The themes—highlighted in dark—which emerged through the workshops were understood to reflect notions of social engagement and enjoyment (i.e., fun), as well as dance-as-exercise (fitness), and stress-release (relaxation). Drawing from these ideas, the data was analyzed through the lens of polyvagal theory (Dieterich-Hartwell, 2017; Gray, 2017, 2018; Porges & Dana, 2018). What developed was the beginnings of a theoretical construct, described in the study as an exercisePLUS perspective. This perspective aimed to stay close to participant voice/s: for instance, instead of recasting fun as ‘positive affect’ or side-stepping fitness to talk about body image issues, the intention of the exercisePLUS perspective was to use language offered by participants as a basis for theory generation.

The notion of ‘exercise plus’ echoes what dancer and anthropologist, Judith Hanna, has written about dance, health, and wellbeing. For Hanna, dance is associated with physical, cognitive, emotional wellbeing, largely owing to the role of physical exercise which is housed in the art form. As Hanna (2017, p 110) suggests: “Dance is a form of exercise plus the communication of thoughts and feelings, yielding more dividends than other forms of exercise”. Furthermore, she states: “Dance is exercise PLUSFootnote 5” (Hanna, 2017, p. 105). The following analysis builds on the theory that dance is exercise, plus, aesthetic enrichment and more. It considers the role of dancing as a “key ingredient” (Koch et al., 2019a, 2019b) in DMT and discusses the therapeutic significance of three simple but powerful ideas: fun, fitness, and relaxation.

The focus on fitness in this study is inspired by Kaz’s responses which seemed to pivot around her fitness goals and her keen desire to shed weight. Rather than psychologize Kaz’s intention to lose weight as a body image or self-esteem issue—which may be more relevant if working in a longer term, insight-oriented manner—an exercisePLUS perspective mighty seek to validate an individual’s desire to build fitness capacity, and recognize that DMT can accommodate this goal within a therapeutic framework. The notions of functional fitness and exercise does not undermine psychotherapeutic objectives in DMT but rather, refers to the way in which physical exercise can be leveraged as an important therapeutic factorFootnote 6 within some applications of the work.

While it may seem obvious that DMT can accommodate fitness goals, there is in fact very little literature to support the idea that exercise, strength-building, and conditioning are valid therapeutic aims in DMT. The word ‘fitness’ for instance is rarely seen in the literature. Dunphy et al. (2020), however, identify “fitness and release” as a possible therapeutic goal in DMT and go on to associate this with other physical outcomes such as “stamina, strength, flexibility, balance and release of physical tension” (Dunphy et al., 2020, p. 17). Similarly, Koch et al. (2019a, 2019b) examine the effects of flamenco therapy for trauma survivors and include ‘fitness’ within the study's assessment criteria. No doubt dance therapists implicitely work with fitness, though there appears to be a lack of explicit discourse addressing the topic of exercise and fitness in DMT literature, perhaps due the theoretical influence of psychotherapeutic and psychoanalytic perspectives in the field (which tend to emphasize the expressive/communicative power of dance over more physical and functional applications and theory).

As indicated throughout this paper, not all DMT applications are practiced with a psychotherapeutic orientation in mind. In some instances, it will be sufficient to focus on fitness goals whilst practicing DMT in a manner that is trauma-informed and reflective of a therapeutic relationship. While this could expand toward psychodynamic methods over time, it is also valid for the work to remain focused around physical health goals, if that is the wish of service-users. As DMT literature frequently points out: the body is the mind, and the mind is the body. Whichever pathway clients choose to explore, a dance therapist can adapt DMT approaches to target physical and/or mental health with the knowing that embodied and aesthetic experiences offer a non-dual and multilayered way into working with body-and-mind. For instance, gentle strength and conditioning work may become an important resource for a client who is in recovery from trauma. In a DMT context this would likely be facilitated differently to Pilates or a fitness class, in the sense that personal expression and creativity could be incorporated into the session alongside a relational approach to movement discovery. Exposure to new movement language can become a process of artistic self-discovery through which personal strengths and resources may be mobilized and performed. This can occur through improvisation as well as through more structured approaches to movement, including activities derived from exercise (such as a wall press or wall hold, or a squat, or aerobic activity within a choreographed dance sequence).

Notably, therapeutic training remains paramount: dance/movement therapists are not fitness instructors or dance teachers. The importance of therapeutic training is highlighted in a meta-analysis by Koch et al., (2019a, 2019b) who found that specialized use of dance movement interventions within a therapeutic context resulted in larger effect sizes, meaning that studies facilitated by trained DMTs were associated with stronger outcomes compared to dance interventions offered by non-dance specializing experts, such as physiotherapists or exercise instructors (p. 3). DMT is clearly not fitness coaching, yet exercise as a therapeutic factor should not be dismissed or down-played in terms of its significance. In contexts where engagement is difficult to sustain (such was the case in this study) it may be valuable to appeal to fitness goals as the core motivation for therapy, upon which further aims can be developed. For some individuals the idea of fitness or exercise may offer a safer or more familiar way of exploring movement to begin with, as opposed to more vulnerable movements associated with symbolic, improvised, or expressive methods. For Kaz, the idea of moving her body, sweating it out, and getting fit, appeared to be a positive motivating factor for her decision to participate in DMT. Of course, there may be intrapersonal and psychological aspects nested within an individual’s desire to become fit and lose weight which could be therapeutically relevant to address in a psychotherapeutic context. The simple desire for physical health and wellbeing is a common and relatable goal for many individuals however, and, when sensitively leveraged within the DMT process, may lead toward further engagement in therapy.

Alongside fitness aspirations, Min and Kaz appeared to identify dance as an enjoyable form of exercise that enabled the group to muck around, have fun (Min) and sweat! (Kaz). This is indicated in research on dance and wellbeing, with literature suggesting that dance can promote positive-activated states such as feeling happy, elated, energetic, and euphoric (Quiroga Murica et al., 2010). Moreover, exercise alone is known to promote a sense of feeling good (Haskell et al., 2007; Penedo & Dahn, 2005; Warburton et al., 2006), meaning that dance—as a form of exercise—can offer a similar ‘feel-good’ experience. The theoretical basis for an exercisePLUS perspective acknowledges the therapeutic value of moderate physical activity and positions dance-based exercise as key therapeutic factor in DMT (Koch et al., 2019a, 2019b), alongside play, pleasure, aesthetic experience, creativity, and several other (psycho)therapeutic affordances identified in the literature (Koch, 2017; Lauffenberger, 2020).

While the two cheeky F-words—fun and fitness—can be difficult to ‘intellectualize’ they may point toward other significant concepts in humanistic approaches to therapy such as freedom, expression, and social connectivity. Furthermore, the availability of a safe-enough environment in which to ‘just have fun,’ relax, and sweat it out, cannot be underestimated in criminal justice settings. Importantly, having fun and engaging in relational movement exchanges are recognized as crucial therapeutic factors in trauma recovery (Gray, 2017). DMT offers more than ‘just’ exercise and should not be reduced to a utilitarian-like fitness routine or dance class activity. DMT can nonetheless accommodate exercise goals—PLUS—it offers a psychosocial and creative/aesthetic outlet. It is perhaps, an enriched version of exercise that incorporates social, relational, and artistic expression alongside physical and functional goals and outcomes.

Unlike other fitness endeavours, DMT can support nervous system restoration in trauma work through the careful balancing of up- and down-regulation of the nervous system (Dieterich-Hartwell, 2017, 2020; Gray, 2017). Gray describes trauma care as multidirectional and refers to up- and down- regulation as well as ‘sideways shifting’ toward social engagement. Sideways-shifting points to an attuned and relational use of dance, which activates social connectivity. According to Gray’s framework of polyvagal-informed DMT, “state shifting in the direction of social engagement” involves an invitation to play, which is essentially an upward mobilization of the body’s energy without the anxious/fearful response (Gray, 2017). This relates to the concept of the “social engagement system,” a touchstone of Stephen Porges’ polyvagal theory; succinctly put, the social engagement system efers to a third kind of nervous system which helps individuals navigate social relationships (Dykema, 2006; Porges & Dana, 2018). In addition to the parasympathetic and the sympathetic nervous systems which control the flight-fight response, Porges suggests the vagal nerve acts as a socially-oriented nervous system which plays an importance role in the neurophysiology of trauma (Dykema, 2006). Moreover, trauma survivors—according to Porges—need to be able to experience more than down-regulating strategies to combat persistent ‘flight’ or ‘fight’ responses (Porges & Dana, 2018). Given that exposure to trauma can result in withdrawal and isolation, the re-activation of social connectivity, along with healthy up-and-downward regulation, is considered essential to recovery.

This is particularly meaningful for the creative arts therapies (art, dance, drama, music) which use the arts to support health and wellbeing and emphasis relational and creative processes of aesthetic engagement. Through musicking, mark-making, moving, or play-acting in a social context, individuals may experience flow, or a sense of ‘being in sync’ with oneself, or, a sense of joy or connection. This is indicated in the PhD study with participant feedback suggesting DMT can offer a socially inviting form of therapy. As Min reflected, ‘people could just have fun’ and it ‘wasn’t too serious.’ Through experiencing DMT as a vehicle for fun and fitness, participants appeared to access an enlivened (up-regulated) state, without the shame, anxiety, or fear associated with trauma induced up-regulated responses (such as hypervigilance and hyperarousal). Importantly, DMT took place in a social context, therefore encouraging an active state shift toward social connectivity through the physicality of dance.

Furthermore, research indicates that specific dance activities can help shift the body toward a more invigorated state which can also be beneficial for trauma survivors. Dieterich-Hartwell (2017) notes this can be useful when physiological shutdown or immobilization are present. In such instances, the use of vertical movements, such as bouncing or jumping, have been found to correspond with feelings of joy and pleasure (Koch et al., 2007). Whole-body movements, along with the use of rhythmic synchronization, have also been found to support a vitality affect through up-regulating the body’s physiological systems during dance activities (Dieterich-Hartwell, 2017). Echoing this, somatic psychotherapist, Resmaa Menekam (2017) recommends at least 20 min of consecutive movement, including dancing, as part of a trauma sensitive approach to therapy. The rationale behind this recommendation is grounded once more in polyvagal theory (Porges & Dana, 2018). Through dancing, the body’s “natural defensive and protective urges” (Menekam, 2007 p. 172) are thought to become activated, which is believed to support tension-release through active and full-bodied movement in a safe environment. This can be complemented through downward regulating experiences which are interpreted in this study as ‘relaxation’ or stress-release.

The social engagement system is also self-calming and may allow individuals to enter a more relaxed state, particularly when accompanied by others in an attuned manner. In addition to the sense of relaxation that can be supported through attuned, social connection, feelings of calm are also thought to be associated with a type of muscular release enacted through dance. The physicality of dancing for instance is known to support a “positive-deactivated state” (Quiroga Murcia et al., 2010) such as feeling released, relaxed, and calm.

Relaxation may also be interpreted as a ‘rest-and-settle’ state which is sometimes linked to the use mindfulness-based methods in DMT. Supporting body awareness, for example, can be a valuable tool when assisting individuals to metabolize unpleasant sensations in the body, such as triggers associated with stress, anxiety, and/or trauma. DMT incorporates somatic techniques such as attuning to the breath, which can support participants to notice, tolerate, and explore different sensations in the body. Methods such as guided body scans (using interoception) or paying mindful attention to the external environment (known as exteroception) are well documented in DMT, particularly regarding the therapeutic benefits of mindfulness-based DMT (Barton, 2013; Major-Dusele, 2021; Tantia, 2014). Through mindfulness-based practice and down-regulation, the foundations for further therapeutic work can be laid. Further to this, dance therapists may choose to offer take-home tools and resources to encourage further practice and self-soothing outside of sessions, particularly if working in a short-term or drop-in manner.

To summarize: from a neurophysiological perspective, one of the hallmarks of trauma-informed work is thought to be the balancing of up- and down-regulation of the nervous system (Dieterich-Hartwell, 2017, 2020) alongside ability to sideways-shift toward social connection (Gray, 2017) From an exercisePLUS perspective, up-regulation (and sideways-shifting) can be conceptualised through the lens of fun and fitness, while down-regulation speaks to the idea of relaxation. The physical experience of dancing, when combined with activities which encourage relaxation and downward regulation, can help to support nervous system restoration in short-term as well as longer-term therapy. DMT offers a creative, artistic, exercise-based, and psychosocial approach to therapy and is clearly trauma-informed. While fitness classes alone, such as Zumba or kickboxing, are excellent activities in terms or up-regulating the body system, the structure of a DMT session is likely to include intentional opportunities for calming and soothing, which are offered alongside moderate levels of physical activity (or rather, exercise enriched with creative movement). These ideas also point toward the further research possibilities and directions, including the concept of trauma-informed exercise, fitness and strength training.Footnote 7.