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Previous studies indicate that mindfulness interventions and physical activities can produce positive effects on mood disorders; such activities may be options for individuals who search for non-traditional therapies, or whenever mainstream psychological treatments are not effective. We explored the effects of tango dance, meditation, and exercise (circuit training) in individuals with self-reported depression. Participants were randomly placed into meditation, exercise, tango dance, or control-wait-list groups. Sixty-four participants completed the 8-week program and were assessed before, after, and at 1-month follow-up. The dependent variables were depression, anxiety, stress, fatigue, and insomnia (symptoms measures), and self-efficacy, satisfaction with life, and mindfulness (positive psychology measures). Treatment scores were compared with the control group scores. The meditation group showed benefits at follow-up for depression, stress, and satisfaction with life. The exercise group showed decreased depression and increased self-efficacy at post-test, but only self-efficacy was persistent at follow-up, whereas stress was just significant at follow-up. The tango group showed decreased depression and insomnia and increased satisfaction with life and mindfulness at post-test. All, except for satisfaction with life, were persistent at follow-up, while stress and anxiety improved only at follow-up. As expected, the control group maintained similar scores across pre-test and post-test, and at follow-up. Tango dance was shown to induce a broader and more persistent range of benefits. Meditation produced lasting benefits only when well-learned and practiced, whereas exercise generated rapid benefits, but, except for self-efficacy, temporary. Such differences may provide valuable information when promoting these activities to best match the individual needs within this population.
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Tango Dance Can Reduce Distress and Insomnia
in People with Self-Referred Affective Symptoms
Rosa Pinniger
Einar B. Thorsteinsson
Rhonda F. Brown
Patricia McKinley
Ó American Dance Therapy Association 2013
Abstract Previous studies indicate that mindfulness interventions and physical
activities can produce positive effects on mood disorders; such activities may be
options for individuals who search for non-traditional therapies, or whenever
mainstream psychological treatments are not effective. We explored the effects of
tango dance, meditation, and exercise (circuit training) in individuals with self-
reported depression. Participants were randomly placed into meditation, exercise,
tango dance, or control-wait-list groups. Sixty-four participants completed the
8-week program and were assessed before, after, and at 1-month follow-up. The
dependent variables were depression, anxiety, stress, fatigue, and insomnia
(symptoms measures), and self-efficacy, satisfaction with life, and mindfulness
(positive psychology measures). Treatment scores were compared with the control
group scores. The meditation group showed benefits at follow-up for depression,
stress, and satisfaction with life. The exercise group showed decreased depression
R. Pinniger (&) E. B. Thorsteinsson
School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale,
NSW 2351, Australia
E. B. Thorsteinsson
R. F. Brown
Australian National University, Canberra, ACT, Australia
P. McKinley
McGill University, Montreal, QC, Canada
P. McKinley
Centre Interdisciplinaire de Recherche
en Re
adaptation du Montre
al Metropolitain,
Montreal, QC, Canada
Am J Dance Ther
DOI 10.1007/s10465-012-9141-y
and increased self-efficacy at post-test, but only self-efficacy was persistent at
follow-up, whereas stress was just significant at follow-up. The tango group showed
decreased depression and insomnia and increased satisfaction with life and mind-
fulness at post-test. All, except for satisfaction with life, were persistent at follow-
up, while stress and anxiety improved only at follow-up. As expected, the control
group maintained similar scores across pre-test and post-test, and at follow-up.
Tango dance was shown to induce a broader and more persistent range of benefits.
Meditation produced lasting benefits only when well-learned and practiced, whereas
exercise generated rapid benefits, but, except for self-efficacy, temporary. Such
differences may provide valuable information when promoting these activities to
best match the individual needs within this population.
Keywords Dance Exercise Meditation Mindfulness Mood disorders Tango
Depression is becoming an increasingly prevalent condition, affecting *121
million people globally, and it is expected to become the second leading cause of
disease burden worldwide by 2020 (Chapman, Perry, & Strine, 2005; Murray &
Lopez, 1996; WHO, 2012). Access to effective treatment can be problematic for
some people, especially if they are unaware of the range of available therapies, find
them difficult to access or ineffective, or if they do not wish to be labeled as having
a mental illness (Hollon, Thase, & Markowitz, 2002; Ree & Craigie, 2007; Turner
& Rosenthal, 2008). Additionally, people with self-reported affective symptoms
(e.g., anxiety, depression) are also more likely to use complementary and alternative
therapies than mainstream and primary care treatments (Kessler et al., 2001). Thus,
a broader range of new and effective treatment strategies, including complementary
and alternative therapies, is required to meet this growing demand.
Interventions that utilize meditation practice, such as Mindfulness-Based
Cognitive Therapy, have previously been shown to be successful in treating
depression (Kingston, Dooley, Bates, Lawlor, & Malone, 2007; J. D. Teasdale, Z.
Segal, & J. M. G. Williams, 1995). The purpose of these therapies is to normalize
one’s thinking patterns so that mild sadness does not escalate into a more severe
state (Lau & McMain, 2005). In contrast, treatment approaches that include exercise
as a component have also been reported to improve depression outcomes (McAuley,
Jerome, Elavsky, Marquez, & Ramsey, 2003), and some of these therapies are
reported to show similar or better efficacy than antidepressant treatments,
suggesting there are effective alternative approaches for people who do not wish
to take antidepressants (Daley, 2008; Phillips, Kiernan, & King, 2003).
Dance has recently been examined as a physical activity which may improve
physical and psychological well-being (Quiroga Murcia, Bongard, & Kreutz, 2009).
Along with the physical benefits of exercise, dance includes the elements of social
interaction, connectedness, and awareness of another person’s body when moving in
a synchronized fashion (Behrends, Mu
ller, & Dziobek, 2012; Mala, Karkou, &
Meekums, 2012). In particular, dance is reported to be an effective adjunct to
standard depression therapy (Koch, Morlinghaus, & Fuchs, 2007). Further, an
Am J Dance Ther
earlier study of 12 psychiatric inpatients provides support for the antidepressant
effects of dance/movement therapy as a complement to standard depression
treatment, and the main components of the program focused on concentration,
awareness of body boundaries, and social cohesion (Stewart, McMullen, & Rubin,
1994). A recent randomized-controlled trial (RCT) of tango dance has also reported
that, similar to meditation, this activity can significantly reduce depression, but can
also decrease stress and increase mindfulness relative to wait-list controls (Pinniger,
Brown, Thorsteinsson, & McKinley, in press). However, in this study, tango dance
was the only exercise-based activity; thus, it was not possible to exclude general
improvement in physical health as a probable cause. To address this issue in the
present study, we assessed the efficacy of tango dance in relation to an exercise-
based activity (i.e., circuit-training), as well as meditation and wait-list control
Tango dance evolved in Buenos Aires, Argentina, and Montevideo, Uruguay, at
the end of the 1800s. Nowadays, it is danced in cities all around the world by a
diversity of people and cultures (Seyler, 2007). Tango is described as a ‘walking
embrace’ that can easily be implemented in a wide range of clinical populations, as
it is claimed that anyone who can walk can learn the dance (Jacobson, McKinley, &
Rainville, 2006). Several international studies have recently shown that tango dance
is effective in the clinical context, in Canada (McKinley et al., 2008), the United
States (Hackney, Kantorovich, Levin, & Earhart, 2007), and Argentina (Peidro &
Comasco, 2007). However, these studies only evaluated improvements in physical,
rather than psychological, function. Thus, in this study we will examine the effects
of tango dance on an expanded range of symptoms, including psychological stress,
anxiety, depression, insomnia, and fatigue, as well as the positive psychology
constructs of self-efficacy, satisfaction with life, and mindfulness.
Regarding the above symptoms, insomnia is a risk factor for developing
depression and depression relapse (Buysse et al., 2008; Jindal, Buysse, & Thase,
2004), and depressed people with severe insomnia tend to display worse overall
functioning than those with depression and no insomnia (O’Brien et al., 2011).
Fatigue is also a commonly reported symptom in the primary care setting (Hickie,
Koschera, Hadzi-Pavlovic, Bennett, & Lloyd, 1999; Wessely, Chalder, Hirsch,
Wallace, & Wright, 1996) and is a core symptom of major and minor depression and
mixed anxiety-depressive disorder. Afari & Buchwald (2003) suggest that
alternative treatments, in particular graded exercise and cognitive restructuring
programs, may better treat chronic fatigue syndrome symptoms than does
conventional medical treatment (Afari & Buchwald, 2003).
Finally, the relationship between self-efficacy and depression is well-docu-
mented, with higher levels of self-efficacy predicting less severe depression
symptoms (Maciejewski, Prigerson, & Mazure, 2000). Similarly, satisfaction with
life shows a negative correlation with psychological distress (Atienza, Pons,
Balaguer, & Garcı
a-Merita, 2000), and Barriopedro, Eran
a, & Mallol (2001)
reported that seniors who engaged in a physical or group activity showed lower
levels of depression and higher satisfaction with life relative to those who did not
participate in either activity (Barriopedro et al., 2001).
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Regarding possible mechanism(s) of action, our group has previously shown that
state-mindfulness increased after six weeks of tango-dance relative to wait-list
controls, suggesting that mindfulness may have been a mechanism of action in this
activity. This is an important consideration, since people are more likely to adhere
to mindfulness-based therapies than other therapy approaches (Baer, 2003),
especially if the experience is regarded to be intrinsically positive, (Teasdale,
Segal, & Williams, 1995) as tango dance is reported to be (Trossero, 2006).
Mindfulness is a state of mind that permits people to observe their thoughts and
feelings as transient experiences, rather than permanent aspects of self or evidence
of reality (Baer, 2003; Segal, Williams, & Teasdale, 2002). This state involves
redirecting attention away from aspects of life that cannot be controlled (e.g.
stressful situation), to that which can be managed (e.g. emotional response to the
situation). Hence, this state facilitates a detachment from negative thoughts,
ruminations, and worries (Ree & Craigie, 2007); and several recent studies have
claimed that this change in focus may underpin the observed reductions in symptom
severity (e.g., depression, pain) with this form of therapy (Masedo & Esteve, 2007;
Segal et al., 2002). Additionally, psychotherapeutic interventions that involve
mindfulness instruction have also consistently shown a positive association with
well-being, and an inverse association to somatic and psychological conditions
(Christopher & Gilbert, 2010; Mason & Hargreaves, 2001), and these interventions
are effective in reducing depression relapse (Teasdale et al., 2000).
Activities that focus people’s attention on aspects of the present, for example by
learning new physical skills, are reported to produce an indirect improvement in
psychological health (Dimidjian & Linehan, 2003). In particular, activities which
direct attention to body posture, movement, and awareness of present moment
experience may interrupt a person’s thoughts about the past and fears about the
future, reducing any associations between negative thoughts and later affective
symptoms (Toneatto & Nguyen, 2007). Similarly, tango dance is described as an
absorbing and highly improvised activity, requiring a strong connection with a
partner, significant skill acquisition, and concentration on the present moment
(Dinzel, 1999; Nau-Klapwijk, 2006), and it has been shown to be sufficient to
enhance mindfulness in people participating in the activity (Pinniger, et al., in
press). For example, tango partners are challenged to move as one in a synchronized
movement, with one partner stepping where the other has just stepped. Each role
requires different skills: ‘leaders’ must improvise to keep up with the demands of
the music, and select steps that are appropriate to the level of expertise and physical
characteristics of the partner (e.g., height); whereas followers must walk backwards,
and therefore they need to trust the leaders’ judgment on the dance floor, and accept
their choice of steps. Thus, three fundamental components of mindfulness (i.e.,
acceptance, trust, absolute attention, and awareness of the moment) are employed in
tango dance.
In the present study, we evaluated an eight-week RCT of weekly tango dance
sessions, in relation to two other activities of similar intensity and duration,
mindfulness-meditation and circuit-training, as well as a wait-list control group. The
study outcome measures included symptoms (i.e. stress, anxiety, depression,
insomnia, fatigue) and positive psychology constructs (i.e. self-efficacy, satisfaction
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with life, mindfulness); these were assessed at baseline (pre-test), at the end of the
program (post-test), and one month later (follow-up).
In accordance with the previously reported literature, we expected that: (a) med-
itation, exercise, and tango participants will show greater reductions in perceived
stress, anxiety, and depression between pre-test and post-test, relative to wait-list
controls; (b) meditation, exercise, and tango participants will show greater increases in
satisfaction with life and mindfulness relative to wait-list controls; (c) the above
differences will be maintained at follow-up; and (d) the remaining variables, insomnia,
fatigue, and self-efficacy, will be examined with no a priori assertions.
This study was conducted with full institutional human research ethics approval
from the University of New England, Armidale, New South Wales, Australia. All
participants provided written informed consent prior to participation; they were
informed of the voluntary nature of their participation and right to withdraw at any
time. They were recruited via advertisements placed in local newspapers, medical
centers, and technical colleges in the metropolitan area of Sydney, Australia.
Information about the study was also displayed on the University of New England
website: The inclusion criteria for the study were participant age
of 18 years or older and self-reported feelings of stress, anxiety, and/or depression.
Exclusion criteria included pregnancy, walking or balance problems (e.g. vertigo,
leg weakness), that might have affected their capacity to participate in the activities.
Based on prior tango dance trials using a similar protocol (Pinniger et al., in
press), and a power analysis using G*Power (Faul, Erdfelder, Buchner, & Lang,
2009), 18 participants were required in each group, using an alpha = .05, power
[.80, and large expected effect size (d [ 0.80). Initially 114 people responded by
telephone or e-mail to the advertisements. Seventeen people did not agree to be
randomly assigned and were therefore excluded, leaving 97 people who were
randomly assigned to one of four groups: tango dance (n = 24), meditation
(n = 24), exercise (n = 24), or wait-list control (n = 25). Sixty-four participants
completed a minimum of 6 of the 8 sessions, and their responses were analyzed.
Table 1 shows the demographic profile of the participants.
Interested people contacted the researcher and were sent an information package,
consent forms, and a hard-copy pre-test questionnaire that they completed and
returned in a reply-paid envelope prior to the study. The survey included
demographic questions (e.g. age, gender, education), and questions about their
recent experiences of perceived stress, anxiety, depression, insomnia, fatigue, self-
efficacy, satisfaction with life, and mindfulness.
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Participants were then randomly assigned to one of four groups and asked to attend
the eight-week program to which they were allocated. After the eight sessions, they
completed a post-test survey that included the same measures as at baseline. At follow-
up, all participants were mailed the same survey, which they completed and returned,
and they were also offered four free tango classes, if they so wished.
The meditation, exercise, and tango classes were each led by experienced,
registered instructors who developed special programs for this study. Meditation
classes were based on the mindfulness teaching proposed by Kabat-Zinn (1990).
Exercise classes involved a series of circuit training activities, and the tango lessons
were based on the Argentinean close-embrace tradition. All classes ran for 1
hours, as detailed below.
At the start of each meditation, exercise, or tango session, participants were asked
to relax, leave the world behind, and pay full attention during the class. They were
reminded that the emphasis was on enjoying the experience, rather than achieving a
particular outcome. This was followed by a warm-up period (*ten minutes), then
the one-hour class.
Table 1 Percentages of the demographic variables by groups (N = 64)
Variables Sample
(N = 64)
(n = 11)
(n = 18)
(n = 12)
(n = 23)
Male 10.9 9.1 11.1 16.7 8.7
Female 89.1 90.9 88.9 83.3 91.3
Marital status
Never married 47.6 36.4 55.6 45.5 47.8
Married/de facto 31.7 36.4 22.2 36.4 34.8
Widowed 1.6 N/A 5.6 N/A N/A
Divorced/separated 19.0 27.3 16.7 18.2 17.4
Year 10 or below 3.2 N/A 5.6 N/A 4.3
Year 12/HSC 22.2 N/A 33.3 9.1 34.8
TAFE certificate /diploma 23.8 9.1 22.2 45.5 56.5
University or college degree 31.7 63.6 22.2 36.4 78.3
Higher degree (post-graduate) 19.0 27.3 16.7 9.1 N/A
Employment status
Employed full-time 26.6 27.3 27.8 25.0 26.1
Employed part-time/casual 40.6 18.2 27.8 50.0 56.5
Unemployed 9.4 27.3 11.1 N/A 4.3
Retired 3.1 N/A 5.6 8.3 N/A
Student (full- or part-time) 17.2 18.2 27.8 8.3 13.0
Permanently unable to work 3.1 9.1 N/A 8.3 N/A
Country of birth
Australian 37.5 27.3 27.8 41.7 47.8
Born overseas 62.5 72.7 72.2 58.3 52.2
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In each session, a new aspect of the activity was introduced. For example, in
meditation, the first session focused on breathing, and later sessions focused on the
mindfulness of eating, body scan, walking meditation, and music meditation (Kabat-
Zinn, 1990). The exercise classes consisted of a circuit of eight to ten exercises
involving the work of each body part as follows: upper-body, lower-body, core and
trunk, and total-body. The workload was varied in each session by changing the type
and number of exercises, sets or repetitions, duration, and recovery time. In tango
dance, each session focused on a different aspect of the dance, for example the
consciousness of walking, awareness of one’s own body and that of the partner,
resistance, transference of weight, close-embrace, and understanding the different
attributes of the two roles (i.e. leader and follower).
At the end of each activity session, a ten-minute wrap-up provided the participants
with the opportunity to ask questions and share their experiences of the session.
Afterwards, they signed the sign-out sheet and indicated how often they were engaged
with their activity (i.e. almost always, frequently, infrequently, almost never).
Participants were asked demographic questions (e.g., age, gender, education,
occupation, marital status, country of birth) and about their recent exercise
participation (see Table 1). Specifically, they were asked if they had participated in
a regular aerobic exercise program (e.g., jogging) or engaged in other physical
activities (yes/no) in the prior month and, if so, how often they had performed the
activity, from 1 (once a month or less)to6(five times a week or more).
Symptom Measures
Perceived stress, anxiety, and depression were evaluated using the Depression,
Anxiety and Stress Scale, DASS-21 (Lovibond & Lovibond, 1995). This 21-item
self-report scale assesses the emotional states of stress, anxiety, and depression on
three subscales, using four-point Likert scales ranging from 0 (did not apply to me at
all)to3(applied to me very much/most of the time), with higher scores indicating
greater stress, anxiety, or depression. Internal consistencies for the subscale are high
with Cronbach’s alphas of .95 for stress, .92 for anxiety, and .97 for depression.
Factor analyses support the three-factor structure of this scale, with the subscales
showing moderate construct validity (Antony, Bieling, Cox, Enns, & Swinson,
1998). In the present study, internal consistencies were high with Cronbach’s alphas
of .85 for stress, .84 for anxiety, and .88 for depression.
Sleeping difficulty was evaluated using the Insomnia Severity Index, ISI (Bastien,
res, & Morin, 2001). This self-report seven-item scale assesses insomnia on
two subscales, degree of difficulty, and degree of dissatisfaction with current sleep,
using five-point Likert scales ranging from 0 (none)to4(very severe), and from 0
(very satisfied)to4(very dissatisfied), respectively. A total score is obtained by
summing the seven items, with high scores indicating more severe insomnia. The
scale has high internal consistency with a Cronbach’s alpha of .88 (Bluestein,
Rutledge, & Healey, 2010), and it has been shown to be sensitive to clinical
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insomnia trial treatment (Savard, Savard, Simard, & Ivers, 2005). In the present
study, internal consistency for the scale was high with a Cronbach’s alpha of .88.
Fatigue was evaluated using the Fatigue Severity Scale, FSS (Krupp, LaRocca,
Muir-Nash, & Steinberg, 1989). This nine-item self-report scale assesses functional
impairments resulting from fatigue, using seven-point Likert scales ranging from 1
(strongly disagree)to7(strongly agree), with high scores indicating more severe
fatigue. The scale has high internal consistency in adult samples, with a Cronbach’s
alpha of .88 (Neuberger, 2003). In the present study, internal consistency for the
scale was high, with a Cronbach’s alpha of .89.
Positive Psychology Measures
Self-efficacy was assessed using the General Self-Efficacy Scale, GSE (Schwarzer &
Jerusalem, 1995), that consists of ten statements related to successful coping. Each
item is answered using four-point Likert scales ranging from 1 (not at all true)to4
(exactly true), with high scores indicating greater perceived self-efficacy. The scale
has high internal consistency with a Cronbach’s alpha of .86 (Scholz, Benicio
Gutierrez, Sud, & Schwarzer, 2002). In the present study, internal consistency for
the scale was high with a Cronbach’s alpha of .90.
Satisfaction with life was evaluated using the Satisfaction-With-Life Scale, SWL
(Diener, Emmons, Larsen, & Griffin, 1985). This five-item scale is designed to
assess global perceptions of contentment with life, using seven-point Likert scales
ranging from 1 (strongly disagree)to7(strongly agree), with high scores indicating
greater satisfaction. The scale has high internal consistency with a Cronbach’s alpha
of .80 and excellent test–retest reliability (Schutte & Malouff, 1995). In the present
study, internal consistency for the scale was high with a Cronbach’s alpha of .89.
Mindfulness was assessed using the Mindful Attention Awareness Scale, MAAS
(Brown & Ryan, 2003). It consists of 15 items assessing the frequency of mindful-
states in everyday life situations, using six-point Likert scales ranging from 1 (almost
always)to6(almost never), with high scores indicating greater awareness and
attention to the present. This scale distinguishes between people who practice
mindfulness and those who do not (Brown & Ryan, 2003). The scale has high internal
consistency with a Cronbach’s alpha of .87 (Carlson & Brown, 2005). In the present
study, internal consistency for the scale was high with a Cronbach’s alpha of .89.
Qualitative Analysis
Qualitative analysis was conducted on the individual participant feedback provided for
each activity, using the five-step approach of the Empirical Phenomenological
Psychologicalmethod(EPP): (a) transcriptcomprehension(i.e.goodgrasp); (b) dividing
remarks into meaningful units (i.e. themes, topics, experiences); (c) interpreting themes
in the statements (from explicit facts to implicit meaning); (d) summarizing these for
each participant; and (e) combining the summaries into a general structure for the
participants in each group. The material was examined separately by three of the study
researchers who thensoughtagreement as to the main issues raised by the participants.A
more in-depth qualitative analysis was beyond the scope of this study.
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Statistical Analysis
SPSS (version 18) was used for all routine statistical analyses. ANCOVAs were
used to compare the effectiveness of the four intervention groups in improving the
outcome measures between pre- and post-test, with the pre-test scores used as
covariates in each analysis. The same statistical procedures were used to monitor the
benefits of the interventions at follow-up. Meaningful clinical change scores for
stress, anxiety, and depression were also determined for each activity, relative to
normed values on the DASS-42 (Psychology Foundation of Australia, 2011).
Change in clinical category (e.g., from severe to moderate depression, or mild to
absent depression symptoms) between pre-test and follow-up was assessed for each
participant, and averaged over each group.
Of the 97 participants who agreed to participate, 83 commenced the study program
(i.e. response rate = 86 %). However, after agreeing, 19 participants were unavail-
able due to work, other commitments, or attended fewer than six of the eight sessions,
and were excluded from analysis, leaving 18 tango dance, 11 meditation, 12 exercise,
and 23 wait-list controls (i.e. adherence rate = 77 %).
Participants’ ages ranged from 18 to 68 years, with a mean age of 39.5 years.
There were no significant differences in mean age across the four groups. Most
participants were born overseas and only 46 % spoke English as their first language
at home, with a total of 19 different languages spoken across the sample (i.e. eight
languages in the meditation group, eight in tango, six in exercise, and ten in the
control group). Half of the sample exercised regularly, of whom 31 % exercised at
least three-times a week (i.e. 15 minutes to one hour). Nearly one-fourth (23 %)
used one or more relaxation techniques regularly.
Group Effects (Post-Test)
Regarding the symptom measures, ANCOVAs indicated there was a statistically
significant group effect for stress: F(3,59) = 2.86, p = .044, partial g
= .13; depres-
sion: F(3,59) = 5.75, p = .002, partial g
= .23, and insomnia: F(3,59) = 3.31,
p = .026, partial g
= .14, whereas the results for anxiety and fatigue were not
Regarding the positive psychology measures, ANCOVAs indicated there was a
statistically significant group effect for: satisfaction with life: F(3,59) = 5.31,
p = .003, partial g
= .21; and mindfulness: F(3,59) = 3.22, p = .029, partial
= .14. No significant group effects were found for self-efficacy, although the
effect size was large, partial g
= .11.
Post-hoc testing revealed the exercise group participants showed a significant
decrease in depression (effect size d = .76) and a significant increase in self-efficacy
(effect size d = .83) relative to wait-list controls. Tango group participants showed a
significant decrease in depression (effect size d = 1.10) and insomnia scores (effect
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size d = 0.71) as well as an increase in satisfaction with life (effect size d = 0.96)
and mindfulness (effect size d = 0.88) relative to wait-list controls. Meditation group
participants showed non-significant improvement at post-test (see Table 2).
No other significant group differences were found at post-test.
Group Effects (Follow-Up)
Regarding the symptom measures, ANCOVAs indicated there was a statistically
significant group effect for stress: F(3,57) = 7.00, p \ .001, partial g
= .27;
anxiety: F(3,57) = 3.75, p = .016, partial g
= .16; depression: F(3,57) = 7.17,
p \ .001, partial g
= .27; and insomnia: F(3,57) = 6.74, p \ .001, partial
= .26. Fatigue scores were not significantly different between the four groups.
Regarding the positive psychology measures, ANCOVAs indicated there was a
statistically significant group effect for self-efficacy: F(3,25) = 6.74, p = .028,
partial g
= .15; satisfaction-with-life: F(3,57) = 5.08, p = .003, partial g
= .21;
and mindfulness: F(3,57) = 3.11, p = .003, partial g
= .14.
Post-hoc tests revealed that the meditation group participants had a significant
decrease in stress (effect size d = 0.88) and depression (effect size d = 0.76), and a
significant increase in satisfaction with life (effect size d = 0.07) relative to wait-
list controls. The exercise group showed a significant decrease in stress (effect size
d = 0.86) and an increase in self-efficacy (effect size d = 0.87), relative to wait-list
controls. Tango-group participants showed a significant decrease in stress (effect
size d = 1.37), anxiety (effect size d = 0.85), depression (effect size d = 1.27) and
insomnia, (effect size d = 0.96), and a significant increase in mindfulness (effect
size d = 0.96), relative to wait-list controls. Wait-list control scores showed no
improvements over time for any of the measures.
Qualitative Analysis
Participants in all groups described their instructors as ‘professional, supportive and
easy to relate to,’ and all were grateful for the experience. In order of prevalence,
meditation participants described the activity as helpful (e.g. different attitude to
self/life/situation), relaxing and calming; they identified learning new skills and,
finally, that it was an enjoyable experience. Exercise participants mentioned first the
social interaction during the activity, then the physical benefits, enjoyment of
the experience, and engagement in the activity, but two mentioned that, at times, the
activity was repetitive. Tango participants identified the need to be focused and pay
attention during the lessons, described the activity as engaging, enjoyable, and
challenging, and appreciated the social aspect of the activity.
Clinical Effectiveness of the Activities
Following the DASS Severity Rating guidelines (2011), DASS-21 scores were
doubled, and five clinical categories were utilized: extremely severe, severe,
moderate, mild, normal. Using the above criteria, three categories (better, same, or
worse) were used to describe the clinical changes. Better represents an improvement
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by at least one clinical category (e.g., from severe to moderate); same means there
was no change in category, while worse represents a change by at least one category
(e.g. from moderate to severe). Whereas most meditation, exercise, and tango
Table 2 Means and standard deviations of dependent variables by groups at pre-test, post-test and one-
month follow-up (FU)
Variables Meditation
(n = 11)
(n = 18
(n = 12)
(n = 23)
Life satisfaction
Pre 15.91 4.57 15.94 7.18 16.91 8.91 18.35 7.45
Post 20.18 3.68 22.33 4.99 19.08 8.85 18.09 7.01
FU 22.73 3.04 20.31 7.68 19.42 8.82 17.00 7.36
Pre 3.88 0.53 2.98 0.87 3.78 0.90 3.33 0.90
Post 3.72 0.74 3.84 0.81 4.10 0.49 3.42 0.86
FU 3.98 1.01 3.87 0.78 4.18 0.76 3.37 0.90
Pre 10.27 5.53 12.44 5.73 10.42 3.87 9.39 5.97
Post 6.27 4.00 6.28 3.20 6.25 3.17 9.44 6.31
FU 6.00 4.05 5.38 3.16 6.67 4.90 9.76 6.74
Pre 8.00 4.91 9.28 5.04 6.75 4.88 7.65 5.75
Post 4.91 2.91 4.94 2.88 4.00 4.51 6.74 5.58
FU 4.36 3.44 3.88 3.00 3.58 3.09 6.70 5.71
Pre 12.36 5.44 13.72 4.24 11.25 5.84 10.78 5.10
Post 8.64 5.25 8.61 3.58 7.50 4.35 10.00 5.51
FU 7.73 5.25 7.38 2.44 6.83 3.83 11.00 5.68
Pre 4.91 1.02 4.45 1.22 4.32 1.67 4.32 1.67
Post 4.11 1.80 4.23 1.24 4.25 1.35 4.25 1.35
FU 4.13 1.38 3.74 1.44 4.10 1.81 4.10 1.81
Pre 15.09 5.64 14.67 6.55 12.33 6.11 12.33 6.11
Post 12.00 7.77 11.11 5.14 11.25 7.86 11.25 7.86
FU 9.00 5.53 8.81 6.39 9.83 7.34 9.83 7.34
Pre 26.36 3.47 24.61 6.92 25.17 5.04 27.17 6.30
Post 29.27 3.40 29.06 5.21 30.83 4.66 27.88 6.24
FU 29.18 4.64 28.81 5.71 30.66 4.51 27.43 6.50
Pre before the program, Post at the end of the program, FU one month after the program
Tango group n = 18 at pre- and post-test; and n = 16 at the one-month follow-up
Am J Dance Ther
participants showed clinical improvement in one or more measures (stress, anxiety,
and depression), participants in the wait-list control group were shown to be
clinically stable or worse over time (see Table 3).
Stress: Most meditation participants showed lower levels at follow-up; exercise
participants did not improve at post-test or follow-up; whereas the majority of tango
participants showed lower levels at post-test and follow-up.
Anxiety: Only participants in the meditation and tango groups showed clinical
improvement, with the changes persisting or improving at follow-up.
Depression: Most meditation, exercise, and tango participants showed lower
levels of depression at post-test, and these changes persisted/improved at follow-up.
The primary focus of this randomized study was to systematically evaluate
standardized programs of mindfulness-meditation, exercise, and tango dance that
encouraged participants to focus on their present-moment experiences.
As predicted, participants in the wait-list control condition maintained similar
scores in all measures over time, whereas those who were engaged in an activity
showed improvement in several areas of psychological functioning, although these
changes differed across the three activity groups.
Participants in the meditation group showed no significant improvements at post-
test. However, they did show improvements in stress, depression, and satisfaction
with life at follow-up, but only the decrease in depression scores was clinically
significant. These results are consistent with prior research findings (Kingston et al.,
2007; Teasdale et al., 2000), and it is likely they reflect that meditation, once well-
Table 3 Percentage change in DASS severity ratings for depression, anxiety, and stress
Group Depression Anxiety Stress
Post (n = 11) 36 63 36 63 55 45
FU (n = 11) 27 72 36 63 46 54
Post (n = 12) 8 8 83 8 50 41 67 33
FU (n = 12) 17 25 58 8 42 49 50 50
Post (n = 18) 5 22 72 11 22 66 6 22 73
FU (n = 16) 6 19 75 6 19 76 12 6 82
Post (n = 23) 17 57 26 13 70 16 26 44 30
FU (n = 23) 35 52 13 78 22 30 48 22
Post at the end of the program, FU one month after the program
Am J Dance Ther
learned and practiced, can have lasting benefits, even though the benefits may take
time to accrue as the activity is being learned. Meditation sessions were performed
in a group setting, during which each person performed the activity separately.
Thus, although there were occasions to interact with one another, the participants
tended not to mention the social aspect of this activity; however, qualitative
feedback indicated that they appreciated learning new skills which helped them to
relax and perhaps change their attitude to life.
In contrast, participants in the exercise group did show reduced depression and
increased self-efficacy levels at post-test, and reduced stress and increased self-
efficacy levels at follow-up. The circuit training sessions permitted participants to
quickly acquire the necessary skills without prior knowledge, engage with the
equipment in their own time, and set their own activity goals, which may explain the
increased self-efficacy levels after the program. The relationship between self-
efficacy and physical activity has previously been investigated with a similar range
of outcomes (McAuley et al., 2003). However, it is less clear why the benefits of
exercise in reducing depression symptoms did not persist over time; qualitative
feedback suggests the participants were less inclined to continue the activity on their
own after completion of the study program. Nonetheless, the results are consistent
with the literature reports examining exercise trials, which tend to show that the
decreases in depression symptoms are temporary and only effective during their
involvement in the exercise program (Krogh, 2011). These results suggest that
maintaining any psychological improvements beyond a structured exercise program
is a challenge, and encouraging people to continue with the activity is a hurdle yet to
be overcome (McAuley et al., 2000). However, exercise group participants did
emphasize the social interaction with group members, and their enjoyment.
Moreover, they recognized the physical benefits of the exercise sessions, which may
contribute to the significantly reduced levels of stress at follow-up, as perhaps some
activities of daily living became easier to perform after the eight-week program.
Finally, participants in the tango group showed significant improvements at post-test
in depression, insomnia, satisfaction with life, and mindfulness, and most of these
improvements (i.e., depression, insomnia, mindfulness) persisted at follow-up; in
addition, improvements in stress and anxiety were also significant at follow-up.
Furthermore, the reduced stress, anxiety, and depression levels were shown to be
clinically significant, using DASS clinical change scores. These results are mostly
consistent with those of prior relevant studies; for example, tango dance has previously
been shown to increase mindfulness and decrease stress and depression levels at post-
test, relative to meditation and wait-list controls (Pinniger et al., in press). Qualitatively,
tango dance was described by the participants as an enjoyable, challenging, interesting,
and absorbing activity. In the literature, tango is described as an activity that demands
attention (Nau-Klapwijk, 2006) and significant acquisition of skills, yet is regarded as
pleasurable (Dinzel, 1999; Quiroga Murcia et al., 2009;Trossero,2006).
Thus, regarding a possible mechanism, tango dance was shown to be associated
with persistent increases in mindfulness, from pre- to post-test and to follow-up, but
the same change was not observed in the other two activity groups. This result
suggests that the improvements in psychological (i.e. stress, anxiety, depression)
and physical (i.e. insomnia) symptoms in the tango group may have been due to
Am J Dance Ther
increased mindfulness in at least some participants. Thus, the activity may have
facilitated a detachment from negative thoughts, ruminations, and worries, which
led to a reduction in symptom severity (Ree & Craigie, 2007). This approach
focused primarily on the learning process (e.g. the dance steps they were learning
and executing), and through this process the participants began to acquire and
practice the principles of mindfulness. Consequently, the classes were led by a tango
instructor, not by a dance/movement therapist, and therefore the focus was not on
the therapeutic relationship. Similarly to dance/movement therapy, however, tango
dance also permits participants to have contact with another person in a safe and
structured environment (the embrace) that can be adjusted to match their own
personal psychological space as well as offering numerous opportunities to promote
social interaction, and using the movement relationship to strengthen a sense of
security, acceptance, and a bond between participants.
Further, few benefits were observed in the circuit training activity, and the
changes were not maintained over time, suggesting that physical activity alone was
not sufficient to explain the changes seen in the tango dance group. Finally, by
tradition, tango dancers do not talk to each other while dancing, allowing them to
focus on the dance. In contrast, participants in the circuit-training sessions talked to
each other and described the activity as a social one, and it is possible that this
socializing prevented them from focusing fully on the task at hand, making
mindfulness more difficult to achieve.
Study Limitations
Several study limitations warrant mentioning. First, the sample was relatively small, and
a priori power analysis indicated that a sample of 72 (e.g. 18 per group) was required, but
the study only evaluated responses from 64 participants, although the effect sizes were
larger than expected. Second, most of the participants were well-educated females from
non-English speaking backgrounds, thus the results may not be generalizable to all
populations. Third, participants were admitted to the study on the basis of their self-
evaluations of affective symptoms, thus they were not recruited from within a clinical
setting, and verification of psychological diagnoses was not sought. Nonetheless, it has
been acknowledged that self-reports are at least as effective as clinical interviews in
capturing sub-threshold anxiety (Karsten, Nolen, Pennix, & Hartman, 2011), and that
asking primary care patients if they are depressed is an effective means of detecting
possible depression (Nuyen et al., 2005). Finally, although different instructors were
used for each study group since it was necessary that they were sufficiently trained and
experienced to lead the activity, attempts were made to control for other relevant
differences between the study groups; for example, all study sessions were of equal
duration and intensity, each activity used a similar approach (e.g. single instructor, same
venue, equivalent social interaction component).
In this study, tango dance has been shown to produce a broader range of clinically
significant improvements in psychological function and sleep disturbance than
Am J Dance Ther
meditation or exercise. Specifically, tango induced clinically relevant decreases in
stress, anxiety, depression, and insomnia, and increases in mindfulness, which were
maintained over time; whereas less diverse benefits accrued to participants
completing meditation (i.e. reduced stress and depression, increased satisfaction
with life) or exercise (i.e. reduced stress and depression, increased self-efficacy).
These results suggest that different activities may exert differential effects on
psychological health in people with self-reported affective symptoms.
In future trials, tango dance could be used as an adjunct therapeutic approach for
people diagnosed with mood disorders that are in either inpatient or outpatient
settings. The results of this study suggest that the dance form of tango can serve as a
therapeutic approach to help individuals with psychological disorders to achieve
greater self-expression, a goal that is of particular interest to dance/movement
therapists. Tango is a dance medium that has structure, yet still permits a great deal
of self-expression through its intrinsic use of improvisation and the interpretation of
the music. The significance of these results should be encouraging for dance/
movement therapy professionals who may employ similar techniques.
Acknowledgments We are indebted to Jacqueline Simpson (tango instructor) and Anthony Miller
(assistant instructor), Tom Jones (clinical psychologist and meditation instructor), and John Dowse
(exercise instructor) for their time and dedication in preparing and carrying out the program. We also
wish to thank the tango team, including Annabella Chang, Nga Nguyen, David Owen, Elcira Ratero,
Paula Schooge, and Jean Weiner, for their time and professionalism in assisting as leaders at the tango
classes; as well as Pedro Colombi (Argentinean Consul, Sydney, Australia) for his support in this project;
‘The Kirk’ (venue at Surry Hills, Sydney) for providing an ideal space to conduct the program; and all
the participants whose commitment made the study possible and established grounds for future research.
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Author Biographies
Rosa Pinniger
Bachelor of Psychology (Hons., Class 1). PhD candidature completed in June 2012 at the University of
New England, Australia. Currently awaiting thesis result.
Einar B. Thorsteinsson
is a senior lecturer at the University of New England, Australia. He has a strong research profile in areas
within health psychology.
Rhonda F. Brown
is a senior lecturer and researcher in health psychology at the Australian National University, Canberra.
Patricia McKinley
is an associate professor at McGill University, Montreal.
Am J Dance Ther
... A total of 541 participants were included in the intervention groups and comparison groups. When there were multiple intervention groups, we chose the mindfulness-based programs as the major intervention groups [45][46][47]. Table 2. ...
... The drop-out rates of the trials ranged from 0% to 30.6%, as shown in Table 1. Of the 10 trials, 3 had low drop-out rates (≤ 5%) [31,47,52] and two had high drop-out rates (≥ 20%) [29,46]. The overall LoE was level II (n = 10), showing that the papers under current review were of high LoE. ...
... Therefore, solely utilizing MM [46,47] may not be robust enough to improve sleep problems among people with depression or anxiety disorder, as indicated by the insignificant effect size shown in this study. No wonder recent meta-analyses [70,71] supported that MM is effective in reducing symptoms such as rumination among people with depression or anxiety disorder, but the sleeping problem might be improved in the short-term only. ...
BACKGROUND Sleep problems are particularly prevalent in people with depression or anxiety disorder. Although mindfulness has been suggested as an important component in alleviating insomnia, no comprehensive review and meta-analysis has been conducted to evaluate the effects of different mindfulness-based intervention (MBI) programs on sleep among people with depression or anxiety disorder. AIM To compare the effects of different MBI programs on sleep among people with depression or anxiety disorder. METHODS Related publications in Embase, Medline, PubMed and PsycINFO databases were systematically searched from January 2010 to June 2020 for randomised controlled trials. Data were synthesized using a random-effects or a fixed-effects model to analyse the effects of various MBI programs on sleep problems among people with depression or anxiety disorder. The fixed-effects model was used when heterogeneity was negligible, and the random-effects model was used when heterogeneity was significant to calculate the standardised mean differences (SMDs) and 95% confidence intervals (CIs). RESULTS We identified 397 articles, of which 10 randomised controlled trials, involving a total of 541 participants, were included in the meta-analysis. Studies of internet mindfulness meditation intervention (IMMI), mindfulness meditation (MM), mindfulness-based cognitive therapy (MBCT), mindfulness-based stress reduction (MBSR) and mindfulness-based touch therapy (MBTT) met the inclusion criteria. The greatest effect sizes are reported in favour of MBTT, with SMDs of -1.138 (95%CI: -1.937 to -0.340; P = 0.005), followed by -1.003 (95%CI: -1.645 to -0.360; P = 0.002) for MBCT. SMDs of -0.618 (95%CI: -0.980 to -0.257; P = 0.001) and -0.551 (95%CI: -0.842 to -0.260; P < 0.0001) were reported for IMMI and MBSR in the pooling trials, respectively. Significant effects on sleep problem improvement are shown in all reviewed MBI programs, except MM, for which the effect size was shown to be non-significant. CONCLUSION All MBI programs (MBTT, MBCT, IMMI and MBSR), except MM, are effective options to improve sleep problems among people with depression or anxiety disorder.
... These 17 trials yielded post-intervention sleep quality measures for our analyses, including a total of N ¼ 1645 patients, which had been randomized to 13 treatments yielding 35 comparisons. Average baseline depression severity was mostly moderate [63e65, 71,73,74,76,77] or mild [62,69,70,72,75] based on symptom questionnaires. The remaining trials included patients with severe depression at baseline [68] or only reported that included patients scored above clinical cut-offs in validated unipolar depression questionnaires [61,66,67]. ...
... Patients were allocated to some form of control intervention (all forms: N ¼ 870; treatment as usual: N ¼ 532; active control: N ¼ 94; passive control: N ¼ 244), exercise (all forms: N ¼ 764; aerobic exercise: N ¼ 390; strength exercise: N ¼ 62; mind-body: N ¼ 312) or meditation (N ¼ 11). The meditation group was included as a comparator in our network, since one trial [72] randomized patients to one of four groups: low intensity strength exercise, passive control, meditation, and active control. Treatment as usual (psychotherapy, pharmacotherapy, a combination of both, or general practitioner care) was the most frequent comparator [63e65, 69,70,73,76,77] Fig. 2). ...
... Adverse events were reported only by three trials [62,70,76]. Sleep quality at follow-up was reported only by four trials [61,72,74,77]. Hence, we did not perform a network meta-analysis for these secondary outcomes. ...
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Insomnia predicts the onset, course, and reoccurrence of unipolar depression. However, systematic reviews of treatment options for insomnia in unipolar depression are lacking. After screening 7725 records, 17 trials comprising 1645 patients randomized to 13 treatments were included for quantitative synthesis. Network meta-analysis showed that compared to a passive control condition, all exercise interventions except aerobic exercise alone resulted in better sleep outcomes. Compared with treatment as usual, mind-body exercise plus treatment as usual (SMD: -0.46; 95% CI: -0.80, -0.12) and vigorous strength exercise (SMD: -0.61; 95% CI: -1.12, -0.10) were significantly more effective. Pairwise meta-analyses showed that mind-body exercise (SMD: -0.54; 95% CI: -0.85, -0.23) had beneficial effects compared to passive control. The network meta-analysis is statistically very robust with low heterogeneity, incoherence, and indirectness. However, confidence in the findings was moderate to very low, primarily due to within-study bias. This is the first network meta-analysis to assess exercise's efficacy to improve sleep quality in patients with depression. The findings confirm the benefits of exercise as an add-on treatment for depression. This consolidation of the current state of evidence can help clinicians make evidence-based decisions.
... There is indeed a need for more research aimed at obtaining evidence regarding the link between improved perception of self-efficacy and exercise or physical activity (Craft, 2005). Pinniger et al. (2013) reported that a tango dance program lasting 40 50 min per session in people with depression increased levels of self-efficacy. ...
... These are pharmacological vs. pharmacological + DP on the perception of selfefficacy, depression, and HRV in hospitalized patients with MDD; the primary caregiver's perceptions were also considered and recorded. Although depression and exercise as a Our findings are similar to those by Pinniger et al. (2013), where a tango dance program was applied, showing increased self-efficacy in participants with depression. ...
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This study intended to examine the effects of two programs, pharmacological treatment vs. pharmacological treatment + Dance Program (DP), on the perception of self-efficacy, depression, and heart rate variability (HRV) in hospitalized patients with major depressive disorder (MDD); The primary caregiver's perception was also considered and recorded. The sample consisted of 27 patients (pharmacological = 14 and pharmacological + DP = 13) who were admitted to the IMSS Psychiatric Hospital, with a diagnosis of MDD. There was a significant increase in the perception of self-efficacy in the pharmacological + DP group after treatment (Z = 3.19, p <.01), but not in the pharmacological group (Z =.126, p >.01). Regarding depression, a greater decrease was found in the pharmacological + DP group. In HRV there were differences only in heart rate, showing a reduction due to the impact of the time factor and the time and group factor. As for the results of the interview with primary caregivers, their perceptions indicate that dance is an activity that can fortify the recovery process of their family members. In conclusion, a dance program of moderate to vigorous intensity in conjunction with pharmacological treatment reduces depressive symptoms and increases the perception of self-efficacy, resulting in a greater benefit for the recovery of depressive patients. Similarly, the primary caregivers involved in this study highlighted the importance of the dance program as an option to support the standard treatment of depression.
... Dancers improvise along the dance floor using a loosely defined vocabulary of Argentine tango-specific foundational movements allowing dancers to express their personal interpretation of the songs. In recent years, therapies based on Argentine tango have been studied for the improvement of fitness and balance in older adults [2], as therapy for Parkinson disease [3], [4], and depression [5], and as intervention for depression, anxiety, stress, fatigue, and insomnia [6]. Indeed, dancing with a partner to music has more positive emotional effects than without a partner or music [7]. ...
... Skirtumai tarp objektyvaus ir subjektyvaus miego kokybės vertinimo galėjo būti užfiksuoti dėl to, kad didelio FA tiriamieji savo miego kokybę ir būseną gali įvertinti kaip geresnę. Įrodyta (Pinniger at al., 2013), kad dėmesio reikalaujanti fizinė veikla gali turėti teigiamos įtakos nuotaikos ir emocijų sutrikimams, kurie gali paveikti ir miego kokybę. Nenaudingo miego trukmės pailgėjimas galėjo būti užfiksuotas dėl to, kad labai intensyvūs pratimai, likus 6 valandoms iki miego, asme-nims, kurie didžiąją laiko dalį praleidžia sėdėdami ir neturi miego nusiskundimų, nesukelia didesnės miego būtinybės, bet prailgina negilaus miego stadiją (Wong et al., 2013). ...
Relevance of the topic. Most authors agree that physical activity (PA) affects sleep (Kredlow et al., 2015), but it remains unclear how the quality of sleep varies with individual PA schedule and daily immobility. The goal was to identify the interfaces between physical activity and sleep quality for 18–25-year-old students. Research methods. The International Physical Activity Questionnaire, Pittsburgh Sleep Quality Index, smart watches Polar A300 were used. Results of the study. By analysing the obtained study data, 2 groups were formed according to physical activity: medium PA (56.1%) and high PA (43.9%). The quality of sleep among students was as follows: good (36.4%), bad (63.6%). Signifcant correlations were found between PA aspects and falling asleep time, PSQI. There were no signifcant interfaces between PA aspects and sleep duration. Conclusions. The majority of students were of moderate physical activity, less high physical activity and there were no students of low physical activity. Poor quality of sleep prevailed among students. Weak interfaces were identifed between continuous sitting and the time of useless sleep. Dependences were also found between sleep quality and the duration of intense physical activity as well as the level of physical activity. Signifcant dependencies were not established between the time of day of intense physical activity or the intense physical activity type and sleep quality itself, although the latter signifcantly affected the duration of sleep, the time of awakening and the length of useless sleep. Keywords: students, physical activity, sleep quality, long sitting.
... Min = 0%, Max = 57.38%). Analysis of dropout rates revealed that 7 of the 31 studies reported a dropout that is higher than 30% ( Pinniger et al., 2012Pinniger et al., , 2013Röhricht et al., 2013;and Rios Romenets et al., 2015;Hildebrandt et al., 2016;Martin et al., 2016;Pohlmann et al., 2017). This was in many cases due to the fact that severely impaired patients with schizophrenia or depression had to actively travel to outpatient treatment, requiring a strong motivational state, which is precisely one of the problems in these disorders. ...
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Background: Dance is an embodied activity and, when applied therapeutically, can have several specific and unspecific health benefits. In this meta-analysis, we evaluated the effectiveness of dance movement therapy1(DMT) and dance interventions for psychological health outcomes. Research in this area grew considerably from 1.3 detected studies/year in 1996–2012 to 6.8 detected studies/year in 2012–2018. Method: We synthesized 41 controlled intervention studies (N = 2,374; from 01/2012 to 03/2018), 21 from DMT, and 20 from dance, investigating the outcome clusters of quality of life, clinical outcomes (with sub-analyses of depression and anxiety), interpersonal skills, cognitive skills, and (psycho-)motor skills. We included recent randomized controlled trials (RCTs) in areas such as depression, anxiety, schizophrenia, autism, elderly patients, oncology, neurology, chronic heart failure, and cardiovascular disease, including follow-up data in eight studies. Results: Analyses yielded a medium overall effect (d2 = 0.60), with high heterogeneity of results (I2 = 72.62%). Sorted by outcome clusters, the effects were medium to large (d = 0.53 to d = 0.85). All effects, except the one for (psycho-)motor skills, showed high inconsistency of results. Sensitivity analyses revealed that type of intervention (DMT or dance) was a significant moderator of results. In the DMT cluster, the overall medium effect was small, significant, and homogeneous/consistent (d = 0.30, p < 0.001, I2 = 3.47). In the dance intervention cluster, the overall medium effect was large, significant, yet heterogeneous/non-consistent (d = 0.81, p < 0.001, I2 = 77.96). Results suggest that DMT decreases depression and anxiety and increases quality of life and interpersonal and cognitive skills, whereas dance interventions increase (psycho-)motor skills. Larger effect sizes resulted from observational measures, possibly indicating bias. Follow-up data showed that on 22 weeks after the intervention, most effects remained stable or slightly increased. Discussion: Consistent effects of DMT coincide with findings from former meta-analyses. Most dance intervention studies came from preventive contexts and most DMT studies came from institutional healthcare contexts with more severely impaired clinical patients, where we found smaller effects, yet with higher clinical relevance. Methodological shortcomings of many included studies and heterogeneity of outcome measures limit results. Initial findings on long-term effects are promising.
Background. Plastic, expressive aspects of human behaviour remain underresearched by psychologists. The focus on practices of improvisation is determined by the fact that they show most vividly how expressive movement comes into being. Objective. The aim of the study is to provide psychological analysis of improvised dance action, to identify the conditions of its generation. The hypothesis put forward concerns the formation of overall personal attitude that makes one ready to perform expressive movement in the context of musical-motional improvisation. It seems probable that the principles of movement organisation within free dance practices concern the formation of attitude that lets one perceive spontaneous, involuntary impulses to movement, changes of tonus and breath. Design. The study is a piece of theoretic-psychological analysis of improvisation dance practice. In terms of methodological and theoretical basis the study relies on cultural-historical psychology and theory of action, as well as on N.A. Bernstein’s conception of movement building. There theories allow to reconstruct the conditions of expressive movement generation in the context of musical-motional improvisation. Results. The analysis performed has shown that the principles of movement organisation, the technical aspects of the practices studied are aimed at increasing the degree of freedom of movement. It allows to enhance the receptivity to spontaneous reactions and impulses and to widen the orientation within the context of musical-motional improvisation. It makes one move in a more meaningful way and to integrate the personality into improvisation. Conclusions. Alongside with the practices of structured dances and reproductive approaches to mastering expressive movement, there are cultural-historical practices of improvisation dances. The analysis of such practices allows to single out psychological conditions and and peculiarities of movement organisation that make one generate spontaneous actions, find and try new objectives, plastic forms. Generation of spontaneous movement and musical-plastic improvisation are possible due to tuning up the whole human personality. Openness as personal attitude has its meaningful as well as motional component.
Dementia is a debilitating and progressive neurodegenerative condition expected to affect over 13 million Americans by 2050 (Mitchell et al. in N Engl J Med 361:1529–1538, 2009) and 132 million individuals worldwide (Prince et al. in Alzheimer’s Res Ther 8(1):23, 2016). Characterized by cognitive and physical loss and change, and loss of one’s sense of self, this illness significantly impairs the ability to communicate needs and discomfort successfully; aggressive behaviors are common and may affect overall well-being. Dementia-associated aggression often leads to care facility placement, may contribute to care partner burden, and significantly increases healthcare costs. Dance/movement therapy (DMT) influences physical, psychological, and cognitive behavior, supports productive self-expression, and helps to improve quality of life. This article sheds light on some challenges within the long-term care environment and affirms that DMT, as a complementary approach, is a beneficial, cost-efficient, and non-pharmacologic modality for the treatment of dementia-associated aggression for older adults in these settings.
This chapter investigates design strategies for developing digital musical instruments (DMIs) for participatory music. In particular, we present strategies to enhance collaborative musical skills such as rhythmic entrainment and listening/responding to other participants: building skills of this kind has the capacity to motivate long-term usage and adoption of the DMI by a broad range of communities. The design strategies described here address the problems of developing DMIs for long-term use, both in collaborative, mixed skill level contexts, and in established musical and dance traditions. Interactive Tango Milonga—presented here as a case study—is an interactive dance system allowing social tango dancers to drive musical outcomes in real-time via their dance movement. Motion sensors are attached to dancers, and the signals from these sensors are sent to a computer, where an algorithm transforms them into tango music. The impact of the interactive tango system on the musical listening and response of tango dancer participants is analyzed and discussed.
The 2003 Convention for the Safeguarding of the Intangible Cultural Heritage was adopted by UNESCO to enshrine and preserve exemplars of the intangible heritage of humanity – practices, traditions, and cultural expressions – on a global register. In our view, this convention highlights a tension between the valorization of cultural diversity on one hand and the universal relevance and value of masterpieces of intangible heritage to all humankind on the other. We introduce the term rationalized authenticity to refer to processes by which this tension is mitigated through simultaneous 1) fostering of a diversity of ways that heritage may be expressed or understood and 2) translation into rationalized forms that demonstrate the transnational relevance of cultural heritage. Based on a comparative analysis of three diverse examples of heritage on UNESCO's list from outside the core of the cultural world system – tango from Argentina and Uruguay, acupuncture and moxibustion from China, and the Kodály concept from Hungary – we show how rationalized authenticity encourages the adoption of alternative definitions of cultural heritage and also facilitates the transnational spread and transformation of select masterpieces of intangible heritage.
The Psychometric Properties and Clinical Use of Scales. Delirium and Dementia. Substancerelated Disorders. Somatoform Disorders and Measurement of Pain and Related Phenomena. Dissociative Disorders. Sexual Disorders. Eating Disorders. Sleep Disorders. Impulse Control Disorders. Relationship Problems. Other Conditions of Clinical Interest. Measures of Global Functioning. Index.
Study Objectives (1) To describe the prevalence and prospective course of insomnia in a representative young-adult sample and (2) to describe the cross-sectional and longitudinal associations between insomnia and depression. Design Longitudinal cohort study. Setting Community of Zurich, Switzerland. Participants Representative stratified population sample. Interventions None. Measurements and Results The Zurich Study prospectively assessed psychiatric, physical, and sleep symptoms in a community sample of young adults (n = 591) with 6 interviews spanning 20 years. We distinguished 4 duration-based subtypes of insomnia: 1-month insomnia associated with significant distress, 2- to 3-week insomnia, recurrent brief insomnia, and occasional brief insomnia. The annual prevalence of 1-month insomnia increased gradually over time, with a cumulative prevalence rate of 20% and a greater than 2-fold risk among women. In 40% of subjects, insomnia developed into more chronic forms over time. Insomnia either with or without comorbid depression was highly stable over time. Insomnia lasting 2 weeks or longer predicted major depressive episodes and major depressive disorder at subsequent interviews; 17% to 50% of subjects with insomnia lasting 2 weeks or longer developed a major depressive episode in a later interview. “Pure” insomnia and “pure” depression were not longitudinally related to each other, whereas insomnia comorbid with depression was longitudinally related to both. Conclusions This longitudinal study confirms the persistent nature of insomnia and the increased risk of subsequent depression among individuals with insomnia. The data support a spectrum of insomnia (defined by duration and frequency) comorbid with, rather than secondary to, depression.
Interest in the clinical use of mindfulness practices has expanded rapidly in recent years. To provide. a direction for future research in this area, this article identifies the primary scientific and clinical questions regarding the clinical application of mindfulness practice. In particular, the following questions are addressed: What is mindfulness? What are the consequences of separating mindfulness from its spiritual and cultural origins? Is mindfulness training an efficacious treatment intervention? What are the active or essential ingredients of mindfulness training? Can mindfulness enhance clinical practice apart from its role as a clinical intervention? How does mindfulness work? How should therapists be trained in order to deliver mindfulness interventions competently? Is mindfulness training amenable to widespread dissemination?
Objectives: This study examined the construct and criterion validity of the Mindful Attention Awareness Scale (MAAS) in cancer outpatients, using matched community members as controls. Methods: Cancer outpatients (n = 122) applying for enrollment in a mindfulness-based stress reduction (MBSR) program completed the MAAS and measures of mood disturbance and stress. Local community members (n = 122) matched to the patients on gender, age, and education level completed the same measures. Results: The single-factor structure of the MAAS was invariant across the groups. Higher MAAS scores were associated with lower mood disturbance and stress symptoms in cancer patients, and the structure of these relations was invariant across groups. Conclusions: The MAAS appears to have appropriate application in research examining the role of mindfulness in the psychological well-being of cancer patients, with or without comparisons to nonclinical controls. (c) 2005 Elsevier Inc. All rights reserved.
This article reports the development and validation of a scale to measure global life satisfaction, the Satisfaction With Life Scale (SWLS). Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness. The SWLS is shown to have favorable psychometric properties, including high internal consistency and high temporal reliability. Scores on the SWLS correlate moderately to highly with other measures of subjective well-being, and correlate predictably with specific personality characteristics. It is noted that the SWLS is suited for use with different age groups, and other potential uses of the scale are discussed.
• Fatigue is a prominent disabling symptom in a variety of medical and neurologic disorders. To facilitate research in this area, we developed a fatigue severity scale, subjected it to tests of internal consistency and validity, and used it to compare fatigue in two chronic conditions: systemic lupus erythematosus and multiple sclerosis. Administration of the fatigue severity scale to 25 patients with multiple sclerosis, 29 patients with systemic lupus erythematosus, and 20 healthy adults revealed that the fatigue severity scale was internally consistent, correlated well with visual analogue measures, clearly differentiated controls from patients, and could detect clinically predicted changes in fatigue over time. Fatigue had a greater deleterious impact on daily living in patients with multiple sclerosis and systemic lupus erythematosus compared with controls. The results further showed that fatigue was largely independent of self-reported depressive symptoms and that several characteristics could differentiate fatigue that accompanies multiple sclerosis from fatigue that accompanies systemic lupus erythematosus. This study demonstrates (1) the clinical and research applications of a scale that measures fatigue severity and (2) helps to identify features that distinguish fatigue between two chronic medical disorders.
PALABRAS CLAVE: Ejercicio, depresión, satisfacción, ancianos. RESUMEN: Numerosos estudios han puesto de manifiesto una relación inversa entre la actividad física y los niveles de depresión en ancianos. Han sido propuestos distintos mecanismos, tanto fisiológicos como psicológicos, para explicar este fenómeno. En el presente trabajo, se comparan los niveles de depresión y satisfacción de tres muestras de sujetos: ancianos que realizan actividad física, ancianos que realizan actividades en grupo (no físicas) y ancianos sedentarios. Los resultados muestran iguales niveles de depresión y satisfacción con la vida para los grupos que realizan actividad, siendo diferentes los niveles presentados por los sujetos sedentarios. Estos resultados avalan la implicación de factores psicológicos como mediadores en la relación entre actividad física y salud psicológica. ABSTRACT: Previous studies have demonstrated an inverse relationship between physical activity and depression in elderly samples. It has been proposed psychological and physiological mechanisms to explain the antidepressant effect of exercise. The levels of depressión and life satisfaction of three older Revista de Psicología del Deporte 2001. Vol. 10, núm. 2, pp. También se han investigado los posibles efectos beneficiosos sobre los aspectos psicológicos tanto cognitivos como afectivos-emocionales (Folkins y Sime, 1981; Lawrence, 1987; Sime, 1984; Spirduso, 1980; Tomporowski y Ellis, 1986, Godoy, 1984, Sánchez Barrera, 1993, 1995). Estos autores han estudiado los efectos que el ejercicio físico tiene sobre aspectos como atención, memoria, razonamiento, confianza, estabilidad emocional, satisfacción, ansiedad, depresión, etc. Uno de los desórdenes psicológicos con mayor prevalencia en la población de ancianos, es la depresión (Friedhoff, 1992). Distintos estudios transversales han puesto de manifiesto una relación inversa entre un estilo de vida activo y los niveles de depresión en poblaciones no clínicas (Chodzkozajko, 1990; DeForge, Sobal y Krick, 1989; Parent y Whall, 1984). También, estudios longitudinales en adultos, informan de una mayor vulnerabilidad a presentar altos niveles de depresión entre aquellos sujetos que informan de niveles bajos de actividad física a lo largo de la vida (Camacho, Roberts, Lazarus, Kaplan y Cohen, 1991; Farmer, Locke, Moscicki, Dannenberg, Larson, Radloff (1988); Ruuskanen y Ruoppila, 1995; Stephens, 1988). Aunque las distintas revisiones sobre este tema coinciden en afirmar que el ejercicio físico regular mejora los the sedentary group. These results support the implication of psychological mechanisms to explain the relation between physical activity and mental health.