The study will use a mixed-method appraoch and be split in to two phases:

For the first phase of the study, we will focus on generating arts-based responses to existing research findings and publication of good dance movement psychotherapy and arts therapies practice in the treatment of depression. These responses and the creative process as a whole will be thoroughly documented capturing arts-based material (keep a look out for this!), while qualitative verbal comments of the artists will provide an ongoing narrative of the experience of the creation of these performative material.

This process will become both a creative dissemination of pre-existing findings, exploring ways in which such dissemination can take place as well as data emerging from interdisciplinary work that can provide some first opportunities to advance theory and practice in the treatment of depression.

Practically, this first stage will involve:

• (i) the development of performative material which will be used as a creative dissemination of pre-existing findings. This will allow a greater effect of dissemination outside academia and expand upon current findings. It is also chance to explore the use of creative interventions within a performance setting.
• (ii) the development of a creative documentary that will capture the process of the creation of this material and the final performances and will aim to raise awareness of the use of arts and arts therapies and depression.

The second phase of the project will involve the development of a creative treatment package based on lessons from the previous phase. A thematic analysis of relevant literature will inform the material chosen for the treatment package and will aid the search for helpful factors within previous arts-based therapy sessions. Following the trial of the treatment package, participants will be invited to a focus group to discuss their experience within the workshop – an example of the focus group protocol can be found in Appendix 4.

The treatment package will include:

1. Theoretical basis and underpinning psychotherapeutic principles
2. Selected dance movement psychotherapy methods useful in the treatment of depression
3. Selected creative activities such as creative writing, drawing and music making
4. Clear consideration of verbalisation on the part of the therapist in terms of how clients will be invited to engage with and reflect on creative work
5. Processes in which clients will be recruited, invited to evaluate the process and outcome of the intervention and share their experience of participating in the therapeutic intervention (focus group – please see Appendix 4 for an example protocol and other measures that will be used to evaluate the the workshop can be found under Appendix 5 and 6).

We will also use selected arts-based material generated in Phase A as a springboard to stimulate, inform and engage IAPT staff service users in the treatment package developed. In particular, staff and service users will be offered information and will be invited to participate in experiential workshops (one for each group) which will involve key aspects of the creative treatment package. Each workshop will be followed by a focus group which will aim to generate informed feedback on the potential usefulness and feasibility of such an approach with NHS clients. Both creative responses to the experiential workshop in the form of textual, visual, audio and movement data as well as verbal data collected from the two focus groups will be used to evaluate this part of the project. Findings will inform ways in which the treatment package can be further refined for future use in the NHS with patients with depression.

Longer term impact will be considered through the involvement of our partner NHS Trust to future funding bids. Also, close connections will be nurtured with:

• • Clinical Trials Units
• • Partner Universities with research trial experiences and
• • Arts Psychotherapy NHS Units

who could be part of future multi-centred studies.

Further links in Europe will be explore, especially:

• • The Psychology Department of the University of Juvaskula, Finland and
• • The Arts Therapies Department at Stradins University, Latvia

where some large studies in dance movement psychotherapy and arts psychotherapies for wellbeing and the treatment of depression are currently taking place.

This is an important area for scientific research as depression affects over 350 million people worldwide (World Health Organisation, 2012) and in the UK, depression and anxiety are the most common mental health problems affecting 7.8% of the population (Mental Health Foundation 2016. Given that depression often remains undiagnosed, it is possible that the size of the problem is much larger than these statistics show. Accessing a wide range of different psychological therapies remains difficult. Improving Access to Psychological Therapies (IAPT) was introduced following Layard’s Report (2004) arguing that making psychological therapies available on the NHS would pay for itself by reducing benefit claims and getting people back to work. Currently IAPT is the main provider of evidence-based psychological therapies for adults within the NHS. Whilst cognitive behavioural therapy is the main modality offered within IAPT, other approaches such as ‘counselling for depression’ are offered in a very limited capacity. Even less common is the provision of any arts psychotherapies, i.e. music, drama, art of dance movement psychotherapy.

Recent findings identified that about 44% of clients drop out of IAPT (NHS Digital, 2016). Within IAPT Manchester, which covers one of the most deprived areas in the UK (Department of Communities and Local Government, 2015), the drop-out rate is as high as 60.5% (MMHSCT, 2016). In terms of recovery rates, NHS Digital (2016) reported that only 46.3% of clients who completed therapy moved to recovery, and this figure was reduced to 35% in deprived areas. Internal data from IAPT Manchester shows that the recovery rate in its area is as low as 19.7%. The above data suggests that IAPT has a limited impact on clients’ psychological recovery. As cognitive behavioural therapy is the main therapeutic intervention in IAPT, it is possible to conclude that this intervention may have a limited effect on clients’ recovery, especially in deprived areas. Given the high levels of investment in IAPT, these findings have both ethical and economic implications and require further investigation. Cooper (2008) suggested that as much as 75% of therapeutic outcomes are due to the client factors, therefore researching the factors that clients find helpful and unhelpful in therapies may be the most effective with regards to outcome of the therapy.

Psychological interventions that use creative means to approach mental health issues such as arts psychotherapies remain unavailable in several NHS mental health services despite the fact that users often regard these interventions to be of great value. For example, in a survey of service users conducted by the charity Mind, 70% of participants found arts psychotherapies beneficial and made them the top three treatments of choice (Dudley, 2006). A UK survey by Tizard Centre and Bernardos (Williams and Scott, 2009) also indicated that service users wanted more access to arts psychotherapies. In the case of arts psychotherapies there is a growing body of research that supports the users’ calls for further access to such treatments. The project at hand has the capacity to create a new intervention, that can be used within the arts & depression sector. The project gives a relevant platform to trial the intervention that hass not been tried before but also allows for feedback to be given by the service users and staff. The previous evidence base regarding the therpeis used to aid depression and depressive symptoms does not include creative therapies. The instant feedback and comments can be beneficial to this project and future projects of a similar nature because these comments can shape the perspectives taken as we look at future research.