The roots of dance therapy
can be traced to earliest human history,
when disease was seen as a loss of soul,
and dance was an intrinsic part of the healing ritual.
Joan Chodorow, 2010
Obesity. How big
the problem is?
The number of obese people (body mass index (BMI) above
30) is increasing in the whole world. Reducing obesity is thus a global
challenge. Worldwide, the number of obese people has more than doubled since
1980. Data from The National Health and Examination
Survey of 2010 confirm that about 1/3 of USA adults (33.8%) and approximately
17% (or 12.5 million) of children and adolescents aged 2—19 years are obese. The
latest Health Survey for England data shows that in 2009, 23.0% of adults and
14.4% of children were obese. The
Foresight report predicted that if no action was taken, more than half of the
UK adult population would be obese (60% of men, 50% of women) by 2050. More than one-third of citizens of the
European Union (EU) are overweight and one in ten is obese. 400,000 children of
school age become overweight each year. Eight per cent of all healthcare
expenses are directed towards solutions for the obesity problem.
Obesity can have a severe impact on people’s health,
increasing the risk of type 2 diabetes, hypertension, heart disease, elevated
blood cholesterol levels, stroke; and after the menopause cancer of the breast
and uterus, osteoporosis and joint problems.
The number of Finished Admission Episodes (FAEs) in NHS hospitals with a
primary diagnosis of obesity among people of all ages in 2008/09 was over eight
times as high as in 1998/99 and nearly 60% higher than in 2007/08. Consequences
of obesity are not just physical; quality of life of obese persons is reduced,
because obesity impacts on physical, emotional and social functioning. There is also a significant burden on health
and social services; while precise predictions have been disputed, there is
little doubt that without effective action most societies will continue to bear
an increasing cost due to a greater prevalence of chronic diseases arising from
obesity.
Psychological
aspects of obesity
Some researchers suggest no close relationship between obesity
and psychological disturbance or particular features of a personality. However,
there are a number of quality studies, which contradict this finding, for obese
people who seek medical help and health programs. For example, a relationship
has been demonstrated between obesity and psychological disturbance for Caucasian
women with high social-economic status, and adolescents who suffer from depression
are more likely to become overweight adults than adolescents who are not
depressed. Obese people also have significantly lower self-acceptance and
self-esteem, are at greater risk of psychological distress and suffer more
day-to-day interpersonal discrimination, employment and institutional
discrimination compared to normal weight individuals.
A significant causal relationship between obesity and body
image disturbance acts as a mediator for increased depression and lower self-esteem.
There is a relationship between obesity and poor body image, though not all
obese people suffer from body image distress (BID). The risks for BID include: high BMI, feminine gender, and emotional
eating. There is thus a clinical need to
identify people at risk and to consider developing weight loss programs that
aim to prevent BID. BID in overweight individuals decreases with weight loss,
but increases as weight is regained; depression decreases with weight loss
overall but can increase if the degree of weight lost is lower than expected.
Most of the weight lost as a result of following a reducing diet is regained
within a few years.
Emotional eating,
obesity and diet
Emotional eating can be understood as overeating as a
reaction to emotional states. There is a
need for more research on the role of emotions in relation to overeating, as
the processes are little understood. One possibility is that awareness of
hunger and satiety is reduced in emotional eaters, whereas emotional states
(including positive emotions like joy for example) are not tolerated, food providing
an opportunity to metaphorically swallow feelings. Emotional eating is closely
linked to Binge Eating Disorder (BED); both include the consumption of large amounts
of food together with a subjective loss of control over both eating behavior
and psychological distress.
The term emotional eating does not depend on a medical
diagnosis but on self-report, and highlights the role of the emotions in
determining or maintaining the problematic behavior. Eating in obese persons
(especially when combined with emotional eating) often seems to be initiated in
the absence of perceived hunger. For example, overweight individuals are more likely
to overeat in negative emotional situations than either normal or underweight individuals
(underweight individuals being more likely to undereat in similar situations). A link has been demonstrated between emotional
eating and psychological discomfort, low self-esteem, negative body image and
affective disturbances. These negative experiences are likely to be exacerbated
by the fact that obese people are subjected to stigmatization, discrimination
and lower quality of life. The link between self-esteem and eating disorders
has been reported in several studies, and negative self-evaluation has been
recognized as a risk factor for the development of eating disorders.
Some studies suggest that low self-esteem predicts the
development of eating disorders. A bidirectional relationship has been posited
between dieting, emotional eating and negative self-esteem: each dieting
failure might decrease self-esteem, which in turn jeopardizes dietary adherence. Chronic dieters enter a spiral; dieting failures
inhibit successful acceptance of the body which in turn leads to decreased
self-esteem and decreased self-efficacy (self-efficacy being necessary for dietary
adherence). It has been shown that
chronic dieting and negative body image is a combination which leads to
negative self-esteem.
An important aspect of appearance and body image is body weight,
especially for women; if a woman evaluates her self-worth according to her appearance
(self-esteem increasing with body image satisfaction) this poses a potential risk
factor for both psychological distress and eating disturbance, including depression.
It has been noted that eating disorders and body image dissatisfaction are both
common problems, especially in women. Negative feelings about physical
appearance are linked with a range of psychological consequences which include low
self-esteem and depression for adults as well as for adolescents. Body image
disturbances are recognized as a risk factor for women who change their eating
habits with the aim of changing their appearance or to lose weight. This can
lead to the development of eating disorders, due to the negative spiral identified
above. Preventive programs are especially needed in such cases to promote women’s
awareness of their body image and its link to possible eating problems.
Living in a Body and
Eating Disorder
The eating disorder assumes a powerful role for someone
with an eating disorder by providing them with an illusion of control. This
illusion allows the individual to avoid facing emotional issues by detaching
from their bodily felt experiences.
The quest to distance from the body creates an internal
burial ground in which feelings are stored, restricted, stockpiled, and avoided
at all costs. Individuals with an eating disorder have a tendency to obsess and
pick on their bodies, literally as well as figuratively.
In addition, they may refer to their body as “this body”,
thereby depersonalizing their interpersonal relationship even further. It is
not uncommon to hear someone with an eating disorder describe the relationship
with their body as that of one with a stranger or even an enemy.
Latvian Study
A study led by Bonnie Meekums and conducted in Latvia,
explored the effectiveness of DMT in obese women with emotional eating who were
trying to lose weight. 158 women were recruited from a commercial weight loss
program: 92 with BMI≥28 were identified as emotional eaters and divided into:
an exercise control and non-exercisers. The non-exercises were partially randomized
to non-exercise control and treatment group.
Using a pre- and post-intervention design, all
participants completed all measures on a battery of tests for psychological distress,
body image distress, self-esteem and emotional eating. Findings were analyzed
for statistical significance. The DMT group showed statistically decreased psychological
distress, decreased body image distress, and increased self-esteem compared to
controls. Emotional eating reduced in DMT and exercise groups. The authors
cautiously conclude that DMT could form part of a treatment for obese women
whose presentation includes emotional eating.
Why Dance/Movement
Therapy?
Dance and extensive physical activity is one of the best therapeutic
approaches we can recommend as efficient and safe methods of recovery. However,
sometimes, dance and/or increased physical activity alone is not enough. For
those people who struggle with depression, the emotional scars from being
teased and bullied, social isolation and poor self-esteem, a psychotherapeutic
approach is needed. This is recommended by the U.S. Preventive Services Task
Force, with mention of behavioral management and cognitive-behavioral therapy.
Dance/movement therapy is a behavioral health modality
that combines physical activity, social
support, creativity and emotional expression.
Movement is not necessarily inherently enjoyable for people
who have been too sedentary. When extra weight puts strain on the musculoskeletal system and some
organ systems, the body itself can become a dis-incentive to moving more. When guided by a trained
dance/movement therapist in the context of a supportive psychotherapeutic relationship, the obese
person can overcome fears associated with moving.
Finding one’s own preferred and comfortable ways of
moving through gentle improvisation and
movement exploration can increase the person’s investment
in the process of moving towards health.
Dance/Movement Therapy, or DMT, is a mind/body integrated
form of counseling and creative arts therapy. The American Dance Therapy
Association defines DMT as “the psychotherapeutic use of movement to further
the emotional, cognitive, physical and social integration of the individual.”
There is still a common misconception that dance is
reserved for individuals of a certain body-type or physical ability, however,
quite literally, any body can dance. Another common misconception is that in
order to participate in DMT, a person must have a background in dance training,
when in reality, a person need not ever have set-foot in a dance studio to
participate in DMT. There are no
criteria for involvement in DMT other than the consent and willingness to
participate.
To illustrate the fallacy that only certain body-types or
abilities can dance or participate in DMT, one of the recent studies concerning
individuals who binge-eat and who are obese, benefited significantly from DMT
interventions. Individuals who are obese and engage in binge-eating behaviors
may also suffer from low self-esteem and distorted body image. The specific individuals involved in the
36-week longitudinal study exhibited significant improvement in health-related
quality of life, body consciousness, and mental representations related to body
image. Additionally, all achievements in the study were unrelated to weight-loss,
as weight remained largely unaltered throughout the study.
People with eating disorders tend to become socially isolated.
The relationship focus of DMT, in group as well as in individual formats, helps
the individual risk connecting to others in supported and authentic ways.
Discoveries made in DMT about one’s own mind/body connection and about relating
to others transfer to other relationships and how one moves through life.
Using carefully monitored movements and breathing
techniques, Dance/Movement Therapists help to guide patients in developing body
awareness and tolerance. This can be beneficial for individuals with eating
disorders because eating disorders, characteristically, interfere with natural
body cues such as hunger and satiation. DMT groups may also utilize props and imagery to assist in the
therapeutic process. Dancers are
encouraged to challenge body image distortions and address destructive
behaviors that are sometimes influenced by media or societal pressure. DMT encourages the opportunity for them to welcome and attend to physical and emotional needs, while strengthening
their self-esteem and self-worth.
Genuine and
Long-Lasting Change
Beginning to feel safe enough to experience, express and
understand feelings and sensations as an integral aspect of life is a core task
for individuals with eating disorders. However, this is not easy because the
fear to avoid connection is so strong. Dance/movement therapy as an integral
part of eating disorder treatment can help patients re-claim authentic
connection with themselves in both actions and words. This can, over time, lead
to the genuine and long-lasting change associated with the ability to sustain
recovery.
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