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Let’s Dance: A Holistic Approach to Treating Veterans With Posttraumatic Stress Disorder

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Qualitative Results

Study participants unanimously reported improvements in outlook, well-being, mood, sense of well-being, and interpersonal relationships as a result of taking the DFV class. The most commonly reported preclass–postclass change was an increased sense of camaraderie and belonging. Many participants also expressed reductions in anger and isolation as well as an increase in self/other acceptance. Participants’ comments about the DFV class included, “It makes me forget about everything, and I enjoy myself.” “It relaxes me, makes me smile.” “I’ve made new friends.” “When I came here and tried this group, I felt very nervous. But I came over and over. I am so much more at ease.” “I come to class upset, and I leave with a smile on my face.” “I enjoy the camaraderie. I feel I am part of something.” “The class is helping me by body movement: moving my arms and legs—my attitude just changes.” “It’s a lot of fun!”

Discussion

This hypothesis-generating study examined whether an adjunctive, holistic intervention (dance class) could reduce stress in veterans with PTSD. Results showed significant reductions in state stress levels after DFV class participation. The finding of a significant effect of short-term reduction in state stress levels corroborates the findings from Wilbur and colleagues but with use of a comprehensive, reliable, well-validated measure of stress.17,24,25 This study’s qualitative results are also consistent with the prior qualitative data suggesting improvements in social connection and sense of well-being.

Some experts believe that PTSD-associated symptoms are fairly intractable and that trauma-focused treatments are required to reduce symptoms and promote a sense of well-being. This study did not show sustained reductions in stress levels across class sessions. Nevertheless, the significant state stress reductions that occurred after class suggest that this dance/movement intervention is a helpful adjunctive treatment for enhancing well-being, at least temporarily, in veterans with PTSD. The findings also suggest that veterans can benefit from a single session and need not attend class regularly to see results. Thus, DFV shows promise even on a drop-in basis. Overall, the results of this study provide further impetus to develop and provide more holistic, arts-based programs for veterans diagnosed with PTSD.

Study Limitations

At the beginning of this study, the authors did not expect strong participation of male veterans in a dance class. Surprisingly, 61 veterans enrolled over a period of 2 years 3 months. Nevertheless, the research sample was small, as empirical difficulties were encountered secondary to veterans’ inconsistent attendance and failure to complete ratings in a consistent and timely manner. Therefore, the sample may not have been representative. Research is needed to validate and expand the findings of this study.

Another methodologic concern was lack of a control group. Future studies might use a no-intervention control group and/or comparison groups, including support, meditation, and trauma-focused groups. In addition, veterans were not blinded to the intervention, and the STAI is a self-report survey with face-valid items. Thus, participants may have tried to please the instructors, bringing into question how much social desirability may have accounted for the reductions in stress levels.

The authors also did not examine confounding variables with regard to additional mental health treatments. It would have been helpful to address whether stress reductions were larger for veterans who were also receiving psychiatric medications and/or participating in other mental health groups or individual psychotherapies. The effect of comorbid diagnoses on the reduction in state stress levels also was not examined. Last, the authors did not investigate actual PTSD symptoms (eg, flashbacks, nightmares, hypervigilance, and avoidance). Further studies are needed to measure reductions on the PTSD Checklist for DSM 5 or on other empirical measures of PTSD as a consequence of this class in order to examine its effectiveness in reducing PTSD symptoms.

Qualitative responses from the veterans suggested that DFV promoted quality-of-life and well-being improvements. It would be helpful to assess this quantitatively through control or comparison group studies using measurements that minimize face validity. To understand the mechanism by which this class is effective, research also needs to examine what class-related factors are most effective in promoting positive change. The qualitative data provide glimpses into these factors, but empirical investigation could provide substantive proof of what specific factors are therapeutic.

Conclusion

The VHA has introduced several integrative adjunctive PTSD treatments, including dance, tai chi, mindfulness meditation, breathing/stretching/relaxation, yoga, healing touch, and others with the goal of maximizing veterans’ physical and psychological wellness. Although it seems unlikely that integrative once-a-week treatments lead to sustained reductions in PTSD and other serious psychiatric conditions, it is possible that participating in DFV classes more regularly, as part of adjunctive treatment, could promote a sustained sense of well-being, self-compassion, self-confidence, and sense of belonging. The question still remains whether such programs are effective in promoting well-being. The present study was not conclusive enough to substantiate that claim, but it represents a small step (a dance step) in the right direction, toward a holistic, creative, and well-rounded approach to the treatment of PTSD in veterans.

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