The trial enrolled 24 traumatized refugee women living in communities across Southern Germany, drawn from six different countries of origin. The researchers used a controlled within-group design in which every participant served as her own comparator across time. Each woman was assessed at three points: a baseline measurement (t1), a pretest after an eight-week waiting period (t2), and a posttest following the intervention (t3). This waiting-period structure is methodologically important. Because the women received no other psychotherapy during the entire study period, any change in symptoms during the waiting phase could be attributed to natural recovery, the passage of time, or the mere attention of being assessed. When all symptom scores remained essentially unchanged across those first eight weeks, the researchers could be considerably more confident that whatever happened afterward was linked to the therapy itself.

The measurement strategy reflected the linguistic and cultural diversity of the sample. The primary outcome was the Refugee Health Screener-15 (RHS-15), a validated instrument developed specifically to detect emotional distress in refugee populations. Secondary measures included the Depression Anxiety and Stress Scale (DASS21) and the Posttraumatic Stress Disorder Symptom Checklist (PCL-S), the latter a 17-item instrument used to characterize posttraumatic stress severity. Crucially, all scales were administered in an interview format in each participant’s native language or a language she spoke well, with trained interviewers rather than self-completed questionnaires. This attention to language matters enormously in refugee research, where literacy barriers, unfamiliar response formats and subtle translation problems can systematically distort results. The researchers also conducted an exploratory follow-up with ten participants to examine whether gains persisted beyond the end of treatment.

The intervention itself consisted of eight weekly group sessions, each lasting 1.5 hours, delivered by trained dance movement therapists. Dance movement therapy, or DMT, is one of the creative arts therapies recognized by professional bodies such as the American Dance Therapy Association and its German counterpart. Rather than asking clients to narrate traumatic memories verbally, DMT works through the body: movement improvisation, rhythmic coordination, and expressive physical activity are used as the primary channels of therapeutic work. Two design features of this trial stand out. First, the sessions incorporated music that was emotionally meaningful to the participants themselves, drawing on their own cultural traditions rather than imposing a Western therapeutic soundtrack. Second, the women created their own dance improvisations within the group setting, making the therapy a participatory and culturally adaptive process rather than a standardized protocol imposed from outside.

The results were remarkable in their consistency. At baseline, every woman in the study showed clinically relevant levels of trauma symptoms, confirming the depth of need in this population. During the waiting period, as noted, nothing changed—symptoms of trauma, stress, depression and anxiety all held steady. After the eight weeks of dance movement therapy, however, all four symptom domains dropped significantly. Most strikingly, on the PCL-S trauma measure, scores fell so markedly that the group average dropped below the clinical cutoff value, meaning that the women moved, on average, from a symptom range that would warrant a PTSD diagnosis into the non-clinical range. The statistical analysis employed Greenhouse-Geisser corrected F-tests, a technique that adjusts for potential violations of sphericity in repeated-measures data, alongside t-tests for related samples comparing the matched time points.

The exploratory follow-up added an important nuance to the picture. When ten of the participants were reassessed eight weeks after the intervention ended, the symptom reductions appeared to hold—the benefits carried on. At a one-year follow-up, however, the effects were no longer evident. This pattern, common across many psychotherapy studies for posttraumatic stress, suggests that dance movement therapy can initiate genuine recovery but that some form of maintenance—booster sessions, ongoing group participation, or continued low-intensity support—may be needed to sustain the gains over the long term. For a population whose lives remain marked by insecure residency status, separation from family, and ongoing acculturation stress, the disappearance of treatment effects at one year is less a failure of the therapy than a reminder that trauma recovery is rarely a single event.

Why might moving the body help where words struggle? The theoretical rationale draws on a growing understanding of how trauma is encoded and expressed physiologically. Posttraumatic stress is not purely a cognitive condition; it involves autonomic dysregulation, muscular bracing, disrupted breathing, and a fragmented sense of bodily self. Survivors of violence often experience profound disconnection from their own bodies, and talk-based therapies depend precisely on the verbal reflective capacities that chronic stress and hypervigilance can suppress. Dance movement therapy targets these somatic dimensions directly: rhythmic group movement can regulate arousal, synchronized movement with others rebuilds experiences of trust and social connection, and improvised expression allows emotions to be externalized without requiring linguistic articulation. The incorporation of familiar music from participants’ own cultures may further enhance emotional engagement and safety, addressing a well-known barrier in cross-cultural mental health care where standardized Western interventions can feel foreign or intrusive.

The clinical and economic implications are significant. The authors describe DMT as a low-threshold and cost-effective approach, and the characterization is apt. Group therapy requires fewer therapist hours per patient than individual treatment. It does not depend on a shared spoken language between therapist and client in the way cognitive behavioral therapy does, although skilled, culturally competent therapists remain essential. It can be delivered in community settings rather than specialized clinics, and the participants in this study were recruited through psychosocial centers for refugees and torture victims rather than through psychiatric pathways. For health systems in Germany and across Europe that are chronically unable to meet the mental health needs of refugee populations—remember that fewer than one in ten refugees in need in Germany receives care—interventions that are accessible, acceptable across cultural backgrounds and scalable hold obvious appeal.

Honest appraisal requires acknowledging the study’s limits, and the authors are transparent about them. The within-group design, while strengthened by the waiting-period control, is less rigorous than a randomized controlled trial with an active comparison group; placebo effects, expectancy effects and non-specific therapeutic attention cannot be fully excluded. The sample of 24 women is small, although the authors note it was fully powered for the primary analyses, and the loss of more than half the sample at follow-up restricts the long-term conclusions. The trial was also retrospectively registered at the Center for Open Science in March 2023, which some methodologists would flag. The authors themselves emphasize that the lack of high-quality studies with proper control conditions and long-term follow-ups in this field points to a clear need for future research with more rigorous methodologies, ideally multi-site randomized trials that replicate the culturally adaptive elements that appear central to this intervention’s success.

Even with those caveats, the study adds meaningful weight to the evidence base for creative arts therapies in trauma care, a field that has often relied on smaller or less controlled studies. What makes these findings resonate beyond the statistics is the population at their center: women who survived violence in the countries they left, danger along the routes they traveled, and precarity in the places where they landed, and who in most cases had never before received any mental health treatment. That eight weekly sessions of moving together, accompanied by music that mattered to them, could pull their average trauma symptoms below a clinical threshold is a result worth taking seriously. It suggests that healing for survivors of displacement may not always require words—and that the body, so often the register in which trauma is written, can also be the medium through which recovery begins. The next step is to confirm these effects in larger, randomized trials and to determine how the benefits can be sustained over years, not months. For the twenty-four women who took part, however, the value of those eight weeks has already been measured.

Subject of Research: Effects of dance movement therapy on trauma, stress, depression and anxiety in traumatized refugee women

Article Title: The effect of dance movement therapy on traumatized refugee women – a clinical controlled trial

Article References: Koch, S. C., Nazemi, Z., Arnaud, C., Cook, K., Steltmann, S. J., & Tomaszewski, C. (2026). The effect of dance movement therapy on traumatized refugee women – a clinical controlled trial. BMC Complementary Medicine and Therapies, 26(1), Article 277. https://doi.org/10.1186/s12906-026-05299-1

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05299-1

Keywords: dance movement therapy, refugee women, PTSD, trauma, stress, depression, anxiety, creative arts therapies, RHS-15, clinical controlled trial, mental health, cultural adaptation

The study was led by Saeed M. Alghamdi of Umm Al-Qura University, together with collaborators spanning respiratory care programs across Saudi Arabia and the National Heart and Lung Institute at Imperial College London. The team set out to explore perceptions regarding the use of traditional Saudi singing and dancing as a method to promote general and respiratory health. Their rationale rests on a simple physiological observation: singing, like breathing, demands precise breath control and recruits many of the same anatomical structures that respiratory therapists target in pulmonary rehabilitation, including the diaphragm, intercostal muscles, and the muscles of the upper airway.

Singing is, at its core, the production of musical tones with the voice, and it requires the coordinated regulation of inhalation, phonation, and controlled exhalation. When people sing sustained phrases, they typically deepen their tidal volume, slow their respiratory rate, and increase minute ventilation efficiency, mirroring techniques used in formal breathing retraining. Dancing adds an aerobic dimension, elevating heart rate and ventilatory demand while building endurance in the muscles of respiration. The concept of Singing for Lung Health, often abbreviated SLH in the respiratory therapy literature, has gained traction in recent years as a structured intervention for people with chronic obstructive pulmonary disease and asthma, and previous research suggests that singing and dancing can improve multiple aspects of health in both healthy individuals and those with respiratory conditions.

To test whether these ideas resonate within a Saudi cultural context, the researchers conducted an observational, cross-sectional survey in the Makkah region. The questionnaire combined closed-ended questions, which yielded quantitative data summarized as frequencies and percentages, with open-ended questions designed to surface the key barriers that might prevent people from engaging in traditional performance practices. Ethical approval was obtained from Umm Al-Qura University in Makkah, and the study was conducted in compliance with the Declaration of Helsinki, with all participants providing informed consent before completing the survey.

The results paint a picture of a population already deeply engaged with these traditions and broadly optimistic about their health value. Of the 273 participants, 153, or 56.0 percent, were female, the majority were aged 21 to 41 years, and 88 participants, representing 32.2 percent, reported having chronic respiratory diseases. Among all respondents, 203 people, or 74.4 percent, reported engaging in Saudi traditional singing and dancing. Within this engaged group, 120 participants, or 59.1 percent, believed that traditional singing and dancing had a positive impact on general health, while 93, or 45.8 percent, agreed that these practices are potentially improving lung health.

One of the most compelling findings was the relationship between active participation and perceived benefit. Participants who actively engaged in traditional singing and dancing were significantly more likely to perceive associated health benefits compared to those who did not, with differences reaching statistical significance at p less than 0.001. This pattern held even though the study could not establish causation; it nevertheless suggests that firsthand experience of the breath work and physical exertion involved in traditional performance may shape how people understand its health potential.

Age emerged as a significant factor in engagement. The association was statistically significant, with a chi-square value of 6.20, p equal to 0.045, and a Cramer’s V of 0.151, indicating a modest but measurable effect. Engagement was highest among participants aged 20 years and under, at 85.3 percent, followed by those aged over 41 years at 75.8 percent, and lowest among those aged 21 to 41 years at 69.8 percent. The authors suggest this pattern may reflect the central role of traditional performance in youth gatherings and older community celebrations, while working-age adults may face time constraints that limit participation.

Gender shaped the barrier landscape in a notable way. Female participants were significantly more likely than males to report a lack of community support as a barrier to practicing traditional singing and dancing, a difference that reached statistical significance at p equal to 0.004. No statistically significant gender differences were observed for other perceived barriers. This finding carries practical weight for any future health promotion program: interventions built around traditional performance would need to address social support structures, particularly for women, if they hope to achieve broad participation across the population.

The study’s authors are careful to frame their findings as perceptual rather than clinical. The survey measured what people in Makkah believe about the health effects of singing and dancing, not objective changes in lung function, exercise capacity, or quality of life. Nonetheless, the conclusion points clearly toward the next step: further research assessing the influence of singing and dancing on clinically relevant parameters would be useful. Such studies could measure forced expiratory volume, respiratory muscle strength, six-minute walk distance, and validated quality-of-life instruments before and after structured programs of traditional performance, providing the evidence base needed to move from cultural intuition to clinical recommendation.

If future trials confirm measurable respiratory benefits, the implications could extend well beyond Saudi Arabia. Culturally grounded interventions often outperform generic health messaging because they arrive wrapped in meaning, identity, and joy rather than obligation. Traditional Saudi singing and dancing, practiced for thousands of years in religious ceremonies, social gatherings, and artistic performances, may offer exactly that kind of vehicle: a form of pulmonary rehabilitation that people already love, passed down through generations, waiting to be recognized as medicine hiding in plain sight. The research was funded by Umm Al-Qura University under grant number 26UQU4340488GSSR02, and the study was registered with the Open Science Framework at 10.17605/OSF.IO/867ME.

Subject of Research: Perceptions of traditional Saudi singing and dancing as a means of promoting general and respiratory health in Makkah, Saudi Arabia.

Article Title: The potential use of traditional singing and dancing for respiratory health promotion in Saudi Arabia: an observational study

Article References: Alghamdi, S. M., Kabrah, S. M., Alhawsawi, H. B., Almushayt, B. S., Bajudah, R. K., Abu Dark, R. M., Aldhahir, A. M., Alsulayyim, A. S., Alasimi, A. H., Philip, K. E., Alzahrani, H. A., Alhindi, A. O., Alhindi, A. O., Alasmari, A. M., Alahmadi, F. H., Alqarni, A. A., & Alqahtani, J. S. (2026). The potential use of traditional singing and dancing for respiratory health promotion in Saudi Arabia: an observational study. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05581-2

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05581-2

Keywords: Saudi Arabia, traditional singing, traditional dancing, respiratory health, health promotion, singing for lung health, respiratory therapy, cultural practices, quality of life, chronic respiratory disease, cross-sectional survey, dance movement therapy