Little is understood about how dance/movement therapy affects patients with fibromyalgia and other chronic pain patients. In addition, biological markers have not been studied in patients who have received dance/movement therapy. This study describes the measurement of stress hormones in relation to the effect of dance/movement therapy as interpreted by patients from viewing their movement patterns before and 8 months after the completion of treatment.
Fibromyalgia patients (FMS) suffer from long-lasting generalized pain and other physical and psychological symptoms such as headache, anxiety, fatigue, stiffness, psychological distress, concentration difficulties, and sleeping problems (Burckhardt, Clark, & Bennet, 1993; Henriksson, 1995). Two to seven percent of the population suffer from this disorder and 90% of FMS patients are women, making it one of our most common disorders among women (Wolf, Ross, Anderson, Russel, & Hebert, 1995).
Earlier endocrinology studies in FMS research indicate that patients have perturbations in their stress hormones such as high basic cortisol levels but also low 24 hour mean levels of cortisol compared to healthy controls (Crofford, Pillemer, Kalogeras, Cash, & Michelson, 1994; Griep, Boersma, & deKloet, 1993). Moreover, FMS patients show high levels of neuropeptide Y (NPY), which co-exists with noradrenalin in the sympathetic nervous system and therefore can be regarded as a marker of sympathetic activity (Anderberg et al., 1999 and Anderberg et al., 1999; Anderberg, 1999). The regulation of other neuropeptides, such as nociceptin and oxytocin, which regulate pain, well-being, and stress, have been shown to be affected in FMS patients (Anderberg et al., 1999 and Anderberg et al., 1999; Anderberg & Uvnäs-Moberg, 2000). The regulation of other neuropeptides and neurotransmitters such as substance P and serotonin have also been found to be changed in these patients (Russel et al., 1992; Vaeroy, Helle, Forre, Kass, & Terenius, 1988). These changes in hormones and peptides can reflect perturbations in the stress systems due to long term stress.
Many researchers have argued that creative arts therapies, among them dance/movement therapy, can be an important complement to other forms of therapy and pharmaceutical treatment for patients with long-lasting and chronic pain (Arn, 1991, Gronlund, 1994, Gronlund & Lumsden, 1991 and Teszary, 1991). Creative art therapies are effective in promoting an emotional state of well-being and in helping the patient create symbols that represent emotional experiences. Application of these therapies may also lead to increased self-esteem, physical mobility and self-control (Hanna, 1995). The act of creating symbols for emotions, especially those grounded in negative life events, reawakens suppressed emotions and also helps the patient to deal with them. This may stimulate healing processes (Bojner-Horwitz et al., 2003a and Hanna, 1995). Studies show that FMS patients have often had stressful psychosocial life experiences both as children and adults (Anderberg, Marteinsdottir, Theorell, & von Knorring, 2000; Walker, 1997), and have low levels of self-esteem (Anderberg et al., 1999 and Anderberg et al., 1999). It is therefore possible that dance/movement therapy could have positive effects on these patients with corresponding benefits to their biological health status.
Dance/movement therapy includes several different dimensions that theoretically have the potential to relieve conditions of strain, stress, and pain in fibromyalgia patients. These various dimensions, which are of a physical, emotional, cognitive, and cultural nature, may therefore be more effective than other types of treatment for this patient group. Several researchers argue that through dance, patients can develop an increased sense of self control which in turn can lead to decreased feelings of helplessness and anxiety, feelings that can contribute to the state of stress as well as the experience of pain (Hanna, 1995). The language-like quality of dance movements can be used to express ideas and feelings such as anger and fear from both the past and present, on both conscious and unconscious levels (Hanna, 1979 and Hanna, 1995).
In an earlier study we used video-interpretation as a method to measure changes in movement patterns before and after dance/movement therapy in FMS patients. The results of that study revealed that the FMS patients were affected by viewing their own movements on video and that they identified changes in their movement patterns after a period of 2 months of dance/movement therapy treatment (Bojner-Horwitz et al., 2003b). In the current study we used the same video-interpretation technique in order to identify any relationships between biological markers and movement patterns. Our research question was if it would be possible to see corresponding changes in stress-related hormones and movement patterns after dance/movement therapy treatment.
