Review: systematic review of effectiveness of art psychotherapy in children with mental health disorders

When Attempts to Help Backfire: Psychosocial Interventions that May Inadvertently Prolong Anxiety Among Youth

Anxiety disorders are among the most common and impairing mental health conditions in children and adolescents. Although exposure-focused cognitive behavioral therapy (CBT) is a well-established treatment for this population based on decades of psychological science, many available psychosocial interventions are not based on this strong empirical foundation. In some cases, interventions for youth with anxiety disorders have the potential to maintain anxiety in the long run. Grounded in a well-developed cognitive-behavioral theoretical frame, this commentary aimed to discuss popular and emerging psychosocial interventions for anxious youth that may inadvertently prolong anxiety. We argue that (1) although the availability of gold-standard CBT (with an adequate focus on exposure therapy) appears to be increasing, it continues to be difficult to access for many youth, (2) several available interventions prescribe avoidance-based strategies that do not enable a child to experience self-efficacy building and corrective learning experiences related to their fears or anxieties, thereby potentially maintaining anxiety in the long-run, and (3) several available interventions are not based in any clear, empirically-supported theoretical frame or evidence base, and thus have unclear benefits for anxiety. In a time when there is increasing alarm about anxiety disorders among youth, building systems that can support tried-and-true interventions based on strong science is of utmost importance. Future research, intervention deployment, and policy efforts should pay more attention to the harms that could arise from psychosocial interventions.

The effectiveness of combining interactive media based cognitive behaviour therapy with art and music therapies for ameliorating the generalised anxiety disorder of children exposed to abduction

The researchers examined the efficacy of integrating interactive media-based cognitive behaviour in conjunction with art and music therapy for treating generalised anxiety disorder (GAD) in children abducted in Nigeria. A randomised control trial was carried out using three randomly selected secondary schools in Northern part of Nigeria. The study sample comprised 450 students randomly divided into a control group of (n = 225) and an experimental group of (n = 225). The treatment group was randomly selected into (n = 56) each for cognitive behaviour, art, and music therapy. While CBT + art and music had (n = 57) participants. This study's finding shows that cognitive behaviour therapy combined with art and music delivered through interactive media may be superior for treating paediatric GAD, than using only either CBT, art or music therapy. Participants who were assigned to a combined therapy that involved integrating CBT, music and art therapies reported a lower level of GAD, compared to those who were assigned to either CBT, art, or music alone. However, a cost benefit analysis points to the adopting of CBT in treating the GAD of children kidnapped. This study concluded with some implication for theory and health promotion.

Active Visual Art Therapy in the General Hospital: Facts and Challenges from an Ethical Perspective

For decades, art in its many forms has been used to improve patients' quality of life and mental health. A growing amount of literature has shown the effectiveness of active visual art therapy (AVAT) on different patient outcomes and highlighted the need for international collaboration and harmonization of research methods. Evidence regarding AVAT inside the general hospital is still limited. This context poses unique challenges in terms of feasibility, heterogeneity, settings, and type of participants, together with significant ethical implications in terms of humanization of care. This narrative review aimed to report the available data on the effectiveness of visual art therapy in the general hospital and discuss them through the lens of the key bioethical principles of autonomy, beneficence, non-maleficence, and justice introduced by Childress and Beauchamp. Current evidence supports the effectiveness of AVAT on children and adult inpatients' outcomes, particularly in the areas of pain control, anxiety, and depression, therefore supporting the individual's autonomy and beneficence. With regard to justice and equity, AVAT proved to be a safe and cost-effective adjunct intervention to medical management inside the hospital. A more in-depth understanding of the ethical aspects implied in using AVAT in the general hospital may add a further contribution to the implementation of art interventions in patient-centered care.

Protocol to implement and evaluate a culturally secure, strength-based, equine-assisted learning program, "Yawardani Jan-ga" (horses helping), to support the social and emotional wellbeing of Australian aboriginal children and young people

Australian Aboriginal people experience stressors from inequalities across crucial social determinants, including deep and entrenched disadvantage and exclusion. The impact of unaddressed historical issues is pervasive and intergenerational. The disproportionate rates of Aboriginal youth suicide, juvenile detention and imprisonment highlight the inadequacy of existing social and emotional wellbeing programs and services for Aboriginal children and young people. There is increasing recognition in Australia that aligning social and emotional wellbeing interventions with Western values and conceptions of mental health is one of the main barriers to service uptake among Aboriginal people. This suggests fundamental questions remain unanswered about what type of services effectively address the complex constellation of social-emotional and wellbeing challenges arising from intergenerational poverty and trauma. Yawardani Jan-ga is an Aboriginal-led, operated, culturally secure, Equine-Assisted Learning (EAL) project designed by and with local Aboriginal young people, community Elders, members, and experts to address the complex constellation of social-emotional, spiritual and wellbeing needs of Aboriginal children and young people, aged 6-26 years, across multiple communities in the Kimberley region of Western Australia. EAL is a strengths-based learning approach where participants work with horses' inherent characteristics to learn transferable life skills, such as communication skills, self-awareness, and emotional regulation, to promote social and emotional growth and wellbeing. Although EAL has been previously used with Aboriginal children and young people internationally, they are yet to be widely used with Aboriginal people in Australia. Here, we describe the three subcomponents of the Yawardani Jan-ga implementation science project and the planned Participatory Action Research and phenomenological approaches to capture the distinctive experiences of participants and the local communities where the intervention is implemented. We anticipate that findings will build an evidence base that informs policy and practice by understanding key intervention elements of social and emotional wellbeing support for Aboriginal youth, how to incorporate Aboriginal worldviews across different stages of interventions, and how to capture impact best using culturally secure methods.

Art therapy to control nail biting using a cognitive behavioral approach through new innovative game and animation

BACKGROUND

Nail biting is categorized as a habitual behavior, commonly observed in children and occasionally in adults. This disorder occurs unconsciously, with individuals often unaware of their behavior. Since there are physical and psychological complications and quality of life problems in nail -biting, addressing this problem is very important and there are many theories in support of art therapy including: psychodynamic; humanistic (phenomenological, gestalt, person centered); psycho-educational (behavioral, cognitive behavioral, developmental); systemic (family and group therapy); as well as integrative and eclectic approaches. Art therapy, applied through various methods, serves as a strategy for habit modification. This study evaluates the impact of art therapy as a game and animation on controlling nail biting.

METHODS

The research was conducted as a single-group clinical trial, assessing participants before and after the intervention without a control group. The sample size was 14 participants, picked by the convenience technique. All students were referred to a counseling service center for nail-biting management. Seven girls and seven boys aged 9-12 participated in this study. Initially, the children were medically examined to confirm their physical well-being. Subsequently, assessments were made regarding parenting styles and anxiety levels, followed by baseline measurements and documentation of nail-biting frequency prior to the counseling intervention. Considering the importance of family support in empathizing with the child and the role of loneliness and anxiety in nail biting, two questionnaires (Goodenough's Draw-a-Man Test and Baumrind's Parenting Style Inventory) have been used for this study. A game and animation that increases self-awareness skills and reveals the cognitive error of the false pleasure of nail biting for the child, as well as alternative preventive behaviors are used in this study. Parents and children were then instructed as to how to use the new games and animations created for this purpose as part of the counseling sessions to address nail biting. The frequency of nail biting was monitored throughout the study, and finally, the data were subjected to a statistical analysis. It should be said that not having a control group in this research is one of the limitations of the study.

RESULTS

The results indicated a remarkable improvement in nail biting frequency following the introduction of the games, demonstrating a significant reduction in the behavior. The findings showed that the total number of times of nail biting in the group increased from 149 times a day at the beginning of the study to 20 times a day at the end of the intervention, and it actually shows an 86 percent decrease in the habit of nail biting in the group.

CONCLUSION

Given the effectiveness of the art therapy intervention in curbing nail biting, it is recommended that future research be conducted as a controlled clinical trial with parallel groups and a larger sample. Additionally, at the beginning of studies related to art therapy and habitual behavioral disorders, it is better to measure children's life skills, including self-awareness, problem-solving skills, and creative thinking. Dealing with various tools and methods of art therapy in a comparative manner is another research need in the future because it provides a suitable structure for digital and internet-based services and finally artificial intelligence in this field.

Effect of three group interventions on psychosocial functioning in adolescents exposed to interpersonal violence in Chile: A pilot clinical trial

BACKGROUND

In Chile demand for specialist care following exposure to interpersonal violence (IPV) in youth far exceeds capacity. Group interventions may improve access to care for youth.

OBJECTIVE

To evaluate the effectiveness and acceptability of two low-intensity group interventions: Trama Focused Cognitive Behavioral Therapy (TF-CBT); Interpersonal Psychotherapy (IPT); and treatment as usual, Art therapy-based support (ATBS). Outcomes measured were post-traumatic stress symptoms, depression, interpersonal functioning and affect regulation.

PARTICIPANTS AND SETTING

Participants were 67 Chilean youth aged 13-17 years, victims of IPV on a waiting list to receive specialist individual intervention.

METHODS

Using a randomised controlled trial design, participants were randomly assigned to one of the interventions. Self-report measures were completed at 5 timepoints between baseline and follow up eight weeks after intervention ended. Dropout rates and attendance were also analysed.

RESULTS

TF-CBT showed significant decreases for PTSD (d = 0.91) and depression (d = 0.77) symptoms, sustained at follow-up with affect regulation problems also showing significant decrease from baseline (d = 0.43). IPT showed significant decreases in PTSD symptoms (d = 0.64) and affect regulation problems (d = 0.66), both sustained at follow-up. ATBS showed statistically significant decrease for PTSD (d = 0.79) and interpersonal problems (d = 0.65) but only change in PTSD was sustained at follow-up. There were no significant differences in dropout or attendance between the interventions.

CONCLUSION

Group interventions provide a viable and effective first-phase option for reducing psychological distress in IPV-exposed youth in high-demand contexts. Effectiveness may be further improved through the more active involvement of parents and carers.

The use of creative art therapy to address the mental health of refugee adolescents: a systematic review

INTRODUCTION

Creative art therapy (CAT) has become increasingly popular as a means of promoting positive mental health among adolescent refugees when accompanied by interdisciplinary interventions that engage families and communities. In this pre-registered systematic review (PROSPERO: CRD42022372538), we evaluated and synthesized the available literature reporting the use of CAT as a diagnostic, treatment and mental health promotion intervention with adolescent refugees, aged 10-24 years.

METHODOLOGY

We conducted a systematic search of the grey and black literature published in English and Arabic between 2012 to 2022 on 10 databases.

RESULTS

Systematic database searches revealed 397 articles but only 5 met our inclusion criteria. These studies reported some positive outcomes but the evidence supporting the effectiveness of CAT as a diagnostic, treatment and mental health promotion intervention with adolescent refugees, aged 10-24 years is inconclusive.

CONCLUSION

The findings of this review point to the need for more methodologically robust studies that describe the intervention, implementation, and therapeutic approaches in greater detail to strengthen the evidence for the use of CAT with adolescent refugees.

Psychobiological responses to choir singing and creative arts activities in children and adolescents with mental disorders: results of a pilot study

BACKGROUND

Children and adolescents living with mental health problems often experience stress and poor mood states, which may influence their quality of life and well-being. Arts interventions may improve mood and well-being and reduce physiological stress in this vulnerable population.

METHODS

A cohort of patients in child and adolescent psychiatry (N = 42; age range: 12-18 years) participated in one of four arts activities including choir singing (n = 11), textile design (n = 9), drama (n = 16), and clownery (n = 6). They were led by professional artists and delivered through five consecutive 90-min daily afternoon sessions over the course of 1 week. Questionnaires of mood and saliva samples before and after each session served to assess short-term psychobiological changes. In addition, patients reported their quality of life and well-being at the beginning and at the end of the 1‑week program.

RESULTS

Results showed that alertness was significantly enhanced after textile design (∆post-pre = 4.08, 95% CI [0.77, 7.39]) and after singing (∆post-pre = 2.20, 95% CI [-0.55, 4.94]). Moreover, mood tended to be positively affected by textile design (∆post-pre = 2.89, 95% CI [-0.39, 6.18]). Quality of life increased significantly after singing (∆post-pre = 5.49, 95% CI [1.05, 9.92]). Arts participation except singing was associated with significant reductions in salivary cortisol (sCort) (textile design ∆post-pre = -0.81 ng/mL, 95% CI [-1.48, -0.14]; drama ∆post-pre = -0.76 ng/mL, 95% CI [-1.28, -0.24]; clownery ∆post-pre = -0.74 ng/mL, 95% CI [-1.47, -0.01]). No significant changes were observed for well-being over the whole program and salivary immunoglobulin A (sIgA) after any of the arts activities.

DISCUSSION

These results suggest that arts participation can improve mood state and reduce stress in young people with mental disorders, but there is a need for further studies.

Reimagining Narrative Approaches Through Comics for Systems-Involved Youth

Broadly speaking, the term "narrative" is defined as any account of connected events and experiences. Narrative is used in several therapeutic interventions within behavioral health. Narrative approaches can be an affirming process for the patient and can increase a therapist's understanding of their patients' perspectives.1 Unfortunately, there is a lack of medical education and training on narrative approaches, and these remain underutilized in clinical settings. Comics are an accessible medium of expression that can empower the voices of underrepresented individuals and communities.

Art therapy is associated with a reduction in restrictive practices on an inpatient child and adolescent mental health unit

BACKGROUND

The elimination of restrictive practices, such as seclusion and restraint, is a major aim of mental health services globally. The role of art therapy, a predominantly non-verbal mode of creative expression, is under-explored in this context. This research aimed to determine whether art therapy service provision was associated with a reduction in restrictive practices on an acute inpatient child and adolescent mental health services (CAMHS) unit.

METHODS

The rate (events per 1,000 occupied bed days), frequency (percent of admitted care episodes with incident), duration, and number of incidents of restrictive practices occurring between July 2015 and December 2021 were analysed relative to art therapy service provision. The rate, frequency and number of incidents of intramuscular injected (IM) sedation, oral PRN (as-needed medication) use, and absconding incidents occurring in conjunction with an episode of seclusion or restraint were also analysed.

RESULTS

The rate, frequency, duration, and total number of incidents of seclusion, the frequency and total number of incidents of physical restraint, and the rate, frequency and total number of incidents of IM sedation showed a statistically significant reduction during phases of art therapy service provision.

CONCLUSIONS

Art therapy service provision is associated with a reduction in restrictive practices in inpatient CAMHS.

The effects of art therapy interventions on anxiety in children and adolescents: A meta-analysis

OBJECTIVE

This study aimed to assess the effects of art therapy on anxiety among children and adolescents.

METHODS

We searched several databases, including PubMed, Web of Science, Embase (via Ovid), PsychINFO (through EBSCO), and The Cochrane Library, comprising the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials. Additionally, Chinese databases such as CNKI (China National Knowledge Infrastructure) and Wan Fang Data were explored from their beginnings until October 22, 2023. Studies that investigated the impact of art therapy on anxiety compared to a control group were included. The methodological quality of these randomized controlled trials was evaluated using the Cochrane Handbook's risk of bias instrument.

RESULTS

Six studies involving 422 participants were included. The findings indicated a notable decrease in anxiety symptoms due to art therapy, with a Standardized Mean Difference (SMD) of -1.42, 95% Confidence Interval (95%CI -2.33, -0.51), p < 0.002. Notably, there was pronounced heterogeneity, as evidenced by Tau2 = 1.41, Chi2 = 101.19, df = 6, and I² = 94%, with Z = 3.06.

CONCLUSION

Art therapy significantly improved the anxiety symptoms of children and adolescents, positioning it as an effective means of treating anxiety.

Psychological interventions for children with emotional and behavioral difficulties aged 5-12 years: An evidence review

In low- and middle-income countries (LMICs), children and families face a multitude of risk factors for mental health and well-being. These risks are even further exacerbated in humanitarian emergencies. However, access to effective mental health services in such settings is severely limited, leading to a large mental health treatment gap. Middle childhood (5-12 years) is a crucial period for human development during which symptoms of emotional distress often emerge, with one in three mental disorders developing prior to age 14. However, there is little evidence of effective psychological interventions for children in this developmental stage, and suitable for implementation within LMICs and humanitarian emergencies. We conducted this evidence review to inform the development of a new intervention package based on existing best practice for this age group, drawing insights from both global and LMIC resources. Our review synthesizes the findings of 52 intervention studies from LMICs and humanitarian settings; 53 existing systematic reviews and meta-analyses covering both LMICs and high-income countries, and 15 technical guidelines. Overall, there is limited high-quality evidence from which to draw recommendations for this age group; however, some promising intervention approaches were identified for children experiencing externalizing and internalizing symptoms, traumatic stress and a combination of difficulties. Several effective interventions utilize cognitive-behavioral techniques for children, in either group or individual format, and incorporate caregiver skills training into treatment, although the findings are mixed. Most evaluated interventions use specialists as delivery agents and are lengthy, which poses challenges for scale-up in settings where financial and human resources are scarce. These findings will inform the development of new psychological interventions for children in this age group with emotional and behavioral difficulties.

Cognitive behavior, art, and music therapies intervention for treating the depression of children: A randomized control trial

This study compared the effect of interactive media-based cognitive behaviour, art, and music therapies in reducing depression in children who survived abduction in Nigeria. A randomized control trial was conducted using three randomly selected secondary schools in Northern Nigeria. The study sample comprised 450 children randomly divided into a control group of (n = 225) and an experimental group of (n = 225). The treatment group was further divided into three groups; cognitive behavior (n = 75), art (n = 75), and music (n = 75) therapy, respectively. According to the findings of this study, cognitive behaviour, art, and music therapies via interactive media are a successful intervention technique for treating the depression of schoolchildren who survived abduction in Nigeria. However, compared to art and music therapy, cognitive behaviour therapy is more effective at treating depression. To lessen the depression of children who survived kidnapped in Nigeria, we recommend adopting cognitive behavioural therapy.

Effect of Audio-Visual-Based Art and Music Therapy in Reducing Adolescents Post Traumatic Stress Disorder

PURPOSE

Post-traumatic stress disorder (PTSD) is a severe anxiety disorder that can develop due to exposure to any event that may result in psychological trauma. This study compared the effect of interactive audio-visual-based art and music therapy in reducing post-traumatic stress disorder in adolescents who survived abduction in Nigeria.

METHODS

A quasiexperiment was carried out in two selected secondary schools in Northern Nigeria. The study sample comprised 470 students randomly divided into a control group of 235 and an experiment group of 235. The treatment group was further divided into art 118 and music 117 therapy groups, respectively.

RESULTS

Results suggest that interactive audio-visual art therapy and music therapy is an effective intervention strategy for reducing the PTSD of school adolescents that have experienced kidnapping in Nigeria. However, art therapy is more effective in reducing PTSD than music therapy.

DISCUSSION

We recommend the introduction of audio-visual-based music and art therapy to reduce the PTSD of adolescents that survived kidnapping in Nigeria. More focus should be made on art therapy, which is more effective in curtailing adolescents PTSD.

Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review

This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.

A randomized control trial establishing the effectiveness of using interactive television-based art, music, and poetry therapies for treating the post-traumatic stress disorder of children exposed to traumatic events

This study aimed to compare the effectiveness of interactive television-based music, art, and poetry therapies in reducing symptoms of posttraumatic stress disorder among school children who have experienced abduction. A randomized control trial was adopted using school children from three selected secondary schools in Northern Nigeria that have experienced the issue of kidnapping. The treatment is characterized by (1) group setting, (2) TV instruction (3) school collaboration, and (4) use of artistic mediation. The study sample comprised 470 students randomly divided into a control group of 235 and an experiment group of 235. The treatment group was further divided into art (N = 78), music (N = 78) and poetry (N = 79), respectively. Results suggest that interactive television art, music and poetry therapies are an effective intervention strategy for reducing the PTSD of school children who have experienced kidnapping in Nigeria. However, art therapy is more effective in reducing PTSD. This study has offered empirical evidence that could guide the planning and implementation of therapies aimed at assisting school children to recover from traumatic experiences.

Psychotherapeutic interventions for childhood posttraumatic stress disorder: an update

PURPOSE OF THE REVIEW

We review treatment outcome studies and systematic reviews for childhood and adolescent posttraumatic stress disorder (PTSD) between January 2020 and August 2022, including studies involving younger children and different treatment delivery methods and models. We address predictors, moderators, treatment engagement, and attrition.

RECENT FINDINGS

Recent randomised controlled trials corroborate earlier trials documenting trauma-focused cognitive behaviour therapy (TF-CBT) as a highly efficacious treatment for PTSD. Evidence for treatment effects in complex PTSD in youth is still sparse. Research on moderators and predictors of treatment continues to be hampered by multiple factors, including a lack of sufficiently large homogeneous trauma samples.

SUMMARY

TF-CBT is a very effective treatment for children and adolescents with PTSD. Further work is needed to (i) demonstrate that task-shifting models utilising lay community health counsellors and peer counsellors can effectively and cost-effectively close the mental health treatment gap that exists world-wide in children and adolescents diagnosed with PTSD, but particularly within low- and middle income countries, and (ii) better understand moderators and predictors of treatment which remains a priority.