What is Anxiety?
Anxiety; Definition and Forms
Anxiety. It’s a concept talked about a lot. A pain or nervousness people describe. It’s also the subject of many jokes and memes online. But what actually is anxiety? Google’s top definition states “a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.” Simple enough. But what about in a mental health sense, such as an anxiety disorder? Below that definition google also states “a nervous disorder characterized by a state of excessive uneasiness and apprehension, typically with compulsive behavior or panic attacks.”
Everyone is capable of experiencing anxiety without being diagnosed with an anxiety disorder. What classifies an anxiety disorder is having “intense, excessive and persistent worry and fear about everyday situations” as according to Mayo Clinic. People suffering from anxiety disorders often suffer from panic attacks, or sudden intense feelings of anxiety or fear. There are a few different types of anxiety disorders including Generalized Anxiety Disorder, Panic Disorder, Specific Phobias, Agoraphobia, Social Anxiety Disorder, and Separation Anxiety Disorder.
Generalized Anxiety Disorder is the general form of anxiety. It involves persistent worry and anxiety to the point that it interferes with daily activities. The American Psychiatric Association states that “ongoing worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping.”
Panic disorder is the frequent recurring panic attacks as a result of heightened anxiety. There are a multitude of symptoms that can occur as a result of these panic attacks some of them being a rapid heart rate, shaking, shortness of breath and sweating. Some symptoms can also be more severe like a feeling of dizziness or choking, shills or hot flashes, and nausea. These symptoms can be so severe that “many people who experience a panic attack may believe they are having a heart attack or other life-threatening illness and may go to a hospital ER”
A specific phobia is anxiety caused by “persistent fear of a specific object, situation or activity that is generally not harmful.” People suffering from this generally know their fear is excessive and irrational but they cannot seem to overcome that fear.
Agoraphobia is the fear of being stuck in a situation that the person feels they cannot escape or will be difficult or embarrassing. The fear escalates the situation to something larger than it actually is and can cause more problems or panic attacks with it. And the situations are usually something like using public transportation, being in open spaces, being in enclosed places, or being in a crowd, which to the average person are normal activities.
Social anxiety is anxiety based around social situations. “Being embarrassed, humiliated, rejected or looked down on in social interactions.” Social anxiety usually causes a person to avoid social situations when possible, or endure them with large amounts of anxiety.
And lastly, separation anxiety disorder is found when a person gains excessive anxiety when away from a person whom they have attached themselves to. This is different from a child being clingy to a parent while young, and rather this is an excess of these emotions causing a person to be persistently worried about losing that person or otherwise reluctant to be away from that person. Another symptom is experiencing nightmares about being separated from this person.
A person can have one of more of these different forms of anxiety. In addition, anxiety can be a symptom of other mental disorders such as depression or PTSD. One of the examples later will also talk about substance abusers who have developed anxiety due to that. Many cognitive issues have anxiety as a side effect, however treatment options such as Dance/ Movement Therapy are highly effective (more on that later)
Misconceptions about Anxiety
There are many misconceptions about anxiety. The biggest one being, if a person has anxiety something is wrong with them. This kind of thinking can cause more anxiety and spark other issues. Below is an infographic covering some myths vs their realities in relation to anxiety.
Another misconception is someone with anxiety should totally avoid situations that induce anxiety, however by doing that they run the risk of increasing their stress when those individuals encounter those situations. Another large misconception revolves around pushing out negative thoughts or willing them to go away. However this practice of repression is proven to cause the thoughts to recur more often. This theory was tested by Wegner and his “White Bear” experiment. Here is a link to a full write up on the study however basically the study asked participants if they would speak about anything they wanted to however they could not mention a white bear. Despite this parameter, participants spoke of the bear approximately once every minute.
Another common misconception focuses around treatment and medication. A lot of people resist the idea of taking medications especially for mental disorders. The research states that medication is a tool that can be used however it is not the only method used to treat anxiety. The most commonly used medications are short term medications such as anti-anxiety medications and longer term medications such as antidepressants. One source says Beta blockers are also used in some cases to “control physical symptoms of anxiety.”
Traditional Treatments
Speaking of treatment for anxiety, there are many different methods for treating anxiety beyond medicine. However, the most common types of treatments are psychotherapy also known as “talk therapy,” and medication. One form of talk therapy is called Cognitive behavior therapy (CBT) which is designed to “help a person learn a different way of thinking, reacting and behaving to help feel less anxious.”
Beyond professional help there are some things that can be done to help to make treatment more effective. If you struggle with anxiety please to not use this post as the source to all your answers and please seek medical help from a professional. Anyway, some of these techniques include stress management, meditation, and support groups (which also exist online if in person spaces cause more stress.) Also avoiding caffeine is suggested as it can worsen symptoms. Other things to avoid include drugs and alcohol as they can aggravate symptoms and make it worse. Here is an infographic about other ways to go about treatment for anxiety.
However, there are other forms of treatment that are newer to the world of therapy. Movement therapy and dance therapy aren’t discussed on any of these medical links however they can prove just as, even more effective than these other methods.
How Can Dance Be Used To Treat Anxiety?
Dance through the lens of therapy
Dance is a highly effective tool for anxiety reduction that is often overlooked. Dancing is already proven to have many positive effects, like an increase in memory skills, a release in endorphins, it’s beneficial to concentration and it improves your sleep. Dance is good for the mind, body, and soul. But dance does so much more than that because dance and movement is how humans express themselves. Body language speaks louder than words, it always has. Our bodies tell stories and release emotions when words can’t. Dance is a heightened form of this, it maps a story and releases what needs to be released. Emotion and motion are very strongly connected. So, when it comes to anxiety, dance is a very effective tool because you physically release those emotions and connect with your body rather than be disconnected with the thoughts that cause the anxiety.
When dance is used in therapy for anxiety it is often referred to as “Dance/ Movement Therapy” or DMT. Psychology Today states that DMT is a “psychotherapeutic use of movement and dance to support the intellectual, emotional, and motor functions of the body. As a form of expressive therapy, DMT looks at the correlation between movement and emotion.” Often when someone is suffering from anxiety, the person creates a mental barrier to prevent a flood of emotions. However these mental blocks disconnect an individual from their own conscious awareness. Or in other words, their anxieties get in the way of themselves. When an individual really connects to a dance therapy session however, the mind has to connect to the body and be present in the space. If you’re not it could result in injury. So by being forced to connect the mind and the body and being made to be present in the space the mind releases those emotions because it physically cannot hold onto them and be present.
Some dance instructors, even outside of a therapy based class, have a rule where an individual can have all the emotional baggage they want, however it must be left outside of the door to the dance studio. Once you enter that space you are present and ready to work and the only thing in the world is that class in that space. And most dancers, even if it’s not a set rule in their studio, still do this anyway so they can work effectively. This is the same concept dance therapy tries to convey, make the brain release the emotions and connect to yourself. The “therapist will use movement to help a client achieve emotional, cognitive, physical and social integration.” And the goal is to get the client to convey the emotions and feelings related to the anxiety so the client can better understand them and release them. As previously stated, motion and emotion are linked, and by using dance as a tool to communicate those emotions, the movement becomes a language everyone understands. And this can convey both conscious and unconscious feelings.
In a TedX Talk I found there was a women that was using dance therapy as a way to help Vietnam refugees. She spoke about the “Notion that shared movement provides the neural basis for empathy and compassion between people” also known as Kinesthetic Empathy. So this was what she did. In the groups they were focusing on “Crossing the SEA of Change.” She said it’s the move from sympathy for the other, to empathy with another, to action together.” And she had them do this through mapping out their lives, then each person would perform their choreography and everyone else would feel and understand and move with them with following their movements. In the video here, she shows a video of one client’s choreography and movement and even with the video you can feel the power and struggle that person went through.
The opposite view
It’s not often that one hear’s an argument to the theory that dance and movement prove a reduction in anxiety, however there is one. This piece argued that while studies had been done to test for reduced anxiety as a result of dance, the studies had not “considered the possibility that effects may be due to specific components of dance, such as exercise or listening to music, rather than to dance per se.” So this particular paper conducted a study which had a few groups, a group of dancers, a group of sport-based athletes, a group that got to listen to music when the other groups were not allowed, and finally a group of mathematicians. They measured the anxiety score of each participant by using the Spielberger State-Trait Anxiety Inventory. . The results were that the group of dancers and the group of athletes anxiety levels did go down and the one who had music playing went up. In other words, the music did not factor into the anxiety reduction for those groups. However in the discussion in the article the writer does argue that, in his opinion, the amount of changes present are not significant enough, but that could also be a result of human error based on how the subjects responded to the surveys. This study argues back and forth that yes dance is effective in anxiety reduction then continues on to argue that there are other factors like experience and other subjects that could have affected the results. The study is called “Effects of Dance on Anxiety” by Andre Lest and John Rust. It’s an interesting read for the opposite view however there is so much more evidence that dance is effective for anxiety reduction, and even their study says as much. In addition, this study was completed with a regular modern dance class rather than a movement based therapy taught by a professional. And while individuals can release anxiety or other issues through a regular dance class, someone struggling with a clinical diagnosis should be using a more structured class with a professional.
Studies done on dance used for anxiety therapy sessions
There are many more studies on the effects of dance and movement therapy for anxiety reduction. A book titled “The Use of the Creative Therapies with Chemical Dependency Issues” details one DMT therapist’s work with a group of people in a psychiatric ward. She is working with substance dependent patients who were reluctant to join in with the therapy sessions. She states “ The substance dependent patients, unfamiliar with dance/movement therapy, would come to groups complaining that they did not know how to dance. According to Anxiety Australia (n.d.), the thought or experience of an anxiety-provoking situation causes muscle tension. When an addict is anxious, his/her muscles are contracted. This not only limits range of movement and mobility, but it also limits the flow of energy through the body. An addict’s body and mind has already resisted the experience before it has begun.” This goes back to the baggage outside the door, these patients were coming in with the pre-notion that they couldn’t do it and letting their anxiety block them from receiving help from the therapist or the movement. So the therapist started with simple breathing exercises and movements based on guided imagery. She noticed the patients begin to relax into the movements and be more actively participating and present. This also resulted in a release of muscular tension which also aided in their relaxation and connection to the space and the process.
That was all the precursor to the study. Her study consisted of 60 patients that “met the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria for substance dependency.” Many of them were there for medically managed detoxification for alcohol and or heroine dependency. They used the The Adult Manifest Anxiety Scale (AMAS) to read levels of anxiety in the patients. She did the study in two groups, one of them working only with DMT and one with guided imagery and DMT. There was also a control group of people who refused to participate in the DMT but were willing to fill out the AMAS. All participants completed the AMAS before and at the end of the entire session.
The results? “The anxiety level of each group that received a clinical intervention significantly decreased on all scales. The control group, which received no intervention, showed no significant change, and therefore suggests that those who did not desire change did not experience change.” She also said this:
“In the beginning of the recovery process, an addict needs encouragement to transition from an internal disconnected state, to an external engaged state. At this point in recovery, when given the chance to retreat internally and disconnect, an addict will revert back to his automatic defenses. This is what he has known for many years and what keeps him/her in the cycle of addiction. The techniques of dance/movement therapy used in this study did not allow the participants to take a passive role. They took an active role as their defenses were challenged. Each individual who chose to participate in the study chose to participate in his/her recovery.”
Another study, "Portrait of Karen: A Gestalt-phenomenological approach to movement therapy" a woman, Karen, came into therapy Leni Serlin (the therapist,) with a lot of anxiety and extreme physical tension and the therapist used movement based therapy to help this woman who feels out of control with her life to gain control of her mind and body again. Gestalt-phenomenological approach to therapy is using Gestalt therapy, which "emphasizes awareness, excitement, and involvement (responsibility and contact) in the moment- to- moment process of living" and working phenomenologically with movement- "giving birth to the person's qualities as they actually are, and helping all aspects of the person to emerge."
In the first session, the therapist states that while Karen was talking about different aspects of her life, she couldn't sit still. "She enters, talking rapidly smiling with clenched teeth, her eyes darting around the room, flicking back to me. Tiny, quick gestures, talking and moving, walking past me...Long limbs crossing, uncrossing... shoulders pulling inward, her chest and her trunk sunk deeply in the corner." Later Karen says, after talking about a lot of her childhood that she "still feels out of control." The therapist also notes that, the longer this tense talking goes on she senses discomfort in herself and that she begins to feel anxious. So she suggests laying on the ground and focusing on breath and then tensing and releasing the muscles starting with the toes. "Back to the floor, to basics; standing is too vulnerable and frightening." The next week when Karen came back she said she used these techniques to help her sleep and she indeed slept a lot better.
As sessions go on she started to have Karen walk around the dance space to "find any movement that was comfortable. This became a walking pattern. In the second week they repeated this process and it became a circular walk with an increasingly fast speed and the circle became tight enough that she had to tilt to remain standing. She also, overtime began to use more movement through her body and create a dance of herself. After 5 minutes of this circle she begins to expand her circle to the edges of the platform till Karen stops and asks to talk.
Karen decide to explain the central image that emerged from her walking. She said she felt like a ball and chain that connects her to a stake connects her to the middle of the circle. She said "she likes this feeling of being 'in harness' and in this form she feels purposeful and directed. Once she spread out to the outer edges of the circle she loosened the 'structure' she created and this left her with "too many possibilities, too many decisions to be made." Through this movement the therapist was able to better sense Karen's two coping methods, and her need to create a structure in her life, with structure as a connection to the sense of being in control. The therapist goes on to explain how her worlds work and her physical changes with each. This walking was described to Karen to be a dance of herself, and from the movement she created the therapist was able to understand more about Karen and help both of them to her Karen's situation.
"The process of therapy presented in this paper is about using movement to intensify awareness and style. All parts of the person are brought out, until she is able to identify with her personal mythology. Awareness moves towards self-acceptance, self acceptance moves toward greater freedom and excitement in living."
How dance can be used as a creative tool to express anxiety on the path to healing
Dance techniques used for the purpose of releasing anxiety and creating a mind-body connection
There are many forms of dance and movement that are actually focused on this mind-body connectivity and use it to center a dancer and warm them up. Laban technique, Bartenieff, Alexander, and so many more. Bartenieff specifically has a few fundamentals that speak a lot to this concept and also connect back to the guided imagery exercises from the first study. Some of them are:
Connectivity – The whole body is connected
Breath Support – Breath brings life and movement
Grounding – The earth provides a support, a ground for Being and moving.
Inner-Outer – Movement is meaningful. Outer reflects inner. Inner reflects Outer.
Function-Expression – Function and expression integrate to create meaning in movement.
Bartenieff works functional movement, how your body moves in order to function. While working this technique instructors often talk about breath, and connectivity in different forms depicted here to the right. Thinking about how a body is connected is crucial when focusing on your mind-body connection. Core-distal connectivity is the connection from your core outward. Head tail connectivity is the body's connection from the top of the head down the spine all the way to the tail bone. Upper-Lower connectivity is how your upper half of your body (head, arms, torso) relates to your lower half (legs, pelvis, feet.) Body half connectivity is the connections right to left, splitting the body down the center along that line of symmetry. And finally, cross lateral connectivity is how your body connects on opposite angles, Right arm to left foot and vise versa.
Elements from Bartenieff, Laban, or Alexander technique are often found in dance therapy classes specifically for how they connect the mover's mind and body and forces the focus to shift from something that causes anxiety to the sense of self. Coupled with the cognitive therapy done in conjunction with DMT, clients are swiftly on the road to recovery.
How dancers and choreographers use dance as a release for anxiety and other complicated emotions
I suffer from anxiety. And I have experienced first hand how dancing, even without s DMT session can release my anxiety and allow me to connect to my surroundings. When I do this and allow myself to just give in to the movement and that mind-body connection, it calms my mind and focuses me on the movement I’m learning. When I’m dancing alone outside of a class, I either improv or choreograph… usually it starts as one and ends as another. I have been choreographing theatrical productions for approximately 7 years now. But I have been choreographing non-theatrical dance pieces for years. Ever since I was little. And even when I was little, dancing was how I would express my emotions. I’m not good at words, writing on this blog has been the best I’ve been able to communicate in a form besides dance. Speaking to my is a nightmare without a script. But when I choreograph, I choreograph from my emotions, my struggles, my life. I put my soul into every movement I do. I convey an emotion, or a thought, or a story, and I feel every change in and breath and beat in that movement. I include this in this research paper because I am a dancer and choreographer and sometimes reading pages and pages on the internet doesn’t seem real after a while. But my story is real. I’m real. And I know many people suffering from anxiety just like me use dance, and choreography to tell their story. And when they do, it’s a release. It’s like, the weight of that issue or story or pain has been lifted off of our shoulders. All from telling the story through movement, and having someone listen.
That’s the power of dance.
Some of my sources were not easily clickable sites however here are the citations for those and my other website sources:
“Anxiety Disorders.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 May 2018, www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961.
Brooke, Stephanie L. The Use of the Creative Therapies with Chemical Dependency Issues. Charles C Thomas, 2009.
Gleissner, Greta. “What Is Dance Movement Therapy?” Psychology Today, Sussex Publishers, 12 Apr. 2017, www.psychologytoday.com/us/blog/hope-eating-disorder-recovery/201704/what-is-dance-movement-therapy.
Kline, Frank, et al. “A Report on the Use of Movement Therapy for Chronic, Severely Disabled Outpatients.” Art Psychotherapy, vol. 4, no. 3–4, 1977, pp. 181–183. EBSCOhost, doi:10.1016/0090-9092(77)90034-5.
Langston, Jeanne Merkle. “The Lived Experiences of Adult Male Trauma Survivors with Dance Movement Therapy.” Dissertation Abstracts International: Section B: The Sciences and Engineering, vol. 80, no. 7–B(E), ProQuest Information & Learning, 2019. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2019-41135-092&site=ehost-live.
Lesté, Andre, and John Rust. “Effects of Dance on Anxiety.” American Journal of Dance Therapy, vol. 12, no. 1, Spr-Sum 1990, pp. 19–25. EBSCOhost, doi:10.1007/BF00844312.
Parekh, Ranna. “What Are Anxiety Disorders.” American Psychiatric Association , Jan. 2017, www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders.
Serlin, Leni. “Portrait of Karen: A Gestalt-Phenomenological Approach to Movement Therapy.” Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy, vol. 8, no. 2, Win-Spr - 1976, pp. 145–152. EBSCOhost, doi:10.1007/BF01812968.
Trautmann-Voigt, Sabine. “Tanztherapie: Zwischen Künstlerischem Ausdruck Und Psychotherapeutischem Verfahren = Dance Therapy between an Artistic Expression and a Therapeutic Method.” PDP Psychodynamische Psychotherapie: Forum Der Tiefenpsychologisch Fundierten Psychotherapie, vol. 5, no. 1, Mar. 2006, pp. 40–53. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2006-03497-004&site=ehost-live.
Winerman, Lea. “Suppressing the 'White Bears'.” American Psychological Association, Oct. 2011, www.apa.org/monitor/2011/10/unwanted-thoughts.