With children and adolescents, Cox et al.
They did however, raise high risk of suicidal thoughts in association with antidepressant medication, making psychological interventions potentially safer interventions to use. For older people with depression, the review by Wilson et al.
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However, these approaches rely heavily on verbal interaction. Exercise, although not a form of psychotherapy, offers a non-verbal approach to the treatment of depression that is gaining popularity, finding its way into the draft guideline from NICE.
Still, the Cochrane review of the literature on this topic by Cooney et al. DMT is one such option. Therefore, it can potentially bypass social or cultural barriers. Karkou and Sanderson argue that DMT, alongside other arts therapies art therapy, drama therapy, and music therapy are the other arts therapies practiced in the UK offers an attractive option for clients since it allows them to work through issues that are located at a non- and pre-verbal level.
Thus, DMT may offer a way to work through issues that are difficult to articulate or are buried in the unconscious because they are painful, frightening, or simply difficult to access and address through cognitive means. DMT as a form of psychotherapy is extensively discussed by authors such as Meekums , Karkou and Sanderson , Payne , Payne , and Levy In particular, Meekums discusses DMT as a creative form of psychotherapy. Following on from her theory-generating doctoral research Meekums, , Meekums argues that the therapeutic process follows the same pathway as the creative process.
This process comprises the following phases: preparation, incubation, illumination, and evaluation. Moreover, she identifies the central importance of the movement metaphor within this process, including its links to body memory, body language, and mediation of the therapeutic relationship.
DMT has also been researched as one of the arts therapies by Karkou and Sanderson for example, who reported on survey results Karkou, that explored similarities and differences between DMT and the other arts therapies. An updated survey 17 years later Zubala, ; Zubala et al. However, similar to the work by Meekums , , these studies focus on defining the field and identifying relevant processes and do not attempt to answer questions of effectiveness. With regards to effectiveness, Cochrane reviews in DMT with different client groups are available, albeit often with a small number of studies included.
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For example, next to the Cochrane review on depression mentioned above Meekums et al. The difficulty in capturing the effectiveness of this field with different client populations when the included studies were limited to designs of RCTs is apparent in these highly stringent systematic reviews. In contrast, a larger number of studies was included in the meta-analysis by Koch et al. Of the total 23 studies included, ten studies with RCT and controlled trials included measures of depression total scores or subscales.
A moderate effect of DMT and dance on depression was reported. However, in addition to the diverse research designs, populations were equally diverse not confined to depression , and interventions included any form of dance practice not solely DMT.
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Following an early scoping review of the literature Mala et al. The Cochrane review identified three studies that met the criteria for inclusion participants. A sub-group analysis suggested that for adults, there was evidence of a positive effect for DMT in reducing depression. However, the evidence was too thin to allow any firm conclusions due to the low number of studies and associated number of participants and the varying, generally low, quality.
The authors discussed the potential contribution of dance as a central component of DMT to generate vitality, even joy, for clients who, due to their depression, lacked animation. They supported this claim with reference to a seminal theoretical article by Schmais and recent empirical studies including Koch et al. The positive contribution of music and music therapy in decreasing levels of depression has already been demonstrated Aalbers et al.
Although music is not an essential component of dance practice in a DMT context, its regular use may act as a supporting component to the central active ingredient of dance with this client population. The presence of a therapeutic relationship is a key difference between dance as a sensitive form of teaching or community practice on the one hand and DMT as a form of psychotherapy on the other Karkou and Sanderson, , , ; Meekums, This relationship is also highly valued as an agent of change for clients with depression who often experience isolation and loneliness.
Literature in humanistic and existential approaches to psychotherapy e. In more recent years several psychotherapists argue that this relationship is also the main agent of therapeutic change and directly linked with therapeutic outcomes Ardito and Rabellino, ; Stamoulos et al. In DMT, the therapeutic connection can take the shape of an embodied relationship, particularly present in the model developed by Chace Chaiklin and Schmais, The technique of mirroring 2 is frequently used in this practice as a way of enhancing embodied relationships McGarry and Russo, ; Fischman, and discussed with regards to studies in neuroscience Meekums, ; Berrol, ; Rova, The sensori-motor mirroring system Rizzolatti et al.
Another reason why DMT might be an effective intervention is its capacity to tap into unconscious, hard to reach or taboo feelings and thoughts.
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Imagery, symbolism and metaphors are important DMT tools in this process. Activating imagination is a component of DMT that was discussed as early as Dosamantes-Alperson in the context of the approach known as Authentic Movement 3 Whitehouse, ; Pallaro, ; Chodorow, Active imagination allows access to difficult feelings, and anger in particular, which for people with depression may be internalized, attacking one's own self Freud, With this psychodynamic explanation of depression in mind, it is therefore possible that imagination might act as a vehicle to express difficult emotions and, through symbolism and metaphor, to process them in a safe way, finding resolutions to one's underlying difficulties Meekums, ; Karkou and Sanderson, This proposition suggests that DMT could have profound and long-lasting effects that are not present for interventions that do not address the underlying reasons for depression.
As early as , Schmais argued that integration between mind and body is a key therapeutic factor for DMT. In practice integration can happen through reflecting on movement material that may or may not be congruent with one's own thoughts and feelings. Exploring new and unexpected connections between known things, i.
Finally, summarizing one's experience of therapy in a movement sequence or a symbolic posture or gesture can act as an essential and potent reference back to the process of therapy. Movement material can therefore, act as a form of story-telling, a movement and embodied narrative of key moments in the therapeutic journey Karkou, While there is growing research evidence in the field Zubala and Karkou, , DMT remains largely under-funded and thus, under-researched.
RCTs, the gold standard for assessing the effectiveness of an intervention Higgins et al. Furthermore, as discussed above, RCTs pose limitations when applied to complex interventions. Since DMT is indeed a complex intervention, other research approaches need to also be considered.
Quasi-experimentation, a predominant approach adopted in DMT research, may reveal important information that is typically overlooked and omitted from many systematic reviews. In this review we attempt to change this. To explore evidence of effectiveness in the use of DMT with people with a diagnosis of depression. What patterns emerge from the collected evidence relating to the severity of depression, the setting and overall context, the length, duration or type of intervention? Is there evidence of effectiveness for DMT in decreasing levels of depression when pre and post-treatment scores of depression are compared?
Is there evidence of long-lasting effects of DMT on scores of depression? Is there evidence of effectiveness when DMT is compared with no treatment, treatment as usual TAU or another treatment? Is there evidence of effectiveness of DMT in the treatment of depression based on studies with high quality, i. To synthesize results from all studies of effectiveness of DMT for clients with depression.
To establish effect sizes within groups, comparing pre and post scores on depression immediately after treatment and at the time of follow up. To establish effects sizes between groups, comparing end scores between the experimental and control groups for all RCT designs and for those with low risk of bias.arbourhotsmet.ml
The effectiveness of expressive arts therapies: A review of the literature
A systematic literature review was chosen as the best way to answer the main research question and as the most highly valued methodology of synthesizing evidence from different studies. According to Higgins et al. In this review, conventions and processes used in Cochrane reviews Higgins et al. However, unlike the restrictive inclusion criteria of Cochrane reviews, a more open approach to the choice of studies was followed, aiming to offer a more comprehensive picture of available evidence on the topic. In this review, both a qualitative meta-synthesis and a quantitative meta-analysis of the reviewed studies are provided.
While the former retains a narrative character, the latter involves the use of statistical calculations that enable a quantitative synthesis of data from several studies. The analytic framework and its alignment with the main and sub-questions of this review is presented in Figure 1. As indicated in this diagram, a qualitative meta-synthesis was conducted see no. As an exploratory study, a few meta-analyses were also performed to answer the four remaining sub-questions as follows:. The first meta-analysis was conducted in response to the second question i. Long lasting effects were considered through a subgroup analysis of this initial set of studies in which only studies with follow up scores on depression were included see no.
The third sub-question was considered in this calculation i. The third meta-analysis summarized the effect size for RCTs only i. All RCTs were considered as well as studies with quasi-randomization or systematic methods of allocation.