Introduction

Creative problem solving and research planning go hand-in-hand. In the last 50 years, dance/movement therapy researchers have embraced the ambiguities of a growing profession such as, integrating within pre-existing healthcare systems, navigating varied license and practice standards in different locations; all whilst actively problem solving and contributing to knowledge about the efficacy of interventions in the field of dance/movement therapy (DMT). Within depression research, this includes exploring the use of DMT along with anti-depressants (Hyvönen et al., 2020) and psychedelics, precisely ketamine (Marcantoni et al., 2020). Likewise, researchers in the field of mental health have also attempted to understand and treat depression in novel ways, such as through transcranial magnetic stimulation (Sehatzadeh et al., 2019) and theta-burst stimulation (Liu et al., 2023). Some side effects like headaches, scalp pain, muscle twitching, and gastrointestinal and eye problems have been reported from these treatments (Sehatzadeh et al., 2019). This indicates a need for further research to help identify the appropriate dosage of these sessions to obtain therapeutic benefits without adverse effects. Further, such findings also compel researchers to consider other non-invasive treatment options with potentially lesser side effects, with DMT being one such option.

Treatment-resistant depression (TRD) has not yet been explored in DMT. While this scarcity of research is understandable in a nascent profession, when critically examined from a social justice lens, this is not justified and must be addressed to enable equitable care for all. Although socioeconomic status is a commonly discussed factor in social justice driven research (Amaddeo & Jones, 2007), barriers to equitable care are not limited to financial access. Gaps in the literature may also cause inaccessibility towards treatment. Having identified a gap in DMT literature, where TRD is yet to be explored, gave impetus to my research project on studying the effect/s (if any) of DMT on treatment resistant depression. Creative problem solving was a core component of my research planning process and was crucial in helping me develop a targeted intervention protocol in this area. In this paper, the term intervention protocol refers to the comprehensive list of procedural information needed to carry out research such as eligibility criteria, dosage determination, requirement strategy, fidelity checklist, etc. along with the intervention session plan itself. In this paper, I am primarily focusing on how creative problem solving helped me design the intervention session plan within the larger intervention protocol.

Creswell and Clark (2017) proposed four key areas in research planning aimed at identifying: (1) the research paradigm (e.g., axiology, epistemology, ontology, etc.); (2) the theoretical lens of the researcher and the research (e.g., radical, medical, social etc.); (3) methodological approach (e.g., mixed methods, quantitative, ethnography etc.); and (4) the method of data collection (e.g., questionnaires, interviews, recordings etc.). While an interplay between these four areas may suffice in some research, novel and niche topics often require pioneering thinking, mainly when designing the ‘intervention’ for a given study. Unlike other topics where researchers are informed by pre-existing data that either sets precedence for argumentative reasoning (Greene et al., 2016) or offers an opportunity for replication of some nature, this is not the same for novel and niche topics. The scope of this manuscript to offer a transparent, real-life research experience of problem solving in DMT research, which may be used a template or guide by DMT students or professionals embarking on novel DMT research. In this two-part manuscript, I will first highlight the processes I undertook to explore the traditional key areas of research (Creswell & Clark, 2017) in part I. Next, I will outline a 12-week DMT intervention session plan for adults living with treatment resistant depression developed through the creative and reflexive processes in part II of this manuscript.

Part I: Four Step Creative Problem-Solving Process

Treatment resistant depression (TRD) is a type of depression where one’s symptoms do not reduce despite intervention (Al-Harbi, 2012). Specific theoretical underpinnings of DMT, precisely that of the mind–body nexus (Berrol, 1992), embodiment, and kinesthetic empathyFootnote 1 (Barrero González, 2019; Christopher & Tamplin, 2022; Joufflineau et al., 2018) show promise for symptomatic relief if used in treating resistant depression. However, considering the vulnerability of the population (Gaynes et al., 2020), the mere theoretical potential from a few studies did not provide sufficient knowledge-based insights to help develop the intervention session plan in my research project. Additionally, the emerging literature on treatment resistant depression (TRD) emphasises a prevalence of comorbidities and possible intersections of race (Liu et al., 2021), which further marginalised potential research participants. This re-emphasised the duty of care required through the research planning process to develop an intervention session plan for a first-of-its-kind research study with DMT and TRD. I engaged in a four-step creative problem solving process to develop the intervention session plan for my project. This has been graphically represented in Fig. 1 below.

Fig. 1
figure 1

An illustrative depiction of a four-step creative problem solving process used to help develop a DMT intervention session plan over 2.5 years

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STEP 1: Examining Pre-existing Knowledge

Knowledge is perceived and understood differently across the world. To me, knowledge is best described as the oral or visual understanding that enables us to comprehend the world around us (Cameron, 2020). While examining pre-existing knowledge in step 1 of my problem solving process, I retained this description of knowledge. I consciously considered both formal and informal forms of knowledge, as seen in the questions I sought answers to in this step:

What do I already know about this topic from my clinical experience?

What does the literature say about this topic? and,

How does the ‘self’Footnote 2 of the researcher play a role in influencing the research interests?

In addition to a traditional literature review process, I reflected on the inception of my research interests, which were birthed from my clinical practice.

Clinical Practice

In the early years of my career, I worked as a dance/movement therapist with older adults living with severe and persistent mental health conditions at an outpatient clinic. During this time, I worked with Dina.Footnote 3

Dina was a 66-year-old African-American woman admitted to an outpatient clinic directly after her discharge from an adult in-patient psychiatry ward. She enjoyed the music of Johnny Cash and grooving to disco. Dina was diagnosed with depression and had a history of psychosis and interpersonal conflict. The clinic offered various services, including dance/movement therapy, cognitive behavioural therapy, support groups, housing support, psychopharmacology, and recreational groups. Most of which Dina proactively used/participated in five days a week. Dina roughly participated in two group DMT sessions a week and one individual DMT session every two weeks, amounting to monthly direct contact hours of 7.5 hours with me across 18 months. My work required robust documentation on the client’s experience of sessions. Some of her feedback that struck me includes, “I feel good”, “I enjoy it. You don’t get to do things you enjoy when you get to my age”, “It is so lovely to dance with you”, “Dancing with you is different” and, “these sessions help me get my stress out sometimes”. Dina often reported experiencing significant stress in her life, including a fear of homelessness and loss of health insurance. Although Dina continued to take her medications as prescribed by the psychiatrist, participate in therapy sessions, and attend services offered at the clinic regularly- she still expressed dissatisfaction with her mood. She reported not feeling the benefits of the various interventions despite active participation.

Revisiting Dina’s story helped me reconnect with my curiosity about kinesthetic empathy and the therapeutic movement relationship in DMT. I was also keenly aware that the process of DMT juxtaposed the treatment resistance she experienced at the clinic. Concurrently, I reconnected with my somatic cues of frustration that stemmed from a dissonance between my value of justice-based equitable care that evolved with clients’ needs and structural limitations of support in the outpatient healthcare system in the USA.

The Self of the Researcher and Research Paradigm

The ‘self’ of the researcher is an undeniable part of research planning and warrants similar reflexive exploration as aspects of the research paradigm (as mentioned on p. 1). Here, I refer to ‘self’ as the paradoxical being which is both the essence and the totality of one’s personality, as Jung (1875–1961) described it (McGehee et al., 2017).

AxiologyFootnote 4: Our values play a significant role in justifying our rationale in research. Further, our choices are “influenced by the type of person we are, our experiences, culture, background, social, and economic status” (Roots, 2007, p. 20). Understanding our values from an embodied lens can help clarify research interests and inform the study design and intervention protocol. For instance, awareness and curiosity of my embodied cues (of discomfort and tension) while witnessing the dysregulation my clients experienced due to sub-optimal intervention effects clarified the scope of my research and the focus of the intervention protocol. They were (i) generating systematic knowledge on DMT and TRD and (ii) focusing on emotional regulation in the intervention designed for TRD, respectively. Another example of the influence of my axiology is seen in my use of interviews in data collection and active inclusion of storytelling, meaning-making, and dance stories in the DMT session plan, which stem from the personal value I place on multiple perspectives and oral narratives.

EpistemologyFootnote 5: Another core aspect of identifying a research paradigm is to clarify the researcher’s understanding of knowledge and its creation. By recognizing my embodied response of feeling energised at the thought of combining scientific inquiry with my research participants’ lived experiences, I discovered the importance I laid on knowledge being congruent with social realities (Park et al., 2020). I gained further clarity that my perception of knowledge is “relative to particular social and historical arrangements” (Scott, 2007, p. 5), amounting to epistemic relativism. Like my axiology, these insights also influenced my research’s design and data collection method.

Ontology5: Growing up in a mixed-caste family in India, I was exposed to differences and diversity at a young age. This helped me recognise how social, economic, and cultural factors can affect the perception of one’s reality. My ontological stance is that of a critical realist stance, where one’s perception of reality is affected by their social reality and context (Alele & Malau-Aduli, 2023). For me, my ontological stance was crystalised through my interoceptive awareness. While reviewing different ontological stances, I noticed my body ‘tense up’, namely in my breath, gut, and diaphragm. As I educated myself on the critical realist stance, I noticed these functions to be restored to their natural state. I also noticed that I was no longer clenching the inner muscles of my chest and that my diaphragm had eased back into its resting state. In this way, interoceptive awareness (Khalsa et al., 2009) helped me confirm my ontological stance and create an embodied link between the ‘self’ of the researcher and key steps in research planning.

Methodology: To me, the mind–body nexus inherently symbolises the convergence of two forms of knowledge. Just as DMT embraces both cognitive and somatic processes, similarly, I noticed myself being intuitively drawn to converging two types of data sets by adopting a mixed methodology. From a philosophical perspective, a mixed methodology is rooted in the complexity of reality and seeks to lay a necessary emphasis on different vantage points on a given topic (Watson, 2020). Thus, a mixed methodology could embrace the complexity of TRD and the need for various data sets due to the novelty of this study. Here, I noticed and relied on my embodied felt sense of discerning between ‘alignment vs. fragmentation’ to ensure a clear, logical link between my chosen research paradigm, research interests and the ‘self’ of the researcher. An equally important consideration is the relevance of the intended methodology with the research question; however, I do not reflect on this in this manuscript, as this is commonly discussed in the literature (Tashakkori & Creswell, 2007).

STEP 2: Assessing the Need for Preliminary Studies

Typical of any research endeavour, I first formulated my research question using insights from step one (above), as suggested by McFerran and Silverman (2018). At this stage, my research question was, ‘How can a 12-week group dance/movement therapy intervention support stress management and emotional regulation in adults living with treatment resistant depression?’ Evidently, the research question had a cascading effect on the rest of the research planning process. Next, I revisited the literature reviewed in step one from the lens of the research question. This aimed to ascertain if I had access to enough literature or oral knowledge to develop a session plan that would directly answer the research question. Here, oral knowledge can be best understood as a broad term covering varied lived experiences and stories. Here, the following questions contributed to my successfully navigating this step:

How can I develop an intervention session plan based on existing information (of varied forms)? or

Do I need to generate more knowledge on these topics before I can develop an intervention session plan that can answer the research question?

These questions helped me determine the need for preliminary studies to develop an intervention session plan based on adequate evidence. Once the need for preliminary studies was established, I identified the area of focus of these studies, which was directly informed by the gaps in the literature. Upon identifying the missing links in the literature, I recognised the need to conduct two preliminary studies. The first was a systematic review and meta-analysis on using DMT to treat common symptom clusters in TRD (Christopher et al., under review). The second was a survey study collating practice-based knowledge on how dance movement therapists practiced with their clients with TRD (Christopher & Tamplin, 2022). While the availability of funding and human resources may directly affect the type of preliminary studies that can be carried out, it is unlikely that preliminary studies can be avoided altogether in novel research areas.

STEP 3: Integrating Existing and New Knowledge

Integration is the central action in this third step of creative problem solving. Here, I asked myself the following questions:

How can I integrate new and existing information on this topic? and

How does the integrated information inform the intervention session plan?

Using the study by Shim et al. (2021) as a guide, I integrated the findings of both my preliminary studies and my clinical practice experience using Watson’s (2020) technique of braiding (the findings have been schematically shown in Fig. 2). Braiding was a suitable option as it can combine more than just quantitative or qualitative data. Instead, braiding draws on visual, temporal, and sensorial integrations and is not bound to any one step in the research (Watson, 2020). Although braiding is typically used when two or more methods are sequentially employed across different research phases, I adapted this technique. I used it across different studies to suit my research needs. Watson (2020) also recommends a creative review process that usually has an exegetical output. This process can also be understood from the lens of arts-based research. Here, the words of Hervey (2004) stating “the phenomena of the arts must be allowed to speak for themselves within their unique environments (p. x)” perfectly encapsulated my rationale for the engaging in dance as my creative exegesis, which I termed ‘dancing with the data’ in my research. Through this artistic process, I processed and reviewed the insights from the preliminary studies on a somatic level. I involved the participation of another dance/movement therapist (one of my PhD supervisors, Dr Ella Dumaresq) in this step, who is referred to as the observer below. My rationale for inviting another DMT into this artistic process was similar to what (McNiff) recognises about artistic inquiry being both, subjective but also needing external perspective and potential objectivity (2008). In my case of ‘dancing with the data’, the DMT played the role of the observer bringing to my attention new considerations for movement explorations based on their observations.

Fig. 2
figure 2

The braiding process contributing to the development of the intervention session plan. As stated, the figure begins at the bottom and is designed to be reviewed vertically (bottom-to-top)

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Steps:

  1. 1.

    I reviewed the findings of the systematic review (the first preliminary study in this research project), after which I:

    1. (i)

      Noted down the words that described or alluded to different dance/movement therapy techniques from the systematic review findings. (E.g. improvisation, active choice-making, collaboration, props, etc.).

    2. (ii)

      Wrote down all words that warranted consideration regarding study design (e.g., standard care, 12 weeks, 16 weeks, attrition, etc.).

    3. (iii)

      Read the written words and used these as a prompt for an initial dance exploration, ‘Dancing with the Data-1’ while being witnessed by another dance/movement therapist.

  2. 2.

    Repeated steps (i), (ii), and (iii) with a second dance exploration, which I termed ‘Dancing with the Data-2’ after reviewing the findings of the survey study (the second preliminary study in this research project).

  3. 3.

    The observer shared verbal feedback on any repetitive or striking movement patterns they saw in steps 1 and 2.

  4. 4.

    I then danced in response to the verbal feedback from the observer. This was termed ‘Dancing with the Data-3’.

  5. 5.

    Lastly, after my final movement exploration (which I termed ‘Dancing with the Data-3) was complete, I reflected on ‘Dancing with the Data 1, 2, and 3’ and made a note of the following:

    1. (i)

      Any movement-based need I noticed in myself (that may be a consideration for the dance therapy session plan within the broader protocol).

    2. (ii)

      Any standard DMT techniques I noticed across ‘Dancing with the Data 1, 2, and 3.’

In this novel research, the benefit of using braiding and creative exegesis was that it helped centralise multiple research outputs (Watson, 2020, p. 77). The multiple research outputs obtained from step 5 (as mentioned above) were then ‘braided’ to form the outline of the intervention session plan. This has been schematically depicted below (Fig. 2).

STEP 4: Reviewing Outputs

Maintaining the fidelity of an intervention is part of the ethical duty of care. Since this manner of session plan development involves integration between varied facets, such as the researcher’s self, research paradigm, existing knowledge, and findings from preliminary studies, it was necessary to check my implicit biases that may have clouded my four-step process. I did this by asking the following questions:

Does this session plan directly answer the research question? and,

Is there a clear rationale for each component of the intervention?

If yes, Can I ascertain the links between the preliminary studies, existing literature, and my intervention session plan?

If not, What changes do I need to make to ensure the intervention is built on practice knowledge, new knowledge, and principles of DMT?

A fidelity check may also help maintain the internal validity of the intervention. Here, I sought a ‘content fidelity check’ by one of my supervisors, who read the intervention session plan and provided narrative feedback on the following: (i) any concerns regarding biased use of language and misalignment between the planned intervention session plan and research question of the project, (ii) DMT recommendations in the context of emergent literature on related topics, and, (iii) any further recommendations to enrich research integrity and reduce confirmation or publication biases, if relevant. In some instances, developing an implementation fidelity checklist may also be relevant. In my research, I developed an implementation fidelity checklist adopted from Rolvsjord et al. (2005) framework for research rigour in music therapy, which included four main categories: (i) Essential and Unique, (ii) Essential and Not Unique (iii) Acceptable but not Essential and (iv) Unacceptable. I designed this checklist to be completed after each intervention session of the research project. This also served as a documentation format for any patterns of deviation that emerged during implementation. Any patterns in deviation may also be considered formal inclusions in a second iteration of the intervention session plan if there is one.

Engaging in the aforementioned steps re-emphasised the need for resourceful problem solving while developing a novel intervention session plan, particularly the importance of drawing on multi-faceted resources and forms of knowledge beyond academic literature. Further, recognizing my clients’ lived experiences and insights from clinical practice as core forms of knowledge is also symbolic of the mindset of integration. This was seen in the process of braiding (Watson, 2020) which enabled me to interweave multiple facets of information (cognitive, emotional, sensorial, etc.) that helped me obtain the outline of the intervention. This four-step process helped me navigate the muddy waters of novel research by prioritizing research integrity and personal reflexivity. Having discussed this process, I will present the DMT session plan from the 12-week intervention session plan developed through the abovementioned processes. The following session plan was implemented with one group of five adults with treatment resistant depression (n = 5) between the ages of 20 and 30 with two individuals who dropped at week 6 and 9. All individuals volunteered to participate in a research study, with results to be published in an upcoming companion paper. Individuals were eligible to participate if they fulfilled all the following criteria: (i) have a diagnosis of clinical depression that has either lasted at least 18 months or have been identified to have ‘treatment resistance’ by a medical professional (ii) lived independently (not in an assisted facility) (iii) were between 21 and 50 years of age (iv) did not experienced a significant reduction in symptoms despite engaging in treatment for at least 6 weeks (i.e., antidepressants, or 1:/group psychotherapy) (v) did not have any other illness that requires urgent and persistent medical care (vi) were willing to participate in a 16-week group DMT study (vii) were comfortable with communicating in English (writing, reading, and comprehension) (viii) were not at risk of active self-harm. Further details like exclusion criteria, additional demographic details etc. will be published in an upcoming companion paper.

Part II: The DMT Intervention

Dance/Movemment Therapy Session Plan

Session Structure

To ensure predictability for participants, all sessions were divided into three main parts: a warm-up, theme development, and closure. Since this research was conducted in Australia, it adhered to the guidelines set by the National Statement on Ethical Conduct in Human Research (Council, 2023) which recommends all research risks to be predicted and pre-emptively mitigated or planned for, as appropriate. In the case of this research project, structural predictability was mindfully included in the design of the intervention to offer a sense of control about participants’ exploration and sharing within sessions. Knowledge of the session structure allowed participants to use their agency, judgment and bring up new material accordingly. Each session was planned to be 45 min long and divided into the following time divisions: warm-up—approximately 10 min, theme development—approximately 20 min, and closure—approximately 15 min. A summary of the session plan is depicted below (Fig. 3).

Fig. 3
figure 3

A summary of the DMT session plan. Figure begins at the top and is designed to be reviewed in a vertical manner (top-to-bottom)

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Warm Up

The warm-up was designed to prepare participants for the DMT session, both physically and emotionally. This dual purpose of warm-ups was also seen by the founders of Western DMT as a profession (Levy, 1988), who believed the structured and systematic movements of the warm-up parallelly prepared participants to physically engage in the movements of the sessions while developing a sense of psycho-social flexibility that prepared them for the socio-emotional components of the session (Levy, 1988; Nieman, 2002). I designed the warm-up to include the following options:

  1. (i)

    Head-to-toe warm-up: This warm-up focused on mindful stretching one muscle group at a time. Movements were typically done by rotating body parts in a clockwise, and counter-clockwise directions, and each stretch was held for five to eight counts. If music was used, music with precise rhythms or melodies (percussion or strings) was played. Music with multiple harmonies and complex melodies was avoided. This was adapted from the systematic review (Christopher et al., under review), which revealed the use of structured and planned movements (like stretching and relaxation exercises) to offer predictability and to enhance the effectiveness of the functional movements (Ho et al., 2016, 2020).

  2. (ii)

    Breath-and-limb activation: This warm-up focused on the activation (physiological) of the lungs (by breathing in), ribcage, diaphragm and homolateral activation of upper and lower limbs (i.e., left-hand rises along with the left leg). Here, the limbs did not cross the vertical midsection of the body and were repeated three or four times. This same breath-and-limb activation was then carried out on the opposite limbs. After mastery of this, I invited participants to try contralateral movements with each breath (i.e., left hand rises along with right leg). This was adapted from the systematic review (Christopher et al., under review), in which Ho et al. (2020)’s use of contralateral movements was emphasised to help activate both hemispheres of the brain.

  3. (iii)

    Body-based check-in: Here, I verbally guided the participants to bring conscious awareness to their inner rhythms systematically (i.e., their throat, heartbeat, stomach, gut and so on). As the participants were guided through different parts of their bodies, they were invited to observe any sensory experiences (touch, sound, smell, etc.) they were aware of. When relevant, I invited participants to focus on the nature and intensity of any identified sensorial experiences through the check-in. This emphasis on increasing interoceptive skills in participants was obtained from the findings of the second preliminary study, where interoceptive awareness may be a beneficial way to track somatic depression symptoms (Christopher & Tamplin, 2022).

  4. (iv)

    Physicalizing: This warm-up was based on projective techniques in dance therapy (Chaiklin & Wengrower, 2015) Here, each participant was invited to identify a feeling that best described their presence in the group, verbalizing the identified feeling and adding a movement of their own to express their feeling ‘in-the-moment physically’. A variation of this was to create a small group dance from all the emergent movements. The use of creating small group dances as a DMT technique was emphasised in the individual studies included (Ho et al., 2016, 2020); another study included in the review also emphasised the importance of group cohesion (Pylvänäinen et al., 2015). Hence, small group dances were retained in the intervention sessions as a possible way to foster said cohesion based on the findings of the systematic review (Christopher et al., under review).

  5. (v)

    Feeling check and play with props: Occasionally, props were offered to foster orientation to time, place, and person. Examples of movements that emerged from the props may include movements like ‘passing a ball’ from one participant to the following or more complex movements like using an octaband to demonstrate one’s emotional state. This was also based on physicalizing (Levy, 1988). Here, props were incorporated in the intervention sessions based on the DMT approaches mentioned in all studies included in the systematic review (Christopher et al., under review). Props were used to facilitate expression through metaphors and symbols and increase movement repertoire.

Lastly, the importance of a physical warm-up was also directly aligned with a dance movement therapist’s duty of care by taking all the necessary steps to prevent physical injury.

Theme Development

The overarching theme across the sessions was broadly anticipated but not predetermined. However, due to my presence and creative orientation (Young, 2017), changes and spontaneity were introduced to respond to any emergent needs of the participants. Keeping in line with the National Statement on Ethical Conduct in Human Research (2023), I was prepared to work with potential themes identified based on preliminary studies. These overarching themes were derived from research and practice and were not considered fixed; predictability was primarily structural.

The 12-week DMT intervention was divided into four phases, each consisting of four sessions. These four phases were developed as a result of the braided insights from steps A, B and C (Fig. 1 above). Phase 1 was based on the findings of preliminary study 1 (Christopher & Tamplin, 2022) that identified that interoception to be helpful in developing a rapport, considering it was the beginning of the intervention sessions, this was suitable to phase one of the study. Sensory identification was also introduced in phase one as pre-determinant to emotional regulation, which was the aim of the research endeavour and goal designed for phase 4 of the intervention sessions. Phase two was largely informed by the literature on stress, depression and TRD. Again, considering the research question “How can a 12-week group dance/movement therapy intervention support stress management and emotional regulation in adults living with treatment resistant depression” focusing phase two on co-regulation whilst working towards the goal of independent emotional regulation was aligned with the aim of the research project and needs of the participants.

Phase 1: Theme Development: Weeks 1, 2, 3, 4

Goal: Sensory Identification and Interoception

In this study, sensory identification was best described as linking words to sensory experiences (Motamedi et al., 2021). This specifically included the activation and felt experience of all five senses. Sensory identification was offered via the following:

  1. (i)

    Sensory exposure via props: First, different textures were introduced via different props. Next, the participants were invited to select a prop (from the various options presented) and asked to spend three to 4 min tracing their fingers across the prop. Each prop had a different texture (elastic, hard ball, etc.) and was used to elicit descriptive vocabulary around their sensory experience. This was offered as a practical way for participants to normalize and practice ‘tuning in’ to their sensorial experiences. A verbal discussion and sharing/exchanging props between group members was also offered. One variation included conscious breathwork, where participants may trace their hands on a prop. Here, I also guided the participants to notice changes in breathwork and note any associations that might emerge. It is important to note that I emphasised parasympathetic tones and exhalation of breath, not merely deep inhalations, as the latter can erroneously activate the sympathetic nervous system (Jerath et al., 2019). Another variation was to invite participants to align their breathing patterns to their internal rhythm. This included bringing one’s attention to their heartbeat, etc. This was also directly influenced by the findings of Christopher and Tamplin (2022), in which somatic tracking was emphasised as an essential way to understand the “embodied culture” of oneself (p. 126).

  2. (ii)

    Externalizing internal rhythms: Participants were invited to create movement patterns based on their internal rhythms. This was designed to help enhance/develop sensory identification and interoception due to the close attention to tuning into internal rhythms. This was done by inviting the participants to pay close attention to an internal rhythm, such as their heartbeat, and then clapping to the ‘identified rhythm’. I also invited this ‘identified rhythm’ to be externalized through different body parts (for example, stomping with one’s legs).

  3. (iii)

    Somatic tracking: Typically, this was designed to engage after a body-based check-in during the warm-up section. Here, I invited participants to focus on one sensory experience in their body and respond to a verbal prompt such as, “If this sensation has to find its way out of your body, how would it travel?” or, “If this sensation had to find a safe and comfortable spot in your body, where would it go?” etc. Visual aids (such as an outline of a body on paper) were also offered to draw the path of specific sensory experiences. This was offered to be done 3 or 4 times to help identify any common or recurrent areas where sensory experiences reside or travel through in participants’ bodies.

  4. (iv)

    Mirroring: Typically, this was facilitated after sensory exposure and externalization of internal rhythms. Here, I paired participants into duos and invited them to mirror each other’s rhythms. The rhythm may be a unique movement pattern or their partner’s externalized internal rhythms. In each duo, one participant was invited to engage in a movement of their choice (‘movement A’). While the partner mirrored ‘movement A’, the mover typically witnessed this movement, followed by reversed roles. Mirroring is a DMT technique used in an individual study conducted by Pylvänäinen et al. (2015), which revealed a reduction in low mood in the dance/movement therapy group more compared to the control group as noted in the systematic review (Christopher et al., under review).

  5. (v)

    Using memory to track past body-based sensations: Here, the therapist-facilitator invited the participants to recall a ‘pleasant moment they wished to relive. Participants were invited to verbalize the details of the memory in their minds or with a partner (in duos). Next, they were invited to externalize any emergent sensory experiences that arose with recalling the memory. As done in mirroring, one participant was invited to engage in a movement of their choice (termed ‘movement A’). Secondly, while the partner mirrored ‘movement A’, the mover witnessed this movement. The sequence was then repeated by reversing each role.

Phase 2: Theme Development: Weeks 5, 6, 7, 8

Goal: Co-regulation

In this theme development phase, co-regulation was the primary goal. Co-regulation, like emotional regulation, is a form of coping with dysregulation. Different from emotional regulations that occurs independently, co-regulation is a synergistic process that is influenced by both relational, socio-cultural, and social theories (Moreno et al., 2016) and draws on the interdependence or co-dependence among individuals that enables the goal of regulation (for one or both) to be reached. As a process, co-regulation is heavily dependent on safety within the therapeutic relationship and has previously been identified as common and essential factor in therapy (De Witte et al., 2021). The findings of one of the preliminary studies, (Christopher & Tamplin, 2022), also reinforced the need for a safe holding environment (Winnicott, 1960) was a possible link between kinesthetic empathy and emotional regulation. The authors proposed that expressive movement within a safe space creates the opportunity for emotional self-regulation (Christopher & Tamplin, 2022). This link between safety and kinesthetic empathy has also been seen in the work of Imus and Young (2023) which further validates the interweaving of literature and preliminary studies in order to develop a robust intervention session plan (Fig. 1). Further, teaching/coaching and practicing self-regulation skills was previously identified as one of the steps involved in learning self-regulation (Rosanbalm & Murray, 2017). Hence, I designed to offer co-regulation in the following ways:

  1. (i)

    Playing with polarities: Here, I invited the participants to walk around the room, spot an item that seemed to draw their attention and embody the nature (texture, shape) of the object followed by the opposite of its nature. Playing with polarities, as theorized by DMT Trudi Schoop (de Laban, 1974) contributed to emotional flexibility and potentially increased openness to sharing diverse movements with another participant. Props were offered as a ‘surrogate mover’ if desired by the participants.

  2. (ii)

    Paired polarities: ‘Playing with polarities’ (mentioned above) can also be done in pairs. Here, the mover’s partner identifies and embodies the ‘opposite’ of one’s current/felt emotion. Like the activities in phase 1, one participant from the duo was first invited to engage in a movement of their choice (termed movement A) while the partner mirrored ‘movement A’. Typically, the mover witnessed this movement, followed by roles being reversed. Verbal discussion was offered, and some prompts included: “How did both those extremes feel in your body? Do these polarities feel familiar or unfamiliar?” etc.

  3. (iii)

    Improvisational movement and/or choreography: In this intervention sessions, a choreography is best understood as a string of movements put together with contributions from the participants. The therapist may use improvisation to expand on these contributions and create a group/dyad movement after the polarities have been experienced (as mentioned above). As mentioned earlier, the use of improvisational techniques was adapted from the systematic review (Christopher et al., under review) that revealed a short-term reduction in depression (Ho et al., 2020), increased social connection, and engagement in healthier coping responses after the DMT intervention (Ho et al., 2016).

  4. (iv)

    Recognizing the ‘point of return and no return’: Here, the participants were led through a guided meditation where they were lying down on a mat/sitting in a chair. Through this guided meditation, the participants were invited to reflect, identify, and embody the somatic cues that indicated “how” participants felt in their body “when” they were emotionally uncomfortable whilst also being able to tolerate the dysregulation that accompanied this state. The goal was not to expand their window of tolerance but identify and familiarize themselves with their window of tolerance being activated (Siegel, 2020) and recognise the ‘the point of no return’ when one goes beyond one’s window of tolerance to such a degree after which regulation may not seem immediately attainable. In this context, activation refers physiological and emotional arousal. This prepared the participants sufficiently to then engage in the next step of somatic modulation (described in phase-3 below). This was a logical precursor to somatic modulation where participants recognised their window of tolerance being activated and attempted to regulated themselves when hyper or hypo-aroused. This session was based on the finding that mindfulness could be a potential link between the dance/movement therapy sessions, kinesthetic empathy, and self-regulation in DMT sessions in adults with TRD (Christopher & Tamplin, 2022).

Phase 3: Theme Development: Weeks 9, 10, 11, 12

Goal: Emotional Self-regulation

Emotional self-regulation is one way to foster an optimally regulated nervous system (Koole et al., 2011). This was fostered through the following:

  1. (i)

    Somatic Modulation: Once the participants practiced identifying and embodying the somatic cues that indicated activation of their tolerance window (movement-1), they were invited to engage in somatic modulation. Here, the goal was to try alternative movements instead of engaging in the typical movement patterns while starting to feel dysregulated or recognizing an activation of one’s window of tolerance. I often role-modelled this by providing examples of somatic modulation, after which the participants were invited to create a three-step movement pattern that they could engage in to modulate their sensory experiences towards regulation. This was offered to be done X3 or X4 times, as appropriate. For example,Footnote 6 if a participant identified movement-1 to include, tense and slightly lifted shoulders, slightly rounded back and heavy knees. The three set movement may involve: step 1: recognition of movement-1 (description above) step 2: very gently bobbing the shoulders and knees in the vertical plane and step 3: shifting gaze to a different/new area in the room. These steps 1, 2, 3 maybe repeated as few times, as mentioned.

  2. (ii)

    Somatic Modulation, Practice, and Sharing: I encouraged participants to engage in somatic modulation outside the DMT sessions. Any insights/reflections were encouraged to be brought back to sessions and were further explored in the sessions.

Closure

Finally, all sessions ended with a 10-min closure. Just as the warm-up offered a dual purpose, the closure was designed to offer a physical ‘cool down’ and ensure an emotionally safe transition from the session to the participants’ individual lives. No new themes were consciously introduced or explored in this section. Closure was facilitated in the following ways:

  1. (i)

    Structured and planned movements (like stretching): Like the warmup activities where different body parts are systematically activated, different body parts may be stretched again to bring moving to a close. This was done with or without musical accompaniment (slow and non-lyrical music was used here).

  2. (ii)

    Self-soothing touch: Participants were invited to engage in a ‘self-soothing’ touch. This may include giving oneself a gentle neck rub or rubbing one’s palm against another.

  3. (iii)

    Verbal processing: The need for verbal processing was determined depending on the themes explored in the session. A verbal discussion may be initiated since words are a common and more familiar way for individuals to process and typically understand new and old experiences. This was based on the study by Ho et al. (2020) (included in the systematic review, in peer-review) (Christopher et al., under review), in which verbal processing was explicitly used to help foster a sense of closure. A few examples of verbal prompts were: How are you feeling as we reach the end of today’s session? Can you identify a part of you that you discovered or reconnected with in today’s session? How did it feel to move your body in the same or new ways today? Lastly, are there one or two insights from today’s session that you want to keep in mind?

Mobility accessibility: The entire 12-week DMT session plan could be done seated or standing. Chairs were always in the room, and yoga mats were present when needed.

Response to Intervention Session Plans: Overall, there were a few modifications made to the intervention session plan based on spontaneous movement and emotional needs that emerged in the moment. Participants responded most positively to the planned activity: ‘identifying the point of return and no return’, this was evidenced by the qualitative data collected as part of this research study. Overall, the emergent movement patterns had a small kinespheric range and were interestingly expansive in space, with more movement in the extremities of the body compared to the torso; this may be attributed to the severity of illness. Each participant engaged in the sessions in a unique manner. It is beyond the scope of this paper to discuss this; however, the results of this research will be presented in a case series format in an upcoming companion paper.

Limitations

While this research provides a transparent and replicatable way for dance/movement therapy students and professionals to engage in creative problem solving of their own, the findings of this article need to be tested across various niche/novel dance/movement therapy research topics in order for the findings of this study to be validated or critically questioned and bettered over time. Further, the current intervention session plan developed was only used with a sample size of n = 5. Larger studies with the same population would be ideal to test the suitability of the intervention plan developed via the processes described in this article.

Conclusion

An embodied exploration of the ‘self’ of the researcher and research paradigm can aid in developing both the larger intervention protocol and the intervention session plan. As mentioned, this is especially helpful whilst embarking on the journey of novel research that lacks precedence for replication or argumentative reasoning (Greene et al., 2016). In my research on DMT and treatment resistant depression, I attempted to navigate the challenges of developing a 12-week session plan based on the research question, How can a 12-week group dance/movement therapy intervention support stress management and emotional regulation in adults living with treatment resistant depression? I navigated the challenges of novel and niche research by engaging in a four step creative problem solving process, which entailed asking myself reflexive questions at each stage (mentioned above at each stage). Further, using an arts-based approach can be helpful in integrating various sources of information such as clinical practice, existing literature, preliminary studies, embodied self-reflection and dance in order to obtain centralized research outputs (Watson, 2020). This multilayered information served as the outline of the intervention session plan in my research. This creative problem solving approach maybe be one of many ways to develop a comprehensive intervention session plan in novel research. Additional evaluation is required to validate this creative problem solving approach to be helpful across in novel research in DMT.