Suzi Tortora, EDD, BC-DMT, LCAT, LMHC
Dance/movement therapy is a complementary modality that is being explored for symptom control and for improving the quality of life of patients with cancer, especially pediatric patients. Self-expression as well as the creative and interpersonal aspects of dance/movement therapy can help patients get in touch with their innermost feelings, which can empower and support adaptation and symptom management. In this article, Dr. Tortora describes dance/ movement therapy and summarizes the clinical evidence of its impact on the physical and psychosocial symptoms for patients with cancer.
Overview
THE APPLICATION of dance/movement therapy as an integrative medicine modality to support patients with cancer is a growing interest in the field.1-5 However, a common question dance/movement therapists are asked when introducing this type of therapy is, “How can a patient in the depths of cancer treatment dance?” A better understanding of the biopsychosocial support that dance/movement therapy provides to patients with cancer, their caregivers, and family members will enable this viable treatment to become more widely utilized.
Jun J. Mao, MD, MSCE
What Is Dance/Movement Therapy?
DANCE/MOVEMENT therapy, known as dance movement psychotherapy in Europe, is a synergy between psychotherapy and the self-expressive, communicative elements of dance, creating a body-mind emotional connection to enable participants to share feelings that may be difficult to express with words. It is defined by the American Dance Therapy Association as “the psychotherapeutic use of movement to promote emotional, social, cognitive, and physical integration of the individual, for the purpose of improving health and well-being.”6 Dance/movement therapy in a medical setting provides psychosocial support during conventional and standard medical treatments.3
GUEST EDITOR
Integrative Oncology is guest edited by Jun J. Mao, MD, MSCE, Laurance S. Rockefeller Chair in Integrative Medicine and Chief, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York.Although dance is in the title of the modality and may be incorporated into the session, dance/ movement therapy encompasses a wide variety of activities, including movement, guided visualization, mindfulness, as well as body and breath awareness, creating an emotionally inviting milieu to support self-expression. Sessions are conducted individually or in groups (and can include family and friends) and may incorporate both movement and verbal expression.
Providing emotional outlets during cancer treatment is especially important, for cancer is a complex illness. It takes a profound toll on patients and on all those close to patients, causing emotional reactions that can be extreme and not easily expressed verbally.3,7 The goals of dance/movement therapy in cancer care include improving quality of life, physical and cognitive fatigue, and pain management; enhancing self-expression related to unresolved grief, anxiety, fear, depression, and feelings of isolation; enhancing self-esteem; and strengthening patients’ connection to personal resources through imagery and metaphors.1,4,8
Why Dance?
THE MULTIDIMENSIONAL, self-expressive, creative, and interpersonal aspects of dance enable patients with cancer to get in touch with personal feelings, building a sense of self-efficacy that empowers them as well as supporting adaptation and symptom management.4 “Dance therapy offers a more diversified and less monotonous approach compared to conventional fitness programs. Dance therapy focuses more intensely on the entity of body and soul, supporting coordination, creativity and activation of resources such as emotional stability in addition to building and maintaining a social network that enables mutually beneficial experiences that might evolve into a support group.”9
“Dance/movement therapy encompasses a wide variety of activities, including movement, guided visualization, mindfulness, as well as body and breath awareness, creating an emotionally inviting milieu to support self-expression.”— Suzi Tortora, EDD, BC-DMT, LCAT, LMHC
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Evidence Base
CLINICAL RESEARCH involving dance/movement therapy is limited. In the only study in pediatric cases involving 16 children with a brain tumor receiving chemotherapy, individual creative arts therapy sessions using dance/movement, music, and art therapies were compared with receiving attention from a volunteer. Improvements were found in parents’ report of their pain (P = .03) and nausea (P = .0061), along with improved mood (P < .01), excitement (P < .05), feeling happy (P < .02), and less nervous (P < .02).8
Dance/movement therapy was also evaluated in the breast cancer population. In a randomized study of 139 patients undergoing radiotherapy, dance/ movement therapy (six 1.5-hour group sessions, twice a week for 3 weeks) was reported to significantly affect perceived stress, pain severity, and pain interference (P < 0.05) when compared with the control group.10 In a follow-up study with 104 patients, those who received dance/movement therapy during radiotherapy benefited more than patients who received it 1 to 2 months after completing treatment. Patients reported improved coping with cancer symptoms and treatment; improved well-being and appreciation of self and body; total functioning; bridging back to a normal life; and participating in a shared positive experience.11
Systematic reviews1,2 and a meta-analysis4 have thus far concluded that dance/movement therapy and dance/movement therapy–specific activities were well received, caused no detectable adverse effects, and were associated with low dropout rates. Qualitative measures in individual studies, including analyses of narrative data from semi-structured interviews, demonstrate dance/movement therapy’s effectiveness and patient-perceived benefits in quality of life, including improved mood, vitality, decreased depression, and anxiety.2,4,8-13
However, limited number of studies, small sample sizes, as well as inconsistency and lack of rigor in study design preclude firm conclusions. Two specific limitations of dance/movement therapy research that have been cited include: the improvisational clinical methodology of dance/movement therapy does not easily lend itself to systematized quantitative research; and the nonverbal, body and behavioral focus of dance/movement therapy methods is not easily measured through verbal intervention tools.
Dance/Movement Therapy at MSK
A VALUED PROGRAM of the Integrative Medicine Service at Memorial Sloan Kettering Cancer Center (MSK), dance/movement therapy has provided individual and group sessions for pediatric patients and their family members5 for more than 16 years; and it has recently grown to include a group for adult patients and caregivers.
“The ability to actively express their experience of cancer during treatment within the context of a psychotherapeutic milieu enables patients to create a cohesive narrative about their experience.”— Suzi Tortora, EDD, BC-DMT, LCAT, LMHC
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Pediatric dance/movement therapy is a highly requested modality used for pain management, psychosocial and family support, as well as palliative and end-of-life care. Dance/ movement therapists participate in all aspects of treatment, working alongside the medical team. The ability to actively express their experience of cancer during treatment within the context of a psychotherapeutic milieu enables patients to create a cohesive narrative about their experience. This sense of empowerment has the potential to synthesize the potentially traumatic aspects of cancer and its treatments.
Future Recommendations
AS STATED by Sherri Goodill, PhD, of Drexel University College of Nursing and Health Professions, “The range of methods used by dance and movement therapists in practice is indeed very broad…and the creative patient-centered nature of the therapy means that context and patient preferences will always drive clinical reasoning to a large degree.”2 Research in a mixed qualitative and quantitative design will best demonstrate the efficacy of this growing field, which can be a viable addition to integrative medicine offerings.5
“Researching the traumatic preventative aspects of dance/movement therapy is essential to confirm the efficacy of this modality to provide support to a wider range of patients.”— Suzi Tortora, EDD, BC-DMT, LCAT, LMHC
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The empowerment and sense of control achieved through dance/movement therapy’s self-expressive–embodied activities provide a way for patients with cancer to express feelings that are not easy to share verbally. Getting in touch with such feelings fosters expression rather than creating internal representations that have the potential to become traumatic memories. Researching the traumatic preventative aspects of dance/movement therapy is essential to confirm the efficacy of this modality to provide support to a wider range of patients. ■
A board-certified and licensed dance/movement therapist at the Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, Dr. Tortora also has a private dance/movement therapy practice in New York City and the Hudson River Valley region of New York.
DISCLOSURE: Dr. Tortora reported no conflicts of interest.
REFERENCES
1. Bradt J, Shim M, Goodill SW: Dance/movement therapy for improving psychological and physical outcomes in cancer patients. Cochrane Database Syst Rev 1:CD007103, 2015.
2. Goodill SW: Accumulating evidence for dance/movement therapy in cancer care. Front Psychol 9:1778, 2018.
3. Goodill SW: An Introduction to Medical Dance/Movement Therapy: Health Care in Motion. Philadephia, PA; Jessica Kingsley Publishers; 2005.
4. Koch S, Kunz T, Lykou S, et al: Effects of dance movement therapy and dance on health-related psychological outcomes: A meta-analysis. The Arts in Psychotherapy 41:46-64, 2014.
5. Tortora S: Children are born to dance! Pediatric medical dance/movement therapy: The view from integrative pediatric oncology. Children (Basel) 6;E14, 2019.
6. American Dance Therapy Association: What is dance/movement therapy? Available at https://adta.org/2014/11/08/ what-is-dancemovement-therapy/. Accessed February 26, 2019.
7. Cohen SO, Walco GA: Dance/movement therapy for children and adolescents with cancer. Cancer Pract 7:34-42, 1999.
8. Madden JR, Mowry P, Gao D, et al: Creative arts therapy improves quality of life for pediatric brain tumor patients receiving outpatient chemotherapy. J Pediatr Oncol Nurs 27:133-145, 2010.
9. Strum I, Baak J, Storek B, et al: Effect of dance on cancer-related fatigue and quality of life. Support Care Cancer 22:2241-2249, 2014.
10. Ho RT, Fong TC, Cheung IK, et al: Effects of a short-term dance movement therapy program on symptoms and stress in patients with breast cancer undergoing radiotherapy: A randomized, controlled, single-blind trial. J Pain Symptom Manage 51:824-831, 2016.
11. Ho RT, Lo PH, Luk MY: A good time to dance? A mixed-methods approach of the effects of dance movement therapy for breast cancer patients during and after radiotherapy. Cancer Nurs 39:32-41, 2016.
12. Dibbell-Hope S: The use of dance/movement therapy in psychological adaptation to breast cancer. The Arts in Psychotherapy 27:51-68, 2000.
13. Ho RTH: Effects of dance movement therapy on Chinese cancer patients: A pilot study in Hong Kong. The Arts in Psychotherapy 32:337-345, 2005.
