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Body-Awareness and Movement-Based Group Treatments for Stress TRISTIN RONEY, MA JENNIFER CANNON, PH.D. Bräuninger, I. (2012). Dance movement therapy group intervention in stress treatment: A randomized controlled trial (RCT). Arts in Psychotherapy, 39(5), 443-450. doi:10.1016/j. aip.2012.07.002 Nyklíček, I., Mommersteeg, P. M. C., Van Beugen, S., Ramakers, C., & Van Boxtel, G. J. (2013). Mindfulness-based stress reduction and physiological activity during acute stress: A randomized controlled trial. Health Psychology, 32(10), 1110–1113. doi:10.1037/a0032200.

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recently published poll conducted by the American Psychological Association (APA) found that 20% of surveyed Americans report levels of stress at an 8, 9, or 10 on a 10-point scale, with 10 indicating the highest levels of stress. About three-quarters of these surveyed Americans reported that their stress levels have increased or stayed the same in the past year (APA, 2013). Researchers find that stress quite possibly plays a role in the development and/or prognosis of diseases as diverse and widespread as depression, cardiovascular disease, HIV/AIDS, and cancer (Cohen, Janicki-Deverts, & Miller, 2007). In light of this, the fact that only 37% of American respondents believe they are doing a good to excellent job of managing stress is significant and deserves our attention (APA, 2013). Stress is defined as how the body reacts to real or imaginary stressors (Lazarus & Folkman, 1984). While few clinical treat-

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ments focus on stress reduction alone, most approaches incorporate an element of stress reduction that involves controlling the emotional, cognitive, and physical responses to stress (Folkman, 2010). Treatments that make body awareness their focus may be particularly successful at improving clients’ coping abilities. This would be due to the strong physical components of the human stress response (Edwards, 1988). The purpose of this article is to review two studies that address the treatment of stress through the use of different forms of body awareness. The first of these two articles is based on research conducted in the Netherlands by Nyklíček and colleagues (2013). They examined the effects of Mindfulness-Based Stress Reduction (MBSR) on cardiovascular and cortisol activity during acute stress. According to the protocol developed by Jon Kabat-Zinn (1990), MSBR therapy groups consist of eight weekly, 150-minute sessions incorporating mindfulness, defined by Kabat-Zinn as “paying attention… on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p. 4), as well as education, mindfulness practice, and experience sharing. This treatment also includes 45 minutes of home mindfulness practice. The educational portion of MBSR focuses on learning to recognize and interrupt maladaptive thought patterns and uses various mindfulness techniques, such as body scans and sitting and walking meditation. This study included an original sample of 88 community participants, with 85 of these individuals finishing the study. These participants reported experiencing stress symptoms “often” or “regularly.” Participants were excluded from the study if they experienced serious psychopathology (which, unfortunately, was not defined by the study authors) or serious cardiovascular disease. This total sample consisted of 70.6% women and 29.4% men, with an average age of 46.1 years. Participants were also surveyed about education, medication use, amount of physical exercise per week, cigarette and coffee intake, menopause, and menstrual phase. Perceived stress levels were measured using the Perceived Stress Scale, and negative affect was measured using the Negative Affect Subscale from the Positive and Negative Affect Schedule. No significant pre-treatment differences were found between the treatment and control group condition on any



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variable or measure. Participants were randomly assigned to an MBSR group or a waitlist control group. The 44 participants in the waitlist control group did not receive any form of treatment, but they were invited to participate in the MBSR training after the experiment was completed. Nyklíček and colleagues set out to measure reactions to induced acute stress before and after the course of MBSR treatment. They also paralleled these measurements with those in the waitlist control group. Acute stress was induced in participants by providing them with increasingly difficult mental-arithmetic problems and by having them give three-minute speeches describing their good and bad traits in front of a camera. The researchers measured physiological responses to stress by monitoring participants’ heart rates, blood pressure, and cortisol levels. Changes in negative affect were also monitored throughout this stress-induction process, which took place before treatment and at the conclusion of the eight-week treatment. Participants in the MBSR groups experienced significantly greater reductions in perceived stress and negative affect, as well as significantly greater decreases in overall systolic blood pressure (SBP) and diastolic blood pressure (DBP). Additionally, the MBSR group members showed significantly smaller changes in SBP and DBP in reaction to stress at the post-treatment assessment. This effect was observed even when controlling for the use of hypertension medication, suggesting that MBSR is an effective method of strengthening the ability to cope with stress. These findings support previous research showing reductions in stress, negative affect, and blood pressure as a response to mindfulness training (Campbell, Labelle, Bacon, Faris, & Carlson, 2012). However, no significant differences were found between the two conditions in terms of heart rate variability or salivary cortisol, which decreased significantly across assessments for both conditions. The study was limited by a number of factors: technical difficulties (e.g., malfunctioning blood pressure equipment and cardiac arrhythmias) that invalidated the measurements of several participants; the relative inexperience of the mindfulness instructor; the fact that participants were self-selected; and the relatively small sample size used.

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The second study in this review was reported by Bräuninger (2012), who examined the effect of dance movement therapy (DMT) on stress management improvement and stress reduction. DMT was compared to a waitlist control condition in a randomized controlled study involving 162 self-selected participants from throughout Germany. The majority of participants were female (90.7%) and considered their health level to be “moderate” (32.7%) or “well” (41.4%). None of the participants considered their health “very bad.” The mean age of participants was 44 years. Potential participants were excluded if they had received psychological or medical treatment in the last 12 months, if they had a psychiatric illness, or if they had a serious physical disability or limitation. Participants were randomly assigned to either one of 12 closed DMT groups (n = 97) or 9 waitlist control groups (n = 65). DMT consisted of 10 weekly 90-minute sessions over the course of 3 months. Group leaders provided interventions and structured sessions as they saw fit to meet the needs of their groups, and no treatment protocols were prescribed. Interventions used were tracked but not reported in this paper. Waitlist control groups were inactive throughout the study and received no treatment. Measurements were taken at three time points: before treatment, at the conclusion of treatment, and approximately six months after treatment end. The Brief Symptom Inventory (BSI) was used to track psychopathology, general psychic strain, various symptoms of distress, and overall distress in the last seven days. The Coping and Stress Questionnaire was used to measure coping style and stress-management strategies in stressful situations; specifically, it was used to track whether coping styles were beneficial or detrimental to the stress-reduction process. The DMT groups showed significantly greater reduction in psychological distress and psychopathology than the waitlist groups on three of the BSI scales: Obsessive Compulsiveness, Anxiety, and Positive Symptom Distress. The Coping and Stress Questionnaire also showed a significant advantage in coping skills in favor of the DMT group. This suggests that DMT is more effective than non-treatment in terms of short-term reduction in psychological distress and improvement of stress management.



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Additionally, DMT groups showed significant reduction of negative coping strategies and improvement in relaxation ability from pre-treatment to post-treatment, as compared with the control groups. The use of DMT showed significant improvement in study participants on measures of obsessive compulsiveness, interpersonal sensitivity, depression, hostility, paranoid ideation, psychoticism, addiction, symptom severity, and total symptom reporting over the same time period. DMT groups showed significantly greater improvement than the control groups in terms of improved psychological distress and psychopathology, interpersonal sensitivity, depression, phobic anxiety, psychoticism, symptom severity, paranoid ideation, and coping strategies. Participants in DMT groups showed long-term improvement from pre-treatment to six-month follow-up in terms of psychopathology and psychological distress, somatization, interpersonal sensitivity, anxiety, hostility, addiction, symptom severity, total symptoms reported, and coping strategies. Follow-up assessments were not given to the control group, so no comparison could be made in regard to long-term improvement. These results suggest that DMT effectively aids in improvement of stress management and reduction in psychological distress and psychopathology, and that it is more effective than non-treatment. Results also show that participants in DMT training will continue to show improvement from their initial status even six months after termination of treatment. This is with a brief 10-week treatment program. However, the study only tracked participants for a total of 9 months, included very few male participants (9%), and it did not report interventions used, although a paper with this information is in preparation. Clinical Implications

The two studies reviewed in this article suggest that body-awareness techniques such as MBSR and DMT can be effective means of empowering clients in their management of stress levels. The authors’ findings demonstrate that group members from various backgrounds, whether healthy or having histories of high stress, can make significant progress in decreasing daily stress through the use of MBSR and DMT. Further, the cross-cultural nature of

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these two group formats between the Netherlands and Germany, respectively, suggests a potential relevance to the effectiveness of using b ­ ody-centric groups across various cultural settings. Finally, in the case of Bräuninger’s research, the fact that positive results were observed across groups, and in spite of the lack of a prescribed treatment protocol, suggests that the observed positive effects of DMT may be generalizable to various forms of this treatment approach. However, further information about Bräuninger’s research, as well as additional study of DMT, is needed to verify this possibility. More research is required to address the limitations and to support the findings of each of these studies. Specifically, they do not address the question of whether group leaders can incorporate aspects of mindfulness and dance into existing psychotherapy groups independently of MBSR or DMT protocols, or whether the improvements reported are dependent upon the protocols in their entirety. Nevertheless, these two studies provide promising indicators that body- and movement-based group treatments can be efficiently and effectively applied to the management of stress.

REFERENCES American Psychological Association. (2013). Stress in America: Missing the health care connection. Washington, DC: American Psychological Association. Campbell, T. S., Labelle, L. E., Bacon, S. L., Faris, P., & Carlson, L. E. (2012). Impact of Mindfulness-Based Stress Reduction (MBSR) on attention, rumination and resting blood pressure in women with cancer: A waitlist-controlled study. Journal of Behavioral Medicine, 35, 262-271. doi:10.1007/s10865-011-9357-1 Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease. Journal of the American Medical Association, 298(14), 1685-1687. Edwards, J. (1988). The determinants and consequences of coping with stress. In C. Cooper & R. Payne (Eds.), Causes, coping and consequences of stress at work (pp. 233–263). Chichester: Wiley. Folkman, S. (2010). The Oxford handbook of stress, health, and coping. New York: Oxford University Press.



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Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Delacourt. Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer. Tristin Roney, M.A. 1500 WSC Brigham Young University Provo, UT 84602 E-mail: [email protected]