Volume: 26, Issue: 1
Page: 124-129
International Journal of Science and Business
2023
Journal homepage: ijsab.com/ijsb
Dance Movement Therapy Intervention on
Anxiety Symptoms in Palliative and
Hospice Carers in Nursing Department
Richard Yunxi Zuo & Lanye Wang
Abstract
This article demonstrates the effect of using Dance Movement Therapy
(DMT) to alleviate stress symptoms in Palliative and Hospice carers. Twenty-
five carers participated in the study, and ten of them underwent DMT.
Researchers recorded the changes in these participants' movement patterns
during three therapy sessions and analyzed the results using Laban's effort-
shape system. By comparing the movement patterns before and after the
therapy, the study shows a significant improvement in stress levels among
palliative and hospice carers. However, further studies are needed to IJSB
Accepted 02 August 2023
strengthen the evidence base. Published 06 August 2023
DOI: 10.58970/IJSB.2160
ISSN: 2520-4750 (Online) 2521-3040 (Print)
Papers published by IJSAB International are
licensed under a Creative Commons Attribution-
NonCommercial 4.0 International License.
Keywords: Dance Movement Therapy, Laban Movement Analysis, Anxiety Symptoms.
About Author (s)
Richard Yunxi Zuo (Corresponding Author), Guangdong Experimental High School (GEHS),
Guangzhou, China.
Lanye Wang, Guangdong Experimental High School (GEHS), Guangzhou, China.
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1. Introduction and Introducing Dance Movement Therapy
Due to the increasing awareness of psychological health, people are gradually focusing on the
current mental state of medical workers, including doctors, nurses, and care workers. In China,
healthcare workers providing palliative and hospice care commonly encounter experiences
with death, questioning of individuals' faiths, confronting impossible care situations, and
experiencing secondary trauma (White et al., 2004; Rokach, 2005, 2017). Under these
circumstances, healthcare workers providing palliative and hospice care are more likely to
suffer from stress symptoms. According to Sadauskas and Benošytė's (2016) investigation, all
the social workers who participated in the research expressed stress while offering palliative
care to patients. To address this issue, our researchers conducted a simple Dance Movement
Therapy intervention, which yielded positive results. This official report investigates the
impact of Dance Movement Therapy (DMT) on the psychological stress experienced by care
workers providing palliative and hospice care in a nursing department.
Dance Movement Therapy (DMT) has been regarded as an art therapy since the early 1950s
(Berrol, 1990; Palo-Bengtsson & Ekman, 1997). In DMT, movements act as therapeutic tools to
facilitate emotional, cognitive, physical, and social integration (ADTA 2013). Both DMT and
Body Psychotherapy share the view that the overall state of the body, mind, and spirit can
influence each other; conversely, altering physical movements of the body can also affect the
mind and spirit. The tool used to analyze and assess DMT is based on Rudolf von Laban's Effort-
Shape system (Laban 2011). This system requires researchers to observe participants' body
movements and body language as evaluation criteria to assess the inner state of the
participants. For the EFFORT aspect, it can be divided into four factors: Space, Weight, Time,
and Flow, each of which reflects distinct inner intentions of people (Laban 2011; Stanton-Jones,
1992). All four factors have two ways to be accessed. Space can be described as either Direct
or Indirect, representing whether the movement is straightforward and without hesitation or
flexible, agile, and multi-focused. Weight is also described through two aspects: Light and
Strong. A weak and relaxed movement is considered Light, while an unwavering and long-
lasting movement is considered Strong. Time is divided into two features: Quick and Sustained,
which are more correlated to people's decision-making. Quick movement indicates fast
implementation of actions, while Sustained movement implies sluggish, motionless
movements. As for the perspective of Flow, it can be described as either Free or Bound, used to
define whether a movement is relieved or restricted.
Distinct movements can reflect different intentions of a person. For instance, when a person
performs direct movements, it can indicate that the person is focused and less likely to be
disturbed by others. Conversely, if a person performs indirect movements, he or she is more
likely to transfer attention through multiple things. If a person exhibits lots of strong
movements during the therapy, he or she can be regarded as a consistent person who is likely
to resist other opinions and thoughts. On the other hand, a person with Light movements is
perceived as more soft and relaxed. Furthermore, if a person tends to have Quick movements,
he or she will more likely experience nervous and anxious feelings, while Sustained movements
represent cheerful and leisurely feelings. In terms of mental state, a person with Free
movements can be seen as fearless and bold under the current circumstances, while people
with Bound movements show opposite characteristics, meaning they feel restrained and
concerned.
Regarding another aspect of DMT—SHAPE, it can be defined as the relationship between
actions and their immediate surroundings. It usually describes how the body encloses, spreads,
rises, sinks, advances, or retreats (Shafir 2016). These actions are indicators of people's distinct
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mental states. For instance, retreating, condensing, enclosing, binding, or moving backward can
elicit fear. Strong, sudden, forward, or direct movements may elicit anger, whereas passive
weight, bringing the arm to the upper part of the body (such as the chest, shoulders, or face),
sinking or dropping the head can elicit sadness. On the other hand, happiness can be expressed
through jumping, rising, spreading, and free, light, upward, or rhythmic movements (Shafir
2016)
2.Methodology
2.1 Experimental design
Volunteers were recruited from 25 palliative and hospice care workers employed in nursing
apartments of a second-class hospital in the Guangdong-Hong Kong-Macao Greater Bay Area
(GBA). These 25 care workers voluntarily participated in the study and were asked to complete
the Self-rating Anxiety Scale (SAS) to assess their recent feelings. SAS is a professional mental
state assessment tool designed by Zung et al. (1990).
All GBA carers took the SAS test under supervision and within the same time period to ensure
the quality of the collected questionnaires. The SAS scale comprises 20 questions that assess
daily psychological status, psychomotor disturbances, somatic disorders, and anxiety
disorders. Each question is rated on a frequency scale of 1 to 4, indicating "a little of the time,"
"some of the time," "usually," or "most of the time" (Hao Xu Dong, 2020). Questions 5, 9, 13, 17,
and 19 are negatively worded, with scores reversed on a 4-to-1 scale. The raw scores for each
question were aggregated and multiplied by 1.25, and then rounded to integer numbers.
A score of 50 is the boundary for determining anxiety. Participants who scored below 50 were
considered to have normal levels of anxiety. Scores between 50 and 59 indicated mild anxiety,
while scores between 60 and 69 indicated moderate anxiety. Scores above 69 were classified
as severe anxiety. The participants included five males and 25 females, ranging in age from
their mid-20s to mid-45s, with an average SAS rating above 49. Ten of them scored above 50,
indicating mild anxiety. Four participants scored above 60, indicating moderate anxiety. To
address the psychological stress among Care Workers, ten of those who scored above 50
underwent DMT.
2.2Therapy Sessions
The DMT sessions were arranged in a total of two sessions, each lasting 60 minutes, with a
format that included dance experiences, sharing, and communication. The purpose of the first
activity was to build and integrate the team, allowing the team members to get acquainted with
each other, open their hearts, promote physical activity, foster openness, and recognize the
connection between emotions and the body. The additional activity aimed to inspire and
motivate team members to enrich their own action library based on the team's motivation,
encouraging them to explore various ways to express emotions. This process further opened
the possibilities for physical activity and helped team members gain a deeper understanding
and acceptance of their emotions through their own actions, ultimately achieving the goal of
releasing pressure.
Each session was divided into three main themes: (a) warming up, (b) releasing the body, and
(c) action intervention. During the warming-up phase, participants were asked to introduce
themselves using body language, and share their name, the current weather, and their feelings.
In the second part, participants listened to different styles of music, such as jazz, absolute
music, piano music, and rock, and were encouraged to express their feelings through body
movements in response to the rhythms. The final part of the session gradually led participants
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to move freely in the space, guiding them to adjust their breath and observe the entire process.
Eventually, they were directed to find a safe and comfortable place to sit, where they could
draw or write down their inner awareness and feelings. Throughout the sessions, researchers
recorded the form and state of each participant and measured the physical movements and
inner emotional changes of the team members from multiple dimensions using Laban's Effort-
Shape system. These dimensions included Space, Weight, Time, Flow, and the Shape of the
movements (such as changes in vertical dimension, lengthening or shortening, changes in
horizontal dimension, widening or narrowing, drumming, or deflating)
2.3Results:
(1) The results of the ten people movement in DMT in the first theme are shown in Table 1.
Table 1: The results of the ten people movement in DMT in the first theme.
Participants Shape Weight Space Flow Time
A male Small/extension/narrow/deflate Light Indirect Bound Quick
B female Small/shorten/narrow/deflate Light Indirect Bound Quick
C male Small/shorten/narrow/deflate Light Indirect Bound Quick
D female Large/shorten/narrow/deflate Light Indirect Bound Quick
E female Large/shorten/narrow/deflate Light Indirect Bound Quick
F female Small/shorten/narrow/deflate Light Indirect Bound Quick
G female Small/extension/narrow/deflate Light Indirect Bound Quick
H female Small/shorten/narrow/deflate Light Indirect Bound Quick
I female Small/extension/narrow/deflate Strong Direct Free Sustanined
J female Small/extension/narrow/deflate Strong Indirect Bound Quick
The data in Table 1 indicates that during the first theme of DMT, 70% of the participants
displayed small, shortened, narrowed, and deflated movements, suggesting that they were
relatively nervous and stressed during the initial phase of the therapy, reflecting their anxious
inner state. Additionally, eight out of ten participants showed light movements, indicating that
most of them exhibited softness and inconsistency in their emotions and thoughts. Regarding
the Space aspect, only one person demonstrated direct movement, while the remaining
participants seemed unfocused on their personal feelings and likely to be influenced by their
surroundings. Similar patterns were observed in the perspective of Flow and Time, as most of
the participants exhibited restricted, constrained, and quick movements, symbolizing inner
tension, closure, and a tendency to become worried and intense.
(2) The results of the ten people in DMT in the second theme are shown in Table 2.
Table 2: The results of the ten people in DMT in the second theme.
Participants Shape Weight Space Flow Time
A male Large/extension/Widen/deflate Light Indirect Free Quick
B female Large/extension/Widen/drum Light Direct Free Sustanined
C male Small/shorten/narrow/deflate Strong Indirect Bound Quick
D female Large/extension/Widen/deflate Strong Direct Free Sustanined
E female Small/extension/narrow/deflate Strong Indirect Free Sustanined
F female Large/extension/Widen/drum Light Direct Free Sustanined
G female Small/extension/Widen/deflate Strong Indirect Free Sustanined
H female Large/extension/narrow/deflate Light Indirect Free Sustanined
I female Large/extension/Widen/drum Strong Direct Free Sustanined
J female Large/extension/Widen/deflate Strong Indirect Free Quick
(3) The results of the ten people in DMT in the third theme are shown in Table 3.
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Table 3: The results of the ten people in DMT in the third theme
Participants Shape Weight Space Flow Time
A male Large/extension/Widen/drum Strong Strong Free Sustanined
B female Large/extension/Widen/drum Strong Strong Free Sustanined
C male Large/extension/Widen/drum Strong Strong Free Sustanined
D female Large/extension/Widen/drum Strong Strong Free Sustanined
E female Large/extension/Widen/drum Strong Strong Free Sustanined
F female Large/extension/Widen/drum Strong Strong Free Sustanined
G female Large/extension/Widen/drum Strong Strong Free Sustanined
H female Large/extension/Widen/drum Light Strong Bound Sustanined
I female Large/extension/Widen/drum Strong Direct Free Sustanined
J female Large/extension/Widen/drum Strong Indirect Bound Sustanined
Upon comparing the comes about from Table 2 and Table 3, it is clear that there are critical
changes within the participants' developments.
The analysis of movement changes between Tables 2 and 3 reveals a gradual transformation
in the participants' movement shapes. Initially, the movements were characterized by being
small, short, narrow, and inflated, indicating feelings of anxiety. However, through the DMT
process, these anxious feelings gradually dissipated and were replaced with confidence, joy,
cheerfulness, and a more open-hearted acceptance of their emotions. Subsequently, their
movements became more pronounced, large, extended, widened, and drummed.
The observed changes within the participants' developments propose that they got to be more
centered on their current state of development amid the DMT session. They illustrated
commitment to their choices, and their movements showed up solid, coordinate, free, and
supported. These signs indicate that after engaging in the DMT session, the members felt more
freed, at ease, and loose. In outline, the change in development shapes watched in Table 3
outlines the positive affect of DMT on the participants' emotional state. The therapy seems to
assist them to release their anxious feelings and become more confident and open outlook
towards their emotions and movement expressions.
3.Conclusions
The report demonstrates that the application of Dance Movement Therapy has appeared
promising comes about in diminishing mental pressure among carers providing palliative and
end-of-life care. By analyzing development designs utilizing Laban's effort-shape system, the
treatment was found to be related with diminished levels of stress and anxiety in healthcare
workers These discoveries propose that incorporating and empowering the utilize of DMT
within the mental treatment of health care workers could be a valuable approach. However, it
is fundamental to acknowledge certain limitations within the report, essentially stemming
from the little test measure utilized within the think about. With a constrained number of
members, the information may not be completely agent of a bigger population of healthcare
specialists in comparative settings. As a result, the discoveries may not be effectively
generalizable to a broader setting. To strengthen the reliability and validity of the results,
further research with a larger and more diverse sample is warranted. Future studies should
also consider implementing longer-term follow-up assessments to examine the sustainability
of the positive effects observed in this study. Additionally, the inclusion of control groups in the
research design could provide better insight into the specific impact of DMT compared to other
interventions or no intervention at all. Despite these limitations, the report provides valuable
insights into the potential benefits of Dance Movement Therapy for healthcare workers,
particularly those facing the challenges of palliative and end-of-life care. This highlights the
significance of addressing psychological stress in this profession and highlights the need for
continued research to build on these initial findings.
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In conclusion, while the report demonstrates the potential advantages of DMT in reducing
psychological stress in health care workers, it is important to recognize the limitations and call
for further investigation to strengthen the evidence base for the use of DMT in psychological
treatment.
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Cite this article:
Richard Yunxi Zuo & Lanye Wang (2023). Dance Movement Therapy Intervention on Anxiety
Symptoms in Palliative and Hospice Carers in Nursing Department. International Journal of
Science and Business, 26(1), 124-129. doi: https://doi.org/10.58970/IJSB.2160
Retrieved from http://ijsab.com/wp-content/uploads/2160.pdf
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