Who invented dance movement therapy

History of Dance and Movement Therapy. By: Emily Sexto n This is a brief timeline of important events and dates in the history of Dance and Movement Therapy The idea of dance as psychotherapy was first recorded by Carl Gustav Jung.

His original paper was widely circulated but remained unpublished until [1]. Elizabeths Hospital in Washington, D. She pioneered the combination of comedy and dance therapy working jointly together [3]. Authentic movement is a branch of dance therapy that involves deep inner listening and expressive movement [5]. The ADTA advocates nationally and internationally for the development and expansion of dance therapy training and services. Considering the high heterogeneity of outcome measures in this domain, they need in any case to be further investigated plus more standardized outcome measured need to be developed.

Changes in motor skills are most pronounced and consistent in dance intervention studies, with the most and the most rigorous evidence from studies of interventions for Parkinson patients e.

Changes in motor skills are usually not in the focus of DMT studies. The non-significant results on motor skills confirm DMT as a psychotherapeutic intervention. In order to obtain information about the long-term effects of DMT and dance interventions, we analyzed the available follow-up data see Table 8. Eight studies reported follow-up data, the mean period from post- to follow-up assessment was 22 weeks.

In most studies, the effect remained constant. The effect was reduced by half, but remained significant. In Baptista et al. In the studies from Pinniger et al. The authors explain this unusual increase with an increase in mindfulness detachment from negative thoughts, ruminations, and worries, which led to a reduction in symptom severity; Ree and Craigie, and a personal bond between the participants as a learning process, which became more effective after the participants had practiced for a while.

In this meta-analysis, we investigated the effectiveness of DMT and dance interventions on health-related psychological outcomes. We included 41 primary trails published between and March of that contained a total of 2, participants. Twenty-one of these trials considered DMT interventions, whereas 20 trials considered dance interventions.

Analysis of heterogeneity yielded that an estimated This could be due to the fact that in the interpersonal skills cluster, many trials assessed dependent variables with observation rating scales, which yielded larger effect sizes in general. Sub-analyses revealed that the mean effect in the anxiety cluster was as large as the effect in the depression cluster. Assessment of heterogeneity in the outcome clusters revealed that all mean effects, except the effect for psycho- motor skills, remained inconsistent i.

Furthermore, the larger the mean effect, the larger the heterogeneity of results, which indicates that larger effects were produced by outliers rather than by consistently higher effect sizes see end of the next paragraph. In order to identify which study characteristics contributed most to dissimilarities of results, we conducted a sensitivity analysis. Most importantly, we found that the type of intervention DMT vs. Therefore, it was reasonable to analyze data in two separate groups to obtain more meaningful results:.

In the DMT group , we obtained smaller but more consistent effects. Effects of motor skills were non-significant, thus confirming DMT as a mainly psychotherapeutic intervention. In the dance cluster , we observed larger but less consistent effects. Apart from Koch et al. The consistent effects for psycho motor skills were carried by the dance for Parkinson studies. Dance studies seem to uphold certain characteristics that produce a broader range of results, especially in the large-positive spectrum of effect sizes i.

One factor might be different sample characteristics: Most DMT studies were conducted in a clinical setting, whereas most dance studies were conducted in a non-clinical setting. In severely impaired patient samples, such as in most of the DMT primary studies that entered into this analysis, effects are usually smaller than in non-clinical or subclinical populations we know this, for example, from pretests of designs with student populations; e.

This may be a major reason why the dance intervention studies have yielded larger medium effect sizes. Non-clinical samples also contained a broader age range. Additionally, in dance interventions, the implementation and methods were more heterogeneous than in the DMT group.

In terms of culture, most DMT studies were conducted in Germany and other Western European countries, whereas the majority of dance intervention studies were conducted in non-Western countries.

Dance intervention studies tended to have smaller sample sizes, less randomization, and more missing information in the reporting of results. In sum, we obtained encouraging results, which indicated that DMT and dance have positive effects on various health-related outcomes. We did not find enough studies on psycho- motor functioning, physiological changes, and positive symptoms of schizophrenia in the DMT cluster to draw conclusions.

The high variety of results, especially in the dance cluster, needs more investigation in future studies. In our meta-analysis, we also assessed and analyzed various study characteristics to deepen our understanding of factors that influenced the effects of DMT and dance on health-related outcomes. One important issue in most intervention studies is the question about unspecific and specific effects of the intervention. Often the fact that we pay attention to the participants already can change their symptoms Hawthorne effect: firstly described in Roethlisberger and Dickson , and reviewed by McCambridge et al.

Using alternative interventions in the control groups helps to distinguish attention effects from specific effects. Therefore, we assessed control group activity. In the primary trials, one third of the DMT and dance intervention groups were compared to active control groups. The participants followed the following tasks: listening to music, cycling, Pilates, physical exercises, psychoeducation, meditation, or relaxation exercises. Control group activity was not a significant moderator of effect, which means that the effects of DMT and dance interventions were still evident when we controlled for attention effects.

In other words, this indicates that there are specific effects of DMT and dance interventions. We compared the intervention groups to control groups that participated in physical exercises and meditation exercises. The effects of DMT and dance interventions declined but remained significant. The advantages of DMT and dance interventions were larger compared to physical exercises than to meditation.

This indicates that the change mechanisms of DMT and dance possibly lie beyond the pure execution of sports or mindfulness. The effect sizes observed in DMT and dance intervention groups were about as large as the effect sizes in meditation interventions. There is plenty of evidence that meditation interventions, for example, training programs in mindfulness-based stress reduction MBSR; Teasdale et al.

On basis of this evidence, there is also an increase in promotion and support of mindfulness-based interventions by the health insurance companies, such as free MBSR training programs at work.

Thus, observing that DMT and dance interventions seem to be as effective as meditation suggests promoting these kinds of interventions as well. Mindfulness is an important component of DMT. For example, mindful investigation of body sensations is part of DMT, with similar techniques as the body-scan exercise in MBSR training programs Dreeben et al.

Besides that, getting mindfully in contact with other people therapist or other group members is an important mechanism of change in DMT. Concerning dance interventions, there is less explicit use of mindfulness, but if we look closer, similar mechanisms of change stand out. One central component frequently mentioned in the literature on mindfulness is the termination of rumination and automatic negative thoughts, which occurs, because there is high concentration, focus on the here-and-now, and a state of mind, which allows the participant to observe feelings and thoughts from a more distant perspective non-judgmental state of mind.

Future research should investigate to what extent these mechanisms are relevant in DMT and dance intervention and how they influence the outcomes of the interventions.

Moreover, we assume that an important overarching therapeutic factor in both mindfulness practice and DMT could be introspection Price and Smith-DiJulio, Another central mechanism of change in dance and DMT might be the experience of flow Csikszentmihalyi and Csikszentmihalyi, It is based on the same principles as mindfulness, such as high concentration, absorption, focus on the here-and-now, physical presence, and joy Csikszentmihalyi and Csikszentmihalyi, In order to find out which populations DMT and dance interventions are indicated for, we investigated the influence of sample characteristics on the effect sizes.

Age range and clinical vs. We observed larger mean effects in children and elderly than in younger and older adults. At the same time, there was higher heterogeneity of results in the group of children and elderly. The fact that outcome variables in children and elderly were assessed with observation rating scales more often might contribute to these differences.

Furthermore, the larger effects in children may also have come about because there were more prevention studies or studies in educational context with children and older adults, whereas the adults were mostly severely impaired clinical populations. Prevention studies yielded larger effects but higher heterogeneity than clinical studies.

Again, this means that rather than more pronounced effects, there are outliers at the large-positive spectrum of effect sizes. From these results, we cannot come to recommendations about the indication of treatment in certain populations.

Further research is needed to ascertain moderators that produce the variety of results. Regarding outcomes characteristics , DMT is indicated when a psychological change is intended, whereas dance interventions are indicated to improve motor skills the consistent effect only occurred on those. Thus, we assessed and analyzed methodological characteristics of studies. Observation rating scales yielded the largest effect sizes followed by physiological data, motor tests, self-report questionnaires, cognitive tests, and interviews.

Some measurements may be superior to detect changes or more sensitive to certain risks of bias, therefore producing larger effects than others. For example, observation rating scales and self-report questionnaires are more likely to be affected by expectation effects, which will be discussed further in the limitations of the present study paragraph.

However, it is important to mention that method effects can also systematically bias the results. There was also a correlation between country of publication and methodological characteristics of the trials risk of bias, randomization, sample size , with both factors having a slight influence on the observed effects. This is not surprising, because standards and traditions of research vary between countries. In countries with less evidence-based research traditions, methodological standards tend to be less strict and resulting effects tend to be larger.

However, the effect of country could also be related to other cultural factors such as experience with the specific dance form, or the sub- cultural value system around dance, which may all influence motivation for and responsiveness to treatment. We also analyzed whether the intensity of treatment had an influence on effect sizes.

The intensity of treatment was indicated by three factors: duration of the whole treatment, duration of one session, and frequency of treatment. None of these factors reached significance.

In the last paragraphs, we discussed moderators that showed a significant influence on the effects of DMT and dance in our sensitivity analysis. However, we assume that there are more potentially important moderators of effects , which we were not able to address in our analysis.

In the literature, there are factors that we can allocate to four clusters: a factors that relate to characteristics of the participants, b factors that relate to characteristics of the intervention, c factors that relate to characteristics of the implementing person, and d factors of environment and factors that relate to the relation between persons involved. Firstly, we will discuss characteristics of participants.

Savill et al. They performed a secondary analysis with the data of a large multicenter randomized controlled trial by Priebe et al. To approach this issue, we also assessed percentages of female participants in intervention and control groups in our meta-analysis.

We conducted a sensitivity analysis using the total percentage of female participants and the relation between female and male participants of intervention group and control group as a moderator. We found no significant influence of gender.

Thus, future research needs to investigate whether gender is an important moderator of effects. Further potential participant-related factors are self-efficacy or outcome expectations Murrock and Madigan, , attitude toward intervention treatment adherence, motivation , and previous dance experiences. Regarding characteristics of DMT interventions, there is a high variety of methods and therapeutic styles, because only a few of the trials included manualized implementation of treatment Martin et al.

Dance instructors used many different dance styles and teaching approaches. Although it was not possible in our meta-analysis, it would be useful to investigate differences between the effects of several methods and styles in the DMT and dance spectrum, in order to gain more knowledge about differential indications Koch, and therapeutic factors. In her meta-analysis, Peters found qualification of therapist to be a significant moderator of effects.

Concerning environmental factors, she discussed the influence of social support. Murrock and Madigan found that social support from friends mediated the effect between culturally specific dance and lifestyle physical activity. Finally, as in most therapeutic interventions, the relationship between the therapist and the participant is important Grawe et al.

As previously mentioned in the Introduction, the relationship between participants group cohesion is also assumed to be an important mediator of effects Schmais, , ; Yalom, in interventions that are conducted in a group setting. It is always difficult to observe long-term effects in meta-analyses.

In our sample, only eight of the included trials reported follow-up data mean period: 22 weeks. The analyses yielded various results, but most effects remained constant or increased. Regarding the encouraging follow-up findings, we assume that DMT and dance interventions have the potential to initiate a learning process body access, interoception, insight that might instigate positive changes several months after the intervention.

Additionally, it is plausible that the permanence of effects depends on the participants' behavior after the intervention, such as revising what they have learned, continuing dance or movement classes, or maintaining contact with the other participants.

Further research needs to follow to investigate long-term effects and their moderators. One of the biggest limitations of our present study was the heterogeneity of results, which occurred due to mild inclusion criteria and various study characteristics of the included trials. The heterogeneity mostly concerned the dance intervention studies, whereas the DMT studies were rather homogeneous.

Heterogeneity was caused, for example, by dissimilarities in methodological designs of studies, methods of interventions, and sample characteristics. Besides that, we observed effects on several different health-related psychological outcomes. For this reason, we employed a random-effect model, which considers that not all studies measure the same effect. Such results are less conclusive. However, we should be aware that we lose specific information about discrete sorts of fruits and mostly create a starting point to generate useful hypotheses for future, more specific secondary analyses and primary trials.

Our meta-analysis is one of the first in the field to conduct sensitivity analysis , which is one approach to deepen the understanding about the sources of heterogeneity. Nevertheless, it is impossible to detect all important factors and to draw firm conclusions about causal relationships between those factors.

The strength of our paper is that it provides a broad overview of current research on the therapeutic use of dance as an orientation for researchers summarize findings, identify explanatory variables, help identifying research gaps and develop research questions, control standards of research. It informedly transfers knowledge about the effectiveness of DMT and dance interventions to practitioners, clients, and public decision-makers. However, the disadvantage of broad analyses is that we only obtain results for a rough orientation.

It is the assignment of secondary analyses with more narrow research questions such as provided in Cochrane Reviews for single clinical populations to gain sharp and more detailed knowledge about the effectiveness of DMT and dance interventions and the interdependency with contributing contextual factors.

In the present study, we also included studies with considerable methodological constraints e. The most important question is how much the methodological constraints may systematically bias the results reported in this paper the weighted medium effect sizes. We approached the methodological variety of primary trials with sensitivity analysis.

There was a tendency that more outliers, especially with large effect sizes, were studies with more severe methodological constraints. This might be a hint that studies with more significant methodological constraints tend to overestimate the effects of DMT and dance.

Since all of these problems were more pronounced in the dance intervention studies, one resulting recommendation is to separate DMT and dance intervention studies in the next general meta-analysis. By guessing the goal of the research, participants try to comply with its assumed goal Rosenthal, Thus, self-report-questionnaires or observation rating scales are more prone to bias than cognitive, physiological, or motor test, which are somewhat less subjective, but still reactive note that the reactiveness of measurement type ranked differently in our study as indicated above.

Furthermore, it is possible that researchers tend to analyze, interpret, and report results in favor of positive effects, because of their own expectancies or potential conflicts of interest. Another critical element that might contribute to the fact that higher-risk studies yielded larger effect sizes could be publication bias.

One criterion of methodological quality of study was sample size. If there is publication bias, smaller studies yield larger effects, on average, because smaller studies, which did not detect positive effects, remained unpublished. In the distribution of our sample of primary trials, there was a small tendency for publication bias, which did not affect our results significantly see Methods section. Furthermore, smaller studies yielding larger effects could also be explained by the fact that, in smaller samples, the intervention was more tailored to the individual and therefore more focused.

Apart from quality of included trials, quantity of studies is also a matter in meta-analysis. Compared to Koch et al. The advantage of a bigger sample per outcome would be that more homogeneous clusters could be considered and addressed with sensitivity analysis. In addition, several included trials were conducted by the same research group total: 7 of 41 trials by Koch et al. This is particularly relevant, when it comes to analysis of clusters DMT group: 7 of 21 trials, clinical outcome cluster: 4 of 12 trials, interpersonal skills trials: 2 of 6 studies by the research group of Koch et al.

Finally, there is a general discussion on the issue of whether quantitative analyses are the appropriate means to evaluate the therapeutic use of dance. Borg stated that the dilemma of scientific positivistic research in behavioral sciences is that it applies traditional concepts of physical science to the study of living organisms, although living organisms are far more complex than physical objects of study.

The authors imply that naturally dynamic, interdependent networks of factors involved in psychological phenomena are sometimes hard to detect when we apply concepts of causality, predictability, and scientific reducibility. This argument is underlined by a vivid discussion on the ecological validity of studies reducing complex processes, such as an aesthetic experience or the impact of art perception and production on health, into its single components see e.

While quantitative methods are helpful for generating facts and explanations, qualitative methods might be more suitable for meaning-making and understanding of such Berrol, In order to overcome the gaps between a non-linear reality and linear means of investigation, and to generate new scientific insights, quantitative research ought to be applied together with qualitative research, ideally in mixed-methods designs that reflect the epistemological background assumptions of the studied processes.

Hervey takes the discussion a step further by stating that artistic inquiry is needed to adequately reflect the results of such process-oriented domains as DMT. She introduces the concept of artistic inquiry, as part of arts-based research to DMT, which implies the use of the respective art form dance not only as an intervention to help the recipient but also as a form of data assessment, analysis, and presentation that aims at answering the research question.

Leavy's textbook is the basic source for arts-based research today, providing a terminological and historical overview and best practice examples of arts-based research. Best practice examples of specific and particularly well-described arts-based research methods are Jola's embodied neuroscience Jola, , and Eberhard's aesthetic answering Lange et al.

However, at this point, final recommendations about arts-based research as a method are difficult, because the field is young and in a dynamic development Leavy, Generally, non-verbal methods employing DMT or dance may detect changes in psychological outcomes that are not necessarily accessible with traditional methods and thus create innovative knowledge.

This meta-analysis shows that quantitative research on the therapeutic use of dance is augmenting. However, there is still an urgent quest for more trials with rigorous standards in respect to the chosen way of research quantitative, qualitative, arts-based. Quantitative trials should consider larger sample sizes, randomized controlled designs, and active control groups, which compare DMT and dance interventions to other psychotherapeutic interventions with existing knowledge about therapeutic mechanisms different types of psychodynamic therapies, cognitive behavioral therapy, pharmacological therapy.

Furthermore, a detailed description of the intervention and its implementation is necessary e. To avoid bias, there should be as much blinding as possible involved in the process. While complete blinding is not possible in therapy studies and should thus not be part of the quality assessment of therapeutic trials to add this critique here , blinding of the randomization process and the accessor should be standard.

Researchers ought to employ assessment tools that are least sensitive to expectation effects e. All relevant treatment conditions should be reported in as much detail as possible e.

Statistical results should be reported in detail including results that were not in line with the central hypotheses of the papers and descriptive statistics means, standard deviations, and sample sizes in each group.

To provide information on the impact of a treatment, long-term effects must be considered. Therefore, we highly recommend including follow-up assessment in intervention studies on the therapeutic use of DMT and dance. In order to obtain more comparable research across the globe, there should be more communication between researchers, and they should strive for international standards. We recommend researchers conducting future meta-analyses to include more precise assessment of risk of bias, than was possible here.

In addition, systematic analyses of moderators of effects should be performed in the future. Because we observed many dissimilarities between DMT and dance intervention studies, we recommend analysing those two types of studies separately in future studies. Finally, to draw conclusions for practice, there is a need to complement quantitative research inquiry with qualitative and arts-based research best in mixed-methods designs, reflecting the epistemological framework and with clinical mechanism studies.

Priebe et al. Small improvements in expressive deficits and movement disorder symptoms were detected in favor of body psychotherapy. No other outcomes were significantly different. The NESS paper's data were mixed though, and further analyses in the secondary trial of Savill et al. Pilates , and the selective reporting and shortfall in conclusions, which do not appropriately reflect what is evidenced in the data e.

In the context of the mechanism problem, we will merely discuss the second argument here. Active control groups are recommended for most studies by the increasing standards of the evidence-based medicine.

From the perspective of DMT though, with its present pronounced research on therapeutic mechanisms, Pilates is not a suited control group to DMT. In Pilates, the torso is the focus of the work, the muscle tone is actively controlled and altered in specific regions of the torso, the muscles are strengthened and stretched, and the practice includes breath work for bringing the movements of the torso in resonance with the breath.

In DMT theory, the torso is the seat of the emotions, and the breath brings the emotions to the fore: on the basis of DMT core knowledge, the work with the torso and breath is the direct pathway to sensation, experience, and expression of emotions e. While we know very little about the mechanisms of BPT and DMT, we know even less about the mechanisms of Pilates and other body practices. Thus, it is very difficult, if not impossible, to select suitable active control groups for DMT studies, without any knowledge of either intervention's main mechanisms.

This example shows that good outcome research needs scholarly mechanisms research Hayes, and that there is a strong interdependency between these two types of clinical research. As long as the major mechanisms of these therapies remain unclear, it is hard to draw any valid conclusions from the according outcome research.

With this paragraph, we hope to have illustrated the urgent need for mechanisms studies due to their intricate interdependency with outcome research. In conclusion, the results of our meta-analysis suggest that therapeutic use of dance potentially affects various health-related psychological outcomes. In total, there was a medium significant overall effect based on heterogeneous results. However, since type of intervention was a significant source of heterogeneity, we explored trials on DMT and trials on dance interventions in two separate groups.

We found empirical evidence that DMT consistently and with a high homogeneity improved affect-related psychological conditions by decreasing anxiety and depression levels, and increased quality of life and cognitive skills.

More high-quality primary studies need to be conducted and included into meta-analyses to expand the evidence. Dance intervention studies consistently improved motor skills, while findings for the other outcomes had a high heterogeneity.

Results of this meta-analysis suggest that DMT and dance interventions improve clinical outcomes, cognitive outcomes, and psycho- motor outcomes. The high variability of results, especially in the dance cluster, needs further attention.

Moreover, this study contributes initial findings that DMT and dance interventions have persistent long-term effects. These encouraging results are limited by methodological shortcomings of the primary studies. Further research is needed that expands on the evidence of effects of DMT and dance interventions on health-related psychological outcomes. LM and KT did the systematic literature search. RR and AB planned and implemented the methodological approach, AB supervised the methodology of the study.

RR analyzed the results and wrote the first draft. All authors contributed to the paper and revised it into its final version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. We would like to thank all colleagues who have supported us to find relevant literature, and all authors of primary studies who helped to clarify data issues. Thanks to all participants of the primary studies for completing the scales and driving research on embodied interventions further.

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She was recruited to work with patients who were nonverbal and markedly withdrawn and shutdown; her reputation for using dance as a means of expression and communication was widely known. Chace had great success in reaching nonverbal psychiatric patients.

She reached them through the power of moving, physical interaction, and dancing with them. Chace would play music and interact with patients through mirroring their movements, establishing eye contact, engaging in physical contact, and waltzing to rhythmic steps Chaiklin, Patients responded well to to the methods she employed.