Dance movement therapy for depression

BACKGROUND: Depression is a debilitating condition affecting more than 350 million people worldwide (WHO 2012) with a limited number of evidence‐based treatments. Drug treatments may be inappropriate due to side effects and cost, and not everyone can use talking therapies.There is a need for evidence‐based treatments that can be applied across cultures and with people who find it difficult to verbally articulate thoughts and feelings. Dance movement therapy (DMT) is used with people from a range of cultural and intellectual backgrounds, but effectiveness remains unclear. OBJECTIVES: To examine the effects of DMT for depression with or without standard care, compared to no treatment or standard care alone, psychological therapies, drug treatment, or other physical interventions. Also, to compare the effectiveness of different DMT approaches. SEARCH METHODS: The Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR‐Studies and CCDANCTR‐References) and CINAHL were searched (to 2 Oct 2014) together with the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. The review authors also searched the Allied and Complementary Medicine Database (AMED), the Education Resources Information Center (ERIC) and Dissertation Abstracts (to August 2013), handsearched bibliographies, contacted professional associations, educational programmes and dance therapy experts worldwide. SELECTION CRITERIA: Inclusion criteria were: randomised controlled trials (RCTs) studying outcomes for people of any age with depression as defined by the trialist, with at least one group being DMT. DMT was defined as: participatory dance movement with clear psychotherapeutic intent, facilitated by an individual with a level of training that could be reasonably expected within the country in which the trial was conducted. For example, in the USA this would either be a trainee, or qualified and credentialed by the American Dance Therapy Association (ADTA). In the UK, the therapist would either be in training with, or accredited by, the Association for Dance Movement Psychotherapy (ADMP, UK). Similar professional bodies exist in Europe, but in some countries (e.g. China) where the profession is in development, a lower level of qualification would mirror the situation some decades previously in the USA or UK. Hence, the review authors accepted a relevant professional qualification (e.g. nursing or psychodynamic therapies) plus a clear description of the treatment that would indicate its adherence to published guidelines including Levy 1992, ADMP UK 2015, Meekums 2002, and Karkou 2006. DATA COLLECTION AND ANALYSIS: Study methodological quality was evaluated and data were extracted independently by the first two review authors using a data extraction form, the third author acting as an arbitrator. MAIN RESULTS: Three studies totalling 147 participants (107 adults and 40 adolescents) met the inclusion criteria. Seventy‐four participants took part in DMT treatment, while 73 comprised the control groups. Two studies included male and female adults with depression. One of these studies included outpatient participants; the other study was conducted with inpatients at an urban hospital. The third study reported findings with female adolescents in a middle‐school setting. All included studies collected continuous data using two different depression measures: the clinician‐completed Hamilton Depression Rating Scale (HAM‐D); and the Symptom Checklist‐90‐R (SCL‐90‐R) (self‐rating scale). Statistical heterogeneity was identified between the three studies. There was no reliable effect of DMT on depression (SMD ‐0.67 95% CI ‐1.40 to 0.05; very low quality evidence). A planned subgroup analysis indicated a positive effect in adults, across two studies, 107 participants, but this failed to meet clinical significance (SMD ‐7.33 95% CI ‐9.92 to ‐4.73). One adult study reported drop‐out rates, found to be non‐significant with an odds ratio of 1.82 [95% CI 0.35 to 9.45]; low quality evidence. One study measured social functioning, demonstrating a large positive effect (MD ‐6.80 95 % CI ‐11.44 to ‐2.16; very low quality evidence), but this result was imprecise. One study showed no effect in either direction for quality of life (0.30 95% CI ‐0.60 to 1.20; low quality evidence) or self esteem (1.70 95% CI ‐2.36 to 5.76; low quality evidence). AUTHORS' CONCLUSIONS: The low‐quality evidence from three small trials with 147 participants does not allow any firm conclusions to be drawn regarding the effectiveness of DMT for depression. Larger trials of high methodological quality are needed to assess DMT for depression, with economic analyses and acceptability measures and for all age groups.