During the treatment period at the clinic, the medical examination indicated the severity of depression to be moderate or severe in the majority of patients in both groups. Participant data at the pre-measurement—depression characteristics. In the whole group, there were five patients, whose primary diagnosis was of anxiety or eating disorder or in the personality disorder range.
This reflects the common clinical situation in specialized psychiatric care, that patients' depression is rarely just plain depression. This is also reflected a in the second diagnoses the patients had. Twenty-four percent of these second diagnoses related to soma: pain, heart, lungs, diabetes, hyperkinesis.
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Fifteen percent of the second diagnoses related to anxiety. The mean duration of time since the first episode of depression was 6. At the pre-measurement, for the majority of the patients, the length of the current treatment period was less than 12 months. One reason for the referral to the psychiatric unit was a medication resistant depression, where the patient did not benefit from antidepressants.
George Tesar, MD
The DMT intervention was delivered by a psychologist and dance movement therapist trained in the DMT methods of Marian Chase and in authentic movement. The essence of the Chacian approach is engaging in improvised, shared movement, and creating an interactional space through movement Levy, ; Fischman, The Chacian method is primarily a DMT form of group therapy. Authentic movement, initially developed by Mary Whitehouse and Janet Adler, can be applied as a method in individual or group therapy Payne, b. Both the Chacian method and authentic movement promote the integration of intra-actional within the individual and interactional relating with the environment systems Capello, The therapy groups were small with 4—7 participants.
The guiding principles for the group facilitation were:. As DMT is based on interaction, the group facilitation in practice was an integration of these principles, pre-planned structures and themes, and responses to the needs and themes of the group in the moment. The same therapist working with each group was the constant factor. All sessions included a discussion at the start and after the movement explorations.
The discussions were oriented toward expressing embodied experiences and reflecting on them. Discussions also echoed the process and needs of the group. A group model based on the integration of the four different DMT group processes. The background information assessment included the patient's gender, date of birth, diagnosis, duration of illness, severity of depression, use of medication, and the treatment received by the time of answering the inquiry.
The score range is 0— Higher points indicate more severe depression 0—13 indicates no or very few depressive symptoms, 14—19 indicates mild depression, 20—28 moderate depression and 29—63 severe depression. HADS screens for depression and anxiety symptoms Norton et al. The questions assess a wide range psychiatric symptoms, including depression, anxiety, and somatization Holi, Many of the symptoms reflect bodily states and autonomous nervous system arousal.
A single number representing the severity of the patient's condition is GSI global severity index , which is the average score of the 90 questions of the inventory. Between the general and clinical populations, the clinical cut-off point is 10 points Connell et al. It can be used for assessing clinical effectiveness of various models of therapy Evans et al. The self-evaluation measurements were presented to the participants at the start pre-assessment , after 3 months post assessment , and 3 months after the end of the intervention follow-up assessment.
Baseline between-group differences in demographic data and pre-treatment measures were analyzed with independent t -tests and chi-square tests, or using Mplus statistics see below. The HLM uses a full information approach, with standard errors that are robust in the case of a non-normal distribution MLR estimator in Mplus. The analyses were as follows. First, the group x time interaction was tested with Wald test. Secondly, if the interaction was statistically significant the group differences were tested for the intervention period pre to post , and follow-up period post to follow-up separately.
Effect sizes ES were calculated as follows. The between-groups ES was calculated after the treatment and at follow-up by dividing the difference between the DMT group mean and the TAU group mean by the pooled standard deviation of the two conditions. The within-group ES was calculated for both the post- and follow-up measurements by dividing the mean change from pre-measurement by the combined pooled standard deviation SD Feske and Chambless, ; Morris and DeShon, Due to possible differences between groups at pre-measurement, between-group ES differences at post- and at follow-up measurements were corrected by the pre-measurement difference.
Thus, corrected between-group ES were reported. A between-group effect size of 0. A within-group ES of 0. In the HADS scores, there was a trend for a significantly different change over the three measures. Between-group effect-sizes d are also presented corrected with pre-measurement difference. To assess the size of the treatment effects, effect sizes were analyzed see Supplementary Table 1. The duration of the participants' illness, the length of the current treatment period, and the measurements score level differed according to the use of antidepressant medication.
Compared to no-antidepressants patients, patients taking antidepressive medications had suffered longer from their illness and had more severe psychiatric symptoms at the pre-measurement point. The TAU group participants on antidepressive medication had the most severe psychiatric symptoms in this material. However, the mean duration of their illness and the length of the current treatment period were shorter than in the subgroup of DMT antidepressant users.
Since medication could have affected the results we decided to conduct additional analyses. We were especially interested to ascertain, if the DMT group on medication showed a different change pattern from that in the TAU group on medication. Further, we were also interested in comparing the members of the DMT group with medication and without medication. During the follow-up period there was no statistically significant change.
In all other comparisons Wald test did not reveal any statistically significant difference. As there were no statistically significant differences between the score changes of the DMT group with no medication and DMT with medication subgroups, DMT appears to be effective whether the patient is taking antidepressive medication or not. At the post-measurement, assessing the clinical significance of the changes after the intervention period, the greatest improvements in the condition appeared in the group of DMT participants who were not on antidepressant medication see Supplementary Table 2.
The DMT participants on antidepressants had also clearly improved, but the within-ES changes were slightly smaller than for the DMT participants not on antidepressants. In the DMT group on antidepressants the range of effect sizes d was 0. In the TAU group, where all the patients were on antidepressant medication, the changes in the scores during the data collection time were minor. The range of within-group effect sizes d was 0.
There was a tendency for the effect of DMT to be slightly better with patients who were not taking antidepressive medication. In addition, the within-group effect sizes were considerably larger among patients attending to the DMT group. However, more studies are needed to confirm the clinical effects of DMT.
In these self-evaluation assessments, the verbal content of the statements is geared toward bodily felt sensations, symptoms, and emotions. In the SCL one third of the questions refer to somatization or phenomena that relate to autonomous nervous system arousal. This may be one reason why the change was expressed more clearly through these measurements.
These observations are in line with the study by Punkanen et al. In their study the mean decrease on the BDI from baseline to post-measurement was Both these studies produced a similar favorable outcome in the treatment of depression. This suggests that favorable changes could also be achieved using a shorter DMT group intervention. The observations made in this study are also in accordance with the previous reviews by Meekums et al.
These suggested positive effects of DMT on quality of life and on depression and anxiety. One focus in DMT is engaging with movement activity in the here and now. Further, the aim of activity is to be attentive to the movement experiences and to develop the skills to be aware of experiences, and to communicate about them in words Meekums, ; Koch and Fischman, ; Nolan, Thus DMT involves experiential exercises including mindfulness skills and attention training. There are several other studies suggesting that this type of training, which includes experiential exercises, could be beneficial to the patients Hayes et al.
It could also be speculated that DMT increases psychological flexibility, which has been shown to be associated with wellbeing and quality of life Hayes et al. Thus, given that DMT is a useful intervention method for patients with depression symptoms, more studies are needed to examine the possible mechanism of change. A tendency was observed for the greatest improvement the be achieved when the patient participated in the DMT group and was not on antidepressive medication.
However, it should be noted that the patients in the DMT group without or with antidepressant medication benefited from the intervention, and no statistically significant differences were observed between the groups. Thus, more studies are needed to investigate the impact of DMT interventions with or without medication. The importance of observing medication in the treatment is emphasized by the fact that the more difficult symptomology appears to go along with more complex diagnosis set, longer treatment period, and taking of medication.
It is of particular interest that at the pre-measurement point in the DMT group, the patients on antidepressive medication and those without antidepressive medication had a fairly similar level of symptoms, but the score differences between these two subgroups had clearly increased at the post-measurement, in favor of no antidepressants sub-group. The question arises as to whether the DMT participants on antidepressants had a more difficult type of depression and the medication had alleviated their symptoms so that their symptom scores were on the level of a less complicated depression at the pre-measurement point.
If this was the case, it could be assumed that the smaller score changes after the intervention could have been due to the more difficult type of depression. This study has limitations to be born in mind when drawing conclusions from the results.
One concern is the use of self-evaluation measures only, and the lack of movement based assessment of the effects of the intervention. Videotaping the sessions was not part of the usual clinical practice at this clinic, and the goal was to study the natural clinical practice. Without video recordings it is difficult to produce any reliable movement assessment of the four groups. Even with video recordings, movement observation of group activity would have been challenging to carry out reliably. The participants joined the research groups on the basis of self-selection.
They were not randomly divided among the groups. Thus, we cannot ignore the possibility that the selection bias has affected the results. On the other hand, the DMT group had a slightly longer history of illness, more frequently two diagnoses and more frequently an experience of psychotherapy than the TAU group patients. Also, as more patients in the DMT group had experience of psychotherapy, it is possible that DMT attracts patients who are positively disposed to therapeutic work, willing and able to use self-reflection and interaction as means for their recovery. As we did not systematically assess their expectations, we can draw no conclusions of the impact of expectations on the results.
Further, the follow-up time was relatively short 3 months , thus in light of the current data it is difficult to draw firm conclusions about the long-term effects of DMT. Another limitation is the small number of participants included in the study. In the TAU group there was a fairly high drop-out rate. However, we applied hierarchical linear modeling in data analyses, since it included all the patients who started the treatment.
According to the patient records, all the patients who left the research did continue their treatment at the psychiatric clinic over the study period. No data were collected about their reasons for leaving the study. The TAU patients were not interested in joining the DMT group, but this study offers no information about their reasons for this. This prompts a question, whether the participation in the DMT group, personal commitment and joining the interaction supported the motivation for treatment and also the alleviation of depression.
If this was the case, DMT seems to offer a suitable social context to be utilized in health care to offer new interactional experiences and learning through them. The TAU did not significantly improve the patients' wellbeing. This study suggests that experiential treatment methods such as DMT could improve the effects of treatment. However, not all clients want to join a DMT group as was observed in this study. In the future, more attention could be devoted for increasing patients' motivation for experiential and action based treatment methods. These results encourage the use of creative, interactive, psycho-physical, and experiential therapy interventions in the treatment of depression.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. PP wants to acknowledge her gratitude to the City of Tampere Psychiatric Clinic for providing a base for this research. National Center for Biotechnology Information , U. Journal List Front Psychol v.
Front Psychol. Published online Jul Muotka , 2 and Raimo Lappalainen 2. Joona S. Author information Article notes Copyright and License information Disclaimer. This article was submitted to Psychology for Clinical Settings, a section of the journal Frontiers in Psychology. Received Apr 17; Accepted Jun The use, distribution or reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice.
No use, distribution or reproduction is permitted which does not comply with these terms. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Table1. DOCX 68K. DOCX K.
PDF K. Abstract We were interested in investigating the effects of dance movement therapy DMT in a psychiatric outpatient clinic with patients diagnosed with depression. Keywords: dance movement therapy, depression, antidepressants, treatment outcome, group therapy, psychiatric outpatient clinic. Introduction The global burden of disease studies show unipolar depression as the leading cause of years lived with disability YLD in adult population throughout the world WHO, 1.
Methods Recruitment procedure The research plan was approved by the City of Tampere Research Board, which also is a regional board for ethical research practices. Table 1 Participant data at the pre-measurement—depression characteristics. Open in a separate window. Table 2 Participant data at the pre-measurement—treatment features.
Table 3 A group model based on the integration of the four different DMT group processes. Theme Process exercises 1 Introduction, start Circular motion in joints. Improvisation with name gestures. With picture cards, expressing one's expectations of the DMT group. In a dyad, reflecting each other's movement.
Sensing body boundaries. Moving eyes open or closed. Exploring the spatial options in movement. Imagery and improvisation: If you were an animal, how would the animal move? In a circle, moving by holding hands. Playing with different movement qualities. Mindfulness skills and breathing: sensing one's walking. Breathing exercises. Mindfulness skills: breathing and seeing the other. Polarity: familiar and unfamiliar in movement.
Movement improvisation with a focus on near space, middle space, far space. Walking in a dyad and sensing the connection.
Drawing a picture of one's experience. Getting into vertical slowly and through different postures. Exploring earth, water, air, and fire through movement improvisation—expressing and describing associated feelings. On a tape line, improvising movement in relation to the line; working with a partner who accompanies the movement in the way one asks for. Homework: to write a poem of one's experiences in this group. Activating the body, grounding, being aware of the body. Simple qigong exercise same as in the session 11 Poems: sharing them, improvising movement on them. Feedback of the process.
Outcome measures The background information assessment included the patient's gender, date of birth, diagnosis, duration of illness, severity of depression, use of medication, and the treatment received by the time of answering the inquiry. Statistical analysis Baseline between-group differences in demographic data and pre-treatment measures were analyzed with independent t -tests and chi-square tests, or using Mplus statistics see below. Conflict of interest statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Acknowledgments PP wants to acknowledge her gratitude to the City of Tampere Psychiatric Clinic for providing a base for this research. Click here for additional data file. References Adler J. Who is the witness. Body Movement: Coping with the Environment. His areas of expertise and research interest are in anxiety and mood disorders, the interface between psychiatric and medical illness e.
Tesar also teaches and supervises psychiatry residents, general medical residents, and medical students in the disciplines of psychotherapy, psychopharmacology, neuropsychiatry, consultation-liaison psychiatry and administrative psychiatry. AD H D, adult psychoparmacology, anxiety, anxiety and mood disorders, anxiety disorders, attention deficit hyperactivity disorder, consultation liaison psychiatry, consultation psychiatry, coping with general and medical illness and specific medical illness, Depression, depressive disorders, emergency psychiatry, generalized anxiety, heart brain medicine, mood and anxiety disorders, mood disorders, Panic Disorder, psychiatric issues in epilepsy, psychosomatic medicine consultation liaison psychiatry , social anxiety disorder, treatment of anxiety disorders including obsessive-compulsive disorder, epilepsy and behavior, epilepsy and behavior research interest, psychosis, Schizophrenia, telemedicine.
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As such, gifts of substantial value are generally prohibited. The Patient Satisfaction Rating is an average of all responses to the care provider related questions shown below from our nationally-recognized Press Ganey Patient Satisfaction Survey.
Patients that are treated in outpatient or hospital environments may receive different surveys, and the volume of responses will vary by question. The comments are submitted by patients and reflect their views and opinions. The comments are not endorsed by and do not necessarily reflect the views of Cleveland Clinic. Tesar's therapeutic use of humor always helps me view my circumstances with a more realistic and optimistic lenses rather than a lender of cynicism, self-doubt, or victimized perspective that I can lean towards when life gets tough, a universal experience of life on our blue planet ;.
I have never had a bad experience with Dr. Tesar or his office staff. Tesar is very professional, and explains things very well. He is a Doctor that actually listens to his Patients, unlike many of Docs these days. I would recommend him to anyone. Tesar is an A-1 Doctor. He is up on any new meds or treatments.
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He is very smart and talks things over with you, if he has any ideas of trying. He explains it very well. His staff is very professional also. Very nice, and writes down any concerns of mine and passes it on to the Doctor. Tesar treats me, both as a patient and as a person. I'm very blessed to have him as my caregiver. Tesar books up fast for appointments.