Article

Art Therapy Improves Mood, and Reduces Pain and Anxiety when Offered at Bedside during Acute Hospital Treatment

Article

Art Therapy Improves Mood, and Reduces Pain and Anxiety when Offered at Bedside during Acute Hospital Treatment

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Abstract

Art therapists can engage medical inpatients in the creation of art to encourage emotional and physical healing. Utilizing a chart review, the impact of art therapy sessions at the bedside, with patients (N = 195) in a large, urban, teaching hospital was reviewed. The sample was predominantly female (n = 166) as more women than men agreed to participate in an art therapy session. Patients were seen by registered art therapists, and as a part of regular clinical practice, asked to rate their perception of mood, anxiety, and pain using a 5-point faces scale before and after an art therapy session. Multiple diagnoses were included in this chart review, making this study more representative of the variety of medical issues leading to hospitalization. Analysis of pre and post results demonstrated significant improvements in pain, mood, and anxiety levels of art therapy sessions within all patients regardless of gender, age, or diagnosis (all p < 0.001).

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... Varied qualitative and quantitative research designs have been used to examine the effect of art therapy on people with life threatening conditions. Reviews of qualitative and quantitative art therapy studies in cancer care have found that art therapy can reduce pain (Shella, 2018), anxiety, and depression, and improve personal growth, self-expression (Geue et al., 2010), meaning-making, personal empowerment (Wood, Molassiotis, & Payne, 2011), coping, social interactions, and quality of life (Geue et al., 2010;Wood et al., 2011). One study examined the effect of art therapy on 28 palliative care patients who were involved in 53 sessions involving patient preferred techniques, including painting, drawing, modeling, or sculpture. ...
... The current and traditional practice of art therapy in medical settings usually involves individual sessions with the art therapist at the patient's bedside (Ridley & Hartley, 2013;Shella, 2018) and an expectation that the patient actively participates by making their own artwork (Carr, 2014). The palliative care setting offers a number of challenges to this. ...
Article
There are multiple barriers to art therapy engagement in the palliative care setting, including treatment fatigue, the intrusive nature of the inpatient hospital environment, and the wide variation in patient health status. This paper describes a response to these challenges with Art on Behalf, an art therapy approach in which the art therapist creates an artwork on behalf of the patient. The patient conceptualizes the image while the art therapist produces the painting. Art-making is not obligatory in this process, and the patient may feel inspired to create art at a later time. Case study methodology is used to describe three cases that illustrate the psychotherapeutic aspects of the Art on Behalf approach that offered meaningful art therapy engagement within the many restrictions of the palliative care environment.
... Art therapy (AT) as a non-pharmacological medical complementary and alternative therapy 20 holds promise to address a range of bio-psycho-socio needs for individuals who are medically ill or undergoing invasive medical procedures. [21][22][23][24] AT provided by a masters' level trained clinician uses the creative process, artmaking, and applied psychological theory to improve behavioral and mental health of individuals, families, and communities. 25 AT can serve to improve cognitive and sensorimotor functions, foster self-esteem and self-awareness, cultivate emotional resilience, promote insight, enhance social skills, and reduce and resolve conflicts and distress. ...
... 48 The qualitative themes indicate that there is a congruence with the current literature on the beneficial effects of AT in medical settings on symptom management, emotional expression and insight, metaphorical and symbolic representations, and tactile-sensory explorations. [22][23][24]49 The study demonstrated that AT goes beyond merely symptom reduction to expression of rich visual narratives, pleasant memories, and symbolic representations. The data shows that AT facilitated connection and expression of feelings and awareness of self and positive relationships that gave some patients hope for the future/after discharge from the hospital, as noted in other AT tudies. ...
Article
This study aimed to investigate the feasibility of facilitating four sessions of art therapy intervention with a primary focus on implementation and acceptability. The exploratory aim was on assessing the impact of art therapy on self-reported outcomes on anxiety and mood among 5 individuals (aged 18+ years) hospitalized for burn injuries and to understand their perceptions of engagement with art therapy. A convergent mixed methods small N design was adopted wherein both quantitative and qualitative data are gathered and then integrated, and an individual served as his/her own control when assessed before and after art therapy. Anxiety was assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety short-form of the emotional distress bank, and mood was assessed using the Positive and Negative Affect Schedule (PANAS). There was a statistically significant decrease in anxiety scores and negative mood scale. Positive mood scale scores tended to improve after art therapy though were not statistically significant. Thematic analysis of qualitative data indicates that art therapy improves a) symptom management, b) facilitates emotional expression and c) insight, d) brings out symbolic and metaphorical representations, and e) allows tactile and sensory exploration of art media. This study demonstrated that art therapy can be successfully implemented with acute burn patients and can have promising psychosocial benefits. More research in needed to determine the impact and effectiveness of art therapy with burn patients, in ways that is meaningful to the patients.
... The shared neural pathways of sensory pain and implicit emotional experiences suggest the advantages of employing a non-verbal sensory intervention approach (Hass-Cohen & Clyde Findlay, 2009). Indeed, creative art therapy approaches have demonstrated significant and positive trends for chronic pain reduction (Czamanski-Cohen et al., 2014;Hass-Cohen et al., 2018;Shella, 2018). In this research, modified pain-related images, drawing characteristics, self-interpretations, narratives, and resources illustrated that MR was likely triggered and then sustained, resulting in reduced distress. ...
... By exposing people to tangible images of their pain in a therapeutic space, the fear of approaching their memories and experiences is mitigated and positive expectations associated with pain may develop (Hass-Cohen & Clyde Findlay, 2009;Hass-Cohen et al., 2018). Related MR advantages are that art therapy interventions are easily accessible, cost-effective, safe, and may reduce the need for addictive medications (Shella, 2018). Art therapy interventions are cross-culturally sensitive and support MR, as people will usually choose colors and symbols that are personally and culturally familiar (Betts, 2013;Prasad, Howie, & Kristel, 2013;Schieffelin, 2008). ...
Article
This pilot study explored the effects of a psychosocial empirically supported arts drawing protocol for trauma on chronic pain reduction, positive and negative affect, as well as relationships and resources. Additional aims were to explore memory reconsolidation as a change factor in art therapy. The study examined three- and four-drawing protocols and two resource reminder conditions to evaluate which version of the protocol was most helpful. Significant improvements were found in ratings of pain, depression, anxiety, relationship quality, and helplessness from pre-test to post-test, and in the frequency of experiencing pain, depression, fear, anger, relationship problems, and endorsed resources. There were significant differences between groups for anger, and a time by resource reminder condition interaction effect for fear. Exploratory analyses showed similar results for those who participated in the study before and during the first three months of the COVID-19 pandemic, and online versus in-person participation. However, pre-pandemic participants reported an increase in frequency of hopefulness over time, yet participants during the pandemic reported a decrease in frequency of experiencing hopefulness over time. Also, online participants reported a greater decrease in hopefulness frequencies when compared to in-person participants. There were no significant differences between the two versions of the protocol or the memory reconsolidation reminder conditions.
... Brief multidisciplinary interventions, such as art therapy, are needed to potentially reduce the burden of lengthy interventions (Czamanski-Cohen et al., 2014;Hass-Cohen, 2016;Mazer, 2018;Portelli, 2018;Roditi & Robinson, 2011;Shella, 2018). A discussion of artmaking reinforces perceived internal and external coping with pain resources to support identity development, positive meaning-making, locus of control, self-empowerment, hopefulness, and personal growth (B€ ussing et al., 2010). ...
... Artmaking, creativity, and imagination support meaning-making, and are protective factors that allow for a sense of functionality, pleasure, and expression of difficult experiences and emotions (Prescott et al., 2008). Art therapy interventions have shown significant reductions in experienced and perceived pain (Czamanski-Cohen et al., 2014;Hass-Cohen et al., 2021;Shella, 2018), and associated negative effects (Hass-Cohen & Clyde Findlay, 2009;Hass-Cohen, et al., 2018). Meaningful alteration of pain and self-images facilitates accessing familiar and new resources, aiding the coping process. ...
... It has also been highlighted in the literature that pre-morbid risk factors including childhood diagnosis of any mental health illness such as Attention Deficit Hyperactivity Disorder (ADHD), or conduct disorder; and general psychological stability of child, family, environmental stressors may play a role in management of pediatric burns and its effects [20]. The art therapy approach at this stage could focus on information gathering of child's past coping strategies, resources and supports, as well as pre-existing psychological -Establishing routine and structure through therapeutic relationship [12] -Information gathering-child's past coping mechanisms, significant relationships and supports, premorbid psychopathology [19] -Expressing survival anxiety through art [13,19] -Art therapy for distraction, desensitization, and breathing techniques to alleviate pain and anxiety [12] -Encourage impromptu or spontaneous drawings and paintings through different art media [12,16] -Artwork as a feedback for spatial disorientation, morbidity, maps for the details of the burn accident [12] -Directive approach, containment through art therapy decisions of the size of paper for boundary [12] -Digital artmaking for relieving procedural pain and anxiety [21] -Use of art installations in space-digital art projection, murals, window art [22] providing agency to children for choice of video projection -Nonverbal aspects to facilitate patient's struggle to cope with overwhelming stress [12] -Reinforcing sense of mastery through completion of tangible projects that require steps, e.g., collage art [12,13] -Encouraging media that provide structure and control [30] -Instilling hope through collaborative decisions on choice of media, setting goals, and plans to achieve them [29] -Modified developmentally appropriate art therapy assessments and use of different media for understanding cognitive and developmental level-e.g., use of bridge drawing [29] -Art therapy to allow safe expression and preparation for medical procedures by enhancing predictability and control, and reducing pain [13,29,28]. E.g., use of medical equipment in art therapy-syringe painting, cotton balls, gauze, or suturing threads -Sensory and tactile media in managing the itching sensation, encouraging relaxation, distraction and then allow processing at emotional and cognitive level [12,30]-e.g., bleed through tissue collages, pour painting, scratch art -Reduce isolation and promote normalization through joint projects and holiday projects -Trauma processing using body mapping or therapeutic puppetry to assess and process abuse and neglect [17À18] -Metaphorical expression to explore difficult feelings and situations in a safe manner. ...
... Art therapy as developmentally normative activity can provide structure and control through choice of art media, art projects, and a sense of mastery through completion of tangible projects [12,13]. As a nonpharmacological intervention, it can aid in pain-reduction [28], along with safe expression of emotional distress through use of various art media, including creative use of medical equipment such as syringe painting [29]. Sensory and tactile art media (such as clay and paints) have the potential to aid in managing the itching sensations by helping the children stay busy with their hands and encourage occupational goals through fine motor and gross motor movements through a dominant or non-dominant hand. ...
Article
Highlights •A conceptual framework for art therapy with pediatric burns for three stages of burn treatment- critical, acute, and rehabilitation is presented. •Framework is based on narrative synthesis of research on the psychosocial needs of children with burn injuries, art therapy literature on pediatric burn patients, and medical settings. •Art therapy has the potential to support pediatric burn recovery as a psychosocial intervention for short-term and long-term psychosocial care. Abstract Burn injuries are an unexpected traumatic event and can be physically and emotionally devastating for a child and their families. This article presents a conceptual framework for art therapy practice with pediatric burns, founded on the three stages of burn treatment- critical, acute, and rehabilitation. The framework is based on narrative synthesis of research on the psychosocial needs of children with burn injuries, art therapy literature on pediatric burn patients, as well as in medical settings. Based on the stages of burn recovery, and the role of other relevant stakeholders, the framework provides recommendations for clinical practice of art therapy with children sustaining burn injuries, their caregivers and siblings, and healthcare providers. Robust studies including art therapy as interventions are recommended to determine their effectiveness in addressing the specific psychosocial needs in different stages of pediatric burn care.
... Dostarczanie innych przeżyć o charakterze artystycznym i okazji do kontaktu ze różnymi formami sztuki (np. w postaci muzyki na żywo i przedstawień teatralnych czy pokazów klaunów) przy łóżkach pacjentów redukuje uczucie lęku, zmniejsza doświadczenia bólowe oraz podnosi stopień zaangażowania w leczenie i przestrzegania procedur medycznych niezależnie od wieku (Bruins Slot, Hendriks, Batenburg, 2018;Rokach, 105 Matalon, 2007;Sextou, Monk, 2013;Shella, 2018;Sridharan, Sivaramakrishnan, 2016). ...
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Full-text available
Książka zawiera przegląd badań na temat znaczenia twórczości dla kształtowania, utrzymywania oraz powracania do zdrowia oraz dobrostanu. Ukazuje również model wyjaśniający mechanizm „prozdrowotnego” oddziaływania twórczości, na podstawie dotychczasowych ustaleń teoretycznych oraz najnowszych wyników badań empirycznych. Dla uzyskania pełnego obrazu tego zjawiska uwzględnione zostały zarówno procesy pozytywnie oddziałujące na zdrowie, jak i czynniki ryzyka towarzyszące twórczości, które mogą być dla niego pewnym zagrożeniem. Ukazane zostały także najważniejsze kierunki rozwoju i wyzwania w zakresie badań naukowych i praktyki w obszarze związków między twórczością a funkcjonowaniem zdrowotnym.
... The utilization of complementary and alternative therapies (such as mind-body interventions, art, or pet therapy) is emerging to work alongside and/or instead of traditional treatments to support and enable people to manage their mental health (Mental Health Foundation [MHF], 2016). There is some evidence to suggest that when these therapies are used alongside standard care, they are effective in reducing MH symptoms and pain (Cushing & Braun, 2018;Horton, 2016;Krause-Parello et al., 2016;Shella, 2018;Uttley et al., 2015). In general, there has been an emphasis on moving away from clinical settings to outdoor activities and virtual environments (MHF, 2016). ...
Article
Full-text available
There is evidence to suggest that self-compassion is related to positive health and wellbeing outcomes, therefore, this paper explores this concept within the military veteran population. The aim of this review was to identify research and explore the evidence based of self-compassion as a protective factor, from negative health outcomes, amongst military veterans.
... Although successful use of tablets originated and empirically documented about a decade ago in Great Britain, with investigations continuing into the present both in Europe and beyond [42][43][44][45][46][47], its adoption in the United States has been slow [34,[48][49][50][51][52][53][54][55]. Two Great Britain studies offer a progressive look at how tablets can be applied to improve communications between persons living with dementia and their caregivers [56,57]. ...
Preprint
BACKGROUND Individuals with Alzheimer’s disease or related dementia (ADRD) represent a significant and growing segment of the older adult (65 years and over) population. Individuals with ADRD are often challenged expressively and may experience difficulties with sharing their feelings or moods. Availability of and easy access to tablets and smart phones facilitates use of information and communication technologies (ICTs) as delivery mechanisms for non-pharmacological interventions, especially for older adults with ADRD. Evidence of the impact of ICTs in different community settings on quality-of-life and mood with older adults and their caregivers is needed for widespread adoption and sustainment of these technologies. OBJECTIVE This projects’ research aim was to determine extent of the effects of ICTs (iPad) on positive mood change, and examine effects of study variables on participants’ mood changes and caregivers’ daily activities. METHODS The ICT (iPad) intervention was developed and its impact evaluated in five tablet engagement pilots (2017-2018). The primary outcome was caregiver-assessed participants’ mood (n=1,096) before and after an iPad engagement session using an 8-point mood visual analog scale. Session impact on caregiver daily activities was captured for a sub-sample of participants (n=544). Frequency distributions were computed for each of the study variables, including the degree of patients’ mood changes. χ2 tests of association were calculated to determine the impact of the variables on mood changes for all patients, as well as those being treated in skilled nursing facilities and in-home, and then those that affected caregiver daily activities. RESULTS iPad interventions substantially improved most patients’ mood. Cumulatively, 51% showed mood improvement while another 41% of patients maintained an already-positive mood resulting from the caregiver engagement session. χ2 analyses demonstrated that positive mood changes resulted from using music (χ2(15) = 93.84, P < .001), using YouTube as the sole app (χ2(6) = 18.38, P=.005), or when cared for in a skilled nursing facility (χ2(6) = 236.36, P < .001) across all participants. Positive improvements in the caregivers’ day occurred for patients with a movement disorder (χ2(2) = 10.04, P=.007), or when socialization was a component of other interventions (χ2(2) = 35.26, P < .001). CONCLUSIONS The study is one of the first to explore the impact of ICTs, in particular tablets such as iPads and apps such as YouTube, to improve mood in older adults and enhance caregiver perceptions about their patient interactions, especially those with ADRD. Importantly, these pilot data substantiate ICTs as part of a person-centered engagement approach, as beneficial alternatives to pharmaceutical interventions for mood enhancement. However, a more comprehensive study that explores the ICT impact on additional quality of life and clinical outcomes is needed to confirm these preliminary findings.
... Out of the 50 participants in the cited study, 45 claimed that art therapy directed their thoughts away from their illness and drew their attention to something positive, while 18 considered art therapy to be calming and relaxing, six felt they were more productive and valuable, and 12 found it to be a fun activity, while three participants noticed no effect. A. T. Shella (2018) also studied changes in mood during art therapy sessions. Patients with different diagnoses (N = 195) were included in the study. ...
Article
Full-text available
Research background. The causes of fibromyalgia (FM) are unclear and diagnosing FM is complicated, which limits treatment options, and no treatment to date has proven fully effective in alleviating its symptoms. In current studies, where art therapy has been applied in the case of FM, art therapy has been part of a multidisciplinary intervention. The authors were unable to find any published data on the effects of art therapy on FM. The aim of the research was to determine the effect of group art therapy on pain, emotional state, and feeling of health and comfort of FM patients. Research methods. Intervention included ten structured art therapy sessions. The participants were 20 women between the ages of 39–64 years. In order to assess the results of therapy, a self-rate questionnaire was used. Therapy session changes were registered using pain and fatigue NRS and semantic differential scales of feeling of health and comfort. The outcome of group art therapy was assessed with a pain and fatigue NRS, and an Emotional State Questionnaire (EST-Q2). An open question was used to study the expectations of participants at the beginning of therapy and the main result of the therapy upon its conclusion. Research results. During the group art therapy session, pain and fatigue decreased and the feeling of health and comfort improved. This was confirmed by the content analysis of open questions. Following therapy, a significant decrease had taken place in the subscales of the Emotional State Questionnaire in depression, anxiety, and agoraphobia-panic; a substantial decrease in pain and fatigue took place in patients with heightened baseline measures. Conclusion. The changes following the therapy session confirm the results of earlier studies on the positive effects of psychotherapy and art therapy sessions on pain. The pilot study provided promising results for the application of structured short-term group art therapy with FM patients. Keywords: group art therapy, fibromyalgia, pain, fatigue, emotional state. Keywords: group art therapy, fbromyalgia, pain, fatigue, emotional state.
... Step 3 was inspired by such examples as bedside art therapy for medical inpatients (Shella, 2018) and art therapy with older adults at risk for depression in nursing homes (Yao, Yang, & Chen, 2019). ...
Article
Full-text available
Despite a growing number of art therapists in some areas of Atlantic Canada, a significant percentage of the general population is currently not aware of art therapy as a clinical mental health intervention. With the exception of a few larger hospitals, it is often not a practice incorporated into mental health organizations, educational institutions, or community agencies. Misinformation about the term art therapy has limited people in their understanding of its inherent benefits. Atlantic Canada’s geography, climate, and cultural and language differences have created additional barriers for residents in accessing these services. Inspired by the art hive movement, the history of the Grenfell traveling missions, and the present state of mental health reform in Newfoundland, three art therapists set out to connect with community professionals in an “on the road” approach to art therapy outreach in smaller towns, remote locations and with other marginalized groups. These collaborations resulted in open art studios for each visited community. These studios have the potential to become ongoing and permanent mental health resources for the region.
... Although successful use of tablets originated and empirically documented about a decade ago in Great Britain, with investigations continuing into the present both in Europe and beyond [42][43][44][45][46][47], its adoption in the United States has been slow [34,[48][49][50][51][52][53][54][55]. Two Great Britain studies offer a progressive look at how tablets can be applied to improve communications between persons living with dementia and their caregivers [56,57]. ...
Article
Full-text available
Background: Persons living with dementia represent a significant and growing segment of the older adult (aged 65 years and older) population. They are often challenged expressively and may experience difficulties with sharing their feelings or moods. Availability of, and easy access to, tablets facilitates the use of information and communication technologies (ICTs) as a delivery mechanism for nonpharmacological interventions, especially for persons living with dementia. Evidence of the impact of ICTs in different community settings on mood with older adults and the impact of engagement on their caregivers is needed to promote broader adoption and sustainment of these technologies in the United States. Objective: This study aimed to determine the extent of the effects of tablets on positive mood change and examine the effects of study variables on care recipients' mood changes and caregivers' daily interactions. Methods: The tablet intervention was developed and evaluated in five programs. The primary outcome was caregivers' assessment of care recipients' mood (n=1089) before and after a tablet engagement session using an eight-point mood visual analog scale. Session influence on caregivers' daily activities was captured for a subsample of participants (n=542). Frequency distributions were computed for each study variables. Chi-square tests of association were calculated to determine the association of the variables on mood changes for all care recipients, as well as those being treated in skilled nursing facilities and in-home, and then for those that affected caregivers' daily activities. Results: The study sample comprised 1089 care recipient and caregiver engagement sessions. Cumulatively, 50.78% (553/1089) of care recipients showed a transition from negative to positive moods, whereas another 41.78% (455/1089) maintained an already-positive mood after the caregiver engagement session. Chi-square analyses demonstrated that positive mood changes resulted from using music (χ210=72.9; P<.001), using YouTube as the sole app (χ212=64.5; P<.001), using multiple engagement strategies (χ22=42.8; P<.001), and when cared for in a skilled nursing facility (χ24=236.8; P<.001) across the entire care recipient sample. In addition, although many features of the engagement session positively influenced the caregivers' day, the largest effect was observed when care recipients' mood was considered to have improved following the session (χ24=234.7; P<.001). Conclusions: The study is one of the first in the United States to explore the impact of ICTs, in particular managed tablets and Web-based video services that can be used on a tablet through an app, on improving mood in persons living with dementia, and enhancing caregivers' perceptions about their care recipient interactions. Importantly, these pilot data substantiate ICTs as part of a personalized engagement approach, as beneficial alternatives to pharmaceutical interventions for mood enhancement. However, a more comprehensive study that explores the ICT's impact on additional clinical outcomes is needed to confirm these preliminary findings.
... Kazemi et al 22 reported that playing the music of Johann Sebastian Bach significantly decreased the anxiety of pediatric inpatients. Art 23 and pet therapies 24 have also been described as effective modalities. ...
Article
OBJECTIVES: Hospitalization generates increased psychological discomfort for children and their caregivers. This anxiety can affect the patient-caretaker response to the health care team and the course of treatment. We aim to evaluate the impacts of a magic therapy program, organized and facilitated by medical students, on alleviating pediatric inpatient and caregiver anxiety. METHODS: Patients aged 5 to 16 years admitted to an inpatient pediatric unit and their caregivers were eligible for inclusion. Patient-caregiver pairs were randomly assigned to a magic therapy intervention group or a control group. Anxiety was measured before and after the intervention by using validated self-report tools. The Facial Image Scale and Venham Picture Test were used to measure anxiety for young patients, the short State-Trait Anxiety Inventory and Facial Image Scale were used for older patients, and the short State-Trait Inventory was used for caregivers. A subset of the intervention group was reevaluated at 1 hour posttherapy. Health professionals were also surveyed regarding their opinions of the program. RESULTS: One hundred patients and 90 caregivers were enrolled. The patient magic group’s standardized anxiety was reduced by 25% (n 5 47; P , .001) posttherapy. The caregiver magic group’s anxiety was reduced by 24% (n 5 34; P , .001). Data suggest that anxiety reductions lasted through at least 1 hour posttherapy. Physicians (n 5 9), nurses (n 5 8), and pediatric residents (n 5 20) supported program continuance, reported favorable impressions, and suggested patient, caregiver, and staff benefits. CONCLUSIONS: Integration of a magic therapy program into pediatric inpatient care was feasible and successful in decreasing patient and caretaker anxiety. Health care professionals support the program’s continuance.
... Cabe resaltar que el individuo no necesita tener experiencia previa o habilidad para el arte para ser tratado desde este enfoque. (Burns, 2018;Castro y Martínez, 2011;Shella, 2017). La arteterapia abarca una amplia modalidad de aplicaciones. ...
Article
Full-text available
Resumen El presente es un estudio cualitativo de caso único de carácter terapéutico con evaluación continuada planteado con diseño de no reversión. La paciente fue una mujer de 21 años que llegó al Centro de Atención Psicológica para solicitar psicoterapia, es diagnosticada con agorafobia. En las fases de evaluación e intervención se presentaron diversas resistencias a trabajar con el motivo de consulta, por ello se opta por utilizar técnicas arteterapéuticas de Torres (2005) y Guerrón (2015) planteándose como objetivo disminuir estas resistencias. En conclusión, se encontró que estas técnicas funcionaron como promotor del autoconocimiento y la percepción de control interno, teniendo un impacto significativo en la disminución de resistencias a la confrontación y al cambio en psicoterapia.
... Art therapeutic interventions have shown effectiveness in the treatment of psychiatric-and psychosomatic illnesses. They have been found to stabilize health-related quality of life, 1-3 improve self-esteem, self-confidence and mood, 4,5 reduce symptoms of anxiety, depression and pain [5][6][7] and enhance emotional regulation, insight and behavioral change. 8,9 Recent evidence supports the relevance of anthroposophic painting therapy (APT) developed by Margarethe Hauschka and Liane Collot d'Herbois in the 1920s. ...
Article
Objective Anthroposophic painting therapy (APT) is a specific form of art therapy that aims to activate self-healing capacities through painting aquarelles. Methods The Anthroposophic Art Therapy Assessment-Paint’ (AART-ASSESS-P) was developed to measure pictorial expression and validated in the framework of a comprehensive cohort design study that includes 68 breast cancer patients with fatigue. Art therapists made pre- and post-assessments of spontaneously drawn water-color paintings with a preliminary version of the AART-ASSESS-P (58 items). Inter-rater reliability (IRR) for the items was examined with Cohen's weighted Kappa (κw) and with a reliability- and factor analysis (FA). Convergence criteria were patients’ self-report measures: the Satisfaction with Painting Therapy (SPT), Inner Correspondence with Painting Therapy (ICPTh) and the Self-Regulation Questionnaire (SRS). Results IRR for the items was heterogeneous (κw = 0.09-0.89, Mean κw = 0.40, SD = 0.17). Thirty-six items were excluded due to insufficient IRR and item-total correlation (κw = < 0.30, ρitem-total < 0.30). A FA with 22 items revealed 5 subscales: Shape Development (6 items), Shape Arrangement (6 items), Order and Symmetry (5 items), Color Application (3 items), and Color Quality (2 items) explaining 61% of total variance. Psychometric properties for the AART-ASSESS-P were satisfying with Cronbach's alpha coefficients (rα = 0.60-0.80) across subscales. Due to weak inter-subscale correlations (r = 0.18-0.48, p < 0.05) and the ambiguity of face validity a sum-score was not formed. Correlations between subscales and self-reports were small (all p < 0.05). Conclusion The ART-ASSESS-Pis the first reliable instrument to measure pictorial expression during APT.
... Art therapeutic interventions have shown effectiveness in the treatment of psychiatric-and psychosomatic illnesses. They have been found to stabilize health-related quality of life, 1-3 improve self-esteem, self-confidence and mood, 4,5 reduce symptoms of anxiety, depression and pain [5][6][7] and enhance emotional regulation, insight and behavioral change. 8,9 Recent evidence supports the relevance of anthroposophic painting therapy (APT) developed by Margarethe Hauschka and Liane Collot d'Herbois in the 1920s. ...
... 75). Bu konuyla ilgili Shella (2018), sanat terapistlerinin -psikoterapi yaklaşımı olarak-hastaların sanatsal çalışma oluşturması ve hastaları değerlendirmesinin yanında hastaları duygusal ve fiziksel iyileşmeye teşvik ettiğinden bahseder (s. 59). ...
... Some programs provide psychological support through creative outlets under the guidance of art therapists. [6][7][8] Other methods have included the use of the arts directly within physical therapy programs. [9][10][11][12] Such inclusion of the arts in health care may have an impact on the 3 domains of learning: (1) psychomotor, (2) affective, and (3) cognitive development. ...
Article
Objectives: The purpose of this scoping review was to analyze the published literature regarding the use of art in the context of rehabilitation for consideration in physical therapy. Methods: The CINAHL, PsycArticles, APA PsycInfo, Art Index, Music Index, Cochrane Reviews, and PubMed electronic databases were accessed. Inclusion and exclusion criteria were established and utilized to determine study eligibility. Study details were extracted from each article by researchers using a systematic format. Summation of journal type, participants, dosing and type of intervention, setting and interventionist, outcome domains, and study results were included. Results: Out of 1452 studies, 76 were included for extraction. Of these studies, most had outcome measures aligned with the psychomotor and affective domains of learning (n = 66). Very few studies had outcome measures with psychomotor and cognitive domains (n = 2) or psychomotor, affective, and cognitive outcome measures (n = 8). Regarding the arts used, music, dance, or both were used in 77 instances. Fewer studies reported using creative arts therapy, singing, theater, writing, and rhythm (n = 17). Of the 76 studies analyzed, 74 reported a within-group treatment effect. Conclusions: The arts effectively enhance physical therapist practice; therefore, it is recommended that physical therapists continue to seek collaboration with art professionals and explore the use of arts in practice. Impact: Findings demonstrate that combining the arts with physical therapist practice amplifies not only psychomotor but affective and cognitive outcomes as well. The arts have applicability across broad populations (eg, chronic pain, neurologic dysfunction, respiratory conditions). This study supports that physical therapist education and practice should embrace the arts as a collaborative modality to promote enhanced psychomotor, affective, and cognitive outcomes.
... 12(p66) Currently, medical art therapy is a rapidly growing subspecialty with an expanding body of evidence-based research that demonstrates the effect of art therapy in medical settings. [13][14][15][16][17] Medical art therapists provide a range of services to children and adults in hospitals, outpatient clinics, home health agencies, community programs, centers for integrative health, and private practice. These services include the use of assessment and diagnostic evaluations; consultation; and individual, group, and family art therapy. ...
Article
In this article, we provide an overview of the literature on contributions of art making and medical art therapy for patients with burn injuries. The potential value of art therapy in addressing the complex physical and psychosocial needs of burn patients is discussed through examination of 7 peer-reviewed articles. Two case examples of burn survivors, 1 pediatric and 1 adult, are included to demonstrate the use of art therapy in an inpatient and outpatient setting, respectively. Art therapy and other intervention strategies for overall psychosocial adjustment of burn patients are often underutilized. Further research in art therapy is needed to examine the psychosocial aspects of burns patients and the potential role that medical art therapy may have in a burn care center.
Article
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.
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Introduction: Anxiety and depression are among the variables that children with cancer need psychological treatment for them. The aim of this study was to determine the comparing the effectiveness of group story therapy and the art-play therapy on anxiety and depression in children with cancer based on the framework, principles and rules of cognitive-behavioral approach. Methods: The research method was semi-experimental, and research design was three groups with three stages (pre-test, post-test and follow up design). In order to carry out the research, from 8-12 years old children with cancer in Amir Hospital, in Shiraz city in the Summer of 2018, 36 children were purposefully selected and randomly assigned to three groups (two experimental and one control group, each group was 12 children). Children Anxiety Scale (SCAS-Spence, 1998) and Children Depression Scale (CDS-Tisher & Lang, 1978) was used to measure the dependent variable in the pretest, post-test and follow up. The group of cognitive-behavioral story therapy and cognitive-behavioral art-play therapy received 12 sessions of treatment. The data were analyzed with the use of repeated measures analysis of variance. Results: The results showed that there is a significant difference between cognitive-behavioral story therapy and cognitive-behavioral art-play therapy with control group in anxiety (F=29.98, P<0.001) and depression (F=28.62, P<0.001). Also, cognitive-behavioral art-play therapy had stronger effects than cognitive-behavioral story therapy in reducing anxiety and depression (P<0.001). Conclusions: Based on the results of this study, it can be said that cognitive-behavioral story therapy and cognitive-behavioral art-play therapy can be used as a treatment to reduce the anxiety and depression of children with cancer in educational and therapeutic settings.
Article
The main aims of the study are to a) evaluate the effectiveness of a three session program of “art therapy” on changing emotional indicators (depression, anxiety, stress, and psychological well-being) in individuals with mental illness and b) analyze the meanings attributed to creative self-expression. We performed a pre-experimental mixed approach study, with a pretest–posttest design, with twelve Portuguese male subjects, admitted to an acute psychiatry unit. The instruments used were Depression, Anxiety and Stress Scale [DASS-21]; and Ryff Scales of Psychological Well-Being [SPWB – 18] and a semi-structured interview. Comparison of the pre- and posttest indicated improvement in anxiety, stress, self-acceptance, purpose of life, and overall psychological well-being. The categories resulting from the thematic analysis of the interviews revealed the usefulness of the program in the participant recovery process. This type of psychosocial intervention in specialized clinical practice in Mental Health Nursing minimizes the disease’s impact in an organizational culture that should increasingly be oriented toward recovery.
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Research background. The existing evidence supports the effectiveness of Tai Chi for persons with multiple sclerosis (MS) in various domains including depression, coordination, balance, and fatigue. However, we are not aware of any previous studies of the effects of Tai Chi on cognition and motor skill learning in persons with MS. The aim of this study was to determine the effects of Tai Chi on cognitive functions and motor learning in persons with multiple sclerosis. Methods. The study included 16 participants with MS. They were randomly assigned to intervention (n = 8) and control (n = 8) groups. The intervention consisted of a 60-min Tai Chi exercise program twice a week, for 8 weeks, while the control group was instructed to maintain their routine daily activities. Cognitive functions and learning of accurate movements were evaluated before and after the 8 weeks in each group. Results. Tai Chi exercise program improved (p < 0.05) working memory and attention switching, whereas no changes were observed in short-term memory and attention stability in persons with multiple sclerosis. Furthermore, Tai Chi facilitated (p < 0.05) motor learning when compared with the control group. Conclusions. Tai Chi can be used as an effective intervention to improve cognitive functions, such as working memory and predictable attention switching, and motor skill learning in persons with multiple sclerosis. Keywords: working memory, attention switching, meditation, motor skills. Keywords: working memory, attention switching, meditation, motor skills.
Article
Research background. Virtual reality and visual feedback improve motor performance, motor function and balance, so we want to fnd if it affects the function of legs and balance of children with spastic hemiplegia. Research aim was to establish if the use of virtual reality and visual feedback with traditional physiotherapy improve the function of legs and balance of children with cerebral palsy. Methods. Nine children with cerebral palsy participated in the research. Participants were randomly divided into two groups – virtual reality group (n = 6) and control (n = 3). Virtual reality group practised exergaming and stretching exercises for 10 weeks, twice a week. Control group practiced conventional physiotherapy and stretching exercises for 6 weeks, twice a week. We measured the range of motion of the lower limb, spasticity of the lower limb using Modifed Ashworth’o Scale, static, dynamic balance, trunk coordination using Trunk Impairment Scale at the start and the end of the research, and balance using Pediatric Balance Scale. Results. Virtual reality and visual feedback reduced the spasticity of the lower limb, improved balance and postural control for children with cerebral palsy, but it did not improve the range of motion of the lower limb of children with cerebral palsy. Conclusions. Virtual reality and visual feedback did not improve the range of motion of the lower limb of children with cerebral palsy. Virtual reality and visual feedback reduced spasticity of the lower limb, improved balance and postural control for children with cerebral palsy. Keywords. Cerebral palsy, virtual reality, visual feedback, postural control, muscle architecture.
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Background: Peripheral venous cannulation (PIVC) is one of the most common needle procedures associated with the therapies of pediatric patients, which causes pain and anxiety in children. Trace Image and Coloring for Kids-Book (TICK-B) is one of the arts-based interventions to relieve pain and anxiety, but none of the existing studies use the TICK-B to decrease children’s pain intensity and anxiety levels during PICV. Objective: This study aimed to investigate the effectiveness of the Trace Image and Coloring for Kids-Book (TICK-B) in decreasing children’s pain and anxiety during PIVC. Methods: A parallel, randomized, double-blind controlled trial was used in this study. Children aged 6–12 years were randomly allocated to one of two groups: intervention or control. The intervention group (n = 48) received the TICK-B during the PIVC, compared to no intervention in the control group (n = 52). The children, their parents, and an observer nurse rated outcomes 1-2 min after completion of the procedure. The patients in both groups were similar in age, gender, duration of hospitalization, injections, mother’s age, and education. Faces Pain Scale-Revised (FPS-R), Children’s Fear Scale (CFS), and Visual Analog Scale (VAS) were used to measure pain and anxiety. Paired and independent t-tests were used for data analysis. Results: Patients in the intervention group reported significantly reduced pain levels than those in the control group (p <0.001), as reported by children (3.08 vs. 7.06), parents (3.08 vs. 7.13), and the observer nurse (3.06 vs. 7.13), respectively. Anxiety levels were also significantly lower among patients in the intervention group than in the control group (p <0.001), as reported by children (0.88 vs. 3.17), parents (0.94 vs. 3.19), and the observer nurse (0.85 vs. 2.94), respectively. Conclusions: TICK-B is an effective technique for reducing children’s pain and anxiety during PIVC. TICK-B is a simple, inexpensive, and effective technique that nurses can use to decrease the levels of pain and anxiety of pediatric patients during intravenous cannulation.
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More than half of cancer patients are dealing with moderately severe pain on a monthly basis and most of them report a breakthrough pain experience at least once. Despite the importance of pain management for cancer patients, cancer pain remains undertreated. With computer technology and especially Virtual Reality offering open endless opportunities for pain management, we must consider how low-cost home-based Virtual Reality for cancer patients can be sensitively designed to provide comfortable, enriching pain management experiences. Working closely with 51 cancer patients, medical and paramedical personnel, we co-designed an intelligent personalized mobile application to first collect ecologically momentary assessment data on symptoms like pain and fatigue and Health-Related Quality of Life and subsequently enhance symptom management of cancer patients at home. Through this paper, we thoroughly explain the screening process and quantitative analysis we run to identify which environments patients would like to receive as a Virtual Reality intervention that can facilitate the design of Virtual Reality interventions for cancer patients.
Article
Context : Many people with cancer experience fear or anxiety when starting chemotherapy for the first time. Mandala coloring is an art therapy approach commonly used for anti-stress therapy. Objective : To assess whether mandala coloring reduces the anxiety experienced by women with early-stage breast cancer during their first chemotherapy session. Design : A quasi-experimental controlled study with pretest/posttest design. Setting : The study was conducted in the outpatient chemotherapy unit of the Istanbul University Institute of Oncology between March 2017 and May 2018. Participants : Eight-four women with early-stage breast cancer who presented for their first session of chemotherapy were included, 41 in the intervention group and 43 in the control group. Intervention : Patients in the intervention group were asked to color a mandala for 30 minutes while receiving premedication prior to chemotherapy. No intervention was applied to the control group. Main outcome measures : Levels of distress and anxiety were assessed before and after premedication using the distress thermometer and State–Trait Anxiety Inventory. Results : The sample group consisted primarily of women who had primary school education, were married, and were homemakers. Average distress levels were low in both the intervention and control group before premedication, and state anxiety scores did not differ statistically between the groups before or after premedication. However, patients in the intervention group who had high distress levels before premedication showed a significant decrease in state anxiety score after premedication, while patients in the control group showed no decrease.
Article
Background Venipuncture is a common procedure resulting in intense discomfort, anxiety, and pain in children. In this regard, we examined the effectiveness of a simple and practical art-based intervention on pain and anxiety in children who underwent venipuncture procedures. Method In this parallel randomized control trial, children aged 6–12 years were randomly allocated to either an intervention or a control group. The intervention group (n = 73) received an art-based intervention called Trace Image and Coloring for Kids-Book (TICK-B) during the venipuncture procedure compared to no intervention in the control group (n = 71). The children, their parents, and an observer nurse rated the outcomes 1–2 min after the venipuncture procedure was finished. Findings The patients in the intervention group had a substantially lower mean value of pain and anxiety—as rated by children, their parents, and an observer nurse—compared to the control patients. The average values of pain reported by the children, parents, and observer nurse were 3.50, 3.52, and 3.49 in the intervention group in contrast to 6.53, 6.59, and 6.45 in the control group (a large effect). Similarly, the patients in the intervention group had significantly lower mean values of anxiety compared to the control group: 0.88, 1.43, and 1.42 vs. 3.09, 2.52, and 2.52, respectively. Conclusions This study showed that TICK-B is an effective technique to reduce the levels of pain and anxiety in children undergoing venipuncture procedures. Practice implications The TICK-B can be used easily by nurses to relieve the pain of children during venipuncture procedures. Trial registration Clinical Trial Registry, NCT04690257. Registered on December 30, 2020.
Chapter
The arrival of the 2019 novel coronavirus (COVID-19) has accelerated the replacement of old lifestyles by new lifestyles. In the post-COVID-19 era, the various behavioral changes, emotional and psychological problems caused by the COVID-19 epidemic may not yet be over, forcing the public to face a variety of experiential changes. Therefore, the purpose of this paper is to summarize the influence of COVID-19 on the psychology, emotion, behavior and experience of the public through literature review, and analyze the causal relationship between them. Then this paper looks for a usability design strategy to solve the user experience from the perspective of design and ‘creation of cure’. Finally, the logical framework of the design strategy is summarized to deal with the realistic needs of the post-COVID-19 era. Based on the analysis of the existing literature, this paper proposes: 1) the potential design strategies of mental models and art therapy for psychological and emotional experience, 2) the potential design strategy of behavioral model and art therapy is proposed for behavioral experience, and 3) user experience models in different fields are proposed for the change of user experience.
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Abstract The present study aims to study the effectiveness of art-based group training on anxiety and self-esteem of elementary female students. This study was quasi-experimental with pre-test and post-test design and a control group. The statistical population of this study included all the students of Sabaye Noor Girls' Elementary School, located in Tehran's second district in the academic year of 2017-18. From the above population, the sample was obtained via available sampling methodology and randomly placed. Spielberger's State-Trait Anxiety Inventory (STAIC), and Coopersmith's Self-Esteem Inventory (SEI), was used to evaluate all fifth-grade students. Those with anxiety score above the mean (state anxiety=29/6 and trait anxiety=37/3) and a lower general self-esteem score (34/7) were identified and from among them 24 individuals were selected as the sample and were assigned to two experiment and control groups of 12. In order to conduct the research, the experiment group underwent Art-based group training (AT) in eight sessions and were reassessed in the post-test phase. Results of multivariate covariance analysis showed significant differences in anxiety and self- esteem between the experiment and control groups. (P<0.05). According to research findings, it can be concluded that art-based group training has been effective in reducing anxiety and increasing self-esteem in students. Keywords: Art-based group training, anxiety, self-esteem
Article
Purpose This study aims to examine the effects of activity groups using art activities on resilience and related factors in mothers with disabled children. Design and Methods This randomized controlled experimental design study was conducted with 33 mothers (18 in the control and 15 in the intervention group). Findings A statistically significant difference was found between the intervention group's pretest and posttest mean scores on the Resilience Scale for Adults, the Satisfaction with Life Scale, Zarit Burden Interview, and 12‐item General Health Questionnaire scales. Implications for Nursing Practice The psychological activity groups that used art activities were found to increase psychological well‐being and satisfaction with life among the families of disabled children with various types of distress (physical, psychological, economic, and social), as well as reducing their mothers' perceived caregiving burden.
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Künstlerische Therapien sind erlebnis- sowie handlungsorientierte Formen der Psychotherapie, wobei der Begriff der Psychotherapie im Kontext der künstlerischen Therapien nicht im Sinne des Psychotherapeutengesetzes verwendet wird, sondern als ein therapeutischer Zugang zum Patienten. Zentrales therapeutisches Mittel der künstlerischen Therapien sind Materialien und Ausdrucksformen der bildenden (Malerei und Plastik) wie auch der transitorischen Künste (Musik und Tanz). Hierbei sind der Gestaltungsprozess und das schöpferische Resultat gleichermaßen dialogische Bezugspunkte der therapeutischen Arbeit. Im schöpferischen Prozess werden das eigene Erleben sowie bewusste und unbewusste Anteile der Psyche unmittelbar angesprochen. Psychische und geistige Funktionen des Menschen werden aktiviert und in Bewegung gebracht. Gleichzeitig findet, wie beispielsweise in der Tanztherapie und im therapeutischen Plastizieren, eine auf den Körper bezogene Auseinandersetzung statt, die die Körperwahrnehmung und das Körperbild beeinflussen und verändern kann. Durch künstlerische Therapien können seelische, körperliche und auch soziale Ressourcen aktiviert werden.
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Objetivos: Objetivou-se identificar a percepção de um grupo de três mulheres em sofrimento psíquico sobre um Programa de Arteterapia de um Centro de Atenção Psicossocial álcool e outras drogas e caracterizar as participantes do estudo de acordo com variáveis sociodemográficas e clínicas. Método: Estudo qualitativo, descritivo e exploratório, realizada em Brasília/DF/Brasil, com três mulheres toxicômanas. A coleta de dados foi com entrevistas semiestruturadas; os registros de dados foram codificados e foram realizadas análises descritivas simples para as variáveis categóricas. Resultados: As sessões de Arteterapia reduziram a tensão e a ansiedade, mostraram melhor adaptação ao meio ambiente, autoconfiança e ajustamento emocional. Conclusão: A Arteterapia permitiu a expressão de sentimentos das participantes que faziam parte de um grupo de difícil adesão, o que mostra a importância do tema para o serviço e para a equipe de saúde e de enfermagem.
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Objetivo: avaliar o uso de histórias em Arteterapia na perspectiva terapêutica para mulheres dependentes de drogas. Método: estudo descritivo, exploratório, comparativo e avaliativo, com abordagem quantitativa, aplicado a 22 mulheres usuárias de um serviço de Saúde Mental. Realizadas quatro intervenções de Arteterapia com uso de histórias, aplicados questionário e inventário estruturado de saída. Realizada estatística descritiva e analítica. Resultados: observou-se escore médio alto (≥8,8) para as variáveis eficácia (9,22±1,23), satisfação (9,13±1,64), criatividade (9,09±1,97), relaxamento (8,86±3,05), estado de ânimo (8,86±3,05) e autoconfiança (8,86±3,05). Conclusão: o estudo apresentou a relevância do uso de histórias como processo terapêutico e desta forma, sugere-se que programas de Arteterapia na reabilitação psicossocial com mulheres dependentes de drogas sejam estimulados no contexto da Saúde Mental. Palavras-chave: Histórias em Arteterapia. Saúde da mulher. Dependência de drogas. Saúde mental. Abstract Objective: to evaluate the use of stories in Art therapy in the therapeutic perspective for drug dependent women. Methodo: descriptive, exploratory, comparative and evaluative study, with quantitative approach, applied to 22 women who use a Mental Health service. Four Art therapy interventions were carried out with the use of histories, questionnaire and structured exit inventory applied. Descriptive and analytical statistics were performed. Results: a high average score (≥8.8) was observed for the variables efficacy (9,22 ± 1,23), satisfaction (9,13 ± 1,64), creativity (9,09 ± 1,97), relaxation (8.86 ± 3.05), mood (8.86 ± 3.05) and self-confidence (8.86 ± 3.05). Conclusion: the study showed the relevance of using stories as a therapeutic process and, thus, it is suggested that art therapy programs
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The Check (“Check, Change What You Need To Change and/or Keep What You Want”) art therapy protocol is a sequence of directives for treating trauma that is grounded in neurobiological theory and designed to facilitate trauma narrative processing, autobiographical coherency, and the rebalancing of dysregulated responses to psychosocial stressors and trauma impacts. This article reviews the neurobiological systems involved in trauma processing and demonstrates the Check protocol with the case of a woman with posttraumatic stress disorder who had witnessed the September 11, 2001, attacks on the World Trade Center in New York, New York. A comparison of pre- and post-treatment assessments showed decreased anxiety and avoidance behaviors and improved resiliency.
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This review article examines current knowledge about the efficacy of art therapy based on the findings of 8 randomized controlled trials (RCTs) conducted with adult populations from 2008–2013 that met a high standard of rigor. Of these studies, all but one reported beneficial effects of art therapy. Review findings suggest that art therapy may benefit a range of individuals, including older adults, war veterans, and prison inmates. However, there is a need for further research using RCTs to examine more conclusively art therapy outcomes and the specific populations in which art therapy interventions offer greatest benefit.
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Chronic pain is acknowledged as a phenomenological experience resulting from biological, psychological, and social interactions. Consequently, treatment for this complex and debilitating health phenomenon is often approached from multidisciplinary and biopsychosocial perspectives. One approach to treating chronic pain involves implementing mind-body treatments such as art therapy. Art therapy for chronic pain is a nascent area of study, and this literature review endeavours to (a) evaluate the quality of literature investigating this area, (b) discuss how art therapy and other creative arts therapies treated the biopsychosocial dimensions of chronic pain, and (c) identify challenges and future directions for research on this topic.
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The holistic aspect of stroke rehabilitation to include psychological well-being is currently neglected, with more emphasis placed on physical recovery despite anxiety and depression being common poststroke. From the limited amount of current literature, it seems that creative strategies such as art therapy (AT) can be beneficial in reducing isolation and anxiety among stroke patients. Stroke patients (able to consent) in a hospital rehabilitation unit were invited to participate in two weekly AT sessions for 6 weeks, facilitated by an art psychotherapist using paints, crayons, clay, a camera and an iPad. Hospital anxiety and depression scales (HAD) and therapy outcome measures (TOM) were measured at the beginning and end of the study. Six male patients were recruited, average age 69 years (38-85). Group discussions allowed patients to express openly feelings of frustration as well as hope for physical and emotional recovery: 'fight like a ferret', an expression used by a group member. The group produced several art objects and photographic images that were collated using stop-frame animation to produce a 10 min film. Median HAD score for the group was eight points upon entering the study and six points on finishing the study. There is little attention to the emotional needs of stroke patients in rehabilitation. Properly designed research studies exploring the role of AT in addressing anxiety and depression poststroke are needed. Our study showed that AT was a feasible intervention that helped patients explore the sequel of stroke in an open supportive environment.
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The experience of pain presents a complex interaction of neurological, emotional, cognitive, social, and cultural factors. A major public health concern, chronic back pain calls for adapted, short-term approaches as chronic patients may find lengthy assessments or long-term treatment a burden. An art therapy relational neurobiology (ATR-N) brief assessment protocol is proposed that demonstrates advantages for the assessment of the multiple psychosocial dimensions of pain experiences. As pain experiences are experienced in the body non-verbal visual approaches are often used for the assessment of pain. The shared neuropathways of sensory pain and emotional experiences suggest the advantages of employing a non-verbal sensory assessment and treatment approach. The sequential visual expressions of sensory, emotional, and cognitive pain assist in revealing coping skills and the potential for symptom reduction. Interpersonal neurobiology perspectives of the art from a protocol of a woman suffering from back pain further demonstrates how the interface of stress responses and adult attachment styles affect each individual's unique pain experiences. Understanding the shared neuropathways of pain also suggests the value of including attuned interpersonal interventions such as supportive witnessing of the art making. The role of strengths, such as awareness and creativity, in mitigating pain experience are underscored in the protocol's structure. Finally, the protocol approach holds the potential for future development of reliable art therapy measures of change providing a framework for advancing ATR-N research and clinical approaches.
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The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity. Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom Questionnaire and a measure of Type D personality traits. Postoperative cardiac morbidity was confirmed after surgery during the index hospitalization and included stroke,renal failure, ventilation>24 h, deep sternal wound infection, reoperation, arrhythmia and 30-day mortality at any location (n=59, 37.3% of total). After adjustment for age, recent myocardial infarction, heart failure, hypertension, urgency of surgery and time spent on cardiopulmonary bypass generalized anxiety disorder was associated with cardiac morbidity (odds ratio [OR]=3.26, 95% confidence interval [CI] 1.10-9.67, p=0.03). Adjusted analysis of personality traits revealed the NA component of Type D personality was associated with cardiac morbidity (OR=1.07, 95% CI 1.01-1.14, p=0.03). The Mood and Anxiety Symptom Questionnaire subscales were not associated with increased morbidity risk. Affective disorders, affective phenotypes, and personality traits were differentially associated with post-cardiac surgery morbidity outcomes independent of cardiac surgery morbidity risk factors. Concurrent investigation of depression and anxiety with respect to cardiac outcomes warrants further research.
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This study was to objectively assess the effect of music therapy on patients with advanced disease. Two hundred patients with chronic and/or advanced illnesses were prospectively evaluated. The effects of music therapy on these patients are reported. Visual analog scales, the Happy/Sad Faces Assessment Tool, and a behavior scale recorded pre- and post-music therapy scores on standardized data collection forms. A computerized database was used to collect and analyze the data. Utilizing the Wilcoxon signed rank test and a paired t test, music therapy improved anxiety, body movement, facial expression, mood, pain, shortness of breath, and verbalizations. Sessions with family members were also evaluated, and music therapy improved families' facial expressions, mood, and verbalizations. All improvements were statistically significant (P<0.001). Most patients and families had a positive subjective and objective response to music therapy. Objective data were obtained for a large number of patients with advanced disease. This is a significant addition to the quantitative literature on music therapy in this unique patient population. Our results suggest that music therapy is invaluable in palliative medicine.
Article
This study examined expressions of distress and changes in self-perception in women who had breast cancer, in self-figure drawings. The Machover Draw-A-Person test was administered to 70 survivors twice: first they were asked to draw themselves today, then they were asked to draw themselves as they had seen themselves pre-illness. The expressions in self- figure drawings were compared using seven indicators: breasts, hair, body outline, lower body, mouth, eyes, head outline. The findings indicated differences in self-perception pre-post cancer by three drawing indices: hair (short, shaggy), body outline (double, bold) and eyes (dots, hollow, shaded), which express disillusionment and connection to self, accompanied by signs of distress, anxiety, and damage to self-esteem and sense of femininity. In conclusion, we will demonstrate that the projective tool tested could be used as an aid for structuring supportive care to alleviate the distress of such women as part of a rehabilitation program.
Article
Background: Mindfulness-based art therapy (MBAT) induces emotional relaxation in cancer patients and is a treatment known to improve psychological stability. The objective of this research was to evaluate the treatment effects of MBAT for breast cancer patients. Methods: Overall, 24 breast cancer patients were selected as subjects of the study. Two groups, the MBAT group and control group with 12 patients each, were randomly assigned. The patients in the MBAT group were given 12 sessions of treatments. To measure depression and anxiety, low scales of the personality assessment inventory (PAI) was used. Health-related quality of life was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTCQLQ-C30). The treatment results were analyzed using analysis of covariance (ANCOVA) and two-way repeated measures analysis of variance (ANOVA). Results: The results showed that depression and anxiety decreased significantly and health-related quality of life improved significantly in the MBAT group. In the control group, however, there was no significant change. Conclusions: MBAT can be seen as an effective treatment method that improves breast cancer patients׳ psychological stability and quality of life. Evaluation of treatment effects using program development and large-scale research for future clinical application is needed.
Article
Background: Depression is associated with increased mortality amongst patients with chronic heart failure (HF). Whether depression is an independent predictor of outcome in patients admitted for worsening of HF is unclear. Methods: OPERA-HF is an observational study enrolling patients hospitalized with worsening HF. Depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D) questionnaire. Comorbidity was assessed by the Charlson Comorbidity Index (CCI). Kaplan-Meier and Cox regression analyses were used to estimate the association between depression and all-cause mortality. Results: Of 242 patients who completed the HADS-D questionnaire, 153, 54 and 35 patients had no (score 0-7), mild (score 8-10) or moderate-to-severe (score 11-21) depression, respectively. During follow-up, 35 patients died, with a median time follow-up of 360days amongst survivors (interquartile range, IQR 217-574days). In univariable analysis, moderate-to-severe depression was associated with an increased risk of death (HR: 4.9; 95% CI: 2.3 to 10.2; P<0.001) compared to no depression. Moderate-to-severe depression also predicted all-cause mortality after controlling for age, CCI score, NYHA class IV, NT-proBNP and treatment with mineralocorticoid receptor antagonist, beta-blocker and diuretics (HR: 3.0; 95% CI: 1.3 to 7.0; P<0.05). Conclusions: Depression is strongly associated with an adverse outcome in the year following discharge after an admission to hospital for worsening HF. The association is only partly explained by the severity of HF or comorbidity. Further research is required to demonstrate whether recognition and treatment of depression improves patient outcomes.
Article
Background: The aim of this study is to evaluate the prevalence of depressive symptoms (DS) and its relation on hospitalization for cardiovascular (CV) causes and all-cause mortality risk among outpatients with HF. Methods: A prospective study was conducted on 130 adult outpatients with HF. The Beck Depression Inventory Scale-second edition (BDI-II) was used to screen for DS. All-cause mortality and hospitalization for CV causes were registered over 6 years. Logistic regression and multinomial logistic regression analysis were used to evaluate the independent prognostic value of DS on mortality and hospitalization for CV causes after adjustment for clinical risk factors. Results: During a mean follow-up of 6 years, 44% of patients were classified as having DS. Sixty-two participants died for all causes, representing 61% of those with DS and 37% of those without (p=0.006); Forty-nine participants (38%) were hospitalized for CV causes, representing 49% of those with DS and 29% of those without (p=0.027). Logistic regression analysis indicated that DS predicted all-cause mortality (OR: 2.905; 95% CI:1.228-6.870; p=0.006) and multinomial logistic regression indicated that DS were predictive of hospitalization for CV causes (OR: 3.169; 95% CI: 1.230-8.164; p=0.027). These associations were independent of conventional risk factors. Limitations: Only outpatient sample; measure of DS only at baseline; cause of death was not known. Conclusion: This study, first held in a portuguese population, showed that DS are independent predictors of death and hospitalization for CV causes among HF patients and its impact persists over 6 years.
Article
This study identified decreased distress after art therapy in a proxy pretest study with a convenience sample of 73 patients being treated for cancer. Art therapy outcomes from 4 settings (oncology unit, infusion clinic, individual sessions, and open studio) were measured via the self-report Distress Thermometer, which was collected as part of an ongoing hospital evaluation of the art therapy program. Results indicated decreased patient distress following art therapy, and the art therapy open studio showed the largest mean decrease for stress post-art therapy.
Article
Background: Heart failure (HF) is a major healthcare problem contributing significantly to hospital admission stays and National Health Service (NHS) spending. Reducing length of hospital stay (LoS) in HF is paramount in reducing this burden and is influenced by factors relating to the condition, sociodemographics and comorbidities. Psychiatric comorbidities are being increasingly identified amongst HF patients but their impact on LoS has not been studied in the UK. Methods: We investigated the impact of psychiatric comorbidities on LoS amongst 31,760 HF patients admitted to hospitals in North England between 1st January 2000 and 31st March 2013 from the ACALM (Algorithm for Comorbidities, Associations, Length of stay and Mortality) study. The ACALM protocol uses ICD-10 and OPCS-4 coding to trace HF patients, psychiatric comorbidities and demographics including LoS. Results: Amongst 31,760 HF patients mean LoS in the absence of psychiatric comorbidities was 11.2days. The presence of a psychiatric comorbidity increased LoS by 3.3days. Logistic regression accounting for age, gender and ethnicity showed that LoS was significantly longer in patients suffering from depression (3.4days, p<0.001), bipolar disorder (8.8days, p<0.001) and all types of dementia (4.2days, p<0.001). Conclusions: Our results demonstrate that psychiatric comorbidities have a significant and clinically important impact on LoS in HF patients in the UK. Clinicians should be actively aware of psychiatric conditions amongst HF patients and manage them to reduce LoS and ultimately the risk for patients and financial burden for the NHS.
Article
Objective: Although death or readmission shortly after hospital discharge is frequent, identifying inpatients at higher risk is difficult. We evaluated whether in-hospital depressive symptoms (hereafter "depression") are associated with short-term readmission or mortality after discharge from medical wards. Methods: Depression was assessed at discharge in a prospective inpatient cohort from 2 Canadian hospitals (7 medical wards) and defined as scores ≥11 on the 27-point Patient Health Questionnaire (PHQ-9). Primary outcome was all-cause readmission or mortality 90days postdischarge. Results: Of 495 medical patients [median age 64years, 51% women, top 3 admitting diagnoses heart failure (10%), pneumonia (10%) and chronic obstructive pulmonary disease (8%)], 127 (26%) screened positive for depression at discharge. Compared with nondepressed patients, those with depression were more frequently readmitted or died: 27/127 (21%) vs. 58/368 (16%) within 30days and 46 (36%) vs. 91 (25%) within 90days [adjusted odds ratio (aOR) 2.00, 95% confidence interval 1.25-3.17, P=.004, adjusted for age, sex and readmission/death prediction scores]. History of depression did not predict 90-day events (aOR 1.05, 95% CI 0.64-1.72, P=.84). Depression persisted in 40% of patients at 30days and 17% at 90days. Conclusions: Depression was common, underrecognized and often persisted postdischarge. Current symptoms of depression, but not history, identified greater risk of short-term events independent of current risk prediction rules.
Article
Purpose Anxiety and depression are frequent comorbidities in people with epilepsy (PWE), but possible gender differences are often neglected. The aim of the present study was to analyze if men and women with epilepsy differ with regard to anxiety and depressive symptoms and to identify possible predictors. Methods Adult consecutive PWE (N = 302; 53% women) completed self-report questionnaires, including the depression module of the Patient Health Questionnaire (PHQ-9), the anxiety module of the Hospital Anxiety and Depression Scale (HADS-A) and the subscales "medication effects" and "seizure worry" of the Patient-weighted Quality of Life in Epilepsy Inventory-31-P (QOLIE-31-P). Results There was no gender difference in extent of anxiety (p =.532), which was mainly due to higher anxiety levels in men compared to the general population. The gender difference in depressive symptoms was significant (p =.009), with female patients being more affected. The most important predictors for anxiety and depressive symptoms were detrimental effects of medication (QOL medication effects) and of seizure worry (QOL seizure worry). Moreover, these predictors were more closely associated with anxiety and depressive symptoms in men. Conclusion Future intervention studies could show whether providing more information about the illness and medication effects may improve anxiety and depression. Our results suggest that such interventions should be tailored to the different needs of men and women.
Article
Introduction: Surgery is a major stress factor for patients, and is associated with significant anxiety or depression. The Hospital Anxiety and Depression Scale is one of the most common instruments used for assessment of patients' psychological stress. Here, we aimed to identify predictors of anxiety and depression in surgical inpatients. Methods: The study group consisted of consecutive two-hundred patients who completed the Hospital Anxiety and Depression Scale questionnaire. A patient scoring more than cut-off values (10 for anxiety and seven for depression) was considered as being at risk of anxiety or depression. Demographical data, socioeconomic status, education level and diagnoses were recorded. The Chi-square, Fisher's exact, Mann-Whitney, Kruskal-Wallis tests and binary logistic regression analysis were used to identify the predictive parameters for anxiety and depression. Results: It was found that female patients, patients older than 35 years, patients with low socioeconomic status and low education level had a relatively higher risk of anxiety. In addition, patients with low education and a hospital stay greater than seven days were at risk of depression. Logistic regression analysis revealed that socioeconomic status and education level were strongly predictive for anxiety. However, presence of anxiety was shown to be strongly predictive for depression. Conclusion: Healthcare providers should be aware of their patients' psychology and, therefore, it is recommended to consider predictive factors for anxiety and depression.
Article
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.
Article
This randomized controlled clinical trial explored the feasibility of implementing a fast-acting mandala intervention to reduce physical pain and psychological anxiety experienced during needle sticks. Forty pediatric patients participated in this two-group study: 20 participants created a mandala on an iPad (Treatment Group) and 20 participants received standard care treatment (Control Group). Results indicated clinical feasibility of using the mandala during needle sticks. Physiological stress behaviors were significantly reduced in the Treatment Group, p = .03, compared with the Control Group. Psychological anxiety decreased significantly in Treatment Group participants, p = .04. These findings support the use of mandalas created on an iPad with pediatric patients undergoing acute pain procedures.
Article
The reach of art therapy in assisting a hospice patient in confronting existential issues at the end of life is illustrated in this article with a case that took place over the course of 22 semiweekly sessions. Painting with an art therapist allowed the patient to shift from a state of anxiety and existential dread to a more accepting, fluid awareness of the dying process. Additional benefits to the patient included improved quality of life, self-expression, and meaning making, as well as an increased ability to relate to the art therapist and to connect with family members and staff. The case illustrates the power of art, art therapy, and the therapeutic relationship in coping with end-of-life issues and concerns.
Article
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.
Article
Common symptoms reported by cancer patients include pain, fatigue, breathlessness, insomnia, lack of appetite, and anxiety. A study conducted by an interdisciplinary research team (Nainis et al., 2006) demonstrated statistically significant reductions in these cancer symptoms with the use of traditional art therapy methods. The study found a strong correlation between the use of art therapy and a significant decrease in tiredness and anxiety. This paper reflects on the author's participation as the art therapist who conducted the art therapy interventions used in the study. It considers approaches to art therapy interventions for cancer survivors and their particular needs relative to the creative process and symptom management. The paper also discusses the question of why some cancer patients refuse art therapy when it is offered to them on the inpatient unit.
Article
While art therapy in cancer care has been documented for over 60 years, there remains a lack of awareness of art therapists within the UK cancer workforce. The study addressed this knowledge gap. This cross-sectional mixed-methods survey used web-based questionnaires for art therapists and service users, and semi-structured interviews with service users. The sampling frame covered England, Scotland, Wales and Northern Ireland; data collection occurred in May-July 2011. Inclusion criteria were cancer, art therapy experience and an age of at least 18 years. Art therapists had to be registered with the Health and Care Professions Council. Therapists' questionnaires used the cancer care pathway and NICE four levels model of psychological difficulties. Thirty-two art therapists and 55 service users participated. Service users found art therapy helpful (92%), agreeing that it benefited coping, aided communication, facilitated expression of feelings, provided new perspectives and assisted distraction from worries. Thematic analysis identified five themes: accessibility; mental wellbeing; creativity; support; and multiple perspectives. Art therapists are part of the UK cancer workforce, contributing their services from diagnosis to end of life. Service users confirmed the psychological importance of art therapy. The non-verbal, embodied, aesthetic aspects of art therapy provide a distinctive addition to verbal psychosocial support.
Article
Art therapy research is beginning to identify more precisely the active ingredients that produce change in treatment and to test commonly held assumptions about efficacy. This editorial discusses the progression from clinical observation to single-case research and randomized controlled trials in building an evidence-based model of art therapy.
Article
Art therapy in psycho-oncology is gaining increasing importance, but systematic evaluations of its effects are rare. The aim of this study is to investigate the effects of an art therapy intervention for cancer patients in ambulant aftercare on psychological distress and coping. The intervention consisted of 22 sessions. At three points of measurement (t1: before intervention, t2: following intervention, t3: 6 months after t2), participants responded to questionnaires (Freiburg Questionnaire on Coping with Illness, Perceived Adjustment to Chronic Illness Scale, Hospital Anxiety and Depression Scale). A group of haemato-oncological patients served as the comparison group (CG). Pre-post comparisons and analyses of variance were applied for statistical analysis. Relevant confounders were controlled. Fifty-four patients (intervention group, IG) with various cancer diagnoses completed the intervention. One hundred and twenty-nine data sets were available for the CG. Analyses of variance included group membership (IG vs. CG) and the following factors: gender, other psychosocial help and major life events. None of these variables was a predictor for changes in depression, anxiety and coping. Therefore, we could not prove intervention effects over time. Our results contradict those of preliminary studies and raise important questions. Further work on evaluating art therapy is necessary to explore which intervention concepts in which setting at which treatment stage show significant effects. Therefore, controlling for relevant confounders is needed.
Article
Children with epilepsy are at risk for numerous psychological and social challenges. We hypothesized that art therapy focus groups would enhance the self-image of children and adolescents with epilepsy. Sixteen children with epilepsy, ages 7-18 years, were recruited from pediatric neurology clinics at the University of Wisconsin to participate in four art therapy sessions. Pre-group assessments included psychological screens (Piers-Harris Children's Self-Concept Scale; Childhood Attitude Toward Illness Scale; Impact of Childhood Neurologic Disability Scale) and art therapy instruments (Formal Elements Art Therapy Scale; Seizure Drawing Task; Levick Emotional and Cognitive Art Therapy Assessment). Developmental levels of drawings were significantly below age-expected standards. Following completion of focus groups, a repeat Childhood Attitude Toward Illness Scale showed no differences between pre- and post-test scores on any measure of this scale. However, subjects and parents were uniformly positive about their group experiences, suggesting a qualitative benefit from participation in art therapy focus groups.
Article
The purpose of this paper is to describe the music therapy program at the Harry R. Horvitz Center for Palliative Medicine, to present different music therapy interventions that are used with individuals who have terminal illnesses, and to introduce initial findings from a pilot study of the effects of music therapy on an inpatient palliative medicine unit. For the first time, a computerized database has been designed to evaluate clinical practice by tracking music therapy intervention effectiveness on common symptoms. Measurement techniques included visual analogue scales and behavioural observation. Music therapy was shown to have a significant effect on common symptoms in advanced cancer patients, suggesting that it should be included in palliative medicine programs as an adjunct to symptom treatment.
Article
Cancer patients are particularly vulnerable to depression and anxiety, with fatigue as the most prevalent symptom of those undergoing treatment. The purpose of this study was to determine whether improvement in depression, anxiety or fatigue during chemotherapy following anthroposophy art therapy intervention is substantial enough to warrant a controlled trial. Sixty cancer patients on chemotherapy and willing to participate in once-weekly art therapy sessions (painting with water-based paints) were accrued for the study. Nineteen patients who participated in > or =4 sessions were evaluated as the intervention group, and 41 patients who participated in < or =2 sessions comprised the participant group. Hospital Anxiety and Depression Scale (HADS) and the Brief Fatigue Inventory (BFI) were completed before every session, relating to the previous week. BFI scores were higher in the participant group (p=0.06). In the intervention group, the median HADS score for depression was 9 at the beginning and 7 after the fourth appointment (p=0.021). The median BFI score changed from 5.7 to 4.1 (p=0.24). The anxiety score was in the normal range from the beginning. Anthroposophical art therapy is worthy of further study in the treatment of cancer patients with depression or fatigue during chemotherapy treatment.
Touch painting: An art therapy intervention on anxiety in older adults
  • C M Ezell
Ezell, C. M. (2017). Touch painting: An art therapy intervention on anxiety in older adults., 2017-05712-021.