Dohsa-hou

Naruse and the work with cerebral palsy

Published English-language reviews credit Gosaku Naruse with developing Dohsa-hou in 1966, from studies of hypnosis used to improve motor difficulties in children with cerebral palsy. According to a 2018 review, Naruse observed excess muscle tension in the movements of these children and found that they moved more fluidly on directed movement tasks under hypnosis, which he took to show that psychological processes are involved in motor control.

Naruse formulated a theory in which the psychological and physiological processes of movement are coherent when a person intends to move a body part, strives toward that goal and realizes the intended movement. The review describes this as the basis for later motor action training tasks. This account rests on the authors of the reviews summarizing Naruse's work; the original Japanese sources were not examined for this page.

Later applications and spread

The same review reports that the movement tasks were extended to other groups, including people with schizophrenia, depression and anxiety, and that they were later used outside Japan, for example in workshops in Cambodia, a pilot in a daycare center in Bulgaria and camps in South Korea, India, Malaysia and Thailand. These are the authors' descriptions of applications, not evidence of outcomes.

A 2004 cross-cultural study and a 2006 questionnaire study describe six-day or one-week Dohsa-hou camps in which trainers work with children with disabilities while their mothers take part, and they characterize the method as widely used in Japan and other Asian countries for children with intellectual disability, cerebral palsy and autism. These papers measured social interaction among camp participants, not clinical outcomes.

Name and spellings

Dohsa-hou is the Japanese term often translated as body movement method. Journals use several romanizations, including Dohsa-hou, Dohsahou and Dousa-hou, and one 2007 article calls it a Japanese psychorehabilitation method. A 2011 Japanese-language study describes it as a holistic psycho-rehabilitation method. Searches of a biomedical database under these spellings return a small set of papers, many from a few research groups.

A 2022 experimental paper states that Dohsa-hou is distinct from, and should not be conflated with, forms of exercise therapy, and that its fit among mainstream body psychotherapies is debated. The same paper reports that Dohsa-hou researchers do not yet agree on a core theory of embodiment.

Related programs and professional terms

Self-Active Relaxation Therapy (SART) is a related program described as growing out of Dohsa-hou movement tasks. Hiroyuki Ohno reorganized a narrower set of tasks so that the trainee generates the relaxation rather than receiving trainer-initiated movements. SART is therefore a derivative program, and findings about it should not be read as findings about Dohsa-hou itself.

The Association of Japanese Clinical Dohsalogy, the English name given on its own website, uses the Japanese terms Clinical Dohsa-hou and Clinical Dohsalogy, and defines three credentials: Certified Dohsalogy Practitioner, Clinical Dohsalogy Practitioner and Clinical Dohsalogy Lecturer. Requirements for each credential were not available on the page reviewed.

Movement tasks and the intention-effort-realization sequence

A 2022 experimental paper describes a four-step process in clinical Dohsa-hou: the client forms a mental image of an intended movement, enacts it with effort, notices a change in feeling states from feedback on the performance, and adjusts the movement in an iterative process. Tasks are described as scaffolded from simple actions to larger sections of the body, with verbal instruction and feedback from the therapist given alongside the movement.

A hemodialysis study distinguishes two general task types, relaxation tasks that release excess muscle tension and motor-action tasks. In that study, patients lying on a bed opened and closed a hand, bent and stretched a wrist, and moved arms and shoulders, while staff watched the movement and muscle tension and gave positive feedback. The settings and tasks vary across studies.

Session formats

Formats reported in the sources differ widely. A laboratory study used about 4 to 5 minutes of warm-up movements and 6 to 7 minutes of a shoulder raising and lowering task. A trial in children with Down syndrome used 21 sessions over seven weeks, lasting 45 to 60 minutes, in groups of 6 to 9 led by clinical psychologists. A 2024 exploratory report used 20-minute sessions delivered by video from a certified trainer, with participants copying the movements.

Other reports describe bi-weekly individual treatment with relaxation procedures and physical interaction between therapist and patient, and week-long training camps where trainers work with trainees and their mothers. The sources do not describe a single standard session length or frequency.

Trainers and credentials

In the hemodialysis study, staff were supervised by a psychotherapist holding a supervisory license from the Japanese Association of Rehabilitation Psychology, and a clinical psychologist with a trainer license in Dohsa-hou worked at the hospital. The Association of Japanese Clinical Dohsalogy states that it defines its own credentials through its certification regulations. No statutory licensing of Dohsa-hou trainers was identified in the sources reviewed, and the 2022 experimental paper says the method is less integrated into formal psychotherapist training than its research suggests, even within Japan.

Populations and settings described

The sources describe Dohsa-hou as used with children and adults with cerebral palsy, Down syndrome, intellectual disability and autism, and in studies of depression, chronic pain in hemodialysis patients, healthy students and mothers of children with disabilities. Case reports describe its use alongside medication for maladaptive behaviors in young adults with Down syndrome and for a girl with Kabuki syndrome and autism spectrum disorder.

The review of the related SART program also lists use with elders, school children, mothers raising children and residents of disaster-affected areas in northern Japan. The authors consider these as applications of a derivative program, with the research on them largely uncontrolled.

Mechanisms proposed

Authors in this literature propose that guided attention to body movement, with therapist feedback, supports self-regulation, body awareness and relaxation. A 2022 paper frames this through cognitive control theory, and a 2011 Japanese study separated the effects of attention to body sensations from muscular relaxation. These are hypotheses developed within the Dohsa-hou research community, and the authors themselves state that the mechanism is not settled.

Overall evidence base

No systematic review or meta-analysis of Dohsa-hou itself was found in a PubMed search under the spellings Dohsa-hou, Dousa-hou and Dohsahou combined with review, systematic and trial. A 2022 paper notes that the development of Dohsa-hou relied heavily on clinical case reports, and a 2018 review of the related SART program, which searched English and Japanese databases, found mostly uncontrolled pre-post designs, two studies with a non-training control group and none with reported randomization. Most research was done in Japan, which limits generalizability.

Controlled studies

A randomized trial of 40 boys with Down syndrome, aged about 6 to 10 years, compared 21 sessions of Dohsa-hou training with an active control of board games and blood pressure checks. Bimanual coordination accuracy and consistency improved with Dohsa-hou from baseline to the end of seven weeks and to a 4-week follow-up, with large reported effect sizes, but not in the control group. The study was small, included only males, measured one motor outcome, and compared against a non-movement activity, so it cannot separate movement practice from other elements of the method.

A laboratory study assigned healthy Japanese university students to a shoulder movement task with guided attention, an active movement control or a resting control (55 participants in one cognitive task, 57 in another). Group differences were small or marginal: error rates on one trial type rose only in the resting group, and a Stroop congruency difference was absent only after Dohsa-hou. The authors report that the experimenter was not blind to assignment and that group sizes were modest.

A 2011 Japanese randomized study of three groups reported, from its abstract, that attention to body sensations was associated with higher decentering scores and muscular relaxation with lower depressed mood than control. Sample sizes were not available in the abstract, so the study could not be appraised for risk of bias.

Single-case series and case reports

A single-case ABABABA design in five women aged 59 to 62 on hemodialysis compared treatment as usual with 12 weeks of Dohsa-hou relaxation tasks. Visual analysis of pain scores showed decreases in Dohsa-hou phases, and participants reported more capacity for personal care. The authors state it was a pilot, with scheduled rather than randomly assigned phases, no blinding and a small sample.

Other reports are smaller. Two pre-post studies by one author, with 10 young adults with cerebral palsy and 7 children with cerebral palsy, reported changes in rated body movement and in self-rated body consciousness, and a three-participant depression study reported lower depression scores after 12 sessions. Case reports describe young adults with Down syndrome, a girl with Kabuki syndrome and four adults with intellectual disabilities receiving video sessions, all uncontrolled.

Reported adverse events and monitoring

Most studies reviewed do not report adverse events systematically. The trial in children with Down syndrome and the video-delivered exploratory report state that none were reported. A case report of a 19-year-old man with unexplained regression in Down syndrome records a sudden episode of agitation and violence toward family in the eighth month of treatment; the authors say it could have reflected medication adverse effects or an unintended consequence of the psychological intervention, that medication adjustment was needed to resolve it, and that clinicians should monitor for acute aggression in people with a history of it.

The same report lists close physical contact as a possible disadvantage, for example when contact is restricted during a pandemic. The SART review describes an intake step in which the therapist asks about tense, sensitive or painful areas to avoid. Frequency and seriousness of harms in Dohsa-hou cannot be estimated from the sources reviewed.

Care boundaries

The studies reviewed present Dohsa-hou alongside, not instead of, medical and psychiatric care, and the case reports describe medication as continuing. Sources in this literature that report on children, people with severe intellectual disability and people with cerebral palsy involve parents, caregivers or clinical staff. A person with a medical or psychiatric condition should not delay or replace necessary care with a movement method. Japanese-language studies, the society's training standards and most trainer manuals were not covered.