Running head: THE EFFECTS OF DANCE/MOVEMENT THERAPY

The Effects of Dance/Movement Therapy on

Breast Cancer Patients and Survivors

Olivia Baker

Journal Critique

Submitted to Angela L. Watson

in Partial Fulfillment of the Requirements

for Honors PSY 201

Oral Roberts University

April 15, 2015

THE EFFECTS OF DANCE/MOVEMENT THERAPY

The Effects of Dance/Movement Therapy on Breast Cancer Patients and Survivors

About 1 in 8 (12%) women in the US will develop invasive breast cancer during

their lifetime. While white women are more likely to develop the disease, African-

American women are more likely to die from it. 3% of women’s deaths are due to breast

cancer. It is the second leading cause of cancer death in women. The American Cancer

Society predicted that about 231,840 new cases of invasive breast cancer will be

diagnosed in women and 40,290 women will die from breast cancer in 2015. In 2014,

there were more than 2.8 million women currently being treated and women who have

finished treatment for breast cancer in the US (American Cancer Society, 2015). With

this many current patients and survivors, it is necessary to find ways to counter the

negative physical and psychological effects it causes. Patients often receive further

medical intervention such as medication for pain and depression. Additionally, patients

and survivors may receive other forms of therapy. One therapy option available is

dance/movement therapy, a type of creative arts/expressive therapy that addresses both

the physical and the psychological effects of breast cancer.

Background to the Problem

Dance has been used as a form of medicine since the Middle Ages and became

known as dance/movement therapy (DMT) when it became a part of psychiatry in the

1940s. Based on the theory of Carl Jung, DMT seeks to heal the mind and the body

through the interconnectivity of the two. One of the many areas DMT can be applied to

is breast cancer. Breast cancer negatively affects a woman physically and

psychologically. DMT seeks to counter these effects by providing healthy physical

activity, possible increased range of motion, lower tension and fatigue, social support,

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THE EFFECTS OF DANCE/MOVEMENT THERAPY

and improved body image, locus of control, and mood.

Personal experience with the therapeutic effects of the arts led me to research one

of my favorite art forms to engage in—dance. Long-standing personal interest in how the

arts and therapy may officially be combined to help others in psychiatry encouraged my

research into this area. In my search of DMT studies, breast cancer stood out as a more

specific area of study under DMT. The rise in breast cancer awareness over the past

decade led me to pursue this specific area of DMT. It was also particularly fascinating

because I never thought to apply DMT to this area of need.

Purpose of the Study

The purpose of this study is to examine how DMT may be used to improve the

quality of life of breast cancer patients and survivors. Although dance has been used in

medicine since the Middle Ages, it has only more recently been used as DMT to

counteract the negative physical and psychological effects of breast cancer on patients

and survivors. To fully understand this, one must look at the what, why, and how of the

situation: What is DMT? Why is it needed? More specifically, how does breast cancer

affect patients and survivors physically and psychologically? And most importantly, how

does DMT improve their physical and psychological state?

Defining Dance/Movement Therapy

Definition

According to the American Dance Therapy Association, dance/movement therapy

is defined as “the psychotherapeutic use of movement to further the physical, emotional,

cognitive, and social integration of the individual.” It is based on Carl Jung’s theory of

psyche-body connection in which the mind and body, or movement and emotion, are

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THE EFFECTS OF DANCE/MOVEMENT THERAPY

interdependent (Dibbell-Hope, 2000; Fladager; Ritter & Low, 1996). Therapy can come

in many forms of dance including ballroom dance, cultural dance, aerobic dance, ballet,

jazz, modern, and more. The presence of a therapist is what makes it therapeutic, rather

than the type of dance itself (Molinaro et al., 1986; Strassel, Cherkin, Steuten, Sherman,

Vrijhoef, 2011). Authentic movement is another branch of DMT that focuses on moving

on impulse in tune with the mind, and is less structured than other forms of DMT

(Dibble-Hope, 2000; Fladager, Ritter & Low, 1986).

History

Dance has long been a part of cultures, especially as a part of religion. It became

a form of medicine in the Middle Ages used for healing, fertility, birth, sickness, and

death (Aktas & Ogce, 2005; Levy, 1988; Strassel et al., 2011). The modern dance

movement of the early 1900s saw a switch from technical dancing to more emotive

dancing. Modern dance emphasized looking within oneself to express complex feelings

(Levy, 1988). One modern dancer, Marian Chase, went on to establish her own studio in

Washington D.C. The form of dance she taught at her studio proved to be therapeutic for

many psychiatric patients in the area. By the mid-forties, she was spreading her

methodology across the nation. Other early pioneers of DMT include Blanche Evan,

Liljan Espenak, Mary Whitehouse, Trudy Schoop, and Alma Hawkins (Levy, 1988).

DMT officially became a part of psychiatry in the 1940s. The American Dance Therapy

Association (ADTA) was founded in 1966 with Marian Chase as the first president

(Aktas & Ogce, 2005; Levy, 1988).

Process

Dance/movement therapy. Although it can be done on an individual basis,

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THE EFFECTS OF DANCE/MOVEMENT THERAPY

DMT is most often carried out in a group setting. DMT as it applies to breast cancer is

conducted in a group setting. Most dance/movement therapy sessions have four stages:

preparation, incubation, illumination, and evaluation. Preparation involves creating a

safe place for the individuals (movers). This includes removing obstacles and

distractions as well as establishing a supportive relationship with the witness. The

witness(es) may be the therapist or another member of the class, or could even be a small

portion of the class or the entire class. Preparation also involves helping the movers

become comfortable moving with their eyes closed. In the early days of some programs,

this may also mean teaching a dance sequence to make individuals comfortable with

dancing (Ho, 2005; Molinaro et al., 1986). Incubation is a time when the therapist gives

open-ended imagery prompts to help the mover access her subconscious. Illumination

follows through dialogue with the witness. Reflection through journaling may also

follow this dialogue. Insights are then gathered and explored with the therapist during

the evaluation stage (Fladager).

Authentic movement. Along the same lines, authentic movement has five

components: safe environment, active listening, active imagination, witnessing, and

processing. Again, a safe environment, free of obstacles, is established. During active

listening, the mover is encouraged to close her eyes and look inward. The mover is to

have a positive attitude toward herself as she pays careful attention to her present

experience. The mover then transitions into the active imagination. This is when the

mover acts on her impulses through physical action. She has total freedom over how she

moves, or doesn’t move. The goal is to practice conscious awareness, allowing herself to

be moved by her psyche. Throughout this process, witnessing takes place. The witness

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observes the mover from the side. Rather than trying to interpret the actions for the sake

of the mover, the witness is to apply the same principles of the mover to herself. As she

watches the mover, she is to look into herself with a positive attitude. Finally, at the end

of the movement, the mover and witness discuss their experiences. Journaling, art, or

other forms of recording may also be used after the discussion to establish in the

conscious what was taken from the unconscious (Fladager).

Effects of Breast Cancer

As with all other forms of cancer, breast cancer can potentially spread throughout

the body and eventually lead to death. While there are definite negative effects from the

breast cancer itself, including the knowledge of the disease’s potential, many of the

negative effects result from the treatments required to remove or at least slow down the

cancer.

Physical

Treatments for breast cancer include surgery, chemotherapy, radiation therapy,

hormonal therapy, and target therapies. These treatments have many potential side

effects such as weakened immune system, hair loss, and pain (Breastcancer.org).1

Surgery may involve the removal of the entire breast (mastectomy), removal of the

affected region of the breast (lumpectomy), cryotherapy, lymph node removal, and/or

breast reconstruction. Surgery can result in decreased range of motion and muscle loss.

Extended bed rest may also lead to decreased physical fitness and loss of muscle/muscle

tone.

Psychological

1 An extensive list of potential physical side effects can be found at http://www.breastcancer.org/treatment/side_effects

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THE EFFECTS OF DANCE/MOVEMENT THERAPY

Breast cancer also has multiple psychological side effects. Cancer patients often

experience fear of death. They may also experience grief over multiple losses, including

the partial or entire loss of a breast, loss of independence, possible loss of fertility, and

even loss of sex drive. Such losses, especially the loss of breast tissue, lead patients to

feel that a part of them is missing. They may seek out wholeness and/or express a desire

to adjust to their new body image. They may also express a need to maintain a useful role

in society (Molinaro et al., 1986). They are likely to experience anxiety over bodily

disfigurement, disturbance of mood, increased level of distress, distorted body image, and

diminished self-esteem. Cancer patients also often experience a diminished locus of

control (Dibbell-Hope, 2000). They may feel that their body has turned against them,

and that they have no control over their bodies, as cancer can be highly unpredictable.

They may also sense a loss of direction in life (Ho, 2005).

Effects of Dance/Movement Therapy

Physical

Research has proven that physical exercise is good for both the soma and the

psyche. Physical activity can boost self-image and raise energy levels. Physical exercise

can improve cardiovascular health, skeletal strength, respiratory capacity, muscular

definition, and coordination, and remove unhealthy fat cells. Physical activity can also

lower stress, anxiety, depression, pain, and body tension, regulate appetite, and improve

immune response through the release of endorphins in the brain. Participants in DMT

receive these benefits of exercise, especially improved coordination and muscle tone. In

comparison to other physical activity, dance is particularly beneficial because it is a total

body movement – involving the circulatory, skeletal, respiratory, and muscular systems

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THE EFFECTS OF DANCE/MOVEMENT THERAPY

(Aktas & Ogce, 2005; American Cancer Society, 2008). Dancing is also usually more

engaging, uplifting, and enjoyable than other forms of exercise (Strassel, 2011).

In 1986, the Breast Cancer Rehabilitation Program at Albert Einstein Medical

Center-Northern Division used modern jazz and ballet in their DMT program. Through

these dances, they focused on muscles affected by mastectomy and lumpectomy. These

include the pectoralis major and minor, shoulder girdle, neck, and trunk. Ballet was used

to improve posture, balance, and body symmetry, and for general stretching. Modern

jazz was used for coordination and range of motion. (Molinaro et al., 1986).

DMT is also used to increase range of motion and decrease tension and fatigue

(Dibbell-Hope, 2000; Ho, 2005; Molinaro et al, 1986; Ritter & Low, 1996; Strassel,

2011)

Social

Studies have shown that healthy social interaction is vital to healthy psychological

functioning (Strassel, 2011). The group therapy setting of DMT helps individuals by

providing this social interaction and even becoming a source of social support.

According to Aktas (2005), “moving as a group brings people out of isolation, creates

powerful social and emotional bonds, and generates the good feelings that come from

being with others.” Participants in DMT programs often develop camaraderie and

friendly competitiveness. They share a common bond through shared experience. Those

who are newer to experiencing breast cancer also receive support from those who have

dealt with it longer. The cohesiveness of this group is also a great source of social

support when they lose one of their own (Dibbell-Hope, 2000; Ho, 2005; Molinaro et al.,

1986; Ritter & Low, 1996).

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THE EFFECTS OF DANCE/MOVEMENT THERAPY

Self-perception

Self-esteem. DMT improves participants’ awareness of their bodies. It allows

them to realize the conscious and unconscious feelings they hold toward themselves and

their bodies, and then to constructively explore and physically express these feelings.

This process leads to greater self-awareness and deeper self-understanding. This then

generates better body image and more acceptance of one’s self (Aktas & Ogce, 2005;

Dibbell-Hope, 2000; Ho, 2005; Ritter & Low, 1996; Strassel, 2011).

Trust and control. DMT also involves listening to one’s impulses and choosing

whether or not to act on them. The spontaneity of acting on impulse develops trust in the

mover. The mover must learn to listen and trust herself and her body. The push-pull

relationship of impulse and movement allows the mover a greater sense of control over

her body. While the mover is to listen to and trust her impulse, she makes the ultimate

decision on whether to act on it. This also serves to help the mover learn to accept and

enjoy the moment (Aktas & Ogce, 2005; Dibbell-Hope, 2000; Ho, 2005). Furthermore,

the closing of the eyes during this process encourages comfort with the unknown. This

also leads to a greater sense of internal trust (Dibbell-Hope, 2000).

Emotional

DMT allows individuals to explore and express their emotions. Often some

emotions are too difficult to express in words. DMT provides an outlet for these

emotions to be expressed (Strassel, 2011). These emotions may include anger,

frustration, anxiety, depression, and loss (Aktas & Ogce, 2005). The healthy expression

and evaluation of these emotions through DMT can lead to greater joy, confidence, hope,

and ease. Individuals may also experience increase in pleasure, fun, and spontaneity

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through the DMT program. DMT results have indicated a decrease in negative mood,

depression, anxiety, and distress (Aktas & Ogce, 2005; Dibbell-Hope, 2000; Ritter &

Low, 1996; Strassel, 2011). Ho (2005) also noted that participants experienced less

concern over the future.

It is important to note that these emotional improvements in the participant are not

limited to the mover. Studies show that observing another dancer may fire mirror neurons

in the observer. This means that the same neuron being activated in the mover may fire in

the witness as well. Therefore, the witness in the DMT process may also receive the same

benefits as the mover (Berrol, 2006).

Implications and Conclusions

Summary

Breast cancer has many negative affects on a woman’s body and psyche. DMT is

one of the many therapies available to breast cancer patients and survivors in an attempt

to counteract these negative effects. DMT has numerous physical, social, and

psychological benefits. DMT participants receive the benefits of physical activity and

may experience improved range of motion, particularly those who had a lumpectomy or

mastectomy. DMT participants also gain social support, learn how to accept themselves,

and may experience better mood. These benefits lead to improved quality of life in

individuals (Ho, 2005; Strassel, 2011).

Limitations

Despite the many observable, qualitative benefits of DMT, there are some

variables and limitations to these studies. No research was found to compare the benefits

of dance/movement to the benefits of other physical activities. Music is also a variable in

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DMT. Music can increase relaxation and aid in reducing pain and anxiety (Strassel,

2011). It is unclear how the benefits of DMT might be affected by the exclusion of music

(Molinaro et al., 1986; Ritter & Low, 1996). Many of the benefits of DMT also came

from the social support provided by the group setting of DMT. It is unclear if DMT

provides more benefits than other forms of group therapy. The research conducted for

this paper also did not include the effects of DMT in other cultures, with the exception of

the study conducted in Hong Kong. There is minimal research in this area of DMT, and

therefore any studies of DMT in other cultures require more similar studies before the

results can be considered viable.

Although DMT has been a part of psychiatry since the forties, it has only more

recently been used with cancer. Meta-analyses conducted by Ritter and Low in 1996,

Koch et. al. in 2013, and most recently by Bradt et. al. in 2015 found minimal studies that

met the proper criteria. They found that these studies often were qualitative and did not

include sufficient quantitative results. According to Bradt et al. (2015), the only certain

effect of DMT on cancer patients was improved quality of life. Ritter & Low (1996) and

Koch et al. (2013) also found that DMT is effective in reducing depression and anxiety.

More research is needed.

Applications

DMT is applicable in many people groups including the mentally disabled, cancer

patients, psychiatric patients, and healthy people of all ages. DMT can be used with

breast cancer patients after diagnosis, during treatment, and even with breast cancer

survivors.

Implications for Future Studies

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There is no clear evidence that DMT is more beneficial than other forms of

physical activity, group therapy, other arts therapies, or any other forms of therapy.

Further research into these comparisons is recommended. Further studies into the use of

DMT in other cultures should be conducted as well. The area of research in DMT and its

effects on cancer patients, especially breast cancer patients, is also in need of more study.

Finally, according to Ritter & Low (1996), Koch et. al. (2013), and Bradt et. al. (2015),

any future studies relating to DMT must be conducted more carefully with the standards

of scientific study in mind, particularly in the use of a control group and more

quantitative results.

Final Comments

DMT has long been used to help people in many situations. Although more

research is needed to prove the benefits of DMT, there is no evidence that DMT has any

harmful effects. It is recommended that the individual talk to his/her doctor before

participating in a DMT program, as it is a physical activity involving increased heart rate

and extensive use of the joints (Aktas and Ogce, 2005; American Cancer Society, 2008.

Nonetheless, the continued use of DMT will continue to be beneficial to breast cancer

patients physically and psychologically.

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References

About dance/movement therapy. American Dance Therapy Association. (2015). Retrieved from http://www.adta.org/About_DMT

Aktas, G. & Ogce, F (2005). Dance as a therapy for cancer prevention. Asian Pacific Journal of Cancer Prevention, 6, 408-411. Retrieved from http://apjcpcontrol.net/paper_file/issue_abs/Volume6_No3/Gurbuz%20Aktas%20.pdf

Berrol, C. F. (2006). Neuroscience meets dance/movement therapy: Mirror neurons, the therapeutic process and empathy [Abstract]. The Arts in Psychotherapy, 33 (4), 302-315. doi: 10.1016/j.aip.2006.04.001

Bradt, J., Shim M., & Goodill S.W. (2015) Dance/movement therapy for improving psychological and physical outcomes in cancer patients [Abstract]. Cochrane Database of Systematic Reviews, 1. doi: 10.1002/14651858.CD007103.pub3

Dance therapy. American Cancer Society. (2008, Nov 1). Retrieved fromhttp://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/mindbodyandspirit/dance-therapy

Dibbell-Hope, S. (2000). The use of dance/movement therapy in psychological adaptation to breast cancer. The Arts in Psychotherapy, 27 (1), 51-68. doi: 10.1016/S0197-4556(99)00032-5

Fladager, L. (n.d.). An understanding of dance therapy and authentic movement. Retrieved from http://www.bahaistudies.net/asma/dancetherapy3.pdf

Ho, R. T. H. (2005). Effects of dance movement therapy on Chinese cancer patients: a pilot study in Hong Kong. The Arts in Psychotherapy, 32 (5), 337-345. doi: 10.1016/j.aip.2005.04.005

Koch, S. C., Kunz, T., Lykou, S., & Cruz, R. (2013). Effects of dance movement therapy and dance on health-related psychological outcomes: A meta-analysis (n.d.). The Arts in Psychotherapy, 41(1), 46-64 . doi: 10.1016/j.aip.2013.10.004

Levy, F. J. (1988). Dance/movement therapy. A healing art. Waldorf, MD: AAHPERD Publications. Retrieved from http://eric.ed.gov/?id=ED291746

Molinaro, J., Kleinfeld, M., & Lebed, S. (1986). Physical therapy and dance in surgical management of breast cancer: a clinical report. Physical Therapy Journal of the American Physical Therapy Association and the Royal Dutch Society for Physical Therapy, 6 (6), 967-969. Retrieved from http://ptjournal.apta.org/content/66/6/967.full.pdf

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Ritter, M. & Low, K. G. (1996). Effects of dance/movement therapy: a meta-analysis. The Arts in Psychotherapy, 23 (3), 249-260. doi: 10.1016/0197-4556(96)00027-5

Strassel, J. K., Cherkin, D. C., Steuten, L., Sherman, K. J., & Vrijhoef, H. J. M. (2011). A systematic review of the evidence for the effectiveness of dance therapy. Alternative Therapies in Health and Medicine, 17 (3), 50-59. Retrieved from http://eds.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=8806c44e-bae3-4c52-8abe-454c74ed7990%40sessionmgr4005&vid=1&hid=4111

Treatment and side effects. Breastcancer.org. (2013, May 15). Retrieved from http://www.breastcancer.org/treatment

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