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What impact does drama therapy have on well-being for those with chronic conditions?

According to the Center for Disease Control and Prevention (2020), more than half of the population of US Adults (51.8%) have a chronic health condition, and 27.2% of US adults have multiple chronic conditions. Studies have revealed that life expectancy decreases depending on the number of chronic conditions an individual has (DuGoff et al., 2014). Researchers have identified a gap in care for these individuals due to “systemic deficits,” which often exacerbate symptoms (Chwastiak et al., 2014). In addition to systemic change, implementing alternative types of treatment, such as art therapy, may prove effective in enhancing the quality of life for those with chronic conditions. Art has been a method of healing used since the middle ages (Rubin, 2019). Psychodrama, also known as drama therapy, is one method of delivering art therapy that has elicited promising results in studies focused on Fibromyalgia, Substance Abuse, and Cancer.

What is Drama Therapy? According to Leather & Kewley (2019), psychodrama became a popular treatment method in the 1940s. The theoretical foundation for drama therapy is based on Role Theory. Role theory, founded by Robert Landy in 1993, suggests that humans assume a “role” that governs “patterns of behavior that suggest a particular way of thinking, feeling, or acting” (Frydman, 2015). Drama therapy provides an opportunity to explore new roles and identities by using a mixture of techniques, including role-play, improvisation, scriptwriting, storytelling, puppetry, mask making, and group reflection (Leather & Kewley, 2019).

Recent Drama Therapy Research Bonjer Horwitz et al. (2009) explored drama therapy (ie psychodrama) with individuals diagnosed with fibromyalgia by having participants act out a piece of literary text in three different scenarios, including with a professional actor, alone, and with a dance movement therapists. These enactments were recorded and played back for the participants. Participants then rated the intensity of their emotional expression in each clip. The results were that participants rated the power of their emotions the most when they performed with a professional actor. Furthermore, self-rated health reports improved, and pain intensity decreased. These results remained at three and six-month follow-up visits. Leather and Kewley (2019) conducted a systematic review exploring drama therapy as an intervention for those in recovery from Substance Use Disorder. Three studies were reviewed that involved people in active recovery. For this reason, it was unclear if drama therapy is effective for people in the early stages of the recovery process. Key findings, however, were that role-plays in drama therapy allowed participants to re-enact old scenarios, assisting them in identifying future relapse prevention methods. Furthermore, they found that art therapy helped with recovery identity formation and that psychodrama groups provided crucial social support for those in recovery. Menichetti et al. (2016) explored the effect of psychodrama on the subjective experience of adjustment for individuals with a recent cancer diagnosis. The study results were that engagement in art therapy groups increased feelings of empowerment and agency, and also provided a safe place to process anticipatory grief. Furthermore, groups were found to provide relational comfort through connection and the opportunity to provide care for others in similar situations.

Although drama therapy has shown positive results in the articles examined, many limitations need to be addressed to support validity and reliability. The two research studies reviewed had a minimal sample size and had challenges in the sampling procedure. The research design was also problematic. For example, the Bonjer Horwitz et al. (2009) study did not have a control group which decreases the validity of the results. Leather and Kewely (2019) address these research challenges stating, “small sample. sizes and methodological issues hamper the already scarce published research around this topic.”

Art therapy appears to effectively support people with chronic conditions such as Fibromyalgia, Substance Use Disorder, and Cancer. Role Theory seems to be significant in psychodrama in terms of allowing individuals to explore different or new roles to assist them in discovering new, different, or more empowered parts of themselves. Psychodrama appears to be highly relational, suggesting that healing often comes from connection with others. Further research is needed concerning this topic. The Bonjer Horwitz et al. (2009) study also highlights the need for further research on the healing effect of working with professional actors.

References: Boersma P, Black LI, Ward BW. Prevalence of Multiple Chronic Conditions Among US Adults, 2018. Prev Chronic Dis 2020;17:200130. DOI: icon.

Chwastiak, L., Vanderlip, E., & Katon, W. (2014). Treating complexity: Collaborative care for multiple chronic conditions. International Review of Psychiatry (Abingdon, England); Int Rev Psychiatry, 26(6), 638–647. 10.3109/09540261.2014.969689

DuGoff, E. H., Canudas-Romo, V., Buttorff, C., Leff, B., & Anderson, G. F. (2014). Multiple Chronic Conditions and Life Expectancy: A Life Table Analysis. Medical Care; Med Care, 52(8), 688–694. 10.1097/MLR.0000000000000166

National Cancer Institue. (2020, September 25) . Cancer statistics.

National Center for Drug Abuse Statistics. (n.d). Drug abuse statistics. Frydman, J. S. (2016).

Role theory and executive functioning: Constructing cooperative paradigms of drama therapy and cognitive neuropsychology. The Arts in Psychotherapy, 47, 41–47. 10.1016/j.aip.2015.11.003

Horwitz, E. B., Kowalski, J., & Anderberg, U. M. (2010). Theater for, by and with fibromyalgia patients — Evaluation of emotional expression using video interpretation. The Arts in

Psychotherapy, 37(1), 13–19. 10.1016/j.aip.2009.11.003 Leather, J., & Kewley, S. (2019). Assessing Drama Therapy as an Intervention for Recovering Substance Users: A Systematic Review. Journal of Drug Issues, 49(3), 545–558. 10.1177/0022042619845845

Menichetti, J., Giusti, L., Fossati, I., & Vegni, E. (2016). Adjustment to cancer: exploring patients’ experiences of participating in a psychodramatic group intervention. European Journal of

Cancer Care; Eur J Cancer Care, 25(5), 903–915. 10.1111/ecc.12412

Rubin, S. Y. (2019). Supportive Art Making as a Therapeutic Tool for Nurses. Pediatric Nursing, 45(2), 95–98.

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