Effectiveness of Drama Therapy for Adolescents with Anxiety

This research paper evaluates the effectiveness of drama therapy for treating anxiety issues in adolescents. It explores the consequences of untreated anxiety, the popularity of non-traditional therapies, and the efficacy of drama therapy. The research adopts a systematic review of existing literature and focuses on qualitative data to create awareness of the effectiveness of drama therapy in treating adolescents with anxiety issues.

Running head: DISSERTATION PARTIAL
DISSERTATION PARTIAL: SYSTEMATIC REVIEW OF THE EFFECTIVENESS
OF DRAMA THERAPY FOR ADOLESCENTS WITH ANXIETY
Name of the Student:
Name of the University:
Author note:

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
Abstract
Treatments administered conventionally and traditionally for management of anxiety
in adolescents, such pharmacology and psychotherapy, are met with rebellion and distress.
Such resistance results in aggravation of symptoms and impairment of adolescents’ social-
emotional development. For this reason, alternative approaches have been postulated in the
management of anxiety in adolescents. These approaches are considered popular and
effective as they are sensitive and appreciate liberal expression of an adolescent's complex
emotional, psychological and cognitive needs. This research paper evaluated the effectiveness
of drama therapy for treating anxiety issues in adolescents. The research paper answered
three questions: (a) What are the consequences in the individual, if adolescents with anxiety
issues are left untreated? (b) Why are non-traditional forms of therapy gaining popularity in
treating anxiety issues? And (c) How effective is drama therapy in reducing anxiety issues in
adolescents? This paper also examined Landy’s role theory and additional theoretical
observations. This research adopted a systematic review of existing literature and focused on
the collection of qualitative data to create an awareness of the effectiveness of drama therapy
in treating adolescents with anxiety issues.
Keywords: anxiety treatments, adolescents, drama therapy

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
Introduction
Research Background
Cook et. al (2007) noted that adolescence is a phase in lifespan that is
oftenaccompanied by varied social, cognitive and behavioural changes and ischaracterized as
a period of emotional instability. These changes result in a host ofdilemmas, paradoxes and
conflicts in the minds of an adolescent (ibid). Coupled with the demands of daily life such as
conflicts in familial relationships and academic pressures, adolescents are often victims of
anxiety issues, which if left untreated affects daily functioning (Olofsdotter et al. 2016).
James et al. (2015) add that certain adolescents experience debilitating symptoms of fear,
panic and stress which lead to anxiety issues. These according to Strawn et. al. (2015) yield
detrimental impacts in their developmental, functional and cognitive development. The major
characteristic feature of anxiety issues are feelings of worry and fear (Olofsdotter et al.
2016).Hence, the existing background of increased susceptibility to anxiety in adolescents,
rationalised the performance of this research.
Conventional institutionalized treatments often heighten adolescent feelings ofanxiety
and anger as they regard of such therapies as restrictive and forceful(Iverach and Rapee
2014). Smyth and Nobel (2017) highlighted that such adolescent avoidance and resistance to
treatment have necessitated the consideration of alternative therapies which are sensitive to
their needs. Consequently, a range of on-conventional therapeutic options have set the scene
for improvements in adolescent anxiety treatment (Spence and Rapee 2016).
Spence and Rapee (2016) mentioned that one such alternative treatment is drama
therapy. Drama therapy is gaining popularity due to its potential to tap into the creative
capabilities of adolescents whilst reducing anxiety by improving adolescents’
communication, mindfulness and self-reflection, which otherwise undergo suppression by

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
adolescents who fear dogmatic societal obligations (Fernández-Aguayo and Pino-Juste 2018).
Carroll (2018) noted that traditional treatments of anxiety issues, such as cognitive behaviour
therapy (CBT), are perceived as monotonous and repetitive and are viewed negatively due to
its institutionalized nature. Various Creative Arts Therapy and Expressive Arts Therapy, such
as drama therapy, have been considered more beneficial due its flexibility to meet the client’s
needs (ibid.). He adds drama therapy is becoming more popular as it integrates the various
creative expressions and capabilities of the client and it can be improvised as per the interests
of the client. Also, the playful nature of this therapy makes it effective during the emotionally
charged phase of adolescents (Caroll 2018).Hence, considering the growing prevalence of
anxiety disorders in adolescents coupled with the emerging support on benefits underlying
creative arts therapy, this research reviewed the associated significance between drama
therapy and adolescent anxiety management.
Rationale, Justification and Aim of the Research
Siegel and Dickstein (2011) and Beiter et al. (2015) mention that the most pervasive
mental health concern adolescents face is anxiety and its prevalence ishigh. This was
reaffirmed by a research by the Child Mind Institute, USA in 2017. It is noted that anxiety
disorders are most prevalent among adolescents. Data from the National Institute of Mental
Health, USA (2017) indicated that anxiety issues are common in individuals in the age group
of thirteen to eighteen years. Hurley (2018) added that severe anxiety disorder is the most
common among of this population. Data from the National Comorbidity Survey Adolescent
Supplement found that38.0% of adolescent females are more likely to be affected by anxiety
disorders as compared to the 26.1% of adolescent males (Nimh.nih.gov. 2017). The data
indicated the prevalence as: (a) Specific Phobias (19.3%), (b) Social Anxiety (9.1%),(c)
Separation Anxiety (7.6%), (d) Post Traumatic Stress Disorder (5.0%), (e) PanicDisorder
(2.3%) and (f) Generalized Anxiety Disorder (2.2%). However, Child MindInstitute (2017)

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
noted that Social Anxiety Disorder is most prevalent in adolescentsbecause of peer
relationships and bullying.
While a number of traditional psychotherapeutic and CBT are beneficial andhave
positive mental health implications, various non-conventional treatment optionsare gaining
popularity (Quinlan 2016). These are however less explored byresearchers (ibid.). This
opinion was reiterated by Frydman (2016) who noted that despite drama therapy emerging
popularity, there is lack of research conducted to evaluate its effectiveness. Factoring the
prevalence of anxiety issues in adolescents, the shortcomings associated with traditional
therapies and the emerging potential of drama therapy asa medium of intervention in the
treatment of anxiety issues in adolescents as well asthe limited research in this area, the aim
of this research was to review the effectiveness ofdrama therapy in the management of
anxiety issues in adolescents. It also discuss the causative factors behind its popularity in
comparison to traditional anxiety treatments.
Aligned to the aim of the research, the objectives of this research were to:
(a) Understand the mental health consequences in an adolescent when there is
prolonged lack of treatment for anxiety issues
(b) Comprehend the reasons for the emerging popularity of non-traditional therapeutic
procedures in the treatment of adolescent anxiety issues and
(c) Evaluate the efficacy of drama therapy in the reduction of adolescent anxiety
issues.
Based on these objectives, the research addressed the following research questions:
(1)What are the consequences in the individual, if adolescents with anxiety issues are
left untreated?

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
(b) Why are non-traditional forms of therapy gaining popularity in treating anxiety
issues?
(c) How effective is drama therapy in reducing anxiety issues in adolescents?
Research Paradigm, Methodology and Theoretical Perspectives
For the optimum conductance and completion of a research, executing a literature
review is of utmost importance. A literature review implies the summarization and evaluation
of the existing evidence available aligning the identified research question, aims and
objectives. The significance of an appropriately conduced literature review, lies in its ability
to provide an exhaustive yet concise information on relevant background of the research
conducted as well as in identifying the limitations existing in the same (Machi and McEvoy
2016). A literature review’s ability to highlight the research gap is significant since it dictates,
guides and aligns the researcher’s identification of limitation and the process to be followed
to find solutions to unanswered questions, which is in this case, is associated with the
effectiveness of drama therapy. A literature review is conducted with the help of an extensive
research using relevant keywords across databases. Hence, for the following literature review
pertaining to effectiveness of drama therapy, an electronic search strategy was conducted
using keywords such as: ‘anxiety’, ‘adolescent anxiety’, ‘anxiety treatment’, ‘drama therapy’
and ‘psychodrama’. The literature search was conducted across relevant databases such as
CINAHL, Medline, PubMed and BioMed considering their emphasis on containing health
based studies. (McGowan et al. 2016).
Since the aim of this research was nestled on obtaining knowledge on the
effectiveness of drama therapy in the context of anxiety management in adolescents, an
interpretive research paradigm was opted. This research did not examine variables but would

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
focus on the narrative on the efficacy of drama therapy. As such,a systematic review of
publicly available documents was adopted to obtainqualitative data from secondary sources
such as journal articles,government publications, books, reports and newspaper articles
(Bowen 2009).
Landy’s role theory and role methods would be examined in relation to thefunctioning
of people and how drama therapy aids in playing different roles in life.
Key findings & Benefits of Study
The findings of this paper will provide insights on the effectiveness of drama therapy
in comparison to traditional therapies in treating adolescents with anxiety issues. These
findings may encourage practitioners to incorporate drama therapy in their practice. The
study will also benefit other professionals as such educator’sand youth workers, who work
closely with adolescents as the insights gained could mitigate anxiety due to academic
pressures (Butler 2017).

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
Literature Review
Types of Anxiety Disorders in Adolescents
The types of anxiety disorders, as examined in the epidemiological study by
Bandelow and Michaelis (2015), which have been found to commonly affect adolescents
include: agoraphobia, panic disorders including or excluding symptoms of agoraphobia,
social anxiety disorder, generalized anxiety disorder and separation anxiety disorder, which
also contribute extensively to financial burdens. Anxiety disorders may contribute to be key
co-morbidities in additional mental health issues during adulthood if not managed during
adolescence (ibid.).
Prevalence of Anxiety in Adolescents
Existing research is indicative of the wide prevalence of anxiety in adolescents. The
systematic review by Zarafshan, Mohammadi and Salmanian (2015) extensively explored
and reported the widespread nature of anxiety disorders among adolescents. As per this
research, the population group of adolescents and children are the most affected with anxiety
disorders, with over 10 to 20% individuals suffering from the same. Taking insights from a
national face-to-face survey conducted in the United States in 2014, and reviewed by the
authors of this research, it was reported that 3 to 9% of adolescents displayed symptoms of
social phobia and generalized anxiety disorder. Selective mutism has been reported by the
authors, as a cause of concern among 0.18% of adolescents and school children residing in
urban areas of the Republic of Ireland in 2012. Further, a research reviewed to be conducted
in Qatar in 2011, indicated prevalence of specific phobia in 7.5% and agoraphobia among
12.7% among students aged 6 to 18 years. A nationwide research and a national cohort study
reviewed by the authors to be conducted in Korea in 2010, and Denmark in 2010, reported

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that specific phobias inflicted 7.9% of students in the age group of 6 to 17 years, followed by
Danish adolescents suffering from social phobias, separation anxiety disorders, specific
phobias, generalized anxiety disorders and other anxiety disorders at rates of 1.1%, 0.4%,
0.5%, 1.5% and 2.4%, respectively. In 2009, Finnish adolescents, aged 12 to 17 years old,
were found to be affected by social phobias at a prevalence rate of 3.2%, whereas, in 2004
Polish adolescents were reviewed to be suffering from generalized anxiety disorders and
specific phobias at rates of 7% and 17% respectively. The study also reviewed that, 13.2% of
adolescents aged between 11 to 18 years, residing in Australia were suffering from anxiety
(ibid.).
Statistics on the widespread prevalence of anxiety disorders in adolescents can be
uncovered extensively in the report on ‘Anxiety and Depression in Adolescence’ published
by the Child Mind Institute (2019). As per this report, anxiety disorders are the most
prevalent mental health disorders among adolescents, of which, social anxiety disorder is the
most common, considering the importance adolescents attach to social networks during this
stage. It has been estimated that, the following anxiety disorders affect adolescents at the
following prevalence rates: social phobia (9.1%), specific phobia (19.3%), post-traumatic
stress disorder (PTSD)(5.0%), separation anxiety (7.6%) and generalized anxiety disorder
(2.2%). The report also notes that female adolescents are twice as likely to suffer from
anxiety and panic disorders as compared to their male counterpart, as evident by the
following statistics: separation anxiety (females: 9%, males: 6.3%), social phobia (females:
11.2%, males: 7.0%), panic disorders (females: 2.6%, males: 2.0%) and PTSD (females: 8%,
males: 2.3%) (ibid.). Hence, this data is indicative, not only of the widespread nature of
anxiety in adolescents, but also sheds light on gender differences which further necessitates
the need to immediately administer targeted and specific treatment interventions in the future.

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To further highlight the global severity of this disease in young populations, we may
also consider the worldwide statistics reported by the World Health Organization (WHO) in
their Global Fact Sheet on Adolescent Mental Health (2018). According to the WHO, major
mental health disorders like anxiety and depression, contribute to 16% of the global burden of
disease among individuals within the age group of 10 to 19 years. A major cause of concern,
notably is the fact that often such disorders forgo timely detection, diagnosis and treatment
among adolescents. If not treated, the WHO notes that the anxiety associated mental
disorders may contribute to suicide or lead to disturbances in future physical and
physiological development among adolescents in their future life stages as adults. Hence, the
need of the hour is to focus extensively on the conducting mental health disorder prevention
and mental health promotion among adolescents (ibid.).
However, limited research exists on the true pathological pathways which may
contribute to high prevalence of anxiety disorders among adolescents. Toazza et al. (2016), in
their research, postulated the possibilities between impairment of functional connectivity and
prevalence of anxiety disorders among adolescents. Comparative examinations in terms of
magnetic resonance imaging results between the adolescents suffering from anxiety
disorders, and their healthy counterparts highlighted disruption in the communication and
functional activities between the basolaterla amygdale located in the left to the regions of the
brain associated with regulation of emotions, moods and perceptions of rewards and
punishments in adolescents suffering from the anxiety disorders. Considering the limited
availability of evidence considering intrinsic causative pathologies, therapies and treatment
interventions targeting management of anxiety associated symptoms target primarily the
various social and extrinsic cues contributing to the same, among adolescents (ibid).

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Further, a number of researches also indicate that the disorders and symptoms
pertaining to anxiety are reported and treated the least in adolescents (Bennet and Walkup
2018; Child Mind Institute 2017; Meyer et al. 2015; Siegel and Dickstien 2011).
Adolescents with Anxiety Issues and the Implications of Lack of Treatment
Despite the prevalence of anxiety issues in adolescents, research has noted that
anxiety disorders are the least treated problems in adolescents (Siegel and Dickstien 2011;
Meyer et al. 2015; Child Mind Institute 2017; Bennet and Walkup 2018). According to Schol
et al. (2014) prolonged lack of treatment of anxiety in adolescents results in harmful
emotional and physiological health implications which distort growth and development.
Quach et al. (2015) added that untreated anxiety results in debilitating physiological
symptoms such as; (a) difficulty in sleeping, (b) muscle soreness, (c) increased sweating and
heart rate, (d) feelings of nausea and (e) increased disease susceptibility. All of these in turn
damage the immune system (ibid.). Both research expounds that such adolescents find it
difficult to perform daily tasks because of increased forgetfulness, lack of concentration and
difficulties in proceeding or completing work successfully. These consequences aggravate
into detrimental behaviours during adulthood (Garnefski and Kraaij 2018). These behaviours
can be projected in the form of: (a) lack of relaxation due to presence of a constant state of
agitations, tension and restlessness, (b) increased uneasiness or excessive sensitivities
towards criticism, (c) excessive feelings of pessimism leading to difficulty in daily life
performance, (d) avoidance of novel challenges or unfavourable circumstances, (e) loss of
self-esteem leading to increased social isolation and withdrawal, and (f) constant
preoccupation with obsessive and compulsive thoughts and behaviors (ibid.).
Ineffectiveness of Traditional Anxiety Treatments
According to Wehry et al. (2015) and Muris and Ollendick (2015), traditional
treatment procedures in adolescents generally include a collective therapeutic approach

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encompassing family therapy, medication administration, educational assistance and support
from parents and elders, along with the use of psychotherapeutic procedures such as CBT in
hospitals. CBT teaches adolescents suffering from anxiety issues to replace their negative
thoughts and distress in response to a challenging stimuli such as socially demanding
situation, with positive and self-empowering thoughts (James et al. 2015). However, the
ineffectiveness of CBT lies in adolescents perceiving it to be uninteresting and mundane
(Carroll 2018). 9 The administration of the above treatments in institutions such as hospitals
results in feelings of distress among adolescents (Iverach and Rapee 2014). Luxford, Hadwin
and Kovshoff (2017) added that adolescents suffering from anxiety often exhibit
unwillingness, resistance in response to such institutionalized treatment as adolescents view
such approaches as attempts to suppress them. The reasons outlining the ineffectiveness of
traditional institutionalized therapy has been explored extensively by Emunah (2005), in the
book, ‘Clinical Applications of Drama Therapy in Child and Adolescent Treatment’.
According to Emunah (2005), adolescence is a sensitive period characterised by identity
confusion and the sudden, unplanned and disorganized separation from their families and
peers, which is common in traditional anxiety treatments, results in disruption of family
dynamics and identity diffusion. Due to the same, the adolescent begins to then view
institutionalised treatments as an attempt to demean, isolate and shame them, resulting in
them attending the therapeutic sessions with a mindset to ‘fight’ or protest against this
isolation with rebellion, anxiety, distress and agitation. Hence, such misinterpretations of
traditionally therapy, which is characteristic during the stage of adolescence, not only renders
them as ineffective in the management of anxiety in adolescents but also results in worsening
of symptoms during future stages of adulthood (ibid.). As such, more recent research from
Quinlan et al. (2016) and Werner-Seidler et al. (2017) suggest the need for alternative
methods of treatment to consider the above when treating adolescent anxiety.

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
Popularity of Non-traditional Anxiety Treatments
Quinlan et al. (2016) expounds that alternative forms of anxiety treatments like
creative therapies are increasingly gaining popularity in the treatment of adolescent anxiety
issues. Creative therapy include; art therapy, drama therapy, music therapy and movement or
dance therapy (ibid.). According to Akhan and Atasoy (2017), such therapies are known as
creative since they allow individuals especially adolescents who are encountering dramatic
strides in emotional, social and cognitive development to freely express their emotions which
may otherwise be required to be inhibited and bound in the standardized protocols and set
rules of treatment recommended by the traditional therapeutic interventions. Similarly,
Chaiklin and Wengrower (2015), notes that such therapies are called creative, due to their
ability to provide a platform for individuals to express their intrinsic and suppressed desired,
which can be related extensively to Freudian psychoanalytical principles of expression of
desires and sublimation using artistic expression. These creative therapies are popular
because they allow adolescents to accomplish several things such as (a) enhance their
creative potential, (b) improve their communication skills, (c) self-reflect on their actions and
(d) regulate their emotions, which are otherwise difficult to achieve through traditional
therapies (Caroll 2018).
Drama Therapy and Its Effectiveness
Drama therapy is a type of creative treatment method characterized by the integration
of role playing and story enactments with therapeutic principles of psychotherapy (McAdam
& Johnson 2018). According to Keulen-de Vos et al. (2017), drama therapy includes the
systematic and intentional usage of theatrical oriented activities, for the purpose of symptom
eradication, provision of relief and establishment of control and integrity in the individual’s
personal, emotional and physiological characteristics. Noting that adolescents unregulated
emotions and difficulties in expression result in anxiety issues (Gordon, Shenar and Pendzik

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
2018), drama therapy helps improve such difficulties as it uses role play (Lištiaková 2015).
Armstrong et al. (2015) noted that increased emotional expressions results in improved self-
control, awareness, reflection and self-regulation which are salient treatment objectives in
anxiety management. The utilization of adolescents’ creative and receptiveness to novel
stimuli, along with provision of a liberal platform to express form the cornerstones of the
effectiveness of drama therapy (ibid.).
Role theory and role method that were developed by Robert Landy (1994, 2009) looks
at role and counter role in the polarity of roles people have in their lives (Lištiaková 2015).
She explains that based on role theory, drama therapy creates safe space for the story and role
being played whilst allowing the connection and proximity to a sensitive topic. Activities like
role play allow adolescents to enact real life or fantasized personalities and this improves
self-esteem and decision-making skills (ibid.). D’Amico, Lalonde and Snow (2015) posits
that drama therapy adapts an experiential therapeutic approach resulting in improving the
individual’s capability in many areas such as; (a) expressing emotions, (b) solving problems,
(c) formulating goals, (d) enhancing social interactions and networks, (e) improving self-
reflections and (f) strengthening the capability to undertake real life roles and responsibilities.
As researched by McAdamsand Zapata-Gietl (2015), additional theory which may be
used to evaluate the effectiveness of drama therapy in adolescents is Erik Erikson’s theory of
psychosocial development of which the stages of identity vs. Confusion and Intimacy and
Isolation may be the most relatable. Early adolescence ranging between the ages of 12 to 18
years encounter the stage of identity and role confusion which is characterized by a
development of one’s identity, which when reciprocated with encouragement, positivity and
motivation, contributes to positive development during adulthood (ibid.). Further, as
researched by Amin et al. (2017), if adolescents, their views and their journey towards self-
discovery of identity are met with lack of appreciation and discouragement, it may lead to

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
development of feelings of resentment, remorse and acquisition of severe mental disorders
during adulthood. Hence, drama therapy, by allowing adolescents to take up new roles and
identities and in turn, resulting in expression of personal emotions and opinions, encourages
this psychosocial development in adolescents – which is often overlooked by traditional
anxiety treatments – hence, making it extremely effective in anxiety management. Similarly,
as researched by Cherry (2017), the stage of late adolescence, characterized by intimacy vs.
isolation, regards social relationships and personal identity as extremely important, which is a
lack of the same has been associated with social isolation and anxiety in adolescents. The
effectiveness of drama therapy, lies in its ability to develop these complex relationships with
self and others by allowing adolescents to take on diverse roles and characters and hence,
contributes positively to anxiety treatment and future personality development (Haenand
Webb 2018).
Henson and Fitzpatrick (2016) add that drama therapy’s effectiveness lies in its ability
to be appealing to adolescents. Adolescents exhibit greater willingness and responsiveness to
drama therapy in anxiety management due to its opportunities to enact novel roles, to engage
in expression of personal stories and opinions liberally to a non-judgmental audience and to
possess the ability to change the features of their stories (ibid.). Klees (2016) stated that
drama therapy’s effectiveness also lie in its encouragement of acting as an educational and
therapeutic procedure. He adds that the provision of differential perspectives for management
of criticism or challenging situations and the seeming fun and creative appeal of drama make
adolescents receptive to this form of anxiety treatment. Chae and Kim (2017) noted that
drama therapy like CBT enhances anxiety management in adolescents by encouraging them
to undertake problem solving. They posit that since drama therapy integrates the key tenets of
therapy through role playing everyday life activities at school, home or work, this further
enhances its effectiveness in adolescent anxiety management. One of anxiety’s major

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
consequences include increased sensitivities to criticism (Young and Dietrich 2015). Drama
therapy treats this by allowing adolescents to creatively exhibit their responses and reactions
to such challenging situations, resulting in improved emotional management and rapid
contemplation of solution to real life problems (Prosen and Jendričko 2018). Adolescents
with anxiety issues display social isolation (ibid.). This, as discussed previously, is due to the
innate psychosocial need for establishing personal identity and nurturing relationships with
others, which if not met, will discourage positive development, result in fears or phobia of
social interaction, hence further leading to social anxiety and isolation, as compared to other
age groups such as adults, where such a need is important but not absolute for emotional and
social development (Arnold 2017).Drama therapy is effective in the management of social
isolation as it promotes social interactions (Prosen and Jendričko 2018).Drama therapy
encourages social interaction, by not only allowing individuals to take up personal roles and
characters but also necessitates individuals to engage into conversation with ‘other
characters’ hence further resulting in conversations within and beyond the venue of
performance. It is this aspect of drama therapy which encourages and fulfils adolescents’
intrinsic developmental need to develop personal identities and engage in fulfilling
relationships, further resulting in eradication of symptoms of social anxiety, social phobias
and associated social isolation (Lisman 2018).

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Methodology
The methodology of the proposed research is a document study that focuses on
conducting an extensive evaluation of available scholarly, peer reviewed researches in the
form of a systematic review. Systematic review engages in secondary data collection,
critically appraise available researches and evidences as well as engage in an overall
synthesis of the available information (Bowen, 2009). Petticrew (2015) and Whiting et al.
(2016) expounded that systematic reviews are characterized by their ability to provide an
extensive and critical summarization of current research for the purpose of presenting data
that is of relevance to the research questions under investigation.
Methodology: Strengths & Limitations
Slutskaya, Game and Simpson (2018) stated that the evaluation of documents is
advantageous as compared to additional methodologies such as interviews or surveys due to
its cost effectiveness. Additionally, it is less time consuming since it requires only collection
and analysis of data (ibid.). Factoring the topic under investigation, a systematic review
permit the conceptualizing large amounts of information and thus allowing effective
understanding of recent evidence (Whiting et al. 2016). Also, as systematic reviews are
highly advantageous to evidence based practice, this would facilitate the yielding of
information on the usage of drama therapy in current clinical practice (ibid.). This then
permits the identification of possible gaps in the available information (Whiting et al. 2016).
Systematic reviews are documented to be effective in establishing the safety of a
medication or treatment procedure (ibid.). Hence this methodology was suitable in addressing
the ethical issue of safety in the context of the use of drama therapy in anxiety management.
However, the prevalence of publication bias is a major disadvantage of documents in
systematic reviews (Higgins et al. 2016). Loannidis (2016) added that this methodology could

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
be flawed; if the research contains information irrelevant to the research objective and is
outdated Reliability and Validity Leung (2015) expounds that validity refers to
“appropriateness” which include sampling, methods, results whilst reliability refers to
replicability of the research and its results. To ensure reliability and validity, documents
which are peer reviewed were selected as these documents have undergone the vigour of
validity and reliability testing (ibid). Studies which engaged in the utilization of randomized
controlled trials or control groups would be included as these studies have external validity
(Leung, 2015). Loannidis (2016) highlighted that systematic reviews may produce results
which lack reliability if the information presented by the authors only include those which are
easily available or have been previously published. He also mentioned that often authors
engage in publication bias and would avoid publication of inconclusive findings. This
consequently makes systematic reviews lack validity as there is a possibility of suppression
of negative results and exaggeration of positive ones (Loannidis 2016) .
Inclusion and Exclusion Criteria
The documents were selected based on the principles of authenticity, credulity,
representativeness and meaning (Gaborone 2006). Documents were searched from
Googlescholar and university peer reviewed, scholarly, library databases such as PubMed,
CINAHL and BioMed, to ensure that data collected are from reliable sources. Most of the
literature search was performed electronically. Documents were selected based on their
relevance to the research questions (ibid.).
The literature search for the systematic review included researches topics like (a) the
prevalence and effects of anxiety on adolescents, (b) the outcomes of prolonged lack of
treatment of anxiety disorders on adolescents, (c) the use of conventional and non-
conventional anxiety treatment procedures which are gaining popularity in current clinical
practice and (d) the effectiveness of drama therapy on the treatment of anxiety in adolescents.

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The search would be conducted using keywords that are linked to the research questions such
as: ‘anxiety’, ‘adolescent anxiety’, ‘anxiety treatment’, ‘drama therapy’ and ‘psychodrama’.
Searches would be narrowed to studies conducted within the year 2013 to 2018 to ensure
currency of the documents that would be examined. Boolean operators would be used to
further scale down the studies to be include (McGowan et al. 2016). Considering the
inevitable presence of statistical errors in every research, each of the selected studies would
be examined for its statistical methods with the aim to reduce variance and bias (Leung
2015). Studies which focused largely on anxiety management in adults or aged individuals
and emphasized on non-traditional therapies other than drama therapy would be excluded as
these would impede the validity of the findings. Studies which focus on policies and
programs pertaining to anxiety or anxiety management in adolescents would be excluded too.
Data Collection and Organization
Qualitative data would be collected which as the narratives reflect the effects of
untreated anxiety, the usage of non-traditional treatment methods and the effectiveness of
drama therapy in adolescent anxiety treatment. Data would be organised through content
analysis which critically organizes data into key points. This will lead to derivation of
practical conclusions pertaining to the research questions.
Ethical Considerations
During the process of data collection and analysis ethical concerns were taken into
due consideration. Ethical procedures like informed consent, confidentiality and ability to
withdraw at free will, were not be taken into consideration for a document study (Bowen
2009). The process acknowledging the works of other researchers; without any form of
plagiarism is important and was adhered to for the same (Clarke and Cossette 2016). Also,
the results from other studies were not be misrepresented to avoid any form of bias and
acquisition of incorrect results (Bowen 2009).

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Timeline
The proposed research would take approximately nine months to complete. The
timeline for this proposed research has been attached in Appendix 3.

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Findings
Upon extensively reading the literature so obtained, the relevant findings from the
studies have been categorised in the form of the following contents. It was ensured that the
contents so analysed were aligned to the objectives of the research which have been identified
in the beginning of this study. The process of content analysis, implies a form of descriptive
analysis which is characterised by obtaining and extensively describing the articles relevant
to the objectives of the study (Machi and McEvoy 2016). Hence, pertaining to the primary
aim of this research to review the effectiveness of drama therapy, the following findings were
evaluated using content analysis as per the following identified research objectives:
Effects of Anxiety on Adolescents
This severity of anxiety disorders in adolescents were also found in the data presented by the
World Health Organization’s (WHO) report on Global Factsheet on Adolescent Mental
Health (2018). The findings from the report highlighted that a major section of the population
worldwide, that is 16% and belonging to the age group of 10 to 19 years, were found to be
suffering from disruptive mental health disorders such as depression and anxiety. If left
untreated, such disorders result in harmful effects on the emotional and psychological
development on the young individual, of which the emergence of suicidal thoughts and
ideation is a major cause of concern. Lack of timely and adequate management can also result
in future emergence of disruptive mental health symptoms such as low self-esteem, low self-
confidence and increased social isolation during adulthood.
Beiter et al. (2015), aimed to investigate the major reasons which contributed to an
unprecedented increase in the reporting of anxiety and depression in a counselling centre

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located within college premises, among a sample of college-going students. Using the
Depression Anxiety Stress Scale (DASS21), the authors examined reasons underlying
depressive and anxiety symptoms among 374 undergraduate students. The findings indicated
that the major contributors outlining symptoms of anxiety and associated mental health
disorders in college adolescents and young adults, were: their levels of academic proficiency
and performance, future professional and personal plans after graduation and post graduation
and personal as well as familial pressures to excel and succeed academically (ibid.).
Outcomes of Prolonged Lack of Treatment of Anxiety Disorders on Adolescents
The WHO has also noted that despite the high rates of prevalence of anxiety disorders
among adolescents, such incidences often forgo timely reporting, diagnosis and treatment
hence resulting in the concerned adolescent suffering from future harmful psychological
complications as adults (World Health Organization 2018). The lack of adequate treatment
for prolonged periods, as indicated in the research by Schol et al. (2014), have been
implicated to lead to detrimental physiological and emotional outcomes harmful for future
growth and development during adulthood. Such findings were further expanded and
explored extensively in the research by Quach et al. (2015), where it was indicated that
untimely and inefficient anxiety treatment is associated with soreness in muscles, excessively
high sweating and heart rates, sleeping disorders, symptoms of nausea and vomiting and high
risk of acquiring chronic diseases during future adulthood. Prolonged lack of treatment has
been associated with chronic health outcomes such as loss of efficiency of the immune
system (ibid). The findings from the above research also postulate that lack of timely

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treatment can result in additional harmful health outcomes such as difficulties in
concentration, loss in memory and information recollection, which further aggravate to
difficulties in the performance of daily tasks, successful completion of essential activities and
hence, loss of functioning in activities of daily living. The findings of the research by
Garnefski and Kraaji (2018), further denoted that lack of anxiety treatment for long time
periods can aggravate into harmful mental health disorders as well as increased severity of
anxiety symptoms during adulthood. Such health outcomes emerge during adulthood in the
form of difficulties to relax due to constant preoccupant with thoughts of agitation,
restlessness and tension, loss of sense of optimism resulting in difficult to function efficiently
in daily life, high susceptibility of fearing or reacting sensitively to criticism, loss of
eagerness to engage in activities which are novel, challenging and demoing, decreased rates
of self-esteem leading considering oneself to be worthless and hence the associated
preference towards social isolation and increased tendency to preoccupy oneself with actions
and thoughts deemed to be obsessive and compulsive.
Conventional and Non-conventional Anxiety Treatment Procedures which are
gaining popularity in Current Clinical Practice
Prior to the correct emergence of novel and innovative treatments for anxiety
management, such as creative art therapies (of which, drama therapy has been emphasised), a
numberof a treatment interventions have been considered as traditional options for anxiety
management (Wehry et al. 2015; Muris and Ollendick 2015). Further, as noted by James et
al. (2015), conventional treatments of anxiety disorders in adolescents traditionally comprise
of collectively administered therapeutic approach which included administration of
medications, family therapy, provision of education on the disease and support from the
adolescent’s family, coupled with the administration of psychotherapy of which, cognitive

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behavioural therapy (CBT) is use prevalently. CBT administration is characterised by mental
health professional educating the concern adolescents on strategies underlying control and
regulation of their negative, anxiety associated thoughts and actions in response to socially
challenging situations, with thoughts of optimism and self-empowerment. However, such
treatments have been found to be ineffective, as noted by Carroll (2018), due to adolescents
regarding the same as monotonous, uninteresting and mundane. Further, the ineffectiveness
of traditional and conventional treatments of anxiety lies in adolescents responding to the
same with resistance, unwillingness and a perception of being suppressed, as researched by
Luxford, Hadwin and Kovshoff (2017). Considering that such traditional anxiety treatments
are administered upon the concerned adolescents in institutions like clinics and hospitals,
Iverach and Rapee (2014) noted that such institutionalised treatments are regarded by
adolescents as distressful. Hence, taking insights from the above, the research by Quinlan et
al. (2016) and Werner-Seidler et al. (2017), necessitate the need to administer and adopt
alternative methods of anxiety treatment which are novel, innovative and suited to the unique
needs of adolescents.
Hence, considering the same, the findings from Quinlan et al. (2016) noted that non-
traditional forms of anxiety therapies, are gaining popularity and interest, under the collective
umbrella term of ‘creative art therapy’. Creative therapies for treatment of mental health
conditions such as anxiety disorders include music therapy, drama therapy and movement
based interventions such as drama therapy (ibid). Such interventions are gaining popularity,
due to their identity as being ‘creative’, which Akhan and Atasoy (2017) note as the ability of
these treatments to allow adolescents, a target population undergoing dramatic emotional,
social and cognitive changes, to express in abundance, their emotions, which otherwise are
compelled to be restricted and bound due to the standardised and rigid nature of conventional
institutionalised treatment. Additionally, the findings from the research by Chaikli and

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Wengrower (2015), indicate that such therapies are implied to be as creative due to their
compliance to the psychoanalytical principles of expression of desires and sublimation using
artistic expression, by Sigmund Freud, which is characterised by allowing individuals, in this
case adolescents, to express their intrinsic and suppressed desires and emotions. As indicated
by the findings reported by Caroll (2018), the popularity of these creative therapies lie in their
ability to enhance the creative potential of adolescents, improvement of their skills of
communication, provision of opportunity to engage in self-reflection of adolescent’s actions
and enhancing the ability of adolescents in the regulation of their emotions. Such effects are
otherwise are difficult to achieve in traditional and conventional therapies of anxiety
treatments in adolescents (ibid.). The underlying reasons behind such perceptions from
adolescents will be discussed in detail in the chapter on Discussion.
Effectiveness of Drama Therapy on the Treatment of Anxiety in Adolescents
According to McAdam and Johnson (2018), drama therapy is a type of creative arts
therapy which implies administration of collective principles of psychotherapy, story
enactments and role therapy for the purpose of management of mental health disorders. As
evidenced by Keulen-de Vos et al. (2017) the major components of drama therapy includes
the usage activities which are theatrical oriented, with the aim to eradicate mental health
symptoms, provide relief and enhance the adolescent’s ability to integrate control and
regulation of their emotional, physiological and personal abilities. Gordon, Shenar and
Pendzik(2018) noted that a major causative factor contributing to anxiety issues in
adolescents is their inability to regulate and express their emotions. Taking insights from the
same, Lištiaková (2015), noted that the effectiveness of drama therapy lies in its ability to
improve this emotional regulation among adolescents due to usage of procedures such as role
play. Drama therapy for the management of anxiety among adolescents, as researched by

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Armstrong et al. (2015), has been deemed to be effective since it provides a platform for
adolescents to liberally express their emotions through theatrical role play and hence, gain
improved skills of emotional self-control, awareness, reflection and regulation – which are
further essential hallmarks for the treatment and management of anxiety. The effectiveness of
drama therapy in the management of anxiety in adolescents, also lie in its ability to
incorporate creative stimuli and a liberal platform for emotional expression which have been
proven to be beneficial for treatment of the same (ibid.). Theories of psychosocial
development by Erik Eriksson as well as role theory by Robert Landy (1994, 2009) will be
used to analyse and explore the effectiveness of drama therapy in greater detail, in the chapter
of Discussion.

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Discussion
The following paragraphs of this chapter will aim to shed light on expanding and
further analysing the findings discussed in the previous chapter. The aim of the chapter on
discussion is to evaluate and expound upon the major findings obtained from the literature
review, using additional supportive literature. Hence, for the purpose of exploring the
effectiveness of drama therapy in the management of anxiety in adolescents, the findings of
relevant literature discussed previously will be discusses in the following sections, with the
help of content analysis. Content analysis is a form of descriptive research which focuses
upon answering the selected research question with the aid of categorizing findings from the
relevant literature reviewed into subsections or themes consisting of similar wordings (Machi
and McEvoy 2016). Hence, the effectiveness of the objectives pertaining to exploration of the
effectiveness of drama therapy has been discussed as per the following contents:
Prevalence and Effects of Anxiety on Adolescents
The previously discussed findings on the high prevalence rates of anxiety in
adolescents acquired from the World Health Organization (2018) and the Child Mind
Institute (2019) can further be expanded and supported by the systematic review conducted
by Zarafshan, Mohammadi and Salmanian (2015), which extensively evaluated global
statistics on the widespread nature of this mental health issue among the target population.
The review analysed the prevalence rates of anxiety and its associated disorders across a
number of countries. In the United States, social phobia and generalised anxiety disorder was
reported to prevail among 3% to 95% adolescents. In urban areas of the Republic of Ireland,
selective mutism was reviewed as the prevalent anxiety disorder in 0.18% of adolescents.
Students within the age group of 6 to 17 years, residing in Qatar, were found to be inflicted
with agoraphobia and specific phobia at prevalence rates of 12.7% and 7.5% respectively.

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Likewise, Korean adolescents have been found to be suffering from specific phobias at rates
of 7.9% while adolescents in Denmark have been found to be suffering from social phobias,
separation anxiety disorders, specific phobias, generalized anxiety disorders and other anxiety
disorders at prevalence rates of 1.1%, 0.4%, 0.5%, 1.5% and 2.4%, respectively. Adolescents
in Poland, belonging to the age group of 12 to 17 years, were reviewed to be inflicted with
social phobias and specific phobias at prevalence rates of 7% and 17% respectively. The
alarmingly widespread nature of anxiety in adolescents was further expounded by the study
in examining high rates of the disease in Australian adolescents at 13.2% within the age
group of 11 to 18 years. The high rates of anxiety in adolescents can be associated to various
social and physiological reasons, discussed previously in the literature review and evaluated
further in the following contents:
Social Challenges
The association between social factors and anxiety in adolescents have been explored
extensively by the research conducted by Beiter et al. (2015) which aimed to evaluate the
reasons underlying increased reporting of depression and anxiety among college going
students in a counselling centre located in the premises of the concerned college. With the aid
of the Depression Anxiety Stress Scale (DASS21) across 374 undergraduate students it was
uncovered that the primary causative factors underlying the occurrence of anxiety disorders
across adolescents could be attributed to: pressures of excelling in terms of academic results
and proficiency, future plans of career, professionalism and personal plans beyond graduation
and post graduation and pressures from family to succeed exceptionally well in academic
fields.
Pathological Pathways
An additional factor which may contribute to anxiety in adolescents can be attributed
to pathological processes underlying the physiological functioning of basic cerebral

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processes. As researched by Toazza et al. (2016), the occurrence of anxiety in adolescence
can be due to impairments in functional connectivity in the cerebral processes. Through the
conductance of comparing results of magnetic resonance obtained images between healthy
subjects and those subjects suffering from anxiety, a significant disruption was observed in
the functional and communication activities between the left basolateral amygdalea and
cerebral regions implicated to serve emotional regulation, perceptions and moods toward
rewards and punishments. Such findings could be implicated hence, as a major causative
factor underlying the strong association between anxiety and adolescence and hence, paves
the way for the need of novel treatments other than those targeting merely social and
emotional factors underlying anxiety.
Hence, from the above contents identified, it can be evaluated that the strong
association between anxiety and adolescence can be implicated due to prevalent social factors
as well as altered physiological processes associated with cerebral functioning in adolescents.
Outcomes of Prolonged Lack of Treatment of Anxiety Disorders on Adolescents
As discussed previously in the research by Garnefski and Kraaij (2018), lack of
adequate treatment of anxiety in adolescents can result in prolonged and disruptive
psychological, social and emotional issues in adolescents in later stages of adulthood. Such
health effects emerge in adulthood in the form of difficulties in sleep and relaxation, constant
preoccupations with agitated, tensed and restless thoughts, lack of eagerness towards social
engagement resulting in social isolation, increased sensitivities towards criticism and the
associated loss of self-esteem, fear of engaging in challenging situations and hence
emergence of feelings of low esteem and self worth. As reviewed previously, the reasons
underlying such detrimental effects of anxiety in adolescents can be attributed to features of
psychosocial development characteristic to the stage of adolescence.

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Adolescent Psychosocial Development
As researched by McAdams and Zapata-Gietl (2015), to further understand the
severity of untreated anxiety in adolescents, we may focus upon Erik Erikson’s psychosocial
stages of identity vs. confusion and intimacy vs. isolation which are prevalent during the
early and late stages of adolescence. Taking insights from the research by Amin et al. (2017),
identity vs. confusion stages are characterised by the young adolescents seeking to explore
their identities hence resulting in dramatic emotional and psychological changes which
further influence adolescents’ sensitivities towards environmental stimuli. It is for this reason,
when this quest of understanding one’s identity is met with the social and academic pressures
which is widespread during adolescence, the same may be psychosocially responded bythe
adolescence with discouragement and lack of appreciation resulting in emergence of
symptoms of fear, anxiety and distress. Cherry (2017) further notes that as per Erikson’s
intimacy vs. isolation stages in late adolescence, young individuals focus extensively on
development and maintenance on social relationships which if not reciprocated due to
specific life events can result in distress towards social engagement further resulting in social
isolation, social anxiety and social isolation.
Hence as per the above content, the high risk of adolescents acquiring severe
symptoms of anxiety during adulthood due to lack of prolonged treatment, can be attributed
to the unique psychosocial developments undergoing during this stage.
Conventional and Non-conventional Anxiety Treatment Procedures which are
gaining popularity in Current Clinical Practice
Taking insights from James et al. (2015), as discussed previously, conventional and
traditional treatments of anxiety in adolescents comprise of collaborative approaches like
family therapy, CBT, educational interventions and pharmaceutical provisions, which are
generally institution bound and hence, have been found to be met with disinterest, lack of the

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compliance and rebellion among adolescent. Such findings have been expounded further by
Iverach and Rapee (2014) as well as Luxford, Hadwinand Kovshoff (2017), who noted that
such forms of traditional institutionalised treatment are considered by adolescents as
distressful, mundane and as attempts to suppress them. To further understand the reasons
underlying the response of adolescents towards traditional anxiety treatments, the following
content can be postulated.
Adolescent non-compliance to Institutionalised Treatment
The reasons underlying such responses of adolescents towards traditional anxiety
treatments, have been discussed extensively by Emunah (2005) in the book, ‘Clinical
Application of Drama Therapy in Child and Adolescent Treatment’. Taking insights from the
same, it is worthwhile to mention to note that a key characteristic feature during adolescence
is the state of ‘identity confusion’ in which adolescents struggle with the exploration and
understanding behind establishing an identity of themselves. During traditional treatments of
anxiety, the sudden separation from essential friends and family due to the institutionalised
nature of the same, is regarded by adolescents as inappropriate and are perceived by them as
an attempt to isolate, demean and suppress their true identity and nature. Such feelings result
in the emergence of an identity diffusion further leading to adolescents viewing such
establishments of treatment as one which they must combat against to regain their true
meaning and identities. Hence, this explains the symptoms of rebellion, distress, restlessness
and agitation adolescents undergo which render these treatments as ineffective and encourage
the need to administer alternative therapeutic intervention appropriate to their age, personality
and preferences (ibid.).
Hence, from the above content, the ineffectiveness of traditional anxiety treatments
can be understood as an inability of the same to comply with the age-appropriate expectations
of this sensitive group of young individuals.

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Effectiveness of Drama Therapy on the Treatment of Anxiety in Adolescents
As discussed in preceding sections, Quinlan et al. (2016), noted that as an alternative
to traditional forms of therapy, creative, novel and innovative modes of therapeutic
interventions are emerging which are regarded as effective for the management of anxiety in
adolescents. Such therapies, collective known as creative or creative arts therapy, comprise of
music, drama and dance therapies (ibid.). As reviewed in the preceding sections such
therapies have been deemed as effective and popular for the management of anxiety in
adolescents. The reasons behind such effectiveness, as evidenced in the reviewed literature
can be postulated to the following contents or categories:
Role Theory
It is worthwhile to note that a key component of drama therapy is role play, which is
why, Robert Landy’s Role Theory and Role Method (1994, 2009) can be applied to
understand the same. Role theory and role method stresses importance on the importance of
roles, counter-roles and role polarities in the lives of individuals (Lištiaková 2015). Taking
insights from role theory, drama therapy provides a safe platform for adolescents to weave
their own stories, play their own personalised parts and hence, allows them to establish close
connections and proximity to topics which are sensitive and regarded as close by them. By
allowing adolescents to freely act out their fantasies and enact real life incidences, drama
therapy increases decision-making skills and self-esteem in adolescents (ibid.). Further, as
researched by D’Amico, Lalonde and Snow (2015), drama therapy, due to its adoption of an
experiential therapeutic approach leads to improvement of adolescents’ capacity in fields
such as: emotional expression, problem solving, goal formulation, improved social
interactions and networks, improved self-reflections and strengthened capability to take
control over personal decisions and responsibilities.

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Psychosocial Development
Additionally, a key theory which may explain the effectiveness underlying drama
therapy, is Erik Erikson’s psychosocial theory of development of which, the stages of identity
vs. confusion and intimacy vs. isolation may be regarded as most relevant. During the stages
of identity vs. confusion, which spans across early adolescence, individuals encounter the
journey to explore one’s identity, which often results in role confusion and hence, providing
adolescents with positive feedback, encouragement and optimism, result in positive
psychological implications during adulthood (McAdams and Zapata-Gietl 2015). Further, as
researched by Amin et al. (2017), receiving negative feedback and discouragement result in
feelings of remorse, anxiety, resentment and low self-esteem during adulthood. Drama
therapy, due to its provision of opportunities to undertake new roles benefit adolescents in
exploring their true identities and hence, encourages optimum psychosocial development and
associated reductions in anxiety (ibid). As researched by Cherry et al. (2017), the stage of
intimacy vs isolation, prevalent during late adulthood, is characterised by adolescents
emphasising heavily on social interactions and relationships, the lack of which, results in
social isolation and social anxiety. As noted by Haenand Webb 2018), drama therapy aids in
the management of social anxiety by allowing adolescents to enact and develop diverse roles
with others on stage which further encouragement social interaction off the stage.
Creative and Appealing
An additional reason which makes drama therapy so effective and popular among
adolescents is its ability to allow adolescents to express their internally suppressed emotions
and hence shows compliance to Freudian psychoanalytical principles of expression of desires
and sublimation using artistic expression (Chaiklin and Wengrower 2015). Additionally,
taking insights from Carroll (2018), drama therapy has been regarded to be effective since it
taps on to the creative potential of adolescents by increasing their ability to achieve a number

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of capabilities such as a) enhance their creative potential, (b) improve their communication
skills, (c) self-reflect on their actions and (d) regulate their emotions, which are otherwise
difficult to achieve through traditional therapies. As researched further by Henson and
Fitzpatrick (2016) drama therapy’s has been deemed to be effective since it has been found to
be appealing to adolescents, since the same allows them the choice to novel roles, engage in
narration and enactment of individual experiences liberally to a non-judgmental audience and
provides them the opportunity to change the features of their stories (ibid.). According to
Klees (2016) drama therapy’s has been found to be effective sinceit encourages acting as an
educational and therapeutic procedure. Drama therapies provision ofvaried perspectives for
mitigating criticism or challenging situations and the seemingly fun and creative appeal of
drama make adolescents receptive to this form of anxiety treatment.
Self, Ethics and the ALIVE model
Holmwood (2014) in his book, ‘Drama Education and Drama Therapy - Exploring the
Space between Disciplines’, notably highlight three major areas, which enhance the
effectiveness of drama therapy. One of the key areas which makes drama therapy so
appealing and effective is the presence of a client-centred, ethical approach. Adopting a client
centred approach means that in drama therapy, where individual roles are regarded as ‘art’,
the adolescents gain complete authority, accessibility and ownership of their artwork, as
compared to the absence of such individuality in traditional treatments. Further, an additional
key area is provision of ethical treatment of clients which implies that adolescents
undertaking drama therapy have the freedom to leave, walk away or abandon the stage as per
their choice. Such freedom and liberality are absent in traditional treatments which not only
makes drama therapy popular and appealing but also enhances the participants’ skills of self-
control, empowerment and decision-making. Lastly, the key feature facilitating effectiveness
and appeal in drama therapy is its utilization of the ALIVE or Animated Learning by

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
Integrating and Validating Experience Model. This implies drama therapy’s ability to provide
a platform for adolescents to express their emotions and vent their stressful thoughts to non-
judgmental audience beyond their family and the opportunity to recognise their feelings of
distress. Such an opportunity not only provides a cathartic form of relief to adolescents but
also enhances their recognition, control and regulation over personal emotions.
Conclusion
To conclude, this research provided key insights into the background of anxiety
disorders in adolescents and the effectiveness of drama therapy in the management of the
same. From the findings of the research, it could be understood that anxiety continues to be
widespread in adolescents and is associated with chronic harm if left untreated for long.
Further, restrictions and role confusion associated with traditional treatments and the
liberality, empowerment, ethics and individuality associated with drama therapy contribute to
its effectiveness and appeal.
Understanding the effects of alternative therapies on adolescents with anxiety issues is
critical in aiding the management of the condition and overall positive outcomes in
adulthood. It has been noted from the literature review that alternative therapies are gaining
popularity in therapeutic practice. Currently, there is insufficient research to expound the
impacts on the drama therapy on adolescents with anxiety issues. Despite the provision of a
detailed finding and discussion sections, this research merely explored current evidence on
the effectiveness of drama therapy without however, delving in depth, concerning the key
processes which contribute to such effectiveness. Further, despite opting for secondary data
which is peer reviewed and scholarly, systematic reviews pose key limitations in their
inability to provide update research findings considering the absence of a primary research
associated with the same. Thus, a thorough comprehension of the outcomes of drama therapy

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
on adolescents with anxiety issues is critical, and hence, paves the way for future research
using primary research means and real life population or scenarios.
The significance of this research lies in its ability to provide insights into the
effectiveness of drama therapy in the management of anxiety issues in adolescents. The
findings from this research would be valuable to practitioners like counsellors and
psychotherapists who could consider incorporating drama therapies in the treatment of
anxiety issues in adolescents who do not show adequate positive responses to traditional
therapies.Additionally, to conclude, the findings may spur other associated professionals such
as teachers or youth workers to include drama therapy to the existing educational curriculum
as a means by which adolescents can mitigate their social anxiety issues.

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20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
Appendices
Appendix 1: Database Chart, Notes and Keywords
Database Keywords Findings Details/Notes Harvard Citation
Google Scholar Prevalence,
anxiety disorder,
adolescents,
global statistics
Zarafshan, H.,
Mohammadi,
M.R. and
Salmanian, M.,
2015.
Prevalence of
anxiety
disorders among
children and
adolescents in
Iran: a
systematic
review. Iranian
journal of
psychiatry,
10(1), p.1.
Used in
Literature
review,
Findings,
Discussion
(Zarafshan, H.,
Mohammadi,
and Salmanian
2015)
Creative arts
therapy, anxiety
Akhan, L.U. and
Atasoy, N.,
2017. Impact of
marbling art
therapy
activities on the
anxiety levels of
psychiatric
patients. Journal
of Human
Sciences, 14(2),
pp.2121-2128.
Used in
Literature
review,
Findings,
Discussion
(Akhanand
Atasoy 2017).

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
Identity,
adolescents
Amin, A.F.M.,
Amir, R.,
Rahman, S. and
Lubis, M.A.,
2017. Profile Of
Self-Identity
Amongst
Adolescents: A
Study In Johor.
Asean
Comparative
Education
Research
Journal On
Islam And
Civilization
(Acer-J).
Eissn2600-769x,
1(1), pp.124-
134.
Used in
Literature
review,
Findings,
Discussion
(Amin et al.
2017)
Erik Eriksson,
identity,
adolescents
McAdams, D.P.
and Zapata-
Gietl, C., 2015.
Three strands of
identity
development
across the
human life
course: Reading
Erik Erikson in
full. The Oxford
handbook of
identity
development,
pp.81-94.
Used in
Literature
review,
Findings,
Discussion
(McAdamsand
Zapata-Gietl
2015)

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY
Erik Eriksson,
identity,
adolescents
Cherry, K.,
2017. Erik
Erikson's Stages
of Psychosocial
Development.
Psychology.
Psychosocial
Theories.
Päivitetty, 14,
p.2017.
Used in
Literature
review,
Findings,
Discussion
(Cherry 2017)
Creative arts
therapy, anxiety
Chaiklin, S. and
Wengrower, H.
eds., 2015. The
art and science
of
dance/movement
therapy: Life is
dance.
Routledge.
Used in
Literature
review,
Findings,
Discussion
(Chaiklinand
Wengrower
2015)
Drama therapy,
adolescents
Emunah,
R.E.N.É.E.,
2005. Drama
therapy and
adolescent
resistance.
Clinical
applications of
drama therapy
in child and
adolescent
treatment,
pp.107-120.
Used in
Literature
review,
Findings,
Discussion
(Emunah 2005)
University
Library
Drama therapy,
adolescents
Holmwood, C.,
2014. Drama
Education and
Dramatherapy:
Exploring the
space between
disciplines.
Routledge
Used in
Dsicussion
(Holmwood
2014)

20DISSERTATION PARTIAL: EFFECTIVENESS OF DRAMA THERAPY