How can elements of Drama Therapy be used to help relieve psychogenic insomnia?

Final thoughts

The drama was my major for four years as an undergraduate, but the Drama I studied in the past has only been presented on stage for people to watch and be entertained. This postgraduate journey has provided me with an issue: The change I want to see. When I was thinking about this topic, I was always in a state of insomnia, so I asked myself: can I use Drama to do something about insomnia?

Prior to this, I had little knowledge about Drama therapy and had not learn anything related to drama and sleep. For my research, I participated in seminar at Professor Russell and Dr. Neil, talking to drama therapy expert Professor Peng Yongwen. In the process, I learnt a lot about the psychology of sleep and how drama therapy can be applied to insomnia. My tutor has also been providing a lot of useful advice on my interventions and I am refining my programme step by step.

I would like to say that this is not the end of a study, but precisely the beginning. This course has guided my independent thinking and critical thinking. These abilities will continue to help me in my future studies and work. At the end of the course, I would like to thank all my tutors, classmates, the stakeholders involved in my intervention, my parents, and myself.

To inform my research, I interviewed an expert in drama therapy, Professor Peng Yongwen from the Department of Social Performance at the Shanghai Theatre Academy, who provided me with a lot of knowledge and references related to drama therapy.

He analyzed to me how insomnia is actually related to psychological issues such as anxiety or depression, and that my intervention could start with these psychological issues.

At the same time, he shared with me two important references: 15 Lectures on Expressive Arts Therapy and Personality and Masks.

Expressive Art Therapy 15 Lectures was released in Taiwan and offer many ideas for art therapy. It includes drama therapy and focuses on the 5 stages of drama therapy: Dramatic Play, Situational Performance, Role Play, Performance Climax and Dramatic Ritual.

In this reference book, I record some important points as follows：

Drama therapy systematically uses the process of acting to bring about psychological growth and change. Its aims are rooted in psychotherapy, and its tools are derived from five streams: theatre, dramatic play, psychological drama, roleplay and dramatic ritual (Ermunah, 194).

1.Dramatic Play

Landy (1986) described the dramatic play as “a dialectic between the real world and the imaginary world (in Play) we explore the real through our imagination. Since childhood, people have played games of chance and have had significant meaning, discovering, becoming and healing, as well as being happy and fulfilled by creation.

2. Theatre

Theatre can be seen as an extension of dramatic play, where the characters and personalities are as protective and liberating as the physical side. The individual is given the opportunity to express himself through a mask, and acting is a process of organising emotions and the mind.

3. Psychodrama

Psychodrama is very similar to drama therapy, however it cannot and need not be distinguished from psychodrama: whereas psychodrama often focuses on the individual, drama therapy focuses more on the interaction of the whole group and does not necessarily perform real events in the lives of individuals, but is more often improvised and uses more drama-related techniques.

4.Role Play

According to the Russian dramaturg Stanislavsky, improvisation allows the actor to recall his own life experiences and to find similar emotions needed by the character, i.e. a “display of empathy”. In addition, the German theatre director Bertolt Brecht approached the performance of a character as an interlocutory third party, a rational perspective, both of which influence drama therapy. Depending on the needs of the participant, it helps him to increase his capacity for empathy or to view his own emotional experiences in a rational manner.

Moreno believes that people can play different sides of themselves and others by swapping roles and that being aware of the multiple roles in one’s life and being able to play them flexibly can improve their mental health.

5. Dramatic Rituals

In ancient times, theatre was a religious healing ritual used by witch doctors to combat fear, celebrate hope, prepare for and respond to important life events, increase one’s sense of control and empowerment, and give figurative expression to one’s emotions, mind, spirituality, etc. Dramatic ritual is the origin of all art forms and supports the process of personal healing and transformation.

The five stages of Drama Therapy

The five stages of drama therapy are influenced by five source streams. The five stages are dramatic play, contextual performance, role play, performance peak and dramatic ritual.

Stage 1: Dramatic Play

The first stage focuses on stimulating spontaneity and reducing anxiety through dramatic play, enabling the individual to enter naturally into the imaginary world and warm up before entering drama therapy mode.

Dramatic play must be designed to be safe, fun, age-appropriate for group members and allow for failure so that they can naturally recall their childhood playtime during play. Developing an identity with the group allows members to understand that there is no rush to criticise, explain or lay down a diagnosis in the group. Thus, warm-up games have a social function as well as triggering individual spontaneity. And the more structured the activity in the initial stages, the more it reduces the anxiety of the group members.

Stage 2：Contextual Performance

The second stage focuses on developing characters and expanding character possibilities through scripted or improvised performances. This concept and technique is derived from theatre techniques and working models, and the participants take on different roles in this phase, which is the beginning of a new experience. The self-revelation begins under the protection of the theatrical form, and acting becomes an act of liberation for the participant. When the participant begins to connect theatre and real life, this is an indicative experience, representing a moment in which the participant enters into a simultaneous theatrical and therapeutic situation and thus expresses trust in the group. At the same time, the participant, as actor, is also an audience member, watching and associating with his or her own life experiences and feelings, and it is up to the participant to decide after the performance whether to review the process and share all the experiences with the group members.

Stage 3：Role play

The third stage focuses on moving from the fantasy of the previous stage into real life, presenting the real-life relationships, dilemmas and conflicts of the people involved and finding new solutions. This concept is derived from “theatre as a rehearsal ground for the real world”.

The person reenacts his or her real life in the form provided by the theatre, which helps him or her to perform himself or herself, to watch himself or herself and to become more aware, thus gaining a deeper perspective on his or her own life experience, and thus moving away from the repetitive patterns of the life script. At the end of this stage, the client can feel that he or she is not only an actor in the script of life, but also a director, a scriptwriter, an audience member and a critic.

Stage 4: Culmination of the performance

In this stage, the person’s self-disclosure gradually shifts from the specific difficulties of everyday life to life issues, and the material for their subconscious triggers may be fragmented memories, associations, dreams, family emotions, childhood traumas, etc. The concept of this phase is derived from psychodrama, which also uses more psychological techniques and shifts the focus to the individual.

The difference between drama therapy and psychodrama, however, is that drama therapy goes through a step-by-step build-up to the climax of the performance, whereas psychodrama goes straight to the climax of the performance, so that the presentation of drama therapy is more detailed and more memorable for the participants.

Stage 5: Dramatic ritual

This stage focuses on digesting and integrating previous experiences and bringing the concrete changes that they have brought about to life. It is a journey of completing the pain, and group members can give back to each other by reviewing the journey, expressing grief and joy, and feeling the meaning and results of the healing process.

The role and classification of ‘roles’ and how can be used in drama therapy are analysed in detail in Personality and Masks.

Professor Peng’s answers and the literature provided opened my mind to research and provided me with a compass for the design of my workshop.

Question 

How can elements of Drama Therapy be used to help relieve psychogenic insomnia? 

Stakeholder 

People who suffer from insomnia due to psychological factors. 

The 2021 White Paper on Exercise and Sleep, published by the China Sleep Research Association, shows that over 300 million people in China currently have sleep disorders. And according to a survey by the World Health Organisation, 27% of the world’s population has problems with sleep quality. 

The pace of life of modern young people is gradually accelerating, and the pressure of work or life is gradually increasing.” Sleep disorders” gradually become an “epidemic” among modern young people. According to the medical definition, the most typical manifestation of “Sleep disorder” is “Insomnia”, the main characteristics of which include little sleep, much sleep and sleep rhythm disorder, etc. Whenever we go to the hospital with these symptoms, we are more or less likely to receive some “medication” to treat them. But are these medications necessary? Do they have an impact on our health? Is it possible to replace these drugs with another way of relieving our ‘sleep disorder’? 

Among my interviewed stakeholders, they expressed a strong need for relief from insomnia through means other than medication. They have tried to attend workshops such as yoga, sound baths, etc., but physical incoordination and fear of ethereal music prevented some from achieving a soothing effect in these forms. Therefore, I made the conjecture of using drama therapy to alleviate psychological insomnia. 

Based on stakeholders’ feedback and advice from my mentor Jasminka, I addressed the issue of the “Breathing Exercise” part of fifth intervention being too lengthy.

Firstly, it was shortened from 20 minutes to 2 minutes. Secondly, I re-recorded and re-edited the “Breathing Exercise” part in order to better connect it with the dramatic storytelling part, as well as to give the stakeholders more emotional coherence and better engagement with their imagination.

Breathing exercises outline：

At the same time, this intervention will edit different audio clips according to the different stakeholders, this is to better match their imaginative rhythms and psychological expectations.

Here is a sample of one of the interventions：

Based on the feedback from the last intervention, I realised the importance of the warm-up part. To enable the stakeholders to better enter the imagination, I add a breathing exercise before the story begins. This allows them to be able to calm down for a while in the midst of their busy lives in order to be ready to go to sleep.

Secondly, in order to make the rhythm of the instructions more appropriate for each stakeholder, I suggest that stakeholders can interrupt or play each instruction on their own.

But based on the feedback they gave, this also brought some drawbacks. For example, when they clicked pause, the corresponding music also stopped, which interrupted their imagination. Therefore, I think my next step needs to be to separate the music and the recording of my instructions into two mutually uninterrupted audio sessions. Secondly, the need for stakeholders to click play and pause on their own also prevents them from focusing on the imagination of the story, and I am looking for a solution to this problem.

Based on the feedback from the third intervention and the advice given by my tutor Jasminka, I tried to make an audio clip of my intervention workshop so that it would be easier for my stakeholders to start their interventions whenever and wherever they want.

Feedback from Stakeholders:

This approach facilitates the timing of stakeholder engagement, which can start and finish at any time and place. However, there were individual participants who responded that because the audio was fixed, my intervention instructions could not be changed differently for each of their different responses. For example, in the ‘garden’ part of the imagery, some people had more space to imagine and needed to imagine for longer, while others needed to imagine for less time, and it would have been better if the rhythm of my instructions could have been adapted to each stakeholder’s emotional experience.

In addition, some stakeholders also responded that the warm-up time for the first part was too short to allow them to settle down and start to develop their imagination, which made it difficult for them to get into the dramatic situation. I embarked on the next step of the adjustment programme.

Based on stakeholder feedback from the first and second interventions, I started thinking about how to use more elements to help stakeholders sleep. At the same time, these elements could be made into emotional memories and links to emotions to help them better transfer the memories from the workshop to real-life sleep.

Theatre is a comprehensive art, and apart from the story, music, art and so on are all important parts. For the third intervention, I created a new story and consulted a music expert to change the musical elements, in order to give the stakeholders better auditory stimulation. I also added the element of the Scented Bags, which I hope will also help them in the sense of smell.

Examples of music I have used before：

The music I have used in Third intervention：

https://youtu.be/-lwPUYA2N6k

Unlike the previous two interventions, I shifted the location of the intervention from outside to the stakeholder’s bedroom, which was to better help the stakeholder get to sleep faster. At the same time, I helped them redefine their sleep space based on the advice of a sleep psychologist.

Before：

After：

In addition, in order to better detect the sleep status of the stakeholders, I created a form to record.

Feedback from Stakeholders：

The storyline of this intervention helped the stakeholders to be more imaginative and engaged in the story, while the music and scented bags also played a key role. However, due to time and space constraints, this one-to-one approach cannot be more widely used and replicated. I still need to find a more universal way.

Introduction

The pace of life of modern young people is gradually accelerating, and the pressure of work or life is gradually increasing.” Sleep disorders” gradually become an “epidemic” among modern young people. According to the medical definition, the most typical manifestation of “Sleep disorder” is “Insomnia”, the main characteristics of which include little sleep, much sleep and sleep rhythm disorder, etc.

Whenever we go to the hospital with these symptoms, we may be anxious to get a result, or perhaps the doctor wants us to leave with a satisfactory result, and we are more or less likely to receive some “medication” to treat them. But are these medications necessary? Do they have an impact on our health? Is it possible to replace these drugs with another way of relieving our ‘sleep disorder’? With these questions as a starting point, I set out to explore the theme of research into insomnia relief through drama elements.

Question

Drama therapy is a model of expressive arts therapy developed in Europe and the United States in the 1950s, which can give participants a relatively safe environment to heal their psychological problems. As such, sleep disorders that are partly due to psychological factors may be alleviated by drama elements rather than by medication.

So ‘How can apply elements of drama to interventions for the relief of psychogenic insomnia?’ is the direction of my research.

Research Methodology

Quantitative methods:

This anonymous questionnaire consists of 11 questions. The aim was to gain a better understanding of recent insomnia (including age, occupation, hours of study/work per day, level of insomnia and attitudes towards insomnia, etc.) in the modern 18-45-year-old age group. Seventy-eight participants responded and as not all surveys were fully completed, 63 findings were included in the analysis.

Link to Questionnaire: https://docs.google.com/forms/d/e/1FAIpQLSeeGLmYGgabLMsmNv-k9J0qb-EPvLJSwizVoyrQEWM0310DBA/viewform?usp=sf_link

Qualitative methods:

In order to gain a better insight into the possibilities of using drama elements to improve insomnia, I conducted interviews with experts and six stakeholders. The experts included Professor Yongwen Peng in the field of Drama, and Professor Russell and Dr. Neil in the field of Sleep. The six stakeholders were from different professions and two of the interviewees had attended yoga or sound bath workshops for sleep interventions.

Research

The 2021 White Paper on Exercise and Sleep, published by the China Sleep Research Association, shows that over 300 million people in China currently have sleep disorders. And according to a survey by the World Health Organisation, 27% of the world’s population has problems with sleep quality. Among my interviewed stakeholders, they expressed a strong need for relief from insomnia through means other than medication. They have tried to attend workshops such as yoga, sound baths, etc., but physical incoordination and fear of ethereal music prevented some from achieving a soothing effect in these forms. In contrast, theatre is much more inclusive of participants.

As early as the ancient Greeks, Aristotle referred to “purification” in his Poetics, a theory that amply demonstrates the “healing power” of drama. The definition of ‘Drama therapy’ also varies, with the most famous being the American drama therapist Robert Landy, who pointed out that drama therapy is drama-oriented and therapeutic in nature. At the same time, according to the Current Situation and Prospects of Drama Therapy Research in China and the West, although drama therapy has been developed in Western countries since early times, there was almost no research on drama therapy in mainland China before the 1980s. It is not yet widely used in the general population, and there is a gap in research on insomnia interventions.

Intervention

Two interventions have been completed so far. The scripts of the workshops for the interventions are recorded in my Blog.

The first intervention took place in Victoria Park with nine participants. The setting of the park was perfect for the scenario described in my script, it gave the participants a greater sense of trust. The workshop lasts approximately one hour and the participants respond to the scenario I have described, ending with a drawing.

Based on the feedback I received during the first intervention, I reworked the script and the second intervention was conducted online, with the aim of making the location more flexible. At the same time, the length of the intervention was adjusted to 15 minutes per session in order to better suit the time of each participant, in order to test the flexibility and wide application of the workshop.

Audience

Stakeholder: People who suffer from insomnia due to psychological factors.

While the majority of the participants in the first intervention were university students who had recently experienced insomnia, the stakeholders in the second intervention focused on the working group who often stayed up late and worked overtime. In my interviews, I found that this group had irregular sleep patterns due to their inevitable overtime work and expressed a strong need for some help to get them into a better and quicker lunch break to maintain a better mental state.

Concluding

Strengths

1. The model of insomnia relief through drama allows stakeholders to avoid taking medication that affects their health to a certain extent.
2. The Drama workshop was more tolerant of the participants, for example, according to some participants, their inflexibility made them too focused on their limbs to concentrate during the yoga workshop.
3. Drama workshops allow for more flexibility in terms of time and space for participants to participate.

Weaknesses

1. There are not as many practitioners in Drama therapy as there are in other forms such as yoga.
2. There are not enough tests of interventions for Drama to alleviate insomnia and there is no script or training system available for widespread use.
3. Public recognition still needs to be improved.

Reflection During my research, I have become broader in scope, but not deep enough in depth. My next step needs to be more critical thinking, as well as constantly challenging myself to reflect on new findings from the questions

Participant feedback：

A： The story of the first intervention was richer and more experiential for me. However, the second intervention was more flexible and allowed me to connect directly to sleep, but I wish the second part of the story could have been a little longer, which facilitated my emotional expression.

B： The configuration of the music was very helpful, but perhaps it was the online aspect that made the music playback not very clear for me to hear.

C： When imagining an ice cream parlour, it would be more realistic to have an olfactory sensation, but perhaps switching to a flower shop would help me sleep more as the food would make me feel hungry.