effects of dance movement therapy and dance on health ... of dance movement...are the ones primarily...
Post on 17-Mar-2020
3 Views
Preview:
TRANSCRIPT
Seediscussions,stats,andauthorprofilesforthispublicationat:http://www.researchgate.net/publication/259120783
EffectsofDanceMovementTherapyandDanceonHealth-RelatedPsychologicalOutcomes:AMeta-Analysis
ARTICLEinTHEARTSINPSYCHOTHERAPY·NOVEMBER2013
ImpactFactor:0.58·DOI:10.1016/j.aip.2013.10.004
CITATIONS
10
DOWNLOADS
394
VIEWS
700
4AUTHORS,INCLUDING:
SabineKoch
SRHHochschuleHeidelberg
115PUBLICATIONS286CITATIONS
SEEPROFILE
RobynFCruz
LesleyUniversity
39PUBLICATIONS304CITATIONS
SEEPROFILE
Availablefrom:SabineKoch
Retrievedon:28July2015
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
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
*Covering Letter
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 Kunz
2, Sissy Lykou
2, & Robyn Cruz
3
1SRH 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
*Title page with author details
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
*Detailed Response to Reviewers
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
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.
*Highlights (for review)
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
*Manuscript without author identifiersClick here to view linked References
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
1This 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
of
Public
ation
Total
Sample
Size at
Pre-Test
Age Range
(or M, SD)
Target
Group
Diagnosis EG
Intervention
CG Activity Length and
Frequency
of Treatment
Assignment to
Groups
The effect of
dance over
depression
Akandere&
Demir
2011 120
(NEG=60;
NCG=60)
20-24 Non-
clinical
(students)
- Dance
(various
activities i.e.
rumba,
classic)
No
intervention
12 weeks;
3 times a
week;
100 minutes
Randomization
Dance/moveme
nt therapy in
patients with
fibromyalgia:
Changes in self-
figure drawings
and their
relation to
verbal self-
rating scales
BojnerHor
witz, et al.
2006 36
(NEG=20;
NCG=16)
M=57
(SD=7.2)
Clinical Fibromyalgia
(widespread
pain, and
pain in 11 of
18 tender
points)
DMT
(dance/move
ment therapy
intervention)
Waiting-list
control group
6 months;
weekly;
180 minutes
Randomization
Tanztherapie:
Verbesserung
der Lebens-
qualität und
Stress-
Bräuninger 2006 162
(NEG=97;
NCG=65)
16-65,
M = 44
(SD=9)
Subclinical Stress (self-
selected)
DMT Waiting-list
control group
10 weeks;
weekly
Randomization
in 9 of 12
groups (multi-
center study)
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 43
Bewältigung
The use of
dance/movemen
t therapy in
psychological
adaptation to
breast cancer
Dibbell-
Hope
2000 33 (N of
each
group
unclear;
only one
of the two
EGs,
n=17, was
focused in
this
analysis)
35-
80,M=54.7
Clinical Breast cancer
(stage I or II
tumor,
diagnosis
within at
least 1 year,
but no more
than 5 years
ago)
DMT
(authentic
movement)
Waiting-list
control group
6 weeks;
weekly;
180 minutes
Randomization
Effectiveness of
dance/movemen
t therapy on
reducing test
anxiety
Erwin-
Grabner, et
al.
1999 21
(NEG=11;
NCG=10)
19-
44,M=29
Subclinical Test anxiety
(self-
selected)
DMT (body-
oriented
techniques
and
expressive/in
teractive
movement
activity)
No
intervention
2 weeks;
5 sessions;
35 minutes
Randomization
A randomized
controlled trial
of Turkish
folklore dance
on the physical
performance,
balance,
depression and
quality of life in
older women
Eyigor, et
al.
2009 37(NEG=1
9;
NCG=18)
M=73.5
(SD=7.6)
Non-
clinical
(healthy
elderly
women)
- Dance
(group-based
Turkish
folklore
dances)
No
intervention
8 weeks;
3 times a
week;
60 minutes
Randomization
The effects of
individualized
Goldov 2011 14
(NEG=6;
47-71 Clinical Breast cancer DMT
(medical
No 2 weeks;
5 sessions;
No
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 44
brief medical
dance/
movement
therapy on body
image in
women with
breast cancer
NCG=8) of any type dance/move
ment
therapy)
intervention 30 minutes randomization
Dance/
movement
therapy for
adults with
cystic fibrosis:
Pilot data on
mood and
adherence
Goodill 2005 42
(NEG=24;
NCG=18)
17-67 Clinical Cystic
fibrosis
DMT No
intervention
7-10 days;
3 sessions;
45-60
minutes
Randomization
Ballroom dance
lessons for
geriatric
depression: An
exploratory
study
Haboush, et
al.
2006 24
(NEG=12;
NCG=12)
M=69.4
(SD=5.4)
Clinical Depression
(a score of
10 or higher
on the
Hamilton
Rating Scale)
Dance
(foxtrot,
waltz,
rumba,
swing, cha-
cha, and
tango)
Waiting-list
control group
8 weeks;
weekly;
45 minutes
Randomization
Health-related
quality of life
and alternative
forms of
exercise in
Parkinson
disease
Hackney &
Earhart
2009 61
(NEG=44;
NCG=17)
M=66.6
(SD=2.5)
Clinical Idiopathic
Parkinson‟s
disease
Dance (one
combined
experimental
group of
initially three
groups:
waltz/foxtrot,
tango and tai
chi)
No
intervention
13 weeks;
20 sessions;
60 minutes
Randomization
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 45
Creative
movement
therapy benefits
children with
autism
Hartshorn,
et al.
2001 76
(NEG=38;
NCG=38)
3-7,
M=5
Clinical Autism DMT No
description
2 months;
twice a
week;
30 minutes
No
randomization
Senior citizens
benefit from
movement
therapy
Hartshorn,
et al.
2002 32
(NEG=16;
NCG=16)
M=86
(SD=3.3)
Non-
clinical
(senior
citizens)
- DMT Waiting-list
control group
2 weeks;
twice a
week;
50 minutes
Randomization
Wirksamkeit
von Tanzthera-
pie bei somato-
former Störung
Hilf 2009 30
(NEG=15;
NCG=15)
M=46.7
(SD=11.8)
Clinical Somatoform
disorder
DMT Leisure time
program and
body
experience
intervention
6 weeks;
weekly;
100 minutes
Randomization
Dance and
movement
therapeutic
methods in
management of
dementia: A
randomized,
controlled study
Hokkanen,
et al.
2008 29
(NEG=19;
NCG=10)
M=81.5(SD
=6,8)
Clinical Dementia of
any type
DMT Regular
nursing home
activities
9 weeks;
weekly;
30-45
minutes
Randomization
Dance
movement
therapy
improves
emotional
responses and
modulates
neuro-hormones
in adolescents
with mild
Jeong, et al. 2005 40
(NEG=20;
NCG=20)
M=16 Clinical Mild
depression
DMT Waiting-list
control group
12 weeks;
3 times a
week;
45 minutes
Randomization
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 46
depression
Continuing in
the labyrinth?
The use of an
arts therapies
programme in
secondary
education as a
means of
mental health
promotion.
Karkou, et
al.
2009 12
(NEG=6;
NCG=6)
11-13 Subclinical Risk of
developing
mental health
problems
DMT Waiting-list
control group
10 weeks;
weekly;
45 minutes
Randomization
The joy dance:
Specific effects
of a single
dance
intervention on
psychiatric
patients with
depression
Koch, et al. 2007 31
(NEG=11;
NCG=20)
21-66,
M=42,7
(SD=14.9)
Clinical Depression
(main or
additional
diagnosis)
Dance (circle
dance)
One
combined
control group
of initially
two groups:
home trainer
group, music
group
1 time;
20 minutes
Randomization
Therapeutic
mirroring:
Dance
movement
therapy
improves
individual and
interpersonal
outcomes in
young adults
with autism
spectrum
disorder
Koch, et al. 2013 31
(NEG=16;
NCG=15)
16-47,
M=22.0
(SD=7.7)
Clinical Autism DMT No
intervention
7 weeks;
weekly;
60 minutes
Randomization
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 47
Dance
movement
therapy for
obese women
with emotional
eating: A
controlled pilot
study
Meekums,
Vaverniece,
et al.
2012 79
(NEG=24;
NCG=55)
M=39.1 Non-
clinical
(women
who
participated
in a
commercial
weight
loss)
- DMT One
combined
control group
of initially
two groups:
exercising
group, non-
exercising
group
5 weeks;
twice a
week;
90 minutes
Partial
randomization
Effects of a
modified dance-
based exercise
on cardio-
respiratory
fitness,
psychological
state and health
status of
persons with
rheumatoid
arthritis
Noreau, et
al.
1995 29
(NEG=19;
NCG=10)
M=49.3
(SD=12.4)
Clinical Rheumatoid
arthritis
(with a
functional
class I or II)
Dance
(dance-
basedexercis
e program)
Counseling
and
discussion
session
12 weeks;
twice a
week;
50 minutes
No
randomization
The impact of
creative dance
and movement
training on the
life satisfaction
of older adults:
An exploratory
study
Osgood, et
al.
1990 72
(NEG=37;
NCG=35)
M=72.9 Non-
clinical
(people
from
nursing
homes, but
many
cognitively
or
physically
impaired)
- Dance
(dance and
movement)
No
description
8 months;
weekly;
60 minutes
No
randomization
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 48
Effect of body-
oriented
psychological
therapy on
negative
symptoms in
schizophrenia:
A randomized
controlled trial
Röhricht&
Priebe
2006 45
(NEG=24;
NCG=21)
M=38.3
(SD=9.3)
Clinical Schizo-
phrenia
DMT (body-
oriented
psycho-
logical
therapy)
Supportive
counseling
10 weeks;
twice a
week;
60-90
minutes
Randomization
Dance and
movement
program
improves
quality-of-life
measures in
breast cancer
survivors
Sandel, et
al.
2005 38
(NEG=19;
NCG=19)
38-82,
M=59.6
(SD=11.5)
Clinical Breastcancer DMT (Lebed
Method)
Waiting-list
control group
12 weeks;
twice a week
in the first 6
weeks, once
a week in
the last 6
weeks;
60 minutes
Randomization
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 49
Table 2
Clusters Including Trials, Outcome Variables, Scales and Data
Cluster Study Scale Outcome
variable
Pole
change MeanEG SDEG MeanCG SDCG NEG NCG
Quality of
life Bräuninger
(2006)
World Health
Organization Quality of
Life Questionnaire 100
(WHOQOL-100)
Global value -
Post-test
scores 62.4 16.48 57.02 16.46 83 54
Change
scores 3.92 23.58 -0.97 23.05
Eyigor, et
al. (2009)
36-Item Short Form
Health Survey (SF-36) Mean score
b -
Post-test
scores 78.51 22.16 64.4 22.83 19 18
Change
scores 10.58 34.39 -6.56 31.41
Hackney &
Earhart et
al. (2009)a
39-Item
Parkinson‟sDisease
Questionnaire (PDQ-39)
Summary index Yes
Post-test
scores -22.02 2.31 -17.63 3.06 44 17
Change
scores 2.03 3.4 1.5 4.47
Hartshorn,
et al. (2002)
Visual Analogue
Scales(VITAS)
Mean score of
Overall Body
Pain, Leg Pain
and Back Pain b
Yes
Post-test
scores -2.26 2.73 -3.13 2.9 16 16
Change
scores 1.16 4.55 0.41 4.56
Hokkanen,
et al. (2008)
Nurses‟
Observation Scale for
Geriatric Patients
(NOSGER)
Mean score of
Instrumental
Activities of
Daily Living
and Self-Care
Subscaleb
Yes
Post-test
scores -16.74 3.67 -18.45 2.31 19 10
Change
scores 0.24 5.1 -0.95 3.32
Meekums,
et al. (2012)
Clinical Outcomes in
Routine Evaluation-
Subscale
General -
Post-test
scores 2.94 0.33 2.72 0.4 24 55
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 50
Cluster Study Scale Outcome
variable
Pole
change MeanEG SDEG MeanCG SDCG NEG NCG
Outcome Measure
(CORE-OM)
Functioning Change
scores 0.25 0.71 0.05 0.61
Noreau, et
al. (1995)
Arthritis Impact
Measurement Scale
(AIMS)
Subscale Self-
Perception of
Pain
Yes
Post-test
scores -3.47 1.85 -3.7 2.06 19 10
Change
scores 0.9 2.84 0.3 2.98
Osgood, et
al. (1990)
Philadelphia Geriatric
Center Morale Scale
(PGC)
Total score -
Post-test
scores 14.5 3.7 12.5 4.7 37 35
Change
scores 0.2 5.23 -1.8 5.92
Röhricht &
Priebe
(2006)
Manchester Short
Assessment of Quality
of Life (MANSA)
Total score -
Post-test
scores 4.1 0.7 4.1 0.8 21 18
Change
scores 0 1.14 0 1.06
Sandel, et
al. (2005)
36-Item Short Form
Health Survey (SF-36)
Mean score of
Physical and
Mental
Summary b
-
Post-test
scores 49.8 8.65 47.6 11.1 19 16
Change
scores 3 12.51 1.25 14.83
Well-being,
mood and
affect
Bräuninger
(2006)
Stress Management
Questionnaire 120 (SVF)
Mean score of
Positive
Strategies b
-
Post-test
scores 38.54 10.18 37.99 9.76 77 49
Change
scores 0.76 14.66 -0.4 13.68
Dibbell-
Hope
(2000)
Profile of Mood States
(POMS)
Total Mood
Disturbance Yes
Post-test
scores 13.67 15.36 12.22 15.79 6 9
Change
scores - - - - - -
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 51
Cluster Study Scale Outcome
variable
Pole
change MeanEG SDEG MeanCG SDCG NEG NCG
Goodill
(2005)
Profile of Mood States
(POMS)
Total Mood
Disturbance Yes
Post-test
scores -8.14 26.43 -20.82 24.58 22 17
Change
scores 21.56 37.74 14.44 40.87
Koch, et al.
(2013)
Heidelberger State
Inventory (HIS)
Subscale
Psychological
Well-being
-
Post-test
scores 4.45 0.76 3.77 0.84 16 15
Change
scores 0.38 0.92 0.02 1.19
Koch, et al.
(2007)
Heidelberger
Befindlichkeitsskala(HBS)
Mean score of
Vitality and
Affect b
-
Post-test
scores 5.82 1.63 5.97 1.7 11 20
Change
scores 0.94 2.17 0.56 2.53
Meekums,
et al. (2012)
Clinical Outcomes in
Routine Evaluation-
Outcome Measure
(CORE-OM)
Subscale
Subjective
Well-being
Yes
Post-test
scores 2.95 0.56 2.59 0.68 24 55
Change
scores 0.65 1.09 0.11 1
Noreau, et
al. (1995)
Profile of Mood States
(POMS) Total score Yes
Post-test
scores -2.60 23.1 -11.90 28 19 10
Change
scores 19.8 36.07 12.3 46.4
Body Image Dibbell-
Hope
(2000)
Berscheid-Walster-
Bohrnstedt Body Image
Scale (BWB)
Mean score b Yes
Post-test
scores -4.22 0.73 -4.34 0.84 4 8
Change
scores - - - - - -
Goldov
(2011) Body Image Scale (BIS) Total score Yes
Post-test
scores -1.15 0.88 -1.69 0.97 6 8
Change 0.28 1.45 -0.07 1.3
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 52
Cluster Study Scale Outcome
variable
Pole
change MeanEG SDEG MeanCG SDCG NEG NCG
scores
Goodill
(2005) Human Figure Drawings Total score Yes
Post-test
scores 34.86 5.80 33.72 6.77 22 16
Change
scores 0.63 8.47 0.08 8.43
Koch, et al.
(2013)
Questionnaire of
Movement Therapy(FBT)
Subscale Body-
Awareness -
Post-test
scores 4.35 0.61 3.67 0.77 16 15
Change
scores 0.27 0.9 -0.17 1.1
Meekums,
et al. (2012)
The Situational Inventory
of Body Image Dysphoria
(SIBID)
Total score Yes
Post-test
scores -31.41 14.33 -33.54 13.1 24 55
Change
scores 10.54 20.23 3.4 17.95
Sandel, et
al. (2005) Body Image Scale (BIS) Total score Yes
Post-test
scores -15.20 6.1 -16.90 5.2 19 16
Change
scores 4.2 9.06 2.8 8.34
Clinical
Outcomes Bräuninger
(2006)
Brief Symptom Inventory
(BSI)
Global Severity
Index Yes
Post-test
scores -0.67 0.48 -0.79 0.53 87 54
Change
scores 0.23 0.7 0.04 0.74
Dibbell-
Hope
(2000)
Symptom Checklist 90,
Revised (SCL-90R)
Global Severity
Index Yes
Post-test
scores -0.23 0.2 -0,29 0.18 6 9
Change
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
Cluster Study Scale Outcome
variable
Pole
change MeanEG SDEG MeanCG SDCG NEG NCG
al. (2006) Revised (SCL-90R) Index scores
Change
scores 20.6 57.17 11.91 55.26
Hartshorn
(2001) a
Wandering (observational
measurement) Total score Yes
Post-test
scores -10 3.1 -15 2.9 38 38
Change
scores 4 3.92 1 4.03
Hilf (2009)a Brief Symptom Inventory
(BSI)
Global Severity
Index Yes
Post-test
scores -0.62 0.53 -0.71 0.38 15 15
Change
scores 0,76 0,87 0,37 0,54
Jeong, et al.
(2005)a
Symptom Checklist 90,
Revised (SCL-90R)
Global Severity
Index Yes
Post-test
scores -47.4 11.7 -46.7 6.2 20 20
Change
scores 3.9 16.69 -2.2 8,77
Karkou, et
al. (2009) Youth Self-Report (YSR) Total score -
Post-test
scores 67.7 6.8 58 18.9 6 5
Change
scores 0.2 8.1 -7.8 21.43
Koch, et al.
(2013)
Emotional Empathy Scale
(EES), short form Total score -
Post-test
scores 3.23 0.52 2.86 0.60 16 15
Change
scores 0.11 0.67 -0.1 0.86
Meekums,
et al. (2012)
Clinical Outcomes in
Routine Evaluation-
Outcome Measure
(CORE-OM)
Subscale
Psychological
Symptoms
Yes
Post-test
scores -0.79 0.55 -1.24 0.69 24 55
Change
scores 0.63 1 0.06 0.92
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 54
Cluster Study Scale Outcome
variable
Pole
change MeanEG SDEG MeanCG SDCG NEG NCG
Röhricht &
Priebe
(2006)
Positive and Negative
Symptom Scale (PANSS)
Subscale
Negative
symptoms
Yes
Post-test
scores -18.90 4.3 -23.30 7.4 24 19
Change
scores 4.5 5.94 1.3 8.85
Depression Akandere&
Demir
(2011)
Beck Depression
Inventory (BDI) Total score Yes
Post-test
scores -13.9 5.57 -17.48 7.74 60 60
Change
scores 1.82 8.95 -0.95 9.75
Bojner
Horwitz, et
al. (2006)a
Montgomery Åsberg
Depression Rating Scale
(MADRS)
Total score Yes
Post-test
scores -16.26 7.94 -14.27 8.15 20 16
Change
scores 2.11 10.38 -1,07 11,04
Bräuninger
(2006)
Brief Symptom Inventory
(BSI)
Subscale
Depression Yes
Post-test
scores -0.65 0.75 -0.79 0.73 84 54
Change
scores 0.23 1.08 -0.14 1.05
Dibbell-
Hope
(2000)
Symptom Checklist 90,
Revised (SCL-90R)
Subscale
Depression Yes
Post-test
scores -0.28 0.25 -0.44 0.23 6 9
Change
scores - - - - - -
Goodill
(2005)
Profile of Mood States
(POMS)
Subscale
Depression
Yes Post-test
scores -4.36 5.76 -6.76 6.28 22 17
Change
scores 4.39 10.21 3.26 9.91
Haboush, et
al. (2006)
Geriatric Depression Scale
(GDS) Total score Yes
Post-test
scores -13.00 6.75 -15.58 6.07 10 12
Change 4.08 8.18 2.5 7.56
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 55
Cluster Study Scale Outcome
variable
Pole
change MeanEG SDEG MeanCG SDCG NEG NCG
scores
Hilf (2009) Beck Depression
Inventory-II (BDI-II) Total score Yes
Post-test
scores -11.36 9.68 -14.91 9.33 15 15
Change
scores 14.71 14.84 10.23 11.7
Jeong, et al.
(2005)a
Symptom Checklist 90,
Revised (SCL-90R)
Subscale
Depression Yes
Post-test
scores -46.4 10.2 -46.10 5.7 20 20
Change
scores 5.40 15.60 -2.5 8.42
Koch, et al.
(2007)
Heidelberger
Befindlichkeitsskala (HBS
/ HSI)
Subscale
Depression Yes
Post-test
scores -3.59 1.2 -4.3 1.81 11 20
Change
scores 1.23 1.84 -0.15 2.38
Noreau, et
al. (1995)
Arthritis Impact
Measurement Scale
(AIMS)
Subscale
Depression Yes
Post-test
scores -1.18 1.29 -1.52 1.1 19 10
Change
scores 0.87 2.02 0.2 1.58
Anxiety
Bräuninger
(2006)
Brief Symptom Inventory
(BSI)
Subscale
Anxiety Yes
Post-test
scores -0.67 0.57 -1.02 1.32 84 54
Change
scores 0.29 0.82 -0.18 1.46
Dibbel-
Hope
(1990)
Symptom Checklist 90,
Revised (SCL-90R)
Subscale
Anxiety Yes
Post-test
scores -0.12 0.16 -0.18 0.2 6 9
Change
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
Cluster Study Scale Outcome
variable
Pole
change MeanEG SDEG MeanCG SDCG NEG NCG
Grabner et
al. (1999)
(TAI) scores
Change
scores 13.5 14.06 4.4 16.51
Jeong et al.
(2005)a
Symptom Checklist 90,
Revised (SCL-90R)
Subscale
Anxiety Yes
Post-test
scores -45.3 10.3 -47.8 6.5 20 20
Change
scores 5.9 15.59 -2.8 9.26
Noreau et
al. (1995)
Arthritis Impact
Measurement Scale
(AIMS)
Subscale
Anxiety Yes
Post-test
scores -3.07 1.74 -3.93 1.33 19 10
Change
scores 1.15 2.3 0.53 2.53
Interpersonal
Competence Bräuninger
(2006)
Brief Symptom Inventory
(BSI)
Subscale
Interpersonal
Sensitivity Yes
Post-test
scores -1.02 0.77 -1.17 0.9 84 54
Change
scores 0.35 1.14 0.11 1.29
Dibbell-
Hope
(2000)
Symptom Checklist 90,
Revised (SCL-90R)
Subscale
Interpersonal
Sensitivity
Yes
Post-test
scores -0.22 0.23 -0.14 0.12 6 9
Change
scores - - - - - -
Hartshorn
(2001)
Social-Relatedness
Toward Teacher
(observational
measurement)
Total score -
Post-test
scores 25.00 7.9 21.00 8.3 38 38
Change
scores -3 12.2 -4 13.94
Hokkanen
et al.
(2008)a
Nurses‟
Observation Scale for
Geriatric Patients
Subscale Social
Competence Yes
Post-test
scores -14.79 4.1 -17.6 2.59 19 10
Change 0.5 4.89 -0.3 3.73
META-ANALYSIS OF DANCE MOVEMENT THERAPY AND DANCE 57
Cluster Study Scale Outcome
variable
Pole
change MeanEG SDEG MeanCG SDCG NEG NCG
(NOSGER) scores
Jeong
(2005)
Symptom Checklist 90,
Revised (SCL-90R)
Subscale
Interpersonal
sensitivity Yes
Post-test
scores -44.30 8.2 -51.10 6.7 20 20
Change
scores 7.5 13.01 -3.2 9.76
999999999999999
Koch et al.
(2012)
Questionnaire of
Movement Therapy(FBT)
Mean score of
Awareness of
Self-Other-
Distinction and
Social
Competence b
-
Post-test
scores 4.42 0.81 3.72 0.61 16 15
Change
scores 0.28 1.12 -0,16 0.92
aDue to baseline differences, only change scores were analyzed in a separate analysis
bCalculated 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
Cluster
Post-test scores Change scores
Nstudies NEG NCG SMD (95 % CI) Z NEG NCG SMD (95 % CI) Z
Quality of life 9 257 232 0.37 (0.18 -
0.55)
3.9*** 301 249 0.23 (0.06 -
0.41)
2.64**
Well-being, mood and affect 7 175 175 0.30 (0.07 -
0.53)
2.52* 169 155 0.23 (0.00 -
0.45)
1.97*
Body image 6 91 118 0.27 (-0.04 -
0.57)
1.69† 87 109 0.27 (-0.02 -
0.56)
1.80†
Clinical outcomes 7 173 169 0.44 (0.22 -
0.66)
3.89*** 240 233 0.44 (0.25 -
0.63)
4.6***
Depression 8 227 197 0.36 (0.17 -
0.56)
3.66*** 261 224 0.34 (0.16 -
0.52)
3.64***
Anxiety 4 120 83 0.44 (0.15 -
0.72)
3.00* 134 94 0.46 (0.19 -
0.73)
3.33***
Interpersonal competence 5 164 136 0.45 (0.07 -
0.83)
2.33* 177 137 0.29 (0.03 -
0.55)
2.18*
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.
top related