“Mental health effects of COVID-19 - How can dance help adapt to the persistent effects of COVID-19?” Webinar presentation, Dance for Health Summer School – The Rosella Hightower National Centre for Dance Excellence in Cannes, France dance, dance for health, dance movement therapy, health, mental health, wellbeing

1. Dance for Health Summer School –
The Rosella Hightower National Centre for Dance Excellence in Cannes
Dr Nicoletta P Lekka, MD, MSc, PhD, Consultant Psychiatrist
Member of the IADMS Dance for Health Committee
Virtual Event, Cannes, France, 28 August 2021
Mental health effects of COVID-19
‘How can dance help adapt to the persistent effects of COVID-19?’

2. Outline
• Mental health effects of COVID-19
(indirect)
• Mental health effects of COVID-19 (direct)
• How can dance help with mental health and
wellbeing in the COVID-19 era?

3. Let’s talk about the persistent
mental health effects of COVID-19
Of

4. Managing the long-term effects of
COVID-19 NICE guideline: Definitions
 Acute COVID-19: Signs and symptoms of COVID-19 for
up to 4 weeks
 Ongoing symptomatic COVID-19: Signs and symptoms
of COVID-19 from 4 weeks up to 12 weeks
 Post-COVID-19 syndrome: Signs and symptoms that
develop during or after an infection consistent with COVID-
19, continue for more than 12 weeks and are not explained
by an alternative diagnosis.
The National Institute for Health and Care Excellence, UK
Nice.org.uk. 2021

5. Managing the long-term effects of
COVID-19 NICE guideline: Definitions
 The term 'long COVID' is commonly used to describe signs
and symptoms that continue or develop after‘acute COVID-
19’
 Includes both‘ongoing symptomatic COVID-19’ (from 4 to
12 weeks) and‘post-COVID-19 syndrome’ (12 weeks or
more)
 Clusters of symptoms, often overlapping, which can fluctuate
and change over time and can affect any system in the body
The National Institute for Health and Care Excellence, UK
Nice.org.uk. 2021

6. Mental health effects of COVID-19
(indirect)

7. Impact of COVID-19 pandemic on mental
health in the general population
 People's lives drastically altered, uncertainties and fears
associated with the virus outbreak, mass lockdowns,
economic recession
 Relatively high rates of symptoms of anxiety,
depression, post traumatic stress disorder,
psychological distress, stress
Xiong, J. et al. (2020), Crook, H., (2021)

8. Risk factors associated with psychological
distress
 Female gender: caregiving role in families, providing
financial and emotional support to children or the
elderly, affected by job losses, unpredictability
 Younger age group (≤40 years)
 Student status: school closures, cancelation of social
events, lower study efficiency with remote online
courses, postponements of exams
Xiong, J. et al. (2020)

9. Risk factors associated with psychological
distress
 Presence of chronic/psychiatric illnesses:
compromised immunity caused by pre-existing
conditions, postponement / inaccessibility to medical
services and treatment, social isolation
 Unemployment: decrease in quality of life and
uncertainty as a result of financial hardship
Xiong, J. et al. (2020)

10. Risk factors associated with psychological
distress
Frequent exposure to social media/news
concerning COVID-19:
 Potential fake news/reports/disinformation
 Possibility for sadness and anxious feelings when
constantly seeing members of the community suffering
from the pandemic via social media platforms or news
reports
Xiong, J. et al. (2020)

11. Efforts to reduce symptoms of mental
disorders - Policymaking
 Prioritising vulnerable groups, such as females, people <40,
students, those suffering from chronic/psychiatric illnesses
 Proper / timely dissemination of COVID-19 related information
 Easily accessible mental health services
 Financial provisions, housing support, access to psychiatric first
aid, encouragement at the individual level of healthy lifestyle
behaviour
Xiong, J. et al. (2020)

12. Efforts to reduce symptoms of mental
disorders - Individual
 Self-care
 Exercising regularly and maintaining a healthy diet pattern
 Distracting oneself from checking COVID-19 related news to
avoid potential false reports and contagious negativity
 Keeping in touch with friends and family
Xiong, J. et al. (2020)

13. Mental Health effects of COVID-19
(direct)

14. COVID-19 patients and mental health
 COVID-19: multi-organ pathology, includes the brain and
nervous system
 High incidence of acute psychiatric symptoms in COVID-
19 patients
 At least 35% of the patients display symptoms of anxiety
and depression
Schou, T., et al, 2021

15. COVID-19 patients and mental health
Psychiatric symptoms might also persist after recovery from the
initial infection
 Anxiety and/or depression
 Symptoms or diagnosis of post-traumatic stress disorder
(PTSD)
 Cognitive deficits
 Fatigue at follow-up
 Sleep disturbances
Schou, T., et al, 2021

16. COVID-19 patients and mental health
 Risk factors for persistent symptoms: disease
severity, duration of symptoms, female sex
 Overall, the results from a recent systematic
review suggest that survivors of COVID-19 are
at risk of psychiatric sequelae but that symptoms
generally improve over time
Schou, T., et al, 2021

17. How can dance help with mental
health and wellbeing in the COVID-
19 era?

18. The supportive nature of dance
Oneness - aliceunderwoodfilms.com
movedancefeel.com
Camilla Greenwell (Photographer)

19. Mental health and dance
 Mental health is as
important as physical health
 Dance can help to develop
a variety of important
mental strengths to help
excel in life: self-awareness,
self-confidence, focus,
commitment, motivation,
mastery of emotions,
positive thinking
c. (Photographer) Kazuo ota - Unsplash

20. Which style of dance?
 Contemporary,
freestyle, ballet,
folk/traditional (from
all continents),
ballroom, Latin (e.g.
tango, salsa), hip-hop,
tap, jazz...
c. (Photographer) Kazuo ota - Unsplash

21. Dance and Health
Dance interventions are
used by patients with
 Parkinson's
 Fibromyalgia
 Cancer
 Hypertension
 Rheumatoid arthritis
 Multiple sclerosis
 Dementia
 Depression
 Anxiety
...and much more
c. (Photographer) Nathalie Jufer, "Senior Stars"
Fancourt, D. and Finn, S. (2019), Hernandes, J.C. et al, 2018

22. Dance and Social Health
 Dance is appealing and
socially engaging
 Dancing together
disrupts loneliness /
isolation and connects
people
c. (Photographer) Mikael Theimer

23. Dance and Social Health
 Dance can interfere
positively on improving
health, well-being, and the
quality of life of people
with different socio-
demographic
characteristics
c. (Photographer) Rainier Ridao - Unsplash

24. Dance and Social Health
Important mechanisms in
group settings:
 Mutual support,
empowerment, mutual
trust, cohesion,
experience to be part of
something larger,
corrective emotional
experiences, social roles,
interpersonal learning
c. (Photographer) Jolanda Prfunder, "Senior Stars"
Koch, SC et al, 2019

25. Dance and Social Health
 Dance contributes to
a sense of shared
purpose - feeling of
achievement
c. Unsplash
Koch, SC et al, 2019

26. Dance and Mental Health
 Dance can improve
emotional, social,
psychological, and
physical well-being
 Can promote self-
expression, self-
esteem, self-
confidence, and self-
motivation
Koch, SC et al, 2019

27. Dance and Mental Health
 Dance can have a
positive impact on
quality of life, subjective
well-being, body image
c. Unsplash

28. Dance and Mental Health
 Dance can improve stress
management and
interpersonal skills
 Can decrease depression
and anxiety
c. (Photographer) Nathalie Jufer, "Senior Stars"

29. Dance and Trauma
 Dance can help people with
PTSD to build a healthy
relationship with their body
 Can help to counteract body
armouring (muscle tensions
in response to stress)
c. (Photographer) Kazuo ota - Unsplash
Fancourt, D. and Finn, S. (2019)

30. Dance and Trauma
 Can help in reducing
perceived stress
 Increasing movement
(which can become
limited and stiff following
trauma)
c. (Photographer) Kazuo ota - Unsplash
Fancourt, D. and Finn, S. (2019)

31. Dance and Mindfulness - Similarities
Mindfulness:
 A state of mind which allows
the participant to observe
feelings and thoughts from a
more distant perspective
 Focus on the here-and-now
 Termination of rumination
and automatic negative
thoughts, because of high
concentration
c. (Photographer) Kazuo ota - Unsplash
Koch, SC et al, 2019

32. Dance and Mindfulness - Similarities
Dance:
 Experience of‘flow’(a
mental state of being
fully immersed and
focused), absorption,
focus on the here-and-
now, high
concentration, physical
presence, and joy
c. (Photographer) Kazuo ota - Unsplash
Koch, SC et al, 2019

33. Dance Movement Therapy
 A creative arts therapy (art
therapy, drama therapy, and
music therapy are the other
arts therapies)
 Focuses on the expressive
or improvisational aspects
of dance as a therapeutic
tool, rather than on specific
movement patterns
c. (Photographer) Patrick Pleau - National Centre for
Dance Therapy – Grands Ballets Canadiens de Montréal

34. Dance Movement Therapy and Mental
Health
 The psychotherapeutic use
of movement to promote
emotional, social,
cognitive, and physical
integration of the
individual, for the purpose
of improving health and
well-being
 Founded on the principle
that movement reflects an
individual’s patterns of
thinking and feeling
Koch, SC et al, 2019

35. Dance Movement Therapy and Mental
Health
A form of psychotherapy
that
 Uses non-verbal
communication
 Emphasises the human
body as its primary
means of
communication and
expression
Karkou, V et al, 2019

36. Dance Movement Therapy and Mental
Health
 May offer a way to
work through issues
that are difficult to
articulate because they
are painful,
frightening, or simply
difficult to access and
address through
cognitive means
Karkou, V et al, 2019
c. (Photographer) Kazuo ota - Unsplash

37. A lifetime of dance

38. Dance Interventions and COVID-19
(summary)
 COVID-19 is affecting
global mental health
 There are increased levels
of anxiety, depression,
insomnia, post-traumatic
stress symptoms, and a
general negative impact on
mental health
c. (Photographer) Ahmad Odeh - Unsplash

39. Dance Interventions and COVID-19
(summary)
Dance interventions can
offer opportunities for
improved mental health
c. (Photographer) Nadim Merrikh - Unsplash

40. Dance - A joyful, creative experience
 A meaningful, valued and
enjoyed activity
 Great sense of pleasure,
leading the individual to
find a sense of belonging
c. (Photographer) Clare Guss-West, "Senior Stars"

41. Dance - A joyful, creative experience
 Feelings of joy, satisfaction
and social connectedness
likely to have significant role
in encouraging attendance /
completion of a dance
intervention
c. (Photographer) Nathalie Jufer, "Senior Stars"

42. Side by Side: Reflections on Two
Lifetimes of Dance
‘Even though in this time of uncertainty we are challenged
about the role of dance, we know that we will continue to
communicate through dance. I am reminded that everyone
finds his or her own way in dance, that no one way is the right
or only way.’
Ann Kipling Brown
Kipling Brown, A. and Penniston Gray, A., 2021.

43. Side by Side: Reflections on Two
Lifetimes of Dance
‘I am excited by how people have engaged in dance and with
others, how professional dancers, schools, and companies are
generously sharing their teaching and resources and how many
have found dance to be a new place to connect with family,
friends, and strangers.’
Ann Kipling Brown
Kipling Brown, A. and Penniston Gray, A., 2021.

44. Please share!
‘Dance for Health provides holistic, evidence-based alternatives
for the individual to manage and adapt to physical, mental and
social health challenges.
In Dance for Health sessions, trained teaching artists engage
people as dancers, rather than patients, in joyful, interactive,
artistic activity.’
Dance for Health, IADMS

45. Acknowledgements
Dance for Health Committee, InternationalAssociation for Dance Medicine & Science
(IADMS) www.iadms.org - an interdisciplinary team of teaching artists, dance educators,
researchers, and healthcare professionals
‘Promoting dance as a life-long partner for health and
wellbeing’

46. Sources
What is the evidence on the role of
the arts in improving health and
well-being?
A scoping review.
Health Evidence Network synthesis report,No.
67
Daisy Fancourt and Saoirse Finn.
Copenhagen: WHO Regional Office
for Europe; 2019

47. References - Sources
1. Crook, H., Raza, S., Nowell, J.,Young, M. and Edison, P., 2021. Long covid—mechanisms, risk factors, and management.
BMJ, p.n1648.
2. Karkou,V.,Aithal, S., Zubala,A. and Meekums, B. (2019). Effectiveness of Dance MovementTherapy in theTreatment of
AdultsWith Depression:A Systematic ReviewWith Meta-Analyses. Frontiers in Psychology, 10:936. doi:
10.3389/fpsyg.2019.00936.
3. Karkou,V. and Meekums, B. (2017). Dance movement therapy for dementia. Cochrane Database of Systematic Reviews.
[online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464250/
4. Kipling Brown,A. and Penniston Gray,A., 2021. Side by Side: Reflections onTwo Lifetimes of Dance. Frontiers in
Psychology, 12.
5. Koch, S.C., Riege, R.F.F.,Tisborn, K., Biondo, J., Martin, L. and Beelmann,A. (2019). Effects of Dance Movement
Therapy and Dance on Health-Related Psychological Outcomes.A Meta-Analysis Update. Frontiers in Psychology, 10:1806.
doi: 10.3389/fpsyg.2019.01806.
6. Lancet, 2021. Understanding long COVID: a modern medical challenge. [online]The Lancet.Available at:
<https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01900-0/fulltext> [Accessed 27 August
2021].
7. Nice.org.uk. 2021. Overview | COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance |
NICE. [online] Available at: <https://www.nice.org.uk/guidance/NG188> [Accessed 25 August 2021].
8. Schou,T., Joca, S.,Wegener, G. and Bay-Richter, C., 2021. Psychiatric and neuropsychiatric sequelae of COVID-19 –A
systematic review. Brain, Behavior, and Immunity,.
9. Xiong, J. et al. (2020) ‘Impact of COVID-19 pandemic on mental health in the general population: A systematic review’,
Journal ofAffective Disorders, 277, pp. 55–64. doi: 10.1016/j.jad.2020.08.001.
Photo credits
 Images by Clare Guss-West, Jolanda Prfunder and Nathalie Jufer are from Clare Guss-West's "Senior Stars" projects with
KonzertTheater Bern and University Bern Institute of Sports Science, Switzerland

48. Thank you for listening!
Dr. Nicoletta P. Lekka
Consultant Psychiatrist
T: https://twitter.com/nicoletta_lekka