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Dance movement therapy group intervention in stress treatment: A randomized controlled trial (RCT)

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The
Arts
in
Psychotherapy
39 (2012) 443–
450
Contents
lists
available
at
SciVerse
ScienceDirect
The
Arts
in
Psychotherapy
Dance
movement
therapy
group
intervention
in
stress
treatment:
A
randomized
controlled
trial
(RCT)
Iris
Bräuninger,
PhD,
BTD
University
of
Deusto,
Department
of
Personality,
Evaluation
and
Psychological
Treatment,
Avda.
Universidades,
24,
E-48080
Bilbao
(Vizcaya),
Spain
a
r
t
i
c
l
e
i
n
f
o
Keywords:
Dance
movement
therapy
(DMT)
research
Stress
management
and
stress
reduction
Randomized
controlled
trial
(RCT)
Treatment
effectiveness
Group
therapy
a
b
s
t
r
a
c
t
This
randomized
controlled
trial
compares
the
effect
of
a
dance
movement
therapy
(DMT)
group
inter-
vention
on
stress
management
improvement
and
stress
reduction
with
a
wait-listed
control
group
(WG).
162
self-selected
clients
suffering
from
stress
were
randomly
assigned
to
a
WG
or
a
DMT
intervention
that
received
10
group
therapy
sessions.
Stress
management
[Stressverarbeitungsfragebogen/SVF
120],
psychopathology
and
overall
distress
(Brief
Symptom
Inventory/BSI)
were
evaluated
at
baseline
(t1:
pre-
test),
immediately
after
completion
of
the
ten
sessions
DMT
group
intervention
(t2:
post-test),
and
6
months
after
the
DMT
treatment
(t3:
follow-up
test).
Analysis
of
variance
was
calculated
to
evaluate
the
between-group
(time
×
condition)
and
within-group
(time)
effect
of
the
DMT
intervention.
Negative
stress
management
strategies
decreased
significantly
in
the
short-term
at
t2
(p
<
.005)
and
long-term
at
t3
(p
<
.05),
Positive
Strategy
Distraction
improved
significantly
in
the
short-term
(p
<
.10),
as
well
as
Relax-
ation
(p
<
.10).
Significant
short-term
improvements
were
observed
in
the
BSI
psychological
distress
scales
Obsessive-Compulsive
(p
<
.05),
Interpersonal
Sensitivity
(p
<
.10),
Depression
(p
<
.05),
Anxiety
(p
<
.005),
Phobic
Anxiety
(p
<
.01),
Psychoticism
(p
<
.05),
and
in
Positive
Symptom
Distress
(p
<
.02).
Significant
long-
term
improvement
in
psychological
distress
through
DMT
existed
in
Interpersonal
Sensitivity
(p
<
.05),
Depression
(p
<
.000),
Phobic
Anxiety
(p
<
.05),
Paranoid
Thinking
(p
<
.005),
Psychoticism
(p
<
.05),
and
Global
Severity
Index
(p
<
.01).
Results
indicate
that
DMT
group
treatment
is
more
effective
to
improve
stress
management
and
reduce
psychological
distress
than
non-treatment.
DMT
effects
last
over
time.
© 2012 Elsevier Inc. All rights reserved.
Introduction
Dance
movement
therapy’s
impact
on
stress
management
and
stress
reduction
has
not
been
addressed
specifically
by
research.
A
randomised
controlled
trial
(RCT)
evaluated
this
question.
Dance
movement
therapy
(DMT)
is
defined
as
a
form
of
creative
body-
oriented
psychotherapy
that
uses
movement,
dance,
and
verbal
intervention
(BTD,
2011)
to
further
the
emotional,
cognitive,
phys-
ical
and
social
integration
of
the
individual
(ADTA,
2011).
A
nation-
wide
research
project,
conducted
in
Germany,
examined
if
DMT
group
participants
would
obtain
better
stress
management
strate-
gies
and
show
less
psychological
distress
symptoms
compared
to
the
wait-listed
control
group
who
did
not
receive
treatment.
Stress
and
stress
reduction
research
in
dance
and
dance
movement
therapy
Various
cultures
have
used
dance
as
a
form
to
reduce
stress
and
promote
well-being
and
higher
tolerance
against
stress.
Dance
Tel.:
+34
644350114.
E-mail
addresses:
iris.brauninger@deusto.es,
dancetherapy@mac.com
enables
a
person
to
cognitively
process
and
overcome
frightening
events,
feel
one’s
physical
self,
analyse
problems,
find
constructive
solutions
for
everyday
life,
and
improve
one’s
body
image
and
self-
esteem
(Hanna,
2006).
It
stimulates
the
vestibular
system,
creates
a
more
alert
state
of
consciousness,
and
positively
impacts
the
fitness
and
strength
of
the
cardiovascular
system
(Hanna,
1988).
One
DMT
research
project
on
stress
evaluated
indices
of
stress
between
nonverbal
patterns
in
26
parent–child
dyads
(N
=
52)
and
parental
stress
(Birklein
&
Sossin,
2006).
Children
of
stressed
par-
ents
demonstrated
more
mismatch
between
their
safety/danger
and
comfort/discomfort
affects
and
their
parents
exhibited
less
ani-
mated
(neutral)
abrupt
movements
and
discordance
compared
to
parent–child
dyads
of
parents
with
low
stress
ratings.
DMT
serves
as
a
holistic
model
of
psychological
stress
adjustment
in
cancer
treatment
and
addresses
comprehensive
psy-
chological
needs
(Cohen
&
Walco,
1999;
Rainbow,
2005).
Results
of
a
DMT
intervention
on
cancer
patients
demonstrated
that
Per-
ceived
Stress
Scale
Scores
were
significantly
lower
after
DMT
with
a
medium
effect
size
(Rainbow,
2005).
In
another
randomized
DMT
study
with
fibromylagia
patients,
movement
pain
and
life
energy
improved
significantly
in
the
DMT
treatment
group
com-
pared
to
the
wait-listed
control
group
(Bojner
Horwitz,
Theorell,
&
Anderberg,
2003).
0197-4556/$
see
front
matter ©
2012 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.aip.2012.07.002
444 I.
Bräuninger
/
The
Arts
in
Psychotherapy
39 (2012) 443–
450
A
study
on
the
effect
of
dance
and
yoga
on
psychological
and
neuroendocrine
responses
in
college
students
revealed
that
African
dance
(n
=
21)
and
Hatha
Yoga
(n
=
18)
showed
signif-
icant
reductions
in
the
Perceived
Stress
Scale,
negative
affect,
and
time
×
treatment
interactions
compared
to
the
control
group
(n
=
31)
who
received
biology
lessons.
The
perceived
stress
and
negative
affect
(also
defined
as
emotion-focused
coping,
Lazarus
&
Folkman,
1984)
decreased
in
both
interventions
although
cor-
tisol
level
increased
in
African
dance
participants
and
decreased
in
Hatha
Yoga
participants
(West,
Otte,
Geher,
Johnson,
&
Mohr,
2004).
However,
findings
of
a
study
on
emotional
and
hormonal
responses
to
tango
dancing
demonstrated
that
short-term
posi-
tive
psychobiological
reactions
after
tango
dancing
were
obtained
(Quiroga
Murcia,
Bongard,
&
Kreutz,
2009).
A
study
on
T’ai
Chi
and
aerobics
interventions
showed
the
improvement
of
emotion-
oriented,
but
not
on
problem-oriented
coping
skills
(Bond,
Lyle,
Tappe,
Seehafer,
&
D’Zurilla,
2002).
To
conclude,
studies
on
dance
and
DMT
demonstrated
that
inter-
ventions
reduced
stress
and
improved
psychological
parameters,
such
as
emotional
states,
life
energy,
and
negative
affect.
Hence,
DMT
fosters
emotion-oriented
stress
and
coping
strategies.
Fur-
thermore,
DMT
might
influence
cognitive
stress
reactions
as
DMT
raises
awareness
of
senses,
feelings,
images,
thoughts
and
cogni-
tion,
similar
to
cognitive
stress
strategies
of
cognitive
behavioral
therapy
(Meichenbaum,
1991).
The
effect
of
DMT
on
problem-
focused
coping,
which
includes
cognitive
and
behavioral
strategies
used
to
manage
a
stressful
situation
(Lazarus
&
Folkman,
1984),
still
remains
to
be
verified.
The
research
question
arises
whether
DMT
intervention
has
a
long-term
effect
on
stress
reduction,
and
emotion-oriented
and
problem-oriented
stress
management
strategies,
as
follow-up
studies
on
the
persistence
of
treatment
effect
over
time
are
rare
(Bojner
Horwitz
et
al.,
2003).
Research
question
Does
DMT
group
intervention
improve
stress
management
and
reduce
stress
in
the
treatment
group
in
the
short
and
long-term
in
comparison
to
a
wait-listed
control
group
condition
that
receives
no
intervention?
Hypotheses
1.
Short-term
results
at
t2
are
better
in
the
DMT
intervention
group
compared
to
the
wait-listed
control
group:
Between-
group
effect
(time
×
condition).
2.
Short-term
results
at
t2
on
the
DMT
intervention
group
are
bet-
ter
than
the
DMT
group’s
results
at
the
first
test
t1
(pre-test):
Within-group
effect
(time).
3.
Long-term
effects
at
t3
(6
months
follow-up-test)
on
the
DMT
intervention
group
remain
or
fall
slightly,
but
the
results
are,
in
any
case,
better
compared
to
the
wait-listed
control
group:
Between-group
effect
(time
×
condition).
4.
Long-term
results
at
t3
on
the
DMT
intervention
group
are
better
than
the
DMT
group’s
results
at
the
first
test
t1:
Within-group
effect
(time).
Method
Participants,
therapists,
and
procedure
The
author
recruited
seventeen
dance
therapists
from
Germany
via
announcements
at
the
DMT
newsletter
of
the
national
dance
therapy
association
BTD
and
a
BTD
annual
meeting.
Requirements
for
dance
movement
therapists
were
that
they
had
finished
their
DMT
training
and
were
experienced
in
conducting
DMT
groups.
Table
1
Number
of
participants
in
each
location.
Group
Location
Total,
n
DMT
TG,
n
WG,
n
a
Sindelfingen
15
8
7
b Hamburg 16 8 8
c1 Freiburg
16
9
3
c2
Freiburg
4
e Schorndorf
12
9
3
d
Stuttgart
10
10
i
Tübingen
17
10
7
n
Neuss
17
8
9
k Köln 19 9 10
l
Lübeck
15
7
8
u Korbach
8
8
r
Leipzig
17
7
10
Total
162
97
65
From
Bräuninger
(2012,
p.
297).
n:
number
of
participants.
Six
dropped
out
before
the
onset
of
the
study
due
to
organiza-
tional
difficulties.
Eleven
dance
therapists
(ten
women,
one
man)
with
different
DMT
approaches
participated
in
the
study
in
eleven
different
locations
(see
Table
1).
All
therapists
worked
in
private
practice,
which
in
Germany
requires
an
additional
certificate
as
health
psychotherapist.
All
dance
therapists
recruited
participants
suffering
from
stress
on
site
through
a
press
release.
Some
therapists
put
up
posters
in
health
centres
and
doctors’
practices.
One
therapist
recruited
participants
within
a
large
company,
another
following
a
radio
interview.
Self-selected
interested
participants
learned
during
the
first
telephone
contact
about
conditions
for
participation
(ran-
domization,
wait-list
control
condition,
three
investigation
dates,
course
fees,
refund
of
1/5
of
the
fees
upon
completion
of
all
three
tests).
Therapists
informed
participants
about
the
exclusion
criteria
(not
in
psychological,
psychotherapeutic
and/or
medical
treatment
within
previous
12
months
or
at
present;
absence
of
written
con-
sent
at
onset
of
DMT
group;
psychiatric
illness;
serious
physical
disability
or
limitation).
In
nine
cities,
randomization
into
treat-
ment
and
wait-listed
control
group
was
possible.
In
three
cities
the
response
rate
was
too
low
and
allowed
only
the
set
up
of
three
treatment
groups
without
randomization.
In
total,
N
=
162
persons
suffering
from
stress
signed
consent
forms.
Twelve
DMT
groups
(n
=
97)
and
nine
wait-listed
control
groups
(n
=
65)
were
recruited.
DMT
intervention:
the
independent
variable
The
DMT
intervention
consisted
of
a
90
min
DMT
group
inter-
vention,
once
a
week,
for
10
sessions
over
an
approximate
time
span
of
3
months.
No
specific
DMT
approach
or
defined
interventions
were
required
from
therapists.
They
rather
chose
interventions
and
structured
the
sessions
according
to
their
approaches,
methods,
and
techniques
and
in
response
to
the
groups’
needs.
In
order
to
capture
therapists’
chosen
interventions,
therapists
had
to
fill
out
two
intervention
checklists
after
each
of
the
ten
sessions.
Ther-
apists
filled
out
intervention
checklist
1
(ICL1)
per
client
after
each
session,
in
order
to
document
their
individual
interventions
per
participant
per
session,
for
example
if
they
introduced
dance
techniques,
synchronicity
in
rhythm,
space,
efforts,
or
if
they
sup-
ported
the
client
to
use
metaphors.
Intervention
checklist
2
(ICL2)
measured
interventions
per
group,
which
checked
for
the
leading
styles
of
therapists,
their
chosen
DMT
approaches
and
differences
and
similarities
in
group
themes
and
development
(Bräuninger,
2006a,
2006b).
ICL2
further
detected
treatment
modalities
and
self-
expectancy
of
therapists
as
well
as
modes
of
clients
(Bräuninger,
2006c).
A
correlational
analysis
between
dance
movement
ther-
apy
interventions
and
results
form
the
standardized
questionnaires
on
QOL
and
stress
treatment
was
conducted
to
capture
mostly
I.
Bräuninger
/
The
Arts
in
Psychotherapy
39 (2012) 443–
450 445
successful
DMT
interventions
(Bräuninger,
in
preparation).
A
semi-
open,
in-depth
interview
was
conducted
and
recorded
with
each
therapist
after
completion
of
the
last
session
where
they
could
describe
their
experiences
and
give
feedback
on
the
process.
That
opportunity
further
captured
some
understanding
of
their
deci-
sions
such
as
which
interventions
to
use,
to
follow
or
not
follow
a
thematic
plan
(Bräuninger,
in
preparation).
Randomization
and
briefing
of
DMT
participants
The
author
randomly
assigned
participants
into
treatment
group
(TG)
and
wait-list
group
(WG)
by
lottery,
in
order
to
avoid
possible
bias
of
the
respective
dance
therapist.
Participants
were
informed
upon
their
group
assignment
into
TG
or
WG
by
their
dance
therapist.
A
code
for
questionnaires
was
used
to
avoid
social
desirability
in
responses.
One
week
before
the
DMT
groups
started,
therapists
separately
invited
TG
and
WG
and
handed
out
ques-
tionnaires
at
t1.
They
informed
participants
that
questionnaires’
codes
guaranteed
confidentiality
and
anonymity
and
that
thera-
pists
could
not
access
personal
data
disclosed
in
questionnaires.
For
ethical
reasons,
WG
received
the
option
of
a
10-session
TG
after
completion
of
all
three
tests
(about
9
months
after
the
preliminary
investigation
at
t1).
Measurements
Standardized
questionnaires
were
used
at
all
three
measure
points.
Table
2
gives
an
overview
on
the
different
types
of
variables.
Brief
Symptom
Inventory
The
Brief
Symptom
Inventory
(BSI)
(Derogatis,
1977;
Franke,
1995,
2000)
is
a
self-evaluation
questionnaire.
It
records
psy-
chopathology
and
provides
a
measure
of
general
psychic
strain
(on
several
subscales),
assesses
cognitive,
physical,
and
emotional
symptoms
of
distress,
and
overall
distress
in
the
last
7
days
rated
on
a
5-point
Likert
scale
with
53
items,
nine
scales,
and
three
global
parameters:
Global
Severity
Index/GSI,
which
captures
fundamental
psychological
distress,
Positive
Symptom
Distress
Index/PSDI,
which
measures
response
intensity,
and
Positive
Symp-
tom
Total/PST
which
informs
about
the
number
of
symptoms.
The
internal
consistency
for
the
9
scales
lies
between
r
=
.63
and
r
=
.85
and
the
test-retest
reliability
after
7
days
falls
between
r
=
.73
and
r
=
.92.
The
items
show
“face
validity”.
The
BSI
was
used
as
a
DMT
outcome
measurement
to
assess
if
psychological
distress
was
reduced.
Furthermore,
the
GSI
was
operationalized
for
screening
for
emotional
distress
reduction,
hence
improvement
of
emotion-
oriented
coping
strategies.
Coping
and
Stress
Questionnaire
[Stressverarbeitungsfragebogen]
(SVF)
120
The
Coping
and
Stress
Questionnaire
(SVF)
120
(Janke,
Erdmann,
Kallus,
&
Boucsein,
1997)
is
a
multidimensional
self-assessment
tool
that
measures
coping
styles
and
stress
management
strate-
gies
in
stressful
situations.
It
is
rated
on
a
5-point
Likert
scale
with
120
items
in
20
subtests.
Coping
and
stress
management
strategies
are
differentiated
according
to
whether
they
reduce
stress
(Positive
Strategies
1–3)
or
increase
stress
(Negative
Strategies).
The
three
positive
sub
areas
are
Positive
Strategy
1
(Defence/Depreciation),
Positive
Strategy
2
(Distraction),
Positive
Strategy
3
(Controlling).
The
subtest
“Relaxation”
is
additionally
presented
although
its
6
items
are
included
in
the
calculation
of
Positive
Strategy
2.
Internal
consistency
(Cronbach’s
alpha)
of
subtests
lies
between
r
=
.62
and
r
=
.92.
Construct
validity
exists,
intercorrelations
(.37–.66)
of
the
subtests
are
derived
from
the
standardization
study
(20–64y.),
and
different
types
of
coping
methods
are
recognized.
The
SVF
120
was
used
to
operationalize
the
variable
of
problem-oriented
coping
and
stress
management.
Design
This
multicentric
RCT
with
a
between
and
within
subject-design
applied
a
mixed
methods
approach
combining
quantitative
and
qualitative
methods.
Results
regarding
stress
reduction
and
stress
management
improvement
are
reported
here.
Results
regarding
improvement
of
quality
of
life
and
qualitative
study
results
are
already
published
(Bräuninger,
2012,
2006a,
2006b,
2006c).
The
between
subject-design
compares
two
groups:
a
DMT
treatment
group
(12
TG,
n
=
97)
with
a
wait-listed
control
condition
(9
WG,
n
=
65).
The
WG
received
no
treatment
during
all
three
measure
points
t1
t3
and
was
inactive.
Test
times
when
participants
filled
out
standardized
questionnaires
were
at
baseline
at
t1,
after
ten
sessions
DMT
intervention
at
t2
(for
short
term
treatment
effects)
and
6
months
after
termination
of
the
treatment
at
t3
(for
long
term
treatment
effects).
Participants
were
recruited
via
news
advertise-
ments
and
randomly
assigned
to
TG
or
WG.
Experienced
dance
movement
therapists
led
the
groups.
The
aim
of
this
controlled
intervention
study
was
to
validate
the
short-term
and
long-term
effect
of
DMT
treatment
on
stress
reduction
and
stress
management
improvement.
Data
analysis
Analysis
of
variance
(ANOVA)
was
conducted
to
evaluate
the
between-group
(time
×
DMT
intervention)
and
within-group
(time)
effects.
Eleven
participants
of
the
TG
were
excluded
from
data
analysis
because
they
participated
less
than
five
times
in
the
DMT
group.
This
information
was
detected
from
analysing
the
intervention
checklist
1.
Two
people
from
the
WG
were
excluded
from
statistical
analysis.
They
filled
out
the
questionnaires
at
one
single
measure
point
only.
No
difference
between
TG
and
WG
is
expected
at
the
pre-test
t1.
For
the
second
measure
point
at
t2
(post-test)
it
is
expected
that
the
TG
shows
better
results
than
the
WG.
For
the
short-
and
long-term
treatment
effect
at
t2
and
t3,
the
main
effect
of
group
affiliation
should
be
significant.
This
should
not
Table
2
Variables
in
the
overall
study.
Independent
variables
Moderating
variables
Dependent
variables
Objective
data
Subjective
data
DMT
TG
versus
WG
s
t1,
t2,
t3
t2,
t3
t1,
t2,
t3
-
Demographic
data
Other
therapies
Stress
Quality
of
lifea
-Suggestibility/imagination
ability
(imagination
test)
-
Stress
management
(SVF
120)
-
WHOQOL-100
-
General
self-efficacy
(GSE)
-
Psychological
distress
and
psychopathology
(BSI)
-
MLDL
aResults
regarding
quality
of
life
are
presented
in
Bräuninger
(2012,
p.
298).
446 I.
Bräuninger
/
The
Arts
in
Psychotherapy
39 (2012) 443–
450
be
true
at
t1
because
the
group
allocation
is
random.
The
crucial
test
for
short-term
effect
of
DMT
treatment
is
the
interaction
between
group
affiliation
and
the
measure
points
at
t1
and
t2,
because
at
t2,
the
TG
had
almost
completed
treatment
(9
out
of
10
h).
The
crucial
test
of
the
long-term
effect
of
DMT
treatment
is
the
inter-
action
between
group
affiliation
and
measure
points
at
t1
and
t3.
We
expect
that
the
treatment
effect
at
t3
for
the
termination
of
the
treatment
6
months
earlier
is
still
strong,
but
weaker
than
in
t2.
The
analysis
of
variance
with
measure
points
t1
and
t3
on
the
measure-
ment
repetition
factor
is
less
likely
to
show
a
significant
interaction
as
those
with
the
measure
points
at
t1
and
t2.
Calculation
includes
the
means
of
TG
and
WG,
the
overall
average,
and
the
interaction
between
–TG
and
WG
and
main
effect
of
factors
time
(t1
and
t2,
respectively
t1
and
t3).
–TG
and
measure
points
t1
(pre-test)
and
t2
(post-test),
respec-
tively
t1
(pre-test)
and
t3
(6-month
follow-up-test).
The
measure
points
t1
and
t2,
and
t1
and
t3,
were
compared
in
Greenhouse
Geisserscher
tests.
All
statistical
tests
were
performed
with
a
significance
level
at
*p
<
.10
=
significant
and
**p
<
.05
=
highly
significant.
Results
Demographic
data
of
participants
At
baseline
t1,
no
significant
difference
existed
in
age,
educa-
tion,
and
health
between
TG
and
WG
(see
demographic
data
of
participants
in
Table
3)
except
for
two
sub-items
of
marital
status.
Effects
of
DMT
on
reducing
psychological
distress
and
improving
stress
management
strategies
Table
4
shows
the
DMT
short-term
effects
on
psycholog-
ical
distress
reduction
and
stress
management
improvement
between
groups
(main
effect:
interaction
between
group
mem-
bership
×
time
of
measurement)
and
within
groups
(main
effect:
time).
Results
of
the
BSI
and
SVF
confirmed
the
first
hypotheses:
The
TG
showed
significant
short-term
reduction
in
psychological
distress
and
psychopathology
in
some
of
the
BSI
scales
Obsessive
Com-
pulsiveness
(p
<
.05),
Anxiety
(p
<
.005),
and
the
Positive
Symptom
Distress
PSDI
(p
<
.02)
compared
to
the
WG.
In
the
SVF
120
ques-
tionnaire,
the
pre-post
comparison
of
the
TG
with
the
WG
always
showed
improvement
in
the
TG,
but
not
in
the
WG.
This
became
significant
in
the
Positive
Strategy
2
(Distraction)
(p
<
.10),
in
the
Negative
Strategy
(p
<
.005),
and
in
the
Subtest
Relaxation
(p
<
.10).
To
conclude,
DMT
is
clearly
more
effective
in
the
short-term
to
reduce
psychological
distress
and
improve
stress
management
than
non-treatment.
The
second
hypothesis
assumes
an
effect
of
time
within
groups
effect
of
time:
short-term
results
in
the
treatment
group
are
better
after
the
10
sessions
of
DMT
intervention
(at
post-test
t2)
compared
to
the
TG’s
pre-treatment
status
at
t1
(pre-test).
This
hypothesis
was
partially
confirmed,
because
Negative
Strat-
egy
(p
<
.005)
of
stress
management
decreased
and
Relaxation
(p
<
.05)
ability
improved.
The
hypothesis
was
fully
confirmed
regarding
psychological
distress
of
psychopathology:
nearly
all
symptom
dimensions
improved,
as
in
Obsessive-Compulsive
Behaviour
(p
<
.01),
Interpersonal
Sensitivity
(p
<
.005),
Depres-
sion
(p
<
.10),
Hostility
(p
<
.000),
Paranoid
Ideation
(p
<
.005),
Table
3
Demographic
data
of
participants.
All
participants DMT
TG WG
n
%
n
%
n
%
Gender
Total
162
100
97
59.9
65
40.1
Female
147
90.7
88
90.7
59
90.8
Male 15 9.3
9
9.3
6
9.2
Age M
44
44
44
SD
9
9
9
Minimum/maximum
16/65
16/65
26/62
School No
school-leaving
certificate
0
0
0
0
0
0
Secondary
school
16
9.9
9
9.3
7
10.8
Junior
high
school
29
17.9
16
16.5
13
20.0
Technical
college
entrance
level
15
9.3
8
8.2
7
10.8
High
school
A
level
16
9.9
9
9.3
7
10.8
BA/BS
degree
36
22.2
25
25.8
11
16.9
MA/MS
degree
48
29.6
30
30.9
18
27.7
Postgraduate/PhD
degree,
etc.
2
1.2
0
0
2
3.1
Marital
1
single
43
26.5
26
26.8
17
26.2
2
married
68
42
39
40.2
29
44.6
3
living
with
partner
23
14.2
10
10.3
13
20.0
4
living
separated
8
4.9
8
8.2
0
.0
5
divorced
15
9.3
9
9.3
6
9.2
6
widowed
0
.0
0
.0
0
.0
7
(1
+
5)
1
.6
1
1.0
0
.0
8
(3
+
5)
2
1.2
2
2.1
0
.0
9
(2
+
3)
1
.6
1
1.0
0
.0
10
(4
+
5)
1
.6
1
1.0
0
.0
Health
at
t1 1
very
bad
0
.0
0
0.0
0
0.0
2
bad
19
11.7
11
11.3
8
12.3
3
moderate
53
32.7
35
36.1
18
27.7
4
well
67
41.4
39
40.2
28
43.1
5
very
well
17
10.5
11
11.3
6
9.2
Non
valid
6
3.7
1
1.0
4
6.1
Bräuninger
(2012,
p.
299).
n:
number
of
participants;
t1:
pre-test.
I.
Bräuninger
/
The
Arts
in
Psychotherapy
39 (2012) 443–
450 447
Table
4
Mean
(M)
and
standard
deviation
(SD)
of
BSI
and
SVF
Scales
at
t1
and
t2.
Main
short-term
effect
of
interaction
between-groups
×
measuring
point
and
main
short-term
effect
of
time.
Group nBSI:
t1
t2
comparison
Group
×
Time:
t1
t2
Measuring
point:
t1
t2
t1:
M
(SD)
t2:
M
(SD)
F
F
1.
Somatization
TG
84
.73
(.61)
.63
(.62)
(1,136)
=
.183
(1,136)
=
.28
WG 54 .63
(.55) .68
(.54) n.s.
n.s.
2.
Obsessive-Compulsive TG
84
1.15
(.77)
.87
(.68)
(1,136)
=
6.08
(1,136)
=
7.75
WG
54
1.06
(.72)
1.05
(.78) **p
<
.05 **p
<
.01
3.
Interpersonal-Sensitivity
TG
84
1.37
(.84)
1.02
(.77)
(1,136)
=
3.50
(1,136)
=
12.37
WG
54
1.28
(.92)
1.17
(.90) *p
<
.10 ***p
<
.005
4.
Depression TG 84 .88
(.78) .65
(.75) (1,136)
=
5.36 (1,136)
=
3.54
WG 54 .65
(.75) .79
(73) **p
<
.05 *p
<
.10
5.
Anxiety TG
84
.96
(.59)
.67
(.57)
(1.136)
=
8.42
(1,136)
=
.44
WG
54
.84
(.62)
1.02
(.1.32) ***p
<
.005
n.s.
6.
Hostility TG
84
1.05
(.68)
.80
(.67)
(1,136)
=
00
(1,136)
=
17.74
WG
54
1.08
(.87)
.82
(.73)
n.s. ***p
=
.000
7.
Phobic
Anxiety
TG
84
.42
(.56)
.29
(.44)
(1,136)
=
7.08
(1,136)
=
.90
WG
54
.34
(.51)
.40
(.59) **p
<
.01
n.s.
8.
Paranoid
Ideation TG 84 .96
(.70) .73
(.68) (1,136)
=
1.13 (1,136)
=
9.36
WG
54
.82
(.72)
.72
(.60)
n.s. ***p
<
.005
9.
Psychoticism
TG
84
.72
(.71)
.44
(.47)
(1,136)
=
5.69
(1,136)
=
11.72
WG
54
.64
(.69)
.59
(.62) **p
<
.05 ***p
<
.005
10.
Addition
TG
84
.81
(.72)
.59
(.52)
(1,136)
=
.15
(1,136)
=
11.57
WG
54
.82
(.68)
.64
(.62)
n.s. ***p
<
.005
GSI:
Global
Severity
Index TG 87 .90
(.51)
.67
(.48)
(1,139)
=
6.68
(1,139)
=
12.37
WG
54
.83
(.52)
.79
(.53) **p
<
.05 ***p
<
.005
PSDI:
Positive
Symptom
Distress
Index
TG
63
1.55
(.48)
1.39
(.43)
(1,104)
=
5.39
(1,104)
=
1.87
WG
43
1.53
(.46)
1.58
(.57) **p
<
.02
n.s.
PST:
Positive
Symptom
Total
TG
87
27.33
(10.57)
20.13
(13.41)
(1,142)
=
.71
(1,142)
=
40.86
WG
57
24.86
(.10.00)
19.33
(12.96)
n.s. ***p
=
.000
Group
n
SVF:
t1
t2
comparison
Group
×
Time:
t1
t2
Measuring
point
t1
t2
t1:
M
(SD)
t2:
M
(SD)
F
F
Positive
Strategy
1
(Defense/Depeciation) TG
79
25.72
(8.99)
27.13
(9.22)
(1,125)
=
1.60
(1,125)
=
2.55
WG
49
26.10
(7.70)
26.13
(8.54)
n.s.
n.s.
Positive
Strategy
2
(Distraction) TG 77 42.74
(12.25)
44.77
(11.34)
(1,126)
=
3.58
(1,126)
=
.87
WG
515
43.90
(12.59)
43.22
(12.15) *p
<
.10
n.s.
Positive
Strategy
3
(Controlling)
TG
77
44.88
(10.39)
43.71
(9.98)
(1,126)
=
.27
(1,126)
=
2.19
WG
51
45.19
(8.44)
44.63
(8.60)
n.s.
n.s.
Negative
Strategies TG
74
77.31
(22.67)
68.69
(22.13)
(1,124)
=
9.75
(1,122)
=
12.24
WG
50
71.65
(20.71)
71.16
(17.09) ***p
<
.005 ***p
<
.005
Item
7
Relaxation TG
71
10.94
(5.15)
12.38
(4.59)
(1,129)
=
3.69
(1,129)
=
6.05
WG
40
10.98
(4.85)
11.16
(4.60) *p
<
.10 **p
<
.05
TG:
DMT
treatment
group,
WG:
wait-listed
control
group,
t1:
pre-test
(before
the
intervention),
t2:
post
test,
n.s.:
non
significant.
*p
<
.10.
** p
<
.05.
*** p
<
.01.
Psychoticism
(p
<
.005),
Addiction
(p
<
.005),
and
in
Global
Severity
Index
(p
<
.005),
and
Positive
Symptom
Total
(p
<
.000)
(see
Table
4).
Table
5
shows
the
DMT
long-term
effects
on
psycholog-
ical
distress
reduction
and
stress
management
improvement
between
groups
(main
effect:
interaction
between
group
mem-
bership
×time
of
measurement)
and
within
groups
(main
effect:
time).
The
third
hypothesis
is
largely
confirmed:
It
presumes
a
long-
term
effect
at
t3
(6
months
follow-up-test)
in
the
intervention
group
as
a
result
of
DMT
compared
to
the
wait-listed
control
group
(between-group
effect:
time
×
condition):
significant
long-term
improvement
in
psychological
distress
and
psychopathology
were
detected
in
the
TG,
but
not
in
the
WG,
in
the
BSI
scales
Interpersonal
Sensitivity
(p
>
.05),
Depression
(p
>
.000),
Phobic
Anxiety
(p
>
.05),
Psychoticism
(p
>
.05),
and
in
the
Global
Severity
Index/GSI
(p
>
.01),
and
Paranoid
Ideation
(p
>
.005).
Stress
management
improved
only
in
the
TG
in
the
follow-up
test
t3,
where
Negative
Strategies
(p
<
.05)
decreased,
but
not
in
the
WG.
The
fourth
hypothesis
assumes
that
long-term
results
at
t3
on
the
DMT
intervention
group
are
better
than
results
at
the
first
test
t1
(see
Table
5).
This
hypothesis
is
confirmed:
the
TG
showed
significant
long-term
improvement
at
t3
in
psychopathology
and
psychological
distress
in
the
BSI
scales
Somatization
(p
<
.05),
Inter-
personal
Sensitivity
(p
<
.05),
Anxiety
(p
<
.05),
Hostility
(p
<
.005),
Addiction
(p
<
.05),
Global
Severity
Index/GSI
(p
<
.05),
Positive
Symptom
Distress
Index/PSDI
(p
<
.05),
and
Positive
Symptom
448 I.
Bräuninger
/
The
Arts
in
Psychotherapy
39 (2012) 443–
450
Table
5
Mean
(M)
and
standard
deviation
(SD)
of
BSI
and
SVF
Scales
at
t1
and
t3.
Main
long-term
effect
of
interaction
between-groups
×
measuring
point
and
main
long-term
effect
of
time.
Group
n
BSI:
t1
t3
comparison
Group
×
Time:
t1
t3
Measuring
point:
t1
t3
t1:
M
(SD)
t3:
M
(SD)
F
F
1.
Somatization
TG
74
.69
(.54)
.53
(.48)
(1,121)
=
.43
(1,121)
=
4.69
WG
49
.70
(.62)
.62
(.55)
n.s.
p
<
.05**
2.
Obsessive-Compulsive TG 74
1.11
(.77)
.96
(.75)
(1,121)
=
1.41
(1,121)
=
2.09
WG 49
1.06
(.69)
1.04
(.80)
n.s.
n.s.
3.
Interpersonal-Sensitivity
TG
74
1.34
(.81)
1.01
(.71)
(1,121)
=
5.54
(1,121)
=
4.44
WG
49
1.25
(.84)
1.26
(.90)
p
<
.05** p
<
.05**
4.
Depression
TG
74
.88
(.77)
.66
(.68)
(1,121)
=
15.02
(1,121)
=
.06
WG 49 .67
(.49) .91
(79) p
=
.000*** n.s.
5.
Anxiety TG 74 .95
(.56)
.73
(.58)
(1,121)
=
1.77
(1,121)
=
4.37
WG
49
.86
(.61)
.81(.79)
n.s.
p
<
.05**
6.
Hostility TG
74
1.01
(.66)
.74
(.63)
(1,121)
=
.18
(1,121)
=
12.49
WG 49 1.11
(.85)
.89
(.70)
n.s.
p
<
.005***
7.
Phobic
Anxiety
TG
74
.46
(.64)
.37
(.57)
(1,121)
=
4.70
(1,121)
=
.02
WG
49
.30
(.42)
.38
(.57)
p
<
.05** n.s.
8.
Paranoid
Ideation
TG
74
1.00
(.79)
.75
(.59)
(1,121)
=
10.32
(1,121)
=
2.04
WG
49
.73
(.60)
.83
(.66)
p
<
.005*** n.s.
9.
Psychoticism
TG
74
.71
(.70)
.53
(.54)
(1,121)
=
5.07
(1,121)
=
.58
WG 49 .55
(.55)
.64
(.54)
p
<
.05** n.s.
10.
Addition TG
74
.82
(.74)
.58
(.55)
(1,121)
=
2.15
(1,121)
=
5.42
WG
49
.74
(.64)
.69
(.70)
n.s.
p
<
.05**
GSI:
Global
Severity
Index
TG
74
.90
(.50)
.68
(.45)
(1,121)
=
7.68
(1,121)
=
6.78
WG
49
.80
(.45)
.81
(.55)
p
<
.01** p
<
.05**
PSDI:
Positive
Symptom
Distress
Index
TG
57
1.52
(.44)
1.37
(.47)
(1,95)
=
1.64
(1,95)
=
5.26
WG 40 1.56
(.48)
1.52
(.48)
n.s.
p
<
.05**
PST:
Positive
Symptom
Total
TG
87
27.33
(10.59)
18.62
(13.96)
(1,142)
=
.93
(1,142)
=
36.73
WG
57
24.86
(10.00)
18.54
(14.01)
n.s.
p
=
.000***
Group
n
SVF:
t1
t3
comparison
Group
×
Time:
t1
t3
Measuring
point
t1
t3
t1:
M
(SD)
t3:
M
(SD)
F
F
Positive
Strategy
1
(Defense/Depeciation)
TG
68
26.34
(9.12)
28.35
(8.98)
(1,111)
=
1.58
(1,111)
=
4.67
WG
45
25.90
(7.02)
26.43
(7.28)
n.s.
p
<
.05**
Positive
Strategy
2
(Distraction)
TG
71
43.21
(12.91)
44.85
(12.01)
(1,114)
=
.42
(1,114)
=
1.32
WG 45 43.89
(13.47)
44.34
(12.65)
n.s.
n.s.
Positive
Strategy
3
(Controlling) TG
71
45.66
(9.80)
44.32
(10.05)
(1,114)
=
.49
(1,114)
=
1.76
WG
45
44.90
(7.31)
44.49
(9.17)
n.s.
n.s.
Negative
Strategies
TG
66
75.91
(23.05)
67.08
(23.50)
(1,108)
=
5.19
(1,108)
=
11.29
WG
44
70.74
(19.97)
69.05
(17.86)
p
<
.05** p
<
.005***
Item
7
Relaxation TG
75
11.28
(5.23)
12.20
(4.58)
(1,118)
=
1.21
(1,118)
=
1.78
WG
45
10.87
(4.85)
10.96
(4.58)
n.s.
n.s.
TG:
DMT
treatment
group,
WG:
wait-listed
control
group,
t1:
pre-test,
(before
the
intervention),
t3:
6-month
follow-up
test,
n.s.:
non
significant.
*p
<
.10.
** p
<
.05.
*** p
<
.01.
Total/PST
(p
<
.000).
DMT
fostered
the
positive
stress
manage-
ment
strategy
Defense/Depreciation
(p
<
.05)
and
reduced
Negative
Strategies
(p
<
.05)
in
the
long
term.
Results
clearly
indicate
that
DMT
improves
stress
management
strategies
and
reduces
psychological
distress
and
psychopathol-
ogy
and
DMT
treatment
is
more
effective
than
non-treatment.
When
compared
to
the
WG,
DMT
is
especially
successful
in
the
short-
and
long-term
as
it
reduces
negative
stress
strategies
and
always
reduces
psychological
distress.
DMT
is
effective
to
import
Distraction
and
Relaxation
strategies
in
the
short-term
as
stress
management.
To
conclude,
DMT
is
a
successful
treatment
in
the
short-
and
long-term
to
reduce
psychological
distress
and
improve
stress
management
strategies
and
is
significantly
more
efficient
than
non-treatment.
This
RCT
fulfilled
the
criteria
of
the
“gold
standard”
in
health
science
(Schulz,
Altman,
&
Moher,
2010).
It
intended
to
evalu-
ate
the
effect
of
DMT
on
psychological
distress
reduction
and
improvement
of
stress
management
in
the
short-
and
long-run.
The
multicentric
nature
of
this
study
ensured
external
validity.
Between
and
within
group
comparison
revealed
the
confirma-
tion
of
all
hypotheses.
The
findings
are
in
accordance
with
other
research
that
reported
improved
depressive
mood
(Brooks
&
Stark,
1989;
Mannheim
&
Weis,
2006),
reduced
fears
(Brooks
&
Stark,
1989;
Cruz
&
Sabers,
1998;
Mannheim,
Liesenfeld,
&
Weis,
2000;
Ritter
&
Low,
1996),
increased
social
interaction
and
competence
(Mannheim
et
al.,
2000;
Rossberg-Gempton,
Dickinson,
&
Poole,
1999;
Stoll
&
Alfermann,
2002),
and
improved
general
health
status
(Mannheim
&
Weis,
2006)
by
means
of
DMT.
I.
Bräuninger
/
The
Arts
in
Psychotherapy
39 (2012) 443–
450 449
Discussion
DMT
is
significantly
better
than
non-treatment
The
BSI
symptoms
improved
in
all
10
scales
and
three
global
parameters
in
the
TG
from
pre-
(t1)
to
post-test
(t2)
and
sig-
nificantly
more
in
the
TG
than
in
the
WG.
The
values
of
the
WG
deteriorated,
however,
four
out
of
thirteen
times
or
remained
unchanged.
With
regard
to
stress
management
the
val-
ues
improved
in
eight
(of
ten)
strategies
and
subtests
of
the
SVF
120
in
the
TG,
but
not
in
the
WG.
These
results
are
consistent
with
studies
that
demonstrated
better
results
in
the
DMT
TG
than
in
the
control
group
at
post-test
(Berrol,
Ooi,
&
Katz,
1997;
Brooks
&
Stark,
1989;
Cruz
&
Sabers,
1998;
Mannheim
et
al.,
2000;
Ritter
&
Low,
1996;
Rossberg-Gempton
et
al.,
1999).
The
present
study
detects
the
superiority
of
DMT
via
a
wait-listed
control
condition:
All
the
psychological
stress
symptoms
(BSI)
were
reduced
in
the
TG
from
the
pre-test
(t1)
to
the
6-month-follow-up-test
(t3)
and
more
than
in
the
WG.
The
TG
showed
in
most
individual
sub-tests
(eight
from
ten)
of
the
coping
and
stress
management
strategies
(SVF
120)
better
results
at
t3
compared
to
the
WG.
This
result
is
vital,
as
it
clearly
indicates
that
it
is
neither
advisable
nor
scientif-
ically
confirmed
that
“time
heals
all
wounds”.
DMT
is
significantly
better
than
non-treatment.
DMT
significantly
reduces
stress
in
the
short
and
long
term
This
RCT
on
DMT
showed
that
both
stress
level
decreased
and
mental
health
improved
in
the
TG
in
the
short
and
long
term.
A
controlled
study
on
a
14-week
moderate
physical
activation
pro-
gram
with
pre-,
post-comparison
revealed,
in
comparison,
that
only
body
self-image
improved,
while
resources,
well-being
and
mental
health
did
not
(Stoll
&
Alfermann,
2002).
DMT
combines
physi-
cal
activation,
movement,
expressive
psychotherapeutic
work,
and
addresses
interpersonal
and
intrapsychic
awareness.
This
combina-
tion
might
account
for
the
reduction
of
psychological
distress
and
psychopathology,
thus
the
improvement
of
mental
health.
As
in
the
study
of
Bojner
Horwitz
et
al.
(2003),
a
positive
long-term
effect
of
DMT
on
stress
was
assumed.
This
was
confirmed
fully
with
regard
to
psychological
distress
reduction:
The
Global
Severity
Index
(GSI)
of
the
BSI,
which
indicates
a
person’s
severity-of-illness
and
mea-
sures
treatment
outcome
based
on
reducing
symptom
severity
(Pearson,
2012),
decreased
in
the
short-
and
long-term
due
to
DMT.
The
hypothesis
is
predominantly
confirmed
in
relation
to
stress
management
strategies.
This
result
is
crucial,
as
it
demonstrates
a
long-term
effect
of
DMT
whereas
research
so
far
mainly
focused
on
pre-,
post
DMT
treatment
effects.
The
present
RCT
presents
a
significant
contribution
to
support
the
efficacy
of
DMT
as
a
stress
treatment
that
lasts
over
time.
DMT
promotes
emotion-oriented
and
problem-oriented
stress
and
coping
strategies
The
positive
results
of
the
short-term
and
long-term
Global
Severity
Index/GSI
values
(BSI
questionnaire)
in
this
study
con-
firm
that
DMT
has
reduced
emotional
distress,
which
can
be
interpreted
that
DMT
improved
emotion-oriented
coping
strategy.
This
is
in
accordance
with
a
T’ai
Chi
and
aerobics
study,
where
emotion-oriented
coping
skills
(Bond
et
al.,
2002)
were
found.
The
significant
outcome
beyond
these
findings
is
that
DMT
promotes
problem-oriented
coping
strategies:
Negative
strategies
such
as
flight
impulses,
social
isolation,
mental
retention,
resignation,
self-
pity
and
self-blame
were
significantly
reduced
in
the
TG,
whereas
in
the
WG
they
remained.
Moreover,
the
positive
distraction
strategy
improved
in
the
TG.
To
conclude,
DMT
is
a
successful
treatment
to
promote
both
emotion-oriented
and
problem-oriented
coping
strategies.
Limitations
of
the
present
study
There
are
several
limitations
to
this
study:
the
use
of
self-rating
instruments
might
have
caused
bias
of
psychological
distress
or
stress
management
strategies.
Other
limitations
might
be
the
lack
of
a
second
treatment
or
placebo
group
as
a
control,
the
DMT
inter-
vention’s
length
(10
sessions),
questionnaires’
responses
and
the
interpretation
of
these
results
which
depended
on
participants’
vol-
untary
compliance.
Recruiting
participants
for
a
“Dance
Movement
Therapy
Study”
might
be
reason
why
the
majority
of
participants
were
women,
as
they
are
generally
more
attracted
to
“dance-like”
activities.
The
small
sample
size
of
15
(9%)
male
participants
was
included
in
the
evaluation
without
testing
for
gender
related
dif-
ferences.
Three
out
of
twelve
treatment
groups
had
no
wait-listed
controlled
groups.
Conclusions
The
present
multicentric
randomized
controlled
trial
investi-
gated
the
short-
and
long-term
effect
of
DMT
treatment
on
stress.
DMT
is
more
successful
than
non-treatment
and
is
significantly
more
effective
compared
to
a
wait-listed
control
group.
The
medical
costs
caused
by
stress
and
mental
stress
symptoms
are
economi-
cally
significant
(McDaid,
Knapp,
&
Medieros,
2008).
Therapies
that
are
efficient
and
effective
in
stress
treatment
have
economic
bene-
fits
and
favoured
in
health
policy.
Findings
of
this
RCT
are
relevant
for
promoting
DMT
as
an
innovative
and
successful
treatment
of
stress.
Results
of
this
study
are
revealing
in
another
respect.
The
appli-
cation
of
DMT
has
had
little
formal
discussion
as
brief
therapy.
A
10-sessions’
DMT
treatment
format
is