Efficacy of Performing Arts: Changing Minds
PlayWrite has the unique task of helping youth create, cultivate and communicate their personal histories through performance art. Students are paired with a coach who helps them dig into the meat of their stories by building a trust worthy relationship and calling on the potential of each student to transform themselves. The coaches know the work is important. The many supporters of the organization know it’s potent as well. When students, who write and direct their plays with professional actors realize the impact of their creations, they too understand how transformative this work is. And a study with University of Oregon and Oregon Health & Sciences University helped put this impact into perspective.
The study was performed as a small-scale, randomized efficacy trial, with a waitlist control design. It indicated that PlayWrite workshop participants experienced improvements across multiple behavioral domains. School respondent reports suggested that relative to adolescents on the waitlist (control group), workshop participants had decreased levels of mood symptoms, hyperactivity and emotional dysregulation.
The findings are defined below:
Hyperactivity: being restless and easily distracted (75%).
Mood: including withdrawal, shame, and lethargy (63%).
Anhedonia: an inability to experience pleasure or happiness (58%).
Anger Dysregulation: culturally inappropriate (disruptive or destructive) emotional expression of anger and irritability (tantrums) (50%).
Emotion: including anxiety, somatic complains, depression (50%).
In addition, the self-report data indicated that 63% of PlayWrite participants reported improved impulse control as well as greater expressivity. Neurophysiological research is revealing the dynamics of how the emotional memories of traumatic events may be processed in the brain. Over the past two decades, various research studies have shown that focused or expressive writing regarding significant emotional events produces positive changes in the writer. The benefits are enhanced when expression is manifested through writing combined with movement. This combination is the foundation for PlayWrite’s workshops.
Behavioral changes impact both physical health and behavior, and persist overtime (2,3). David Spiegel, a notable Stanford physician points out, if there were “…similar outcome evidence about a new drug, it likely would be in widespread use within a short time” (4). To better understand what is taking place neurologically, a few well placed puzzle pieces must also make sense. Much of the neurological research has focused on the traumatic end of the resilience spectrum. As neurophysiological research continues to reveal the dynamics for how emotional memories of traumatic events may be processed in the brain, we can begin to understand the scope of its impact on developing youth.
Recent studies on Post-Traumatic Stress Disorder suggest that PTSD might be a useful model for thinking about this problem. Highly charged emotional experiences, particularly traumatic ones, interfere with the formation of declarative memory. This is our ability to consciously recall experiences. It does not however, inhibit implicity memory; the system responsible for conditioned emotional responses and the sensorimotor sensations related to the experience (5). When the individual is subsequently stressed, the high state of arousal seems to promote the retrieval of traumatic memories along with the sensory memories and behaviors associated with those events. It is as though the individual relives the event. Animal studies have shown that when exposed to high stressors, they react to novel stimuli with fright regardless of the outcome. Repetitive exposure to highly charged events further inhibit the neocortical function, the part of our brain responsible for logical thought processing. So, it seems perseverating behavior is without choice. Hippocampal function is disrupted by stress-induced, corticosterone production and a reduction in serotonin, which is correlated with an increase in impulsivity and aggression in humans. Thus there is no opportunity for analytic thought and executive function.
However, there is extensive neurogenesis in the hippocampus throughout life. Animal studies have demonstrated that “new neurons continue to be added in specific regions of the adult brain, including the dentate gyrus, a subregion of the hippocampus that is crucial in cognitive functions such as learning and memory (6).” There are effective ways to undo this process and we have found it is through creative engagement. Emotional writing exercises, for example, combined with exploration of emotion through movement and sound, may be a mechanism for unblocking communication between the hippocampus and the neocortex. It is also helpful to modulate activation of the amygdala, when traumatic memories are retrieved.
Putting emotion into written language is a crucial element. The activity of writing and recalling emotionally charged events challenges multiple brain centers simultaneously and has the potential to retrain neural pathways. The critical element in the PlayWrite process is the one-to-one interaction between coach and writer. This series of interactions, and the way they are structured, may promote remodeling through increased neurogenesis, particularly in the hippocampus.
The relationship between coach and writer in a PlayWrite workshop embodies profound trust and acceptance, which co-operates with attuned challenge. The coach has an unshakeable belief in the strength and creative power of the writer. In the PlayWrite program, each writer is constantly pushed to draw on the emotional truth of his or her own experience in the creation of a play, a drama that emerges from deep conflict between two non-human characters. The words and feelings belong to and are always and entirely generated by the writer (participant). Over the ten days of the workshop, supported by an empathic yet challenging coach, a student/ writer is often able to transform traumatic implicit memories into narratives, leading to persisting improvements in health and behavior. Beyond the positive changes cited above, there may be intergenerational effects on future behavior.
The cycle of abuse and neglect can be broken. Mary Main (7) and her colleagues (8) have shown that people who are able to construct a coherent narrative of their childhood are more than 80% likely to form secure and healthy attachments with their children, even if they have suffered childhood trauma such as abuse and/or neglect. These individuals are also less prone to develop psychopathology such as anti-social personality disorders and other disorders that may lead to violent behavior. Writing a play demands writing about feelings. The author must be able to see events unfolding from different points of view and to honestly inhabit those opposing points of view. PlayWrite workshops require the writer to use his or her own emotional experiences to build characters, understand the history of those characters’ relationship, and explore emotional conflict.
The playwright creates a dramatic narrative – utilizing his or her own life experiences – that works through emotional conflict and crisis toward resolution. These efforts work in harmony with PlayWrite’s primary purpose: supporting and challenging young people in the process of creating art. A quantitative analysis by Dr. Jacqueline Waggoner in 2007* found that “the PlayWrite program engendered compassion and understanding while improving students’ skills in writing, speaking, and listening.” Dr. Waggoner’s research provided the impetus for a wait-list control study of PlayWrite workshops. The research protocol was designed and implemented by a team from the University of Oregon and the Oregon Health & Science University; this two-year research study by Bernstein, Ablow & Nigg was completed in 2012. The study found that – compared to controls – PlayWrite participants improved their ability to appropriately manage their anger, showed increased emotional regulation, and lower hyperactivity as well as better impulse control.
These results are far-reaching and dramatic in the lives of those touched by this transformation. Youth can become more resilient and able to cope with stressors, more confident in themselves and more empowered to lead a life as a creative contributor in their communities.
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