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The Effectiveness of Art Therapy in the Treatment of Traumatized Adults: A Systematic Review on Art Therapy and Trauma
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Art therapy has often been applied in the treatment of traumatized adults, and good results in clinical practice have been reported. However, although art therapy experts underline these benefits, the effectiveness of art therapy in trauma treatment has not been established by systematic review. The aim of this systematic review is to identify and evaluate empirical evidence of the effectiveness of art therapy for trauma treatment. As a result of the systematic review, six controlled, comparative studies on art therapy for trauma in adult patients were found. In half of the included studies, a significant decrease in psychological trauma symptoms was found in the treatment groups, and one study reported a significant decrease in depression. Although there are limitations in the number of included studies, the number of participants, the heterogeneity of included studies, and their methodological quality, the results contribute to insight into the effectiveness of art therapy in trauma treatment and form an evidence base for the urgent need for further research on art therapy and trauma treatment.
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... As mentioned, a great deal of research has been done on art therapy. Studies have been conducted in the form of review articles on art therapy, including studies related to the effectiveness of art therapy for traumatized adults (Schouten et al., 2015), Alzheimer's disease, and other dementias (Cowl & Gaugler, 2014), breast cancer (Boehm et al., 2014), schizophrenia (Ruddy & Milnes, 2005). Nevertheless, art therapy research has not been studied from the perspective of scientometric analysis so far. ...
... In terms of article type of the 100 most-cited articles in the field of art therapy, systematic reviews (Boehm et al., 2014;Cowl & Gaugler, 2014;Maujean et al., 2014;Puetz et al., 2013;Schouten et al., 2015;Uttley et al., 2015), critical review (Geue et al., 2010;Lobban, 2014;Van Lith et al., 2013), and randomized controlled trials (RCT) Kim, 2013;Monti et al., 2012) had the highest number of articles. Du et al. (2016) found that nonprimary research (such as Review/Commentary) or evidence-based research articles such as Systematic Review/Meta-Analysis and Clinical Trials were more likely than other types to be highly cited. ...
... The co-occurrence mapping of the words of 100 most-cited studies in the field of art therapy showed that keywords such as cancer, psychology, Alzheimer's disease, schizophrenia, dementing disorders, trauma, post-traumatic stress disorder, depression, quality of life, anxiety, and stress have larger nodes, indicating that these diseases and disorders have been addressed in art therapy studies. Therefore, a significant number of 100 most-cited art therapy studies examined art therapy in the treatment of diseases and disorders such as cancer (Forzoni et al., 2010;Geue et al., 2010;Puetz et al., 2013;Wood et al., 2011), breast cancer (Boehm et al., 2014;Monti et al., 2012;Thyme et al., 2009), post-traumatic stress disorder (Gantt & Tinnin, 2009;Lobban, 2014), schizophrenia Patterson et al., 2011), cognitive impairments (Lavretsky, 2009;Lazar et al., 2016), trauma (Schouten et al., 2015), Alzheimer and other dementing disorders (Cowl & Gaugler, 2014), and prison populations (Gussak, 2009). ...
Bibliometric citation analyses have been widely used in medicine to help researchers gain foundational knowledge about a topic. The purpose of this study is to analyze the 100 most-cited articles in art therapy to determine their characteristics and to reveal the influential articles in this field. This applied and scientometric study was conducted using retrospective bibliometric and co-occurrence analysis (by VOSviewer software). One hundred of the most-cited articles in the field of art therapy were retrieved from Scopus and analyzed. In this article, the most productive journals, authors, countries, and institutions in producing the 100 most-cited articles were introduced. The co-occurrence maps showed that keywords including cancer, Alzheimer’s, schizophrenia, dementing disorders, and Post-Traumatic Stress Disorder had larger nodes. Moreover, depression, life quality, anxiety, and stress were among other studied concepts. This finding indicates the positive effect of art therapy in the treatment of various diseases, particularly cancers and mental disorders.
... As stated in the introduction, there is a significant body of literature on art therapy in the contexts of trauma and short term disaster (Appleton, 1993;Havsteen-Franklin, 2021;Karcher, 2017;Schouten et al., 2014;Thammachack, 2020) and art therapy already has a large body of literature on best practice and recovery from trauma (Appleton, 1993;Havsteen-Franklin, 2021;Kalmanowitz & Ho, 2016;Kost, 2019;McTavish, 2018;Schouten et al., 2014;Talwar, 2007), for example, about the retrieval and reprocessing of traumatic memories that are often encoded in images rather than in words (Hass-Cohen, 2003;Sarid & Huss, 2010;van der Kolk et al., 2001), protocols for working with young people (Lyshak-Stelzer et al., 2007;Pifalo, 2007;Talwar, 2007) and adults with PTSD (Appleton, 1993;Baker, 2006;Jacobson, 1994). There is also a large body of literature within art therapy on art and mindfulness, as a method to enhance self-regulation and coping (see for example Kalmanowitz & Ho, 2016;Kost, 2019). ...
... As stated in the introduction, there is a significant body of literature on art therapy in the contexts of trauma and short term disaster (Appleton, 1993;Havsteen-Franklin, 2021;Karcher, 2017;Schouten et al., 2014;Thammachack, 2020) and art therapy already has a large body of literature on best practice and recovery from trauma (Appleton, 1993;Havsteen-Franklin, 2021;Kalmanowitz & Ho, 2016;Kost, 2019;McTavish, 2018;Schouten et al., 2014;Talwar, 2007), for example, about the retrieval and reprocessing of traumatic memories that are often encoded in images rather than in words (Hass-Cohen, 2003;Sarid & Huss, 2010;van der Kolk et al., 2001), protocols for working with young people (Lyshak-Stelzer et al., 2007;Pifalo, 2007;Talwar, 2007) and adults with PTSD (Appleton, 1993;Baker, 2006;Jacobson, 1994). There is also a large body of literature within art therapy on art and mindfulness, as a method to enhance self-regulation and coping (see for example Kalmanowitz & Ho, 2016;Kost, 2019). ...
During the COVID-19 pandemic crisis, art therapists used new methods, materials, and techniques to help address the needs of community members. The practices that emerged from art therapy while adjusting to the pandemic, created new perspectives and ways to re-theorize and re-energize community art therapy engagement. As the acute stage of the pandemic passes, the art therapy profession can take this opportunity to pause and explore the new practice-based knowledge and techniques developed “on the ground” during the acute crisis and canonize them by connecting practice to the growing body of theory on social art therapy. This paper will help conceptualize, articulate, and thus demystify these developments, anchoring them to social theories of com- munity. This paper will integrate setting, role of art, role of art therapists, ethical considerations, and evaluation, into social theories, describing specific features of a new theory of social art therapy in the context of community crises.
... As stated in the introduction, there is a significant body of literature on art therapy in the contexts of trauma and short term disaster (Appleton, 1993;Havsteen-Franklin, 2021;Karcher, 2017;Schouten et al., 2014;Thammachack, 2020) and art therapy already has a large body of literature on best practice and recovery from trauma (Appleton, 1993;Havsteen-Franklin, 2021;Kalmanowitz & Ho, 2016;Kost, 2019;McTavish, 2018;Schouten et al., 2014;Talwar, 2007), for example, about the retrieval and reprocessing of traumatic memories that are often encoded in images rather than in words (Hass-Cohen, 2003;Sarid & Huss, 2010;van der Kolk et al., 2001), protocols for working with young people (Lyshak-Stelzer et al., 2007;Pifalo, 2007;Talwar, 2007) and adults with PTSD (Appleton, 1993;Baker, 2006;Jacobson, 1994). There is also a large body of literature within art therapy on art and mindfulness, as a method to enhance self-regulation and coping (see for example Kalmanowitz & Ho, 2016;Kost, 2019). ...
... As stated in the introduction, there is a significant body of literature on art therapy in the contexts of trauma and short term disaster (Appleton, 1993;Havsteen-Franklin, 2021;Karcher, 2017;Schouten et al., 2014;Thammachack, 2020) and art therapy already has a large body of literature on best practice and recovery from trauma (Appleton, 1993;Havsteen-Franklin, 2021;Kalmanowitz & Ho, 2016;Kost, 2019;McTavish, 2018;Schouten et al., 2014;Talwar, 2007), for example, about the retrieval and reprocessing of traumatic memories that are often encoded in images rather than in words (Hass-Cohen, 2003;Sarid & Huss, 2010;van der Kolk et al., 2001), protocols for working with young people (Lyshak-Stelzer et al., 2007;Pifalo, 2007;Talwar, 2007) and adults with PTSD (Appleton, 1993;Baker, 2006;Jacobson, 1994). There is also a large body of literature within art therapy on art and mindfulness, as a method to enhance self-regulation and coping (see for example Kalmanowitz & Ho, 2016;Kost, 2019). ...
... Nevertheless, the effectiveness of art therapy interventions in the field of trauma is not yet evidence-based. It has been pointed out in recent reviews (Schnitzer et al., 2021;Schouten et al., 2015) that art therapists should describe their intervention more clearly (to allow faithful replication) and should define more accurately the treatment targets (to facilitate a proper assessment). ...
... The participants were asked to explain their drawing once completed using open-ended questions, methods known to increase participation [49]. The frame of the drawing was used to ask and discuss questions of violence and gave some distance to emotionally loaded material through the production and discussion of the artwork [50]. ...
Arts-based methods are underutilized in violence research and may offer improved means of understanding these phenomena; but little is known about their value, especially in low-resource settings. A pilot study using a cross sectional sample was conducted in rural South Africa to determine the feasibility and acceptability of using arts-based methods in research with adults and children, in preparation for a longitudinal multigenerational cohort study on mechanisms that underly the intergenerational transmission of violence. Four arts-based methods were piloted with young adults aged 22-30 years (n = 29), children aged 4-7 years (n = 21) and former caregivers of the young adults aged 40-69 years (n = 11). A sample of qualitative interviews were audio recorded and transcribed (child n = 15, adults n = 19). Three focus group discussions (FGDs) were conducted to understand implementation and lessons learnt with the six interviewers on the study team, none of whom had used these methods in research before. Interviews and FGDs were audio recorded, transcribed and reviewed by the investigative team. Using a rapid analytical approach, our pilot study demonstrated that using arts and play-based methods in multigenerational violence research is feasible and acceptable to participants and interviewers. These methods worked well for nearly all participants regardless of age or ability and offered a comfortable and 'fun' way to engage in weighty conversations. They presented benefits in their capability to facilitate disclosure , expanding understanding, particularly around violence that is often a stigmatizing and sensitive experience. Interviewers required increased capacity and sensitivity in using the methods carefully, to maximize their full potential, and ongoing mentorship was indicated. Our study adds to the burgeoning evidence base of the effectiveness of the use of arts-based methods in health research.
... This study is a pilot study of a specific intervention program, bound in time and scope, with a small sample of participants, where the findings can be directly transferred or generalized. As Schouten et al. (2015) concluded in a review of studies assessing PTSD work with veterans, "Although there are limitations in the number of included studies, the number of participants, the heterogeneity of included studies, and their methodological quality, the results contribute to insight into the effectiveness of art therapy in trauma treatment" (p. 220). ...
... The act of art creation also stimulates areas of the brain responsible for storage of visual memories [19] and assists recapture and reframing of memories in order to restructure them into a more productive framework [20]. It has been utilised successfully in a range of modalities including trauma and crisis therapy [21] and to mitigate pain associated with chronic illness [22]. The synthesis of AT techniques with CBT serves as an opportunity to address the potential barriers to talking-based therapy, whilst adding the therapeutic value of art-based interventions [17,23] (Fig. 1). ...
Background
The period of pregnancy and early motherhood is a substantial life change associated with psychological turbulence. During this period, some women experience symptoms of anxiety and depression of sufficient severity to warrant professional psychological assistance. Psychosocial and psychological interventions are key therapeutic approaches for women at this life stage. There is growing evidence of the value of the arts in the prevention and treatment of mental health problems. Evidence suggests that women prefer psychological interventions that provide social support and shared space for reflection.
Cognitive Behavioural and Art-based intervention (CB-ART) is a novel therapy for prevention and treatment of perinatal mental health problems. The aim of this study was to implement and evaluate CB-ART for acceptability, feasibility, safety and preliminary efficacy among women admitted to a residential early parenting unit.
Methods
The pilot study used a single-centre, mixed-methods pre- and post-test design to evaluate CB-ART among women admitted to a 5-day residential early parenting service in Melbourne, Australia. Participants completed questionnaires before and after attendance at two 1-h CB-ART group sessions on day 2 and day 5 of admission during which field notes were taken. Evaluation interviews were conducted by telephone 1 week after discharge. The Short Profile of Emotional Competence and the Edinburgh Postnatal Depression Scale were used to assess emotional insight and symptoms of depression, respectively. Feasibility, acceptability and safety were assessed using an analysis of field notes, with quantitative data collected by telephone questionnaire and qualitative data by telephone interviews.
Results
Nine participants enrolled in the program; eight provided complete data. Two CB-ART groups were conducted. Before and after comparisons showed that there was an improvement in symptoms of postnatal depression and a marginal improvement in emotional insight. Thematic analysis of qualitative data indicated CB-ART was a feasible and acceptable means of assisting reflection.
Conclusion
The preliminary data indicate that the CB-ART program is a feasible, acceptable and safe addition to the 5-day residential program, with potentially therapeutic benefits. A larger randomised study is required to assess the effects of the CB-ART intervention on symptom measures in this and other postnatal settings.
Trial registration
Australian and New Zealand Clinical Trials Registry, ACTRN126220000354785. Registered 1 January 2022—retrospectively registered.
Introduction
Interdisciplinary teams are often leveraged to improve quality of cancer care in the perioperative period. We aimed to identify the team structures and processes in interdisciplinary interventions that improve perioperative patient-reported outcomes for patients with cancer.
Methods
We searched PubMed, EMBASE, and CINAHL for randomized control trials published at any time and screened 7,195 articles. To be included in our review, studies needed to report patient-reported outcomes, have interventions that occur in the perioperative period, include surgical cancer treatment, and include at least one non physician intervention clinical team member: advanced practice providers, including nurse practitioners and physician assistants, clinical nurse specialists, and registered nurses. We narratively synthesized intervention components, specifically roles assumed by intervention clinical team members and interdisciplinary team processes, to compare interventions that improved patient-reported outcomes, based on minimal clinically important difference and statistical significance.
Results
We included 34 studies with a total of 4,722 participants, of which 31 reported a clinically meaningful improvement in at least one patient-reported outcome. No included studies had an overall high risk of bias. The common clinical team member roles featured patient education regarding diagnosis, treatment, coping, and pain/symptom management as well as postoperative follow up regarding problems after surgery, resource dissemination, and care planning. Other intervention components included six or more months of continuous clinical team member contact with the patient and involvement of the patient’s caregiver.
Conclusions
Future interventions might prioritize supporting clinical team members roles to include patient education, caregiver engagement, and clinical follow-up.
The aim of this study was to examine the influence of psychosocial stressors and demographic factors on psychopathology in asylum seekers and refugees with posttraumatic stress disorder (PTSD) prior to participation in the Den Bosch model for group treatment, as well as to explore their influence on the treatment results. The results showed no significant differences in the mean levels of psychopathology between asylum seekers and refugees prior to treatment. There were no differences found in treatment outcomes between the two groups. Living conditions do not influence either the mean levels of psychopathology prior to treatment or the treatment effects in our sample. The participants who are living separated from their families and/or who are single show the same levels of PTSD and depressive complaints prior to and post treatment compared with participants living together with family members. Ongoing psychosocial stressors in the course of treatment had no impact on treatment outcomes. Torture survivors, war victims, and a torture/war group profited equally from group treatment effectiveness. The results suggest that the effects of group therapy with asylum seekers and refugees according to the Den Bosch model are not impacted by demographic characteristics of the participants.
In this study, treatment results of three different trauma-focus group day-treatment programs for asylum seekers and refugees with post-traumatic stress disorder (PTSD), were compared with a supportive outpatient psychotherapy group, and a waiting list control group. The group programs differed in the number of nonverbal therapy sessions combined with group psychotherapy and in the number of treatment days per week that the programs were executed.
The results suggest that trauma-focus day-treatment groups lead to a significant decrease of psychopathology compared with the outpatient supportive group psychotherapy and the control group. Within the day-treatment programs, the more nonverbal treatment sessions are applied in a week time, the better the results. Equal treatment effects were obtained with the same number of sessions per week applied over 2 and over 3 days.
Most systematic reviews rely substantially on the assessment of the methodological quality of the individual trials. The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of randomized clinical trials (RCTs). The invited participants were experts in the field of quality assessment of RCTs. The initial item pool contained all items from existing criteria lists. Subsequently, we reduced the number of items by using the Delphi consensus technique. Each Delphi round comprised a questionnaire, an analysis, and a feedback report. The feedback report included staff team decisions made on the basis of the analysis and their justification. A total of 33 international experts agreed to participate, of whom 21 completed all questionnaires. The initial item pool of 206 items was reduced to 9 items in three Delphi rounds. The final criteria list (the Delphi list) was satisfactory to all participants. It is a starting point on the way to a minimum reference standard for RCTs on many different research topics. This list is not intended to replace, but rather to be used alongside, existing criteria lists.
This study examined the effectiveness of different types of art activities in the reduction of anxiety. After undergoing a brief anxiety-induction, 84 undergraduate students were randomly assigned to color a mandala, to color a plaid form, or to color on a blank piece of paper. Results demonstrated that anxiety levels declined approximately the same for the mandala- and plaid-coloring groups and that both of these groups experienced more reduction in anxiety than did the unstructured- coloring group. These findings suggest that structured coloring of a reasonably complex geometric pattern may induce a meditative state that benefits individuals suffering from anxiety.
Despite voluminous literature on trauma, studies on specific trauma and art expression remain sparse. Recurring graphic forms produced by sexual abuse victims have appeared in art therapy publications dating back to Naumburg (1958), but links between sexual abuse-assault and recurring graphic forms were not considered. In 1973, this author began a 30-year study of recurring graphic forms in drawings by this incidentspecific group. Results reveal victims produce an artistic language not produced by nonvictims. Analyses using repeated ANOVAS determined frequency of occurrence of graphic forms across 225 drawings of 45 adult females. Findings indicate distinct graphic forms symbolize sensory-perceptual elements and stimulate integration of traumatic effects by image conversion through language translation, artistic to linguistic.