Study Protocol for a Randomised Controlled Trial of Dance-movement Therapy for Adolescents With Depression
Phase: NA
Conditions: Depression
Sponsor: Helsinki University Central Hospital

 
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Cover page 
 
 
Official title of the study: Study Protocol for a Randomised Controlled 
Trial of Dance-Movement Therapy for Adolescents with Depression 
 
Date of the document: 6th December 2025 
 
Registration details: This study is registrated at ClinicalTrials, 
identifier HUS 391/2021. NCT ID not yet assigned 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
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Study Protocol for a Randomised Controlled Trial of Dance-Movement 
Therapy for Adolescents with Depression 
 
 
Background 
Dance-movement Therapy (DMT) is a promising treatment for depression among adult 
patients. A systematic review and meta-analysis of eight studies included 351 patients with 
depression, of whom 192 received DMT combined with treatment as usual (TAU) and 159 
received TAU only. All studies showed a decrease in the severity of depression. One study in 
the meta-analysis reported moderate depression symptoms decreasing to minimal symptoms. 
The effect size of DMT was 0.64 compared to control groups. The meta-analysis concluded 
that DMT is a beneficial intervention in the treatment of depression. However, only one study 
in the review included young patients, indicating a need for future studies, especially 
targeting this population. (1) 
Research on Dance Movement Therapy (DMT) in the treatment of adolescent depression is 
limited. A Korean trial assessed the effectiveness of DMT for mild depression in young 
patients, with a mean age of 16 years. Patients were randomized to either a DMT group or a 
waiting list control group, with 20 patients in each group. In the DMT group, depressive 
symptoms decreased compared to the control group. Additionally, participants in the DMT 
group showed an increase in plasma serotonin concentration and a decrease in dopamine 
concentration compared to the control group (2) 
In Finland, clinical trials of Dance Movement Therapy (DMT) for depression have included 
only adult patients. A randomized multicenter study  included 109 patients with depression 
from psychiatric outpatient clinics, occupational healthcare, and health centers. Participants 
were randomized into groups receiving DMT combined with treatment as usual (TAU) and 
TAU only. Depression symptoms were measured using the Beck Depression Inventory-21 
(BDI-21), Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), and 
Symptom Checklist-90 (SCL-90) questionnaires. A clinically significant decrease in depression 
symptom scores was observed in the DMT group compared with the control group. (3) 
Aim of the study and hypotheses 
The aim of this clinical trial is to investigate the effectiveness of a group-based dance-
movement therapy in treating depression among adolescents. We tailored a group-based 
DMT treatment for adolescents based on knowledge from the multi-center study (3) of adults. 
Research questions are as follows: 
1. Is dance movement therapy (DMT) effective in the treatment of adolescent 
depression? 
2. Does the effectiveness of DMT persist for a 3-month follow-up period? 
3. Are there clinical or background moderators that affect the treatment outcome?  
4. What type of body image is observed in adolescents with depression, and does this 
body image change during dance movement therapy (DMT) 

 
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Hypotheses related to the research questions are as follows: 
1. Dance Movement Therapy (DMT) combined with treatment as usual (TAU) is more 
effective in treating adolescent depression compared with TAU alone. 
2. Treatment gains from active DMT persist until the 3-month follow-up. 
3. The severity and recurrence of depression and comorbid psychiatric disorders predict 
poorer outcomes for DMT. 
4. The body image of adolescents with depression is negative and will change to a more 
positive perception during DMT. 
Methods 
Participants and recruitment 
The aim is to recruit 140 adolescent patients with depression into the study. Recruitment 
began at Helsinki University Hospital's adolescent outpatient unit in September 2022 
(specialist level, Tier 3). Since September 2024, recruitment has been expanded to adolescent 
mental health services in Helsinki (targeted level, Tier 2).  
Patients' ages range from 13 to 17 years. A clinical diagnosis of moderate or severe depressive 
disorder (ICD-10 codes F32.1x, F32.2, F33.1x, F33.2) is present, and comorbid illnesses may 
also be present. The requirement for the K-SADS-PL interview is that 4 or more depression 
symptom criteria must be fulfilled (22). The K-SADS-PL interview is widely used at the 
specialist level; therefore, not all participants have been assessed with it. 
Exclusion criteria include primary psychotic disorders, personality disorders, severe eating 
disorders, or substance use disorders requiring treatment. Patients receiving long-term 
psychotherapy administered by a psychotherapist are excluded; however, those receiving 
brief therapy (7-12 sessions) administered by a psychiatric nurse or psychologist are eligible. 
Patients receiving psychophysiological physiotherapy are also excluded, as the treatment 
outcome could be confounded by another body-oriented therapy. 
Patients meeting the inclusion criteria and their caregivers are informed about DMT and the 
trial during routine visits at the outpatient clinic. Those wishing to participate are screened 
and are required to sign written informed consent. Participants are randomly allocated into 
either the intervention or control group, stratified by age and sex. 
Participants are divided into two age categories, with separate DMT groups for those aged 13-
15 years and 16-17 years, to ensure developmental consistency within groups. 
Randomization is conducted by a research nurse through drawing lots once two patients have 
been recruited from the same age and sex category. It may take time to randomize and 
assemble a group of five to six participants. There is no masking for the researcher or the staff 
responsible for gathering measurements. 
The intervention group (DMT+TAU) will participate in the DMT group in addition to receiving 
treatment as usual (TAU). The control group will receive TAU. 
 
 

 
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Intervention: Dance-movement therapy group  
The dance-movement therapy (DMT) intervention group is led by a dance-movement 
therapist, accompanied by an assistant leader and staff from adolescent mental health 
services, such as a nurse, psychologist, medical doctor, or occupational therapist, since 
autumn 2023. Each group consists of 5 to 6 patients. 
Before the dance movement therapy (DMT) group begins, each participant will meet 
individually with the therapist to facilitate understanding of special needs and expectations. 
The purpose of this interview is also to share information and rules of the group therapy and 
to assess participants' body image. Additionally, the importance of attending each session will 
be emphasized by the therapist. 
DMT group sessions are conducted once a week for 12 weeks, with each session lasting 75 
minutes. Sessions are held in the physical education room of the psychiatric hospital. 
DMT therapists are professional health care or social workers who possess qualifications as 
dance-movement therapists. All therapists have experience in mental health work and youth 
engagement. Additional training in group-form dance movement therapy for the treatment of 
depression has been completed by the therapists. Prior to initiating the DMT groups, the 
therapists underwent training for a specially tailored intervention specific to this study. The 
training aimed to ensure consistency and quality of the therapeutic intervention across all 
groups. Therapists were instructed in group therapy methods appropriate for this patient 
population, based on knowledge acquired from previous studies. The training was conducted 
by a PhD psychologist and DMT therapist (PP), and a physiotherapist, DMT therapist, and 
supervisor (ML). 
Therapists participate in a supervision hour four times during the 12-week therapy period 
under the guidance of a supervisor. A report is written by the therapist for each patient after 
the completion of therapy, which can be considered in planning further patient care. 
The goal of this dance movement therapy (DMT) intervention is to examine participants' 
relationships with their own bodies and movement in a safe, nonjudgmental atmosphere. 
Participants learn to observe their physical reactions, thoughts, and emotions. The aim is to 
strengthen a kind, curious, safe, and positive relationship with their own bodies, with 
attention to bodily activity and individual needs. Attendees learn various methods to 
modulate their feelings through embodied and movement-based techniques by engaging in 
mindful and communication-related physical exercises. The experiences of these exercises are 
communicated through discussion, drawing, and writing. The foundational principles of the 
group include trustworthiness, nonjudgmental attitudes, avoidance of harm (to oneself or 
others), and appreciation of embodied experiences. Each session begins with a warm-up 
exercise, followed by movement explorations within a specific theme that includes 
psychoeducation, and concludes with sharing experiences. Materials used in DMT include 
mattresses, balls, scarves, blankets, and beanbags. The schedule and themes of each session 
are described in Table 3. Suitable exercises for each group are selected by the therapist, who 
actively demonstrates the exercises with the group. 
 
 

 
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Control group: Treatment as usual 
Members of the control group continue their treatment in the psychiatric outpatient clinic as 
previously planned. Most participants in the control group attend weekly visits to the clinic, 
which consist of psychoeducation, brief cognitive behavioral therapy, family counseling, or 
non-directive supportive care according to individual treatment plans. Medication is expected 
for many participants. Additionally, a few participants are on the waiting list for special 
therapy or rehabilitation and do not have regular clinic visits. Details of the treatment 
modalities and frequencies are being collected and will be described in future research 
reports. 
Measures 
Inclusion criteria include a clinical diagnosis of depressive disorder and a total score of 16 or 
more on the Beck Depression Inventory (BDI-21). The BDI-21 consists of 21 questions, with 
each question scored from 0 to 3 points, resulting in a total possible score of 0 to 63 points. 
Higher total scores on the scale indicate more severe depressive symptoms.  
Primary outcome measures 
 
The severity of depressive symptoms among participants will be assessed primarily using the 
Beck Depression Inventory-II (BDI-II) and the Young Person's Clinical Outcomes in Routine 
Evaluation (YP-CORE) questionnaires. The YP-CORE includes 10 questions, each scored from 
0 to 4 points, with a total score range of 0 to 40 points. A higher total score on the scale 
indicates more severe psychological distress. The scale is specifically designed for monitoring 
changes in psychological distress.  
 
Primary outcome measures will be assessed at baseline and at 8 weeks, 12 weeks, and 6 
months from baseline. Both measures have been translated into Finnish, validated, and used 
in previous studies. 
 
Secondary outcome measures 
The Adolescent Depression Rating Scale (ADRS) interview will be used as a secondary 
outcome measure. The ADRS interview consists of 10 questions, each scored from 0 to 6 
points, for a total of 0 to 60 points. A higher total score indicates more severe depressive 
symptoms and impaired agency. The ADRS interview will be conducted by clinical staff or a 
researcher who is unmasked to the treatment allocation. 
The body image of the participants will be assessed using the Body Image Scale, a seven-point 
Likert scale consisting of 11 statements, such as "I feel comfortable in my body." The Body 
Image Likert statements were developed from the Body Image Assessment Interview in a 
DMT study on depression. This measure has primarily been used with adults. It is offered to 
the youth in this study because it is concise and is proposed to consist of four factors: 1) 
memories of suffering, 2) ignorance of body sensations, 3) using the body for safe self-
regulation, and 4) relating to one’s body in a comfortable way. 

 
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Secondary outcome measures will be assessed at baseline, 12 weeks, and 6 months from the 
baseline (beginning of the intervention). 
Moderators 
Data are collected from patient records during the treatment period according to health 
register information systems and notes from psychiatric clinics. The onset, duration, and 
recurrence of depression were obtained from K-SADS-PL interviews or clinical records. 
Additionally, information about other measurement tools, psychiatric medication, living 
conditions, and education will be gathered. Living conditions are categorized as living with 
both parents, living with one parent, or other, which includes all other alternatives. Patient 
education is categorized as attainment of expected education or assignment to special support 
or a small group. No register information was available regarding the education of parents or 
their socioeconomic class. 
Sample size and power calculations 
The appropriate sample size of 140 patients was determined by power calculation. It was 
estimated that the difference between the intervention and control groups using the specified 
measures is approximately 0.5 SD. With the test power set at 0.8 and a significance level of 
0.05, calculations indicated that 64 participants would be needed for each group. If the 
treatment outcome by categorical variable is estimated to emerge in approximately 35% of 
the controls and 60% of the DMT group, 62 participants would be required for each group. 
Considering an expected 10% dropout rate, the target sample size should be 140. 
Statistical analysis  
The intention-to-treat (ITT) sample will include all patients who have provided consent and 
are randomized. The per-protocol sample will include all patients from the control group and 
those from the DMT group who attended at least seven DMT group sessions. No more than 
20% of missing items per scale are allowed and will be replaced by the mean value of the 
scores. Appropriate imputation methods will be selected for other missing data. 
The primary outcomes are the time-by-treatment interactions in linear regression models 
with the intention-to-treat and per-protocol samples at the end of the intervention and at 
follow-up, measured by the Beck Depression Inventory-21 and the Young Person's Clinical 
Outcomes in Routine Evaluation. Effect sizes of the differences in symptom scores within and 
between groups will be measured. The statistical significance level will be set at a p-value of 
<0.05, and 95% confidence intervals will be calculated. 
References: 
1. Karkou, V, Aithal S, Zubala A, Meekums B. Effectiveness of Dance Movement Therapy in the 
treatment of Adults with Depression: A Systematic Review with Meta-Analyses. Front Psychol. 
2019; 10:936. Published 2019 May 3. Doi: 10.3389/fpsyg.2019.00936 
2. Jeong Y, Hong S, Lee MS, Park M, Kim Y, Suh Y. Dance movement therapy improves 
emotional responses and modulates neurohormones in adolescents with mild depression. Int 
J Neurosci. 2005; 115:1711-1720, DOI: 10.1080/00207450590958574 

 
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3. Hyvönen K, Pylvänäinen P, Muotka J ym: The Effects of Dance movement Therapy in the 
treatment of depression: A Multicenter, Randomized Controlled Trial in Finland. Front 
Psychol 11,1687. DOI: 10.3389/fpsyg.2020.01687