موانع اخبار: ارزیابی یک مبتنی بر هنر آموزش تنظیم احساسات در زندان

Abstract Creative arts therapies have long made use of the interconnection between body, emotion, and mind. Movement is intimately intertwined with emotional and cognitive functions, and role play promotes perspective taking, empathy, and interactive competencies. In this pilot study, with a pre-/post-test waiting-group design of male prison inmates in three German prisons (n = 47), we conducted an evaluation of the movement- and drama-therapy based, anti-violence training e|m|o processing® (Lutz, 2008). The training is an action-oriented and neuroscience informed method, including movement therapy interventions for handling rage and promoting respectful interaction by means of Aikido stick fighting practice, perspective taking, and enactments. Upon completion of the training, the experimental group reported an increase in body awareness and social competence, experienced distance to their own aggression, and experienced a higher degree of closeness to the group and trainer. No changes occurred on anger and on explicit as well as implicit aggression measures. Movement analysis from behavior observations indicated a decreased immediate aggression potential and an increase in expression of needs upon termination of the training. Statements from focus groups after the training indicated improved empathy, respect, and perspective taking, both among participants and in relation to victims.

Introduction Arts therapies can directly touch our essence (Cruz and Feder, 2013 and Koch, 2008). At their basis, body, movement and play are a primary source of our identity (Stern, 1985) and embed humans into primary interaction systems (Kestenberg, 1975). They can impact the inner as well as the outer life of each individual, particularly the implicit processes of movement and movement repetition from our functional (physiological, sensory, mnemestic) as well as our interpersonal relations (emotional, agentic) – as increasingly also shown by research from cognitive sciences and neurosciences (e.g., Gallese, 2005 and Gibbs, 2006) and discussed by phenomenology (e.g., Fuchs, 2012). In the context of psychiatry and psychosomatics, therapy therefore has adapted creative elements of body movement such as dance or rhythm. Beyond clinical contexts, creative therapies are also used in schools (Hervey and Kornblum, 2006 and Karkou, 2010), with refugees (Harris, 2007, Koch and Weidinger-von der Recke, 2009 and Reka, 2011), or in the penal system (Smeijsters & Cleven, 2006), which is the target context of the present study. In 2012, there were 195,143 violent crimes committed in Germany (Bundeskriminalamt, 2012). Aggressive behavior is tightly bound to the tendency to experience quick and intense anger in response to provocation (e.g., Watt & Howells, 1999). This tendency as well as the difficulty to control one's anger are predictors of factual violent behavior (Novaco, 1997). The treatment of aggressive behavior is difficult and particularly so, if the person has reached the stage of violent social action (Guerra & Slaby, 1990). In Germany as in many other European countries, the principles of re-socialization and reintegration are the prevalent ideas (Paragraph 2, Strafvollzugsgesetz) of bringing prison inmates back to their own social responsibility and at the same time efficiently protect the public. Out of the necessity to provide effective means for the reduction of violent behavior, several approaches to forensic interventions and trainings have resulted (Moon and Eisler, 1983, Rokach, 1987 and Watt and Howells, 1999). However, none of these cognitive-behavioral-based approaches has an explicit action-, arts- or resource-oriented focus. In this context, a dance/movement and drama therapy-based training in a workshop-format of a limited time frame (one week) has been developed by drama therapist Ingrid Lutz, M.A. and dance/movement therapist Fabian Chyle, M.A. (Lutz, 2008). Their concept – e|m|o processing® – is specifically tailored to address the increased readiness for conflict- and aggression potential in prison inmates and is conducted in the trainer constellation of a female and male dance/movement therapist and drama therapist (Lutz, 2008). The main objective of this study was to evaluate whether this training is effective for emotion recognition and regulation, increase in body awareness, reduction of aggression, development of empathy and/or improvement of interpersonal relations related to the re-socialization process of prison inmates. We also wanted to investigate whether the format of the training was suited to produce changes and which outcome variables were particularly affected by the training. Therefore, we assessed the following emotion regulation related outcome variables: affect, anger and aggression reduction, body awareness, and social competence. The intervention e|m|o processing® is an acronym for emotion, motion, and organization. Based on neuroscientific findings (Bauer, 2004 and Hüther, 2005), it assumes that through physical experiences (motion), emotional competences are promoted (emotion), and behavioral patterns can be re-organized (organization). The anti-violence-training of e|m|o processing® strongly focuses on the individual's attitudes towards violence rather than re-educating or superimposing models of alternative behavior. In the core of the prevention idea of e|m|o processing®, is the possibility to establish a “buffer”, which separates emotion (aggression) and action (violence). Traditional anti-violence trainings in German prisons are mostly based on confrontation principles and combined with cognitive-behavioral approaches in order to increase personal control and self-esteem. As neuroscientific research has shown (Bauer, 2004 and Hüther, 2005) it is crucial for learning and change processes that anxiety is decreased to a minimum, trust is installed, experiences are connected to physical processes, and that the clients are confronted with challenges, which are manageable for them. Goals of the training are decreased aggression, and increased body awareness on the personal and interpersonal level, better emotion regulation, and the development of healthier interpersonal boundaries as well as non-violent strategies that generalize across situations. One cornerstone of the e|m|o processing® training is the constant change of the role of the inmates (“being the perpetrator” versus “being the victim”) in order to reactivate individual situations where violent behavior was executed or encountered. Therefore, the anti-violence and emotion regulation training of e|m|o processing® incorporates elements of Aikido stick-fighting techniques. The work with the 110 cm long wooden stick allows for a variety of physical experiences in relation to establishing interpersonal boundaries: attacking, defending, retreating, empowering, stopping, or redirecting are some of the core actions which are experienced in the training. The long Aikido stick has some advantage to shorter ones (e.g., those used in Escrima): it provides more physical distance between clients, and at the same time enlarges the individual's actions. Additionally, stick fighting is a way to involve inmates more easily into movement or drama-therapy interventions, because it is closer to their (movement-) culture/subculture. Those movement- and body psychotherapeutic techniques sensitize inmates to the perception of psychosomatic changes in their own as well as the other's body. Through the constant change of role (perpetrator versus victim) the inmates are confronted with critical situations (e.g., “a weapon in my hand”; “a weapon against me”), which promotes experiences on three levels: On the individual level, clients become more aware of their own bodies, their internalized automatic reactions and their individual dispositions to violent behavior. On the interpersonal level, clients are sensitized to the body of the other, communication patterns, role-preferences, and perspectives (dyadic interactions), and on the collective level of group behavior, clients become aware of their social standing and strategies in groups. On all three levels, participants dive into the relations among aggression, communication, and violent behavior. They do so in a quite different way as they commonly do in a cognitive-behavioral training, much more body-, action-, and self-regulation related. They directly dive into situations related to aggression and aggressive behavior. By practicing alternative behaviors throughout the training, the development of a constructive handling of emotion regulation and aggressive energy, and an improvement of social skills and empathy is assumed to be facilitated. These predictions were tested in the present study. More information on the intervention can be obtained from the second author, who was the organizer of the trainings and the main therapist in all three settings of the study. Hypotheses In a pretest–posttest waiting group design, we tested 47 male prison inmates taking part in either the training group (EG) or a control group (CG) with multiple methods. Dependent variables and hypotheses were generated from the set of goals of the e|m|o processing®-method, resulting in the following hypotheses. The experimental group was expected to show increased anger control, higher internal and lower external control beliefs, higher body awareness, decreased aggression on explicit and implicit measures, and a more realistic self-perception after the training. The control group was expected to show no pre-/post-test change in the according variables. The training progress questionnaire was expected to show an increase in body awareness, social competence, experienced distance to one's own aggression, and closeness to group and trainer. Regarding the behavior change we expected a decrease in mixed fighting rhythms (indicating a high immediate aggression potential on the body level) assessed with the KMP. Both of the latter measures were conducted without a control group. The focus group was supposed to convey a more differentiated picture regarding the causes, motives, and backgrounds of the results obtained.

Results There was no significant multivariate effect for the main questionnaire F(16,30) = 1.25; p = 0.286; η2 = 40, and no significant effect for the univariate interactions of group (EG vs. CG) * time (pre-test vs. post-test), except for “trait anger” (STAXI) F(1,45) = 5.07; p = 0.029; η2 = 0.10 (see Table 2). The interaction showed that participants in the CG improved, whereas participants of the EG did not change, yielding an effect opposite to our pre-dictions. In addition, there was a tendency in the experimental group to show more relaxation at the end of the training, and in the control group to show less body consciousness at the end of the training period (both effects on the 10% level). All other measures showed no significant changes neither from pre- to post-test (within-group), nor between EG and CG (between-group). The IAT showed no significant differences between EG and CG in pre- and post-test differences, F(1, 46) = 0.924; p = 0.343; η2 = 02. Table 2. Outcomes of the experimental group and the control group and p-values of analysis of variance (group comparison EMO group–Control group). EMO group Control group p-value Pre (M ± SD) Post (M ± SD) Pre (M ± SD) Post (M ± SD) CB – Private Body Consciousness 17.75 ± 4.08 16.21 ± 2.62 18.72 ± 2.08 15.44 ± 2.98 0.055 CB – Body Competence 13.11 ± 2.44 14.21 ± 2.01 12.61 ± 2.55 13.61 ± 2.40 0.900 STAXI – Trait Anger 19.81 ± 4.98 19.72 ± 4.75 20.28 ± 6.39 17.70 ± 5.73 0.029* STAXI – Anger In 15.90 ± 3.51 16.91 ± 4.10 17.17 ± 4.57 16.77 ± 5.17 0.132 STAXI – Anger Out 14.03 ± 4.07 14.10 ± 3.51 14.33 ± 5.06 14.08 ± 5.25 0.733 STAXI – Anger Control 22.46 ± 5.04 22.59 ± 4.37 23.78 ± 6.04 24.22 ± 5.28 0.779 FKK – Self Concept 31.79 ± 4.86 32.88 ± 4.63 34.72 ± 7.71 34.83 ± 6.41 0.438 FKK – Internal LoC 32.72 ± 4.37 33.59 ± 4.05 34.89 ± 6.65 33.79 ± 6.16 0.190 FKK – External LoC, social 25.03 ± 4.63 25.83 ± 4.47 26.44 ± 5.65 26.00 ± 7.07 0.402 FKK – External LoC, fatalistic 24.94 ± 6.31 25.34 ± 5.80 21.94 ± 6.90 22.05 ± 8.64 0.843 BPAQ – Physical 13.86 ± 4.10 13.58 ± 3.96 11.72 ± 5.39 11.56 ± 5.07 0.849 BPAQ – Verbal 8.06 ± 2.94 7.66 ± 3.15 6.78 ± 3.18 7.00 ± 3.01 0.262 BPAQ – Hostility 9.62 ± 1.99 9.03 ± 1.94 7.67 ± 3.25 7.89 ± 2.47 0.254 BPAQ – Anger 4.52 ± 2.10 4.62 ± 1.97 4.88 ± 2.34 4.72 ± 2.42 0.621 HSI – Tension 13.79 ± 2.92 12.7 ± 3.40 12.22 ± 3.60 12.67 ± 3.05 0.096 HSI – Positive Affect 17.69 ± 2.66 17.68 ± 2.78 19.56 ± 3.22 19.78 ± 3.16 0.176 HSI – Anxiety 11.17 ± 2.48 11.80 ± 3.20 10.94 ± 3.33 10.89 ± 4.01 0.448 HSI – Depressed Affect 10.07 ± 3.16 9.69 ± 3.26 9.33 ± 4.07 9.72 ± 3.48 0.418 * Significant decrease in control group vs experimental group. Table options Within-group analysis of training group The training progress questionnaire (see Fig. 1) showed a significant increase in body awareness t(1, 23) = 2.99; p = 0.007, and social competence t(1, 22) = 2.95; p = 0.007. Experienced distance to one's own aggression in the training group decreased during the first two days t(1, 25) = −2.76; p = 0.011, and increased then significantly t(1, 24) = 3.22; p = 0.004. The degree of engagement with the training increased overall t(1, 24) = 3.57; p = 0.002 (particularly in the last two days), and the experienced closeness to group and trainer increased from the beginning to the end of the training (t(1, 24) = 3.12; p < 0.01; Fig. 1). Results of training progress questionnaire. Means for body awareness, social ... Fig. 1. Results of training progress questionnaire. Means for body awareness, social competence, degree of engagement with training, and distance to one's own aggression on three points in time of measurement (all changes from t1 to t3 significant with p < 0.01). Figure options The movement observations with the KMP showed that on the last day of the training participants used more rhythms overall (suggesting that they showed more needs), t(1, 20) = 2.21; p = 0.039, and less mixed fighting rhythms, t(1, 46) = −2.37; p = 0.028 (suggesting that inmates showed less immediate aggression potential following Kestenberg & Sossin, 1973; see Fig. 2 and Fig. 3). Results of the KMP-rhythm-analysis. Depicts the increase in total body rhythms ... Fig. 2. Results of the KMP-rhythm-analysis. Depicts the increase in total body rhythms (micro-movements) indicating inmates increasing ability to show their needs (n = 21). Figure options Results of the KMP-rhythm-analysis. Shows the decrease in mixed-fighting ... Fig. 3. Results of the KMP-rhythm-analysis. Shows the decrease in mixed-fighting rhythms, indicating the decrease in aggressive needs and immediate aggression potential in the inmates; low n limits this finding. Figure options The focus groups yielded the following picture: Single participants criticized that they could not manage to “let go” in the training, and that it was not sufficiently solution-oriented. The majority of the participants (>90%) reported new and positive learning experiences. More than 80% mentioned an improvement in their body competence (perception and action-related), a better knowledge of their own limits, a higher competence to handle difficult situations, and a better or even an initial perspective taking of the victim (e.g., “Role play exercises were very important, it was an impressive learning and thought-changing experience to take the perspective of the victim. I have never done this before. Everybody should do this.”) More than two thirds of the participants suggested to extend the training to two or three weeks and to accompany it with one-on-one therapy. Participants were positively surprised by the e|m|o processing®-method, and the majority stated that for them it was more effective than the usual confrontational trainings.