ATINER CONFERENCE PAPER SERIES No: ART2012-0080 Athens Institute for Education and Research ATINER ATINER's Conference Paper Series ART2012-0080 How Can Dramatic Expression Promote Mental Health? The Use of Drama Therapy in Post-Traumatic Stress Disorder: Insights from Neuroscience Lígia Batista Undergraduate Student Bachelors of Liberal Arts and Sciences Quest University Canada, Canada North-American Drama Therapy Association 1 ATINER CONFERENCE PAPER SERIES No: ART2012-0080 Athens Institute for Education and Research 8 Valaoritou Street, Kolonaki, 10671 Athens, Greece Tel: + 30 210 3634210 Fax: + 30 210 3634209 Email: [email protected] URL: www.atiner.gr URL Conference Papers Series: www.atiner.gr/papers.htm Printed in Athens, Greece by the Athens Institute for Education and Research. All rights reserved. Reproduction is allowed for non-commercial purposes if the source is fully acknowledged. ISSN 2241-2891 4/09/2012 2 ATINER CONFERENCE PAPER SERIES No: ART2012-0080 An Introduction to ATINER's Conference Paper Series ATINER started to publish this conference papers series in 2012. It includes only the papers submitted for publication after they were presented at one of the conferences organized by our Institute every year. The papers published in the series have not been refereed and are published as they were submitted by the author. The series serves two purposes. First, we want to disseminate the information as fast as possible. Second, by doing so, the authors can receive comments useful to revise their papers before they are considered for publication in one of ATINER's books, following our standard procedures of a blind review. Dr. Gregory T. Papanikos President Athens Institute for Education and Research 3 ATINER CONFERENCE PAPER SERIES No: ART2012-0080 This paper should be cited as follows: Batista, L. (2012) "How Can Dramatic Expression Promote Mental Health? The Use of Drama Therapy in Post-Traumatic Stress Disorder: Insights from Neuroscience" Athens: ATINER'S Conference Paper Series, No: ART2012-0080 . 4 ATINER CONFERENCE PAPER SERIES No: ART2012-0080 How Can Dramatic Expression Promote Mental Health? The Use of Drama Therapy in Post-Traumatic Stress Disorder: Insights from Neuroscience Lígia Batista Undergraduate Student Bachelors of Liberal Arts and Sciences Quest University Canada, Canada North-American Drama Therapy Association Abstract Throughout history, dramatic expression has promoted change, the benefits of which are not confined to the stage. Drama therapy, the use of drama for therapeutic purposes, has served various populations, namely those who suffer from post- traumatic stress disorder (PTSD). In order to improve treatment outcomes, scientific knowledge should complement models used in drama therapy. Neuroscience suggests that PTSD treatment should focus on decreasing the intensity of flashbacks as well as increasing the patient's emotional distance from the traumatic memory. Drama therapy's use of executive functioning, movement, and indirect access to emotional responses offers a therapeutic option that is more advantageous to PTSD patients than traditional verbal therapy. In particular, drama therapy may enhance memory extinction, which has been linked to the treatment of PTSD. Although research suggests that drama therapy may be a viable form of treatment for those who suffer from PTSD, further research ought to be conducted to corroborate this hypothesis. Ao longo da história, a expressão dramática tem promovido mudança muito para além do palco. Drama Terapia, o uso da expressão dramática para fins terapêuticos, tem servido vários grupos, nomeadamente aqueles que sofrem de stress pós-traumático. Dada a natureza deste grupo, é importante que os modelos usados em drama terapia se possam basear nos avanços alcançados na área das neurociências. Os modelos terapêuticos devem concentrar-se em diminuir a intensidade de memórias intrusivas e, ao mesmo tempo, distanciar o paciente da carga emocional associada à memória traumática. Visto que aqueles que sofrem de stress pós-traumático têm dificuldade em verbalizar memórias associadas ao incidente, o uso da expressão dramática permite explorar o episódio traumático indirectamente, sem o narrar. É necessário alargar esta pesquisa para corroborar que o uso de drama pode ajudar a criar uma nova memória para assim suprimir a memória traumática inicial. Acknowledgements: The author would like to thank Quest University Canada, Dr. Neal Melvin, PhD, Lauren Head, Kaltrina Kusari, Jonathan Farmer, Isha Aran, Easton Smith, as well as the North-American Drama Therapy Association, particularly Sally Bailey, MFA, MSW, RDT/BCT, for all the support given. Contact Information of Corresponding author: [email protected] 5 ATINER CONFERENCE PAPER SERIES No: ART2012-0080 How can dramatic expression promote mental health? Throughout history, dramatic expression has promoted intra- and inter- personal change, the benefits of which are not confined to the stage. The use of drama for therapeutic purposes gave rise to the field of Drama Therapy (DT) – “the intentional and systematic use of drama/theatre processes to achieve psychological growth and change” (Emunah, 1994:3). DT has been used with a variety of populations, namely with those suffering from trauma. In particular, DT has helped individuals who suffer from post-traumatic stress disorder (PTSD). The causes of this chronic neurological disorder, for which there is no cure, are still unknown. Nonetheless, research in neuroscience recognizes the potential of DT to be an effective and viable therapy option for PTSD (Högberg et al., 2011). At first, to combine the fields of DT and Neuroscience may seem somewhat impossible. However, when we take a closer look, we find that we cannot talk about any form of therapy without referring to the brain. After all, the goal of psychotherapy is to change brain activity. In the case of DT, drama stimulates that change, hence the need to look at both fields. The scientific knowledge we have of the brain is still very limited. Undeniably, the brain is highly complex and it would be naïve to reduce the causes of any disorder, including PTSD, to a few brain structures. Nevertheless, this paper focuses on the major structures implicated in PTSD to highlight the importance of scientific knowledge in DT. For those involved in drama or DT, this paper may seem too scientific; for those coming from a scientific perspective, this paper may appear to oversimplify research in neurobiology. But bear with me. This paper suggests that findings in neuroscience may improve treatment methods in DT. Specifically in the context of PTSD, it is vital to consider the risks associated with “playing” with traumatic memories. It might be the case that drama- based therapies may actually detract from treatment. The reliving of traumatic memories could worsen flashbacks and the intensity of exaggerated responses, as opposed to improving the patient's condition (Kellerman, 1999). Therefore, it would seem obsolete to deal with the patient's traumatic memories without learning from research that focuses on the neural underpinnings of emotion and memory. This paper will address concepts borrowed from neuroscience and DT that are relevant to the treatment of PTSD. Firstly, I will start by exploring how drama has encouraged change at a social and individual level; secondly, I will highlight the importance of the concept of dramatic/ordinary reality in DT (Pendzik, 2006); thirdly, I will give an overview of the neurological mechanisms behind PTSD; and lastly, I will compare findings in neuroscience and DT to suggest that dramatic expression has the capacity to treat PTSD by impairing memory re-consolidation, overcoming difficulties in accessing declarative memories, and improving emotional and working memory. Drama as change When applied to theatre, dramatic expression is a tool for social change. For example, Bertolt Brecht used his epic theatre to combat capitalism (Brecht and Mueller, 1961), John McGrath used dramatic expression to fight for Scottish independence (McGrath, 1981), and Eve Ensler used verbatim theatre to fight for women's rights (Ensler, 2001). In each of these instances, dramatic expression promoted discussion, provoked sociocultural traditions, and made the stage available 6 ATINER CONFERENCE PAPER SERIES No: ART2012-0080 for neglected or marginalized groups of individuals and ideas. However, the fourth wall has always been a challenge for those involved in theatre – the wall that separates the actors from the spectators. The actors often become deliverers of a revolutionary message that is supposed to instigate change. Catharsis allows the actors to inspire the audience, who, by extension, passively observe and slowly become agents of change. But, what if we eliminated the dichotomous concepts of actor and spectator? Augusto Boal, Brazilian practitioner and founder of the Theatre of the Oppressed, did. Boal saw in dramatic expression the potential to “rehearse revolution” (Boal, 2000:141). He created the concept of “spect-actor” to turn theatre into an interactive process, in which the participant is both the actor and the spectator. In Theatre of the Oppressed, the point is not to produce a play, but rather to use dramatic expression in a round-the-circle group setting. This method aims to address the oppressive forces that control the participants' lives – be they psychological, political, or social. This form of theatre merges the individual's political and personal spheres of action.