Sei sulla pagina 1di 73

Elsevier Editorial System(tm) for The Arts

in Psychotherapy
Manuscript Draft

Manuscript Number: AIP-D-13-00077R1

Title: Effects of Dance Movement Therapy and Dance on Health-Related


Psychological Outcomes: A Meta-Analysis

Article Type: Full Length Article

Keywords: dance movement therapy; therapeutic use of dance; meta-


analysis; review; randomized controlled trials; clinical controlled
trials; integrative medicine.

Corresponding Author: Dr. Sabine Christa Koch, PhD, Psychology, M.A.,


Creative Arts

Corresponding Author's Institution: SRH University Heidelberg

First Author: Sabine C Koch, Prof. Dr.

Order of Authors: Sabine C Koch, Prof. Dr.; Sabine Christa Koch, PhD,
Psychology, M.A., Creative Arts; Teresa Kunz, M.A.; Sissy Lykou, M.A.;
Robyn F Cruz, PhD
*Covering Letter

Ms. Ref. No.: AIP-D-13-00077


Title: Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes: A
Meta-Analysis, The Arts in Psychotherapy

Dear editorial office,

We would like to thank the reviewers for their comments and addressed each one in the outline of
our details on changes. We integrated them in blue text color into the manuscript.

With best regards,

Sabine Koch
*Title page with author details

Running head: EFFECTS OF DANCE MOVEMENT THERAPY AND DANCE. A META-

ANALYSIS.

Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes:

A Meta-Analysis

Sabine Koch1, Teresa Kunz2, Sissy Lykou2, & Robyn Cruz3


1
SRH University Heidelberg, 2University of Heidelberg, 3Lesley University, Cambridge, MA

Contact details:

Prof. Dr. Sabine C. Koch

SRH University Heidelberg

Maria Probst Str.. 3

69123 Heidelberg

Germany

Email: sabine.koch@hochschule-heidelberg.de

Acknowledgements

We would like to thank Astrid Kolter, who accompanied the first part of the collection and

systematization of the studies, Annabelle Humm for her help with data extraction and

retrieval of articles, and Joke Bradt and Malte Stopsack for methodological advice.

Correspondence concerning this article should be addressed to: Prof. Dr. Sabine C. Koch,

SRH University Heidelberg, Maria Probst Str. 3, 69123 Heidelberg; email:

sabine.koch@hochschule-heidelberg.de
*Detailed Response to Reviewers

Ms. Ref. No.: AIP-D-13-00077


Title: Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes: A
Meta-Analysis, The Arts in Psychotherapy

Dear editorial office,

We would like to thank the reviewers for their comments and addressed each one in this outline of
our details on changes.

Reviewer #1:

Reviewer 1 lists some problems with validity issues:

* Of the 23 studies analyzed, 16 were DMT and 7 various dance/movement forms;

 this is true, but not a problem since our criterion was to include studies aiming at health-related
psychological outcomes, which both groups of studies did.

* More than half had no intervention

 this is not true, all of them had an intervention


* 7 of the control groups were on waiting lists; 6 offered an alternative and 10 had no control
group;

 this is not true, all of the included studies had a control group
* the sparsity of control groups (i.e., offering some alternative activity administered during a
parallel time frame as the experimental group) is problematic and, likewise, increases the probability
of a Hawthorne effect.

 the problem is in fact that the majority if control groups did not all follow other activities while the
treatment group received treatment, increasing the probability of Hawthorne effects; one of the
major reasons for missing alternative interventions is that DMT-primary studies, operating in a field
without research funding, can often plain not afford to offer patients in control groups alternative
treatment (for time and money constraints); this fact is mirrored in the reality of the primary studies’
designs. The danger of a Hawthorne effect is discussed in some of the primary studies, but not in all.
We addressed this on page 25 of the discussion (see below).

* Twelve were clinical interventions, the rest were not

 the rest were mostly community-based interventions; however, the variability of the populations
and the interventions actually strengthens the generalizability and the validity of the study. Breadth
was an aim.

* Operational definitions could not be discerned, as diverse assessments measured common


dependent variables (e.g., Quality of Life, Well Being and Affect, Body Image, Depression, etc.)

 Operational definitions are provided in the primary studies, when instruments were non-
standardized, which we checked. Many instruments were standardized, providing operational
definitions in their manuals. Space constraints did not allow us to go further with this in the meta
analysis.

* Descriptive variables, such as length of a study, length and frequency of sessions varied: e. g.,
from a one time, 20 minute session to five sessions of 30 minutes in two weeks, to 180 minute
sessions for six months (curious as to whether these three hours were purely DMT or combined with
other activities).

 The data on length of intervention varied widely; however, it can be seen as a strength of the
study that even with such wide variability effects were detected (besides: the 180min or three hours
were authentic movement, so yes, purely DMT).

* In one subclinical DMT study (of self selected participants) the experimental group, ages 16-65,
contained an N of 97. The sheer number and range of ages suggests that this was an aggregate of
several disparate groups. One wonders how such diversity impacted the process and analysis, or
importantly, how it might have skewed the validity of the meta analysis despite the compensatory
pooling of the variables of the statistical analyses.

 The great diversity and heterogeneity of this analysis is purposeful and again can be seen as a
positive: despite the large variance in age and population effects were detected. Cochrane protocols
are the alternative and they are followed by other research groups; for our research group the big
picture was more important.

Validity issues summary: We limited our review to health-related psychological outcomes, since these
are the ones primarily aimed at by DMT, and added dance research studies that aimed at improving
the same or similar outcomes. We defined this aim and the selected studies really do address those
health related psychological outcomes, thus validity being generally given. We only used studies that
had control groups, so the reviewer missed that. Combining clinical and nonclinical samples can be
argued to make the study stronger – showing effects in the general population is very useful. The
different types of control groups (active alternative vs wait list) can be addressed as a limitation
(which we did on page…). We checked for sufficient operational definitions in each study. Length and
age variability were embraced for this study, heterogeneity was controlled for, limitations of such
heterogeneity were discussed in detail.

* Importantly, although the authors acknowledge many of the individual studies may have been
quite flawed, inclusion criteria were not based on their robustness but rather, other factors (listed in
inclusion and exclusion section). From this reader's perusal of the information included here, many
would not have withstood the scrutiny of standard research protocols.

 This is true and we reasoned for this on p. 5. “Cochrane Reviews employ the highest standards of
evidence-based health care research, and thus only studies of the highest quality can enter. The small number of
studies eligible to be included in the Cochrane Reviews shows that there is a clear need for improvement of
research designs. It also indicates that the present state of findings calls for another general meta-analysis
assembling the best evidence in the field in a broader manner.”

Reviewer 1 had difficulty reading and interpreting the Figures, i.e., the Forest Plots. Perhaps an
explanation of this statistical procedure should be explicated, including the various symbols, in the
methods section.

 We added an explanation on page 16, where the first forest plot is introduced: “The forest plots
indicate the direction of the effects found in the primary studies and the magnitude of the
effects on the x-axis, the sample size is indicated by the size of the square symbol, and the
rhombus indicates the overall effect size.”
Statistical procedures are described in the SMD-paragraph on page 8 / 9.

One overarching concern re the studies selected in this meta analysis is, a wide range of dance and
movement forms with varying objectives -from clinical and sub-clinical interventions, to the
recreational- are employed to examine their effects on various aspects of mood and emotional
function. This leads one to question whether engagement in other types of activities -that is, any
experiences activating mood enhancing neurotransmitters that produce positive change- that may
last for hours, days, or perhaps, weeks- would have evidenced comparable outcomes? In light of the
fact that, in most instances here, the purpose was not necessarily therapy (but would be considered
therapeutic), does the type of activity (dance or other) really matter?

 type of activity matters as seen for example in the Koch et al., 2007 study; the authors used a
dance condition, a sports condition (moving up to same arousal) and a simulation condition (just
listening to the music of the – well known- dance). The dance condition improved vitality and
decreased depressive affect significantly more than the sports condition and the music listening
condition. Overall, a number of studies had control groups with alternative activities (9 studies used
control groups of either counselling or activity type), and in these and DMT was consistently shown to
be more effective; but of course there are a trillion of other “other activities” that had not been
included; under the logic of falsification, we can only assume the effect with assuming error.

This issue is now newly addressed on page 26/27 of the discussion (see below).

Reviewer #2

As reviewer 2 suspected, this project started out as one focusing on DMT (as intimated early on), but
the lack of sufficient published research studies led to the inclusion of sub- and non- clinical research
( as mentioned above this fact strengthens the generalizability of the study).

A further concern is the dearth of control groups receiving alternatives administered during the same
period as the experimental participants. (I don't perceive the waiting list as a valid control group

 yes, there are only… cases with a true treatment alternative; but given the lack of funding for
DMT-studies, one cannot expect that such an optimal design can often be afforded).

We addressed the “non-active” control group issue newly on p. 25: “One important limitation of the
primary studies was that in many of the control groups, no alternative activities were offered;
only nine studies included an alternative counseling or activity intervention. There is always
the danger of a Hawthorn effect in cases where the control group is not provided with the
same attention as the treatment group.”
Given these factors, I questioned what difference it made whether this analysis was based on
dance/movement forms or any other mood enhancing (therapeutic) experiences set up with
comparable research objectives. I think the authors need to address that issue further.
 We addressed this issue in the discussion on p. 26/27

“Two additional questions are relevant for discussion. Firstly: Does the type of activity (dance
or other) really matter? From the data, we need to state that yes, type of activity seems to
matter as seen for example, in the Koch et al. (2007) study using a dance condition, a sports
condition (moving up to same level of arousal) and a simulation condition (just listening to
the music of the dance); the dance condition improved vitality and decreased depressive
affect significantly more than the sports condition and the music listening condition. Overall,
a number of studies in the present analysis had control groups with alternative activities (nine
studies used control groups of other activities; five DMT and four dance studies), and in these
studies DMT and dance were consistently shown to be more effective; but of course there are
an endless number of other “other activities” that were not included and make the effect
subject to potential falsification. Secondly: Is there any difference between DMT and any
other mood enhancing therapeutic experience with comparable objectives? This question can
be only tentatively addressed. Dance research in this meta-analysis was carefully chosen for
aiming at the same outcomes with therapeutic intentions. These studies did improve mood and
decrease depression in subclinical and nonclinical populations. DMT did the same and more
(decrease of anxiety, increase in quality of life) in mainly clinical and a few subclinical
populations. While at this point comparability is limited, and there is a need for more
research, we can state that the fact that effects were detected for both clinical and community
populations is promising for future work.”

Finally:

There is the possibility that there may be no difference in results whether this analysis was based on
dance/movement forms or any other mood enhancing (therapeutic) experiences set up with
comparable research objectives. However, on the basis of the studies that controlled for this factor
thoroughly, we would like to argue that there is a fair amount of evidence for a specific effect of
DMT… If you consider the studies on dance vs DMT and their effect on decrease of depression
presented here as evidence for the hypothesis that there is no difference here, then evidence stands
against evidence and more studies controlling for exactly that specific effect are needed. On the other
side, since the studies on the effects of dance on decrease of depression were all done with sub- or
non clinical populations, and the DMT studies almost all with clinical populations, you cannot truly
compare them or at least make such a strong claim. …

In general, we cannot control the quality of the research that is out there, but we can do as much as
possible to carefully get the most out of what is out there – which we did, using our best knowledge.

We would like to thank the reviewers for bringing up the important points making our review
more complete or pointing out more open questions!
*Highlights (for review)

Highlights

 Meta-analysis of DMT interventions and the therapeutic use of dance


 Provides a systematic summary of the last 20 years of research findings.
 Includes the effects of 23 evidence-based primary studies (N= 1078).
 Shows moderate effects for quality of life and clinical outcomes (depression, anxiety).
 Yields small but consistent effects for well-being, mood, affect, and body image.
*Manuscript without author identifiers
Click here to view linked References

Running head: EFFECTS OF DANCE MOVEMENT THERAPY AND DANCE. A META-

ANALYSIS.

Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes:

A Meta-Analysis
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 2

Abstract

In this meta-analysis, we evaluated the effectiveness of dance movement therapy1 (DMT) and

the therapeutic use of dance for the treatment of health-related psychological problems.

Research in the field of DMT is growing, and 17 years have passed since the last and only

general meta-analysis on DMT (Ritter & Low, 1996) was conducted. This study examines the

current state of knowledge regarding the effectiveness of DMT and dance from 23 primary

trials (N=1078) on the variables of quality of life, body image, well-being, and clinical

outcomes, with sub-analysis of depression, anxiety, and interpersonal competence. Results

suggest that DMT and dance are effective for increasing quality of life and decreasing clinical

symptoms such as depression and anxiety. Positive effects were also found on the increase of

subjective well-being, positive mood, affect, and body image. Effects for interpersonal

competence were encouraging, but due to the heterogenity of the data remained inconclusive.

Methodological shortcomings of many primary studies limit these encouraging results and,

therefore, further investigations to strengthen and expand upon evidence-based research in

DMT are necessary. Implications of the findings for health care, research, and practice are

discussed.

Keywords: dance movement therapy, therapeutic use of dance, meta-analysis, review,

randomized controlled trials, clinical controlled trials, integrative medicine

1
This term includes the practice of dance movement psychotherapy (UK) and dance/movement therapy (USA).
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 3

Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes:

A Meta-Analysis

Dance is one of the most ancient forms of healing. Today, dance movement therapy

(DMT) is an established profession and, following the definition of the American Dance

Therapy Association (ADTA), it is used therapeutically to strengthen the emotional,

cognitive, physical and social integration of the individual (ADTA, 2013; cf. EADMT, 2013).

Yet, in order to establish dance and particularly DMT as an evidence-based treatment,

empirical proof of its effects is important. Research in DMT has considerably increased in the

last decades, particularly in the last part of the 20th and at the beginning of the 21st century

(Meekums, 2010). Since the foundation of the ADTA in 1966, an increasing interest in dance

movement therapy, its functions, goals, and effects has been observed. Most of the research

over the past 50 years has focused on qualitative descriptions and case studies (Hervey, 2009).

This focus on qualitative rather than quantitative research is mainly due to the nature of

creative arts therapy, which emphasizes creativity and subjective ways of knowing (Junge &

Linesch, 1993). The arts can be employed as methods of inquiry and ways of knowing

(Hervey, 2000; McDougall, Bevan, & Semper, 2011). Many arts therapists, therefore, take a

critical stance on empirical science and the quantitative paradigm which is engaged in

causality or prediction – it is, for instance, questionable whether a few outcomes measured in

a quantitative investigation could meet and capture therapeutic processes, individual change,

the therapeutic relationship, or aesthetics and creativity (Junge & Linesch, 1993). However,

evidence-based research is important in order to ensure that DMT and the therapeutic use of

dance are effective interventions for health-related psychological problems. The

demonstration of its effectiveness is essential for promoting DMT to healthcare and/or

education providers, and to the survival of the profession. Being involved in this challenging

area of disparity between arts and science, it seems necessary to strengthen the development
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 4

of both DMT as an evidence-based discipline, such as in the present analysis, and through

phenomenological-approaches (i.e., subjective, first-person, experience-based approaches)

and qualitative methods (e.g., Serlin, 1996).

Because DMT is increasingly used to treat a variety of behavioral, psychological, and

medical conditions, it is important that the research addresses the increasing standards of

evidence-based medical research. In the hierarchy of evidence, case studies are at the lowest

level followed by clinical controlled studies without randomization at an intermediate level.

Randomized controlled trials (RCTs), meta-analyses and systematic reviews are at the top

levels of evidence (Sackett, 2000). Across the creative arts therapies we found more than 15

meta-analyses in music therapy (e.g., Bradt, & Dileo, 2009; 2010; Bradt, Dileo, & Shim,

2013; Gold, Heldal, Dahle, & Wigram, 2005; Mössler, Chen, Heldal, & Gold, C., 2011;

Pesek, 2007), four in art therapy (e.g., Ruddy & Milnes, 2005; Campbell, 2010), and one in

drama therapy (Ruddy & Dent-Brown, 2007). We found three meta-analyses that summarize

studies in DMT (Bradt, Goodill, & Dileo, 2011, for psychooncology; Ritter & Low, 1996,

general overview; and Xia & Grant, 2009, for schizophrenia), one descriptive review for

DMT and depression (Mala, Karkou, & Meekums, 2012), and two systematic reviews for

effects of DMT and dance (Kiepe, Stöckigt, & Keil, 2012; Strassel, Cherkin, Steuten,

Sherman, & Vrijhoef, 2011; both reviews of 2012 were not actively included into our

analysis, since they were published after April 2012). Three meta-analyses in DMT were in

progress: next to our own, there were two Cochrane Reviews at protocol stage by UK-based

dance movement therapists Bonnie Meekums and Vicky Karkou (Karkou & Meekums, 2013;

Meekums, Karkou, & Nelson, 2012). Effects of dance were not yet included into a DMT

meta-analysis.

Out of all of the meta-analyses in DMT, Ritter and Low‟s meta-analysis (1996)

provides the only general overview of quantitative DMT studies, including 23 studies

published between 1973 and 1993. The authors showed that DMT is an effective intervention
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 5

for a wide range of symptoms, with particularly good results in the reduction of anxiety. The

study also provides support for the effectiveness of DMT with different client groups.

Moderate effect sizes for DMT interventions were found in subclinical participants (i.e.,

participants “at risk”, but yet without diagnosis), children, adult psychiatric patients, adults

with developmental or physical disabilities, as well as in elderly populations. However,

limitations in calculations and interpretation of the Ritter and Low study (e.g., combined

effect sizes (r) for between-groups and repeated measure designs), led Cruz and Sabers (1998)

to recalculate the data with the result that DMT was found to be even more effective than

reported by Ritter and Low (1996). In fact, DMT-effects were found to be comparable to

effects of other types of therapies including pharmacological and verbal psychotherapies.

Examining the meta-analyses from the Cochrane Reviews (Bradt, et al., 2011; Xia &

Grant, 2009) more closely, only very few primary studies fulfilled the criteria to enter the

final analyses: in the first case – out of 17 studies reviewed - only the studies by Dibbell-Hope

(2000) and Sandel et al. (2005) entered the analysis and in the second case – out of 6 studies

reviewed – only the primary study of Röhricht and Priebe (2006) yielded the quality to enter

the review. Cochrane Reviews employ the highest standards of evidence-based health care

research, and thus only studies of the highest quality can enter. The small number of studies

eligible to be included in the Cochrane Reviews shows that there is a clear need for

improvement of research designs. It also indicates that the present state of findings calls for

another general meta-analysis assembling the best evidence in the field in a broader manner.

Regarding the dependent variables, we limited our review to health-related

psychological outcomes, since these are the ones primarily aimed at by DMT, and added

dance research studies that aimed at improving the same or similar outcomes. In addition to

individual health outcomes we also included interpersonal outcomes (such as interpersonal

sensitivity and social relatedness). The clusters resulting from repeated reviewing of the

outcome measures and the comparability of the measurement instruments employed in the
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 6

primary studies (i.e., the single studies included) were: (a) quality of life; (b) body image; (c)

well-being, mood and affect; and (d) clinical outcomes. For the clinical outcomes we did one

main analysis and three sub-analyses of depression, anxiety and interpersonal competence.

Many of the studies we examined did not enter this meta-analysis because they did not fulfill

the inclusion criteria (see methods section for details). However, they frequently contributed

important aspects to evidence-based research. Such as a study on the effectiveness of creative

dance on children vs. senior citizens in terms of enhancing their social functioning,

administered in separate groups vs. intergenerational groups, favoring the intergenerational

group (Rossberg-Gempton, Dickinson, & Poole, 1999). Or a study researching the effects of

Waltz-lessons on skill learning for patients with mild Alzheimer dementia vs. patients with

depression, showing that the patients with Alzheimer benefited more than the patients with

depression (Rösler et al., 2002). These studies could not be included in our meta-analysis,

because there was no clear control group and a very low N in the second case. Other studies

had not been completed by the time our data analysis was conducted (e.g., Janković Marušić

& Boban, 2013, on eating disorders), or there were studies with an appropriate design but

available descriptive data were insufficient (Berrol, 1984, on school children; Berrol, Ooi, &

Katz, 1997, on older adults with neurological insult; Kaplan Westbrook & McKibben, 1989,

on patients with Parkinson's disease; or Skye, Christensen, & England, 1989, on stress and

anxiety reduction). The study by Skye et al. (1989), for example, – based on an educational

doctoral dissertation – investigated effects of a dance program on stress reduction in

American Indian adolescent girls, and demonstrated a significant decrease of STAI trait

anxiety and state anxiety after the dance intervention.

In sum, there is a need for a new general meta-analysis that provides evidence for the

effectiveness of DMT and dance in health-related psychological issues. We compiled and

systematized all evidence-based findings published since the last general meta-analysis in the

field, to provide an overview as valid and comprehensive as possible. Our aim was to examine
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 7

the effectiveness of DMT and dance as psychotherapeutic interventions for various

populations.

Methods

Search Methods

The systematic research of suitable primary studies was finalized in April 2012.

Initially the focus of the search was on studies investigating the effects of DMT. Later on, the

search was expanded to the effects of the therapeutic use of dance. The relevant electronic

databases used were PubMed/Medline, Psyndex, PsycINFO, ERIC, CENTRAL, and Google

Scholar. The following keywords were used in order to find eligible results: “dance

movement psychotherapy”, “dance movement therapy”, “dance therapy”, “therapeutic

movement”, “dance-effectiveness”, “dance” and “dance-therapy” with the additional search

terms “controlled trial” and “random”. The journal “Body, Movement and Dance in

Psychotherapy” was hand-searched from its first issue in March 2006 until March 2012.

Additionally, through the European Association of Dance Movement Therapy (EADMT), the

American Dance Therapy Association (ADTA), the German Association of Dance Therapy

(BTD) and through personal e-mail distribution lists, a letter was sent out to dance movement

therapists and researchers, requesting them to help identify relevant research studies.

Selection of Studies

Three independent researchers carried out the selection of relevant studies. They

included studies that fulfilled the following criteria:

a. Intervention study (investigating the effect of dance movement therapy, creative

movement or dance) conducted as a controlled trial using a between-group design and

at least two assessments (pre-test and post-test)

b. Focusing on health-related psychological outcomes (as opposed to health-related

physical outcomes such as shoulder range of motion)


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 8

c. Presentation of all necessary statistics to enable the calculation of effect sizes (plus

contact with the authors to include missing statistics)

d. Conducted after 1993 (with two exceptions that were not included in the meta-analysis

of Ritter and Low, 1996)

There were no restrictions on age, gender, ethnicity, clinical or non-clinical samples,

published or unpublished papers, length of treatment, or language.

Data Extraction

Two researchers independently extracted the data from the selected trials. When any

important information was missing, the authors of the corresponding study were contacted for

clarification. The data extractions were compared and, when there were any differences, the

aspects were once again checked and discussed.

The following aspects were extracted: title, author, year of publication, sample size,

diagnosis, clinical vs. non-clinical sample, age range, kind of intervention, kind of control

group activity, length and frequency of treatment, randomization (see Table 1). Variables and

statistics are presented in Table 2, alongside the corresponding data.

– Insert Table 1 about here –

Data Synthesis

This meta-analysis was performed using the Review Manager 5.1 software program

(2011). Because outcomes were derived from different scales, standardized mean differences

(SMD) with 95% confidence intervals (CI) were calculated. SMD were calculated using post-

treatment data. The formula implemented in Review Manager 5.1 for SMD is Hedges‟

adjusted g, which is similar to Cohen‟s d, but additionally includes an adjustment for small

sample size bias (Deeks & Higgins, 2010):


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 9

SMD<0.40 are interpreted as small, SMD of 0.40 to 0.70 as moderate, and SMD larger than

0.70 are considered to be large (Higgins & Green, 2008).

It was assumed that the studies were not all estimating the same intervention effect,

but estimated intervention effects that follow a distribution across studies. Therefore, the

random effects model was implemented. In order to avoid dependence among multiple effect

sizes within the same study in one cluster, a decision was made as to which outcome measure

would be the main one for each study and cluster, and this main outcome measure was used in

the respective analysis.

To ensure the comparability of the groups within the single trials, baseline differences

for pre-test scores were calculated for each study. If there were baseline differences larger

than d = 0.5, change scores were calculated in addition. These outcomes could not be

included in the analysis of post-test scores because it is not possible to combine post-test data

and change scores when using SMD (Higgins & Green, 2008). Therefore, when baseline

differences were detected, we conducted additional analyses on change scores. One trial

(Dibbell-Hope, 2000) only reported post-test data, therefore no investigation of baseline

differences was possible and, consequently, only post-test values from that trial were reported

and analyzed.

When two or more experimental groups were compared to one control group

(Hackney & Earhart, 2009), or more than one control group was compared to one

experimental group (Koch, Morlinghaus, & Fuchs, 2007; Meekums, Vaverniece, Majore-

Dusele, & Rasnacs, 2012), then the groups were combined, resulting in one experimental and

one control group, as recommended by Higgins and Green (2008). In one case (Dibbell-Hope,

2000), two independent samples, two experimental groups and two control groups from

geographically distinct regions (Northern Alameda County vs. Southern Alameda County),
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 10

were reported. In order to avoid biases from reporting two samples that received the same

intervention, the one with more participants (Southern Alameda County) was chosen.

Assessment of Heterogeneity

To quantify inconsistency, I-squared tests were conducted. I² describes the percentage

of the variability in effect estimates that is due to heterogeneity rather than chance. I² > 40%

indicates heterogeneity (Higgins & Green, 2008). For a tentative classification of I², Higgins

and Thompson (2002) proposed that small heterogeneity corresponds to I2=25%, moderate

heterogeneity to values around I²=50%, and high heterogeneity to values higher than 50%.

Sensitivity Analysis

Sensitivity analyses were conducted to examine the impact of randomization methods.

These types of analyses are used to determine and assess whether results are robust to the

decisions made in the selection process (Higgins & Green, 2008). In the present meta-

analysis, six studies were included which did not use randomization. Therefore, sensitivity

analyses were conducted in which the results of trials with randomization were compared to

those of trials that were partially randomized or not randomized. For this purpose, first all

studies were included, and in a second step, studies without randomization were excluded in

each cluster. To investigate whether the difference between these tests was significant, Z-tests

were computed.

Quality of Included Trials

There is a risk that studies may overestimate or underestimate the true effect of an

intervention. Hence, the recommendation is to assess the risk of bias in reviews in order to

produce meaningful results and conclusions (Higgins & Green, 2008). There are many tools,

scales and checklists that provide summary scores to assess the quality of studies, but there is

no consensus on the best approach (Viswanathan et al., 2012). There were three reasons we

decided not to use any of these tools in this review. First, it was shown that summary scores

provide unreliable assessments of the validity of studies, because scores differ from scale to
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 11

scale (e.g., Jüni, Witschi, Bloch, & Egger, 1999; Moher, Jadad, & Tugwell, 1996). Second,

there is little empirical evidence supporting the existing risk-of-bias scales (Conn & Rantz,

2003). And third, none of the reviewed assessment methods seemed to fit the purpose of the

primary studies. For example, the participants in medical research are blind to whether they

are receiving the active ingredient or a placebo and this is a commonly used item in those

scales, but this form of blinding is not possible in DMT and/or dance studies. For all of these

reasons, study quality was characterized descriptively (see below under “Quality of included

trials”).

Results

Included Studies

Twenty-three studies were included in this meta-analysis. Sixteen of the included

studies investigated the effect of DMT on psychological variables, and seven investigated the

effects of dance on different clinical outcomes. Dance interventions varied in terms of dance

forms (e.g. ballroom dance or folk dance).

Regarding the control group activity, in 15 studies the control group received no

intervention or formed a wait-list control group (for an overview see Table 1). The other

studies differed in their control group activity. In the study by Hilf (2009), the control group

took part in a leisure time program and received a body experience intervention, whereas

Hokkanen et al. (2008) provided a control group who spent their time on regular nursing

home activities. In the study by Koch et al.(2007), there were initially two control groups – a

home trainer group and a music listening group. Because it is only possible to compare the

intervention group to one control group, we combined both control groups as recommended in

the Cochrane Handbook (Higgins & Green, 2008). Also, Meekums, Vaverniece, et al. (2012)

initially included two control groups; an exercise group and a non-exercise group, which were

combined into one control group. The control group in the study by Noreau, Martineau, Roy

and Belzile (1995) received counseling and discussion sessions, and Röhricht and Priebe
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 12

(2006) provided supportive counseling as a control group activity. In total, 15 studies reported

no intervention control groups, 6 studies offered some kind of activity for the control group,

and 2 studies did not specify the control group intervention (Hartshorn et al., 2001; Osgood,

Meyers, & Orchowsky, 1990).

With respect to the target groups, clinical, subclinical and non-clinical populations

were included. Out of the 23 studies, 15 focused on clinical populations, whereas 8 trials

worked with subclinical and non-clinical populations. The diagnoses of the clinical trials can

be summarized as follows: three studies investigated breast cancer (Dibbell-Hope, 2000;

Goldov, 2011; Sandel, et al., 2005) and three researched the effects of dance or DMT on

patients with depression (Haboush, Floyd, Caron, LaSota, & Alvarez, 2006; Jeong et al.,

2005; Koch, et al., 2007); two studies focused on patients with somatization problems (Bojner

Horwitz, Kowalski, Theorell, & Anderberg, 2006, on fibromyalgia; Hilf, 2009, on

somatoform disorder). In addition, the effects of DMT on patients with autism (Hartshorn, et

al., 2001; Koch et al., 2013), schizophrenia (Röhricht & Priebe, 2006), dementia (Hokkanen,

et al., 2008), Parkinson‟s disease (Hackney & Earhart, 2009), rheumatoid arthritis (Noreau, et

al., 1995) and cystic fibrosis (Goodill, 2005) were investigated. Three out of the eight

remaining studies were subclinical trials that worked with populations “at risk”: Karkou,

Fullarton and Scarth (2009) worked with young people who were at risk of developing mental

health problems, Bräuninger (2006) focused on adults suffering from stress, and Erwin-

Grabner, Goodill, Hill and Von Neida (1999) worked with students with test anxiety. The five

remaining non-clinical studies concentrated on students (Akandere & Demir, 2011), the

elderly (Eyigor, Karapolat, Durmaz, Ibisoglu, & Cakir, 2009; Hartshorn, Delage, Field, &

Olds, 2002; Osgood, et al., 1990) and women who participated in a commercial weight loss

program (Meekums, Vaverniece, et al., 2012).

For a description of the outcomes, a main outcome for each study was identified and

then all outcomes were summarized into four clusters – identified by the authors and then
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 13

discussed with and validated by two external clinicians – as follows. Clinical aspects were in

the focus of most studies: in three studies, data from depression scales were investigated

(Akandere & Demir, 2011; Haboush, et al., 2006; Koch, et al., 2007), one study examined

emotional eating (Meekums, Vaverniece, et al., 2012), and another (Erwin-Grabner, et al.,

1999) test anxiety. In the study by Röhricht and Priebe (2006), symptoms of schizophrenia

were targeted, whereas Hilf (2009) collected data on somatoform disorder, and Hokkanen et

al. (2008) analyzed scales for dementia. The studies by Koch et al. (2013), and Hartshorn et

al. (2001) focused on symptoms of autism. Karkou et al. (2009), Noreau et al. (1995), and

Jeong et al. (2005) mainly targeted data on mental health. Besides clinical aspects, quality of

life was examined as the main outcome measure in five studies (Bräuninger, 2006; Eyigor, et

al., 2009; Hackney & Earhart, 2009; Osgood, et al., 1990; Sandel, et al., 2005). Impact on

mood was selected from the studies by Goodill (2005) and Hartshorn et al. (2002). Dibbel-

Hope (2000) targeted psychological adaptation to breast cancer, Goldov (2011) examined

body image outcomes in patients with breast cancer, and from Bojner Horwitz (2006) we

selected the self-figure drawings to be included into the body image cluster.

Further details of the included studies are summarized in Table 1.

Quality of included trials.

All 23 studies described clearly the aim, objective or hypothesis of their investigation

and all of them addressed the characteristics of their participants as well as the inclusion and

exclusion criteria. The main anticipated outcomes and the main findings were described in all

of the included studies. The intervention was clearly described and clarified in all cases.

Baseline differences were reported and analyzed in 15 studies. Consequently, eight studies did

not explicitly report whether the groups were comparable prior to intervention (Bojner

Horwitz, et al., 2006; Goldov, 2011; Goodill, 2005; Hartshorn, et al., 2002; Hartshorn, et al.,

2001; Karkou, et al., 2009; Koch, et al., 2007; Osgood, et al., 1990). Due to the nature of

DMT interventions and the therapeutic use of dance, as stated earlier, participants were not
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 14

blind to the treatment condition in all of the included studies. Four studies (Bojner Horwitz, et

al., 2006; Erwin-Grabner, et al., 1999; Jeong, et al., 2005; Karkou, et al., 2009) explicitly

reported that randomization was conducted by a person blind to the experimental procedures.

Also, in four studies the assessors of the participants were blind to the experimental

conditions (Goodill, 2005; Haboush, et al., 2006; Röhricht & Priebe, 2006; Sandel, et al.,

2005).

With regard to randomization, 6 out of the 23 studies did not conduct (complete)

randomized trials and, therefore, did not offer randomization methods (Goldov, 2011;

Hartshorn, et al., 2001; Koch, et al., 2013; Meekums, Vaverniece, et al., 2012; Noreau, et al.,

1995; Osgood, et al., 1990). In small samples careful matching is often a better choice than

randomization. Meekums, Vavernice, et al. (2012) used partial randomization due to

limitations of sample size. Hartshorn, et al. (2001), Koch, et al. (2013), and Osgood, et al.

(1990) used matched samples due to logistic and situational demands, in Hartshorn et al.‟s

case parents and teachers were also blind to the conditions of the study. Noreau, et al. (1995)

did not further specify why randomization was not possible, and Goldov (2011) used self-

selection of patients with breast cancer into intervention and control group, because it was not

possible to “oblige women to give up their choice and control over their bodies at a vulnerable

and demanding time” (p. 94).

Overall, all of the included studies offered a quite satisfactory degree of

methodological quality. However, there were differences in the quality of the included

studies, especially with regard to randomization, blinding strategy, and the analysis of

baseline differences. Risk of bias and the impact of methodological quality on the results of

this meta-analysis will be further explored in the Discussion section.

Excluded Studies

Studies were excluded from the analysis when they did not meet the above mentioned

criteria for inclusion. Also, various studies were excluded because they did not contain the
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 15

necessary statistics (e.g., Berrol, et al., 1997; Kaplan Westbrook & McKibben, 1989; Kipp,

Herda, & Schwarz, 2000; Rösler, et al., 2002; Rossberg-Gempton, et al., 1999; Skye, et al.,

1989) or because the outcome variables were not targeted in this meta-analysis. This applied,

for example, to studies that examined cognitive variables (e.g., Jansen, Kellner, & Rieder,

2012), or studies that measured only functional physical effects (e.g., Couper, 1981; Flores,

1995; Hackney, Kantorovich, & Earhart, 2007; Hopkins, Murrah, Hoeger, & Rhodes, 1990;

Lausberg, 1998; Shigematsu et al., 2002). Two RCTs of the last category need further

inspection – because we found them too late for inclusion: McKinley, Jacobson, Leroux,

Bednarcyzk, Rossignol, and Fung (2008) on the effects of tango on elderly patients with fear

of falling, and Belardinelli, Lacalaprice, Ventrella, Volpe, and Faccenda (2008) on the effects

of Walz dancing on stable chronic heart failure. Finally, studies had to be excluded when the

intervention was neither dance nor DMT (e.g., Kissane et al., 2007; Van de Winckel, Feys, De

Weerdt, & Dom, 2004).

Effects of Interventions

In order to analyze the effects of interventions on the various variables, the outcomes

were classified into five main clusters: quality of life, well-being, mood and affect, body

image, and clinical outcomes. Moreover, sub-analyses of clinical outcomes related to

depression, anxiety, and interpersonal competence were conducted.

Table 2 summarizes the clusters and the corresponding studies and outcomes, Table 3

provides a summary of the results within each category including estimated effect sizes and

significance tests.

– Insert Table 2 about here –

– Insert Table 3 about here –


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 16

Quality of life. Ten trials (see Table 2) examined the effects of dance or DMT on

quality of life with 550 participants altogether (NEG= 301, NCG= 249). Out of these trials, the

data of one trial (Hackney & Earhart, 2009) could not be included in the analysis of post-test

scores, because baseline differences were detected between the control group and the dance

intervention groups, which were aggregated into one group. A meta-analysis of the remaining

nine trials (see Figure 1; N = 489; NEG= 257, NCG= 232) resulted in a pooled estimate of SMD

= 0.37 (see Table 3) that supported an effect of dance and DMT on quality of life, and the

results were consistent across studies (I² = 0%). The forest plots indicate the direction of the

effects found in the primary studies and the magnitude of the effects on the x-axis, the sample

size is indicated by the size of the square symbol, and the rhombus indicates the overall effect

size.

– Insert Figure 1 about here –

An additional analysis on change scores was performed because one study (Hackney

& Earhart, 2009) could not be included in the analysis of post-test scores due to baseline

differences. Therefore, all studies were analyzed based on change scores (N = 550; NEG= 301,

NCG= 249), resulting in a pooled estimate of SMD = 0.23 (see Table 3) with homogenous

results (I²= 0%).

Well-being, mood and affect. A total of seven studies (see Table 2) reported the

effects of dance or DMT on well-being, mood and affect. The pooled estimate of those seven

trials (see Figure 2; N = 350; NEG= 175, NCG= 175) indicated that DMT and dance

interventions improve well-being, mood and affect (SMD = 0.30; see Table 3). The results

were consistent across trials (I²= 5%).

– Insert Figure 2 about here –


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 17

Body Image. Six studies (see Table 2) reported the effects of DMT or dance on body

image (see Figure 3; N= 209; NEG=91, NCG= 118). Their pooled estimate yielded support for

an effect of dance or DMT on body image (SMD = 0.27; see Table 3) and the results were

consistent across trials (I²= 11%).

– Insert Figure 3 about here –

Clinical Outcomes. Ten trials (see Table 2) compared the effects of DMT or dance to

control group interventions on the reduction of negative clinical outcomes. Three trials

(Hartshorn, et al., 2001; Hilf, 2009; Jeong, et al., 2005) could not be included because

baseline differences in the outcome measure were detected between the control group and the

experimental group. Pooled estimate of the included trials (see Figure 4; N = 342; NEG= 173,

NCG= 169) indicated support for an effect of dance or DMT on depression (SMD = 0.44; see

Table 3), and the results were consistent across the trials (I²=0%).

– Insert Figure 4 about here –

An analysis of all trials based on change scores including the three trials with baseline

differences (excluding Dibbell-Hope, 2000 because change scores were not computable) (N =

474; NEG= 240, NCG= 233) revealed an effect of DMT or dance on clinical outcomes (SMD =

0.44; see Table 3). The results were consistent across trials (I²=0%).

Depression. Because 10 studies reported data regarding the effects of DMT or dance

on depression (Akandere & Demir, 2011; Bojner Horwitz, et al., 2006; Bräuninger, 2006;

Dibbell-Hope, 2000; Goodill, 2005; Haboush, et al., 2006; Hilf, 2009; Jeong, et al., 2005;

Koch, et al., 2007; Noreau, et al., 1995), a separate analysis on this variable was conducted.
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 18

A sub-analysis of global outcomes on depression was conducted with four studies that

had already entered the clinical outcome cluster (re-analysis of Bräuninger, 2006; Dibbell-

Hope, 2000; Goodill, 2005; Jeong, et al., 2005). Bojner Horwitz et al. (2006), Hilf (2009),

Akandere et al. (2011), Koch et al. (2007), Haboush et al. (2006), and Noreau et al. (1995) all

contributed new data to the analysis that had not entered the clinical outcome cluster before.

Two trials (Bojner Horwitz, et al., 2006; Jeong, et al., 2005) could not be included in

this analysis on post-test scores in the end, because baseline differences were detected

between the control group and the experimental group. The pooled estimate of the remaining

eight trials (see Figure 5; N = 424; NEG= 227, NCG= 197) showed support for an effect of

dance or DMT on depression (SMD = 0.36; see Table 3), and results were consistent across

the eight trials (I² = 0%).

– Insert Figure 5 about here –

In order to include and analyze the two studies with baseline differences, an additional

analysis of change scores was conducted. One trial could still not be included due to missing

pre-test scores (Dibbell-Hope, 2000). The pooled estimated effect of the nine included trials

(see Figure 6; N= 485; NEG= 261, NCG= 224) revealed an effect of DMT on depression (SMD

= 0.34, I²= 0%; see Table 3).

Anxiety. A sub-analysis was conducted for anxiety. Two trials reported additional data

on anxiety (Erwin-Grabner, et al., 1999; Noreau, et al., 1995). Anxiety subscales of global

outcome measures, which have already been analyzed in the clinical outcomes cluster, were

derived from the trials by Dibbell-Hope (2000) and Bräuninger (2006). Also, Jeong et al.

(2005) reported a subscale for anxiety, but, due to baseline differences, this outcome could not

be included in the analysis of post-test scores.


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 19

The pooled estimate of the four included trials (see Figure 6; N= 203; NEG=120,

NCG=83) indicated that DMT and dance interventions decrease anxiety (SMD = 0.44; see

Table 3), and the results were consistent across the trials (I² = 0%).

– Insert Figure 6 about here –

An analysis of change scores, including the trial by Jeong et al. (2005), and excluding

the data by Dibbell-Hope (2000) because of missing pre-test scores, revealed a robust pooled

estimate that supported an effect of DMT and dance on anxiety (N= 228; NEG= 134, NCG= 94,

SMD= 0.46; see Table 3).

Interpersonal Competence. To analyze the effects of DMT on interpersonal

competence (which was not an outcome variable included in any of the dance investigations),

a sub-analysis on this dimension was conducted. In four studies, interpersonal competence

was measured as a sub-dimension of the already analyzed global clinical outcomes

(Bräuninger, 2006; Dibbell-Hope, 2000; Hokkanen, et al., 2008; Jeong, et al., 2005), and two

trials provided additional data on this dimension, which had not been analyzed before

(Hartshorn, et al., 2001; Koch, et al., 2013).

Five studies investigated the effects of DMT on interpersonal competence by

measuring interpersonal sensitivity (Bräuninger, 2006; Dibbell-Hope, 2000; Jeong, et al.,

2005; Koch, et al., 2013), or social relatedness (Hartshorn, et al., 2001), in 300 participants

(see Figure 7; NEG= 164, NCG= 136). The pooled estimate supported an effect of dance and

DMT on interpersonal competence (SMD= 0.45; see Table 3), but the results were

inconsistent across studies (I²= 52%).

– Insert Figure 7 about here –


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 20

One additional study examined the effects of DMT on social competence (Hokkanen,

et al., 2008) but could not be included because there were baseline differences between the

experimental group and the control group. Consequently, an additional analysis of change

scores was performed. Dibbell-Hope‟s study (2000) was excluded because of missing pre-test

scores. The analysis of the remaining five studies (N= 314; NEG=177, NCG= 137) based on

change scores resulted in a homogeneous outcome with a pooled estimate that found evidence

of an effect of DMT on interpersonal competence (SMD = 0.29, I²=17%; see Table 3).

Sensitivity Analysis. Sensitivity analyses, excluding those trials without or with only

partial randomization methods, did not significantly change the results in any cluster.

Additionally, differences between analyses of change scores and post-test scores were

explored in each cluster in which additional analysis on change scores had been conducted,

resulting in non-significant differences.

Discussion

This meta-analysis systematically reviewed the results of studies investigating the

effects of DMT interventions and the therapeutic use of dance since 1996. Twenty-three

primary studies of the last 20 years were included (N = 1078). Results suggest that DMT was

supported as effective intervention for the following populations or disorders: anxiety, autism

(children and adults), breast cancer, cystic fibrosis, depression (including geriatric and

adolescent forms), dementia, eating disorders (emotional eating and obesity), elderly,

fybromyalgia, youth at risk, rheumatoid arthritis, schizophrenia, somatoform disorder, and

stress. Dance was effective for depression, elderly patients, and Parkinson‟s disease. For a

differentiated quantification, data were classified into psychological outcome clusters. DMT

improved well-being, mood, affect, quality of life, body image and interpersonal competence,

and reduced clinical symptoms such as anxiety and depression. Dance was particularly

effective on quality of life and depression reduction. Pooled effect sizes varied from small to
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 21

moderate (SMD = 0.27 to 0.45), depending on the single clusters, which will now be

discussed in more detail.

With regard to quality of life, a moderate pooled effect size was observed. This result

strengthens the assumption that DMT and dance are beneficial interventions for increasing

quality of life (e.g., Earhart, 2009). Moreover, this finding is in agreement with previous

findings from other studies that showed a significant improvement in quality of life, for

example, in patients with cancer or Parkinson‟s disease (Earhart, 2009; Lacour, 2006;

Mannheim & Weis, 2005) but were not randomized controlled trials. Since quality of life is

regarded as an important objective criterion for evaluating medical interventions (Bräuninger,

2012), this finding has implications for the professional acceptance and standing of DMT and

dance interventions in the health sciences.

The analysis of the impact of DMT and dance on well-being, mood and affect revealed

a small pooled effect size, suggesting that DMT and dance may play a useful role as a

contributor to well-being, positive mood, and affect. Still, the findings of our study should be

interpreted with caution as this cluster was conceived as a more global cluster that included

quite different variables such as subjective well-being, affect, mood, and stress. Previous

findings for the effects of dance and DMT on well-being, mood and affect were mostly

supportive of DMT and dance. Goodill (2006) and van der Merwe (2010), for example,

reported beneficial effects of dance and movement on affect and well-being by reviewing the

literature.

For body image, a small effect was observed indicating limited impact of DMT and

dance on this variable. Three out of the six included primary studies did not initially find

significant differences in body image between the experimental and the control group

(Dibbell-Hope, 2000; Goodill, 2005; Sandel, et al., 2005) and one trial did not include tests of

significance (Goldov, 2011). Because body image is thought to be shaped by bodily

experiences amongst other things, and movement-based activities are thought to positively
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 22

influence body image (Leventhal & Schwartz, 1989), we would have expected a larger effect.

The findings of Lewis and Scannell (1995) regarding the impact of dance on body image

suggest that body image changes may happen only after longer time periodes, since they

found significantly more satisfying results for improvement of body image in participants

who had been dancing for at least five years. Following this reasoning, the included primary

studies would have needed a longer intervention time to yield larger effects. However, the

limited impact of DMT and dance on body image found in this meta-analysis could also stem

from the fact that studies varied widely in their operationalization of body image. For

instance, Sandel et al. (2005) and Goldov (2011) employed the Body Image Scale (Hopwood,

Fletcher, Lee, & Al Ghazal, 2001), whereas Goodill (2005) used human figure drawings to

assess body image. Therefore, the use of consistent, valid, and standardized measures of body

image are necessary in subsequent studies.

A moderate effect size was found for clinical outcomes. This result is consistent with

the finding of the meta-analysis of Ritter and Low (1996; recalculated by Cruz & Sabers,

1998) who also reported that DMT was moderately effective in psychiatric patients. Together

with numerous uncontrolled or partly controlled clinical trials, this finding supports the

effectiveness of DMT and dance with psychiatric patients and fostered the extension of the

implementation of DMT and dance to reduce clinical symptoms.

Three sub-analyses were conducted, including sub-categories of variables that have

partly been analyzed before. The first sub-analysis of clinical outcomes for depression

resulted in a moderate pooled effect size of DMT and dance interventions in reducing

depression. In the meta-analysis by Ritter and Low (1996; recalculated by Cruz and Sabers,

1998), one pilot study was included that investigated the effects of DMT on depression

(Brooks & Stark, 1989), which showed a moderate effect size. Clinical studies of other good

evidence levels contribute further encouraging findings to the effects of DMT and adjacent

body psychotherapies on the reduction of depression (e.g., Heimbeck, 2008; Kipp, Herda, &
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 23

Schwarz, 2000; Röhricht, Papadopoulos, & Priebe, 2013). Moreover, since many clinical

measures include depression, there are many trials that provide scores on depression as a sub-

measurement. The present findings support the effectiveness of DMT and dance on

depression including ten primary studies with convergent evidence. More studies,

investigating the effects of DMT on depression are underway. Most notably, Meekums,

Karkou and Nelson (2012) are currently conducting a Cochrane Review on the effects of

DMT on depression.

A second sub-analysis was carried out to examine the effects of DMT and dance on

anxiety, also suggesting a moderate pooled effect. The meta-analysis of Ritter and Low (1996)

had also analyzed changes in anxiety. According to the recalculation of Cruz and Sabers

(1998), there were large effects in anxiety reduction. Although the finding of the present

meta-analysis is somewhat smaller, the positive impact of DMT and dance on anxiety,

including test anxiety in academic settings (Erwin-Grabner et al., 1999), can be confirmed by

the more recent trials.

In order to investigate interpersonal aspects, the third sub-analysis focused on

interpersonal competence. To the best of our knowledge, this meta-analysis is among the first

to provide empirical support for the frequently stated assumption that DMT and dance affect

social and interpersonal variables. The result supported the assumption that DMT influences

interpersonal variables, because a moderate pooled effect size was found. Yet, the percentage

of total variation across studies was moderate (I² = 52%), possibly due to the many different

operationalizations of interpersonal competence. Such heterogeneity can usually be explored

by subgroup analyses. However, due to the small number of included studies subgroup

analyses were not meaningful here. The heterogeneity of the studies thus indicates the need

for more research.

The additional analysis of change scores we conducted confirmed the robustness of

the results, because magnitude and direction of observed effects for both analyses were quite
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 24

similar (see Table 1). Furthermore, with the exemption of interpersonal competence, the

percentage of the variability in effect estimates that was due to heterogeneity rather than

sampling error was small, suggesting homogeneous results. This implies that, despite

differences in study characteristics, magnitude and direction of observed effects were

comparable and quite similar, suggesting robustness of the effects.

The impact of missing or only partial randomization was addressed by sensitivity

analyses. Results did not differ significantly when the six studies without adequate

randomization methods were exlcluded. This finding underlines that, in the present analyses,

the results of randomized and non-randomized trials were comparable. However, non-

significant results could also be due to the small samples. On the one hand, it is frequently

argued that trials without randomization overestimate effect sizes (Higgins & Green, 2008).

On the other hand, Deeks et al. (2003) analyzed eight reviews and concluded that the effects

estimated by randomized and non-randomized trials did not differ consistently. Additionally,

in the field of creative arts therapies, randomized controlled trials may miss valuable

information, for example experiences of participants regarding the acceptability of such

interventions. Therefore, as a solitary source, randomized controlled trials are not sufficient

for assessing the effects of DMT and dance (Clay, 2010; Goldov, 2011).

Compared to the meta-analysis by Ritter and Low (1996), the present study provided a

more detailed analysis of outcomes and more analyses on health-related psychological

outcomes. Ritter and Low (1996) analyzed their data only regarding psychological change in

general (by evaluating anxiety, fatigue, self-esteem, trust, depression, sexual differentiation,

friendliness and anger in one analysis), and separately for anxiety, anger and self-concept.

Hence, more narrowly defined categories were analyzed in the present study providing more

accurate and more generalizable information. This rests on the fact that evidence-based

studies in DMT have increased since 1996 and more studies with more diverse measures and
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 25

specific trials (e.g., concerning population, diagnoses, and outcomes) have been published

since then, which enabled the analysis of more distinct outcome categories.

Limitations of the Present Study

The present meta-analysis provides encouraging results for DMT and dance

interventions. Although, several limitations should be considered when intepreting the results.

A common criticism in meta-analysis is “mixing apples and oranges” (i.e., the

inclusion of studies with very heterogeneous groups or outcomes) which could lead to

meaningless results (Higgins & Green, 2008). However, because our approach was a very

broad review to start with, we intended to focus on the higher order category of health-related

psychological outcomes. To address the critical aspects of the breadth of our analysis, it

should be mentioned that meaningful summaries can only be provided by meta-analyses that

include sufficiently homogeneous primary trials (e.g., with regard to participants or outcomes)

(Deeks, Higgins, & Altman, 2008). Because meta-analyses with more narrowly defined

approaches improve validity (O‟Connor, Green, & Higgins, 2008), the present analysis used

distinct clusters and investigated heterogeneity within each cluster to ensure the comparability

of results. Due to the limited number of primary studies in the single clusters, subgroup

analyses regarding the influence of DMT or dance interventions on specific age groups,

samples, or with a specific duration of intervention, were not conducted.

Another critical aspect lies in the limitations of the included primary studies. One

important limitation of the primary studies was that in many of the control groups, no

alternative activities were offered; only nine studies included an alternative counseling or

activity intervention. There is always the danger of a Hawthorn effect in cases where the

control group is not provided with the same attention as the treatment group. Due to the

varying quality of the included studies, results may be inconsistently biased. To counter the

common criticism of the „garbage in, garbage out‟ principle in meta-analyses, certain

inclusion criteria were chosen in the present meta-analysis, and the studies were carefully
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 26

selected with much attention to detail. However, the investigation of study quality revealed a

number of differences in the included studies, possibly confounding results, and thus limiting

the generalizability and validity of this research. Moreover, only a small number of studies

was included in this meta-analysis and consequently, the number of studies in the individual

clusters was limited. This affects the accuracy of the estimated effect size: Hedges and Vevea

(1998) pointed out that tests resulting from random effect models should be regarded as only

approximate, if the number of studies is less than five. In the present meta-analysis the

numbers of included studies were – with the exception of the anxiety analysis – five or more.

Results on anxiety should be interpreted with caution because only four studies were

included.

Furthermore, publication bias, also called the “file drawer problem”, is always a

critical issue that needs to be discussed. Statistically significant findings are more likely to be

published, and, therefore, effects in meta-analyses may be overestimated (Kugizaki, 2009;

Rosenthal, 1979). To minimize publication bias in the present study, comprehensive searches

were conducted, also including studies that had not been published and contacting authors

when data were missing. Still, it cannot be ruled out that studies on DMT or dance

interventions are missing. The file drawer problem was also examined visually in the form of

funnel plots, i.e., scatter plots of the estimated intervention effects against the standard errors

as a measure of study size. An asymetrical appearance of the funnel plot can indicate

publication bias (Higgins & Green, 2008). The funnel plots in this study did not show

evidence of publication bias. However, due to the limited number of included studies in the

single clusters, visual inspection of the funnel plots alone should be interpreted with caution.

Another critical aspect is that confidence intervals in the single clusters were relatively

wide, indicating that further information was needed to draw more definite conclusions as to

where the best estimate of the average effect was located. However, confidence intervals of
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 27

the average intervention effects will always be wider when the random effects method is

applied (Higgins & Green, 2008).

Finally, the present analysis only provides information on the effectiveness of DMT

and dance immediately following the intervention. No information about long-term effects

and follow-up developments could be included.

Two additional questions are relevant for discussion. Firstly: Does the type of activity

(dance or other) really matter? From the data, we need to state that yes, type of activity seems

to matter as seen for example, in the Koch et al. (2007) study using a dance condition, a sports

condition (moving up to same level of arousal) and a simulation condition (just listening to

the music of the dance); the dance condition improved vitality and decreased depressive

affect significantly more than the sports condition and the music listening condition. Overall,

a number of studies in the present analysis had control groups with alternative activities (nine

studies used control groups of other activities; five DMT and four dance studies), and in these

studies DMT and dance were consistently shown to be more effective; but of course there are

an endless number of other “other activities” that were not included and make the effect

subject to potential falsification. Secondly: Is there any difference between DMT and any

other mood enhancing therapeutic experience with comparable objectives? This question can

be only tentatively addressed. Dance research in this meta-analysis was carefully chosen for

aiming at the same outcomes with therapeutic intentions. These studies did improve mood and

decrease depression in subclinical and nonclinical populations. DMT did the same and more

(decrease of anxiety, increase in quality of life) in mainly clinical and a few subclinical

populations. While at this point comparability is limited, and there is a need for more

research, we can state that the fact that effects were detected for both clinical and community

populations is promising for future work.

Recommendations for Further Research


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 28

As the reviewed studies differed greatly in their quality, more well-designed studies

are generally needed. To meet criteria of evidence-based research, study designs in DMT and

dance research need to be adapted and improved. Next to further qualitative investigations,

more randomized controlled trials with well-suited control groups are desirable. Regarding

experimenter effects, blinding of the randomization procedure and blindness of the assessor

should be a standard in future research. Dance movement therapists or dance instructors

guiding the sessions should ideally also be blind to the hypotheses. However, qualitative

research including non-traditional and creative approaches are undoubtedly of utmost

importance for research in DMT and dance. Thus, in order to obtain a holistic and integrated

view of effects in the fields of DMT and dance, methodological diversity is required.

Therefore, qualitative and quantitative approaches should be combined into mixed methods

designs, resulting in an appropriate approach within the creative arts therapies, but also in

meaningful and comparable quantitative results.

Since the majority of trials were conducted with small samples, comprehensive studies

with larger sample sizes should be carried out. In the field of DMT and dance, however, there

is a lack of funded research, which makes it difficult to gather large sample sizes, conduct

long-term studies, or multicenter studies (i.e., studies conducted in more than one institution

with the same population). In such studies, a better generalizabuility of results could be

achieved.

A third important point would be the use of more standardized measurements. In

many studies, self-constructed items were used, and often non-standardized measurements

were employed. Homogeneous measurements and measurement methods should be applied in

order to establish consistency and to guarantee comparability of results. Taking into account

that nonverbal interventions were measured with verbal intervention tools here, more specific

measures geared to the body or behavioral level and nonverbal communication should in
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 29

future studies yield effects of greater magnitude than the ones reported here. There are several

such instruments in development in DMT at this point in time.

Moreover, statistical meticulousness is indicated. The inclusion of all descriptive

statistics (all means, standard deviations, and exact N for all pre- and post measures) into the

results section needs to become a standard of the primary studies in the field. Several studies

we reviewed missed this information.

DMT studies – and in fact any psychotherapy research – need to provide detailed

descriptions of the interventions used. Given that in the 23 studies included here only seven

described their interventions in a replicable way and only two used treatment manuals this is

an important factor for increasing the replicability of DMT studies. This criterion should be

more emphasized as an evidence-based standard in general.

An increased focus in the future should also lay on the investigation of specific factors

of effectiveness: What specific method and what specific part of the intervention is actually

effective for addressing specific aspects of a problem? Movement analysis tools in the field of

DMT offer differentiated hypotheses about the connection of movement and meaning, we

only need to start testing them more soundly and systematically in the context of evidence-

based or experimental research (e.g., Koch, et al., 2007). On the basis of the evidence-based

knowledge gained thus far, we could also gear our interventions even more specifically to

directly addressing the desired outcome (e.g., Röhricht & Priebe, 2006). In the future, a

Cochrane review on effects of DMT on anxiety reduction could be next, after one or two more

good quality primary studies with such a focus. A systematic review on the effects of DMT

and dance on interpersonal variables would further be important. Variables capturing positive

resources such as joy, hedonism, well-being, quality of life, life satisfaction and affect

expression – which are difficult to address with medication – should remain in the research

focus of the arts therapies in general.


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 30

Finally, the present study has implications for researchers, practitioners and the health

care system. Researchers can benefit from this work through obtaing a comprehensive

overview of the current state of research in the field of dance and DMT. Moreover, the

present work provides important ideas for future research, and offers researchers the

possibility to discuss and classify their results in light of the latest findings. For practitioners

and clinicians, this work contributes to the developing knowledge and evidence base of their

profession. On the one hand, it has implications for their self-perception as they learn about

their work‟s verifiable effects. On the other hand, this analysis delivers many arguments that

can lead to more acceptance and approval, and hence raise the awareness and appreciation of

DMT and the therapeutic use of dance by health care professionals. On a more global level,

implications can also be drawn for health care providers. Meta-analyses improve the

accessibility of research to decision makers. The present study intends to meet the current

evidence-based research standards of our health care systems. Based on the findings, it is

suggested that health care policy makers and providers should encourage the further

implementation of DMT and dance interventions, particularly with regard to the treatment of

clinical symptoms such as anxiety or depression, and the improvement of patients‟ quality of

life. A conceivable implication resulting from this analysis could be to encourage the

combination of DMT as a nonverbal psychotherapeutic component with other therapeutic

approaches, because of its effects on health-related psychological outcomes. However,

additional research evidence for this assumption is needed.

Conclusions

In sum, the present study provides a comprehensive summary of the current state of

research on effects of DMT and the therapeutic use of dance on health-related psychological

outcomes. It suggests that DMT and dance are effective interventions in many clinical

contexts. Empirical support was found for an increase in quality of life, well-being, mood,

affect, body image, and clinical outcomes, and particularly for a decrease of depression and
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 31

anxiety. Due to unexplained heterogeneity across results, effects for interpersonal competence

remained inconclusive, requiring further attention. In general, the resulting effect sizes from

SMD = 0.27 to 0.45 indicate that DMT is a meaningful evidence-based intervention for

health-related psychological outcomes, with according implications for decision making of

health care providers. The study supports DMT and dance as an effective and useful treatment

method in clinical and prevention contexts. Future research needs to investigate the effects of

DMT and dance by differentiating effects of specific interventions and analyzing further

characteristics and moderators, so that the present results can be put to test and expanded

upon.

References

References marked with an asterisk indicate studies that are included in the meta-analysis

ADTA. (2013). Homepage of the American Dance Therapy Association. Retrieved January

27, 2013, from http://www.adta.org/

*Akandere, M., & Demir, B. (2011). The effect of dance over depression. Collegium

Antropologicum, 35(3), 651-656.

Belardinelli, R., Lacalaprice, F., Ventrella, C., Volpe, L., & Faccenda, E. (2008). Waltz

dancing in patients with chronic heart failure: New form of exercise training.

Circulation: Heart Failure, 1(2), 107–114.

Berrol, C. F. (1984). The effects of two movement therapy approaches on selected academic,

physical and socio-behavioral measures of first grade children with learning and

perceptual motor problems. American Journal of Dance Therapy, 7, 32-48.

Berrol, C. F., Ooi, W. L., & Katz, S. 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.


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 32

*Bojner Horwitz, E., Kowalski, J., Theorell, T., & Anderberg, U. M. (2006).

Dance/movement therapy in fibromyalgia patients: Changes in self-figure drawings

and their relation to verbal self-rating scales. The Arts in Psychotherapy, 33(1), 11-25.

Bradt, J., & Dileo, C. (2010). Music therapy for end-of-life care. Cochrane Database of

Systematic Reviews 2010 (1).

Bradt, J., & Dileo, C. (2009). Music for stress and anxiety reduction in coronary heart disease

patients. Cochrane Database of Systematic Reviews 2009 (2).

Bradt, J., Dileo, C., Shim, M. (2013). Music interventions for preoperative anxiety. Cochrane

Database of Systematic Reviews 2013 (6).

Bradt, J., Goodill, S., & Dileo, C. (2011). Dance/movement therapy for improving

psychological and physical outcomes in cancer patients. Cochrane Database of

Systematic Reviews 2011 (10).

*Bräuninger, I. (2006). Tanztherapie: Verbesserung der Lebensqualität und

Stressbewältigung. Weinheim; Basel: Beltz.

Bräuninger, I. (2012). The efficacy of dance movement therapy group on improvement of

quality of life: A randomized controlled trial. The Arts in Psychotherapy, 39(4), 296-

303.

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.

Campbell, E.R. (2010). The effectiveness of art therapy in reducing symptoms of trauma,

anxiety, and stress: A meta-analysis. (Doctoral Dissertation) Retrieved from ProQuest

3409239.

Clay, R. C. (2010). More than one way to measure. Monitor on Psychology, 41(8), 53-55.

Conn, V. S., & Rantz, M. J. (2003). Research methods: Managing primary study quality in

meta-analyses. Research in Nursing & Health, 26(4), 322-333.


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 33

Couper, J. L. (1981). Effects on motor performance of children with learning disabilities.

Physical Therapy, 61(1), 23-26.

Cruz, R., & Sabers, D. (1998). Dance/movement therapy is more effective than previously

reported. Arts in Psychotherapy, 25(2), 101-104.

Deeks, J. J., Dinnes, J., D'Amico, R., Sowden, A. J., Sakarovitch, C., Song, F., et al. (2003).

Evaluating non-randomised intervention studies. Health Technology Assessment,

7(27), 1-173.

Deeks, J. J., & Higgins, J. P. T. (2010). Statistical algorithms in Review Manager 5.

Retrieved December, 2012, from

http://www.cochrane.org/sites/default/files/uploads/handbook/Statistical_Methods_in_

RevMan5-1.pdf

Deeks, J. J., Higgins, J. P. T., & Altman, D. G. (2008). Analysing data and undertaking meta-

analyses. In J. P. T. Higgins & S. Green (Eds.), Cochrane Handbook for Systematic

Reviews of Interventions. Chichester: John Wiley & Sons.

*Dibbell-Hope, S. (2000). The use of dance/movement therapy in psychological adaptation to

breast cancer. The Arts in Psychotherapy, 27(1), 51-68.

EADMT (2013). Webpage of the European Association of Dance Movement Therapy.

Retrieved January 27, 2013, from http://www.eadmt.com

Earhart, G. M. (2009). Dance as therapy for individuals with Parkinson disease. European

Journal of Physical and Rehabilitation Medicine, 45(2), 231-238.

*Erwin-Grabner, T., Goodill, S. W., Hill, E. S., & Von Neida, K. (1999). Effectiveness of

dance/movement therapy on reducing test anxiety. American Journal of Dance

Therapy, 21(1), 19-34.

*Eyigor, S., Karapolat, H., Durmaz, B., Ibisoglu, U., & Cakir, S. (2009). A randomized

controlled trial of Turkish folklore dance on the physical performance, balance,


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 34

depression and quality of life in older women. Archives of Gerontology and

Geriatrics, 48(1), 84-88.

Flores, R. (1995). Dance for health: Improving fitness in African American and Hispanic

adolescents. Public Health Report, 110(2), 189-193.

Gold, C., Heldal, T. O., Dahle, T., Wigram, T. (2005). Music therapy for schizophrenia or

schizophrenia-like illnesses. Cochrane Database of Systematic Reviews 2005 (2).

*Goldov, N. B. (2011). The effects of individualized brief dance/movement therapy on body

image in women with breast cancer. Unpublished Dissertation, Seattle.

*Goodill, S. W. (2005). Dance/movement therapy for adults with cystic fibrosis: Pilot data on

mood and adherence. Alternative Therapies, 11(1), 76-77.

Goodill, S. W. (2006). Dance /Movement Therapy for people living with medical illness. In:

S. C. Koch, & I. Bräuninger (Eds.). Advances in dance/movement therapy. Theoretical

perspectives and empirical findings. Berlin: Logos.

*Haboush, A., Floyd, M., Caron, J., LaSota, M., & Alvarez, K. (2006). Ballroom dance

lessons for geriatric depression: An exploratory study. The Arts in Psychotherapy,

33(2), 89-97.

*Hackney, M. E., & Earhart, G. M. (2009). Health-related quality of life and alternative forms

of exercise in Parkinson disease. Parkinsonism & Related Disorders, 15(9), 644-648.

Hackney, M. E., Kantorovich, S., & Earhart, G. M. (2007). A study on the effects of

Argentine tango as a form of partnered dance for those with Parkinson Disease and the

healthy elderly. American Journal of Dance Therapy, 29(2), 109-127.

*Hartshorn, K., Delage, J., Field, T., & Olds, L. (2002). Senior citizens benefit from

movement therapy. Journal of Bodywork and Movement Therapies, 6(1), 55-58.

*Hartshorn, K., Olds, L., Field, T., Delage, J., Cullen, C., & Escalona, A. (2001). Creative

movement therapy benefits children with autism. Early Child Development and Care,

166, 1-5.
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 35

Hedges, L. V., & Vevea, J. L. (1998). Fixed- and random-effects models in meta-analysis.

Psychological Methods, 3(4), 486-504.

Heimbeck, A. (2008). Bewegungsorientierte Interventionen und depressive Erkrankungen.

[Movement therapy and depression.] Technische Universität Dortmund: Unpublished

Dissertation.

Hervey, L. W. (2000). Artistic inquiry in dance/movement therapy. ProQuest Information &

Learning, US.

Hervey, L. W. (2009). Encouraging research in dance/movement therapy. In S. Chaiklin & H.

Wengrower (Eds.), The art and science of dance/movement therapy: Life is dance.

(pp. 317-329). New York, NY US: Routledge/Taylor & Francis Group.

Higgins, J. P. T., & Green, S. (Eds.). (2008). Cochrane handbook for systematic reviews of

interventions Version 5.0. The Cochrane Collaboration. Chichester: John Wiley &

Sons. Available at www.cochrane-handbook.org.

Higgins, J. P. T., & Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis.

Statistics in Medicine, 21(11), 1539-1558.

*Hilf, Z. (2009). Wirsamkeit von Tanztherapie bei Somatoformer Störung. Unpublished

Diplomarbeit, Technische Universität München, München.

*Hokkanen, L., Rantala, L., Remes, A. M., Härkönen, B., Viramo, P., & Winblad, I. (2008).

Dance and movement therapeutic methods in management of dementia: A

randomized, controlled study. Journal of the American Geriatrics Society, 56(4), 771-

772.

Hopkins, D. R., Murrah, B., Hoeger, W. W. K., & Rhodes, R. C. (1990). Effect of low-impact

aerobic dance on the functional fitness of elderly women. Gerontologist, 30(2), 189-

192.

Hopwood, P., Fletcher, I., Lee, A., & Al Ghazal, S. (2001). A body image scale for use with

cancer patients. European Journal of Cancer, 37(2), 189-197.


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 36

Janković Marušić, S., & Boban, M. (2013). Dance and movement psychotherapy (DMP) with

cancer affected women in Croatia: preliminary results. Unpublished Unpublished

article.

Jansen, P., Kellner, J., & Rieder, C. (2012). The improvement of mental rotation performance

in second graders after creative dance training. University of Regensburg.

*Jeong, Y.-J., Hong, S.-C., Lee, M. S., Park, M.-C., Kim, Y.-K., & Suh, C.-M. (2005). Dance

movement therapy improves emotional responses and modulates neurohormones in

adolescents with mild depression. International Journal of Neuroscience, 115(12),

1711-1720.

Junge, M. B., & Linesch, D. (1993). Our own voices: New paradigms for art therapy research.

The Arts in Psychotherapy, 20(1), 61-67.

Jüni, P., Witschi, A., Bloch, R., & Egger, M. (1999). The hazards of scoring the quality of

clinical trials for meta-analysis. JAMA: The Journal of the American Medical

Association, 282(11), 1054-1060.

Kaplan 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.

*Karkou, V., Fullarton, A., & Scarth, S. (2009). Continuing in the labyrinth? The use of an

arts therapies programme in secondary education as a means of mental health

promotion (project report). Herdfordshire: University of Herdfordshire.

Karkou, V., & Meekums, B. (2013). Dance Movement Therapy for Dementia (Protocol).

Cochrane Database of Systematic Reviews (6).

Kiepe, M.-S., Stöckigt, B., & Keil, T. (2012). Effects of dance therapy and ballroom dances

on physical and mental illnesses: A systematic review. The Arts in Psychotherapy,

39(5), 404–411.
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 37

Kipp, J., Herda, C., & Schwarz, J. (2000). Wirkfaktoren der Ergotherapie: Ergebnisse einer

Pilotstudie. [Factors of effectiveness in occupational therapy: Results of a pilot study.]

Ergotherapie & Rehabilitation, 39(6), 17-21.

Kissane, D. W., Grabsch, B., Clarke, D. M., Smith, G. C., Love, A. W., Bloch, S., et al.

(2007). Supportive-expressive group therapy for women with metastatic breast cancer:

Survival and psychosocial outcome from a randomized controlled trial. Psycho-

Oncology, 16(4), 277-286.

*Koch, S. C., Mehl, L., Sobanski, E., Sieber, M., & Fuchs, T. (2013). Therapeutic mirroring

with high functional autistic adults can increase individual and interpersonal

outcomes. Unpublished Manuscript.

*Koch, S. C., Morlinghaus, K., & Fuchs, T. (2007). The joy dance: Specific effects of a single

dance intervention on psychiatric patients with depression. The Arts in Psychotherapy,

34(4), 340-349.

Kugizaki, M. R. (2009). Meta-analysis: Evaluation of methodology with an example in

nutritional epidemiology. University of California, Los Angeles.

Lacour, M. E. (2006). Dance/movement therapy. A resource for oncological patients and an

approach to comprehensive patient care. In S. C. Koch & I. Bräuninger (Eds.),

Advances in dance/movement therapy. Theroretical perspectives and empirical

findings (pp. 168-182). Berlin, Germany: Logos.

Lausberg, H. (1998). Does movement behavior have differential diagnostic potential?

Discussion of a controlled study on patients with anorexia nervosa and bulimia.

American Journal of Dance Therapy, 20(2), 85-99.

Leventhal, M., & Schwartz, J. (1989). The dance of life: Dance and movement therapy for the

older adult. Topics in Geriatric Rehabilitation, 4(4), 67-74.

Lewis, R. N., & Scannell, E. D. (1995). Relationship of body image and creative dance

movement. Perceptual & Motor Skills, 81(1), 155-160.


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 38

Mala, A., Karkou, V, & Meekums, B. (2012). Dance/Movement Therapy (D/MT) for

depression: a scoping review. The Arts in Psychotherapy, 39(4), 287–295.

Mannheim, E. G., & Weis, J. (2005). Tanztherapie mit Krebspatienten: Ergebnisse einer

Pilotstudie. Musik-, Tanz- und Kunsttherapie, 16(3), 121-128.

McDougall, M., Bevan, B., & Semper, R. (2011). Art as a way of knowing. Conference

report. San Francisco: Exploratorium.

McKinley, P.A., Jacobson, A., Leroux, A., Bednarcyzk, V., Rossignol, M., & Fung, J. (2008).

Effect of a community-based Argentine tango dance program on functional balance

and confidence in older adults. Journal of Aging and Physical Activity, 16(4), 435-

453.

Meekums, B. (2010). Moving towards evidence for dance movement therapy: Robin Hood in

dialogue with the King. The Arts in Psychotherapy, 37(1), 35-41.

Meekums, B., Karkou, V., & Nelson, E. A. (2012). Dance movement therapy for depression

(Protocol). Cochrane Database of Systematic Reviews 2012(6).

*Meekums, B., Vaverniece, I., Majore-Dusele, I., & Rasnacs, O. (2012). Dance movement

therapy for obese women with emotional eating: A controlled pilot study. The Arts in

Psychotherapy, 39(2), 126-133.

Mössler, K., Chen X.J., Heldal, T.O., & Gold, C. (2011). Music therapy for people with

schizophrenia and schizophrenia-like disorders. Cochrane Database of Systematic

Reviews 2011 (12).

Moher, D., Jadad, A. R., & Tugwell, P. (1996). Assessing the quality of randomized

controlled trials: Current issues and future directions. International Journal of

Technology Assessment in Health Care, 12(2), 195-208.

*Noreau, L., Martineau, H., Roy, L., & Belzile, M. (1995). Effects of a modified dance-based

exercise on cardiorespiratory fitness, psychological state and health status of persons


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 39

with rheumatoid arthritis. American Journal of Physical Medicine and Rehabilitation,

74(1), 19-27.

O‟Connor, D., Green, S., & Higgins, J. P. T. (2008). Defining the review question and

developing criteria for including studies. In J. P. T. Higgins & S. Green (Eds.),

Cochrane Handbook of Systematic Reviews of Interventions. Chichester: John Wiley

& Sons.

*Osgood, N. J., Meyers, B. S., & Orchowsky, S. (1990). The impact of creative dance and

movement training on the life satisfaction of older adults: An exploratory study.

Journal of Applied Gerontology, 9(3), 255-265.

Pešek, U. (2007). Musiktherapiewirkung – eine Meta-Analyse. [Effects of music therapy - A

meta analysis.] Musiktherapeutische Umschau, 28(2), 110-135.

Review Manager (RevMan). (2011). [Computer program]. Version 5.1., Copenhagen: The

Nordic Cochrane Centre, The Cochrane Collaboration.

Ritter, M., & Low, K. G. (1996). Effects of dance/movement therapy: A meta-analysis. The

Arts in Psychotherapy, 23(3), 249-260.

Röhricht, F., Papadopoulos, N., & Priebe, S. (2013). An exploratory randomized controlled

trial of body psychotherapy for patients with chronic depression. Journal of Affective

Disorders, 8(4), e60991.

*Röhricht, F., & Priebe, S. (2006). Effect of body-oriented psychological therapy on negative

symptoms in schizophrenia: A randomized controlled trial. Psychological Medicine,

36(5), 669-678.

Rösler, A., Seifritz, E., Kräuchi, K., Spoerl, D., Brokuslaus, I., Proserpi, S.-M., 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.


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 40

Rossberg-Gempton, I. E. v., Dickinson, J., & Poole, G. (1999). Creative dance: Potentiality

for enhancing social functioning in frail seniors and young children. The Arts in

Psychotherapy, 26(5), 313-327.

Rosenthal, R. (1979). The “file drawer problem” and tolerance for null results. Psychological

Bulletin, 86, 638-641.

Ruddy, R. A. and Dent-Brown, K. (2007). Drama therapy for schizophrenia or schizophrenia-

like illnesses. Cochrane Database of Systematic Reviews 2007 (1).

Ruddy, R., & Milnes, D. (2005). Art therapy for schizophrenia or schizophrenia-like illnesses.

Cochrane Database of Systematic Reviews 2005 (4).

Sackett, D. L. (Ed.). (2000). Evidence based medicine: how to practice and teach EBM (2.

ed.). Edinburgh: Churchill Livingstone.

*Sandel, S. L., Judge, J. O., Landry, N., Faria, L., Quellette, R., & Majczak, M. (2005). Dance

and movement program improves quality-of-life measures in breast cancer survivors.

Cancer Nursing, 28(4), 301-309.

Serlin, I. A. (1996). Kinesthetic imagining. Journal of Humanistic Psychology, 36(2), 25-33.

Shigematsu, R., Chang, M., Yabushita N., Sakai, T., Nakagaichi, M., Nho, H., & Tanaka, K.

(2002). Dance-based aerobic exercise may improve indices of falling risk in older

women. Age and Ageing, 31(4), 261-266.

Skye, F. D., Christensen, O. J., & England, J. T. (1989). A study of the effects of a culturally-

based dance education model on identified stress factors in American Indian college

women. Journal of American Indian Education, 29(1), 26-31.

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 & Medicine, 17(3), 50-59.


META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 41

Van de Winckel, A., Feys, H., De Weerdt, W., & Dom, R. (2004). Cognitive and behavioural

effects of music-based exercises in patients with dementia. Clinical Rehabilitation,

18(3), 253-260.

van der Merwe, S. (2010). The effect of a dance and movement intervention program on the

perceived emotional well-being and self-esteem of a clinical sample of adolescents.

University of Pretoria, Pretoria.

Viswanathan, M., Ansari, M. T., Berkman, N. D., Chang, S., Hartling, L., McPheeters, L. M.,

et al. (2012). Assessing the risk of bias of individual studies in systematic reviews of

health care interventions. Retrieved September, 2012, from

http://effectivehealthcare.ahrq.gov/ehc/products/322/998/MethodsGuideforCERs_Vis

wanathan_IndividualStudies.pdf

Xia, J., & Grant, T. (2009). Dance therapy for schizophrenia. Cochrane Database of

Systematic Reviews(1).
Table1

Summary of Studies, Sample Sizes, Age Ranges, Target Groups, Diagnoses, Interventions of Experimental Groups, Control Group Activities,

Length and Frequency of Treatment, and Assignments to Groups.

Title Author Year Total Age Range Target Diagnosis EG CG Activity Length and Assignment to
of Sample (or M, SD) Group Intervention Frequency Groups
Public Size at of Treatment
ation Pre-Test

The effect of Akandere& 2011 120 20-24 Non- - Dance No 12 weeks; Randomization
dance over Demir (NEG=60; clinical (various intervention 3 times a
depression NCG=60) (students) activities i.e. week;
rumba, 100 minutes
classic)

Dance/moveme BojnerHor 2006 36 M=57 Clinical Fibromyalgia DMT Waiting-list 6 months; Randomization
nt therapy in witz, et al. (NEG=20; (SD=7.2) (widespread (dance/move control group weekly;
patients with NCG=16) pain, and ment therapy 180 minutes
fibromyalgia: pain in 11 of intervention)
Changes in self- 18 tender
figure drawings points)
and their
relation to
verbal self-
rating scales

Tanztherapie: Bräuninger 2006 162 16-65, Subclinical Stress (self- DMT Waiting-list 10 weeks; Randomization
Verbesserung (NEG=97; M = 44 selected) control group weekly in 9 of 12
der Lebens- NCG=65) (SD=9) groups (multi-
qualität und center study)
Stress-
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 43

Bewältigung

The use of Dibbell- 2000 33 (N of 35- Clinical Breast cancer DMT Waiting-list 6 weeks; Randomization
dance/movemen Hope each 80,M=54.7 (stage I or II (authentic control group weekly;
t therapy in group tumor, movement) 180 minutes
psychological unclear; diagnosis
adaptation to only one within at
breast cancer of the two least 1 year,
EGs, but no more
n=17, was than 5 years
focused in ago)
this
analysis)

Effectiveness of Erwin- 1999 21 19- Subclinical Test anxiety DMT (body- No 2 weeks; Randomization
dance/movemen Grabner, et (NEG=11; 44,M=29 (self- oriented intervention 5 sessions;
t therapy on al. NCG=10) selected) techniques 35 minutes
reducing test and
anxiety expressive/in
teractive
movement
activity)

A randomized Eyigor, et 2009 37(NEG=1 M=73.5 Non- - Dance No 8 weeks; Randomization


controlled trial al. 9; (SD=7.6) clinical (group-based intervention 3 times a
of Turkish NCG=18) (healthy Turkish week;
folklore dance elderly folklore 60 minutes
on the physical women) dances)
performance,
balance,
depression and
quality of life in
older women

The effects of Goldov 2011 14 47-71 Clinical Breast cancer DMT No 2 weeks; No
individualized (NEG=6; (medical 5 sessions;
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 44

brief medical NCG=8) of any type dance/move intervention 30 minutes randomization


dance/ ment
movement therapy)
therapy on body
image in
women with
breast cancer

Dance/ Goodill 2005 42 17-67 Clinical Cystic DMT No 7-10 days; Randomization
movement (NEG=24; fibrosis intervention 3 sessions;
therapy for NCG=18) 45-60
adults with minutes
cystic fibrosis:
Pilot data on
mood and
adherence

Ballroom dance Haboush, et 2006 24 M=69.4 Clinical Depression Dance Waiting-list 8 weeks; Randomization
lessons for al. (NEG=12; (SD=5.4) (a score of (foxtrot, control group weekly;
geriatric NCG=12) 10 or higher waltz, 45 minutes
depression: An on the rumba,
exploratory Hamilton swing, cha-
study Rating Scale) cha, and
tango)

Health-related Hackney & 2009 61 M=66.6 Clinical Idiopathic Dance (one No 13 weeks; Randomization
quality of life Earhart (NEG=44; (SD=2.5) Parkinson‟s combined intervention 20 sessions;
and alternative NCG=17) disease experimental 60 minutes
forms of group of
exercise in initially three
Parkinson groups:
disease waltz/foxtrot,
tango and tai
chi)
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 45

Creative Hartshorn, 2001 76 3-7, Clinical Autism DMT No 2 months; No


movement et al. (NEG=38; M=5 description twice a randomization
therapy benefits NCG=38) week;
children with 30 minutes
autism

Senior citizens Hartshorn, 2002 32 M=86 Non- - DMT Waiting-list 2 weeks; Randomization
benefit from et al. (NEG=16; (SD=3.3) clinical control group twice a
movement NCG=16) (senior week;
therapy citizens) 50 minutes

Wirksamkeit Hilf 2009 30 M=46.7 Clinical Somatoform DMT Leisure time 6 weeks; Randomization
von Tanzthera- (NEG=15; (SD=11.8) disorder program and weekly;
pie bei somato- NCG=15) body 100 minutes
former Störung experience
intervention

Dance and Hokkanen, 2008 29 M=81.5(SD Clinical Dementia of DMT Regular 9 weeks; Randomization
movement et al. (NEG=19; =6,8) any type nursing home weekly;
therapeutic NCG=10) activities 30-45
methods in minutes
management of
dementia: A
randomized,
controlled study

Dance Jeong, et al. 2005 40 M=16 Clinical Mild DMT Waiting-list 12 weeks; Randomization
movement (NEG=20; depression control group 3 times a
therapy NCG=20) week;
improves 45 minutes
emotional
responses and
modulates
neuro-hormones
in adolescents
with mild
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 46

depression

Continuing in Karkou, et 2009 12 11-13 Subclinical Risk of DMT Waiting-list 10 weeks; Randomization
the labyrinth? al. (NEG=6; developing control group weekly;
The use of an NCG=6) mental health 45 minutes
arts therapies problems
programme in
secondary
education as a
means of
mental health
promotion.

The joy dance: Koch, et al. 2007 31 21-66, Clinical Depression Dance (circle One 1 time; Randomization
Specific effects (NEG=11; M=42,7 (main or dance) combined 20 minutes
of a single NCG=20) (SD=14.9) additional control group
dance diagnosis) of initially
intervention on two groups:
psychiatric home trainer
patients with group, music
depression group

Therapeutic Koch, et al. 2013 31 16-47, Clinical Autism DMT No 7 weeks; Randomization
mirroring: (NEG=16; M=22.0 intervention weekly;
Dance NCG=15) (SD=7.7) 60 minutes
movement
therapy
improves
individual and
interpersonal
outcomes in
young adults
with autism
spectrum
disorder
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 47

Dance Meekums, 2012 79 M=39.1 Non- - DMT One 5 weeks; Partial


movement Vaverniece, (NEG=24; clinical combined twice a randomization
therapy for et al. NCG=55) (women control group week;
obese women who of initially 90 minutes
with emotional participated two groups:
eating: A in a exercising
controlled pilot commercial group, non-
study weight exercising
loss) group

Effects of a Noreau, et 1995 29 M=49.3 Clinical Rheumatoid Dance Counseling 12 weeks; No


modified dance- al. (NEG=19; (SD=12.4) arthritis (dance- and twice a randomization
based exercise NCG=10) (with a basedexercis discussion week;
on cardio- functional e program) session 50 minutes
respiratory class I or II)
fitness,
psychological
state and health
status of
persons with
rheumatoid
arthritis

The impact of Osgood, et 1990 72 M=72.9 Non- - Dance No 8 months; No


creative dance al. (NEG=37; clinical (dance and description weekly; randomization
and movement NCG=35) (people movement) 60 minutes
training on the from
life satisfaction nursing
of older adults: homes, but
An exploratory many
study cognitively
or
physically
impaired)
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 48

Effect of body- Röhricht& 2006 45 M=38.3 Clinical Schizo- DMT (body- Supportive 10 weeks; Randomization
oriented Priebe (NEG=24; (SD=9.3) phrenia oriented counseling twice a
psychological NCG=21) psycho- week;
therapy on logical 60-90
negative therapy) minutes
symptoms in
schizophrenia:
A randomized
controlled trial

Dance and Sandel, et 2005 38 38-82, Clinical Breastcancer DMT (Lebed Waiting-list 12 weeks; Randomization
movement al. (NEG=19; M=59.6 Method) control group twice a week
program NCG=19) (SD=11.5) in the first 6
improves weeks, once
quality-of-life a week in
measures in the last 6
breast cancer weeks;
survivors 60 minutes
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 49

Table 2

Clusters Including Trials, Outcome Variables, Scales and Data

Outcome Pole
Cluster Study Scale MeanEG SDEG MeanCG SDCG NEG NCG
variable change
Quality of World Health Post-test
62.4 16.48 57.02 16.46 83 54
life Bräuninger Organization Quality of scores
Global value -
(2006) Life Questionnaire 100 Change
3.92 23.58 -0.97 23.05
(WHOQOL-100) scores
Post-test
78.51 22.16 64.4 22.83 19 18
Eyigor, et 36-Item Short Form b scores
Mean score -
al. (2009) Health Survey (SF-36) Change
10.58 34.39 -6.56 31.41
scores
Post-test
Hackney & 39-Item -22.02 2.31 -17.63 3.06 44 17
scores
Earhart et Parkinson‟sDisease Summary index Yes
Change
al. (2009)a Questionnaire (PDQ-39) 2.03 3.4 1.5 4.47
scores
Mean score of Post-test
-2.26 2.73 -3.13 2.9 16 16
Hartshorn, Visual Analogue Overall Body scores
Yes
et al. (2002) Scales(VITAS) Pain, Leg Pain Change
1.16 4.55 0.41 4.56
and Back Pain b scores
Mean score of Post-test
-16.74 3.67 -18.45 2.31 19 10
Nurses‟ Instrumental scores
Hokkanen, Observation Scale for Activities of
Yes
et al. (2008) Geriatric Patients Daily Living Change
0.24 5.1 -0.95 3.32
(NOSGER) and Self-Care scores
Subscaleb
Meekums, Clinical Outcomes in Subscale Post-test
- 2.94 0.33 2.72 0.4 24 55
et al. (2012) Routine Evaluation- General scores
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 50

Outcome Pole
Cluster Study Scale MeanEG SDEG MeanCG SDCG NEG NCG
variable change
Outcome Measure Functioning Change
0.25 0.71 0.05 0.61
(CORE-OM) scores
Post-test
Arthritis Impact Subscale Self- -3.47 1.85 -3.7 2.06 19 10
Noreau, et scores
Measurement Scale Perception of Yes
al. (1995) Change
(AIMS) Pain 0.9 2.84 0.3 2.98
scores
Post-test
Philadelphia Geriatric 14.5 3.7 12.5 4.7 37 35
Osgood, et scores
Center Morale Scale Total score -
al. (1990) Change
(PGC) 0.2 5.23 -1.8 5.92
scores
Post-test
Röhricht & Manchester Short 4.1 0.7 4.1 0.8 21 18
scores
Priebe Assessment of Quality Total score -
Change
(2006) of Life (MANSA) 0 1.14 0 1.06
scores
Mean score of Post-test
49.8 8.65 47.6 11.1 19 16
Sandel, et 36-Item Short Form Physical and scores
-
al. (2005) Health Survey (SF-36) Mental Change
3 12.51 1.25 14.83
Summary b scores

Well-being, Post-test
Mean score of 38.54 10.18 37.99 9.76 77 49
mood and Bräuninger Stress Management scores
Positive -
affect (2006) Questionnaire 120 (SVF) Change
Strategies b 0.76 14.66 -0.4 13.68
scores
Post-test
Dibbell- 13.67 15.36 12.22 15.79 6 9
Profile of Mood States Total Mood scores
Hope Yes
(POMS) Disturbance Change
(2000) - - - - - -
scores
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 51

Outcome Pole
Cluster Study Scale MeanEG SDEG MeanCG SDCG NEG NCG
variable change
Post-test
-8.14 26.43 -20.82 24.58 22 17
Goodill Profile of Mood States Total Mood scores
Yes
(2005) (POMS) Disturbance Change
21.56 37.74 14.44 40.87
scores
Post-test
Subscale 4.45 0.76 3.77 0.84 16 15
Koch, et al. Heidelberger State scores
Psychological -
(2013) Inventory (HIS) Change
Well-being 0.38 0.92 0.02 1.19
scores
Post-test
Mean score of 5.82 1.63 5.97 1.7 11 20
Koch, et al. Heidelberger scores
Vitality and -
(2007) Befindlichkeitsskala(HBS) Change
Affect b 0.94 2.17 0.56 2.53
scores
Clinical Outcomes in Post-test
Subscale 2.95 0.56 2.59 0.68 24 55
Meekums, Routine Evaluation- scores
Subjective Yes
et al. (2012) Outcome Measure Change
Well-being 0.65 1.09 0.11 1
(CORE-OM) scores
Post-test
-2.60 23.1 -11.90 28 19 10
Noreau, et Profile of Mood States scores
Total score Yes
al. (1995) (POMS) Change
19.8 36.07 12.3 46.4
scores

Body Image Post-test


Dibbell- Berscheid-Walster- -4.22 0.73 -4.34 0.84 4 8
b scores
Hope Bohrnstedt Body Image Mean score Yes
Change
(2000) Scale (BWB) - - - - - -
scores
Post-test
Goldov -1.15 0.88 -1.69 0.97 6 8
Body Image Scale (BIS) Total score Yes scores
(2011)
Change 0.28 1.45 -0.07 1.3
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 52

Outcome Pole
Cluster Study Scale MeanEG SDEG MeanCG SDCG NEG NCG
variable change
scores
Post-test
34.86 5.80 33.72 6.77 22 16
Goodill scores
Human Figure Drawings Total score Yes
(2005) Change
0.63 8.47 0.08 8.43
scores
Post-test
4.35 0.61 3.67 0.77 16 15
Koch, et al. Questionnaire of Subscale Body- scores
-
(2013) Movement Therapy(FBT) Awareness Change
0.27 0.9 -0.17 1.1
scores
Post-test
The Situational Inventory -31.41 14.33 -33.54 13.1 24 55
Meekums, scores
of Body Image Dysphoria Total score Yes
et al. (2012) Change
(SIBID) 10.54 20.23 3.4 17.95
scores
Post-test
-15.20 6.1 -16.90 5.2 19 16
Sandel, et scores
Body Image Scale (BIS) Total score Yes
al. (2005) Change
4.2 9.06 2.8 8.34
scores

Clinical Post-test
-0.67 0.48 -0.79 0.53 87 54
Outcomes Bräuninger Brief Symptom Inventory Global Severity scores
Yes
(2006) (BSI) Index Change
0.23 0.7 0.04 0.74
scores
Post-test
Dibbell- -0.23 0.2 -0,29 0.18 6 9
Symptom Checklist 90, Global Severity scores
Hope Yes
Revised (SCL-90R) Index Change
(2000) - - - - - -
scores
Haboush, et Symptom Checklist 90, Global Severity Yes Post-test -82.40 42.27 -89.42 42.47 10 12
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 53

Outcome Pole
Cluster Study Scale MeanEG SDEG MeanCG SDCG NEG NCG
variable change
al. (2006) Revised (SCL-90R) Index scores
Change
20.6 57.17 11.91 55.26
scores
Post-test
-10 3.1 -15 2.9 38 38
Hartshorn Wandering (observational scores
Total score Yes
(2001) a measurement) Change
4 3.92 1 4.03
scores
Post-test
-0.62 0.53 -0.71 0.38 15 15
a Brief Symptom Inventory Global Severity scores
Hilf (2009) Yes
(BSI) Index Change
0,76 0,87 0,37 0,54
scores
Post-test
-47.4 11.7 -46.7 6.2 20 20
Jeong, et al. Symptom Checklist 90, Global Severity scores
Yes
(2005)a Revised (SCL-90R) Index Change
3.9 16.69 -2.2 8,77
scores
Post-test
67.7 6.8 58 18.9 6 5
Karkou, et scores
Youth Self-Report (YSR) Total score -
al. (2009) Change
0.2 8.1 -7.8 21.43
scores
Post-test
3.23 0.52 2.86 0.60 16 15
Koch, et al. Emotional Empathy Scale scores
Total score -
(2013) (EES), short form Change
0.11 0.67 -0.1 0.86
scores
Clinical Outcomes in Post-test
Subscale -0.79 0.55 -1.24 0.69 24 55
Meekums, Routine Evaluation- scores
Psychological Yes
et al. (2012) Outcome Measure Change
Symptoms 0.63 1 0.06 0.92
(CORE-OM) scores
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 54

Outcome Pole
Cluster Study Scale MeanEG SDEG MeanCG SDCG NEG NCG
variable change
Post-test
Röhricht & Subscale -18.90 4.3 -23.30 7.4 24 19
Positive and Negative scores
Priebe Negative Yes
Symptom Scale (PANSS) Change
(2006) symptoms 4.5 5.94 1.3 8.85
scores

Depression Post-test
Akandere& -13.9 5.57 -17.48 7.74 60 60
Beck Depression scores
Demir Total score Yes
Inventory (BDI) Change
(2011) 1.82 8.95 -0.95 9.75
scores
Post-test
Bojner Montgomery Åsberg -16.26 7.94 -14.27 8.15 20 16
scores
Horwitz, et Depression Rating Scale Total score Yes
Change
al. (2006)a (MADRS) 2.11 10.38 -1,07 11,04
scores
Post-test
-0.65 0.75 -0.79 0.73 84 54
Bräuninger Brief Symptom Inventory Subscale scores
Yes
(2006) (BSI) Depression Change
0.23 1.08 -0.14 1.05
scores
Post-test
Dibbell- -0.28 0.25 -0.44 0.23 6 9
Symptom Checklist 90, Subscale scores
Hope Yes
Revised (SCL-90R) Depression Change
(2000) - - - - - -
scores
Post-test
Yes -4.36 5.76 -6.76 6.28 22 17
Goodill Profile of Mood States Subscale scores
(2005) (POMS) Depression Change
4.39 10.21 3.26 9.91
scores
Post-test
Haboush, et Geriatric Depression Scale -13.00 6.75 -15.58 6.07 10 12
Total score Yes scores
al. (2006) (GDS)
Change 4.08 8.18 2.5 7.56
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 55

Outcome Pole
Cluster Study Scale MeanEG SDEG MeanCG SDCG NEG NCG
variable change
scores
Post-test
-11.36 9.68 -14.91 9.33 15 15
Beck Depression scores
Hilf (2009) Total score Yes
Inventory-II (BDI-II) Change
14.71 14.84 10.23 11.7
scores
Post-test
-46.4 10.2 -46.10 5.7 20 20
Jeong, et al. Symptom Checklist 90, Subscale scores
Yes
(2005)a Revised (SCL-90R) Depression Change
5.40 15.60 -2.5 8.42
scores
Post-test
Heidelberger -3.59 1.2 -4.3 1.81 11 20
Koch, et al. Subscale scores
Befindlichkeitsskala (HBS Yes
(2007) Depression Change
/ HSI) 1.23 1.84 -0.15 2.38
scores
Post-test
Arthritis Impact -1.18 1.29 -1.52 1.1 19 10
Noreau, et Subscale scores
Measurement Scale Yes
al. (1995) Depression Change
(AIMS) 0.87 2.02 0.2 1.58
scores

Anxiety Post-test
-0.67 0.57 -1.02 1.32 84 54
Bräuninger Brief Symptom Inventory Subscale scores
Yes
(2006) (BSI) Anxiety Change
0.29 0.82 -0.18 1.46
scores
Post-test
Dibbel- -0.12 0.16 -0.18 0.2 6 9
Symptom Checklist 90, Subscale scores
Hope Yes
Revised (SCL-90R) Anxiety Change
(1990) - - - - - -
scores
Erwin- TestAttitudeInventory Total score Yes Post-test -36.60 7.8 -45.00 10.3 11 10
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 56

Outcome Pole
Cluster Study Scale MeanEG SDEG MeanCG SDCG NEG NCG
variable change
Grabner et (TAI) scores
al. (1999) Change
13.5 14.06 4.4 16.51
scores
Post-test
-45.3 10.3 -47.8 6.5 20 20
Jeong et al. Symptom Checklist 90, Subscale scores
Yes
(2005)a Revised (SCL-90R) Anxiety Change
5.9 15.59 -2.8 9.26
scores
Post-test
Arthritis Impact -3.07 1.74 -3.93 1.33 19 10
Noreau et Subscale scores
Measurement Scale Yes
al. (1995) Anxiety Change
(AIMS) 1.15 2.3 0.53 2.53
scores

Interpersonal Post-test
Subscale -1.02 0.77 -1.17 0.9 84 54
Competence Bräuninger Brief Symptom Inventory scores
Interpersonal Yes
(2006) (BSI) Change
Sensitivity 0.35 1.14 0.11 1.29
scores
Post-test
Dibbell- Subscale -0.22 0.23 -0.14 0.12 6 9
Symptom Checklist 90, scores
Hope Interpersonal Yes
Revised (SCL-90R) Change
(2000) Sensitivity - - - - - -
scores
Social-Relatedness Post-test
25.00 7.9 21.00 8.3 38 38
Hartshorn Toward Teacher scores
Total score -
(2001) (observational Change
-3 12.2 -4 13.94
measurement) scores
Hokkanen Nurses‟ Post-test
Subscale Social -14.79 4.1 -17.6 2.59 19 10
et al. Observation Scale for Yes scores
Competence
(2008)a Geriatric Patients Change 0.5 4.89 -0.3 3.73
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 57

Outcome Pole
Cluster Study Scale MeanEG SDEG MeanCG SDCG NEG NCG
variable change
(NOSGER) scores
Post-test
Subscale -44.30 8.2 -51.10 6.7 20 20
Jeong Symptom Checklist 90, scores
Interpersonal Yes
(2005) Revised (SCL-90R) Change
sensitivity 7.5 13.01 -3.2 9.76
999999999999999
scores
Mean score of Post-test
4.42 0.81 3.72 0.61 16 15
Awareness of scores
Koch et al. Questionnaire of Self-Other-
-
(2012) Movement Therapy(FBT) Distinction and Change
0.28 1.12 -0,16 0.92
Social scores
Competence b
a
Due to baseline differences, only change scores were analyzed in a separate analysis
b
Calculated from reported variables
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 58

Table 3

Results of Analyses of Post-Test Scores and Change Scores of the Single Outcome Categories

Post-test scores Change scores


Cluster Nstudies NEG NCG SMD (95 % CI) Z NEG NCG SMD (95 % CI) Z
Quality of life 9 257 232 0.37 (0.18 - 3.9*** 301 249 0.23 (0.06 - 2.64**
0.55) 0.41)

Well-being, mood and affect 7 175 175 0.30 (0.07 - 2.52* 169 155 0.23 (0.00 - 1.97*
0.53) 0.45)

Body image 6 91 118 0.27 (-0.04 - 1.69† 87 109 0.27 (-0.02 - 1.80†
0.57) 0.56)

Clinical outcomes 7 173 169 0.44 (0.22 - 3.89*** 240 233 0.44 (0.25 - 4.6***
0.66) 0.63)

Depression 8 227 197 0.36 (0.17 - 3.66*** 261 224 0.34 (0.16 - 3.64***
0.56) 0.52)

Anxiety 4 120 83 0.44 (0.15 - 3.00* 134 94 0.46 (0.19 - 3.33***


0.72) 0.73)

Interpersonal competence 5 164 136 0.45 (0.07 - 2.33* 177 137 0.29 (0.03 - 2.18*
0.83) 0.55)
Note. Nstudies = Number of studies included in the analysis; NEG = Number of participants in intervention/treatment groups; NCG = Number of
participants in control groups; 95% CI = 95% confidence interval; Z = test of overall effect; †p<.1, *p<.05, **p<.01, ***p<.001
Figure 1. Forest plot from nine trials assuming random effects, representing the SMDs (95%

CI) for effects of DMT and dance interventions (experimental groups vs. control groups) on

quality of life. SMD > 0 indicates an increase, SMD < 0 a decrease in quality of life.
EFFECTS OF DANCE MOVEMENT THERAPY AND DANCE. A META-ANALYSIS 60

Figure 2. Forest plot from seven trials assuming random effects, representing the SMDs (95%

CI) for effects of DMT and dance interventions (experimental groups vs. control groups) on

well-being, mood and affect. SMD > 0 indicates an increase, SMD < 0 a decrease in well-

being, mood and affect.


EFFECTS OF DANCE MOVEMENT THERAPY AND DANCE. A META-ANALYSIS 61

Figure 3. Forest plot from six trials assuming random effects, representing the SMDs (95%

CI) for effects of DMT and dance interventions (experimental groups vs. control groups) on

body image. SMD > 0 indicates an increase, SMD < 0 a decrease in body image.
EFFECTS OF DANCE MOVEMENT THERAPY AND DANCE. A META-ANALYSIS 62

Figure 4. Forest plot from seven trials assuming random effects, representing the SMDs (95%

CI) for effects of DMT and dance interventions (experimental groups vs. control groups) on

clinical outcomes. SMD > 0 indicates a decrease, SMD < 0 an increase in clinical outcomes.
EFFECTS OF DANCE MOVEMENT THERAPY AND DANCE. A META-ANALYSIS 63

Figure 5. Forest plot from eight trials assuming random effects, representing the SMDs (95%

CI) for effects of DMT and dance interventions (experimental groups vs. control groups) on

depression. SMD > 0 indicates a decrease, SMD < 0 an increase in depression.


EFFECTS OF DANCE MOVEMENT THERAPY AND DANCE. A META-ANALYSIS 64

Figure 6. Forest plot from four trials assuming random effects, representing the SMDs (95%

CI) for effects of DMT and dance interventions (experimental groups vs. control groups) on

anxiety. SMD > 0 indicates a decrease, SMD < 0 an increase in anxiety.


EFFECTS OF DANCE MOVEMENT THERAPY AND DANCE. A META-ANALYSIS 65

Figure 7. Forest plot from five trials assuming random effects, representing the SMDs (95%

CI) for effects of DMT and dance interventions (experimental groups vs. control groups) on

interpersonal competence. SMD > 0 indicates an increase, SMD < 0 a decrease in

interpersonal competence.

Potrebbero piacerti anche