key: cord-0885994-oqxquy27
authors: Grasser, Lana Ruvolo; Javanbakht, Arash
title: Virtual Arts and Movement Therapies for Youth in the Era of COVID-19
date: 2021-07-08
journal: J Am Acad Child Adolesc Psychiatry
DOI: 10.1016/j.jaac.2021.06.017
sha: 0e39a05de067ac3b541902387fb4502b95d259ab
doc_id: 885994
cord_uid: oqxquy27

The COVID-19 pandemic has had a significant impact on youth, including through increased isolation, the transition to online schooling, decreased access to arts and sports programming, exposure to illness, and anxiety. The pandemic has also affected the delivery of therapeutic services at a time when youth have needed more help building coping skills and reducing stress. Creative arts and movement therapies promote creativity and adaptability to better develop cognitive flexibility(1) while enhancing self-regulation and self-direction, adaptive skills that are protective in the face of stress.(2) Creative arts and movement-based group therapies delivered through community settings—such as resettlement agencies, schools, and community recreation centers—are feasible, cost-effective, and increase accessibility, especially for populations often underrepresented in the therapeutic space.(3) Offering such interventions at the group level benefits both those who are experiencing significant stress and anxiety(4,5) and those who are not experiencing such symptoms, as they still reap the long-term benefits of building stress-relaxation and emotion regulation skills. Having previously demonstrated the efficacy of art therapy (AT) and dance/movement therapy (DMT) in improving posttraumatic stress and anxiety symptoms for youth,(4,5) our laboratory—the Stress, Trauma, and Anxiety Research Clinic—shifted programming to virtual formats, in partnerships with local resettlement agencies and schools.

Virtual Arts and Movement Therapies for Youth in the Era of COVID-19

To the Editor:

he COVID-19 pandemic has had a significant impact on youth, including through increased isolation, the transition to online schooling, decreased access to arts and sports programming, exposure to illness, and anxiety. The pandemic has also affected the delivery of therapeutic services at a time when youth have needed more help building coping skills and reducing stress. Creative arts and movement therapies promote creativity and adaptability to better develop cognitive flexibility 1 while enhancing self-regulation and self-direction, adaptive skills that are protective in the face of stress. 2 Creative arts and movement-based group therapies delivered through community settings-such as resettlement agencies, schools, and community recreation centers-are feasible, costeffective, and increase accessibility, especially for populations often underrepresented in the therapeutic space. 3 Offering such interventions at the group level benefits both those who are experiencing significant stress and anxiety 4,5 and those who are not experiencing such symptoms, as they still reap the long-term benefits of building stressrelaxation and emotion regulation skills. Having previously demonstrated the efficacy of art therapy (AT) and dance/ movement therapy (DMT) in improving posttraumatic stress and anxiety symptoms for youth, 4,5 our laboratorythe Stress, Trauma, and Anxiety Research Clinic-shifted programming to virtual formats, in partnerships with local resettlement agencies and schools.

Throughout the pandemic, we have brought AT to youths resettled as refugees, as well as DMT to school children in high-risk, low-resource regions via online formats. Sessions are led by certified art therapists and dance/ movement therapists who also hold a joint master's degree in counseling; the team was supported by a psychiatrist specializing in trauma-informed care. Case managers from resettlement agencies and educators from schools shadow sessions and have the opportunity to learn and to adapt techniques from the therapeutic space for their clients and classrooms well beyond the end of programming. This integration also allows for transference of trusting rapport to facilitators, with whom participants may never have had the chance to meet in person. For youths resettled as refugees, AT is delivered weekly via Zoom, and case managers provide Zoom literacy trainings in advance of programming. For youth in high-risk, low-resource regions, DMT is delivered during their regular school day via students' online learning platforms-leveraging technology that is already familiar and in place (eg, Google Classroom). By running programming through existing structures in collaboration with schools, technological barriers are reduced for students and their families, who are supplied with the appropriate technology via the school. The addition of non-therapeutic facilitators to manage participant attendance and technological issues and to take observational notes allows therapists to fully engage in the therapeutic space without disruptions from the virtual environment. Active participation is enhanced by engaging all sensory modalities and extending beyond traditional verbal communication to provide nonverbal expressive spaces. AT and DMT provide youths resettled as refugees and high-risk, low-resource youths with the opportunity to move the body and to express emotions in healthy ways, while teaching youth how to cope with present and future stressors. Therapies that offer somatic and creative components at a time when children (and others) are likely to be sedentary and with reduced environmental enrichment are particularly useful during the pandemic and beyond.

Observations made by art therapists and case managers working directly with participants in art therapy report that the virtual space has increased the comfort of youths resettled as refugees in sharing their art with the group and reflecting in group discussion on the meaning of their art products-youth have been more vocal and active in group discussion when in the virtual space compared to in-persons sessions, both within persons who engaged in art therapy in both spaces, and between persons who engaged in one or the other. Art therapists and case managers also report that, compared to prior in-person sessions, the virtual space has conferred an increased sense of safety, such that youth have felt less vulnerable and less like they are being observed by facilitators. Data from previous in-person implementations, as well as initial data obtained from current virtual programming (data collection and programming are ongoing) regarding changes in trauma-related psychopathology over the course of intervention indicate improvements in posttraumatic stress and anxiety symptoms for participating youth. 4, 5 Educators report that this addition to the school day has supported students' emotional wellness journey.

Educators note improvements in self-esteem and greater engagement in academics following sessions. Creating a safe space in a virtual setting through DMT has led to students becoming more comfortable with turning on screens and actively participating in class in this same virtual setting. Virtual settings have increased the reach of the program to serve a larger number of individuals: instead of a single n ¼ 15 session group over an 8-week period, we are reaching almost 150 youths over the same timeframe.

Now that youth have developed and used these arts and movement practices in the home and the virtual classroom, we hypothesize that youth may be more inclined to continue using them in naturalistic settings following the intervention period. Unlike traditional therapeutic settings, youth do not go elsewhere to engage in therapy, potentially leaving behind the skills gained in that space-although this remains to be studied, and future work should compare therapeutic contexts in continued practice of creative arts and movement-based interventions to optimize treatment environments. Initial evidence supports such integration: educators have reported that youths participating in DMT have incorporated some of the stress-reduction movement techniques at their desks when feelings of frustration and sadness/anger arise. Our pivot toward virtual environments for implementation of creative solutions to build resilience and to reduce stress in the wake of COVID-19 provides an example of one way in which we may-even well beyond the pandemic-increase accessibility and cost-efficacy of therapies to address trauma-related psychopathology as a monotherapy or adjunctive therapy for those who have traditionally lacked access to treatment and for those whose treatment may be enhanced by these somatosensory interventions.

Thinking with the dancing brain: embodying neuroscience

Resilience in the face of stress: emotion regulation as a protective factor

The biology of human resilience: opportunities for enhancing resilience across the lifespan

Art therapy with Syrian refugee youth in the United States: an intervention study

Moving through the trauma: dance/movement therapy as a somatic-based intervention for addressing trauma and stress among Syrian refugee children

All statements expressed in this column are those of the authors and do not reflect the opinions of the Journal of the American Academy of Child and Adolescent Psychiatry. See the Guide for Authors for information about the preparation and submission of Letters to the Editor