Circle of Care Bibliography

Art Therapy

The healing canvas: Art can soothe the mind and body, therapists say. Now science backs them up. Jenny Hontz, The Los Angeles Times March 20, 2006

Chapman L, Morabito D, Ladakakos C, et al.   2001.   The effectiveness of an art therapy interventions in reducing post-traumatic stress disorder (PTSD) symptoms in pediatric trauma patients.   Art Therapy: Journal of the American Art Therapy Association 18(2), pp. 100-4.

Lusebrink, V. (1990). Imagery and visual expression in therapy. New York: Plenum Press.

Lusebrink V.   2004. Art Therapy and the Brain: An attempt to understand the underlying process of art expression in therapy. Art Therapy: Journal of the American Art Therapy Association , 21(3), pp.125-135.

Luzzatto, P. (1998). From psychiatry to psycho-oncology: Personal reflections on the use of art therapy with cancer patients. In Pratt, M. & Wood, M. (Eds.), Art therapy in palliative care (pp. 169-175). New York: Rutledge.

Malchiodi, C. (Ed.) (1999). Medical art therapy with adults . Philadelphia: Jessica Kingsley Publishers.

Monti DA, Peterson C, Kunkel ES, Hauck WW, Pequignot E, Rhodes, L, and Brainard, GC, 2005. A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psycho-Oncology (in press). Article Identifier at Wiley (AID) online: PON988. John Wiley & Sons, Ltd.

Peterson, C . Art Therapy , in Rakel B, MacKenzie E (Eds) Complementary and alternative medicine for older adults: Holistic approaches to healthy aging , (pp. 111-134) Springer 2006.

http://www.springerpub.com/prod.aspx?prod_id=38055

Arts Therapies Books at Jessica Kingsley Publishers

http://www.jkp.com/catalogue/

Art Therapy Outcome Studies

Banks, S., Davis, P., Howard, V. F., & McLaughlin, T. F. (1993). The effects of directed art activities on the behavior of young children with disabilities: A multi-element   baseline study.   Art Therapy: Journal of the American Art Therapy Association, 10 (4), 235-240.

The effects of directed art activities on the behavior of two preschool children and one kindergarten child with developmental delays, as measured by The Vineland Adaptive Scale (Sparrow, Balla, & Ciccheiit, 1984) in a rural classroom were examined.   A multi-element baseline design across participants was used to compare directed art activities with typical preschool art activities.   The target behaviors measured were aggression, eye contact, and social initiation.   Each art activity directed by the teacher focused on an affective concept such as anger or happiness.   The control condition used the same art materials as the directed art activity, and the children chose how they would use the materials.   Baseline data was collected 1-hour per day for five days.   During the control and experimental conditions, “data were collected [by a trained paraprofessional] 5 minutes after the art lesson, and again 30 minutes later....as the target behaviors were more likely to occur at that time” (p. 237) .   Data analysis was conducted by visual analysis of graphed results.   Results indicated that the directed art activity had a larger effect than the control condition on the social condition of two children, while the control condition generated little effect.   However, “both experimental and control art activities resulted in therapeutic improvement of social behaviors, across individuals” (p. 238).   Neither art activity had a measurable effect on the targeted behavior of the third child.   Implications for use by preschool and other teachers were suggested.

Curry, N. A., & Kasser, T. (2005). Can coloring mandalas reduce anxiety?   Art Therapy: Journal of the American Art Therapy Association, 22 (2), 81-85.

This study examined the effectiveness of different types of art activities in the reduction of anxiety.   After undergoing a brief anxiety-induction, 84 undergraduate students were randomly assigned to color a mandala, to color a plaid form, or to color on a blank piece of paper.   ANOVA results demonstrated that anxiety levels declined approximately the same for the mandala- and plaid-coloring groups (p < .32). Both of these groups experienced more reduction in anxiety than did the unstructured-coloring group (p < .001).   “Follow-up t tests revealed again that the mandala group showed larger decreases in anxiety than did the free-form group... (p < .003)” (p. 83), as was also the case when plaid- and free-form groups were compared (p < .03).   These findings suggest that structured coloring of a reasonably complex geometric pattern may induce a meditative state that benefits individuals suffering from anxiety.

Doric-Henry, L. (1997). Pottery as art therapy with elderly nursing home residents.   Art Therapy: Journal of the American Art Therapy Association, 14 (3), 163-171.

An art therapy intervention using an eight-session pottery class based on Eastern Method throwing technique was implemented with 20 elderly nursing home residents, with the aim of improving their psychological well-being.   Quantitative evaluation was based on Hebl & Enright (1993) and employed a quasi-experimental design measuring the participants’ self-esteem (Coopersmith, 1981), depression (Beck Depression Inventory, Beck et al., 1961), and anxiety (State-Trait Anxiety Inventory, Spielberger et al., 1983) compared with 20 nonparticipating elderly residents of the nursing home.   Qualitative evaluation included client self-evaluations (a subjective measure, designed for this study), case progress notes, journal notes, and photographs.   Following the intervention, the participating group showed significantly improved measures of self-esteem, and reduced depression and anxiety at posttest (p < .05) relative to the comparison group.   However, it should be noted that those with high self-esteem and low anxiety at the beginning of the study did not make significant gains; conversely, those with low self-esteem and high anxiety, pre-intervention, benefited the most.   Implications for art therapy intervention with institutionalized elderly and further research are discussed.

Miller, C. (1993). The effects of art history-enriched art therapy on anxiety, time on task, and art product quality.   Art Therapy: Journal of the American Art Therapy Association, 10 (4), 194-200.

The effects of an art history enrichment art therapy task on anxiety, time on task, and at product quality among 13 chronic adult psychiatric day hospital patients were investigated using a repeated-measures, quasi-experimental design.   State-anxiety was measured with the State-Trait Anxiety Inventory   (Spielberger, 1983).   Art product organization level was assessed with the Art Description Scales (Miller & Miller, 1992).   Time on task was measured by the author to the nearest 5 minutes. Two 1 ½ hour sessions were conducted one week apart to reduce the “practice effect.”   Under the control condition, participants were asked to “paint freeform shapes” (p. 196).   Under the experimental conditions, participants were given a short lecture on Kandinsky and viewed his work, then asked to structure the painting: draw “three curving lines across the paper that intersect with each other at a few points” (p. 196).  The results indicated the art history enrichment task reduced anxiety (p < .05) and increased time on task (p < .002).   Art organization level tended toward a significant increase (p = .075) compared with a control condition.   The findings are congruent with the literature concerning supportive art therapy and suggest that the use of art history enrichment in art therapy may be helpful with this population.

Morgan, C. A., & Johnson, D. R. (1995). Use of a drawing task in the treatment of nightmares in combat-related post-traumatic stress disorder.   Art Therapy: Journal of the American Art Therapy Association, 12 (4), 244-247.

Treatment of nightmares in two Vietnam veterans who met DSM-III-R criteria for post-traumatic stress disorder (PTSD) (established by Spitzer & Williams [1985] Structured Clinical Interview for Diagnosis) was conducted comparing a drawing task with a writing task.   The hypothesis was that the isomorphism between visual imagery and the visual modality of nightmares would provide a more effective means of transforming and integrating the traumatic material into normal cognitive schemas.   In a 12-week intervention in which drawing and writing were alternated (ABAB or BABA), both subjects reported reduction in frequency and intensity of their nightmares under the drawing condition.   Each week participants rated four variables: “Frequency of the recurrent nightmare, Intensity of the nightmare, and Startle upon awakening from the nightmare were rated on 5-point Likert scales (0 – 4).   Difficulty going back to sleep after a nightmare (more than one hour) was indicated by a yes/no response.   An overall measure of Nightmare Severity was created by multiplying frequency by intensity of nightmares” (p. 245).    When writing and drawing conditions were compared there was a significant decrease under the drawing condition for both participants (Frequency: p < .01; Intensity: p < .01; Severity: p < .01.; Sleep Problem: p < .001; Startle: p < .001).    Findings provide support for more extensive study of art therapy methods in post-traumatic stress disorder.  

Pifalo, T. (2002). Pulling out the thorns: Art therapy with sexually abused children and adolescents.   Art Therapy: Journal of the American Art Therapy Association, 19 (1), 12 – 22.

A 10-week treatment that integrated art therapy and group process was designed to target short- and long-term effects of sexual abuse in child and adolescent victims.   The Trauma Symptom Checklist (TSCC) (Briere, 1995) was used for pre and post testing.   Three groups of girls (ages 8-10 years; 11 – 13 years; and 14 – 17 years) (total N = 13), were tested for level of dysfunction.   Treatment targeted symptoms associated with trauma: anxiety, depression, posttraumatic stress, anger, dissociation, and sexual preoccupation and distress.   Results show a reduction in symptoms commonly associated with sexual abuse.   Significant differences were found on three of the 12 subscales:   Anxiety (p < .03), Posttraumatic Stress (p< .02), and Dissociation-Overt (p < .03).   All other subscales show a decrease in symptomatology in total group scores, but not large enough to reach significance.

Pizarro, J. (2004). The efficacy of art and writing therapy: Increasing positive mental health outcomes and participant retention after exposure to traumatic experience.   Art Therapy: Journal of the American Art Therapy Association, 21 (1), 5-12.

Is art therapy treatment of trauma-exposure as or more effective than writing therapy in improving psychological and health outcomes?   Forty-five undergraduate students were randomly assigned to one of three conditions: write-stress, art-stress, and art-control.   A baseline questionnaire was used to record demographic information.   Three measurement tools were used in pre/post testing: The General Health Questionnaire-28 (Goldbert & Hillier, 1979) and the global Measure of Perceived Stress (Cohen, Kamarck, & Mermelstein, 1983), the Physical Symptoms Inventory (Wahler, 1968), and the Shortened Version of the Profile of Mood States (Shacham, 1983).   In addition, a Participant Satisfaction Questionnaire was used to assess satisfaction after the last session and one month later.   Efficacy questions assessed how “enjoyable” and “helpful” participating in the study had been.   Treatment consisted of two one-hour sessions, scheduled from 1 – 10 days apart.   Results showed a decrease in social dysfunction under the writing condition as compared to the art therapy conditions (p < .01).   However, satisfaction (related to retention) was better in the art-stress and art-control groups (p < .01).

Ponteri, A., K. (2001). The effect of group art therapy on depressed mothers and their children.   Art Therapy: Journal of the American Art Therapy Association, 18 (3), 148-157.

This study examined the effect of eight consecutive sessions of group art therapy on maternal self-image and self-esteem as well as on the quality of interactions between mother and child.   The participants wee four mother-child pairs in which the mothers wree experiencing depressive symptoms that affected their caregiving capacities. It was hypothesized that group art therapy would improve maternal self-esteem and self-image and, in turn, foster positive mother-child interactions.   The research design was pre-experimental, one-group pretest posttest.   A mother-and-child drawing (Gillespie, 1994), a 20-minute videotaped play session (Interaction Rating Scale [Perez, 1998]), and two self-reports (a 20-item Mother Questionnaire [MQ] that self-assessed parenting skills and a 26-item Maternal Self-Report Inventory-Short Form [MSI-SF] designed to assess adaptation to being a mother and maternal self-esteem [Shea & Tronick, 1988]) were used as pre- and posttreatment assessments. Mother-and-Child drawings were scored using 14 items on an adapted FEATS (Gantt & Tabone, 1998).   Results showed that mothers reported higher levels of self-esteem and a more positive self-image following treatment.   All participants depicted more mature and/or ore self-assured other-child relationships in their mother-and-child drawings following the group.   Only half, however, were able to integrate their more optimistic attitudes and self-beliefs into their behavior and interactions with their children by the end of the study.   Because the sample size was so small, statistical analyses of the data was not conducted.

Rosal, M. L., McCullouch-Vislisel, S., & Neece, S. (1997).   Keeping students in school: An art therapy program to benefit ninth-grade students.   Art Therapy: Journal of the American Art Therapy Association, 14 (1), 30-36.

The pilot study discussed in this article involved the integration of art therapy into the ninth-grade English classroom of an urban high school.   The three goals of the study were to reduce drop-out rates, to decrease school failure, and to improve students’ attitudes about school, family, and self.   The data from three measures indicated that the pilot project was successful in reaching its goals.   The discussion of artwork illustrates the success of the program, and ideas for future programming and research are outlined.   Participants were “50 students... from two ninth-grade English classes at an urban public high school” ages 13 –15 years.   Students were pre/post tested using the 52-item Jefferson County Public Schools Student Attitude Inventory (SAI) to measure issues related to school, family dynamics, and perception of self.   Data also were gleaned from reports cards and number of dropouts per academic year.   A t- test analysis showed significant changes from pre to post test (p £ .001) “in the attitudes of the students” (p. 32).   “None of the 50 students dropped out or failed ninth grade” (p. 33).  

Smitheman-Brown, V., & Church, R. P. (1996). Mandala drawing: Facilitating creative growth in children with ADD or ADHD.   Art Therapy: Journal of the American Art Therapy Association, 13 (4), 252-262.

Using a single-subject, multiple-baseline research design, this study investigates the creative growth and behavioral changes precipitated by the work done in art therapy through employment of the mandala as an active centering device with children (N = 8: 4 experimental and 4 control, ages 10-13) who have been diagnosed with Attention-Deficit Disorder (ADD) or Attention-Deficit Hyperactivity Disorder (ADHD), accompanied by a history of impulsivity.   During specified intervals of treatment, a drawing was requested.   “Draw a person picking an apple from a tree,” and rated according to the guidelines of the Formal Elements Art Therapy Scales (FEATS) (Gantt & Tabone, 1998).   Four scales were used:   #5 Integration, #8 Problem Solving, #9 Developmental, and #10 Details of Objects & Environment.   “Baseline data were gathered from historical and observable patterns of behavior, use of the Child Behavioral Checklist (Attenbach, 1979), general artwork produced before the intervention, and the repeated drawing task...produced prior to the introduction of the intervention” (p. 253).   “Ongoing behavioral data were charted through direct observation.   The [5-minute-minimum, mandala-drawing] intervention was considered to begin during the art therapy sessions in which the mandala drawing was first introduced” (p. 253).   Through examination of the drawings by three independent trained raters, and objective findings of this scale, it appears that a visual measurement of creative growth was achieved.   Preliminary findings indicate that the mandala exercise has the effect of increasing attentional abilities and decreasing impulsive behaviors over time, allowing for better decision making, completion of task, general growth in developmental level, and an interest in personal aesthetics.

Dance/Movement Therapy Studies

Berrol C, Ooi W, Katz S. (1997). Dance/movement therapy with older adults who have sustained neurological insult: A demonstration project. American Journal of Dance Therapy, 19(2), 135-160.

Cohen S, Walco G. (1999). Dance/movement therapy for children and adolescents with cancer. Cancer Practice, 7(1), 34-42.

Dance/movement therapy is introduced as a holistic approach to children’s health issues, incorporating an array of medical, psychological, social, and spiritual issues. Dance/movement therapy, with its unique emphasis on nonverbal communication in assessment and treatment, is presented as an innovative therapeutic approach to address the comprehensive needs of children and adolescents with cancer. Dance/movement therapy assessment and intervention strategies are discussed in the context of cognitive, emotional, and social developmental processes, as well as models of stress and psychological adjustment in pediatric cancer. The inclusion of dance/movement therapy as part of the interdisciplinary team addressing the psychosocial needs of children and adolescents with cancer facilitates greater integration of factors related to coping. By its very nature, this modality offers constructs that promote holistic approaches to cancer care.

Dibbel-Hope S. (2000). The use of dance/movement therapy in psychological adaptation to breast cancer. The Arts in Psychotherapy, 27(1), 51-68.

This article aims to address the psychological effects of cancer and how dance/movement therapy (DMT) can play a role in improving the psychological frame of mind of these female patients. The author focuses on three main criteria, including fear of death and grief over multiple losses, anxiety over bodily disfigurement, and worry about alienation from others. These concerns may be expressed through somatic, interpersonal or psychiatric symptoms. More specifically, the author looked at disturbance of mood, increased level of distress, distorted body-image, and diminished self-esteem. The subjects included 33 women with breast cancer ranging from 35 to 80 yrs. The groups met weekly for a 3-hour session over 6 weeks. Each group had 10-12 people. The subjects participated in a pre-and post-treatment interview and then completed a written evaluation at the end of the 6 weeks. The Profile of Mood States, Symptom Checklist 90-Revised, Borscheid, Walster, Bohrnstedt Body-Image Scale, and Marlowe-Crowne Social Desirability Scale were used for evaluation. The qualitative and quantitative analyses of post-treatment results indicated substantial differences between objective and subjective measures of change.

Erwin-Grabner T, Goodill S, Hill ES, Von Neida K. (1999). Effectiveness of dance/movement therapy on reducing test anxiety. American Journal of Dance Therapy, 21(1), 19-34.

Investigated whether dance/movement therapy (DMT) is an effective intervention for reducing symptoms of test anxiety. 21 graduate and undergraduate students (aged 19-44 yrs) at an urban university participated in this study. Students completed the test Attitude Inventory (TAI) as a pre-test measure of test anxiety, and were matched for pretest TAI scores and gender before being randomly assigned to either the control group or the experimental group. Students in the experimental group participated in 4 movement sessions, 35 min in duration carried out over 2 consecutive weeks. DMT control group and the experimental group were re-administered the TAI and those involved in the movement sessions were asked to provide written comments on their experiences. Results show that the experimental group demonstrated a significantly greater reduction in TAI total scores vs the control group. The results suggest that DMT may be an effective (it got cut off at this point)

Farr M. (1997). The role of dance/movement therapy in treating at-risk African American adolescents. Arts In Psychotherapy, 24(2), 183-191.

Discusses the role of dance/movement therapy in treating at-risk Black American adolescent inpatients at an inner-city psychiatric hospital. Four aesthetic components underlying African-American dance and music performance are discussed as well as African and African-American culture and the use of body-dance movement and cross-cultural barriers for Black adolescents. A comparative look at African-American culture and dance/movement therapy is given, and the role of the dance/movement therapist is addressed. It is concluded that common barriers in cross-cultural counseling need to be considered for their impact on the development of a therapeutic alliance between dance/movement therapists and Black adolescent clients.

Goodill S. (2005). Research Letter: Dance/Movement therapy for adults with cystic fibrosis: Pilot data on mood and adherence. Alternative Therapies in Health and Medicine, 11(1), 76-77.

This study explores the how dance/movement therapy (DMT) can improve quality-of-life for patients with cystic fibrosis (CF). This disease can affect one’s body image, quality-of-life, mood, and adherence. Participants 17 years of age or older and hospitalized for CF. This study used a two-group repeated measures design to determine whether treatment group participants would show more positive mood state, better adherence, and a healthier body image. The Profile of Mood States (POMS) was used to measure mood state with scores for Total Mood Disturbance and 6 subscales including Tension, Depression, Fatigue, Confusion, Anger, and Vigor. Pre- and post-testing , and a one month follow-up was conducted with each participant. DMT intervention was in three individual or small group DMT sessions over a 7- to 10-day period. A within-subjects interaction of Time, Group, and Gender on Levels of Confusion was found (F (2,20)=5.99, P=.007). In addition, treatment group participants also reported significantly better adherence with nutrition regimens after one-month follow up. Findings from this small clinical sample are tentative; yet focus priorities for future work.

Hartshorn K, Olds L, et al. (2001). Creative movement therapy benefits children with autism. Early Childhood Development and Care, 166, 1-5.

Examined the effects of creative movement therapy on autistic children. 38 autistic children (aged 3-7 yrs) underwent movement therapy in small groups in biweekly sessions during a 2-mo period, with behavior observed. Results show that movement therapy was associated with an increase in attentive behaviors and a decrease in stress behaviors. Ss spent less time wandering, more time showing on-task behavior, less time showing negative responses to being touched, and less time resisting the teacher, compared to autistic control Ss not attending therapy.

Heber L. (1993). Dance movement: A therapeutic program for psychiatric clients. Perspectives in Psychiatric Care, 29(2), 22-29.

Assessed the effectiveness of dance movement therapy (DMT) on 204 psychiatric clients (aged 18-60 yrs) diagnosed as underactive or depressed. Ongoing observations of each S were made in terms of affect, energy level, interaction, motivation, and expression of feelings. Ss reported their feelings during daily DMT sessions and completed questionnaires afterwards. Ss generally offered positive cognitive and psychological responses to the treatment. Many also reported feelings of relief from cramps and body aches. Increased self-esteem was identified among Ss who consistently participated in DMT sessions. Six case studies involving 5 women (aged 28, 24, 62 and 32 yrs) and a 22 yr-old man illustrate the positive results.

Hokkanen L, Rantala L, et al. (2003). Dance/movement therapeutic methods in management of dementia. Journal of the American Geriatrics Society, 51(4), 576-577.

Examined the use of dance/movement therapeutic (DMT) methods in the management of dementia. Four patients with moderate to severe Alzheimer’s disease participated in 16 DMT sessions of 30-45 min in length. Cognitive level was assessed using the Mini-Mental State Examination 1 wk before, during, and 4 wks following the intervention; behavioral symptoms and narrative speech were assessed as well. Findings suggest that the DMT intervention exerted favorable effects on language abilities. Ss produced, on average, more information units in narrative speech immediately after a group session than before it, although the difference did not reach statistical significance. Overall cognitive level of Ss remained unchanged. Behavioral symptoms also remained relatively stable during the study period.

Koshland L, Wittaker J, Wilson B. (2004). PEACE through dance/movement: Evaluating a violence prevention program. American Journal of Dance Therapy, 26(2), 69-90.

This pilot research evaluated the use of a 12-week dance/movement therapy-based violence prevention program with 54 multicultural elementary school children, and found that it was effective in reducing aggressive behaviors. The program used a dance/movement therapy group process that focused on socialization and engagement of children in creative, problem solving experiences. Pro-social behaviors and methods of self-control were introduced using movement, children’s stories and discussion. Statistical results showed that teachers noticed a significant decrease of these behaviors in their students instigating fights, failing to calm down, frustration intolerance, and throwing articles. The children reported significant decreases of these behaviors both seen and experienced: “someone doing something wrong,” and “someone throwing something.” Significant changes in the students’ perceptions and feelings about experiencing or seeing aggression were noted in their “not feeling happy” when seeing such incidents, and their observations of handling themselves and responding in such situations showed a decrease of “feeling happy,” and a decrease in “feeling scared.”

Rainbow T. (2005). Effects of dance movement therapy on Chinese cancer patients: A pilot study in Hong Kong. The Arts in Psychotherapy, 32, 337-345.

This study aims to investigate the benefits of dance/movement therapy on coping with the effects of cancer in Hong Kong. This study used a pre- and post-study design. Participants were asked to complete questionnaires at the beginning of the first session and also after the end of the last session. A 90 minute movement therapy session was held once a week for 6 consecutive weeks. Perceived stress and Rosenberg Self-Esteem Scales were used before and after intervention. Twenty-two cancer patients participated (age 39-69 yrs). Scores on the Perceived Stress Scale were significantly lower after the DMT program (t=2.22, p=0.042) and with a medium effect size (d=0.49). Self-esteem scores also improved, with a medium effect size of 0.46, but the change did not reach a statistically significant level (t= -1.77, p=0.099).

Sandel S, Judge J, Landry N, et al. (2005). Dance and movement program improves quality-of-life measures in breast cancer survivors. Cancer Nursing, 28(4), 301-309.

A pilot research study was conducted at 2 cancer centers in Connecticut to determine the effect of a dance and movement program on quality of life and shoulder function in breast cancer survivors treated within the prior 5 years. Thirty-five women completed the trial that included a 12-week intervention, using the Lebed Method, Focus on Healing Through Movement and Dance. The study design was a randomized control trial with a wait list control group crossover to active treatment in weeks 13-25, with the treatment group receiving the program in weeks 1 to 12, and no program in weeks 13-25. Outcome measures were the Breast Cancer Quality of Life (FACT-B), Shoulder range 102.0 +/- 15.8 to 116.7 +/- 16.9, compared with the wait list group 108.1 +/- 16.4 to 107.1 +/- 21.3. (time x group effect, P =.008). During the crossover phase, the FACT-B score increased in the wait list group and was stable in the treatment group. The overall effect of the training at 26 weeks was significant (time effect, P=.03), and the order of training was also significant (P=.015). Shoulder ROM increased in both groups at 13 weeks—15 degrees and 8 degrees in the intervention and wait list groups (Time effect, P=.03; time x group, P=.58). Body Image improved similarly in both the order of training for these outcome measures. A dance movement program that addressed the physical and emotional needs of women following treatment for breast cancer substantially improved a breast cancer-specific quality-of-life measure. Larger studies are justified to determine the acceptability of this therapy as part of the continuum of care for breast cancer survivors.

Serlin I, Classen C, Frances B, & Angell K. (2000). Symposium: Support groups for women with breast cancer: Traditional and alternative expressive approaches. The Arts In Psychotherapy, 27(2), 123-138.

Dance/movement therapy developed as a formal psychotherapy practice in the 1940’s and has spread internationally. Dance/movement therapists address a great range of difficulties experienced by individuals of all ages in their work. This article offers an overview of the history, development, and current state of the profession of dance/movement therapy. Information is presented on educational training for dance/movement therapists, practice issues, and assessment tools. Reviews of some of the research, research applications, and resources for learning more information about dance/movement therapy are included.

Shennum W. (1987). Expressive activity therapy in residential treatment: Effects on children’s behavior in the treatment milieu. Child & Youth Care Quarterly, 16(2), 81-90.

Examined the effects of an art and dance/movement therapy program on the behavior of 42 emotionally and behaviorally disturbed 6-12 yr olds in residential treatment. Results of a 6-wk experiment indicate that greater amounts of expressive activity therapy reduced Ss’ levels of emotional unresponsiveness and acting-out problem behavior. Findings are discussed in relation to the context of the expressive therapy program within the residential treatment milieu.

Westbrook B, McKibben H. (1989). Dance/movement therapy with groups of outpatients with Parkinson’s disease. American Journal of Dance Therapy, 11(1), 27-38.

Hypothesized that dance/movement therapy (DMT) would be more effective that exercise in outpatient treatment of Parkinson’s disease patients. The effects of 6 weekly DMT sessions on the neurological and emotional status of 37 Parkinsonian patients (aged 57-81 yrs) were examined. A 6-wk period of an ongoing exercise group was used in a crossover design as a control. Improvements in movement initiation were seen during the 1-hr DMT sessions, but not during the exercise groups. Subjective improvements in mood were apparent, but no significant improvement in mild depressive symptoms could be concluded.

Dance/Movement Therapy Bibliography

Apter A, Sharir I, Tyano S, Wijsenbeek H. (1978). Movement therapy with psychotic adolescents. British Journal of Medical Psychology, 51(2), 155-159.

Bojner-Horwitz, Eva. (2003). Dance/movement therapy and changes in stress-related hormones: A study of fibromyalgia patients with video-interpretation. Arts in Psychotherapy, 30(5), 255-264.

Brooks D, Stark A. (1989). The effect of dance/movement therapy on affect: A pilot study. American Journal of Dance Therapy, 11(2), 101-112.

Cervasco A, Kennedy R. (2005). Comparison of movement-to-music, rhythm activities, and competitive games on depression, stress, anxiety, and anger of females in substance abuse rehabilitation. Journal of Music Therapy, 42(1), 64-80.

Cruz R, Sabers D. (1998). Dance/movement therapy is more effective than previously reported. Arts in Psychotherapy, 25(2), 101-104.

Dosamantes-Alperson E, Merrill N. (1980). Growth effects of experiential movement psychotherapy. Psychotherapy, 17(1), 63-68.

Goodill, SW (2005) An Introduction to Medical Dance/Movement Therapy. London: Jessica Kingsley Publishers, Inc.

Grodner S, Braff D, et al. (1982). Efficacy of art/movement therapy in elevating mood. Arts in Psychotherapy, 9(3), 217-225.

Hamburg J, Clair A. (2003). The effects of a Laban-based movement program with music on measures of balance and gait in older adults. Activities, Adaptation & Aging, 28(1), 212-226.

Kim C, June K, Song R. (2003). Effects of a health-promotion program on cardiovascular risk factors, health behaviors, and life satisfaction in institutionalized elderly women. International Journal of Nursing Studies, 40(4), 375-381.

Kuettel T. (1982). Affective change in dance therapy. American Journal of Dance Therapy, 5, 56-64.

Loughlin E. (1993). “Why was I born among mirrors?” Therapeutic dance for teenage girls and women with Turner Syndrome. American Journal of Dance Therapy, 15(2), 107-124.

Low K, Ritter M. (1998). “Dance/movement therapy is more effective than previously reported”: Response to Cruz and Sabers. Arts in Psychotherapy, 25(2), 105-107.

Malley S, Dattilo J, Gast D. (2002). Effects of visual arts instruction on the mental health of adults with mental retardation and mental illness. Mental Retardation, 40(4), 278-296.

McComb J, Clopton J. (2003). The effects of movement, relaxation and education on the stress levels of women with subclinical levels of bulimia. Eating Behaviors, 4(1), 79-88.

Ritter M, Low K. (1996). Effects of dance/movement therapy: A meta-analysis. Arts in Psychotherapy, 23(3), 249-260.

Rosler A, Seifritz E, Krauchi K, et al. (2002). Skill learning in patients with moderate Alzheimer’s disease: A prospective pilot-study of waltz-lessons. International Journal of Geriatric Psychiatry, 17(12), 1155-1156.

Rossberg-Gempton I, Dickinson J, Poole G. (1999). Creative dance: Potentiality for enhancing social functioning in frail seniors and young adults. Arts in Psychotherapy, 26(5), 313-327.

Rousseau C, Drapeau A, Lacroix L, et al. (2005). Evaluation of a classroom program of creative expression workshops for refugee and immigrant children. Journal of Child Psychology & Psychiatry & Allied Disciplines, 46(2), 180-185.

Schut HA, et al. (1996). Cross-modality grief therapy: Description and assessment of a new program. Journal of Clinical Psychology, 52(3), 357-365.

Stewart N, McMullen L, Rubin L. (1994). Movement therapy with depressed inpatients: A randomized multiple single case design. Archives of Psychiatric Nursing, 8(1), 22-29.

Wilkinson N, Srikumar S, Shaw K, Orrell M. (1998). Drama and movement therapy in dementia: A pilot study. Arts in Psychotherapy, 23(3), 195-201.

The aim of this prospective study was to investigate the effects of drama and movement therapy in a group of 15 elderly people (mean age 79.6 yrs) with dementia. Nine participated in drama group using the Sesame Method, a symbolic approach that emphasizes the creative and expressive use of the imagination within the safety and containment of art forms. The other 6 served as controls. Instruments included the Alzheimers Disease Assessment Scale, the Mini-Mental State Examination, Clifton Assessment Procedures for the Elderly, Instrumental Activities of Daily Living, the Cornell Scale for Depression in Dementia, and the General Health Questionnaire. Results show that the drama participants enjoyed the experience. Moreover, some of the suggested benefits of drama therapy (e.g., building communal spirit, increasing self-understanding and acceptance, facilitating reminiscence) were well supported by accounts in the qualitative data. In addition, improvements in social interactions appeared to be translated into everyday life.

Drama Therapy & Poetry Therapy Studies

Klontz B, Wolf E, Bivens A. (2000). The effectiveness of a multimodal brief group experiential psychotherapy approach. International Journal of Action Methods: Psychodrama, Skill Training, and Role Playing, 53(3-4), 119-135.

McCarthy J, Light J. (2001). Instructional effectiveness of an integrated theater arts program for children using augmentative and alternative communication and their nondisabled peers: Preliminary study. AAC: Augmentative and Alternative Communication, 17(2), 88-89.

McKenna P, Haste E. (1999). Clinical effectiveness of dramatherapy in the recovery from neuron-trauma. Disability & Rehabilitation, 21(4), 162-174.

Music Therapy and Pain Management

Albert, R., E.(2002). The effect of guided imagery and music on pain and anxiety during laceration repair. [Dissertation Abstract] Dissertation Abstracts International: Section B: The Sciences and Engineering. Vol 62(11-B),   pp. 5030.

Bradt, J. (2002) The effects of music entrainment on postoperative pain perception in pediatric patients. [Dissertation Abstract] Dissertation Abstracts International: Section B: The Sciences and Engineering. Vol 62(11-B),   pp. 5073.

Fratianne, R.B., Presner, J.D., Houston, M.J., Super, D.M., Yowler, C.J. & Standley, J.M. (2001). The effect of music – based imagery and musical alternate engagement on the burn debridement process. Journal of Burn Care and Rehabilitation 22 (1): 47 – 53.

Good, M; Anderson, G., Cranston; A, S; Cong, X, Stanton-Hicks, M.(2005). Relaxation and Music Reduce Pain Following Intestinal Surgery.   Research in Nursing & Health. Vol 28(3), 240-251

Loewy J., Hallan C,. Friedman E., Martinez C. (2005) Sleep/sedation in children undergoing EEG testing: a comparison of chloral hydrate and music therapy. Journal of PeriAnesthesia Nursing.   20(5): 323-32.

Kenny, D., Faunce, G., (2004). The impact of group singing on mood, coping, and perceived p ain in chronic p ain patients attending a multidisciplinary p ain clinic. Journal of Music Therapy . Vol 41(3), 241-258.

Kim, Soo Ji; Koh, lljoo. (2005). The Effects of Music on Pain Perception of Stroke Patients during Upper Extremity Joint Exercises. Journal of Music Therapy . Vol 42(1), 81-92.

Loewy, J. (Ed). (1997). Music Therapy and Pediatric Pain. Jeffrey Books.

Lowey, J.V. (2001) Building bridges in team centred care.(Australian Journal of Music Therapy.

MacDonald, R., Mitchell, L., Dillon, T., Serpell, M., Davies, J., Ashley, E. (2003). An empirical investigation of the anxiolytic and pain reducing effects of music . Psychology of Music . Vol 31(2),   187-203.

Magill, L. (2001). The use of music therapy to address the suffering in advanced cancer pain . [References]. Journal of Palliative Care. Vol 17(3), 167-172.

Schwoebel, J; Coslett, H. B; Bradt, J; Friedman, R; Dileo, C.(2002). Pain and the body schema:Effects of pain severity on mental representations of movement. Neurology. Vol 59 (5), 775-777.

Standley, J.M. (2000). Music therapy in medical treatment. In D. Smith (Ed.) Effectiveness of Music Therapy Procedures: Documentation of Research and Clinical Practice. American Music Therapy Association: Silver Spring, MD

Voss, J A; Good, M., Yates, B., Baun, M., Thompson, A., Hertzog, M. (2004). Sedative music reduces anxiety and pain during chair rest after open-heart surgery. Pain . Vol 112(1-2), 197-203.

Music and Music Therapy Studies

Maru E. Barrera, Mary H. Rykov, Sandra L. Doyle . The effects of interactive music therapy on hospitalized children with cancer: a pilot study Psycho-oncology, vol. 11, no. 5, pp. 379-388.

Background: The use of music therapy with children in health settings has been documented, but its effectiveness has not yet been well established. This pilot study is a preliminary exploration of the effectiveness of interactive music therapy in reducing anxiety and increasing the comfort of hospitalized children with cancer. Methods:Pre- and post-music therapy measures were obtained from children ( N =65) and parents. The measures consisted of children's ratings of mood using schematic faces, parental ratings of the child's play performance, and satisfaction questionnaires completed by parents, children and staff.

Results:There was a significant improvement in children's ratings of their feelings from pre- to post-music therapy. Parents perceived an improved play performance after music therapy in pre-schoolers and adolescents but not in school-aged children. Qualitative analyses of children's and parents' comments suggested a positive impact of music therapy on the child's well-being. Conclusions:These preliminary findings are encouraging and suggest beneficial effects of interactive music therapy with hospitalized pediatric hematology/oncology patients. In future studies replicating these findings should be conducted in a randomized control trial.

Maack, C. and Nolan, P.(1999)The effects of Guided Imagery and Music therapy on reported change in normal adults. Journal of Music Therapy. Vol 36(1) Spr 1999, 39-55.

Examined the main changes gained from Guided Imagery and Music (GIM) therapy as described by former clients. It also explores whether gains are integrated into the clients' lives and if those changes stabilize over periods of time after finishing GIM therapy. Questionnaires were sent to GIM therapists who forwarded them to former GIM clients. 25 former GIM clients (aged 16-83 yrs) returned questionnaires directly to the researcher. Results show that the main gains reported by former clients of GIM therapy are (1) getting more in touch with one's emotions, (2) gaining insights into some problems, (3) spiritual growth, (4) increased relaxation, and (5) discovering new parts of oneself. Results also show that GIM therapy might be helpful for clients with symptoms of anxiety and/or fear, and for clients who want to increase their self-esteem. Changes gained during GIM therapy appear to stabilize over a period of time after finishing GIM therapy. They improved after termination of therapy, especially in the mental and transpersonal areas.

Bittman B . Bruhn KT . Stevens C . Westengard J . Umbach PO .(2003) Recreational music-making: a cost-effective group interdisciplinary strategy for reducing burnout and improving mood states in long-term care workers. Advances in Mind-Body Medicine. 2003 Fall-Winter; 19(3/4): 4-15.

Objectives: This controlled, prospective, randomized study examined the clinical and potential economic impact of a 6-session Recreational Music-making (RMM) protocol on burnout and mood dimensions, as well as on Total Mood Disturbance (TMD) in an interdisciplinary group of long-term care workers. Methods: A total of 112 employees participated in a 6-session RMM protocol focusing on building support, communication, and interdisciplinary respect utilizing group drumming and keyboard accompaniment. Changes in burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively. Cost savings were projected by an independent consulting firm, which developed an economic impact model. Results: Statistically-significant reductions of multiple burnout and mood dimensions, as well as TMD scores, were noted. Economic-impact analysis projected cost savings of $89,100 for a single typical 100-bed facility, with total annual potential savings to the long-term care industry of $1.46 billion. Conclusions: A cost-effective, 6-session RMM protocol reduces burnout and mood dimensions, as well as TMD, in long-term care workers.

Bittman BB . Snyder C . Bruhn KT . Liebfreid F . Stevens CK . Westengard J . Umbach PO.

Recreational music-making: an integrative group intervention for reducing burnout and improving mood states in first year associate degree nursing students: insights and economic impact.  International Journal of Nursing Education Scholarship. 2004; 1(1).   

The challenges of providing exemplary undergraduate nursing education cannot be underestimated in an era when burnout and negative mood states predictably lead to alarming rates of academic as well as career attrition. While the multi-dimensional nature of this complex issue has been extensively elucidated, few rational strategies exist to reverse a disheartening trend recognizable early in the educational process that subsequently threatens to undermine the future viability of quality healthcare. This controlled prospective crossover study examined the impact of a 6-session Recreational Music-making (RMM) protocol on burnout and mood dimensions as well as Total Mood Disturbance (TMD) in first year associate level nursing students. A total of 75 first year associate degree nursing students from Allegany College of Maryland (ACM) participated in a 6-session RMM protocol focusing on group support and stress reduction utilizing a specific group drumming protocol. Burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively. Statistically significant reductions of multiple burnout and mood dimensions as well as TMD scores were noted. Potential annual cost savings for the typical associate degree nursing program ($16,800) and acute care hospital ($322,000) were projected by an independent economic analysis firm. A cost-effective 6-session RMM protocol reduces burnout and mood dimensions as well as TMD in associate degree nursing students.