Dance therapy for schizophrenia

 

Abstract

Background

Dance therapy or dance movement therapy (DMT) is defined as 'the psychotherapeutic use of movement as a process which furthers the emotional, social, cognitive, and physical integration of the individual'. It may be of value for people with developmental, medical, social, physical or psychological impairments. Dance therapy can be practiced in mental health rehabilitation units, nursing homes, day care centres and incorporated into disease prevention and health promotion programs.

Objectives

To evaluate the effects of dance therapy for people with schizophrenia or schizophrenia-like illnesses compared with standard care and other interventions.

Search methods

We searched the Cochrane Schizophrenia Group Trials Register (July 2007), inspected references of all identified studies (included and excluded), and contacted first authors for additional data.

Selection criteria

We included all randomised controlled trials (RCTs) comparing dance therapy and related approaches with standard care or other psychosocial interventions for people with schizophrenia.

Data collection and analysis

We reliably selected, quality assessed and extracted data. We excluded data where more than 30% of participants were lost to follow-up. For continuous outcomes we calculated a weighted mean difference; for binary outcomes we calculated a fixed-effect risk ratio (RR) and their 95% confidence intervals (CI).

Main results

We included one single blind study (total n=45) of reasonable quality. It compared dance therapy plus routine care with routine care alone. Most people tolerated the treatment package but about 40% were lost in each group by four months (RR 0.68 CI 0.31 to 1.51). PANSS average endpoint total scores were similar in each group (WMD -0.50 CI -11.8 to 10.8) as were the positive subscores (WMD 2.50 CI -0.67 to 5.67). At the end of treatment significantly more people in the dance therapy group had a greater than 20% reduction in PANSS negative symptom score (RR 0.62 CI 0.39 to 0.97), and overall average negative endpoint scores were lower (WMD -4.40 CI -8.15 to 0.65). There was no difference in satisfaction score (average CAT score, WMD 0.40 CI -0.78 to 1.58) and quality of life data were also equivocal (average MANSA score, WMD 0.00 CI -0.48 to 0.48). 

Authors' conclusions

There is no evidence to support - or refute - the use of dance therapy in this group of people. This therapy remains unproven and those with schizophrenia, their carers, trialists and funders of research may wish to encourage future work to increase high quality evidence in this area.

 

Plain language summary

Dance therapy for schizophrenia

Schizophrenia can be a long-term disabling illness. The most common treatments for people with this condition are medication (antipsychotics) and talking therapies, especially cognitive behavioural therapy and family therapy. These treatments work well for people with 'positive' symptoms (hearing voices and other alterations of the senses) and delusions (distortions in the way the world is seen). However people experiencing 'negative' symptoms (such as flattening of mood, poverty of speech, lack of drive, loss of feeling, social withdrawal and decreased spontaneous movement) do not respond as well. 

Dance therapy (also called dance movement therapy) uses dance and movement to explore a person’s emotions in a non-verbal way. The therapist will help the individual to interpret their movement as a link to personal feelings. This review aims to assess how successful this therapy is as a treatment for schizophrenia, when compared to standard care or other interventions. Six studies were identified but five were excluded because there were no reliable data, because they were for a therapy other than dance or because they were not properly randomised. The included study compared 10 weeks of group dance therapy plus standard care, to group supportive counselling plus standard care for the same length of time. It was a community-based project involving 45 people and both groups were followed up after four months. 

Of the outcomes measured (mental state, satisfaction with care, leaving the study early, quality of life and adverse effects) the majority showed no difference between the two groups. However, when negative symptoms were specifically measured after 10 weeks of treatment, there was a significant improvement in the mental state of the dance therapy group. At the four month follow-up more than 30% of the participants had been lost from both groups, making it impossible to draw any valid conclusions from the outcomes measured. 

Overall, because of the relatively small number of people, the data from this trial were inconclusive. However a larger randomised trial measuring outcomes such as relapse, admission to hospital, quality of life, leaving the study early, cost of care and satisfaction with treatment would help clarify whether dance therapy is an effective treatment for schizophrenia; especially for negative symptoms that don't respond so well to medication and talking therapies.

(Plain language summary prepared for this review by Janey Antoniou of RETHINK, UK www.rethink.org).

 

摘要

背景

精神分裂症的舞蹈療法

舞蹈療法或舞蹈動作療法(DMT)定義為“動作的心理治療用途,促進個人情感,社會認知和體能結合”. 對發展,醫學,社會體能或心理有障礙的人可能有益. 舞蹈療法可在精神病院所,安養院,日間照護中心執行,也可融入疾病預防和健康促進的活動

目標

評估精神分裂症或類精神分裂症病人,與標準療法和其他介入相比,舞蹈療法的效果

搜尋策略

搜尋Cochrane Schizophrenia Group Trials Register (July 2007),文獻和聯絡第一作者取得額外資訊.

選擇標準

納入比較舞蹈療法與標準療法和其他介入,評估精神分裂症病人的所有隨機對照試驗

資料收集與分析

可靠的選擇,評估品質和擷取資料. 排除超過30%受試者失去追蹤的試驗. 計算連續資料的加權平均差異. 計算二元資料的RR和95%CI.

主要結論

我們納入一個品質合理的單盲試驗(樣本數為45). 比較舞蹈療法和例行療法. 大部分患者可接受治療組合但4個月時各組都有40%患者失去追蹤(RR 0.68 CI 0.31 to 1.51). PANSS平均終點總分在每組差不多. (加權平均差−0.50 CI −11.8 to 10.8)正像分次得分也是(加權平均差2.50 CI −0.67 to 5.67). 治療結束時,舞蹈療法組有較多患者達到20% PANSS負向症狀得分減少(RR 0.62 CI 0.39 to 0.97),總平均負向終點得分較低(加權平均差−4.40 CI −8.15 to 0.65). 滿意得分沒有差異(平勳CAT得分, 加權平均差0.40 CI −0.78 to 1.58)和生活品質資料也相當(平勳 MANSA得分, 加權平均差0.00 CI −0.48 to 0.48).

作者結論

沒有證據顯示證明對這些患者舞蹈療法有效. 本療法療效尚待證實,精神分裂患者本身,照護者. 試驗人員和試驗贊助者希望有更多鼓勵以增加本領域高品質證據.

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

精神分裂症的舞蹈療法: 舞蹈療法或舞蹈動作療法(DMT)使用身體運動當作治療工具. 對發展,醫學,社會體能或心理有障礙的人可能有效. 舞蹈療法可在很多場合進行,通常有以下階段:加入,身體準備,探索,實驗加入時做出的動作,核心動作,身體和心理顯著的動作以產深主題,回顧題材和結論. 療程長度為20 – 90分鐘,依個人耐受度而訂. 但治療性舞蹈需要思考,感覺和意願. 本回顧比較舞蹈療法與常規療法,評估精神分裂症或類精神分裂症病人的療效. 只有納入一個小型隨機對照試驗. 沒有決定性結論,因此目前不能提供方針支持或不支持精神分裂症患者使用舞蹈療法. 需要更多研究以確定舞蹈療法在此族群的價值和療效