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ALL RIVER, Mass. — The two friends were leaving the movie theater when CJ received a phone call from his irate father. The boys rushed to his home, and after the door slammed, his friend heard a series of loud noises, like something being thrown against a hard surface.

The actors froze and the director asked the audience if someone wanted to step into the role of the friend: “What would you have done?”

“This feels so déjà vu,” one of the audience members mumbled under his breath, but didn’t volunteer to get on stage.

Others called out, “go home,” “ask him about it the next day,” “call the cops,” “go home and call my parents.” A volunteer stepped up, mimicking phoning his dad to ask for help.

In between reenactments, the director asked, “Is doing nothing a possibility?” Almost everyone nodded or said yes. “Is everything you’re going to do going to work?”

Finally a slight boy with curly dark hair who rarely looked up when he spoke climbed onto stage. Raising his arms above his head, he mimed breaking down the door to CJ’s house. For a moment, he transformed into a different person.

Fall River, MA -- 08/01/16 -- A participant raises his hand while members of the Trauma Drama troupe perform an interactive therapeutic theatrical exercise on-stage during a Trauma Drama session on August 1, 2016, in Fall River, Massachusetts. (Kayana Szymczak for STAT)
A participant raises his hand while members of the Trauma Drama troupe perform.

And that’s the goal of this whole performance. Called Trauma Drama, it’s a theater-based therapy program for teenagers with severe emotional and behavioral problems.

The idea is that theater can help this group of troubled adolescents regulate their emotions and build skills to cope with trauma.

But it’s an approach that hasn’t gotten much systematic study, despite small programs testing out the potential.

Creative pursuits to work through trauma

Many of the students — who range in age from 15 to 19 — grew up poor, in violent neighborhoods, and have been abused, neglected, and bullied. Such painful experiences cause trauma, which haunts those affected for years or decades, and which is often treated with a combination of talking to a psychotherapist and medication to relieve symptoms like anxiety and depression.

But some therapists are turning to alternatives, like yoga, music, and other creative pursuits to help patients work through trauma. Psychiatrist Dr. Bessel van der Kolk has been one of the pioneers in these efforts toward therapies that engage the body rather than focus exclusively on the mind.

It’s a philosophy built upon van der Kolk’s early work with veterans with post-traumatic stress disorder from the Vietnam War. Over time he came to believe they were “addicted to their trauma,” he said at a psychotherapy conference in Boston in June. He believed that talking about trauma kept it alive, and that patients needed to get in better touch with their bodies instead.

“Trauma is not happening in your brain, it lives in your body,” he said.

Fall River, MA -- 08/01/16 -- Trauma Drama troupe members Simon Davis-Millis (left) and Nicole Craig (right) demonstrate an interactive therapeutic game to Trauma Drama participants on August 1, 2016, in Fall River, Massachusetts. (Kayana Szymczak for STAT)
Troupe members Simon Davis-Millis (left) and Nicole Craig demonstrate a game to Trauma Drama participants.

In the decades since then he has built a clinical practice that draws on techniques including yoga and eye movement therapy to treat traumatized patients.

He founded the Trauma Center at the Justice Resource Institute, outside of Boston, in 1982. Under his guidance, Joseph Spinazzola, executive director of the center, developed Trauma Drama in 2005 for students in Boston Public Schools. After funding ran out in 2010, Spinazzola transitioned it to a semiannual program for youth with complex trauma who are enrolled in residential schools across Massachusetts.

The idea of using techniques like theater to treat trauma, van der Kolk said, came from the biological response to danger. A threatened person typically starts by calling out for help and support. If no one responds, the person defaults to either fighting back or fleeing the location of danger. But if aggression or running away is impossible, the last resort is to shut down.

In those cases, “the body is unable to reset itself to safety or think clearly about a course of action,” said Mimi Sullivan, a psychotherapist and PhD candidate at Widener University, who is writing her dissertation on Trauma Drama.

The students experience the same sort of threatening situations in the scenes, but because they are not in real danger, they are able to react in new ways.

Fall River, MA -- 08/01/16 -- L-R: Trauma Drama troupe members Dave Dorvilier, Nicole Craig, and Kristen Cahill, watch as troupe members rehearse an interactive, therapeutic theatre piece with the theme "family neglect", that they will be performing during next week's Trauma Drama session. (Kayana Szymczak for STAT)
Troupe members Dave Dorvilier, Nicole Craig, and Kristen Cahill (from left) watch as fellow members rehearse a theater piece.

Trained facilitators, called troupe members, begin the scenes, which may portray issues like homophobia, sexting, and teen pregnancy. At a key point, the facilitators freeze and the students have a chance to jump in and act out how they would respond to the situation.

Theater “makes it feel rewarding to do something really scary,” said Sasha Garfunkel, a clinical social worker who helps run the program.

‘Not a standalone form of treatment’

Before each session concludes, the facilitators and students gather in a seated circle on the floor to discuss how the scenes made them feel.

In a debrief of the abusive father scene, some students who had been unresponsive or laughed nervously when the actors were on stage opened up. They said they felt scared, shocked, helpless, anxious, and confused. “I have been in one of those situations before and I was just standing there because I didn’t know what to do,” said one student.

“The acting wasn’t my favorite. It made me uncomfortable, but I got through it,” said another.

The theater approach does risk inflaming students’ personal wounds if a topic on stage hits too close to home, but Trauma Drama takes this into account — scenes are interspersed with lighthearted games to let the tension out of the room. And if a student does feel triggered, he or she can leave the room for that skit.

Fall River, MA -- 08/01/16 -- Trauma Drama troupe members Madeline Panella (left) and Vanessa Medeiros rehearse an interactive, therapeutic theatre piece with the theme "family neglect", that they will be performing during next week's Trauma Drama session. (Kayana Szymczak for STAT)
Troupe members Madeline Panella (left) and Vanessa Medeiros rehearse.

This group of 16 teens meets for 18 weekly sessions this fall, acting out skits, doing teamwork exercises, and playing trust-building games. “It’s not a standalone form of treatment,” emphasized Spinazzola. Alongside these sessions, the Trauma Drama students are receiving multiple types of therapy, including individual therapy and group therapies like bullying intervention and dialectical behavior therapy.

Whether it works is, however, an open question.

Sullivan said her work so far indicates the program has improved students’ capacity to trust others and to manage difficult situations, particularly with adults in their lives. Her findings are based on questionnaires, interviews with students, and physiological data — which measures stress through variations in heart rate and breathing — but they aren’t yet published.

Studies of similar approaches in other places have had mixed results. Dance movement therapy in one study showed benefits to refugees’ mental health; but another study found that role-play and storytelling weren’t helpful for teen refugees. Some small studies have found that theater and yoga are beneficial therapies for people with substance abuse disorders.

Many clinicians, however, are wary of therapies like theater, dance, and art and instead recommend cognitive therapies that help patients modify their thoughts in order to feel and behave differently.

While recognizing that creative arts therapies offer “unique” treatment for trauma, there is little evidence to “support the conclusions of thousands of devoted creative arts therapists,” according to an authoritative guide for clinicians, “Effective Treatments for PTSD,” edited by Edna Foa, a professor of clinical psychology at the University of Pennsylvania.

Fall River, MA -- 08/01/16 -- L-R: Trauma Drama troupe members Sarah Golden Martin, Joe Frank, and Dave Dorvilier, react as troupe members rehearse an interactive, therapeutic theatre piece with the theme "family neglect", that they will be performing during next week's Trauma Drama session. (Kayana Szymczak for STAT)
Troupe members Sarah Golden Martin, Joe Frank, and Dave Dorvilier (from left) react as fellow members rehearse.

“Whether it’s riding a horse or having a dog or body therapy, almost every therapy is going to have some effect,” said Patricia Resick, a psychiatry professor at Duke University.

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Some students may feel their trauma is too “gritty” for this program; others may find it too basic if their previous therapists used theater-based techniques, said Sullivan, who has interviewed many of the students. But most of them say it’s like a “breath of fresh air,” she said.

“They say they feel like themselves for the first time … they find out their own strengths and qualities in themselves they didn’t know they had — for example, they realize they are funny,” she said.

“For real change to take place, the body needs to learn that the danger has passed,” wrote van der Kolk in his recent book, “The Body Keeps the Score.”

When they get up on stage, the students get to step into their worst nightmares — but they are awake, safe, and know it is make-believe. “One of the best ways that we learn is play,” said Dave Dorvilier, codirector of the program. “Here, we are playing games, but they are clinically informed.”

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  • Hello, Shanoor:
    I apologize; after three months, I finally re-read your article. You clarified van der Kolk’s concept of ‘keeping trauma alive as it was’ versus in-the-moment re-experiencing in the body with the action in drama as a way into the healing process. You cracked it! Nice job. Good wishes, Ginger

  • I am the Clinical Director of a group home working with youth 16 – 22yo who are primarily referred through the Department of Children and Families. Typically our clients enter with backgrounds of complex trauma and concomitant deficits in building healthy attachments, fluidity in interpersonal interactions, and neurological sensitivity to threat when interacting in social environments.
    One of the difficulties our clients – and we as therapeutic providers helping them adapt healthier and more effective functioning – contend with is the nature of their daily experience as high-stakes. This dynamic emerges both in their internal, highly-activated stress response systems and in their external interactions with government agencies holding significant power over their lives, unpredictable peers struggling with their own complex psychology, and fraught familial relationships with their own histories and meanings attached. Even minor choices and behaviors are subject to intense scrutiny and are interpreted differently across each of these social layers. Many clients with complex trauma backgrounds already struggle against delayed development across multiple domains, and may have lost out on the normative experiences in early childhood that provide them opportunities to practice and hone interpersonal strategies for handling various social interactions and situations.
    My background includes undergraduate studies in Cultural Anthropology. A perspective that occurred to me as I reflected on the intervention was theory in Anthropology about the significance of “serious games” – that the nature of many human interactions and systems are game-like. Socially (and psychologically), we tacitly agree to complex rules and expectations that we accept and must follow. We expect others to follow the rules of these serious games, across wide-ranging domains that include currency and economy, interpersonal interactions, education, etc. Oftentimes, we looked at child’s play and games as preparatory for the “serious games” we play as adults – very important work that helps our brains develop strategies and reach milestones aligned with socialization into the games of the larger culture. During my experience with Trauma Drama, it occurred to me that it can provide a new space for clients that they otherwise had no access to, that allows them to play games with different scenarios, free from the high-stakes anxiety of “real-life” choice and interactions. It was fantastic to observe a space in which our clients could let their brains toy with different options they might try, experience and interact with the results of those choices, see others try different ideas, and then, without any risk, get to imagine and perform alternatives to explore whether the outcomes may change.
    Through Trauma Drama, I have seen clients – who each day seem trapped in their reactivity and circumscribed interpersonal strategies – explore and create different ways of interacting with other people. I also have seen my clients act observably happier because these choices and behaviors are “just play.” It has been an escape for them to be able to step outside of the seriousness and try out different responses without having to make a grand shift in their day-to-day behavior in the context of the complex social web within which they must attempt to survive. And while they are more free to try these new strategies without having to commit to them, neurologically-speaking the sequence of neurons associated with that thought-process, choice, and behavior all fire together and get reinforced, week-by-week and practice-by-practice. With what we know about plasticity in the brain, creating a regular space and time during which a client is freed to actually enact a different way of being and responding in their lives seems to me to provide another opportunity for complexly-traumatized clients to engage their own capacity for creativity and adaptation.

  • There certainly are inherent healing qualities to drama, as Trauma Drama suggests. As a registered drama therapist and board certified trainer of drama therapy, I would have liked that Drama Therapy as a profession be mentioned in this article. The North American Drama Therapy Association was established in 1979 and provided education, accreditation, and advocacy for its members. All drama therapists are masters level clinicians with training in psychology, theatre arts, and drama therapy. Currently in NJ there is a bill established to license credentialed drama and dance/movement therapists to help the public not be confused with professional drama therapy services and the general use of drama. Here is the link to the North American Drama Therapy Association: http://www.nadta.org

  • Trauma Drama appears to be doing effective work. As a registered drama therapist and board certified trainer for drama therapy who specializes in working with traumatized youth, I would have liked the field of Drama Therapy mentioned in this article. The North American Drama Therapy Association was established in 1979 and all credentialed registered therapists are masters level clinicians with training in psychology, theatre arts, and drama therapy. Currently in NJ Drama and Dance-Movement Therapists have a bill seeking licensure so as not to confuse the public of the general use of drama and trained, qualified Drama Therapists. Here is the site for the North American Drama Therapy Association: http://www.nadta.org

    Brooke Campbell, MA, RDT-BCT, LCAT
    http://www.CreativeKinections.com

  • So glad Trauma Drama was profiled here! I’m the researcher from Widener University who is mentioned in the above article (Mimi Sullivan). Trauma Drama is an evidence-informed promising practice model directly adapted from the Urban Improv theater-based tertiary youth violence prevention model recognized by the Office of Juvenile Justice and Delinquency Prevention (OJJDP) in its Model Program Guide as an evidence-based practice. Here are citations for and links to the research articles on Urban Improv:

    1. Kisiel, C., Blaustein, M., Spinazzola, J., Schmidt, C. S., Zucker, M., & van der Kolk, B.A. (2006). Evaluation of a theater-based youth violence prevention program for elementary school children. Journal of School Violence, 5(2), 19-36.

    http://www.traumacenter.org/products/pdf_files/Getting_Teachers_in_on_the_Act.pdf

    2. Zucker, M., Spinazzola, J., Pollack, A. A., Pepe, L., Barry, S., Zhang, L., & van der Kolk, B. A. (2010). Getting teachers in on the act: Evaluation of a theater- and classroom-based youth violence prevention program. Journal of School Violence, 9(2), 117-135.

    http://www.traumacenter.org/products/pdf_files/Getting_Teachers_in_on_the_Act.pdf

    (FYI, The Trauma Center, JRI has lots of other interesting articles on Trauma and treatments posted on their articles page:http://www.traumacenter.org/products/publications.php )

  • “While recognizing that creative arts therapies offer “unique” treatment for trauma, there is little evidence to “support the conclusions of thousands of devoted creative arts therapists,” according to an authoritative guide for clinicians, “Effective Treatments for PTSD,” edited by Edna Foa, a professor of clinical psychology at the University of Pennsylvania.”

    That attitude reminds me of Simon Wessely et al who have pushed CBT and GET on MECFS patients for the past decade and a half believing false illness beliefs reside in the thinking brain and can be banished with talk therapy.

    Trauma lives in the body and healing must be facilitated in the body. Bravo Trauma Drama.

  • Looks like you are really onto something great. It makes sense to engage the whole experience – body and thoughts.

  • Hi Shanoor
    I just want to reach out and complement you on this great story. I am glad to see that others may see and hear the great work we do through our Trauma Drama program.
    Best regards

  • Hi Shanoor
    I just want to reach out and complement you on this great story. I am glad to see that others may see and hear the great work we do through our Trama Drama program.
    Best regards

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