., & Priebe, S. (2013). An exploratory randomized controlled trial of body psychotherapy for patients with chronic depression. Journal of affective disorders, 151(1), 85-91. 

Abstract. Background. Chronic major depressive disorder and dysthymia are associated with a high burden and substantial care costs. New and more effective treatments are required. This is the first randomized controlled trial designed to evaluate the effectiveness of Body Psychotherapy (BPT) in patients with chronic depression.

Methods. Patients with chronic depressive syndromes (more than 2 years symptomatic) and a total score of ≥20 on the Hamilton Rating Scale for Depression (HAMD) were randomly allocated to either immediate BPT or a waiting group which received BPT 12 weeks later. BPT was manualized, delivered in small groups in 20 sessions over a 10 weeks period, and provided in addition to treatment as usual. In an intention to treat analysis, primary outcome were depressive symptoms at the end of treatment adjusted for baseline symptom levels. Secondary outcomes were self-esteem and subjective quality of life.

Results. Thirty-one patients were included and twenty-one received the intervention. At the end of treatment patients in the immediate BPT group had significantly lower depressive symptom scores than the waiting group (mean difference 8.7, 95% confidence interval 1.0–16.7). Secondary outcomes did not show statistically significant differences. When the scores of the waiting group before and after BPT (as offered after the waiting period) were also considered in the analysis, the differences with the initial waiting group remained significant.

Conclusions. The results suggest that BPT may be an effective treatment option for patients with chronic depression. Difficulty recruiting and subsequent attrition was one of the limitations, but the findings merit further trials with larger samples and process studies to identify the precise therapeutic mechanisms

Sandel, S. L., Judge, J. O., Landry, N., Faria, L., Ouellette, R., & Majczak, M. (2005). Dance and movement program improves quality-of-life measures in breast cancer survivors. Cancer nursing, 28(4), 301-309.

A pilot research study was conducted at 2 cancer centers in Connecticut to determine the effect of a dance and movement program on quality of life and shoulder function in breast cancer survivors treated within the prior 5 years. Thirty-five women completed the trial that included a 12-week intervention, using The Lebed Method, Focus on Healing Through Movement and Dance. The study design was a randomized control trial with a wait list control group crossover to active treatment in weeks 13 to 25, with the treatment group receiving the program in weeks 1 to 12, and no program in weeks 13 to 25. Outcome measures were the Breast Cancer Quality of Life (FACT-B), Shoulder range of motion (ROM), and Body Image Scale. FACT-B significantly improved in the intervention group at 13 weeks from 102.0 ± 15.8 to 116.7 ± 16.9, compared to the wait list group 108.1 ± 16.4 to 107.1 ± 21.3 (time × group effect, ). During the crossover phase, the FACT-B score increased in the wait list group and was stable in the treatment group. The overall effect of the training at 26 weeks was significant (time effect, ), and the order of training was also significant (). Shoulder ROM increased in both groups at 13 weeks—15° and 8° in the intervention and wait list groups (Time effect, ; time × group, ). Body Image improved similarly in both groups at 13 weeks (time effect, ; time × group, ), and at 26 weeks. There was no significant effect of the order of training for these outcome measures. A dance movement program that addressed the physical and emotional needs of women following treatment for breast cancer substantially improved a breast cancer–specific quality-of-life measure. Larger studies are justified to determine the acceptability of this therapy as part of the continuum of care for breast cancer survivors.

Serrano-Guzman, M., Valenza-Pena, C. M., Serrano-Guzman, C., Aguilar-Ferrandiz, E., Valenza-Demet, G., & Villaverde-Gutierrez, C. (2016). Effects of a dance therapy programme on quality of life, sleep and blood pressure in middle-aged women: A randomised controlled trial. Medicina Clínica (English Edition), 147(8), 334-339.

Abstract. Background and objective. Evidence suggests that dance therapy may have positive effects in areas such as cardiovascular parameters and sleep. The aim of the present study is to explore whether a dance therapy programme improves sleep and blood pressure in a population of middle-aged pre- hypertensive and hypertensive women.

Methods. A randomised controlled trial was conducted, in which participants were assigned to one of 2 groups: standard care (with usual activities and medication) or dance therapy (in which the participants followed a dance therapy programme, in addition to their medication). The intervention was an 8-week, 3-times-per-week, progressive and specific group dance-training programme. The dance steps were specifically designed to improve balance by shifting the body and relocating the centre of gravity. The main measures obtained were blood pressure, sleep quality and quality of life, measured by the Pittsburgh Sleep Quality Index and the European Quality of Life Questionnaire.

Results. Sixty-seven pre-hypertensive and hypertensive middle-aged women were randomised to either an intervention group () or a control group () after baseline testing. The intervention group reported a significant improvement in blood pressure values (p < 0.01), as well as in sleep quality (p < 0.05) and quality of life (p < 0.001), compared to the control group.

Conclusion. The dance therapy programme improved blood pressure, sleep and quality of life in pre- hypertensive and hypertensive middle-aged women, and constitutes an interesting basis for larger-scale research.

Keywords. Dance therapy; Hypertension; Quality of life; Sleep; Women

Resumen. Fundamento y objetivo. Existe evidencia sobre los efectos positivos de la danza, como la mejora de los parámetros cardiovasculares y del sueño. El objetivo del presente estudio ha sido explorar si un programa de terapia de baile es capaz de mejorar el sueño y la presión arterial en mujeres de mediana edad, prehipertensas e hipertensas.

Métodos. Se diseñó un ensayo aleatorizado y controlado, donde las participantes fueron asignadas a uno de 2 grupos: grupo control (donde las participantes continuaron con sus actividades y medicación habitual) o grupo de terapia de baile (donde las participantes siguieron un programa de terapia de baile, además de su medicación). La intervención consistió en un programa de baile-entrenamiento específico y progresivo durante 8 semanas, a razón de 3 sesiones semanales. Los pasos de baile fueron específicamente seleccionados para mejorar el equilibrio, desplazando el cuerpo y reubicando el centro de gravedad. Las medidas de resultado fueron la presión arterial, la calidad del sueño y la calidad de vida, estas 2 últimas medidas por el Pittsburgh Sleep Quality Index y el Cuestionario Europeo sobre Calidad de Vida, respectivamente.

Resultados. Se asignó al azar, a un total de 67 mujeres de mediana edad prehipertensas e hipertensas a un grupo de intervención (), o como controles (), después de las pruebas basales. El grupo de intervención informó de mejoras significativas en los valores de la presión arterial (p < 0,01), así como en la calidad del sueño (p < 0,05) y la calidad de vida (p < 0,001) en comparación con el grupo control.

Conclusión. El programa de terapia de baile mejoró la presión arterial, el sueño y la calidad de vida en mujeres de mediana edad prehipertensas e hipertensas, proporcionando la base para continuar la investigación con estudios más amplios.

Palabras clave. Danzaterapia; Hipertensión; Calidad de vida; Sueño; Mujer

Theorell, T., & Anderberg, U. M. (2003). Dance/movement therapy and changes in stress-related hormones: a study of fibromyalgia patients with video-interpretation. The Arts in Psychotherapy, 30, 255-264.