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Art therapy for relief of symptoms associated with HIV/AIDS
AIDS Care
Abstract
Symptom management for persons living with HIV/AIDS is an extremely important component of care management. The importance of pharmacologic interventions for management of symptoms is well recognized, and non-pharmacologic strategies such as art therapy are gaining interest in lay and professional communities. The aim of this research project was to test the feasibility and effectiveness of art therapy for relief of symptoms experienced by people living with HIV/AIDS. In this randomized clinical trial of art therapy, the primary objective was to assess change in physical and psychological symptoms. Participants were recruited from a large urban hospital's inpatient population and outpatient HIV clinic. Seventy-nine people with a diagnosis of HIV infection provided socio-demographic information, participated in either a one-hour art therapy session or viewed a videotape about art therapy, and completed pre- and posttest measures of psychological and physical symptoms. Two separate analysis of covariance models were used to identify if the treatment condition influenced psychological and physical symptoms, after adjusting for pretest score, age, gender, and race/ethnicity. The analyses showed that physical symptom mean scores were better for those who participated in the art therapy compared to those who viewed the videotape, and this difference between conditions was statistically significant (p<0.05). Thus, the study demonstrated the potential benefits of one session of art therapy in relation to symptoms associated with HIV/AIDS.
... Studies included in final narraƟve review n = 16 representation of individual types of arts therapy was not uniform; the least in the field of music was one and the most in the field of visual art therapy were eight. Regarding the type of study design in the included 16 studies, there were five literature reviews [4,20,40,49,51], four nonrandomized clinical studies [31,34,42,60], three self-reported evaluation and case studies [33,35,43], and four randomized designs [45][46][47]50]. Overall, with regard to the type of design in the included studies, no type of study design (literature review, nonrandomized clinical study, self-reported evaluation and case study, randomization in design) predominated. ...
... Six studies were supported by grants, specifically they were from the Foundation for Art and Healing [20], Johnson and Johnson and the Society for Arts in Healthcare [50], FEDER POCI-01-0145-FEDER-007746 [43] [60]. Most of the included articles, ten, stated non funding [4, 31, 33-35, 40, 42, 45, 49, 51]. ...
... Variables that were measured and targeted for analysis in 16 included studies of arts therapy were following: pain intensity [4, 20, 31, 34, 35, 40, 42, 43, 45-47, 50, 51, 60], emotional distress, mood, or wellbeing [4, 20, 31, 33, 34, 42, 43, 45-47, 49-51, 60], social support [20] and quality of life (QoL) [20,35]. The included articles were published between 2004 and 2020 in this layout: 2004 [51], 2005 [45], 2006 [40,46], 2008 [47], 2009 [33,50], 2010 [20,42], 2011 [4], 2012 [35], 2014 [34], 2017 [60], 2018 [31], 2019 [49], and 2020 [43]. ...
Chronic nonmalignant pain is recognized as a complex, dynamic, phenomenological interplay between biological, psychological, and social factors that are individual to the person suffering from it. Therefore, its management and treatment ought to entail the individual’s biopsychosocial aspects that are often addressed by collaborative, inter/multidisciplinary multimodal care, as there is no biologic treatment. In an effort to enhance inter/multidisciplinary multimodal care, a narrative review of arts therapy as a mind–body intervention and its efficacy in chronic pain populations has been conducted. Changes in emotional and physical symptoms, especially pain intensity, during arts therapy sessions have also been discussed in in the context of attention distraction strategy. Arts therapy (visual art, music, dance/movement therapy, etc.) have been investigated to summarize relevant findings and to highlight further potential benefits, limitations, and future directions in this area. We reviewed 16 studies of different design, and the majority reported beneficial effects of art therapy in patients’ management of chronic pain and improvement in pain, mood, stress, and quality of life. However, the results are inconsistent and unclear. It was discovered that there is a limited amount of high-quality research available on the implications of arts therapy in chronic nonmalignant pain management. Due to the reported limitations, low effectiveness, and inconclusive findings of arts therapy in the studies conducted so far, further research with improved methodological standards is required.
... The trials tested the effectiveness of ten complementary therapies: the program comprised of muscle relaxation, electromyographic biofeedback-assisted relaxation training, meditation, and hypnosis; Chinese herbs; therapeutic touch; massage; auricular acupuncture with and without spiritual therapy; mantra; art therapy; Reiki; yoga and mindfulness training. (1,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) Five complementary therapies have been shown to be effective in reducing anxiety in people living with HIV: ear acupuncture with spiritual therapy, therapeutic touch, massage, program consisting of muscle relaxation, relaxation training assisted by electromyographic biofeedback, meditation and hypnosis, and yoga. (1,12,15,17,18,23) Among the complementary therapies with a significant result, two were studies that included interventions only with adults and grouped more than one technique simultaneously: auricular acupuncture with spiritual therapy and the program composed of muscle relaxation, relaxation training assisted by electromyographic biofeedback, meditation and hypnosis. ...
... Among the main factors related to this evaluation were the fact that only three studies used a placebo or sham intervention as control, (13)(14)(15) and four articles reported that the control group received no intervention, being referred to as a usual routine, without description of what it consisted of, waiting list or no treatment. (1,12,22,23) Still, most studies evaluated anxiety through self-report of participants; (1,12,13,15,16,(18)(19)(20)(21)(22)(23)(24) interventions, often due to their characteristics, did not allow blinding of the professionals who offered the treatment; (1,18,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) details on the randomization method were absent (12,16,18,20) and there were drop-outs or poor adherence of participants to therapy and incomplete reporting of outcomes. (14,17,21,24) Furthermore, six studies were self-styled as preliminary, pilot-type, in most cases including samples of less than 40 people and short, one-session interventions. ...
... Among the main factors related to this evaluation were the fact that only three studies used a placebo or sham intervention as control, (13)(14)(15) and four articles reported that the control group received no intervention, being referred to as a usual routine, without description of what it consisted of, waiting list or no treatment. (1,12,22,23) Still, most studies evaluated anxiety through self-report of participants; (1,12,13,15,16,(18)(19)(20)(21)(22)(23)(24) interventions, often due to their characteristics, did not allow blinding of the professionals who offered the treatment; (1,18,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) details on the randomization method were absent (12,16,18,20) and there were drop-outs or poor adherence of participants to therapy and incomplete reporting of outcomes. (14,17,21,24) Furthermore, six studies were self-styled as preliminary, pilot-type, in most cases including samples of less than 40 people and short, one-session interventions. ...
... The trials tested the effectiveness of ten complementary therapies: the program comprised of muscle relaxation, electromyographic biofeedback-assisted relaxation training, meditation, and hypnosis; Chinese herbs; therapeutic touch; massage; auricular acupuncture with and without spiritual therapy; mantra; art therapy; Reiki; yoga and mindfulness training. (1,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) Five complementary therapies have been shown to be effective in reducing anxiety in people living with HIV: ear acupuncture with spiritual therapy, therapeutic touch, massage, program consisting of muscle relaxation, relaxation training assisted by electromyographic biofeedback, meditation and hypnosis, and yoga. (1,12,15,17,18,23) Among the complementary therapies with a significant result, two were studies that included interventions only with adults and grouped more than one technique simultaneously: auricular acupuncture with spiritual therapy and the program composed of muscle relaxation, relaxation training assisted by electromyographic biofeedback, meditation and hypnosis. ...
... Among the main factors related to this evaluation were the fact that only three studies used a placebo or sham intervention as control, (13)(14)(15) and four articles reported that the control group received no intervention, being referred to as a usual routine, without description of what it consisted of, waiting list or no treatment. (1,12,22,23) Still, most studies evaluated anxiety through self-report of participants; (1,12,13,15,16,(18)(19)(20)(21)(22)(23)(24) interventions, often due to their characteristics, did not allow blinding of the professionals who offered the treatment; (1,18,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) details on the randomization method were absent (12,16,18,20) and there were drop-outs or poor adherence of participants to therapy and incomplete reporting of outcomes. (14,17,21,24) Furthermore, six studies were self-styled as preliminary, pilot-type, in most cases including samples of less than 40 people and short, one-session interventions. ...
... Among the main factors related to this evaluation were the fact that only three studies used a placebo or sham intervention as control, (13)(14)(15) and four articles reported that the control group received no intervention, being referred to as a usual routine, without description of what it consisted of, waiting list or no treatment. (1,12,22,23) Still, most studies evaluated anxiety through self-report of participants; (1,12,13,15,16,(18)(19)(20)(21)(22)(23)(24) interventions, often due to their characteristics, did not allow blinding of the professionals who offered the treatment; (1,18,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) details on the randomization method were absent (12,16,18,20) and there were drop-outs or poor adherence of participants to therapy and incomplete reporting of outcomes. (14,17,21,24) Furthermore, six studies were self-styled as preliminary, pilot-type, in most cases including samples of less than 40 people and short, one-session interventions. ...
... Basically, HIV and AIDS is not just confined to the physical aspect of the disease, rather it encompasses other holistic perspectives which involve multidisciplinary strategies such as art therapy (Rao et al. 2009). Art therapy is defined as the process of using art to externally express internalised feelings and emotions that would otherwise not be verbally expressed (Czamanski-Cohen, 2012) or well articulated (Bien, 2005), particularly in deaf-mute individuals. ...
... In the context of HIV and AIDS, art therapy has been shown to alleviate anguish, fears as well as emotional trauma in PLWHIV. Furthermore, art therapy has been used to 107 manage the psychosocial aspect of HIV infection, stigmatisation, discrimination as well as social exclusion frequently experienced by PLWHIV (Rao et al. 2009). In addition, several authors have argued that art therapy is linked to increased health benefits in patients (Czamanski-Cohen, 2012;Svensk et al. 2009;Visser & Op 'T Hoog, 2008;Wood, Molassiotis, & Payne, 2011), because it increases the quality of life (Svensk et al. 2009) and ...
... improves coping skills (Rao et al. 2009;Visser & Op 'T Hoog, 2008). ...
... The improvement in physical health may be attributed to the peer support component and enhanced meaning of life. Rao et al. (2007) contend that physical symptoms experienced by PLHIV may subside since the therapy can function as an interface for exchanging medical information and afford peer support for maintaining medical adherence. Other studies also found that in a peer-based intervention, the mutual support can contribute to better medical adherence among PLHIV (Marino, Simoni, & Silverstein, 2007;Simoni, Frick, & Huang, 2006). ...
... Consistent with prior evaluation studies on art therapy (Feldman, Betts, & Blausey, 2014;Rao et al., 2007), psychodrama (Karabilgin, Gökengin, Doğaner, & Gökengin, 2012), and expressive therapy (Machtinger et al., 2015), the findings of this study offer some evidence for the positive and stabilizing effect of this expressive arts group therapy on psychological health among PLHIV. ...
... While participants' positive affect significantly improved, it was initially surprising to find that their negative affect was also slightly elevated after the intervention. As Rao et al. (2007) highlighted, a group arts therapy can serve a function of creating a safe space for participants to express symptoms associated with HIV rather than "keeping the pain or anxiety bottled-up inside" (p. 68). ...
... Art therapy can provide a space to express the anger, confusion, depression, and guilt that may accompany living with HIV/AIDS (Edwards, 1993). Although only a few studies have assessed the effectiveness of art therapy interventions in addressing health and mental health outcomes among people living with HIV/AIDS, the results have demonstrated evidence of improving psychological and physical symptoms in this population (Fair, Connor, Albright, Wise, & Jones, 2012;Field & Kruger, 2008;Rao et al., 2009). ...
... The findings of this study suggest that participating in art therapy services may help decrease depression severity and increase mental health-related quality of life among people living with HIV/AIDS. Studies of art therapy with people living with HIV/AIDS (Field & Kruger, 2008;Rao et al., 2009) and other disease populations (Monti et al., 2006;Puig, Lee, Goodwin, & Sherrard, 2006;Ross, Hollen, & Fitzgerald, 2006) have demonstrated similar results in decreasing mental health symptoms. ...
... Our evaluation study outcomes also may have differed by the format of art therapy service (i.e., individual art therapy only, group art therapy only, and individual and group art therapy). Although some art therapy intervention studies have used quasi-experimental or randomized control designs (e.g., Field & Kruger, 2008;Rao et al., 2009), we did not find any studies to date that compared the effectiveness of different art therapy formats and modalities. Future outcomes studies, particularly those with larger samples, should analyze the impact of the level and frequency of par-ticipation in art therapy services and type of modality. ...
Program evaluation offers an opportunity for improving the implementation and impact of art therapy. This article describes a process and outcomes evaluation of an art therapy program within the mental health services unit of a community-based organization for people living with HIV/AIDS. The aims were to assess utilization patterns and program impact on decreasing depression and improving health-related quality of life among HIV-positive individuals who received art therapy services during a 5-year period (N = 255). Short-term group art therapy services were found to be most frequently utilized. Significant changes in symptoms of depression and mental health–related quality of life were observed in a subsample of clients (n = 25) between baseline and a 6-month follow-up assessment. The findings, which underscore the value of program evaluation, may be useful in improving art therapy services for people living with HIV/AIDS.
... Creativity also can be transformative (Milia, 2000) and facilitate selfawareness (Rao et al., 2009). Rogers (1993) poetically used the metaphor of a lotus blossom to describe the power of the creative process to stimulate self-awareness and transformation: "It is like the unfolding of a lotus blossom on a summer day. ...
... Counselors who use creative self-care strategies may experience the multiple benefits of engaging in the creative process-both personally and as a means of coping with the demands of a career in the helping profession. Not only can creativity facilitate expression (Ahmed & Siddiqi, 2006;Malchiodi, 1998Malchiodi, , 2005 and serve as a coping mechanism (Charyton et al., 2009;Malchiodi, 2005), but it also can produce increased self-awareness (Rao et al., 2009) and assist in problem solving (Kress et al., 2008). Gladding (2011) described counseling as an inherently creative process and noted the reciprocal relationship between creativity and counseling when he said "counseling is creative and can help both counselors and clients understand themselves and their environments differently and in the process lead to new and better ways of living" (p. ...
... Another important consideration is that of emotional safety. The act of creating can evoke powerful emotions (Rao et al., 2009). Accordingly, professional counselors who use creative self-care strategies should be mindful to consider their own physical and emotional safety (Milia, 2000). ...
Professional counselors experience a range of emotional and personal demands, which can easily impact their quality of life and clinical efficacy. Creative engagement and expression may be effective in managing the impact of a career in helping. In this article, the authors present an overview of counselor self-care, including its applicability to the American Counseling Association Code of Ethics (2005) and the 2009 Council for the Accreditation of Counseling and Related Educational Programs standards. Strength-based, creative approaches to counselor self-care are provided and discussed.
... The mean number of participants was 42.35 with a range of 7 to 158 participants. Study participants were broken down into the following age groups: 12 studies were with children and/or adolescents (Chemtob, Singer, Lyshak-Stelzer, & Patricia, 2007;Chin, Chin, Palombo, Palombo, Bannasch, & Cross, 1980;Dolgin, Somer, Zaidel, & Zaizov, 1997;Epp, 2008;Omizo & Omizo, 1989;Pifalo, 2006;Rosal, 1993;Rosal, McCulloch-Vislisel, & Neece, 1997 Saunders & Saunders, 2000;Wallace-Di Garbo & Hill, 2006;Walsh & Hardin, 1994;White & Allen, 1971), 16 with adults (Brooke, 1995;Franks & Whitaker, 2007;Gantt & Tinnin, 2007;Gussak, 2004;Hughes & da Silva, 2011;Monti et al., 2006;Nainis et al., 2009;Oster et al., 2006;Puig, Lee, Goodwin, & Sherrard, 2006;Richardson, Jones, Evans, Stevens, & Rowes, 2007;Schut, de Keijser, van den Bout, & Stroebe, 1996;Svensk et al., 2009;Theorell et al., 1998;Thyme et al., 2007;Visser & Op' t Hoog, 2008;Walsh, Martin, & Schmidt, 2004) and one was with the aged (Doric-Henry, 1997). The mean duration of treatment was 14.5 sessions (median = 8.5) with a range of 1 to 90 sessions. ...
... Problem types represented were mental health (n = 10; Chemtob et al., 2007;Chin et al., 1980;Doric-Henry, 1997;Franks & Whitaker, 2007;Gantt & Tinnin, 2007;Omizo & Omizo, 1989;Richardson et al., 2007;Thyme et al., 2007;Walsh et al., 2004, White & Allen, 1971), social adjustment and behavioral problems (n = 8; Epp, 2008;Gussak, 2004;Rosal, 1993;Rosal et al., 1997;Saunders & Saunders, 2000;Schut et al., 1996;Wallace-DiGarbo & Hill, 2006;Walsh & Hardin, 1994), cancer (n=6;Dolgin et al., 1997;Monti et al., 2006;Oster et al., 2006;Puig et al., 2006;Svensk et al., 2009;Visser & Op' t Hoog, 2008), other physical health (n = 3; Hughes & da Silva, 2011;Nainis et al., 2009;Theorell et al., 1998), and sexual abuse (n = 2; Brooke, 1995;Pifalo, 2006). ...
... Skelly (2016) talks about processes that loosen up the brain and facilitate being open to new ideas. The feedback both from interviewees and the interviewer in our study suggested that the LSB facilitated this, in particular helping to capture and confront issues related to HIV/AIDS (Rao et al., 2009) and residential school impacts. It would seem that seeing the lifescape enabled the narration of difficult lived experiences of the HIV-positive Indigenous men interviewed. ...
... For instance, for someone who experienced sexual or physical abuse in their foster home growing up, the depiction of this by putting pieces on the board for their deceased parents and a picture of a house brings the past experience into the foreground, but from a somewhat detached perspective as observer. For men who have experienced trauma and discrimination, and for those who may struggle to verbally disclose their lived experiences while living with HIV, the LSB can provide a route of nonverbal expression, an avenue of acceptance, and thus be an effective means to promote disclosure and healing (MacDonald, 2016;Rao et al., 2009). Working with the LSB may prove to be a creative process that affects more than the interviewees' identity with illness. ...
Within the context of a study about the lived experiences of Indigenous males living with HIV in Vancouver, Canada, we explored the utilization of an innovative method of collecting the narratives of study participants. This article describes and assesses the use of the Life Story Board (LSB) as a potentially rich interview tool for qualitative research and explores the process, as well as its advantages and challenges. The LSB uses sets of cards, markers, and notation on a play board to create a visual representation of a verbal narration about someone’s life situation or story. Five study participants took part in a conventional face-to-face interview and 4 months later were interviewed with the use of the LSB. These study participants were asked toward the end of the LSB session about their experience of being interviewed with and without the LSB. Data were also gathered from the interviewers’ experience. The findings suggested that the LSB offers interesting opportunities when used in qualitative research. Study participants found it to facilitate a reflective and more in-depth narration of their lived experience. The interviewer’s perspective for the most part corroborated these observations.
... Human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS), continues to be a major health concern worldwide [1][2][3]. Treatment with antiretroviral therapies (ARTs) has been shown to be effective in controlling the virus, preventing symptoms, increasing life expectancy, and reducing risk of transmitting the virus to others [4][5][6][7][8]. However, there is growing awareness of risks associated with commonly used ARTs. ...
... This literature review was performed to inform the clinician interview questions and ensure that the health state descriptions were consistent with published research. Literature searches focused on symptoms, impact, and treatment of HIV [7,8,44,45] as well as risks associated with ART, including bone [12][13][14], renal [15][16][17], and cardiovascular risks [9][10][11]. ...
PurposeDespite benefits of antiretroviral therapies (ART), people with HIV infection have increased risk of cardiovascular disease, kidney disease, and low bone mineral density. Some ARTs increase risk of these events. The purpose of this study was to examine patients’ perspectives of these risks and estimate health state utilities associated with these risks for use in cost-utility models. Methods
Qualitative thematic analysis was conducted to examine messages posted to the POZ/AIDSmeds Internet community forums, focusing on bone, kidney, and cardiovascular side effects and risks of HIV/AIDS medications. Then, health state vignettes were drafted based on this qualitative analysis, literature review, and clinician interviews. The health states (representing HIV, plus treatment-related risks) were valued in time trade-off interviews with general population participants in the UK. ResultsQualitative analysis of the Internet forums documented patient concerns about ART risks, as well as treatment decisions made because of these risks. A total of 208 participants completed utility interviews (51.4% female; mean age 44.6 years). The mean utility of the HIV health state (virologically suppressed, treated with ART) was 0.86. Adding a description of risk resulted in statistically significant disutility (i.e., utility decreases): renal risk (disutility = −0.02), bone risk (−0.03), and myocardial infarction risk (−0.05). Conclusions
Patient concerns and treatment decisions were documented via qualitative analysis of Internet forum discussions, and the impact of these concerns was quantified in terms of health state utilities. The resulting disutilities may be useful for differentiating among ARTs in economic modeling of treatment for patients with HIV.
... Study author and date n (%) (total n ¼ 90) ; ; Rao et al. (2009) Hamilton Depression Rating Scale (HAM-D) and cut-off of 8 and 49% according to HAM-D and cut-off of 14. ...
... L. Sherr et al. (Cazzullo et al., 1998); sertraline vs. paroxetine vs. fluoxetine (Ferrando et al., 1997); cyclic antidepressant in HIV þ vs. HIV- (Hintz et al., 1990); lowdose or high-dose zidovudine or placebo (Robiner et al., 1993); dextroamphetamine (Wagner et al., 1996 1 ); sertraline (Wagner et al., 1996 1 ) 2 1 1 1 (EE) 1 Not clear, n ¼ 1 Fluvoxamine (Mauri et al., 1994) 1 Substances Yes, n ¼ 5 Chinese herbal treatment for HIV symptoms (Burack et al., 1996;Weber et al., 1999); vitamin A (Smith Fawzy et al., 2007); multivitamins (Smith Fawzy et al., 2007 1 ); selenium therapy (Shor-Posner et al., 2003) 1 4 (continued) 508 L. Sherr et al. (Bormann et al., 2006); life review (Erlen et al., 2001); art psychotherapy intervention (Field & Kruger, 2008 1 ); art therapy (Rao et al., 2009); case management community care (Husbands et al., 2007); internet information consumer skills (Kalichman et al., 2006 1 ); social support group (Kelly et al., 1993 1 ); telephone-delivered psycho-educational family intervention (Stein et al., 2007); proactive smoking counselling delivered via cell phones ( (Markowitz et al., 1998); fluoxetine and cognitive therapy vs. fluoxetine alone (Savard et al., 1998); structured group therapy with fluoxetine vs. with placebo (Targ et al., 1994); supportive group with fluoxetine vs. with placebo (Zisook et al., 1998) (Diego et al., 2001 1 ); aerobic exercise training (Laperriere et al., 1990 1 ); aerobic exercise training (Neidig et al., 2003 1 ); standard acupuncture treatment (Margolin et al., 2005); high vs. moderate intensity exercise training (Terry et al., 1999) 3 1 1 (NE) ...
HIV-positive individuals are more likely to be diagnosed with major depressive disorder than HIV-negative individuals. Depression can precede diagnosis and be associated with risk factors for infection. The experience of illness can also exacerbate depressive episodes and depression can be a side effect to treatment. A systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review aims to provide a comprehensive understanding of evaluated interventions related to HIV and depression and provide some insight on questions of prevalence and measurement. Standard systematic research methods were used to gather quality published papers on HIV and depression. From the search, 1015 articles were generated and hand searched resulting in 90 studies meeting adequacy inclusion criteria for analysis. Of these, 67 (74.4%) were implemented in North America (the US and Canada) and 14 (15.5%) in Europe, with little representation from Africa, Asia and South America. Sixty-five (65.5%) studies recruited only men or mostly men, of which 31 (35%) recruited gay or bisexual men. Prevalence rates of depression ranged from 0 to 80%; measures were diverse and rarely adopted the same cut-off points. Twenty-one standardized instruments were used to measure depression. Ninety-nine interventions were investigated. The interventions were diverse and could broadly be categorized into psychological, psychotropic, psychosocial, physical, HIV-specific health psychology interventions and HIV treatment-related interventions. Psychological interventions were particularly effective and in particular interventions that incorporated a cognitive-behavioural component. Psychotropic and HIV-specific health psychology interventions were generally effective. Evidence is not clear-cut regarding the effectiveness of physical therapies and psychosocial interventions were generally ineffective. Interventions that investigated the effects of treatments for HIV and HIV-associated conditions on depression generally found that these treatments did not increase but often decreased depression. Interventions are both effective and available, although further research into enhancing efficacy would be valuable. Depression needs to be routinely logged in those with HIV infection during the course of their disease. Specific data on women, young people, heterosexual men, drug users and those indiverse geographic areas are needed. Measurement of depression needs to be harmonized and management into care protocols incorporated.
... It is vital in relieving symptoms associated with HIV/AIDS which explains why poor adherence leads to poor health outcomes. 51 Mental health disorders and stigma can also affect health care seeking habits for people living with HIV. Research has established that people who experience HIV-related stigma are less likely to seek care. ...
Stigma remains a significant challenge for people living with HIV/AIDS(PLWHA) despite the advances that have been made in HIV care and treatment. It is known to affect health care outcomes including care seeking habits and medication adherence. In addition to contributing to poor health outcomes, stigma is known to increase the risk of developing mental health disorders. Various researchers have found a correlation between stigma and mental health disorders including depression, anxiety, mental distress, stress, post-traumatic stress disorder (PTSD), and suicidal ideation. The aim of this review is to explore the association between stigma and mental health disorders in PLWHA. It identifies common mental health disorders found in people living with HIV and how these disorders are linked to stigma. The review also identifies how stigma and mental health disorders affect healthcare outcomes of PLWHA. The review concludes by providing a number of measures that can help to end stigma and improve overall health outcomes of PLWHA. Keywords: stigma, HIV-related stigma, HIV/AIDS, mental health disorders, people living with HIV/AIDS
... Several symptom management strategies have been developed among PLWH, such as art therapy [20], community navigation intervention [21], physical activity [22], peer-based intervention [23], manual or guidebook [2,24], health education [25,26], and mobile health (mHealth) application (app) [27]. Currently, the widespread mobile technology users provide great opportunities to implement SMIs for PLWH. ...
Objective:
This study aims to evaluate the effects of a symptom management intervention (SMI) based on symptom management group sessions combined with a mobile health (mHealth) application (app) on the knowledge of symptom management, the certainty of symptom self-management, symptom severity, symptom distress, medication adherence, social support, and quality of life among persons living with HIV (PLWH) in China.
Methods:
A parallel randomized controlled trial with 61 PLWH was conducted in Shanghai, China. The participants in the control group (n = 30) downloaded the Symptom Management (SM) app according to their needs and preferences, and received routine follow-ups. The participants in the intervention group (n = 31) were guided to download and use the SM app, and received four tailored weekly group sessions at routine follow-ups. Each group session lasted for approximately 2 h and targeted one of the major modules of the SM app. All the outcomes were assessed at baseline and post-intervention. The study was registered with the Chinese Clinical Trial Registry (ChiCTR1900024821).
Results:
The symptom management knowledge and certainty of symptom self-management were significantly improved after the intervention (all P < 0.01). Compared with the control group, the scores of symptoms reasons knowledge score improved 11.47 points (95% CI: 3.41, 19.53) and scores of symptoms self-management knowledge score improved 12.80 points (95% CI: 4.55, 21.05) in the intervention group after controlling for covariates. However, other outcomes did not show statistically significant differences between the intervention group and the control group (P > 0.05).
Conclusion:
The SMI could improve PLWH's symptom management knowledge and certainty of symptom self-management. Multi-center studies with larger sample sizes and longer follow-ups are needed to further understand the effects of SM app on ameliorating symptom severity and symptom distress. More innovative strategies are also needed to promote and maintain the sustainability of the SM app.
... Another study found that art therapy was helpful for Native Americans living with HIV/AIDS who had difficulty articulating these emotions (Bien, 2005). In a study on HIV patients it was seen that one session art therapy resulted in improvement in symptoms associated with HIV/AIDS (Rao et al., 2009). ...
HIV as a chronic illness is manageable but not curable. Psychiatric disorders not only act as risk factors for HIV infection but also result from the diagnosis of HIV infection. The psychiatric disorders range from anxiety, depression to neurocognitive disorders. The diagnosis also means psychological and emotional effects on the patients and the caregivers. This requires that biopsychosocial perspective be employed in managing such patients for better treatment adherence and increased quality of life. There are various psychological interventions available like cognitive behavior therapy, group therapy, mindfulness based therapy etc. Despite wide prevalence of such problems present in India, very few clinicians are aware of these psychological interventions and make them available to the patients.
... The HIV Symptom Index [63] was developed to assess bothersome HIV-related symptoms [64,65] and demonstrates strong associations with disease severity and physical and mental health [63]. Other symptom assessment tools used in PWH include the Edmonton Symptom Assessment Scale [66] and the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) [67]. These scales can help providers determine the types of symptoms present, evaluate the overall symptom burden, and track the severity of the symptoms over time. ...
With increased longevity related to the advent of antiretroviral therapy, there are increasing proportions of older persons living with HIV (PWH). Prior studies have demonstrated increased prevalence of geriatric syndromes in older PWH and recommended the Comprehensive Geriatric Assessments (CGA) in this population. However, there is currently no peer-reviewed literature that outlines how to perform CGA in PWH in the clinical setting. In this article, we offer a review on how to perform CGA in PWH, outline domains of the CGA and their importance in PWH, and describe screening tools for each domain focusing on tools that have been validated in PWH, are easy to administer, and/or are already commonly used in the field of geriatrics
... Geçmişte genel olarak depresyon tedavisinde başvurulan sanat terapisi günümüzde anoreksiya, epilepsi, otizm, alzheimer, gelişim bozukluğu, astım, parkinson, AIDS semptomları, post travmatik stres bozukluğu, depresyon, cinsel istismar ve kanser gibi pek çok hastalıkta etkin şekilde kullanılmaktadır (Acharya, Wood, & Robinson, 1995;Anschel, Dolce, Schwartzman, & Fisher, 2005;Beebe, Gelfand, & Bender, 2010;Betts, Harmer, & Schmulevich, 2014;Blomdahl, Gunnarsson, Guregård, & Björklund, 2013;Elkis-Abuhoff, Goldblatt, Gaydos, & Corrato, 2008;Gantt & Tinnin, 2007;Got & Cheng, 2008;Massimi et al., 2008;Pretorius & Pfeifer, 2010;Rao et al., 2009). ...
Amerikan Sanat Terapisi Derneği, sanat terapisini, bireylerin, sanat terapisti tarafından sunulan sanatsal medyayı, yaratıcı süreci ve ortaya çıkan sanat eserini, duygularını keşfetmek ve duygusal çatışmaları uzlaştırmak için kullandıkları zihinsel bir süreç olarak tanımlar. Sanat terapisinin teorik temeli beyin lateralizasyonu teorisidir. Buna göre sol beyin temel olarak mantık, dil, yazma ve akıl yürütme gibi süreçleri yönetirken sağ beyin çizim, müzik, duygu, yaratıcılık vb. süreçleri yönetmektedir. Sağ beyin bu süreçleri yönetirken duyusal veya duygusal bilgilerin işlenmesinde, ilk önce bir görüntü izdüşümü yaratır, bilgiyi işler sonrasında sözlü düşünme ve hafıza üretmek için onu sol beyine iletir. Sanat terapisi, hastalara olumsuz duyguları önleme, davranışsal ve psikolojik semptomları hafifletme ve böylece yaşam kalitesini artırma konusunda yardımcı olan sezgisel bir ifade tarzı sağlar. Diğerleri sanatın kendisini terapi olarak görür. Yani, sanat yapıtına dahil olan yaratıcı süreç, ister çizim, resim, heykel, isterse başka bir sanat formunda olsun, yaşamı geliştiren ve sonuçta terapötik olan uygulama ya da materyaldir. Çeşitli çalışmalardaki kanıtlar, sanat terapilerine katılan hastaların aile fertleri ve sağlık hizmeti verenler için büyük olumlu faydalar olduğunu göstermiştir. Ancak teknolojideki gelişmeler duyguların ve psikolojinin hastalıkları üzerindeki etkilerini açıkça ortaya koymuştur. Genellikle, hastalığın tüm belirtileri “hasta hissetmek” ifadesiyle tanımlanır. Bu durum hasta olma bilincimizin acı ya da üzgün hissetmek gibi duyusal bir bileşen olduğu anlamına gelmektedir. Hemşirelik aynı zamanda yardıma ihtiyaç duyan hasta veya sağlıklı bireyin duygularını ve hislerini okuyabilme sanatıdır. Hemşirelik, bir sanat ve bilim olarak kabul edilir ve bakım, hemşireliğin teorik çerçevesini oluşturur. Hemşirelik bakımı, hemşire-hasta arasındaki sezgisel bir anlayışa, birlik ve bağlantıya dayanmaktadır. Görev odaklı yaklaşımlar hemşirelere bakım kalitesini sürdürme noktasında zorluk çıkarmaktadır. Hemşirelikte kaliteli bakım uygulamaları, sanat ve bilimin birlikte uygulanması gerekliliğini doğurmaktadır. Hemşirenin hasta ile birlikte tıbbi ortamdaki yaratıcı çalışmalara katılması, hastanın güvenli bir şekilde duygularını ifade etmesi için fırsatlar sunabilecektir.
... As a result of the growth in both fields, more research is beginning to examine the specific role artmaking and art therapy may play in well-being and flourishing. A number of studies have found that art therapy reduced depression and anxiety, improved overall mood, and increased positive emotions(Bar-Sela, Atid, Danos, Gabay, & Epelbaum, 2007;Geue et al., 2010;Hughes & da Silva, 2011;Jang, Kang, Lee, & Lee, 2016;McCaffrey, Liehr, Gregersen, & Nishioka, 2011;Monti et al., 2006;Nainis et al., 2006;Puig et al., 2006;Rao et al., 2009;Stuckey & Nobel, 2010; Visnola, Sprūdža, Ārija Baķe, & Piķe, 2010;Wood, Molassiotis, & Payne, 2011). Other research has found that artmaking (outside of a therapeutic relationship) can ...
This capstone project analyzes potential opportunities for integration between the fields of positive psychology and art therapy in the treatment of trauma. The experience of trauma is widespread: between 60-89% of people will likely experience at least one traumatic event during their lifetime (Kilpatrick, Resnick, & Acierno, 2009; Mills et al., 2011; Resnick et al., 1993). Extensive research on trauma over the past few decades has been essential to more deeply understand trauma and recovery. Still, traumatized persons deserve the opportunity to not just survive, but flourish. After reviewing valuable historical information on both fields, four related positive psychology constructs of meaning, posttraumatic growth, optimism, and hope are discussed and practical opportunities for integration are considered. Current and well-researched interventions in positive psychology are reviewed, and a call to action is made to develop a growth-based trauma-informed art therapy approach.
... Cancer patients participating in art therapy experience improvements in mental health, QOL, personal growth, or positive social interaction [13]. Studies have suggested that art therapy leads to increased awareness of self, improved ability to cope with symptoms, stress, and traumatic experiences [14]. ...
Objectives:
The purpose of this study was to evaluate the evidence of art therapy on the psychological outcome, quality of life (QOL), and cancer-related symptoms in women with gynecological cancer.
Methods:
A systematic literature search was conducted. The randomized controlled trials, quasiexperimental studies, case reports, and qualitative studies were all included.
Result:
1,587 articles were retrieved. A total of 9 articles met the inclusion criteria. The existing studies provided initial evidence to suggest that art therapy may benefit gynecological cancer patients with respect to improving psychological outcome and QOL, reducing fatigue related to cancer, and improving subjective overall health condition. However, the quality of the current evidence limits the efficacy of these findings.
Conclusion:
Research on art therapy of gynecologic cancer patients is insufficient. We cannot draw the conclusion that art therapy benefits gynecological cancer patients in the psychological outcome, QOL, and cancer-related symptoms. More rigorous research is needed.
... These medians were entered into CMA, because the means could not be retrieved. Also, five studies [23][24][25][26][27] found no differences between intervention and control conditions on one or more outcome measures, but no data was available. The effect sizes of these outcome measures of the studies were set at zero. ...
In this systematic review and meta-analysis we investigated the effectiveness of different psychosocial treatments for people living with HIV (PLWH) and mental health problems. Additionally, characteristics that may influence the effectiveness of a treatment (e.g., treatment duration) were studied. PubMed, PsycINFO and Embase were searched for randomized controlled trials on psychosocial interventions for PLWH. Depression, anxiety, quality of life, and psychological well-being were investigated as treatment outcome measures. Sixty-two studies were included in the meta-analysis. It was found that psychosocial interventions for PLWH had a small positive effect on mental health (g??=?0.19, 95% CI [0.13, 0.25]). Furthermore, there was evidence for publication bias. Six characteristics influenced the effectiveness of a treatment for depression. For example, larger effects were found for studies with psychologists as treatment providers. To conclude, this systematic review and meta-analysis suggests that psychosocial interventions have a beneficial effect for PLWH with mental health problems.
... Arts-based strategies can help people with HIV/AIDS to manage their illness and symptoms in new and creative ways, rebuild their sense of self, (Aldridge, 1993;Bradley, 2008), and facilitate communication with others (Fraser & Al Sayah, 2011). Although several examples of the use of art in therapy and counseling for people with HIV/AIDS do exist (Feldman, Betts, & Blausey, 2014;Rao et al., 2009;Stuckey & Nobel, 2010), these programs and their evaluations are limited in number. Similarly, the use of photovoice has been suggested as a way to integrate social justice initiatives (via critical thinking and consciousness raising) into counseling, but examples of this in practice are rare (Smith, Bratini, & Appio, 2012). ...
Many women living with HIV/AIDS (WL-HIV/AIDS) experience significant mental distress. Although creative arts strategies are well positioned to help support women by inspiring creativity and meaning-making, few arts programs have been implemented and evaluated with this population. The authors conducted a photography project with 30 WL-HIV/AIDS from three United States cities. Participants took pictures to capture their lives with HIV/AIDS and described their photos and stories in group and individual sessions. Using thematic analysis, the authors identified that the project supported women’s mental health in four ways by facilitating empowerment and helping women to express themselves, address their mental health with new tools like photography, and process past traumas. Photography projects may help WL-HIV/AIDS understand and manage their mental health.
... Beebe, Gelfand, and Bender (2010) reported similar findings and observed that art therapy decreased anxiety for children suffering from asthma compared to the control group. Art therapy also reportedly reduced HIV/AIDS symptoms (Rao, Nainis, Langner, Eisine, & Paice, 2009), and a growing body of outcome studies support art therapy's effectiveness for cancer patients and their families across gender, age, and type/severity of illness (Czamanski-Cohen, 2012;Favaro-Scacco, Smirne, Schiliro, & Di Cataldo, 2001;Geue et al., 2010;Hart, 2010;Svensk et al., 2009;Walsh, Radcliffe, Castillo, Kumar, & Broschard, 2007). ...
This article presents the preliminary results of an outcome study comparing the effectiveness of art therapy and music therapy in a large pediatric medical facility. Measures of pain and mood were taken before and after sessions over two and a half years and across six therapists. The findings suggest that mood improved more effectively after art therapy than after music therapy. Although no significant difference was found in pain measured between modalities, the data indicate that music therapy might be more easily tolerated when patients are experiencing moderate or high levels of pain, as considerably fewer art therapy sessions were completed with patients reporting severe pain. A case illustration and the discussion of findings suggest possible clinical applications for maximizing the impact of expressive treatments in medical settings.RÉSUMÉCet article présente les conclusions préliminaires d'une étude des résultats comparant l'efficacité de l'art-thérapie et de la musicothérapie dans un grand centre médical pédiatrique. Les mesures de la douleur et de l'humeur ont été prises avant et après les séances sur plus de deux ans et demi ans par six thérapeutes. Les résultats indiquent que l'humeur s'améliore de manière plus efficace après l'art-thérapie qu'après la musicothérapie. Bien qu'aucune différence significative n'ait été trouvée dans la douleur mesurée entre les modalités, les données portent à penser que la musicothérapie est plus facilement tolérée lorsque les patients connaissent des niveaux de douleur allant de modérés à élevés, étant donné que beaucoup moins de séances d'art-thérapie ont pu être complétées avec des patients présentant une douleur sévère. Une illustration de cas et la discussion des résultats proposent des applications cliniques possibles pour maximiser l'impact des traitements expressifs dans les milieux médicaux.
... Adjunct therapies are thus needed to maintain their quality of life while undergoing treatment. Individuals often seek alternatives to pharmacologic care to relieve symptoms associated with HIV/AIDS and its treatment (Rao, Nainis, Williams et al., 2009). The researcher proposes that humour therapy, as described further on, be an adjunct therapy for people on ARVs. ...
... ). In their study among music students Karaoglu & Karaoglu (2009) found high rates of depression and anxiety but no differences compared to other undergraduate students. ...
Depression, anxiety and stress are common among undergraduate students and a world-wide phenomenon. In this study we wanted to assess depression, anxiety and stress levels as well as burnout and vigor among undergraduate music education students in one Turkish university and compare the results with the results of medical students from the same institution. We collected data from 160 music education and 928 medical students by self reporting using DASS-42 (Depression-Anxiety-Stress Scale-42), Shirom-Melamed Burnout (SMBM) and Shirom-Melamed Vigor (SMVM) measures. We found that mean depression, anxiety and stress scores were significantly higher among music education students compared to medicine students.
... Another exploratory study found that creative arts were associated with increase of positive emotion and pain reduction among women coping with chronic illness (Kelly, Cudney, & Weinert, 2012). One study showed that participating in a single art therapy session was found to reduce pain symptoms in individuals coping with HIV (Rao et al., 2009). ...
This study was designed to explore the use of a protocol that combines art based and cognitive behavioral interventions (CB-ART) to help thirteen women cope with pain, anxiety and depressive symptoms. We used a qualitative evaluation to understand the women's experience as participants in the protocol. In addition we measured changes in levels of distress using the subjective units of distress measure (SUDS) following the sessions. Client feedback regarding the experience of being part of the CB-ART treatment helped identify how art making can enhance the use of mental imagery in psychotherapy. We found that the CB-ART protocol is beneficial in reducing distress of women coping with pain, anxiety and depressive symptoms. We also found that the protocol is equally efficacious in individual and group modalities. Art making provides an opportunity to externalize distressing experiences. The concrete nature of the art product provides a platform for examining mental imagery, practicing coping skills, examining and changing maladaptive cognitions and behaviors.
... Background A literature search identified excellent work examining art as therapy in various health conditions including HIV/AIDS (Rao, et al., 2009), cancer (Nainis et al., 2006) and rheumatic pain (Muller-Busch & Hoffmann, 1997). Additional research has supported the positive impact of art on health (Graham-Pole, 2000;Graham-Pole & Lander, 2009) and has argued convincingly that art is a determinant of health (Lander & Graham-Pole, 2008). ...
Background: Previous work has identified the importance of art in health and healing but little has been published on specific responses from artistic populations. Aims: The aim of this study was to explore the experience of a group of people living with chronic pain who were able to continue to create art in the face of pain. Our hypothesis was that each of these participants had made a positive adaptation to the experience of pain and that we could learn more about the process of coming to terms with pain from them. Methods: A qualitative approach using thematic analysis was undertaken using a self-report questionnaire containing 16 questions. The data were analyzed using a general inductive approach, dominant themes were summarized and interpretive analysis was done. Results: Key themes that emerged addressed the impact of pain (e.g. limitation, loss, social isolation, stigmatization) along with the process needed to come to terms with it (acceptance, adaptation) and the transformative aspects of creating art. Conclusions: This study confirms the depth of suffering associated with the experience of chronic pain and the incredible resilience required of the creative mind in overcoming serious adversity in a way that fosters growth and finds new meaning.
... Psychosocial interventions: Three (6%) interventions used psychosocial methods: Art therapy (Rao et al., 2009), peer support counselling (Molassiotis et al., 2002) and relaxation training (Fukunishi et al., 1997). Each of these was associated with a significant reduction in anxiety. ...
People with human immunodeficiency virus (HIV) show elevated anxiety levels compared to the general population. Anxiety can predate HIV infection or be triggered by HIV diagnosis and the many stresses that emerge during the course of HIV disease. Many psychological and pharmacological therapies have been shown to treat anxiety in the general population but a systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review examines all published intervention studies on anxiety and HIV from 1980 to 2009 covered by the databases MedLine (1980-2009) and PsycINFO (1980-2009) for a definitive account of effectiveness of interventions and an indication of prevalence of HIV-related anxiety and measurement within studies. Standard systematic research methods were used to gather quality published papers on HIV and anxiety, searching published data bases according to quality inclusion criteria. From the search, 492 papers were generated and hand searched resulting in 39 studies meeting adequacy inclusion criteria for analysis. Of these, 30 (76.9%) were implemented in North America (the USA and Canada), with little representation from developing countries. Thirty-three (84.6%) studies recruited only men or mostly men. A total of 50 interventions were investigated by the 39 studies; 13 targeted HIV, symptoms or associated outcomes/conditions, 20 directly targeted anxiety and another 17 indirectly targeted anxiety. Twenty-four (48%) interventions were effective in reducing anxiety (including 11 indirect interventions), 16 (32%) were ineffective and 10 (20%) had an unknown effect on anxiety. Sixty-five percent of interventions directly targeting anxiety were effective. Psychological interventions (especially cognitive behavioural stress management interventions and cognitive behavioural therapy) were generally more effective than pharmacological interventions. Only three studies provided prevalence rates - these ranged from 13% to 80%. Anxiety was measured using 16 different instruments. Our detailed data suggest that interventions are both effective and available, although further research into enhancing efficacy would be valuable. Also, the vast majority of studies were Western-based, no studies looked at children or adolescents and few looked specifically at women. An international effort to harmonise measurement of anxiety is also missing. There is a need to routinely log anxiety in those with HIV infection during the course of their disease, to provide specific data on women, young people and those in diverse geographic areas and incorporate management into care protocols.
Background
Psychedelic art (PA) emerged in the 1960s during the psychedelic era; then characterized by visuals induced by the ingestion of psychedelic drugs, it is now an art form known for its vibrant colors, distorted forms, and intricate patterns. Building upon the existing research on art viewing as an effective means to improving physiological and psychological well-being, viewing PA is postulated to evoke positive emotions and provide a meditative experience, contributing to improved mental well-being.
Objective
This study aims to investigate how digitally rendered PA influences viewers’ perceived emotional, mental, and physical states compared to imagery of natural scenery, offering insights into potential applications in mental health care and well-being.
Methods
Overall, 102 participants age 18 to 35 years were randomly assigned to either the experimental group viewing 300 seconds of PA imagery (50/102, 49%) or the control group viewing 300 seconds of scenic imagery (52/102, 51%), after which every participant completed a survey that gathered qualitative data on the perceived impact of viewing their given imagery on their physical, mental, and emotional states through open-ended questions. Thematic analysis was conducted to identify the patterns of experiences reported by the participants.
Results
Qualitative analysis unveiled a greater intensity and diversity of emotional, mental, and physical impacts induced by PA compared to natural scenery, including the sense of relaxation and peace, anxiety and stress alleviation, joy, thrill and sense of euphoria, sensations of awe and wonder, hypnotizing effect, holistic meditative effect, provocation of creative thoughts, induced hyperawareness of bodily states, and transitions from induced overstimulation or anxious thoughts to feelings of calmness.
Conclusions
The preliminary findings of this study suggest that PA is a rich and complex form of visual art that has the potential to facilitate healing and promote well-being and mental health. PA presents promising avenues for integration into mental health care, therapeutic practices, digital health, health care environment, and medical research.
Importance
Art therapy has a long-standing tradition in patient treatment. As scientific interest in its use has recently grown, a comprehensive assessment of active visual art therapy is crucial to understanding its potential benefits.
Objective
To assess the association of active visual art therapy with health outcomes across patient groups and comparators.
Data Sources
The systematic literature search included the Cochrane Library, Embase, MEDLINE, CINAHL, ERIC, American Psychological Association PsycArticles, American Psychological Association PsycInfo, PSYNDEX, the German Clinical Trials Register, and ClinicalTrials.gov. No filters regarding language were applied. The search covered all dates before March 2021. Data analysis was conducted from April 24 to September 8, 2023.
Study Selection
Randomized clinical trials with any type of patient population comparing the intervention with any control not using active visual art therapy were included. Two researchers independently screened the abstracts and full texts.
Data Extraction and Synthesis
Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and study quality was evaluated using the Cochrane Risk of Bias tool. Data were synthesized using narrative summaries, forest plots, and random effects meta-analyses.
Main Outcome and Measures
In line with the protocol, all outcome measures of the included studies were extracted.
Results
The search identified 3104 records, of which 356 outcomes of 69 studies were included, with a total of approximately 4200 participants, aged 4 to 96 years, in the review. The meta-analyses included 50 studies and 217 outcomes of 2766 participants. Treatment indications included mental, neurological, and other somatic disorders, and prevention. Most outcome measures focused on depression, anxiety, self-esteem, social adjustment, and quality of life. Art therapy was associated with an improvement in 18% of the 217 outcomes compared with the controls (1%), while 81% showed no improvement. The standardized mean difference in the change from baseline of the meta-analyses of 0.38 (95% CI, 0.26-0.51) and posttest analysis of 0.19 (95% CI, 0.12-0.26) also indicated an improvement of outcomes associated with art therapy. Overall study quality was low.
Conclusions and Relevance
In this systematic review and meta-analysis of randomized clinical trials, visual art therapy was associated with therapeutic benefits for some outcomes, although most studies were of low quality. Further good-quality studies are needed to provide additional insights for its best possible integration into routine care.
Arts therapy is a popular intervention used to work through the effects of traumatic experience. We evaluate previous reviews and report a meta‐analysis of the effectiveness of arts therapy following trauma for reducing symptoms of PTSD, enhancing positive outcomes (e.g., quality of life) and decreasing negative outcomes (e.g., depression). Database searches identified 21 ( N = 868) randomised controlled trials (RCTs). Outcomes were categorised as PTSD specific, positive non‐PTSD specific and negative non‐PTSD specific. Several moderators were tested: age, diagnosis type, trauma type, intervention instruction, control type, therapy mode and therapy duration. Overall, random‐effects analysis indicated that arts therapy was favoured relative to control for positive non‐PTSD‐specific outcomes ( g = 1.53, p < 0.001), but not for negative non‐PTSD‐specific ( p = 0.069) or PTSD‐specific outcomes (g = 0.89, p = 0.052). Regression analyses indicated that arts therapy was effective in reducing PTSD‐specific outcomes in children ( Z = 2.81, df = 1, p = 0.005), positive non‐PTSD‐specific outcomes in group‐based arts therapy ( Z = −2.40, df = 1, p = 0.016, I 2 = 57.33) and for reducing negative non‐PTSD outcomes following acute traumas (e.g., combat‐related trauma or sexual abuse) ( Q = 10.70, df = 3, p = 0.013, I ² = 77.09). We highlight the need for additional RCTs and standardised protocols to address heterogeneity. Our review provides an important benchmark for gauging the effectiveness of arts therapy in the treatment of trauma.
Background: Persistent pain impacts 30% of people worldwide. Evidence on the effectiveness of visual arts in treating persistent pain seems to be emerging. Thus, the aim of this systematic review was to investigate the impact of visual arts on patients with persistent pain.
Methods: Studies were identified by searching seven databases from perception until Jan-2019, then screened by two independent reviewers. Studies were included if they were published controlled trials investigating the impact of visual arts on participants with persistent pain. Studies were excluded if they were abstracts, sampled participants who could not express pain, did not report relevant outcome measures, or did not have a comparator group. The study qualities were assessed by the PEDro scale.
Results: After removing duplicates, 2,732 titles and abstracts were screened. Of 125 full-texts, four satisfied the eligibility criteria; all published within the last decade. Three of four controlled studies were randomised-controlled trials. Studies were conducted in inpatient settings (n=2) and outpatient clinics (n=2). Three studies included elderly participants (>60y/o), while one included patients with HIV (>18y/o). Visual arts interventions included painting, drawing, crafting, and others. Two studies utilised visual arts as the sole treatment, while two studies used visual arts as part of a multimodal treatment. Comparators received usual care in two studies, a music intervention in one, and an art-therapy video in another. The common outcome measure in all studies was pain level (0-to-10 scale). All studies also included psychosocial outcome measures. Quality of studies ranged from grade four to eight on PEDro scale; two had high quality, and two had fair quality. All studies reported statistically significant improvements in pain within intervention groups.
Conclusions: Visual arts seem to benefit patients with persistent pain. Further investigation on the clinical significance of these positive findings on pain and other biopsychosocial factors are required.
Psychotherapy for patients with personality disorders presents major difficulties and questions regarding its effectiveness. This article describes a clinical case of psychotherapy for anxiety-phobic symptoms in a patient with hysterical personality disorder. A complex psychotherapeutic approach was applied, based on the integration of the group psychotherapy, cognitive-behavioral therapy, and art therapy methods into the system of personality-oriented (reconstructive) psychotherapy. Individual and group psychotherapeutic sessions with a psychotherapist and a psychologist, the patient’s drawings, and their further discussion ended with a positive internal transformation, accompanied by elimination of the symptoms. This clinical case, including the results of follow-up observation, demonstrates that psychotherapy for persons with hysterical personality disorder is quite justified. It helps to improve the patient’s quality of life, reduces the frequency of their visits for medical and psychological assistance.
Objectives:
The aim of this study was to explore the role of art psychotherapy as a biopsychosocial approach to bodymind medicine in ameliorating the effects of psychophysical stress among people with non-metastatic cutaneous malignant melanoma (CMM), post-surgical resection.
Study design:
Mixed methods.
Methods:
This study followed a mixed-methods research design, utilising qualitative data gained from a 6-month weekly group art therapy intervention, including both the images made and explored during the 3-h sessions and the accompanying narratives. The narratives were the subject of thematic analysis. The quantitative data arose from ELISA assays for secretory immunoglobulin A (S-IgA) and secretory interferon-γ (S-IFN- γ), DTH (PPD) tests were delivered at timepoints t0, t1, t5, t13, t24 and t52, and questionnaires were delivered at t0, t24 and t52: MAC, HAD, COPE & EORTC-QLQ-C-30.
Results:
The findings of this study included themes of 'otherness' and 'isolation', which also preceded diagnosis, and an upward trend in S-IgA, which continued over time.
Conclusions:
This study found that art psychotherapy promotes enhanced immunological function, coping skills and interpersonal relations. Positive psychoneuroimmunological change can result from group art psychotherapy, facilitating integration of psychological content in a supportive and interactive environment, which improves quality of life, thereby reducing the public health burden.
Although there has been growing interest in visual art interventions for people with dementia, there is a restricted evidence base regarding their theoretical basis. To address this gap, this systematic literature review explored how and why visual art interventions work in dementia care. Common features of successful visual art interventions were identified, including: intervention ‘dose,’ session content, participant choice, artistic ability, the role of the facilitator/therapist, group work, and setting. Understanding the mechanisms and/or processes of visual art interventions is important for future development, evaluation, and implementation.
Background:
Being diagnosed with human immunodeficiency virus (HIV), and labelled with a chronic, life-threatening, and often stigmatizing disease, can impact on a person's well-being. Psychosocial group interventions aim to improve life-functioning and coping as individuals adjust to the diagnosis.
Objectives:
To examine the effectiveness of psychosocial group interventions for improving the psychological well-being of adults living with HIV/AIDS.
Search methods:
We searched the following electronic databases up to 14 March 2016: the Cochrane Central Register of Controlled Trials (CENTRAL) published in the Cochrane Library (Issue 2, 2016), PubMed (MEDLINE) (1996 to 14 March 2016), Embase (1996 to 14 March 2016), and Clinical Trials.gov.
Selection criteria:
Randomized controlled trials (RCTs) or quasi-RCTs that compared psychosocial group interventions with versus control (standard care or brief educational interventions), with at least three months follow-up post-intervention. We included trials that reported measures of depression, anxiety, stress, or coping using standardized scales.
Data collection and analysis:
Two review authors independently screened abstracts, applied the inclusion criteria, and extracted data. We compared continuous outcomes using mean differences (MD) with 95% confidence intervals (95% CIs), and pooled data using a random-effects model. When the included trials used different measurement scales, we pooled data using standardized mean difference (SMD) values. We reported trials that we could not include in the meta analysis narratively in the text. We assessed the certainty of the evidence using the GRADE approach.
Main results:
We included 16 trials (19 articles) that enrolled 2520 adults living with HIV. All the interventions were multifaceted and included a mix of psychotherapy, relaxation, group support, and education. The included trials were conducted in the USA (12 trials), Canada (one trial), Switzerland (one trial), Uganda (one trial), and South Africa (one trial), and published between 1996 and 2016. Ten trials recruited men and women, four trials recruited homosexual men, and two trials recruited women only. Interventions were conducted with groups of four to 15 people, for 90 to 135 minutes, every week for up to 12 weeks. All interventions were conducted face-to-face except two, which were delivered by telephone. All were delivered by graduate or postgraduate trained health, psychology, or social care professionals except one that used a lay community health worker and two that used trained mindfulness practitioners.Group-based psychosocial interventions based on cognitive behavioural therapy (CBT) may have a small effect on measures of depression, and this effect may last for up to 15 months after participation in the group sessions (SMD -0.26, 95% CI -0.42 to -0.10; 1139 participants, 10 trials, low certainty evidence). Most trials used the Beck Depression Inventory (BDI), which has a maximum score of 63, and the mean score in the intervention groups was around 1.4 points lower at the end of follow-up. This small benefit was consistent across five trials where participants had a mean depression score in the normal range at baseline, but trials where the mean score was in the depression range at baseline effects were less consistent. Fewer trials reported measures of anxiety, where there may be little or no effect (four trials, 471 participants, low certainty evidence), stress, where there may be little or no effect (five trials, 507 participants, low certainty evidence), and coping (five trials, 697 participants, low certainty evidence).Group-based interventions based on mindfulness have not demonstrated effects on measures of depression (SMD -0.23, 95% CI -0.49 to 0.03; 233 participants, 2 trials, very low certainty evidence), anxiety (SMD -0.16, 95% CI -0.47 to 0.15; 62 participants, 2 trials, very low certainty evidence), or stress (MD -2.02, 95% CI -4.23 to 0.19; 137 participants, 2 trials, very low certainty evidence). No mindfulness based interventions included in the studies had any valid measurements of coping.
Authors' conclusions:
Group-based psychosocial interventions may have a small effect on measures of depression, but the clinical importance of this is unclear. More high quality evidence is needed to assess whether group psychosocial intervention improve psychological well-being in HIV positive adults.
This article chronicles an art therapist’s experience of having osteoarthritis in both right and left trapeziometacarpal joints and subsequent surgery which provided the opportunity to use art making to manage pain during the recovery period. Meditative painting was used whenever pain was experienced post-surgery, and two series of twelve seven-inch paintings were created. Simple criteria were set and followed for at least three weeks post-surgery, and the questions asked were: Will meditative painting relieve post-surgery pain? Can meditative painting be used to reduce or eliminate the need for pain medication? Are there patterns in the artwork that can be seen in the healing process? It was found that meditative painting minimized pain to the extent that pain medication was unnecessary. Patterns were seen in both series that may illustrate aspects of the healing process.
The psychological effects of medical illness are known to include depression, anxiety, and post-traumatic stress disorder (PTSD), and require appropriate evaluation and management. Since the medically ill are seen in a variety of treatment settings, art therapists will inevitably encounter these patients in their practice and therefore need to be cognizant of the principles of medical art therapy (MAT). This chapter first provides the classification of medical illnesses: medical, surgical, neurological, and palliative care. Art therapists must take appropriate measures and modify the therapeutic intervention in these cases. The goals of MAT differ depending on the patient, illness, treatment setting, and circumstances, and include: decrease isolation and improve socialization; and increase self-confidence through mastery of art materials and processes. The chapter provides a case study of a patient who was able to reconstruct her self-identity through involvement in art therapy and creative work.
As community health clinics provide increased healthcare services the settings are challenged to manage diverse mental health needs alongside primary care support. In public healthcare settings that provide low-barrier service for populations impacted by diverse medical, mental health, social, economic, and environmental concerns, the environment at the sites can become intense. Mental health care alongside primary care can support improved outcomes. Art making can provide a therapeutic encounter outside of traditional individual or group counselling or primary care, and in a more public setting than the clinician's office. When art-based interventions operate outside of traditional psychotherapeutic conventions we revisit an aged discourse: Is it art therapy? Is it effective, and what ethical considerations are necessary? This art-based inquiry uses client artwork images as data supporting the author's observations.
South Africa is home to the largest number of people infected with HIV and living with AIDS (UNAIDS, 2008). Children, in particular, represent one of the most vulnerable groups exposed to the harsh consequences of HIV and AIDS. In 2007 alone, 270,000 children died from AIDS (UNICEF, 2010), and at the same time, 280,000 children were living with HIV (UNICEF, 2009).
Background. Art therapy uses the creative process to encourage personal growth and alleviate symptoms of mental illness. The Art Therapy Institute provides programs for refugee adolescents from Burma to decrease their trauma-related symptoms. This article describes and discusses the methods and findings from an evaluation of this program. The challenges of assessing art therapy with this population and assessment tool gaps are explored and suggestions for future evaluations
discussed.
Method. Four validated clinical assessment tools were administered to 30 participants at baseline
and follow-up to measure symptoms of anxiety, depression, and behavioral problems. Focus group discussions with clinicians were used to assess the evaluation.
Results. Nearly all participants had experienced one or more traumatic events. At baseline, results showed a higher prevalence of depression than national rates among adolescents. Follow-up results showed improvements in anxiety and self-concept. Qualitative findings suggest that specific benefits of art therapy were not adequately captured with the tools used.
Discussion.
This evaluation showed some effects of art therapy; however, symptom-focused assessment tools are not adequate to capture clients’ growth resulting from the traumatic experience and this unique intervention. Future evaluations will benefit by using an art-based assessment and measuring posttraumatic growth.
Keywords: child/adolescent health; community intervention; community organization; mental health; minority health; evaluation methods; outcome evaluation
Self-care is imperative to personal health, sustenance to continue to care for others, and professional growth. This article briefly reviews stressors common to students and nurses and the importance of practicing self-care to combat stress and promote health in practice. Florida Atlantic University offers a course for all levels of undergraduate nursing students called Caring for Self. The course, supported by principles of Adult Learning Theory, focuses on guiding the nurse to practice and model self-care. The author describes the evolution of this self-care initiative by discussing the needs assessment, course description and strategies, examples of course activities, and an exemplar of student impact. The conclusion offers discussion of challenges and lessons noted by faculty and students.
Background: Art-based interventions can improve well-being, particularly among people with life-changing illnesses. We conducted a pilot photo-story intervention with gay-identified men with HIV in the Midwest USA to help men express and manage HIV stigma; and assess the feasibility of arts-based interventions. Methods: Eight men took pictures, participated in three group and one individual discussion session, and planned and attended two public photograph exhibits. Theme and narrative analysis identified key stigma and feasibility themes in qualitative textual and visual data. Results: Men's images and discussions focused on three aspects of HIV stigma: (1) ignorance, (2) difficult disclosures and (3) isolation. Photo-stories facilitated men's ability to manage stigma by promoting (1) self-discovery and (2) social support. Conclusions: Participants' stigma experiences were significant. Stigma intervention solutions are needed at individual, relational, community and social levels. Art-based interventions such as photo-stories are promising strategies to identify and address stigma at all levels.
This chapter focuses on the transpersonal orientation, which includes the spiritual as well as the psychological dimension of experience. Although traditional psychological approaches work with one or more of the psychological, emotive, cognitive, and even somatic and mythological dimensions of human experience, transpersonal psychology includes all these within a philosophical and psychological perspective that grounds all these modalities within a broader spiritual context. The chapter outlines some of the major creative arts therapies (practices and methods also utilized by expressive arts therapists) focusing specifically on art therapy, music therapy, dance/movement therapy, and drama/psychodrama therapy.
Mental health problems account for almost half of all ill health in people under 65 years. The majority are non-psychotic (e.g. depression, anxiety and phobias). For some people, art therapy may provide more profound and long-lasting healing than more standard forms of treatment, perhaps because it can provide an alternative means of expression and release from trauma. As yet, no formal evaluation of art therapy for non-psychotic mental health disorders has been conducted.
This review aimed to evaluate evidence for the clinical effectiveness and cost-effectiveness of art therapy for non-psychotic mental health disorders.
Comprehensive literature searches for studies examining art therapy in populations with non-psychotic mental health disorders were performed in major health-related and social science bibliographic databases including MEDLINE, EMBASE, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Allied and Complementary Medicine Database (AMED) and Applied Social Sciences Index and Abstracts (ASSIA) from inception up to May 2013. A quantitative systematic review of clinical effectiveness, a qualitative review to explore the acceptability, relative benefits and potential harms, and a cost-utility analysis of studies evaluating cost-effectiveness of art therapy were conducted.
In the quantitative review, 15 randomised controlled trials (RCTs) were included (n = 777). Meta-analysis was not possible because of clinical heterogeneity and insufficient comparable data on outcome measures across studies. A narrative synthesis reports that art therapy was associated with significant positive changes relative to the control group in mental health symptoms in 10 out of the 15 studies. The control groups varied between studies but included wait-list/no treatment, attention placebo controls and psychological therapy comparators. Four studies reported improvement from baseline but no significant difference between groups. One study reported that outcomes were more favourable in the control group. The quality of included RCTs was generally low. In the qualitative review, 12 cohort studies were included (n = 188 service users; n = 16 service providers). Themes relating to benefits of art therapy for service users included the relationship with the therapist, personal achievement and distraction. Areas of potential harms were related to the activation of emotions that were then unresolved, lack of skill of the art therapist and sudden termination of art therapy. The quality of included qualitative studies was generally low to moderate. In the cost-effectiveness review, a de novo model was constructed and populated with data identified from the clinical review. Scenario analyses were conducted allowing comparisons of group art therapy with wait-list control, group art therapy with group verbal therapy, and individual art therapy versus control. Art therapy appeared cost-effective compared with wait-list control with high certainty, although generalisability to the target population was unclear. Verbal therapy appeared more cost-effective than art therapy but there was considerable uncertainty and a sizeable probability that art therapy was more clinically effective. The cost-effectiveness of individual art therapy was uncertain and dependent on assumptions regarding clinical benefit and duration of benefit.
From the limited available evidence, art therapy was associated with positive effects when compared with a control in a number of studies in patients with different clinical profiles, and it was reported to be an acceptable treatment and was associated with a number of benefits. Art therapy appeared to be cost-effective compared with wait-list but further studies are needed to confirm this finding as well as evidence to inform future cost-effective analyses of art therapy versus other treatments.
The study is registered as PROSPERO CRD42013003957.
The National Institute for Health Research Health Technology Assessment programme.
Visual arts mediums such as drawing, painting, making symbolic objects out of materials, and collage can be translated into useful creative interventions when counseling clients who self-injure. Theoretical support and guidelines for using visual arts when counseling clients who self-injure are presented. Specific examples of visual arts interventions that can be useful with this population are provided.
Background:Due to ongoing conflict and human rights violations in Burma, an estimated 400 refugee families were relocated to Orange County, NC. Many have experienced traumatic events in Burma and refugee camps in Thailand. Art Therapy Institute (ATI) provides art therapy to school-aged children from Burma to decrease their symptoms associated with trauma and acculturation distress. This paper will describe and discuss the methods and findings from an evaluation of this unique art therapy program and offer recommendations for future refugee mental health evaluations.
Methods: The Piers-Harris Self Concept Scale, Strengths and Difficulties Questionnaire, Hopkins Symptoms Checklist, and Harvard Trauma Questionnaire were administered by clinicians to 28 participants at baseline to measure symptoms of anxiety and depression. Repeated quarterly measures are analyzed using means comparison, t-tests, and Wilcoxon Signed-Rank. Two focus group discussions with clinicians were memoed to provide feedback on the evaluation.
Results:Nearly all (.83) participants had experienced one or more traumatic events. At baseline, results showed higher prevalence of depression (.30) and anxiety (.20) than national rates among adolescents. Qualitative findings suggest that specific benefits of art therapy were not adequately captured with the quantitative tools used.
Discussion: Cultural differences in the experience of trauma may be a hindrance to measuring intervention outcomes. The addition of a qualitative tool would give voice to participants, and may provide a broader picture of the impact that art therapy can have with this refugee population.
Studies showed that university and college students are vulnerable to mental health problems. High rates of depression, anxiety and stress among students have generated increasing public concern in western so-cieties, but in eastern societies this issue remains mostly undiscovered. The healing force of music has been known since ancient times and studies showed the positive impact of music on mental health prob-lems. However, few studies have been conducted on music students' psychological well-being. In this study we wanted to assess the psychological well-being of undergraduate music education students in terms of depression, anxiety and stress as well as their happiness and life satisfaction levels. A second objective of this study was to examine the effects of different types of classical music (baroque versus romantic/post-romantic) on depression, anxiety and stress levels as well as on perceived happiness and life satisfaction. A total of 69 students participated in this study, with 35 assigned to Group I (listened to baroque music) and the other 34 assigned to Group II (listened to romantic/post-romantic classical music). No statistically significant relationships were found between depression, anxiety and stress levels and any of the socio-demographic characteristics that were studied. This was the same for happiness and life sat-isfaction levels. There was, however, a significant relationship between economic status and life satisfac-tion which was found to be positively related. A significant negative correlation was determined between depression and happiness and between depression and life satisfaction. The difference between depression, anxiety and stress levels as well as happiness and life satisfaction levels for Group I and Group II students was not statistically significant.
JUSTIFICATIVA E OBJETIVOS: Em pacientes com síndrome da imunodeficiência adquirida (SIDA), o subdiagnóstico e o subtratamento da dor são alarmantes e poucos estudos analisam esse tema, bem como os registros de sua ocorrência. O objetivo deste estudo foi analisar registros sobre dor e analgesia em prontuários de pacientes com SIDA internados. MÉTODO: Pesquisa documental, com análise de 63 prontuários, realizado em hospital de referência no tratamento da SIDA no Ceará, em 2010. Utilizou-se check-list para obtenção de dados e os resultados foram apresentados em tabelas com frequências relativo/absoluta.RESULTADOS: Encontrou-se registro de dor na maioria dos prontuários (90,5%), especificando localização (90,5%), fatores de melhora/piora (55,6%), intensidade (39,7%), frequência (25,4%), entre outros aspectos. Foram responsáveis pelos registros médicos (94,7%), enfermeiros (87,8%) e fisioterapeutas (12,2%). Quanto à localização, prevaleceu cefaleia (50,9%), dor abdominal (52,6%), torácica (33,3%), membros inferiores (24,6%) e lombalgia (29,8%). Quanto à intensidade, dor forte (56%), leve (28%) e moderada (16%). Quanto à duração, dor contínua (62,5%) e intermitente (37,5%). Nas prescrições farmacológicas, predominou anti-inflamatório não esteroide (66,7%), seguido de analgésicos simples (44,4%) e adjuvantes (41,3%). Medidas não farmacológicas foram prescritas em apenas 11% dos prontuários. CONCLUSÃO: É necessária a atenção dos profissionais para o registro de informações detalhadas das queixas álgicas dos pacientes com SIDA, com a adoção de instrumentos adequados para a avaliação e registro dos dados avaliados, para melhorar a assistência e o controle da dor que incide na maioria desses pacientes.
Little research on symptom impairment and quality of life among HIV-positive (HIV+) individuals has attended to the potential role of cognitive-affective vulnerabilities. Emerging research indicates that emotion regulation (ER), anxiety sensitivity (AS), and distress tolerance (DT) are associated with a range of mental health outcomes and demonstrate meaningful relations to clinical outcomes in HIV+ individuals.
In this investigation, we sought to concurrently examine these factors in relation HIV symptom severity, barriers to medication adherence, and disease viral load.
Participants were 139 HIV+ individuals (34 female; age M = 48.2 years, SD = 8.1, 42 % Black) receiving outpatient HIV care and prescribed at least one antiretroviral medication. We used hierarchical regression analyses to concurrently examine ER, AS, and DT in relation to severity of HIV symptoms, barriers to medication adherence, and disease viral load.
After accounting for alcohol use problems, cannabis dependence, gender, and education, AS was significantly associated with HIV symptom severity (β = .35, p < .01) whereas ER evidenced a trend relation (β = .19, p = .07). ER (β = .45, p < .01), but not AS or DT, was significantly related to barriers to medication adherence, above and beyond variance accounted for by covariates. Finally, ER evidenced a trend level relation to viral load (β = .21, p = .07), above and beyond variance accounted for by cannabis use.
Findings provide an extension of previous research, suggesting unique roles of cognitive-affective vulnerabilities in terms of HIV symptom severity, medication use barriers, and infection symptomatology, and inform the refinement of current treatments for HIV+ individuals so as to improve functioning.
Significant stigma exists to marginalize persons living with HIV/AIDS (PLWHA). Research has demonstrated it is possible to reduce stigma and prejudice through the development of meaningful and innovative education. The purpose of this article is to explore the ways in which the creative and purposeful use of AIDS Artwork as an educational tool may reduce stigma about HIV/AIDS and help adult learners to regulate their own prejudices about the diseases. Using Jarvis’s model for experiential learning as a framework for understanding, this article discusses some of the literature on HIV/AIDS education and the use of socially informed art in adult education. Eight potential educational exercises using AIDS Artwork are suggested and explained. The Critical Senses Conceptual Map is proposed as a helpful framework for adult educators who wish to include these exercises in curriculum designed for the reduction of prejudice and stigma about HIV/AIDS.
Objective:
The aim of the present study was to explore patients' views on the acceptability and feasibility of using colour to describe osteoarthritis (OA) pain, and whether colour could be used to communicate pain to healthcare professionals.
Methods:
Six group interviews were conducted with 17 patients with knee OA. Discussion topics included first impressions about using colour to describe pain, whether participants could associate their pain with colour, how colours related to changes to intensity and different pain qualities, and whether they could envisage using colour to describe pain to healthcare professionals.
Results:
The group interviews indicated that, although the idea of using colour was generally acceptable, it did not suit all participants as a way of describing their pain. The majority of participants chose red to describe high-intensity pain; the reasons given were because red symbolized inflammation, fire, anger and the stop signal in a traffic light system. Colours used to describe the absence of pain were chosen because of their association with positive emotional feelings, such as purity, calmness and happiness. A range of colours was chosen to represent changes in pain intensity. Aching pain was consistently identified as being associated with colours such as grey or black, whereas sharp pain was described using a wider selection of colours. The majority of participants thought that they would be able to use colour to describe their pain to healthcare professionals, although issues around the interpretability and standardization of colour were raised.
Conclusions:
For some patients, using colour to describe their pain experience may be a useful tool to improve doctor-patient communication.
One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for 8 standard statistical tests: (1) the difference between independent means, (2) the significance of a product-moment correlation, (3) the difference between independent rs, (4) the sign test, (5) the difference between independent proportions, (6) chi-square tests for goodness of fit and contingency tables, (7) 1-way analysis of variance (ANOVA), and (8) the significance of a multiple or multiple partial correlation.
The present study examined whether popular self-report measures of depression could be distinguished from self-report measures of anxiety and social desirability response style. Subjects were 391 college students (135 males and 256 females). The scales included the Zung Self-Rating Depression Scale, the Beck Depression Inventory, the Lubin Depression Adjective Checklist, the State and Trait forms of the Spielberger Anxiety Inventory, the Taylor Manifest Anxiety Scale, Endler, Hunt, and Rosenstein's S-R Inventory of Anxiousness, the Crowne-Marlowe Social Desirability Scale, and the Edwards Social Desirability Scale. Reliability estimates indicated that all these measures were internally consistent. Pearson correlation coefficients indicated strong relationships between measures of depression and between measures of anxiety. However, pairs of anxiety and depression measures correlated almost as strongly. All depression and anxiety measures were significantly associated with the Edwards Social Desirability Scale. These findings call into question the use of a self-report measure of depression to select "depressed" subjects among college students.
Art therapy has been used in a variety of clinical settings and populations, although few studies have explored its use in cancer symptom control. The specific aim of this study was to determine the effect of a 1-hour art therapy session on pain and other symptoms common to adult cancer inpatients. A quasi-experimental design was used (n=50). The Edmonton Symptom Assessment Scale (ESAS) and the Spielberger State-Trait Anxiety Index (STAI-S) were used prior to and after the art therapy to quantify symptoms, while open-ended questions evaluated the subjects' perceptions of the experience. There were statistically significant reductions in eight of nine symptoms measured by the ESAS, including the global distress score, as well as significant differences in most of the domains measured by the STAI-S. Subjects overwhelmingly expressed comfort with the process and desire to continue with therapy. This study provides beginning evidence for the efficacy of art therapy in reducing a broad spectrum of symptoms in cancer inpatients.
The language of the expressive arts can often be a new point of view that illuminates the shadows of the mind and reveals our deepest thoughts. Oncology patients did relaxation and guided visualization exercises along with either a painting exercise or interacting with visual imagery. A case study of one of these patients is presented showing how these techniques impact therapy. A discussion follows of how imagery is the line of communication between the conscious mind and the body. The combination of relaxation, visualization and creation of artwork is shown to lead to deeper self-knowledge. This work is evaluated with the use of an informal questionnaire
This is the fourth edition of a very successful textbook on clinical trials methodology, written by three recognized experts who have long and extensive experience in all areas of clinical trials. Most chapters have been revised considerably from the third edition. A chapter on ethics has been added and topics such as noninferiority and adaptive designs now receive considerable discussion. There is much new material on adverse events, adherence, data monitoring, and issues in analysis. This book is intended for the clinical researcher who is interested in designing a clinical trial and developing a protocol. It is also of value to researchers and practitioners who must critically evaluate the literature of published clinical trials and assess the merits of each trial and the implications for the care and treatment of patients. The authors use numerous examples of published clinical trials from a variety of medical disciplines to illustrate the fundamentals. The text is organized sequentially from defining the question to trial closeout. One chapter is devoted to each of the critical areas to aid the clinical trial researcher. These areas include pre-specifying the scientific questions to be tested and appropriate outcome measures, determining the organizational structure, estimating an adequate sample size, specifying the randomization procedure, implementing the intervention and visit schedules for participant evaluation, establishing an interim data and safety monitoring plan, detailing the final analysis plan, and reporting the trial results according to the pre-specified objectives. Although a basic introductory statistics course is helpful in maximizing the benefit of this book, a researcher or practitioner with limited statistical background would still find most if not all the chapters understandable and helpful. While the technical material has been kept to a minimum, the statistician may still find the principles and fundamentals presented in this text useful. This book has been successfully used for teaching courses in clinical trial methodology. © Springer Science + Business Media, LLC 2010. All rights aeserved.
Society calls upon art therapists to meet the needs of troubled community members. This article describes one art therapist?s experience of "giving back" to the community by volunteering to provide art therapy at a therapeutic camp for children whose lives have been touched by HIV/AIDS. Some of the medical, social, and psychological issues affecting this population are addressed. The development of specific art therapy goals and techniques designed to meet the needs of the campers is explored. This report demonstrates the value of art therapy in a therapeutic camp setting, as well as some of the benefits volunteerism can hold for art therapists who wish to contribute more to their communities.
The purpose of this paper is to introduce art therapists to a “differently gendered” population—transgender males with AIDS—through basic terminology and art expressions. Three cases are discussed, with both art processes and products presented. Special attention is paid to the significant role art played in their relationship with the residential community where they lived, and to the ways it served their efforts to resolve their older (e.g., transgenderism) and newer (e.g., AIDS diagnosis) issues. Distinctive and common themes are considered, along with the special challenges and benefits that come with working with this population.
Proposes that creative arts therapies have a significant role to play in the treatment of AIDS patients. Not only do they offer an existential form of therapy that accepts patients as they are and affords them an opportunity to define themselves as they wish to be, they are primarily concerned with aesthetic issues of form and existential notions of potential rather than concepts of pathology. Creative arts therapies emphasize personal contact and the value of the patient as a creative productive human being and play a role in the fostering of hope in the individual. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Offers creative arts therapists working with AIDS patients a theoretical guide based on an analysis of over 600 HIV patients' artwork. Artwork of HIV-positive persons reflects the stage of their illness, personality style, and previous life experiences. Artwork created shortly after diagnosis often reflects anger, depression, guilt, confusion, and stigmatization. Artmaking accesses these emotions and provides a permanent witness to unspoken pain. Not only does the creative process facilitate mourning, it provides for symbolic restitution and identification of meaning. Patients often create what they wish for or need. Interventions based on psychoneuroimmunologic research (the body–mind connection) are described. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
An abstract is unavailable. This article is available as HTML full text and PDF.
Dreams of people with AIDS help illuminate unconscious activities that can be used to guide the people to a peaceful death.
To explore dreams of the people with AIDS in an attempt to understand unconscious processes
Dreams and drawings of three people with AIDS.
Dreams and drawings can be used to understand the unconscious processes of people with AIDS and to help them toward a peaceful death.
Pain and symptom management are a major part of hospice care. Literature and direct experience suggest that pain can be resistant if psychological, emotional, or spiritual issues are not addressed. This article explains how art and music therapies can work in conjunction with traditional medical treatment of pain control in the hospice setting. The process of pain modulation through the use of art and music interventions is diagrammed and described. Brief clinical examples demonstrate the use of art and music therapies for pain reduction with a variety of hospice patients. Information regarding appropriate education and training necessary for art and music therapists to practice in their field is presented.
The Edmonton Symptom Assessment Scale (ESAS) is a nine-item patient-rated symptom visual analogue scale developed for use in assessing the symptoms of patients receiving palliative care. The purpose of this study was to validate the ESAS in a different population of patients.
In this prospective study, 240 patients with a diagnosis of cancer completed the ESAS, the Memorial Symptom Assessment Scale (MSAS), and the Functional Assessment Cancer Therapy (FACT) survey, and also had their Karnofsky performance status (KPS) assessed. An additional 42 patients participated in a test-retest study.
The ESAS "distress" score correlated most closely with physical symptom subscales in the FACT and the MSAS and with KPS. The ESAS individual item and summary scores showed good internal consistency and correlated appropriately with corresponding measures from the FACT and MSAS instruments. Individual items between the instruments correlated well. Pain ratings in the ESAS, MSAS, and FACT correlated best with the "worst-pain" item of the Brief Pain Inventory (BPI). Test-retest evaluation showed very good correlation at 2 days and a somewhat smaller but significant correlation at 1 week. A 30-mm visual analogue scale cutoff point did not uniformly distinguish severity of symptoms for different symptoms.
For this population, the ESAS was a valid instrument; test-retest validity was better at 2 days than at 1 week. The ESAS "distress" score tends to reflect physical well-being. The use of a 30-mm cutoff point on visual analogue scales to identify severe symptoms may not always apply to symptoms other than pain.
Antiretroviral toxicity is an increasingly important issue in the management of HIV-infected patients. With the sustained major declines in opportunistic complications, HIV infection is a more chronic disease, and so more drugs are being used in more patients for longer periods. This review focuses on the pathogenesis, clinical features, and management of the principal toxicities of the 15 licensed antiretroviral drugs, including mitochondrial toxicity, hypersensitivity, and lipodystrophy, as well as more drug-specific adverse effects and special clinical settings.
The purposes of this study were to: 1) characterize physical performance in individuals with human immunodeficiency virus; and 2) examine group differences by pain and fatigue on a multivariate profile of disease, physical, and psychologic symptoms.
One hundred outpatients, 78 men and 22 women (mean age 40.70 +/- 7.49 years) participated. Patients completed a battery of physical performance tests in which the time taken or the distance reached or walked was measured. Self-report questionnaires included measures of pain (0-10 numerical rating scale), fatigue (Brief Fatigue Inventory), and perceived health status (Medical Outcomes Survey-HIV scale).
Physical performance was compromised in a task specific manner. Patients took twice as long as healthy individuals on a belt-tie and 4 times as long on a sit-to-stand task and in 6 minutes walked 75% of the distance covered by healthy individuals. Fifty percent of patients (n = 50) had pain at the time of testing (mean 6.3 +/- 2.4), and 98% had fatigue (mean 5.4 +/- 2.3). Multivariate analysis of variance showed pain had a greater influence on performance than fatigue. Pain, distance walked in 6 minutes, and unloaded forward reach accounted for 26% of the variability in quality of life (r = 0.51, P < or = 0.0001).
Pain has a substantial impact on physical performance and quality of life among ambulatory human immunodeficiency virus patients. Fatigue also impacts physical performance. Compromised ability to perform certain physical tasks affects quality of life. Further investigation of the roles of these relevant variables should be investigated in path analyses.
Death, rather than surrogate markers, is a single and most straightforward clinical endpoint, defining unequivocally the merit of a therapeutic intervention. As there is still neither a cure for AIDS nor a vaccine to prevent HIV infection, an AIDS diagnosis remains associated with a death sentence. V-1 Immunitor (V1) is an experimental, oral, therapeutic AIDS vaccine licensed as a dietary supplement. As part of a charity program V1 has been offered at Wat Phra Baht Nam Phu--a Buddhist hospice for end-stage AIDS patients. Out of 117 approached individuals, 53 decided to take V1 and 64 declined the treatment. Patients in both groups did not differ in age, gender, or severity of disease. All patients were in WHO terminal stage 4 at study entry and had received similar palliative care. None of the patients had received conventional antiviral drugs. At 9 weeks the last two patients in the non-V1 group died. In contrast, 56.6% (30/53) in the V1 group remained alive. Kaplan-Meier survival analysis showed that median short-term survival time for non-treated and treated patients was 4 and 10 weeks, respectively. The difference was statistically significant by Wilcoxon signed rank test (P=0.000089). Patients who remained alive were followed until the last patient died at 142 weeks. Based on the main outcome, i.e. time to death, patients on V1 had a 15.8 times longer life expectancy than the control group (P<0.000001). Observed results are encouraging and V1 needs to be tested in controlled clinical trials as a life-saving immunotherapy.
This article describes the intricate challenges of bringing mental health services to isolated, guarded urban HIV-positive Native Americans suffering from chronic trauma-related illnesses and imbalances, depression, anxiety, substance abuse, thought disorders and trauma-based characterological disorders. It explores the integration of art therapy, Bowen Family Systems Therapy and in-home therapy in the Family & Child Guidance Clinic's attempt to provide support to a population that has profound distrust for "services and treatment," and no historical context for psychotherapy. Changing the paradigm of thought is essential to providing services that respect culture and history as well as addressing current presenting issues. Art therapy and in-home therapy support those community members who are flooded emotionally, but have difficulty speaking about their internal processes.
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