To the Editor:The COVID-19 pandemic has significantly impacted youth, including through increased isolation, the transition to online schooling, decreased access to arts and sports programming, exposure to illness, and anxiety. The pandemic has also affected the delivery of therapeutic services at a time when youth need more help building coping skills and reducing stress. Creative arts and movement therapies promote creativity and adaptability in order to better develop cognitive flexibility1

Minton SC, Faber R. Thinking with the Dancing Brain: Embodying Neuroscience. Maryland: Rowman & Littlefield; 2016.

while enhancing self-regulation and self-direction, adaptive skills which are protective in the face of stress.2

Troy A, Mauss I. Resilience in the face of stress: emotion regulation as a protective factor2011.

Creative arts and movement-based group therapies delivered through community settings—like resettlement agencies, schools, and community recreation centers—are feasible, cost-effective, and increase accessibility, especially for populations often underrepresented in the therapeutic space. 3Feder A. Torres S.F. Southwick S.M. Charney D.S. The Biology of Human Resilience: Opportunities for Enhancing Resilience across the Lifespan. Offering such interventions at the group level benefits those experiencing significant stress and anxiety,4

Feen-Calligan H, Ruvolo Grasser L, Debryn J, et al. Art therapy with Syrian refugee youth in the United States: An intervention study. The Arts in Psychotherapy. 2020/07/01/ 2020;69:101665.

,5Grasser L.R. Al-Saghir H. Wanna C. Spinei J. Javanbakht A. Moving Through the Trauma: Dance/Movement Therapy as a Somatic-Based Intervention for Addressing Trauma and Stress Among Syrian Refugee Children. and those who are not experiencing such symptoms, as they still reap the long-term benefits of building stress-relaxation and emotion regulation skills. Having previously demonstrated efficacy of art therapy (AT) and dance/movement therapy (DMT) in improving posttraumatic stress and anxiety symptoms for youth,4

Feen-Calligan H, Ruvolo Grasser L, Debryn J, et al. Art therapy with Syrian refugee youth in the United States: An intervention study. The Arts in Psychotherapy. 2020/07/01/ 2020;69:101665.

,5Grasser L.R. Al-Saghir H. Wanna C. Spinei J. Javanbakht A. Moving Through the Trauma: Dance/Movement Therapy as a Somatic-Based Intervention for Addressing Trauma and Stress Among Syrian Refugee Children. our lab—the Stress, Trauma, and Anxiety Research Clinic—shifted programming to virtual formats, in partnerships with local resettlement agencies and schools.

Throughout the pandemic, we have brought AT to youth resettled as refugees, as well as DMT to school children in high risk, low resource regions via online formats. Sessions are led by certified art therapists and dance/movement therapists who also hold a joint master’s in counseling; the team was supported by a psychiatrist specializing in trauma-informed care. Case managers from resettlement agencies and educators from schools shadow sessions and have the opportunity to learn and adapt techniques from the therapeutic space for their clients and classrooms well beyond the end of programming. This integration also allows for transference of trusting rapport to facilitators, who participants may have never had the chance to meet with in person. For youth resettled as refugees, AT is delivered weekly via Zoom, and case managers provide Zoom literacy trainings in advance of programming. For youth in high-risk, low-resource regions, DMT is delivered during their regular school day via students’ online learning platforms—leveraging technology that is already familiar and in place (eg, Google Classroom). By running programming through existing structures in collaboration with schools, technological barriers are reduced for students and their families who are supplied with the appropriate technology via the school. The addition of non-therapeutic facilitators to manage participant attendance, technological issues, and take observational notes allows therapists to fully engage in the therapeutic space without disruptions from the virtual environment. Active participation is enhanced by engaging all sensory modalities and extending beyond traditional verbal communication to provide non-verbal expressive spaces. AT and DMT provide youth resettled as refugees and high-risk, low-resource youth with the opportunity to move the body and express emotions in healthy ways while teaching youth how to cope with present and future stressors. Therapies that offer somatic and creative components at a time when children (and others) are likely to be sedentary and with reduced environmental enrichment are particularly useful during the pandemic and beyond.

Observations made by art therapists and case managers working directly with participants in art therapy report that the virtual space has increased the comfort of youth resettled as refugees in sharing their art with the group and reflecting in group discussion on the meaning of their art products—youth are more vocal and active in group discussion when in the virtual space compared to in-persons sessions, both within persons who engaged in art therapy in both spaces, and between persons who engaged in one or the other. Art therapists and case managers also report that, compared to prior in-person sessions, the virtual space has conferred an increased sense of safety such that youth feel less vulnerable and less like they are being observed by facilitators. Data from previous in-person implementations, as well as initial data obtained from current virtual programming (data collection and programming are ongoing) regarding changes in trauma-related psychopathology over the course of intervention indicates improvements in posttraumatic stress and anxiety symptoms for participating youth4

Feen-Calligan H, Ruvolo Grasser L, Debryn J, et al. Art therapy with Syrian refugee youth in the United States: An intervention study. The Arts in Psychotherapy. 2020/07/01/ 2020;69:101665.

,5Grasser L.R. Al-Saghir H. Wanna C. Spinei J. Javanbakht A. Moving Through the Trauma: Dance/Movement Therapy as a Somatic-Based Intervention for Addressing Trauma and Stress Among Syrian Refugee Children.. Educators report that this addition to the school day has supported students’ emotional wellness journey. Educators note improvements in self-esteem and greater engagement in academics following sessions. Creating a safe space in a virtual setting through DMT has led to students become more comfortable with turning on screens and actively participating in class in this same virtual setting. Virtual settings have increased the reach of the program to serve a larger number of individuals: instead of a single n=15 session group over an 8-week period, we are reaching almost 150 youth over the same timeframe.

Now that youth have developed and used these arts and movement practices in the home and the virtual classroom, we hypothesize that youth may be more inclined to continue using them in naturalistic settings following the intervention period. Unlike traditional therapeutic settings, youth do not go elsewhere to engage in therapy, potentially leaving skills gained behind in that space—although this remains to be studied, and future work should compare therapeutic contexts in continued practice of creative arts and movement-based interventions to optimize treatment environments. Initial evidence supports such integration: educators report that youth participating in DMT have incorporated some of the stress-reduction movement techniques at their desks when feelings of frustration and sadness/anger arise. Our pivot towards virtual environments for implementation of creative solutions to build resilience and reduce stress in the wake of COVID-19 provides an example of one way in which we may—even well beyond the pandemic—increase accessibility and cost-efficacy of therapies to address trauma-related psychopathology as a monotherapy or adjunctive therapy to those who have traditionally lacked access to treatment and for those whose treatment may be enhanced by these somatosensory interventions.

References

Minton SC, Faber R. Thinking with the Dancing Brain: Embodying Neuroscience. Maryland: Rowman & Littlefield; 2016.

Troy A, Mauss I. Resilience in the face of stress: emotion regulation as a protective factor2011.

Feder A. Torres S.F. Southwick S.M. Charney D.S.

The Biology of Human Resilience: Opportunities for Enhancing Resilience across the Lifespan.

Biol Psychiatry. https://doi.org/10.1016/j.biopsych.2019.07.012

Feen-Calligan H, Ruvolo Grasser L, Debryn J, et al. Art therapy with Syrian refugee youth in the United States: An intervention study. The Arts in Psychotherapy. 2020/07/01/ 2020;69:101665.

Grasser L.R. Al-Saghir H. Wanna C. Spinei J. Javanbakht A.

Moving Through the Trauma: Dance/Movement Therapy as a Somatic-Based Intervention for Addressing Trauma and Stress Among Syrian Refugee Children.

Journal of the American Academy of Child & Adolescent Psychiatry. 58: 1124-1126Article InfoPublication History

Accepted: June 25, 2021

Received in revised form: June 22, 2021

Received: April 12, 2021

Publication stageIn Press Journal Pre-ProofFootnotes

This work was funded by a Physician Investigator Grant awarded to Dr. Javanbakht by the Detroit Medical Center Foundation.

Author Contributions

Conceptualization: Grasser, Javanbakht

Funding acquisition: Grasser, Javanbakht

Investigation: Grasser

Methodology: Grassermaterials-methods

Project administration: Grasser

Writing – original draft: Grasser

Writing – review and editing: Javanbakht

The authors would like to thank Dr. Holly Feen-Calligan, PhD, ATR-BC, ATCS, of Wayne State University, Ms. Jenna Spinei, MA, Certified Franklin Method© Educator, of Wayne State University, Ms. Jessica Smigels, MED, of Wayne State University, Ms. Natalie McCabe, MED, of Wayne State University, and Ms. Bharti Thakkar, MBA, RYT-200, CYT, MBSR Teacher, of the Beaumont Center for Mindfulness, for their roles in leading the intervention programming described herein. The authors would also like to thank Ms. Breanna Kremmer, BSW, of the Samaritas Resettlement Agency, Ismail Yusif, of the Samaritas Resettlement Agency, and Ms. Mihaela Mitrofan, BA, of the Samaritas Resettlement Agency, as well as Ms. Michelle Mendez, MA, of the Waterford School District and Ms. Jennifer Dean, EdS, of the Pontiac School District of Oakland Schools for their partnership. All acknowledged individuals provided permission via email to be thanked in published media and manuscripts. Acknowledgement does not imply endorsement by acknowledged individuals nor entities.

Disclosure: Dr. Javanbakht has reported support from the National Institute of Child Health and Human Development (R01HD099178). Ms. Grasser has reported support from the National Institute of Mental Health (F31MH120927).

All statements expressed in this column are those of the authors and do not reflect the opinions of the Journal of the American Academy of Child and Adolescent Psychiatry. See the Guide for Authors for information about the preparation and submission of Letters to the Editor.

Identification

DOI: https://doi.org/10.1016/j.jaac.2021.06.017

Copyright

© 2021 Published by Elsevier Inc. on behalf of the American Academy of Child and Adolescent Psychiatry.

ScienceDirectAccess this article on ScienceDirect Related Articles