Dance as a Complex Intervention in an Acute Mental Health Setting: A Place 'In-Between'
Froggett, Lynn, Little, Robert, British Journal of Occupational Therapy
This article discusses the evaluation of a dance programme in the United Kingdom. There is little research specifically on dance within hospital-based environments. The aim was to ascertain whether dance is a useful intervention for service users in such an environment; to identify its effects on participants' inner-world experience; and to understand whether it has a positive contribution to hopefulness, as identified by Spandler et al (2007) in a national study of the effect on mental health of engaging with the arts. Dance was viewed as a complex intervention (Creek and Lawson-Porter 2007), demanding a mixed-method approach (Flick 2002) that illuminated psychosocial, rather than clinical, benefits.
The programme involved collaboration between a professional female dancer employed by a local dance institute, who conducted the sessions on a voluntary basis, and hospital-based staff who were keen to extend cultural activities. The dancer had a particular interest in the potential of dance in mental health contexts and, although no formal agreement with the dance institute was involved, the project, if evaluated as having positive effects on participants, had implications for future partnerships between the hospital and local cultural institutions. The hospital was interested in demonstrating its commitment to cultural provision and had commissioned a local film company to document the programme before the research team began the evaluation. Subject to participant consent, unedited film footage was made available to the research team as data. This rather unusual set of circumstances enabled detailed observation of microprocesses of engagement by a research panel. The evaluation drew on four methods of data collection.
Creative activities have an important place within contemporary occupational therapy (Perruzza and Kinsella 2010). Research has identified dance as a multidimensional experience, involving emotional, physical, spiritual and social elements (Murciaa et al 2010). It can raise perceived levels of physical and mental wellbeing and social contact (Kierr 2011), including among those diagnosed with depression and anxiety (Payne and Stott 2010). These improvements appeared cost effective when compared with other interventions, such as cognitive behavioural therapy (Payne and Stott 2010).
Policy-driven imperatives of cost effectiveness have demanded research that identifies which elements of intervention produce particular effects within given time periods (Staricoff 2006). Practitioners are more likely to be concerned with contextual and relational factors (Payne 2006). Within the National Health Service (NHS), interventions are primarily appraised according to clinical outcomes. In mental health settings, benefits of using dance have included reducing challenging behaviour by people with dementia (Hokkanen at al 2003), relieving symptoms of depression (Koch et al 2007) and reducing negative symptoms of schizophrenia (Xia and Grant 2009). Non-clinical outcomes include dance being described as energising and enjoyable (Cook and Ledger 2005).
Within dance movement therapy (DMT), the relational context of dance has been emphasised (Bloom 2006). Berrol (2000) stressed the need for evaluation of dance in different contexts. Listening to music has been found to reduce agitated behaviour in those with dementia (Sung and Chang 2005) and to increase social engagement (Harrison et al 2010). Physical exercise (without music) can improve both positive and negative symptoms of schizophrenia (Acil et al 2008).
Clinically focused studies have not captured complex contextual and relational elements, such as setting and group interaction. The mixed-method psychosocial approach adopted in this study investigated this complexity by examining the ways in which the dance programme affected the inner-world experience of participants; their orientation to social life within the hospital; and any impact on the hopefulness with which they were able to contemplate life outside it. …