EFFECTS OF DANCE MOVEMENT

THERAPY ON ANGER AND ANXIETY

CASE STUDY
SANCHARI NAG (Msc. Psychology)

A case study submitted in partial requirement for the degree of

Movement Therapist at the Rhythmosiac Dance Academy
 ACKNOWLEDGEMENTS

With heartfelt thanks to my primary supervisor, Mrs Mitul Sengupta, who

provided excellent support, sincere encouragement and astute guidance in all
aspects of the project. I am also extremely thankful to my co-supervisor, Dr.
Anandita Chatterjee, who played an integral role in assisting me with the
results analysis and critiquing drafts of my case study. A special thanks goes to
my Faculty Members- Subha Mam, Shayori Mam, Arpita Mam and Prasanna
Sir who constantly inspired us with work exposure and academic assistance.
My Professional Directors and colleagues of Moner Alo Mental Healthcare Pvt.
Ltd, who gave me constant and unfaltering support in all aspects of
conducting this project owes a special thanks. My Mother, Father, Sister and
Brother-in-law cheered me on and buoyed me up throughout in completion of
this DMT sessions. And lastly, my fervent thanks to the Almighty, who gave me
the incredible opportunity to study my Dance Movement Therapy and who
has given me the strength and ability to complete it.
 ABSTRACT

Dance/ movement therapy (DMT) is defined as the “psychotherapeutic use of

movement as a process that furthers the individual’s emotional, cognitive,
social, and physical integration’. DMT can elicit positive change, growth, and
health among adults and children. The purpose of this study was to examine
the effect of Dance/Movement Therapy (DMT) in decreasing levels of
aggression and anxiety on a 19 yrs old adolescence suffering from anxiety and
aggressive anger expressions. The design of this study was CASE STUDY with
pre-post test. A nineteen year old girl was selected who was diagnosed to have
severe anxiety traits by the Psychiatrist. She was also suffering from Disc
degeneration disease L4-L5 and L5-S1. There were also many episodes of
improper anger expression with her in several occasions. An extensively
followed DMT session plan was administered. The dependent variables,
aggression, and anxiety were measured twice throughout the 8 session study.
45mins DMT sessions were given as the interventions. For collecting data I
used HAMILTON ANXIETY RATING SCALE (HAM-A) Reference: Hamilton: The
assessment of anxiety states by rating. Br J Med Psychol 1959; 32:50–55 and
STATE-TRAIT ANGER EXPRESSION INVENTORY-2(STAXI-2) by Charles D
Spielberg. Data was analyzed by comparing pre and post test scores. It was
found that there was a significant difference in aggression and anxiety scores
between the pre and post test of the subject. The Post test showed lower
incidence aggression and anxiety after DMT intervention. The findings of this
case study suggest DMT can be beneficial for adolescent with Anger and
Anxiety. In addition, DMT can provide a sense of safety, self-awareness, other
or people mindfulness, and mental health for the subject.
CONTENT

Introduction ………………………………………………………………………………….4-6

Literature Review ………………………………………………………………………….6-15

Objective ………………………………………………………………………………………16

Case History ………………………………………………………………………………….16

Methodology …………………………………………………………………………………17-20

Result Table ………………………………………………………………………………….21-22

Interpretation ……………………………………………………………………………….22-24

Conclusion ……………………………………………………………………………………24

Reference ……………………………………………………………………………………..25
 INTRODUCTION
Dance movement therapy is the relational and therapeutic use
of dance and movement to further the physical, emotional, cognitive, social,
and cultural functioning of a person. Dance movement therapy is based on the
empirically-supported unity of body and mind.

Dance/movement therapy (DMT) is defined by the American Dance Therapy

Association (ADTA) 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.

It emerged as a field in the 1940’s as early pioneers, many of whom were

accomplished dancers, began to realize the benefit of using dance and
movement as a form of psychotherapy. It is a holistic approach to healing,
based on the empirically supported assertion that mind, body, and spirit are
inseparable and interconnected; changes in the body reflect changes in the
mind and vice versa. DMT as an embodied, movement-based approach is often
difficult to describe, as it is necessary to actively engage in the process to get a
true sense of what it is.

Dance/Movement Therapy Relies on the Following Premises:

 Movement is a language, our first language. Nonverbal and movement

communication begins in utero and continues throughout the lifespan.
Dance/movement therapists believe that nonverbal language is as important
as verbal language and use both forms of communication in the therapeutic
process.

 Mind, body, and spirit are interconnected.

 Movement can be functional, communicative, developmental, and expressive.

Dance/movement therapists observe, assess, and intervene by looking at
movement, through these lenses, as it emerges in the therapeutic relationship
in the therapeutic session.

 Movement is both an assessment tool and a primary mode of intervention.

Using these premises to guide their work, dance/movement therapists use
body movement, the core component of dance, as the primary inroad to their
psychotherapeutic work. Dance/movement therapists approach individual,
couple, family, and group sessions by observing and assessing both their
clients and their own movements, using verbal and nonverbal communication
to create and implement interventions that will address the emotional, social,
physical, and cognitive integration of an individual.

LITERATURE REVIEW
We may associate anxiety with being worried or scared, but some may also
feel a sense of anger, something experts say is common, but shouldn’t be
ignored. Anger and anxiety are generally regarded as different emotional
experiences with some overlap. They have both unique and common
biological, cognitive, and social features, Joshua Nash, a counselor based in
Austin, Texas, wrote an article for GoodTherapy.org in 2014 about anxiety and
anger in particular.

He explains anxiety can morph into anger because we may not be directly
dealing with our anxiety. “Anger very oftentimes is indeed a symptom —
it’s the expression of judging another emotion as too painful to add ress.”

Dr. Eilenna Denisoff, clinical director of CBT Associates in Toronto , says

there are several situations when people with anxiety (or other mental
health conditions) can turn to anger. If someone has an obsessive
compulsive disorder, for example, and they follow a very strict routine,
any kind of disruption from others could lead to anger. “When that gets
activated, they will respond in a way to try to convince other people to
follow their ritual, and if they don’t, they get angry.” And often, when
someone is scared or worried about something, they could turn to anger
to feel more in control of their situation. In relationships, she adds, those
with social anxiety can also start arguments (sometimes on purpose) with
their partners, knowing they could get out of social situations. “We all
have anxiety systems that are natural and normal, but when it interferes
with their quality of life, work or relationships, you need to do something
about it.” And ignoring it, Nash says, is worse. “Unprocessed anger can
also lead to medical issues and most especially relationship issues.
Unaddressed anger festers in the body mind. It sits there waiting to be
unleashed. It either does get unleashed, causing chaos in the person’s life
and/or leads to addiction issues.”

Current Recommended Treatments for Depression and Anxiety

Meta-analytic literature suggests that for mild-moderate anxiety,

psychological and pharmacological treatments are equally effective (NICE,
2009). However, for severe anxiety, psychological therapies are most effective
as an adjunctive treatment to pharmacotherapy, rather than primary
treatment. Several psychological treatments for anxiety have been supported
as effective by evidence-based systematic reviews and Meta analyses.

Currently, the Australian Psychological Society (APS) acknowledges Cognitive

Behavioral Therapy (CBT), Interpersonal Psychotherapy (I PT), brief
psychodynamic psychotherapy, and self-help (primarily CBT-based) to have
Level 1 evidence supporting their use in the treatment of anxiety in adults
(APS, 2010). For treatment of anxiety in adolescents and children, CBT and
family therapy are supported by Level 1 evidence, while IPT has Level 1
evidence for adolescents only (APS, 2010). For mild-moderate generalized
anxiety disorder, meta-analytic literature suggests that psychological
treatment is more effective than pharmacological treatment (NICE, 2011).
Currently the APS (2010) acknowledges CBT to have Level 1 evidence
supporting its use with adults, adolescents and children for treatment of
generalized anxiety.

Need for Further Research in Effective Interventions for and Anxiety

Despite the presence of well-validated treatment options for anxiety, the ABS
(2009) found that in 2007, nearly two thirds (65%) of people with a mental
disorder had not used professional services for their mental health problems
in the 12 months prior to the survey. Of those with mood disorders, 50% had
not sought services for their disorder, while 78% of people with an anxiety
disorder also had not sought services (ABS, 2009).One explanation for this
may be that many people prefer self-help or complementary and alternative
therapies (Wilson & White, 2007). In a study exploring the views of
participants from an anxiety support group in Western Australia, on
treatment processes, Page, Jones, and Wilson (2004) found that nearly all of
the support group members had used some form of complementary or
alternative therapy (88%), while fewer than half had tried cognitive behavior
therapies (44%). Similar results have been found in the United States. For
example, Kessler, Soukup, Davis, Foster, Wilkey, VanRompay et al (2001)
found that of those who had sought traditional treatment for a mental health
problem, 65.9% of the sample with anxiety disorder and 66.7% of the sample
with depression were also using alternative therapies.
This suggested preference for complementary and alternative therapies is
consistent with the ABS's (2008) findings, which report that complementary
and alternative therapies have experienced a general growth in popularity
over the past decade. This suggested preference is also consistent with studies
that indicate that increasingly, who suffer from depression or anxiety are
seeking treatment from complementary therapies as alternatives or adjuncts
to traditional psychotherapy (Jorm, Christensen, Griffiths, & Rodgers, 2002;
Jorm, Christensen, Griffiths, Parslow, Rodgers, & Blewitt, 2004;Thachil,
Mohan, & Bhugra, 2007; Bassman & Uellendahl, 2003; Xue, Zhang, Lin, Da
Costa,
Complementary and Alternative Therapies
Complementary and alternative therapies can be defined as treatments that
involve beliefs and practices that are not generally consistent with
conventional and dominant healthcare practices in Western countries (e.g.
creative arts therapies, acupuncture,naturopathy, yoga, meditation, St. John's
Wort) (Jorm et al., 2002; Brannon & Feist, 2007). As the term suggests,
complementary and alternative therapies can be used as alternatives to
conventional healthcare, or as complementary or adjunctive treatments to
conventional care.
The rise in the use of complementary and alternative therapies impacts the
provision of both medical and psychological services (Wilson & White, 2007).
At present, complementary and alternative therapies are not routinely funded
through Medicare, with the exception of acupuncture. Relevant concerns for
psychologists and psychology, which is a discipline grounded in the
scientific/medical model, include the need for complementary and alternative
therapies to be subjected to more rigorous scientific testing and the need to
determine which complementary therapies can be used for which
psychological disorders (Wilson & White, 2007; Wilson & White, 2011).
Creative arts therapies are a cluster of complementary and alternative
therapies which may potentially be very useful in the treatment of anxiety,
but which require further empirical validation (Malchiodi, 2005; Pratt, 2004).
Creative Arts Therapies
Creative arts therapies work from the evidence-based foundation that
emotional expression is an essential component of mental and physical health
(Goodill, 2010). Creative arts therapies combine the use of art and science to
improve communication and emotional expression, encourage the integration
of physical, cognitive, and social functioning, and promote mental health
(Goodill, 2010). Many difficulties associated with mental illness (e.g.
withdrawal and problems with relationships, engagement with others,
understanding meaning of behaviour, and managing feelings) are difficulties
with communication, and it has been suggested that creative arts therapies
can compensate for this by offering alternative means of communication and
expression (Odell-Miller, Hughes, & Westacott, 2006; Malchiodi, 2005).

When taking into account the potential usefulness of creative arts therapies in
treating depression and anxiety, it is necessary to understand the importance
of emotional expression, as it is one of the primary mechanisms of creative
arts therapies.

Emotional Expression

The importance of emotional expression in facilitating physical and mental

health has been advocated anxiety, but which require further empirical
validation (Malchiodi, 2005; Pratt, 2004). Researchers such as Horowitz
(1986), Kubler-Ross (1969, as cited in Stanton et al. 2000) and Pennebaker
(1997) have long contended that engaging in active processing and expression
of emotion has been found to be beneficial in increasing physical health and
decreasing distress (Stanton et al. 2000; Berry & Pennebaker, 1993; Quartana,
Laubmeier, & Zakowski, 2006). Conversely, literature also suggests that
inhibiting the expression of emotion amplifies the likelihood of become ill and
suffering from other stress-related physical and psychological problems
(Pennebaker, 1997; Carver, 1993; Stanton & Snider, 1993). Emotional
expression can take many forms, but the primary focus, regarding forms of
emotional expression as interventions, has been on expressive writing
(emotional disclosure).
Research on emotional disclosure, pioneered by James Pennebaker and his
colleagues, has found that talking or writing about stressful experiences
results in physical (improved disease-specific outcomes, regulated dopamine,
and liver function) and psychological (decreased depression, anxiety, distress,
anger, and increased subjective wellbeing) benefits (Frattaroli, 2006). Other
forms of emotional expression, through dance, poetry, music, drama, and art
have also been found to be effective as treatments of psychological illnesses,
and these modalities consist as creative arts therapies (Pratt, 2004; Malchiodi,
2005). There are five primary creative arts specialties: dance/movement
therapy, art therapy, music therapy, poetry therapy, and drama therapy
(Goodill; Karkou & Sanderson, 2006).
Each of these specialties have become important facets of medical and
psychological health care and are represented by their own national
organisations that provide professional credentials, organize credentials,
organise education, and foster research and development (Pratt, 2004).
Despite this, creative arts therapies are still not considered mainstream
therapeutic interventions, but rather, part of the larger field of
complementary and alternative therapies. In relation to the need for
alternative and complementary therapies to be evaluated in regard to their
efficacy in treating anxiety, dance and dance movement therapy, in particular,
have the potential to be effective treatments for anxiety.

Dance Movement Therapy

Dance has been a part of human culture for centuries, being used primarily for
spiritual, therapeutic, artistic, and recreational purposes (Aktas & Ogce,
2005). There have, however, been exceptions to these traditional uses of
dance. Intriguingly, a curious phenomenon referred to as the "Dancing Plague"
or "Dancing Mania" emerged in Europe during the thirteenth century. It
entailed people congregating in large crowds to participate in frenzied
dancing; persisting until the point of exhaustion, or sometimes death
(Donaldson, Cavanagh, & Rankin, 1997). The Dancing Plague became a public
health concern, and was later defined as a "psycho-physical disease.... with an
irresistible impulse to motion, and an insane love of music, often sporadic, but
with a tendency in certain circumstances to become epidemic" (Davidson, 1876,
as cited in Donaldson et al., p.201). Speculated causes ranged from demonic
possession, poisoning by tarantula bite, infection, and mental illness, however,
no firm conclusions have been reached. Accounts of the deleterious effects of
dance, such as this, are rare, and today dance has become epidemic"
(Davidson, 1876, as cited in Donaldson et al., p.201). Speculated causes ranged
from demonic possession, poisoning by tarantula bite, infection, and mental
illness, however, no firm conclusions have been reached.
Accounts of the deleterious effects of dance, such as this, are rare, and today
dance has become a key part of the internationally acknowledged, regulated
and scientifically researched therapeutic intervention known as Dance
Movement Therapy (DMT). DMT is the youngest of the creative arts therapies
to be established as a distinct profession (Karkou & Sanderson, 2006). The
American Dance Movement Association (ADMA, 2011) defines DMT as "the
psychotherapeutic use of movement to further the emotional, cognitive, physical,
and social integration of the individual". DMT is based on the premise that the
mind and body are interrelated and DMT therapists focus on movement and
dance and the mind-body connection as a means of addressing feelings,
cognitions, physiological 8 symptoms, and behaviors associated with mental
illness (Odell-Miller, Hughes, & Westacott, 2006; Malchiodi, 2005; Koch,
2006). Key components of DMT entail the mind-body connection, emotional
expression, communication, social interaction, creativity, expressive and
improvisational movement, dance with or without music, psychological
therapeutic techniques, and the therapeutic relationship (Aktas & Ogce,
2005;Karkou & Sanderson, 2006; Boris, 2001; Pratt, 2004; Lumsden, 2006). It
is both an art and a science that is currently driven by empirical research in
psychiatry, psychology, medicine, nursing, physiotherapy, and the discipline
of dance therapy itself (Dulicai & Hill, 2007). Dance therapists can provide
treatment for people with both physical and psychological problems including
somatic disorders, anxiety, depression, heart disease, and cancer (Serlin,
2010).
Treatment Mechanism and Therapeutic Qualities of Dance/DMT
It is suggested that a number of components make dance/DMT useful
interventions in increasing general wellbeing and reducing anxiety and
depressive symptoms (Jorm et al., 2002). One key component is physical
exercise, which has been found to effective in reducing depression and
anxiety, increasing psychological wellbeing, relieving physical and 10 mental
tension, and regulating serotonin and dopamine levels, which play key roles in
anxiety and depression (Mead, Morley, Campbell, Greig, McMurdo, & Lawlor;
2010, Brannon & Feist, 2007; Annesi, Merali, Poulter, & Hayley, 2005; Dunn,
Trivedi, & O'Neal, 2001; Netz, Wu, Becker, and Tenenbaum, 2005; Sadock &
Sadock, 2007). The fun and pleasurable aspect of dancing is argued to be
another therapeutic component of dance/DMT, as increasing the client's
engagement in pleasurable activities is a behavioral strategy that is used to
reduce anhedonia (loss of interest in pleasurable activities), a core symptom
of depression (Sadock & Sadock, 2007; Gioino, 2005). The integration of
physical with psychological treatment, discussed above, is a unique facet of
dance/DMT, which allows it to be a wholistic intervention. Augmenting
psychological treatment with dance or DMT may allow for a more effective,
efficient, and comprehensive treatment approach that addresses both the
physiological and psychological aspects of depression and anxiety (Dulicai &
Hill, 2007). Social interaction (Westen, Burton, & Kowalski, 2006; Aktas &
Ogce, 2005; Haboush et al., 2006), emotional expression (Rohricht, 2009;
Odell-Miller et al., 2006; Malchiodi, 2005), and mental engagement (Sadock &
Sadock, 2007; Gioino, 2005; Brannon & Feist, 2007) can also all be argued to
be therapeutic components of dance which target symptoms specific to
depression and anxiety.
Neuropsychological Theory Regarding the Mechanism of Dance/DMT
Research in neuroscience has explored the existence of "mirror neurons"
which may play a significant role in empathy and mutual understanding
(Gallese, Eagle, & Mignone, 2007). Researchers have discovered that when a
person witnesses another individualexhibiting movement appropriate to the
emotion that individual is feeling (e.g. displaying a negative facial reaction in
response to eating a sour lemon slice), brain areas appropriate to the
emotional expression of the other individual will demonstrate excitation
(Gallese et al., 2007; Eagle, Gallese, & Mignone, 2009). In other words, like a
mirror-image, the same sets 11 of neurons (mirror neurons) are excited in the
individual observing, as in the individual expressing the emotion or behaviour
(Berrol, 2006). Gallese (2009) argues that mirror neurons contribute to a
mechanism referred to as "embodied simulation", which facilitates our ability
to share the meaning of actions, intentions, feelings, and emotions with others,
providing a foundation for our identification and connectedness with others,
empathy, and our sense of "we-ness". Connections have been made regarding
the role mirror neurons play in empathy and the mechanism of dance/DMT
(Rohricht, 2009). Empathy involves not only emotionally or intellectually
understanding another's emotional state, but also, to some degree, vicariously
experiencing that state (Berrol, 2006). A key aspect of DMT is "movement
mirroring" or "empathic reflection", through which the therapist gains the
trust of the client by feeling and communicating empathy (Dulicai & Hill,
2007). Mirroring does not necessarily involve actual imitation or replication
of the client's actions or words, but rather harmonising and complementary
responses (Eagle et al., 2009; Berrol, 2006). The work of mirror neurons in
sharing and interpreting the emotions of others therefore allows therapist
and client to communicate via movement, permits the therapist to express
empathy, and facilitates the client in feeling "heard" and understood.
Review of Research Examining Effectiveness of Dance/DMT on Anxiety:
Does it Work?
Several systematic reviews have examined the potential usefulness of
dance/DMT as an intervention for anxiety. Jorm et al (2004) reviewed the
effectiveness of complementary and self-help treatments for anxiety disorders
and found that dance/DMT was supported by Level II evidence in reducing
anxiety. They concluded that further study is needed to validate the efficacy of
dance/DMT in reducing anxiety. In their review of complementary and self-
help treatments for anxiety disorders in adolescents and children, Parslow,
Morgan, Allen, Jorm, O'Donnell, & Purcell (2008) found that dance/DMT
wassupported by Level 3b evidence and concluded that there are few studies
of adequate quality which have investigated the use of complementary and
self-help treatments for adolescents and children. In sum, these reviews
indicate that dance/DMT are potentially useful interventions for depression
and anxiety, however at present there is insufficient high-quality evidence to
provide adequate validation for their use.

Dance and Rhythmic Movement have been used to enhance expression and
modify emotions for centuries. Dance Movement Therapy has been used as a
form of Art Therapy in the western world since the early 1950s (Berrol, 1990;
Palo-Bengtesson and Ekman, 1997). DMT combines music, light exercise and
sensory stimulation and would provide a non-pharmacological treatment of
mild depression. A recent summary of research reported that DMT aids
recovery from the psycho-social and psycho-physical effects of physical
trauma and diseases such as cancer, heart diseases, neurological impairments,
(e.g., hemiplegia or brain injury), systemic lupus erythematosus, chronic pain,
and after surgery (e.g., limb amputation) (McKibben, 1988, cited in
BibbellHope, 2000). The literature suggests that DMT produces both
subjective and objective improvements including redefining and
strengthening body image; clarifying ego boundaries; providing an outlet for
relief of physical tension, anxiety, and aggression; reducing cognitive and
kinesthetic disorientation; increasing the capacity for communication,
pleasure, fun, and spontaneity; and support for therapeutic medical goals
(Seide, 1986). Other research studies describe the use of DMT with patients
with specific diseases including cardiac disease, AIDS, cancer, and
neuropathology (Chang, 1988, cited in Bibbell-Hope, 2000).
Thirteen studies of 469 participants total, analyzed for anxiety, self-concept,
body awareness, and separately for all psychiatric patients. Finding: Effect
size values were comparable to those published for CBT, at the time.

An update of Cruz and Sabers, using 23 studies of 1078 participants total.

Findings as excerpted from the Abstract, with emphasis added: “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.”

Anger
Anger or wrath is an intense emotional state. It involves a strong
uncomfortable and hostile response to a perceived provocation, hurt or
threat.

A person experiencing anger will often experience physical conditions, such as

increased heart rate, elevated blood pressure, and increased levels
of adrenaline and non-adrenaline. Some view anger as an emotion which
triggers part of the fight or flight brain response. Anger is used as a protective
mechanism to cover up fear, hurt or sadness. Anger becomes the predominant
feeling behaviorally, cognitively, and physiologically when a person makes the
conscious choice to take action to immediately stop the threatening behavior
of another outside force. The English term originally comes from the
term anger of Old Norse language.

Anger can have many physical and mental consequences. The external
expression of anger can be found in facial expressions, body language,
physiological responses, and at times public acts of aggression. Facial
expressions can range from inward angling of the eyebrows to a full frown.

While most of those who experience anger explain its arousal as a result of
"what has happened to them," psychologists point out that an angry person
can very well be mistaken because anger causes a loss in self-monitoring
capacity and objective observability.

Modern psychologists view anger as a primary, natural, and mature emotion

experienced by virtually all humans at times, and as something that has
functional value for survival. Uncontrolled anger can, however, negatively
affect personal or social well-being and impact negatively on those around
them. While many philosophers and writers have warned against the
spontaneous and uncontrolled fits of anger, there has been disagreement over
the intrinsic value of anger. The issue of dealing with anger has been written
about since the times of the earliest philosophers, but modern psychologists,
in contrast to earlier writers, have also pointed out the possible harmful
effects of suppressing anger.

Anger is inversely proportional to DMT session. With help of mirroring

therapist enhances rapport uses a lot of empathy “Mirroring, an exercise
practiced in Dance/Movement Therapy (DMT), is considered by practitioners
and patients to enhance emotional understanding and empathy for others…In
this review, [the authors] propose that mirroring in DMT enhances
understanding of others’ emotional intentions through enhanced use of
mirror neuron circuitry.

Anxiety
When an individual faces potentially harmful or worrying triggers, feelings of
anxiety are not only normal but necessary for survival.

Since the earliest days of humanity, the approach of predators and incoming
danger sets off alarms in the body and allows evasive action. These alarms
become noticeable in the form of a raised heartbeat, sweating, and increased
sensitivity to surroundings.

The danger causes a rush of adrenalin, a hormone and chemical messenger in

the brain, which in turn triggers these anxious reactions in a process called
the "fight-or-flight' response. This prepares humans to physically confront or
flee any potential threats to safety.

For many people, running from larger animals and imminent danger is a less
pressing concern than it would have been for early humans. Anxieties now
revolve around work, money, family life, health, and other crucial issues that
demand a person's attention without necessarily requiring the 'fight-or-flight'
reaction.

The nervous feeling before an important life event or during a difficult

situation is a natural echo of the original 'fight-or-flight' reaction. It can still be
essential to survival – anxiety about being hit by a car when crossing the
street, for example, means that a person will instinctively look both ways to
avoid danger.
OBJECTIVE
In the present case study the effect of Dance Movement Therapy was
measured on Anger Expression and Anxiety using State-Trait Anger
Expression Inventory 2 and Hamilton Anxiety Rating Scale.

CASE HISTORY
 19 year old female

 Pursuing Graduation

 Nuclear Family

 Parents both working

 Socio-Economic Status: Upper Middle Class

 Stays in Hostel with her roommates away from Hometown

 Complaining about feeling Anxious and Stressed

 Diagnosed with Anxiety and Disc Degenerative Disease L4-L5 and L5-S1
by psychiatrist and other related medical practitioners.

 The subject was a state level swimming and taekwondo champion

 Complaining about inability to control Anger outburst in professional

and personal setups.

 Frequent vascular headache

 Loss of Appetite

 Acute Sleep disturbances

METHODOLOGY
A pre-post design was used for the present case study. The Laban Movement
analysis was done before starting with any DMT session with the help of
Laban Movement Analysis Chart and again after 4 sessions the same analysis
was conducted with the help of LMA Chart. The subject was given the
Hamilton anxiety Rating Scale and State-Trait Anger Expression Inventory 2,
both self-report inventories. This was followed by 8 sessions of
dance/movement therapy, each session being 45 minutes long. Once all the 8
sessions were completed, the inventories were given once again. The results
were compared and interpretations drawn.

Techniques used-
 Breathing techniques
 Shiatsu
 Release Methodology
 Mirroring
 Symbolism
 Isolations
 Behavioural / Psychological Qualities of Effort Elements
by Connie Cook

Pre Session Assessment

Effort Element Effort Quality

Free – Negative - Lack of control
when needed
Positive – Easy going, whole
Flow hearted
(ease or restraint of the action) Bound – Negative – Inhibited,
Repressed
Positive - Prepared
Light – Negative – Superficial,
Weight Shallow
(about concept of self; sensitivity or Positive – Diplomatic, Delicate,
forcefulness of intention) Sensitive
Strong – Positive - Energetic
Sustained – Negative – Overly
Time hesitant
(the leisureliness or urgency of Sudden – Negative - Hasty
decisions) decisions, Easily panicked, Over
excited
Positive – Quick Decision and Idea
Indirect – Negative – Avoiding
situation, Poor concentration,
Space Fragmented, Scattered
(Flexibility of directedness of Positive - Awareness of whole
attention) environment; perspective
Direct – Negative – Rigid holding to
the point
 Behavioural / Psychological Qualities of Effort Elements
by Connie Cook
Post Session Assessment

Effort Element Effort Quality

Free – Positive – Easy going, whole
hearted, a “going with” In situation
rather than resisting momentum
Bound – Positive – Careful,
Flow Prepared, In control
(ease or restraint of the action) Negative – Fear of letting emotions
flow
Light – Positive – Sensitivity,
Weight Delicate, Gentle, Buoyant,
(about concept of self; sensitivity or Diplomatic
forcefulness of intention) Strong – Positive – Strong willed,
Energetic, Healthy aggression
Sustained – Positive – Enjoying
Time leisure, Smooth gradualness of
(the leisureliness or urgency of process
decisions) Sudden – Positive – Creative,
Efficient, Lively
Indirect – Positive – Flexibility,
Exploring for new possibilities,
Space Awareness of whole environment;
(Flexibility of directedness of perspective
attention) Direct – Positive – Keeping to the
point, Not easily distracted
 Dance Movement Therapy Sessions

DMT Session Techniques Used Description

Session 1 Integration and The client was made comfortable and DMT
Rapport orientation was given
Establishment

Session 2 Breathing exercises Relaxing breathing exercises were given with

soft background music making the client aware
of the speed and intensity of the breathing and
establishing control over it.

Session 3 Isolation Isolated body part movement was given to

increase flexibility and enhance co-ordination. It
also enhanced the body awareness.

Session 4 Release methodology Simple Release movement was introduced but

not with sudden fall movement as the client has
a medical history of spinal cord injury.

Session 5 Mirroring The client was instructed to simply make

movements which I, as a therapist was
mirroring. Thus it was taken as a inlet to the
clients traumas and inhibitions by the therapist.
There was a lot of emotional expression after
completion of the session.

Session 6 Symbolism with props The client was given a peacock feather as a prop
and was asked to balance focusing a point in the
feather. The soothing background music was
there. The client could really connect with
feather as something very powerful and was
able to express out her inward suppressed anger

Session 7 Shiatsu The message technique was given to relax and

strengthen the spinal cord movement.

Session 8 Closure All the techniques were assimilated and

comprehended. The client- therapist
relationship was enriched and insight was
established in the client, about the problem she
was suffering from.
RESULTS TABLE

SCALE PRE TEST POST TEST

Somatic Anxiety 16 12

Psychic Anxiety 14 6

State Anger 10 10

Trait Anger 35 20

Temperament 18 15

Reaction 13 10

Anger In 32 20

Anger Out 29 20

Control 28 23

Anger Expression 33 17

Note:

I was interested in the effect of DMT on Trait Anger and not on State Anger.
The reason is that State Anger varies from time to time and from situation to
situation. Trait Anger on the other hand, is more permanent and a person’s
predisposition towards anger expression.
Graph Showing Differences between Pre-Test and Post-Test Scores

40
35
30
25
20
15 PRE TEST
10 POST TEST
5
0

INTERPRETATION
From the above result table, it can be seen that there has been an effect of
DMT on both Anxiety and Anger Expression. Somatic Anxiety which was 16 in
the beginning has seemed to have reduced by 4 points to 12. Scores around 20
are generally considered to be high Somatic anxiety and those around 11 are
considered to be Average anxiety. Thus, for the present testee, Somatic
anxiety has reduced from high level to average level of Anxiety. Psychic
anxiety score which was 14 in the beginning has been reduced by 8 points to
6. Scores around 20 are generally considered to be high anxiety and those
around 6 are considered to be mild anxiety.

Shennum (1987) found out that the children who received DMT sessions had
lower levels of emotional unresponsiveness and negative acting out
According to multiple studies, Dance Movement Therapy has been proven to
reduce anxiety in individuals, including those who suffer from depression and
anxiety in social scenarios. For example, dance techniques have been shown
to help enhance self-expression and confidence in those who are socially
anxious, ultimately increasing their ability to feel comfortable in settings that
involve interacting with other people.

Trait Anger has reduced from 35 to 20, that is it has reduced by 15 points. The
lowest possible score is 24.55 for females and highest possible score is 18.
Thus a score around 20 can be considered to be lower side. The Temperament
has reduced by 3 points from 18 to 15. The highest possible range is 8.98 for
females and the lowest is 3.88.

The reaction of anger has reduced from 13 to 10 where the lowest and highest
possible score ranges from 7.07 and 12.49 respectively.

The inward expression of Anger has reduced by 12 points (from 32 to 20)

where the lowest and the highest score range from 11.46 to 19.94 in females.

The outward expression of Anger has reduced by 9 points (from 29 to 20)

where the lowest and the highest possible scores are 10.9 to 18.94 in females.

The Anger control which was 28 in the beginning has reduced by 5 points. The
lowest and the highest possible score are 16.56 to 27.56 in females.

The Anger expression which was 33 in the beginning has reduced by 16

points. The lowest and highest possible scores are 14.39 to 32.07 in females.

DMT can improve positive coping skills, impulse control, and self- esteem;
bring social support and interactions, self-awareness, improve body language,
body boundaries, in addition, to building empathy and ability to form healthy
relationships with others.

Therefore, the present subject has shown a reduction in Anxiety score and
Anger Expression scores after 8 sessions of DMT.

Thus it can be said that DMT had an effect on both Anxiety and Anger
expression. DMT has neuro-physiological effects. Breathing techniques
Shiatsu and release methodology along with rolling methodology used in DMT
help activate the parasympathetic nervous system, which improves the blood
flow of the body and helps in creating an overall feeling of calmness. DMT also
increases the release of “feel-good” hormones like endorphin, serotonin and
adrenaline and reduces the release of stress hormone like cortisol. The above
may be stated as the reasons behind the reduction in anxiety and anger for the
present subject.

CONCLUSION
The findings of this case study suggest DMT can be beneficial for adolescent
with Anger and Anxiety. In addition, DMT can provide a sense of safety, self-
awareness, other or people mindfulness, and mental health for the subject.

Note- There is certain limitations to this particular study due to time

constraints. If however, longitudinal studies are conducted the results will be
better and the case study more reliable and valid.
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