Literature Review: Dance Movement Therapy

Introduction

Mental health studies frequently study the ways that the slow pace of our brain evolution when compared to the much faster rate of change in the modern world may lead to maladaptation and poor mental health outcomes. Perhaps it is worth studying the aspects of human culture that have been let go in recent decades and whether reintroduction of long held customs may improve overall health of populations. Throughout history, dance has served as a language, passing down rich ancestry stories in Hawaiian populations, celebrating coming of age in Native American populations, and building social bonds in all cultures. While dance still exists, it largely fell out of American popular culture in the 1940’s at the dawn of World War II. It was also at this time that dance movement therapy (DMT) was established, and “spread in Eastern countries and worldwide beginning in the 1990s” (Koch, Sabine C., 2). 

Dance movement therapy is defined as “the psychotherapeutic use of movement, based on the assumption of the interconnection of body and mind, and the healing power of dance” (Koch, Sabine C., 2). Since its invention research has grown substantially “from 1.3 detected studies/year in 1996-2012, to 6.8 detected studies/year 2012-2018” (Koch, Sabine C., 1). Studies have observed the effects of dance therapy on conditions of “quality of life, clinical outcomes (with sub-analyses of depression and anxiety), interpersonal skills, cognitive skills, and psychomotor skills” (Delattre et al., 2). Studies have also been done in populations of various ages and on adult groups with Parkinson’s disease (Delattre et al., 2).While many studies have demonstrated the efficacy of dance movement therapy for improving clinical mental health outcomes, there are significant gaps in the current research and studies are heterogenous. Data-oriented, well formed studies with control groups should be used to determine whether dance therapy is uniquely effective for improving symptoms of PTSD in women who have experienced assault.

Research Review

  The breadth of studies on dance therapy have yielded consistent results that “DMT decreases depression and anxiety and increases quality of life and interpersonal and cognitive skills” (Koch, Sabine C., 1). The dearth of studies observe multiple styles of therapy, many health conditions, and many different populations. It is difficult to assert anything specific from the current body of research. Although it is not certain why dance therapy yields such positive results, it is undeniable that it does. Much of the recent research synthesizes and clusters previous findings without employing new trials.

Capturing specific results of DMT first requires a consistent classification system. A 2023 study utilizes previous work to propose a “novel classification system for social dance mental health research” (Delattre et al., 1). They draw attention to the fact that many factors play a part in positive health outcomes including, “moving in synchronization, the music that accompanies their movements, maintaining eye contact with others, and physical activity”, just to name a few (2). Through the lens of dance research effects on depressive disorders they create five distinct components dance practitioners may employ: solo dance, partner dance, group dance, DMT, and cooperative movement. By parsing studies into these specific categories they are able to more easily cluster therapeutic techniques and positive outcomes.

All five of the categories showed to be effective in treating depression. However, some appeared to have longer lasting and preventative effects. Even though they observed depression, they noted that “interventions have also been associated with decreases in anxiety and stress” (Delattre et al.,19). This finding was repeated in a 2023 study where a systematic review of 10 studies found dance can “increase self-esteem, decrease anxiety, and stress, and improve motivation” (Moratelli, ,9). A 2014 study on a 12-week dance intervention in older, underserved adults supported “dance as a possible adjunct intervention for depression” (Murrock, 4). Here a specific age pool of 45-87 ranging in weight from 108-305 pounds in an underserved community were offered a 12-week, moderate-intensity dance intervention were taught by an experienced dance instructor, leading a total of 24 classes. The baseline data collected on weight, percent body fat, body mass index and depression via the CES-D and LLFDI intakes were compared to the results at the end of the twelve week period. Dance appeared to improve physical function and overall feelings of depression. (Murrock, 4). This study was well designed, targeting a specific control group that shared many life circumstances in common and collecting specific quantifiable data over a set period of time. While it yielded positive results, it was a small sample size of 40 participants, requiring further data. This serves as a good example for the type of study that could be designed to observe results in a controlled group of women with PTSD.

A recurring question inquired whether the benefit of dance therapy may not be a result of music exposure more than the dance itself. To further explore this question a 2009 study compared results of tango groups without music, to those with music, and those with both music and tango. “Quiroga Murcia and colleagues found the most positive effects on emotional state in the condition with partnered tango and music” (Delattre et al., 13). 

Another question of causation is around social movement more generally as related to dance. Many cultures, particularly in the east incorporate movement in social customs that help groups function better together. This is seen in the Sun Dance and Pow wow ceremonies and ritual storytelling such as Hawaiian Hula dance. Hula has been used for centuries to connect the modern generation to the stories of their ancestors. In 2021 a six month behavioral intervention observed the effects of a cultural dance program for reducing hypertension in native Hawaiians. Native Hawaiians have “higher hypertension (HTN) and cardiovascular disease (CVD) rates than non-Hispanic whites” (Kaholokula et al., 1). Both of these conditions are stress-related illness which makes this study potentially relevant to PTSD, another stress related illness.

The indigenous population of Hawaii is “70% more likely to have HTN and 3-4 times more likely to have coronary heart disease and stroke” (Kaholokula et al., 2). It has been speculated that this is related to systemic stress and separation from culture. Hula, which is “a traditional cultural dance of Hawi’i” connects them to their “native language, history, and natural environment” (Kaholokula et al., 2). It is a form of sign language that brings people together, entertains, and combines embodiment with movement. The six month study, which reconnected Hawaiins to their native Hula dance yielded positive results. Retention was high, and of the 263 participants it was 80% more likely to achieve a BP stage in a healthy range. Future studies should emulate the study design to determine if dance intervention improves physical and mental markers of stress in PTSD populations.

There is certainly precedence and space for further research on dance for women suffering from PTSD. A study should be designed that intakes women with similar age, socio economic status, and PTSD diagnosis, offering them a dance therapy intervention spanning multiple months. Intakes for PTSD at outset will be compared to intakes forms for PTSD at the middle and end of treatment. The study can check in one year after completion to see if participants continued dancing, and if so how health outcomes differed in those who did and did not continue. A similar study will be performed using social group exercises that are less focused on embodiment such as kick-boxing and social group exercises that are focused on embodiment such as yoga. By controlling in this way researchers can assess whether dance, embodiment, or socialization are more or less effective. Other variables could be controlled for in the future such as mixed-gender classes versus women only, and individual versus group dance. There is also a potential that women who have suffered from sexual assault may benefit from dance oriented around women and sensuality. Controlling for these various elements will determine which aspects are most therapeutically valuable, or if there is something more unique about the specific combination provided in dance with a group of supportive women.

Conclusion

The positive mental and physical health outcomes of dance therapy, and the ability to be practiced in groups outside of a clinical setting make it a promising intervention to heal and maintain symptoms of anxiety and depression. While research related to PTSD is sparse, the common comorbidity of PTSD and anxiety, as well as the embodiment and social support in dance, suggest that it may be a useful intervention. Studies should be designed to research the efficacy of dance for treatment of PTSD. It is possible that many people who experience assault or severe trauma learn to dissociate from their bodies in a way that can be broached through movement. 

Things to consider in clinical studies may be: in what contexts and modalities does DMT appear to have the most success, and how does movement provide healing in ways that typical talk therapy or other forms of social movement may not. The research will have quantitative components as most of the studies perform numerical analyses on self reported metrics of mental health efforts. These statistics along with a clear, consistent classification system, and use of control groups with talk therapy and other forms of social movement, will help determine whether dance is a unique and positive clinical solution for stress-related disease.