AotD: Argentine tango dance compared to mindfulness meditation and a waiting-list control

Article of the Day:

Argentine tango dance compared to mindfulness meditation and a waiting-list control:

A randomised trial for treating depression

by Pinniger, R., Brown, R.F., Thorsteinsson, E.B., & McKinley, P. (2012).

(Complementary Therapies in Medicine, 20, 377-384. DOI: 10.1016/j.ctim.2012.07.003)

Background & Research

Depression and anxiety problems are massive public health issues, not to mention sources of great suffering for millions of people worldwide. In addition to the current standard approach of medication and/or, more rarely, psychotherapy, a great number of somewhat more alternative treatments/forms of help have been proposed and developed for depression and anxiety. Programs or treatments that would be easy to implement, preferably in group settings, inclusive, and cost-effective garner great interest for practical reasons.

Physical activity overall has been found to significantly alleviate depressive symptoms and psychological distress. This is especially true for recreational physical activity, as opposed to specific rehabilitation exercises. Dance combines physical activity with other features found to promote mental well-being, including expressive characteristics, music and (in the case of pair/group dancing) a strong social and physical connection to another person. Not surprisingly, studies have reported dance “therapies” to be at least an effective adjunct to other forms of therapy for depression and anxiety.

Argentinian-style tango dancing in particular adds to the equation requirements for greater awareness of one’s own body and that of the partner, as well as awareness of the current experience in the here and now overall, trust in the partner, and significant skills acquisition over time. A number of physical and social benefits from tango dancing have already been demonstrated (e.g., improved balance, self-esteem, quality of life, coordination, walking speed). Further, despite its generally melancholic contents, tango music has been shown to generate positive emotions, and combined with partnered dancing to improve a person’s emotional state.

In light of these features of tango music and dancing, the study this article reports on examined the possibility that tango dancing could be employed as a mindfulness-based treatment for affective symptoms. Other more clearly mindfulness-based interventions, such as Mindfulness-based Cognitive Therapy, have previously been shown to reduce symptom severity in, e.g., depression and pain, in several studies. Out of particular mindfulness activities, meditation has repeatedly been found to improve psychological well-being in many ways. The authors propose that tango dancing shares attributes with such mindfulness promoting approaches, and could represent a novel form of group intervention combining elements of physical activity and mindfulness.

A randomised controlled trial study was carried out comparing a six-week program of tango dance to a mindfulness meditation group as well as a waiting-list group, in terms of reductions in anxiety, stress and depression levels, and improvements in self-esteem and satisfaction with life. Possible increases in mindfulness in these different groups were also studied. A final number 66 participants (mean age 44.4 years, 90.9 % female) with self-reported stress, anxiety or depression issues took part in the study.

The DASS-21 scale was used for assessing levels of stress, anxiety and  depression. The Satisfaction with Life Scale, the Rosenberg Self Esteem Scale, and The Mindful Attention Awareness Scale were employed to measure the other variables.

Results & Discussion

60.6 % of the participants indicated moderate to severe depression at pre-test, 66.7 % had moderate to extreme anxiety, and 51.5 % reported moderate to severe psychological stress.

The effects of the two activities in relation to a waiting-list condition were assessed by means of between-groups analyses of covariance (ANCOVA) for each dependent variable. With baseline depression controlled for, a statistically significant effect for depression at the end of the program (F(2,59) = 6.00, p = .004, partial η² = .17) was found. Tango and meditation group participants showed reduced levels of depression at post-test, relative to waiting-list controls (p = 0.010 for tango, p = .025 for meditation). The effect sizes (unbiased Hedges’ g [d]) of both interventions were large compared to control, with d = 0.50 for tango and d = 0.54 for meditation.

With baselines stress levels controlled for, there was also a statistically significant effect for psychological stress at the end of the program (F(2,59) = 3.88, p = .026, partial η² = .12). Only tango participants showed statistically significantly reduced levels of psychological stress at post-test (p = .022).  The effect sizes in this case were d = 0.45 for tango and d = 0.37 for meditation.

There were no statistically significant results in the remaining dependent variables (psychological stress, self-esteem, satisfaction with life), though small to moderate effect sizes towards improvement were observed for both the tango and meditation groups, but not the waiting-list control group.

A multiple regression analysis showed that group membership accounted for a  statistically significant 10 % of the variance in the increase in mindfulness, (R² = .10, adjusted R² = .07, F(2,59) = 3.42, p = .039). Taking part in the tango group was a significant predictor (t(59) = 2.61, p = .012) for this increase, while meditation group membership was not, (t(59) = 1.25, p = .217).

In sum, both tango and meditation group participants showed greater reductions in levels of depression from pretest to post-test compared with waiting-list controls, with large effect sizes for reductions in depression. Tango participants also showed significant reductions in stress levels, which was not  observed for meditation or waiting-list control groups. This may suggest such dynamic physical activities as tango might be more effective in reducing psychological stress as compared to more static activities such as mindfulness meditation. Improvement in anxiety symptoms did not reach significance for any group, perhaps due to the control group also showing some improvement. Likewise, no statistically significant changes were seen in self-esteem or satisfaction in life, again possibly due to improvements in the control group as well as small sample size.

That tango dancing participants showed greater increases in mindfulness is an interesting find. It suggests tango dance could be considered a mindfulness promoting activity, and perhaps one that may be more suitable for the promotion of mindfulness for some individuals than meditation.

In view of these results, the authors suggest tango could be an attractive option for first line or complementary therapy for depression or an adjunct to stress management programs. As a group therapy it is likely to
be quite cost effective, and it represents a more positive, self-affirming approach to addressing depression and similar symptoms, instead of focusing on changing negative thoughts or patterns. It is also of interest to note that at the end of the study, 97 % of participants chose to receive a tango dance voucher rather than a meditation voucher, indicating that tango dance had more appeal for these people, regardless of which activity they had participated in during the study.

The limitations of this study include the small sample of mostly well-educated women, the use of self-reports for assessment, and the nature of the trial as exploratory with no follow-up.

Commentary

Physical activity is in my view so clearly linked to improved mental well-being that it really should be among the first and most important treatments suggested for many kinds of psychological problems, especially depression. When combined with social elements, as with partnered dance, the beneficial effects are likely to be even greater. This small study adds to the evidence for the effectiveness of even relatively short programs (6 weeks here) of, e.g., tango dance, in reducing depressive and stress symptoms.

Coordinated dancing with a partner certainly involves learning to maintain concentration in the present moment and present activity, similar to the goals of mindfulness practices. However, I feel it might be taking things too far to call tango dancing as such, at least without added elements, a mindfulness-based approach. I still find it likely most of its potential benefits for mental well-being are due to its physical and social nature, as well as the effects of music and the close connection formed to another human being. In any case, the relationships between mindfulness, physical/social activities like dance and well-being are interesting areas for future study.

Different types of activities are likely to appeal to and work for different types of people. The sample here was Australian, almost exclusively female, generally well-educated and on average middle-aged. It is not terribly surprising that for this group of people, tango dancing had more appeal as compared to meditation, though they did benefit from mindfulness meditation exercises as well, at least in terms of reductions in levels of depression. That they experienced more increases in mindfulness from tango dancing than mindfulness meditation may be explained by tango dancing being a more familiar and initially appealing activity, leading to greater motivation and concentration. It may also be easier to notice improvements in dancing, whereas the benefits of meditation may take a longer time to take effect and be more subtle, especially at first.

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