A model of dance/movement therapy for resilience-building in people living with chronic pain

Minjung Shim · Joke Bradt

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Diversity and Impact of Dance Musculoskeletal pain and rehabilitation Art Therapy and Mental Health

Abstract

Awareness of pain as a multifaceted phenomenon is growing and more people are seeking complementary and alternative medicine or psychotherapeutic approaches for chronic pain management. Furthermore, the significance of positive health concepts focusing on individuals' strength within the context of adversity, such as resilience, has been recognized in chronic pain management. However, contemporary pain management strategies as well as existing resilience models have largely been neglecting a fundamental component of the experience of chronic pain and its rehabilitation, namely embodiment. This study aimed at examining how Dance/Movement Therapy (DMT), an embodiment and enaction-based psychotherapeutic approach, may help people living with chronic pain to foster resilience through the corporeal experience of the moving body. To answer the question, "What theoretical model grounded in qualitative and quantitative data may explain the therapeutic factors and mechanisms of DMT for resilience building in people living with chronic pain?" an innovative multiphase Mixed Methods Grounded Theory (MM-GT) study was developed and conducted. In phase I, a substantive model was generated based on the findings from two sets of data collection and analysis processes, namely meta-modeling and reflexive GT. Based on these findings, a 10-week group DMT intervention was designed and appropriate quantitative outcome measures were determined. In phase II, the substantive model was tested quantitatively and qualitatively during the clinical intervention. The quantitative and qualitative findings were then compared and integrated to generate a clinical model. Through integrating the models from the two phases, a refined final composite model was constructed. The quantitative findings showed that there was statistically significant change in resilience (p <. 001), kinesiophobia (p=. 031), attention regulation, a subscale from body awareness (p=. 016), and pain intensity (p=. 03) after the 10-week intervention. The Patient's Global Impression of Change score indicated that about 70% of the participants felt moderately to a great deal better after the treatment. The immediate effect of DMT sessions on mood, stress, relaxation, and pain was also tested significant with p <. 001 for all outcomes. Correlation analysis confirmed that there is a statistically significant relationship between body awareness and self-efficacy (p <. 0001). The final GT model shows that the DMT process involves dynamic interactions between various factors that facilitate the intricate mechanisms of DMT to foster resilience resources for chronic pain management. The overall phenomenon is a process of breaking free from the rigidity and imprisoned state created by the overpowering impact of chronic pain toward regaining control over pain and one's life. DMT provides a novel environment for creative self-exploration and interactions, and mobilizes people to loosen up at all levels - physical, cognitive, emotional, and social. Key therapeutic mechanisms include activating self-agency, connecting to self, connecting to others, enhancing emotional intelligence, and reframing. Several moderator factors were identified namely person factors (i.e., peer support and therapist support) and therapy factors (i.e., self-directive structure, optimal level of challenge, music, and home practice). A set of contextual conditions were also identified namely activity level, alexithymia, % of time in pain, social support, other life stressors, and engagement with the psychotherapeutic aspects of the treatment. Therapy outcomes include being in-control, integration, emotional health, plasticity, and readiness to engage with outside world. As a result, people experienced new ways of living in their body and being in the world. Based on the findings, several theoretical, clinical and methodological implications as well as suggestions for future research are proposed. The process and outcome of the study confirmed that MM-GT is an effective research method for generating and testing a theoretical model that can describe complex data.