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Phillips CS, Hebdon M, Cleary C, Ravandi D, Pottepalli V, Siddiqi Z, Rodriguez E, Jones BL. Expressive Arts Interventions to Improve Psychosocial Well-Being in Caregivers: A Systematic Review. J Pain Symptom Manage 2024; 67:e229-e249. [PMID: 38043748 DOI: 10.1016/j.jpainsymman.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
CONTEXT Over 43 million caregivers provide care and support in the United States. Increased stress and burden may contribute to poor psychosocial well-being. Recently, there has been an emergence of art-based interventions to improve well-being among care receivers and caregivers. A synthesis of this literature evaluating expressive arts interventions (EAIs) with caregivers is needed. OBJECTIVES Identify the nature and impact of EAIs for caregivers and outline directions for future research. METHODS Systematic searches were conducted in PubMed/MEDLINE, CINAHL, PsychINFO, and Web of Science for relevant studies between 2001 and 2022. Inclusion criteria included EAI addressing psychosocial well-being of caregivers, quantitative and mixed methods studies, and written in English. RESULTS Twenty-seven studies were included (1359 participants). There was a diverse global representation of countries (n = 14). Twelve studies were randomized controlled trials. The majority (n = 11) were conducted with dementia/alzheimers caregivers and 41% (n = 11) were delivered to the caregiver/receiver dyad. Fifty-nine percent of the EAIs were music-based, 22% were visual arts, and 10% were writing. Intervention length varied from a single one-hour session to biweekly for 10-months; eight lasted two-weeks. Overall, stress improved in 80% of the studies, anxiety in 69%, caregiver burden in 57%, and depressive symptoms in 31%. CONCLUSION Caregivers are essential to the care of people with medically complex and life-limiting conditions. EAIs hold the potential to improve psychosocial outcomes for caregivers, are used globally, and can be culturally tailored. Future research should examine intervention duration and intensity, measures to address additional dimensions of psychsocial well-being, and implementation in additional caregiver populations.
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Affiliation(s)
- Carolyn S Phillips
- The University of Texas at Austin (C.S.P., M.H., C.C.), School of Nursing, Austin, Texas, USA.
| | - Megan Hebdon
- The University of Texas at Austin (C.S.P., M.H., C.C.), School of Nursing, Austin, Texas, USA
| | - Catie Cleary
- The University of Texas at Austin (C.S.P., M.H., C.C.), School of Nursing, Austin, Texas, USA
| | - Dona Ravandi
- The University of Texas at Austin (C.S.P., M.H., C.C.), School of Nursing, Austin, Texas, USA
| | | | - Zaniah Siddiqi
- The University of Texas at Austin (D.R., V.P., Z.S.), Austin, Texas, USA
| | - Erin Rodriguez
- Department of Educational Psychology (E.R.), The University of Texas at Austin, Austin, Texas, USA
| | - Barbara L Jones
- The University of Texas at Austin (B.L.J.), Steve Hicks School of Social Work, Austin, Texas, USA
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Branson Dame K, Jazz Harvey M, Aichele S, Kralewski Van Denburg A, Hoyer L, Joslin S, McKenna A, Lincoln M, Closson L, Flykt M, Salo S, Harvey A, Biringen Z. Movement through motherhood: Exploring mood, wellbeing, and prenatal emotional availability (EA) through EA-based dance intervention. Infant Ment Health J 2024; 45:22-39. [PMID: 38081788 DOI: 10.1002/imhj.22093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023]
Abstract
Emotional availability (EA) is a construct that describes the observed emotional connection in parent-child relationships. During pregnancy, EA is assessed only using caregiver sensitivity and nonhostility. We used the nonverbal aspects of these qualities to create a new dance/movement intervention ("EA-Based Dance Intervention"). Given the scarcity of pregnancy interventions, we provided training to participants on how to be emotionally engaged with their unborn babies through dance/movement. The EA-Based Dance Intervention alone comprised the first intervention arm (n = 12). A second intervention arm involved the combination of EA-Based Dance Intervention with brief psychoeducation (n = 10). The third arm was a control group, which received only the assessments (n = 7). Measures of self-reported symptoms of depression and anxiety, emotional expressivity, flourishing, and the (newly developed) self-reported prenatal EA were used at pre- and posttest. The measure of observed prenatal EA was used to compare intervention versus control at posttest only. In this pilot study, we found that participants receiving the EA-Based Dance Intervention alone or combined with psychoeducation, self-reported improved anxiety symptoms and self-reported higher prenatal EA. When compared with the control group, those experiencing EA-Based Dance Intervention reported fewer depressive symptoms from pre- to posttest.
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Affiliation(s)
- Katelyn Branson Dame
- Human Development and Family Studies and the Prevention Research Center, Colorado State University, Fort Collins, Colorado, USA
| | - Madeline Jazz Harvey
- School of Music, Theatre, and Dance, Colorado State University, Fort Collins, Colorado, USA
| | - Stephen Aichele
- Human Development and Family Studies and the Prevention Research Center, Colorado State University, Fort Collins, Colorado, USA
| | - Ann Kralewski Van Denburg
- Human Development and Family Studies and the Prevention Research Center, Colorado State University, Fort Collins, Colorado, USA
| | - Lillian Hoyer
- Human Development and Family Studies and the Prevention Research Center, Colorado State University, Fort Collins, Colorado, USA
| | - Steffany Joslin
- Human Development and Family Studies and the Prevention Research Center, Colorado State University, Fort Collins, Colorado, USA
| | - Alexandria McKenna
- Human Development and Family Studies and the Prevention Research Center, Colorado State University, Fort Collins, Colorado, USA
| | - Michael Lincoln
- Human Development and Family Studies and the Prevention Research Center, Colorado State University, Fort Collins, Colorado, USA
| | - Lia Closson
- Human Development and Family Studies and the Prevention Research Center, Colorado State University, Fort Collins, Colorado, USA
| | - Marjo Flykt
- Department of Psychology, University of Helsinki, Helsinki, Finland
- University of Tampere, Tampere, Pirkanmaa, Finland
| | - Saara Salo
- Department of Psychology, University of Helsinki, Helsinki, Finland
| | - Ashley Harvey
- Human Development and Family Studies and the Prevention Research Center, Colorado State University, Fort Collins, Colorado, USA
| | - Zeynep Biringen
- Human Development and Family Studies and the Prevention Research Center, Colorado State University, Fort Collins, Colorado, USA
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Aithal S, Karkou V, Makris S, Karaminis T, Powell J. Supporting the wellbeing of caregivers of children on the autism spectrum: A qualitative report on experiences of attending group dance movement psychotherapy. PLoS One 2023; 18:e0288626. [PMID: 37540687 PMCID: PMC10403118 DOI: 10.1371/journal.pone.0288626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/02/2023] [Indexed: 08/06/2023] Open
Abstract
Caregivers of children on the autism spectrum can carry a significant amount of practical, psychological, and social demands and responsibilities that are highly stressful. A group Dance Movement Psychotherapy (DMP) was offered to facilitate the wellbeing of caregivers. In this article, we explore the experiences of the therapeutic processes and outcomes of the intervention from the perspectives of caregivers, the therapist, and the researcher/co-facilitator. METHOD Four clusters of caregivers of children on the autism spectrum (N = 20 Mean age = 39.25 years) took part in five group DMP sessions lasting 90 minutes delivered across two special educational needs settings. Twenty reflective focus groups took place in total, with each taking place at the end of each DMP session. Participants were invited to capture their experiences through arts-based drawings, while therapist and participating researcher/co-facilitator kept session-based notes and arts-based reflections. These arts-based and verbal data were grouped to generate themes. RESULTS Six overarching themes emerged from the arts-based and verbal data with multiple subthemes that describe the contribution of DMP towards promoting caregivers' wellbeing and identified key challenges in implementing the intervention. These themes are: (1) Beholding within and around; (2) Reflecting and reinforcing strengths; (3) Exchanging views; (4) Looking back and carrying forward; (5) Core benefits; and (6) Challenges to engage in DMP. CONCLUSION Caregivers talked about their experience of participating in the DMP groups as positive and acknowledged the helpful and challenging aspects of taking part in DMP intervention. They appreciated the creative and expressive nature of the intervention to promote their emotional and social wellbeing. The challenges identified in the study indicate that further awareness is needed within school environments about the contribution arts therapies can make towards establishing appropriate and sustainable interventions for caregivers.
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Affiliation(s)
- Supritha Aithal
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Vicky Karkou
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Stergios Makris
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Themis Karaminis
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Joanne Powell
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
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Aithal S, Karkou V, Makris S, Karaminis T, Powell J. Impact of Dance Movement Psychotherapy on the wellbeing of caregivers of children with Autism Spectrum Disorder. Public Health 2021; 200:109-115. [PMID: 34717164 DOI: 10.1016/j.puhe.2021.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 07/16/2021] [Accepted: 09/16/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Sustaining the wellbeing of caregivers of children with Autism Spectrum Disorder (ASD) can be highly demanding. This study explored the impact of Dance Movement Psychotherapy (DMP) intervention on the wellbeing of caregivers in comparison with their standard care routine. STUDY DESIGN This pilot evaluation study used a quasi-experimental design. METHODS Thirty-seven caregivers of children with ASD were recruited from two special educational needs settings and were allocated to the DMP intervention or the control group depending on their availability to attend the sessions. The participants in the intervention group received five DMP sessions lasting 90 min each. Adult Wellbeing Scale (AWS) and Parenting Stress Index-Short Form (PSI-SF) were the two outcome measures administered before and after DMP to measure the impact of DMP intervention on caregivers' wellbeing and parental stress. RESULTS The retention rates were poor, with only 50% of participants in the DMP intervention arm attending at least 70% of the sessions until its end. The Minimal Clinically Important Difference (MCID) was achieved for a small effect size in both outcome measures in the DMP intervention group but not in the control group. Results from the Analyses of Covariance (ANCOVAs) showed a significant difference in post-intervention scores between the DMP intervention and the control group for AWS (F1,33 = 106.474, P < 0.001) but not for PSI-SF. In addition, a significant association was found between pre-intervention scores and the number of sessions attended with the postintervention scores of both AWS and PSI-SF. CONCLUSIONS The results of this pilot DMP study are promising. However, before running a larger randomised controlled trial, strategies to support caregivers to attend the intervention need to be considered carefully.
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Affiliation(s)
- S Aithal
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom; Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom.
| | - V Karkou
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom; Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - S Makris
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom; Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - T Karaminis
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom; Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - J Powell
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom; Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
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Morris PO, Hope E, Foulsham T, Mills JP. Dance, rhythm, and autism spectrum disorder: An explorative study. ARTS IN PSYCHOTHERAPY 2021. [DOI: 10.1016/j.aip.2020.101755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vulcan M. The "Muscles of the Psyche": From Body Literacy to Emotional Literacy. Front Psychol 2021; 11:548964. [PMID: 33551892 PMCID: PMC7854468 DOI: 10.3389/fpsyg.2020.548964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
Autism spectrum disorder (ASD) is a neuro-developmental condition, which requires a multi-disciplinary matrix of treatments, including functional, educational, and emotional interventions. The latter mode of treatment entails particular difficulties, inasmuch as the core deficits of this condition seem to challenge the very premises of traditional psychotherapy. Reciprocity, verbal, and symbolic expression and inter-subjective dynamics are often difficult to attain with clients diagnosed with ASD, and emotional treatment thus often turns out to be a frustrating process, which may well elicit questions as to the efficacy of psychotherapeutic emotional interventions. These core challenges, described in the literature, become particularly acute in view of the increasing number of clients diagnosed on the autistic spectrum in recent years, and the growing need for qualified therapists who have trained for working specifically with this condition. It seems, therefore, that it is high time for systematic research into the lived experience of therapists working with these clients in order to attain a better clinical and theoretical understanding of the condition itself and broaden the range of effective interventions. This study, informed by a phenomenological-hermeneutic approach which guided both the collection of data and its subsequent analysis, aims to address these issues by exploring the particular challenges faced by therapists in this field, the questions that come up in the process, modes of personal and professional coping, and the insights elicited by the therapeutic encounter. The research consisted of in-depth interviews with 28 practicing therapists from a broad range of clinical orientations, including dance/movement, arts, music, and drama therapists, clinical psychologists, and clinical social workers. The essential themes that emerged from the participants’ responses and the analysis of the findings lend support to theoretical and developmental approaches, which focus on the primacy and the foundational role of the concrete body in inter-subjective relationships and in the therapeutic process, and indicate the potential efficacy of somatic and kinetic interventions. The clinical implications of this study are thus highly relevant to the training and support of therapists working with ASD, who should be encouraged to develop greater receptivity to non-verbal modes of interaction in the therapeutic process.
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Affiliation(s)
- Maya Vulcan
- Graduate School of Creative Art Therapies, Faculty of Humanities & Social Sciences, Kibbutzim College of Education, Tel Aviv, Israel
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Aithal S, Karkou V, Kuppusamy G. Resilience enhancement in parents of children with an autism spectrum disorder through dance movement psychotherapy. ARTS IN PSYCHOTHERAPY 2020. [DOI: 10.1016/j.aip.2020.101708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Koch SC, Riege RFF, Tisborn K, Biondo J, Martin L, Beelmann A. Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes. A Meta-Analysis Update. Front Psychol 2019; 10:1806. [PMID: 31481910 PMCID: PMC6710484 DOI: 10.3389/fpsyg.2019.01806] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Dance is an embodied activity and, when applied therapeutically, can have several specific and unspecific health benefits. In this meta-analysis, we evaluated the effectiveness of dance movement therapy(DMT) and dance interventions for psychological health outcomes. Research in this area grew considerably from 1.3 detected studies/year in 1996-2012 to 6.8 detected studies/year in 2012-2018. Method: We synthesized 41 controlled intervention studies (N = 2,374; from 01/2012 to 03/2018), 21 from DMT, and 20 from dance, investigating the outcome clusters of quality of life, clinical outcomes (with sub-analyses of depression and anxiety), interpersonal skills, cognitive skills, and (psycho-)motor skills. We included recent randomized controlled trials (RCTs) in areas such as depression, anxiety, schizophrenia, autism, elderly patients, oncology, neurology, chronic heart failure, and cardiovascular disease, including follow-up data in eight studies. Results: Analyses yielded a medium overall effect (d = 0.60), with high heterogeneity of results (I 2 = 72.62%). Sorted by outcome clusters, the effects were medium to large (d = 0.53 to d = 0.85). All effects, except the one for (psycho-)motor skills, showed high inconsistency of results. Sensitivity analyses revealed that type of intervention (DMT or dance) was a significant moderator of results. In the DMT cluster, the overall medium effect was small, significant, and homogeneous/consistent (d = 0.30, p < 0.001, I 2 = 3.47). In the dance intervention cluster, the overall medium effect was large, significant, yet heterogeneous/non-consistent (d = 0.81, p < 0.001, I 2 = 77.96). Results suggest that DMT decreases depression and anxiety and increases quality of life and interpersonal and cognitive skills, whereas dance interventions increase (psycho-)motor skills. Larger effect sizes resulted from observational measures, possibly indicating bias. Follow-up data showed that on 22 weeks after the intervention, most effects remained stable or slightly increased. Discussion: Consistent effects of DMT coincide with findings from former meta-analyses. Most dance intervention studies came from preventive contexts and most DMT studies came from institutional healthcare contexts with more severely impaired clinical patients, where we found smaller effects, yet with higher clinical relevance. Methodological shortcomings of many included studies and heterogeneity of outcome measures limit results. Initial findings on long-term effects are promising.
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Affiliation(s)
- Sabine C. Koch
- Department of Creative Arts Therapies and Therapy Sciences, Alanus University, Alfter, Germany
- School of Therapy Sciences, SRH University Heidelberg, Heidelberg, Germany
| | | | | | - Jacelyn Biondo
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, United States
| | - Lily Martin
- Department of Creative Arts Therapies and Therapy Sciences, Alanus University, Alfter, Germany
| | - Andreas Beelmann
- Department of Psychology, Friedrich-Schiller-University, Jena, Germany
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