The Bodymind Model: A platform for studying the mechanisms of change induced by art therapy

A scoping review of integrated arts therapies and neuroscience research

Introduction

This article provided a scoping review of the current state of the field for integrated arts therapies and neuroscience research. The main arts therapies modalities included in this review were: of arts therapies (i.e., drawing, painting, sculpting, bibliotherapy, cinema therapy, dance movement therapies, drama therapies, music therapies, neuroaesthetics, phototherapies, and poetry). The main objectives of this integrated arts therapies and neuroscience scoping review were to: (1) include multiple modalities of arts therapies, (2) summarize, synthesize, compare, and contrast populations, settings, presenting problems, methods, modalities, measures, and outcomes, (3) discuss implications, and (4) suggest future directions.

Methods

The design for this scoping review was conducted according to PRISMA-ScR and the JBI Scoping Review Manual standardized recommendations. Eligibility criteria included: English language, peer-review, integration of arts therapies and neuroscience, and use of research methodologies such as case studies, quantitative, qualitative, mixed methods, systematic or scoping reviews, and meta-analyses. Articles were gathered from two online databases (EBSCOHost and PubMed) using keywords, and review of articles from reference lists. Publications that met criteria were reviewed and charted for the following information: author, year of publication, sample size and characteristics, research design, data analyses, modality (i.e., intervention, treatment), and outcomes. This scoping review included 84 publications that met inclusion criteria, after the research team discussed to consensus.

Results

Outcomes suggested improvements in brain activity and integration, cognitive, affective, sensory, and social functioning, memory reconsolidation, psychological symptoms, affect, and behavior.

Discussion

Interpretations were limited in that most publications lacked directionality in their approach, were exploratory, and dependent on researcher assumptions, expertise, and access to instruments and populations. Therefore, more research is needed on each modality that upholds stronger research methodology, and can develop focus across researchers. While this scoping review was able to summarize and synthesize the state of the field, it is still too early to be able to compare outcomes or make more solid conclusions about specific neuroscientific processes and benefits for each individual modality. This body of knowledge provided valuable implications for the field and made suggestions for future directions.

Conceptualizing an antiracist framework for neuroscience research in art therapy: a qualitative pilot study

Introduction

Advances in social cognitive neuroscience research have contributed deeper understanding of neural processes relevant to art therapy, and of social, interrelational phenomena including racism and implicit bias. Confoundingly, emerging critical discourse about neuroscience research design highlighted systemic racism, implicit bias, and inequality perpetuated by imaging technologies, lack of diversity, and funding disparities. Emphasis toward antiracist practices within cognitive neuroscience research and various other fields has grown; however, literature on antiracist research practices within art therapy research is scant.

Methods

The purpose of this qualitative pilot research study was to elicit conceptualizations about antiracist research practices from art therapy researchers in response to relevant literature. Purposive sampling was used to recruit four female art therapy researchers from the United States (U.S.) and Europe. Semi-structured interviews were analyzed using grounded theory coding resulting in three main categories, seven themes, and subthemes. Member-checking and reflexive journaling were employed to enhance credibility.

Results

Core categories revealed points of convergence across participants, areas of concern, and requirements outlining antiracist research practices in art therapy. The first core category, shared beliefs and values, had three themes: neuroscience-informed perspective of art therapy; neuroscience research can strengthen art therapy theories; and infusion of antiracism and neuroscience into art therapy begins with education. The second core category, barriers and challenges, had two themes: potential credibility and legitimacy concerns for art therapy; and difficult conversations about disparities in awareness, diversity, and resources. The third core category, requirements and responsibilities for antiracist research, had two themes: due diligence to build accountability and legitimacy; and inclusion of diversity in art therapy research, and subthemes.

Discussion

Preliminary outcomes revealed ideas aligning current antiracist neuroscience research discourse with art therapy experimental research practices. The small group of neuroscience-focused art therapist researchers provided realistic considerations about amplifying discourse within the art therapy profession and infusing antiracist research into neuro-informed art therapy curriculum, and prioritizing diversity throughout experimental research design. An antiracist art therapy research framework with principles including education, intentionality, and diversity was proposed, along with recommendations for further research using the framework and to implement the framework into graduate art therapy education.

Changes in younger stroke survivors' body perception as indicated in body drawings: A comparison between Expressive Arts-based Intervention and control groups

Stroke-related deficits affect stroke survivors' perception of their bodies and possibly impede their progress in rehabilitation and well-being. This study adopted a pre-and post-test design to compare the changes in body perception among younger stroke survivors after participating in an 8-week Expressive Arts-based Intervention (EABI) (n = 32) with the control group (n = 30). Each participant partook in structured drawing interviews at baseline (T0) and 8-week follow-up/post-intervention (T1). The data were analyzed using content analysis. More EABI (n = 27) than control (n = 14) participants reported positive changes in body perception and applied lighter colours or created a more symmetrical drawing at T1. They shared that EABI promoted these positive changes by facilitating the reconnection with one's body and self. While some control participants experienced positive changes in body perception, others tended to apply darker colours or the same colour to show negative or no changes in body perception. More control (n = 8) than EABI (n = 3) participants reported negative thoughts about their bodies and negative influences from other individuals and the environment. The findings suggested that EABI can change stroke survivors' body perception. EABI can be considered one of the interventions that may help foster positive changes in body perception.

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.

The effectiveness of art-based interventions for cancer patients: A systematic review and meta-analysis

PURPOSE

This study aimed to examine the effectiveness of art-based interventions on anxiety, depression, fatigue, and overall quality of life (QoL), including its physical, psychological, and social dimensions in cancer patients.

METHODS

The literature search included all studies published up to March 2024. Searches were conducted in the MEDLINE, Web of Science, EBSCO, and PubMed databases considering the updated Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The quality of the studies was assessed using the Revised Cochrane Risk of Bias Tool (RoB 2) and the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) developed by the Cochrane Collaboration. Data were analysed using the MAJOR package in JAMOVI 2.3.28.

RESULTS

Fifteen studies conducted with 1113 cancer patients were identified and included in this study. Ten of the studies included women with breast cancer. The remaining studies involved chemotherapy patients with various cancers (n = 3), cancer patients in a blood and marrow transplantation unit (n = 1), and nasopharyngeal cancer patients (n = 1). Meta-analysis indicated that art-based interventions had a significant effect on anxiety, depression and physical aspects of QoL but no significant impact on fatigue, overall QoL, or the psychological and social dimensions of QoL.

CONCLUSIONS

This study provided clinical support for pursuing art-based research on anxiety, depression, and the physical QoL in cancer patients. However, the effect of art-based interventions on cancer patients' fatigue and their overall QoL, including its social and psychological dimensions, was insignificant.

REGISTRATION

The study protocol was registered in advance in the PROSPERO (CRD42024531397/April 13, 2024).

Using Drawings to Measure Emotional Processing in Breast Cancer Survivors and Its Association With Depression, Pain, and Fatigue

BACKGROUND

Conscious and unconscious emotional processing (EP) may be related to breast cancer survivors' (BCS) response to the stress of dealing with cancer and its treatment, and often entails myriad psychological and physical symptoms.

AIMS

To examine the relationship between EP expressed by BCS in drawings made during art therapy and its relationship with depression, pain, and fatigue.

METHODS

This cross-sectional secondary analysis used data from the Role of Emotional Processing in Art Therapy study. BCS (N = 81) answered self-report questionnaires measuring depression, pain, and fatigue at baseline. Their drawings were coded for EP using the Drawing-Based Emotional Processing Scale (DRAWEP).

RESULTS

Levels of depression, pain intensity and interference, and fatigue, were high, and a substantial percentage of participants were beyond the cutoff scores for severe symptoms. Controlling for background variables, EP subscales of making sense and organization were negatively associated with pain intensity, pain interference, and depression, but not with fatigue. These relationships are demonstrated with selected drawings.

CONCLUSIONS

Since drawing involves embodied processes and has the potential to capture latent aspects of EP, examining drawings can provide a means of investigating EP among BCS and its relationship to depression and pain and learn more about the emotional experiences of BCS.

IMPLICATIONS FOR PRACTICE

The DRAWEP can assist art therapists in increasing their awareness of EP, which may benefit their ability to identify women at risk. Moreover, this article can contribute to the development and enhancement of art therapists' awareness of EP.

How the arts heal: a review of the neural mechanisms behind the therapeutic effects of creative arts on mental and physical health

Background

The creative arts have long been known for their therapeutic potential. These modalities, which include dance, painting, and music, among others, appear to be effective in enhancing emotional expression and alleviating adverse physiological and psychological effects. Engagement in creative arts can be pursued as a personal hobby, in a classroom setting, or through a formal therapeutic intervention with a qualified therapist. Engagement can be active (i.e., creating) or passive (i.e., viewing, listening). Regardless of the modality and manner of engagement, the mechanisms explaining the therapeutic efficacy of creative arts remain poorly understood.

Objective

This study aims to systematically review research investigating the neurological mechanisms activated during active or passive engagement in creative arts, with a specific emphasis on the roles of the medial prefrontal cortex (mPFC) and the amygdala in emotional regulation (ER) and creative behaviors. The review seeks to provide preliminary evidence for the possible existence of common neural mechanisms underlying both phenomena, which could inform the development of targeted therapeutic interventions leveraging creative arts for ER.

Methods

A systematic review was conducted following the Cochrane Collaboration guideline and PRISMA standards to identify studies examining the neurological mechanisms underlying creative activities.

Results

A total of six out of 85 records meet the inclusion criteria, with all being basic research studies. Preliminary findings suggest that active and passive engagement with creative arts consistently activate neural circuits implicated in adaptive emotional regulation, including the mPFC and amygdala. These activations mirror the neural pathways engaged in effective ER strategies, suggesting the possible existence of shared mechanisms between creative expression and emotional processing.

Conclusion

The evidence underscores the potential of creative arts as a complementary therapeutic strategy alongside conventional care and other evidence-based mind-body modalities. By elucidating the shared neural mechanisms between creative arts engagement and ER, this review contributes to the theoretical and practical understanding of the role of creative arts in mental health. Future research is recommended to further explore these neural correlations and their implications for therapeutic practice.

Art therapy and neuroscience: evidence, limits, and myths

The evidence base for the effectiveness of art therapy continues to grow, even as a mechanistic understanding of how art therapy works remains limited. One promising avenue for increasing our understanding of how and why art therapy works is through the lens of neuroscience. A neuroscience-based approach to art therapy provides opportunities for improving understanding of the neural processes that underlie the complex interaction between perception, cognition, emotion and behavior that play out in the art therapy process. Understanding how therapeutic change occurs can result in improved treatment and better outcomes for clients. However, it can be tricky to connect art therapy and psychological theory directly to neural responses. The purposes of this perspective are to provide an overview of the current evidence and limits of neurobiological concepts of neuroplasticity, mirror systems, and interoception as applied to art therapy practice, and to provide updated information about outdated concepts that are still actively used in clinical practice. Critical analysis and understanding of the current scientific knowledge base can then be used to guide art therapy practice and support the development of hypothesis-based research to determine the primary mechanisms that drive the observed effects of art therapy interventions.

Power of a Few Vagrant Words: Effects of Direct and Indirect Suggestions for Self-Representation in Art-Based Online Interventions

This study compares two groups of university students with differing instructions participating in an object drawing task as a part of an art therapy-based self-help online intervention. The intervention aimed to help participants enhance positive mood and subjective feeling of self-control and reduce negative mood. The object task contained suggestive elements in the instructions similar to self-hypnosis with an indirect and a direct way of formulation. Quantitative (positive affect and negative affect scale and Self-Assessment Manikin scale) and qualitative methods (text and picture rating) were used to investigate the difference between the outcome effects on the two groups. The results found a significant decrease in negative mood for indirect suggestion, while a significant increase of positive mood for the direct suggestion condition. Based on qualitative analyses, findings indicated that hidden implications in the art-making instructions modified the chosen imaginary and emotional changes related to art-making. Suggestions in the instructions can make a difference in one's mood and this should also be considered while designing guidelines for self-hypnosis.

Meeting the multidimensional self: fostering selfhood at the interface of Creative Arts Therapies and neuroscience

Intriguing explorations at the intersection of the fields of neuroscience and psychology are driven by the quest to understand the neural underpinnings of "the self" and their psychotherapeutic implications. These translational efforts pertain to the unique Creative Arts Therapies (CATs) and the attributes and value of the self-related processes they offer. The self is considered as a multi-layered complex construct, comprising bodily and mental constituents, subjective-objective perspectives, spatial and temporal dimensions. Neuroscience research, mostly functional brain imaging, has proposed cogent models of the constitution, development and experience of the self, elucidating how the multiple dimensions of the self are supported by integrated hierarchical brain processes. The psychotherapeutic use of the art-forms, generating aesthetic experiences and creative processes, touch upon and connect the various layers of self-experience, nurturing the sense of self. The present conceptual analysis will describe and interweave the neural mechanisms and neural network configuration suggested to lie at the core of the ongoing self-experience, its deviations in psychopathology, and implications regarding the psychotherapeutic use of the arts. The well-established, parsimonious and neurobiologically plausible predictive processing account of brain-function will be discussed with regard to selfhood and consciousness. The epistemic affordance of the experiential CATs will further be portrayed, enabling and facilitating the creation of updated self-models of the body in the world. The neuropsychological impact of the relational therapeutic encounter will be delineated, acknowledging the intersubjective brain synchronization through communicative verbal and non-verbal means and aesthetic experiences. The recognition and assimilation of neuroscientific, phenomenological and clinical perspectives concerning the nested dimensionality of the self, ground the relational therapeutic process and the neuroplastic modulations that CATs have to offer on the premise of fostering, shaping and integrating selfhood.

Creative puppet therapy reduces hallucinations in patients diagnosed with schizophrenia: Preliminary findings

Anomalous experiences and hallucinations characterize schizophrenia. This study aimed at determining the efficacy of creative puppet therapy (CPT; creation of a puppet with malleable DAS) to reduce severe anomalous experiences and hallucinations among patients diagnosed with schizophrenia. Double-blinded, controlled trials were performed on a convenience sample of 24 patients from a mental health center. The intervention group of 12 patients (who created puppets) and the pseudo-treatment group of 12 patients (who were involved in outdoor leisure trips) were compared to the control group of 12 control participants (who created puppets). Cardiff Anomalous Perceptions Scale (CAPS) assessed hallucinations; Emotional Expression Inventory (EEXI) assessed the emotional expression of one's own puppet. Puppet facial features were measured. Results showed that CPT effectively reduced (d = -4.00) hallucination frequency in patients. Hallucination reduction occurred across all sensory modalities, but touch and bodily interoception. Exteroceptive vs. interoceptive hallucinations was the most valuable classification in patients. Compared to controls, puppets created by patients expressed more negative emotions and had larger eye diameters, shorter noses, and larger whole face width. Eye diameter was correlated with fear, sadness, anger, and disgust, and whole face width with boredom. Fragmented-self integration of schizophrenia through CPT treatment might exploit aggregative dominance of the patient's own body.

A Theoretical Model of Emotional Processing in Visual Artmaking and Art Therapy

Current theoretical models of emotional processing rely mainly on detecting emotional processing through verbal, conscious, and cognitive processes. However, artmaking can potentially reveal embodied and implicit processes that may otherwise remain hidden in verbal expression. This paper attempts to close the scholarly gap by introducing a novel art-based emotional processing model that integrates emotional processing and art therapy literature, incorporating emotional meaning-making, awareness, acceptance, and memory consolidation. The art-based EP model explains the processes through which art creation may benefit emotional processing. It also elucidates the ways in which art therapy can be used to enhance therapeutic outcomes.

Effectiveness of art therapy interventions for treating pain and anxiety in adolescents in the emergency department

OBJECTIVE

To evaluate the effectiveness of art therapy in reducing pain and anxiety in adolescents with painful conditions treated in the ED.

METHODS

We conducted a prospective pilot study of patients 12-18 years old presenting with a painful condition to a tertiary-care children's hospital ED. Primary outcome was pain intensity measured using the Verbal Numerical Rating Scale (scored 0-10); a decrease of ≥ 20% was clinically significant. Anxiety was measured using the short-form six-item State-Trait Anxiety Inventory (scored 20-80: 20-40 = zero-low anxiety; 41-60 = moderate anxiety; 61-80 = high anxiety); a change from higher to lower category was clinically significant. Outcomes were measured at baseline, immediately after, and 1 h after art therapy completion. A standardized interview was conducted immediately after art therapy completion.

RESULTS

We enrolled a convenience sample of 50 patients. Mean duration of art therapy was 34.7 min. Mean baseline pain was 6.2 and decreased by 23.2% (95% CI 14.9-31.5) and 28.6% (95% CI 9.2-48), immediately after and 1 h after art therapy completion, respectively. Mean baseline anxiety was 48 (moderate) and decreased to 38 (low) and 43 (moderate) at the same time points, respectively. Forty-eight patients (96%) reported feelings of relaxation, decreased pain intensity, and/or empowerment (e.g., "Very relaxing"; "I didn't feel as much pain"; "Really showed my emotions"; "A way to explain to doctors what I'm feeling and what parts hurt").

CONCLUSION

Art therapy may be associated with clinically significant decreases and qualitative improvements in pain and anxiety in adolescents with painful conditions being treated in the ED. This novel treatment may improve the holistic care of adolescents with painful conditions in the ED.

Effectiveness of creative arts therapy for adult patients with cancer: a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to assess the effectiveness of creative arts therapy (CAT) interventions on the health outcomes of adult patients with cancer.

METHODS

A comprehensive search was conducted in six databases from their inception to June 10, 2023, with no restrictions on sex, age, cancer type, cancer stage, or treatment type. The Cochrane Risk of Bias (RoB2) tool for randomized controlled trials (RCTs) and the equivalent tool for non-RCTs (ROBINS-I) were used to assess the risk of bias. Meta-analyses were conducted to pool estimates of the effects of CAT on patients' health-related outcomes. A narrative synthesis of outcomes was performed where meta-analysis was not appropriate.

RESULTS

A total of 25 studies (8 RCTs and 17 quasi-RCTs) involving 1489 cancer patients and survivors were included in the final data analysis. Most studies focused on patients with mixed cancer diagnoses who were undergoing active chemotherapy treatment. Most studies utilized painting, drawing, and/or sculpting as CAT interventions. The overall risk of bias in the included studies was moderate to high. Meta-analysis demonstrated a significant improvement in quality of life (SMD with 95% CI = 17.50, 10.05-24.95, P =.0000) and the social aspect of quality of life in cancer patients (SMD with 95% CI = 03.1 (0.06-0.55), P = .01), but no significant effects were found for depressive symptoms and coping strategies among patients who participated in CAT compared to control groups. Narrative analysis and non-RCTs suggested the potential of CAT in reducing levels of depression and anxiety, as well as improving self-image, hope, emotional expression/state, and processing in patients with cancer. However, inconsistent findings were reported regarding the effectiveness of CAT interventions on fatigue, spirituality, and psychosomatic distress/symptom intensity.

CONCLUSION

The findings indicated significant and potential benefits of CAT for individuals with cancer, primarily related to quality of life. However, caution is needed in interpreting these findings due to limitations in the methodologies utilized in the included studies. Further large-scale RCTs are needed to examine the effectiveness of CAT on health outcomes, particularly in relation to self-image, hope, and emotional expression/state and processing among patients with cancer or those in palliative care.

The effects of art-making intervention on mind-body and quality of life in adults with cancer: a systematic review and meta-analysis

PURPOSE

To investigate the effectiveness of art-making interventions on physical and psychological outcomes, as well as quality of life (QOL), in adult patients with cancer.

METHODS

Seven English-language databases (PubMed, Academic Search Premier, EMBASE, CINAHL, PsycINFO, The Cochrane Library, and Web of Science) and three Chinese-language databases (CNKI, WanFang, and VIP) were searched up to and including May 1, 2023. We used the Cochrane Risk of Bias tool 2.0 and the Risk of Bias in Non-Randomized Studies-of Interventions to evaluate the certainty of evidence. The data were analyzed using Review Manager software 5.4. The study protocol was registered with PROSPERO (CRD42022321471).

RESULTS

The studies predominantly focused on visual art (n = 21), two specifically used performing art (n = 2), and five integrated both forms of art-making (n = 5). The pooled results showed that art-making significantly improved anxiety (SMD =  - 1.12, 95% CI [- 1.43, - 0.81], p < 0.01), depression (SMD =  - 0.91, 95% CI [- 1.16, - 0.65], p < 0.01), distress (SMD =  - 1.19, 95% CI [- 1.43, - 0.95], p < 0.01), psychological well-being (SMD = 0.41, 95% CI [0.02, 0.80], p = 0.04), societal well-being (SMD = 0.29, 95% CI [0.04, 0.54], p = 0.03), nausea (SMD =  - 1.81, 95% CI [- 2.84, - 0.78], p < 0.01), physical well-being (SMD = 0.11, 95% CI [0.02, 0.20], p = 0.02), and QOL (SMD = 0.81, 95% CI [0.29, 1.33], p < 0.01). However, it did not significantly improve fatigue (SMD =  - 0.28, 95% CI [- 0.75, 0.19], p = 0.24) and pain (SMD =  - 0.18, 95% CI [- 1.97, 1.60], p = 0.84) in patients with cancer.

CONCLUSIONS

Art-making interventions may boost psychological well-being, physical symptoms, and QOL among patients with cancer. More robust studies are necessary to overcome methodological limitations and promote wider adoption of these interventions.

TRIAL REGISTRATION

Prospero registration number: CRD42022321471.

The impact of arts-inclusive programs on young children's mental health and wellbeing: a rapid review

BACKGROUND

This review evaluated the existing literature exploring the effects of arts-inclusive programs (AIPs) on the mental health and wellbeing of young children. AIPs include activities, programs, or interventions containing creative arts.

METHODS

Literature searches were conducted across three databases (SCOPUS, psycINFO, and ERIC). The search was restricted to studies reporting outcomes of children 0-6 years.

RESULTS

Nine studies were included in the review (3,671 participants). Three key themes were identified: music-related (n = 4); artmaking (n = 3); and storytelling/drama (n = 2). All included studies reported positive outcomes on children's wellbeing following engagement in AIPs.

DISCUSSION

This review found emerging evidence demonstrating positive impacts of arts engagement on the wellbeing of children aged 0-6. However, most studies were low quality and used varying outcome measures. The review is one of the first to highlight the lack of high-quality studies on the relationship between AIPs and wellbeing in young children.

Effects of relaxation interventions during pregnancy on maternal mental health, and pregnancy and newborn outcomes: A systematic review and meta-analysis

BACKGROUND

Stress during pregnancy is detrimental to maternal health, pregnancy and birth outcomes and various preventive relaxation interventions have been developed. This systematic review and meta-analysis aimed to evaluate their effectiveness in terms of maternal mental health, pregnancy and birth outcomes.

METHOD

The protocol for this review is published on PROSPERO with registration number CRD42020187443. A systematic search of major databases was conducted. Primary outcomes were maternal mental health problems (stress, anxiety, depression), and pregnancy (gestational age, labour duration, delivery mode) and birth outcomes (birth weight, Apgar score, preterm birth). Randomized controlled trials or quasi-experimental studies were eligible. Meta-analyses using a random-effects model was conducted for outcomes with sufficient data. For other outcomes a narrative review was undertaken.

RESULT

We reviewed 32 studies comprising 3,979 pregnant women aged 18 to 40 years. Relaxation interventions included yoga, music, Benson relaxation, progressive muscle relaxation (PMR), deep breathing relaxation (BR), guided imagery, mindfulness and hypnosis. Intervention duration ranged from brief experiment (~10 minutes) to 6 months of daily relaxation. Meta-analyses showed relaxation therapy reduced maternal stress (-4.1 points; 95% Confidence Interval (CI): -7.4, -0.9; 9 trials; 1113 participants), anxiety (-5.04 points; 95% CI: -8.2, -1.9; 10 trials; 1965 participants) and depressive symptoms (-2.3 points; 95% CI: -3.4, -1.3; 7 trials; 733 participants). Relaxation has also increased offspring birth weight (80 g, 95% CI: 1, 157; 8 trials; 1239 participants), explained by PMR (165g, 95% CI: 100, 231; 4 trials; 587 participants) in sub-group analysis. In five trials evaluating maternal physiological responses, relaxation therapy optimized blood pressure, heart rate and respiratory rate. Four trials showed relaxation therapy reduced duration of labour. Apgar score only improved significantly in two of six trials. One of three trials showed a significant increase in birth length, and one of three trials showed a significant increase in gestational age. Two of six trials examining delivery mode showed significantly increased spontaneous vaginal delivery and decreased instrumental delivery or cesarean section following a relaxation intervention.

DISCUSSION

We found consistent evidence for beneficial effects of relaxation interventions in reducing maternal stress, improving mental health, and some evidence for improved maternal physiological outcomes. In addition, we found a positive effect of relaxation interventions on birth weight and inconsistent effects on other pregnancy or birth outcomes. High quality adequately powered trials are needed to examine impacts of relaxation interventions on newborns and offspring health outcomes.

CONCLUSION

In addition to benefits for mothers, relaxation interventions provided during pregnancy improved birth weight and hold some promise for improving newborn outcomes; therefore, this approach strongly merits further research.

Values and their relationship with emotion processing and physical and psychological symptoms among Jewish and Arab breast cancer survivors

Introduction

Individuals from different cultures differ in their values, which encompass belief systems that individuals develop based on their culture, and play a pivotal role in shaping their perspectives. These values may affect emotion processing (EP): the recognition, interpretation, expression and response to bodily sensations, translated as emotions. These varying values may contribute to distinct emotional experiences, impacting physical and psychological symptoms in breast cancer (BC) survivors.

Methods

This cross-sectional study investigated how EP including acceptance, expression (avoidance and approach coping), and awareness, may mediate the relationship between conservation values and symptoms of pain, fatigue, and depression among Arab (n = 62) and Jewish (n = 179) women BC survivors in Israel. Conservation values include tradition, conformity, and security.

Results

Depression and fatigue were negatively correlated with acceptance of emotions, and positively correlated with avoidance and conservation levels. Emotion processing mediated the relationship between conservation and fatigue and depression. Arab women reported higher levels of various values, emotional acceptance, pain, fatigue, and depression symptoms compared to Jewish women. Conservation was higher in Arab women and correlated with both approach and avoidance coping which was not the case in Jewish women. Avoidance coping had a positive relationship with fatigue in the Jewish, but not the Arab women. Similarly, approach coping was negatively related to depression in Jewish, but not in Arab women.

Discussion

Cultural differences are important for understanding the experience of cancer in individuals from different cultures. Future interventions for more conservative BC survivors should take culture into account.

Arts Therapy and Its Implications in Chronic Pain Management: A Narrative Review

Chronic nonmalignant pain is recognized as a complex, dynamic, phenomenological interplay between biological, psychological, and social factors that are individual to the person suffering from it. Therefore, its management and treatment ought to entail the individual's biopsychosocial aspects that are often addressed by collaborative, inter/multidisciplinary multimodal care, as there is no biologic treatment. In an effort to enhance inter/multidisciplinary multimodal care, a narrative review of arts therapy as a mind-body intervention and its efficacy in chronic pain populations has been conducted. Changes in emotional and physical symptoms, especially pain intensity, during arts therapy sessions have also been discussed in in the context of attention distraction strategy. Arts therapy (visual art, music, dance/movement therapy, etc.) have been investigated to summarize relevant findings and to highlight further potential benefits, limitations, and future directions in this area. We reviewed 16 studies of different design, and the majority reported beneficial effects of art therapy in patients' management of chronic pain and improvement in pain, mood, stress, and quality of life. However, the results are inconsistent and unclear. It was discovered that there is a limited amount of high-quality research available on the implications of arts therapy in chronic nonmalignant pain management. Due to the reported limitations, low effectiveness, and inconclusive findings of arts therapy in the studies conducted so far, further research with improved methodological standards is required.

The role of emotion processing in art therapy (REPAT) intervention protocol

Psychological and physical health are known to improve with emotion processing, which is becoming aware of bodily sensations, accepting them as information that can be translated into emotion concepts and expressing them symbolically and linguistically as emotions. Art therapy utilizes the visual arts for processing emotions to facilitate self-expression and communication with the goal of improving psychological wellbeing. The mental health of individuals coping with and recovering from cancer is known to benefit from art therapy. The purpose of this paper is to describe the development of the role of emotion processing in art therapy (REPAT) intervention, which is an 8 week, one and a half hour art therapy intervention created to target emotion processing as a primary mechanism of change, through which art therapy has the potential to reduce symptoms (i.e., depression, pain and fatigue) of women coping with breast cancer. To obtain this goal we used template for intervention description and replication (TIDieR) and GUIDance for the rEporting of intervention Development (GUIDED) guidelines for intervention development description, with the goal of ensuring successful implementation for clinical and research use.

Art-based interventions for women's mental health in pregnancy and postpartum: A meta-analysis of randomised controlled trials

Objective

Pregnant and postpartum women are vulnerable to psychological problems with a high estimated prevalence. To date, there is no meta-analysis that specifically assesses the effectiveness of art-based interventions to improve mental health in pregnant and postpartum women. The objective of this meta-analysis was to assess the efficacy of art-based interventions when delivered to pregnant and postpartum women.

Methods

Systematic literature searches were conducted from the inception to 6 March 2022 in seven English databases, including PubMed, Embase, Cochrane Central Register, CINAHL, ProQuest, Scopus, and Web of Science. Randomised controlled trials (RCTs) reporting art-based interventions targeting the improvement of women's mental health in pregnancy and postpartum were included. Cochrane risk of bias tool was applied to assess evidence quality.

Results

Twenty-one randomised controlled trials (RCTs) involving 2,815 participants were eligible for data analysis. A pooled analysis demonstrated that art-based interventions significantly reduced anxiety (SMD = -0.75, 95% CI = -1.10 to -0.40) and depression symptoms (MD = -0.79, 95% CI = -1.30 to -0.28). However, art-based interventions did not alleviate stress symptoms as expected in our findings. Subgroup analysis demonstrated that intervention implementation time, intervention duration and music selected by the participants vs. not could have influence on the efficacy of art-based intervention for anxiety.

Conclusion

In perinatal mental health, art-based interventions may be effective in alleviating anxiety and depression. In the future, we still need to conduct high-quality RCTs to validate our findings and enrich clinical application of art-based interventions.

Dealing with opposites as a mechanism of change in art therapy in personality disorders: A mixed methods study

Introduction

Personality disorders can be characterized by emotion regulation problems, difficulties in self-regulation and by dichotomous, black-and-white thinking. Dealing with opposites as a mechanism of change used by art therapists might be beneficial for people diagnosed with a personality disorder. This study examined the overall question if and in what way dealing with opposites in art therapy is a mechanism of change in achieving personal therapeutic goals.

Method

A convergent parallel mixed-methods pilot study was performed among patients with a personality disorder (N = 32). Participants received four sessions of art therapy focused on opposites. They completed questionnaires on emotion regulation, positive and negative affect and sense of emotional balance before and after each session. Additionally, they completed a questionnaire on self-expression before and after the four sessions. Furthermore, 10 interviews (eight patients/two therapists) were conducted.

Results

Quantitative results comparing baseline versus after the four sessions showed a significant change indicating that there might be a positive change regarding self-expression and emotion regulation (t = -2.45, p = 0.02, ES d = 0.30). A significant change was measured in acceptance of emotional responses (Z = -2.66, p = 0.01) and the state of emotion was rated as more balanced (Z = -2.19, p = 0.03). No further significant changes were found. Qualitative results showed that using opposites in art therapy often helped to gain insight, self-exploration and self-awareness and could facilitate confrontation as well as acceptance although sometimes it was (too) confronting.

Discussion

Integration of conflicting emotions, behaviors, and thoughts were promoted by the explicit use of opposites and supporting coherent representation. Practice based recommendations are therefore to make more explicit use of dealing with opposites as a theme in art therapy. Also, we recommend more research on different mechanisms of change to refine the theory of change that provides an underpinning rationale and structure for art therapy. The results of this research should be regarded as exploratory given the small sample size and limited amount of therapy sessions.

Understanding the value of art prompts in an online narrative medicine workshop: an exploratory-descriptive focus group study

Narrative medicine is an interdisciplinary field that complements and expands on conventional healthcare training by supporting narrative competence skills and creativity derived from the arts and humanities domains to address the needs of healthcare providers and receivers. With the COVID-19 pandemic having had a profound impact on the healthcare workforce with an already high burn-out rate, multimodal arts interventions may help address the holistic dimensions of well-being. While empirical evidence supports the use of arts-based interventions in promoting healthcare workers' well-being and personal growth, art prompts are underexplored and underused in narrative medicine. Moreover, protocols and frameworks adopted in extant research on this topic are inconsistent, resulting in replication and validation challenges. These issues have motivated this exploratory-descriptive study with 11 narrative medicine practitioners to examine the use of short art prompts in an online narrative medicine workshop.The art prompts leveraged art therapy's Expressive Therapies Continuum (ETC) model, which uses the inherent properties of art materials, media and methods to elicit specific levels of information processing and creative experiences. The study aimed to understand how art prompts differ from writing prompts and explore the value art prompts could add to narrative medicine if any. Qualitative analyses revealed that art prompts in narrative medicine increase positive feelings and promote creativity and insight. Specifically, art prompts allowed participants to use sensorimotor functions, enter a flow-like state, be challenged and inspired by novelty and uncertainty, and experience a sense of play and personal discovery.

The Effect of the Art Therapy Interventions on Depression Symptoms Among Older Adults: A Meta-analysis of Controlled Clinical Trials

BACKGROUND

To our knowledge, no systematic reviews and meta-analyses have yet been published that examine the effect of art therapy (AT) interventions on depression symptoms among older adults, and this study aimed to systematically review and meta-analysis of clinical trials, summarize eligible relevant studies and provide a true effect measure for the association between AT and depression symptoms in older adults.

METHODS

The databases of PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials were searched until 15 February 2022. The methodological quality of the included studies was evaluated by the Delphi checklist. The heterogeneity across studies was conducted by chi-squared test and measured its quantity by the I² statistic. We performed this meta-analysis to obtain a summary measure of the mean difference in depression scores between AT and control groups using a random-effects model. All statistical analyses were carried out at a significance level of .05 using Stata software, version 14.

RESULTS

Until 15 February 2022, 222 studies through databases and 199 studies through review of references were included in the present meta-analysis. In total, the analysis covered 8 studies. The difference in mean depression score between the intervention and control groups showed significant reductions in the AT group (MD -.78; 95% CI: -1.17, -.38; I 2 = 67.9%).

CONCLUSION

Our findings suggest that AT can be considered an effective intervention for reducing depression symptoms among older adults and art therapists/psychotherapists can use this method to reduce the symptoms of depression among older adults.

A qualitative inquiry comparing mindfulness-based art therapy versus neutral clay tasks as a proactive mental health solution for college students

Objective: College students experience unprecedented levels of stress and anxiety, impacting their desire to perform well and live a balanced life. Mindfulness-based practices along with art therapy techniques have been demonstrated to improve psychological and physiological impacts of stress and anxiety among college students. Participants: 12 undergraduate college students participated in pre and post-test interviews following their engagement in either mindfulness-based art therapy (MBAT) or a neutral clay task (NCT) using a 5-week online format. Methods: Descriptive phenomenology and artful inquiry were used to elicit participants' perspectives. Results: Both MBAT and NCT elicited relaxing and calming effects, but MBAT provided more proactive and direct benefits, with participants reporting that they could identify and move through stressors. While NCT participants described their experience as fun or playful. Conclusions: These findings offer notable support for implementing online and accessible mental health strategies such as MBAT and NCT into college settings.

Expressive Arts Therapy Combined with Progressive Muscle Relaxation following Music for Perioperative Patients with Gynecological Malignancies: A Pilot Study

Objective

We aimed to assess the impact of an expressive arts therapy combined with progressive muscle relaxation following music on mental health (anxiety and hope) in patients with gynecological malignancies undergoing surgery.

Methods

This was a nonrandomized controlled trial. Eligible patients had a primary or recurrent gynecological malignancy scheduled to be treated with surgery. The intervention consisted of three sessions (preoperation, postoperation, and predischarge) during the perioperative period. Firstly, before starting the first session of intervention, all patients completed three questionnaires including a Hospital Anxiety and Depression Scale (HADS), a Herth Hope Index (HHI), and a State Anxiety Inventory (SAI), and the intervention group patients also had to complete the SAI questionnaire again after completing the intervention. Secondly, after the second session of intervention, all patients completed the SAI questionnaire, with the intervention group completed the SAI questionnaire before the intervention. Thirdly, after the third session of intervention, all patients completed HHI and SAI questionnaires, with the intervention group completed the SAI questionnaire before the intervention. Also, to subjectively rate the benefit of expressive arts therapy, the intervention group additionally completed a separate, supplemental questionnaire.

Results

A total of 116 patients were enrolled and 110 included in the final analysis. No group differences were found for HHI scores between the intervention and control participants (Cohen's d = 0.19, P=0.31), although there was a substantial improvement in intervention participants' HHI scores compared to the standard care control participants. There was a statistically significant improvement in intervention participants' SAI from preintervention to postintervention of preoperation (Cohen's d = −0.23, P=0.002) and postoperation (Cohen's d = −0.34, P ≤ 0.001). However, no differences were observed for the predischarge period (Cohen's d = −0.09, P=0.118). Besides, a supplemental questionnaire indicated that 52 (98%) patients felt that expressive arts therapy was beneficial.

Conclusions

Expressive art therapy combined with progressive muscle relaxation under music may be of some effect on alleviating perioperative anxiety in patients with gynecologic malignancies. Therefore, further relevant studies with large samples and multicenters are urgently needed to provide a reliable evidence-based basis for perioperative psychological care of patients with gynecologic malignancies and to promote rapid recovery of patients. It is recommended that further art therapy studies to examine the impact of patient-tailored arts therapy interventions on spiritual well-being in patients with gynecological malignancies, especially in the perioperative period.

Crafting Life Stories in Photocollage: An Online Creative Art-Based Intervention for Older Adults

Creative arts therapies (CAT) provide a safe and creative environment for older adults to process life experiences and maintain personal growth while aging. There is a growing need to make creative arts therapies more accessible to the aging population, as many have limited access to these services. This need has been catalyzed by the advent of the COVID-19 pandemic. Tele-CAT offers a possible solution. This study explored the experiences of older adults who participated in an online creative process of digital photocollage based on CAT. Twenty-four Italian and Israeli community-dwelling older adults aged 78 to 92 participated in this research through Zoom teleconferencing software. Transcriptions of the sessions and the art produced through the photocollage were qualitatively analyzed through Thematic Analysis. The findings show that the projective stimuli of digital photographs supported older adults' narratives and engaged them in a more embodied emotional experience. Participant experiences involved artistic enjoyment within a positive and safe interaction with therapists. The creation of digital photocollages allowed the participants to process their life experiences and create an integrative view of their life, a vital developmental task in late life. These results point to the advantages and challenges of tele-CAT for older adults.

"God is a painter": How Jewish Ultra-Orthodox art therapists and clients perceive mental health treatment

The current study examined the ways in which 14 art therapists and adult clients from the Ultra-Orthodox sector in Israel perceive mental health and mental health treatment. Semi-structured interviews were subjected to an interpretative phenomenological analysis to capture the meaning ascribed to the treatment and its challenges. Four themes emerged: the perception of mental health as related to the centrality of functioning, purposefulness, and emotional balance; the specific challenges of therapy, in terms of suspicion regarding treatment and difficulties in establishing intimacy and self-disclosure; the interplay between the worlds of therapy and religion; and the intersection of art and religion. The discussion centers on an interpretation of the findings in light of the ontological typology of individualism versus collectivism.

Using mobile brain/body imaging to advance research in arts, health, and related therapeutics

The uses of mobile brain/body imaging (MoBI) are expanding and allow for more direct study of the neurophysiological signals associated with behavior in psychotherapeutic encounters. Neuroaesthetics is concerned with the cognitive and neural basis of art appreciation, and scientific correlations are being made in the field that might help to clarify theories claimed in the creative arts therapies. Yet, most neuroaesthetics studies are confined to the laboratory and do not propose a translation for research methods and clinical applications. The creative arts therapies have a long history of clinical success with various patient populations and will benefit from increased scientific explanation to support intervention strategies. Examining the brain dynamics and motor behaviors that are associated with the higher complex processes involved in artistic expression offers MoBI as a promising instrumentation to move forward in linking ideas from neuroaesthetics to the creative arts therapies. Tracking brain dynamics in association with behavioral change allows for more objective and quantitative physiological monitors to evaluate, and together with subjective patient reports provides insight into the psychological mechanisms of change in treatment. We outline a framework that shows how MoBI can be used to study the effectiveness of creative arts therapy interventions motivated by the 4E approach to cognition with a focus on visual art therapy. The article illuminates how a new partnership among the fields of art therapy, neuroscience, and neuroaesthetics might work together within the 4E/MoBI framework in efforts to advance transdisciplinary research for clinical health populations.

VR Health Experience: A Virtual Space for Arts and Psychomotor Therapy

Introduction: Mental health and well-being are under pressure because of the corona pandemic. Arts and psychomotor therapists said that they had almost no experience with working online, but despite the fact that they felt incapable, they were positive towards it.

Method: This qualitative action research was aimed at how arts and psychomotor therapists can become more skilled in offering online arts and psychomotor therapy and how they can methodically enlist the VR Health Experience (a virtual arts and psychomotor therapy space) in therapy. It is envisaged that the arts and psychomotor therapist could be telepresent in order to offer arts and psychomotor therapy remotely. In online training that made use of the Lean Startup Method, participants (n = 5) integrated their working knowledge with the VR Health Experience. The interventions were immediately tested by the participants and in practice. Participants were interviewed retrospectively and their experiences were thematically analysed.

Results: The VR Health Experience came forward as an innovative addition to the usual arts and psychomotor therapy. Often, clients were encouraged to play and experiment, and the VR world offered several options. The VR Health Experience lowered the threshold, expanded the training areas and held a great attraction for play.

Discussion: This project offered an innovative quality boost for arts and psychomotor therapy. Arts and psychomotor therapy have proven to be possible remotely via telepresence of the therapist. The therapist is present together with the client in the VR Health Experience, the virtual arts and psychomotor therapy space, where connectedness can be felt and new experiences can be gained. VR also offers further possibilities in arts and psychomotor therapy.

Mindfulness based art therapy study protocol to determine efficacy in reducing college stress and anxiety

Background

College students in Generation Z are among the most stressed of our time. Previous research suggests that current interventions on university campuses are primarily for students in crises, but supportive services like psychoeducation to introduce coping skills are scant. Interventions that take both financial and time pressures into account are needed to address the mental health challenges faced by students. This study is designed to determine the unique role of the arts as a proactive mental health strategy for college students.

Methods

A sample of college students in Generation Z (n = 120) will be recruited. Participants will be assigned to Arts-only, mindfulness-only, mindfulness-based art interventions or a non-intervention control group. These interventions will be delivered using a minimal contact, web-based approach. Participants will be screened for eligibility requirements prior to the inclusion in the Time 1 assessment though an online survey. Once enrolled, participants will complete the Time 1 assessment, followed by the intervention. Each assessment will consist of psychological and physiological measures. The MBAT, NCT and MO groups will complete a brief self-care task twice a week for 5 weeks. Upon completion of the assigned intervention, participants will complete a Time 2 assessment and participate in the Trier Social Stress Test. Six weeks post-intervention, participants will complete the final assessment to assess the longevity of effects of the intervention.

Discussion

This study will clarify the effects of Mindfulness-based Art Therapy on several biometric and physiological markers above and beyond isolated art therapy or mindfulness interventions. Qualitative data in the form of transcribed exit interviews will be analyzed to characterize the unique needs of Generation Z students, along with level of engagement, intervention acceptance and satisfaction. The results will identify the efficacy of a low-cost and easily accessible mental health intervention targeting college students experiencing stress and anxiety.

Trial registration ClinicalTrials.gov, NCT04834765, 05/17/21. Retrospectively registered.

From Therapeutic Factors to Mechanisms of Change in the Creative Arts Therapies: A Scoping Review

Empirical studies in the creative arts therapies (CATs; i.e., art therapy, dance/movement therapy, drama therapy, music therapy, psychodrama, and poetry/bibliotherapy) have grown rapidly in the last 10 years, documenting their positive impact on a wide range of psychological and physiological outcomes (e.g., stress, trauma, depression, anxiety, and pain). However, it remains unclear how and why the CATs have positive effects, and which therapeutic factors account for these changes. Research that specifically focuses on the therapeutic factors and/or mechanisms of change in CATs is only beginning to emerge. To gain more insight into how and why the CATs influence outcomes, we conducted a scoping review (N studies = 67) to pinpoint therapeutic factors specific to each CATs discipline, joint factors of CATs, and more generic common factors across all psychotherapy approaches. This review therefore provides an overview of empirical CATs studies dealing with therapeutic factors and/or mechanisms of change, and a detailed analysis of these therapeutic factors which are grouped into domains. A framework of 19 domains of CATs therapeutic factors is proposed, of which the three domains are composed solely of factors unique to the CATs: "embodiment," "concretization," and "symbolism and metaphors." The terminology used in change process research is clarified, and the implications for future research, clinical practice, and CATs education are discussed.

The Embodied-Enactive-Interactive Brain: Bridging Neuroscience and Creative Arts Therapies

The recognition and incorporation of evidence-based neuroscientific concepts into creative arts therapeutic knowledge and practice seem valuable and advantageous for the purpose of integration and professional development. Moreover, exhilarating insights from the field of neuroscience coincide with the nature, conceptualization, goals, and methods of Creative Arts Therapies (CATs), enabling comprehensive understandings of the clinical landscape, from a translational perspective. This paper contextualizes and discusses dynamic brain functions that have been suggested to lie at the heart of intra- and inter-personal processes. Touching upon fundamental aspects of the self and self-other interaction, the state-of-the-art neuroscientific-informed views will shed light on mechanisms of the embodied, predictive and relational brain. The conceptual analysis introduces and interweaves the following contemporary perspectives of brain function: firstly, the grounding of mental activity in the lived, bodily experience will be delineated; secondly, the enactive account of internal models, or generative predictive representations, shaped by experience, will be defined and extensively deliberated; and thirdly, the interpersonal simulation and synchronization mechanisms that support empathy and mentalization will be thoroughly considered. Throughout the paper, the cross-talks between the brain and the body, within the brain through functionally connected neural networks and in the context of agent-environment dynamics, will be addressed. These communicative patterns will be elaborated on to unfold psychophysiological linkage, as well as psychopathological shifts, concluding with the neuroplastic change associated with the formulation of CATs. The manuscript suggests an integrative view of the brain-body-mind in contexts relevant to the therapeutic potential of the expressive creative arts and the main avenues by which neuroscience may ground, enlighten and enrich the clinical psychotherapeutic practice.

Novel Solutions to Student Problems: A Phenomenological Exploration of a Single Session Approach to Art Therapy With Creative Arts University Students

Within the Australian university context, research has uncovered increasing levels of psychological distress, in the form of stress, anxiety and depression. Higher rates of psychological distress have been reported in undergraduate students specifically enrolled in creative arts programs. Despite these increasing levels of psychological distress, university students are reluctant to engage with mental health and wellbeing supports. To explore ways to meet the mental health and wellbeing needs of creative arts university students, the Creative Arts and Music Therapy Research Unit at The University of Melbourne commenced a project exploring the benefits and pitfalls of a brief creative arts therapies approach for students attending a campus based wellbeing clinic. This exploratory research study formed the art therapy component of this much broader research endeavor. Creative arts students in this research study were invited to participate in a single session art therapy encounter that involved the visual exploration of the miracle question, asking students to visually depict “what the problem looks like and how it will look when the problem is resolved or you feel like you can cope with it better?” The descriptive findings of this exploratory research study revealed how the combination of art therapy used within a single session framework was able to afford students a novel means to externalize problems, leading students to forming a less internalized view of the self.

Effects of Cognitive-Behavioral Therapy Based Music Therapy in Korean Adolescents with Smartphone and Internet Addiction

OBJECTIVE

The purpose of this study was to evaluate the effects of adding music therapy (MT) to cognitive-behavioral therapy (CBT) on symptoms of smartphone/internet addiction and psychiatric comorbidities.

METHODS

Overall, 155 patients diagnosed with addiction were assigned to either the CBT-MT group or CBT group. Both groups received CBT for 8 weeks, while the CBT-MT group received additional MT. The intervention was completed by 67 and 71 participants in the CBT-MT and CBT groups, respectively.

RESULTS

The total scores of Young Internet Addiction Scale (YIAT) and Smartphone Addiction Proneness Scale (SAPS) decreased significantly (p<0.001 for both) in both groups, while the total scores of State Anxiety Inventory for Children (SAIC) (p<0.001), Trait Anxiety Inventory for Children (TAIC) (p<0.001), Conners-Wells' Adolescent Self-Report Scale-Short form (CASS(S)) (p=0.048), and Barratt Impulsiveness Scale-11 (BIS-11) (p<0.001) decreased only in the CBT-MT group. The decrements in YIAT (p=0.025), SAIC (p=0.043), TAIC (p=0.011), and BIS-11 (p=0.012) in the CBT-MT group were significantly greater than those in the CBT group.

CONCLUSION

Combined MT and CBT improved the symptoms of smartphone/internet addiction, anxiety, and impulsivity in adolescents. This combination could therefore be an effective treatment of smartphone or internet addiction along with behavioral disorders such as anxiety and impulsivity.

Claymation art therapy in early phase psychosis: A qualitative study to explore participants' experiences with the program and identify outcome effects

AIM

Art therapy is a complex intervention that has mixed evidence for people with schizophrenia and scant research in early phase psychosis. Benefits appear to depend on level of engagement and more qualitative studies are needed to elucidate how it works and what outcomes to measure. The purpose of this study was to determine the feasibility of a 13-week Claymation art therapy group intervention for young adults with early phase psychosis, and to explore participants' experiences with the program and to identify outcome effects.

METHODS

Thirteen participants completed the intervention in two cohorts. The participants' experiences were explored through qualitative thematic analysis of individual interviews postintervention and at 3-month follow-up.

RESULTS

The program had a 62% retention rate and an 80% attendance rate. Qualitative analysis of postintervention and 3-month follow-up interviews identified six themes that described program elements: (a) Claymation valued; (b) film screening fostered support; (c) getting to know each other through art; (d) connecting with others with lived experience; (e) opportunity to build skills; and (f) supportive facilitators. Five themes were identified as outcome effects from both time points: (a) stress relief; (b) self-discovery; (c) pride in art; (d) confidence and hope; and (e) engagement in meaningful activity postintervention. Two themes were unique to the 3-month follow-up interviews: (a) Claymation was enabling and (b) showing my film.

CONCLUSIONS

This group Claymation art therapy intervention effectively engaged people with early phase psychosis and the qualitative analysis identified program elements and outcome effects that can be evaluated in future studies.

Protocol for the REPAT study: role of emotional processing in art therapy for breast cancer palliative care patients

INTRODUCTION

Patients with breast cancer (BC) cope with depression which is linked to functional limitations in survivorship and to physical symptoms. Pain and fatigue are prominent symptoms that affect the well-being of cancer survivors. Emotional processing has been associated with improved physical and psychological health in survivors. Art therapy is a form of psychotherapy that involves the use of visual art-making for expression and communication. It encourages emotional processing and has been linked to symptom reduction in patients with cancer. This protocol is designed to examine two mechanistic changes: emotional processing (awareness, expression and acceptance) and cholinergic anti-inflammatory processes (heart rate variability and cytokine expression) through which an art therapy intervention may reduce depression, pain and fatigue. In addition, we will examine ethnocultural differences in the effect of art therapy in women from different ethnocultural backgrounds.

METHODS AND ANALYSIS

A randomised controlled study with careful controls will randomise 240 patient with BC (50% Jewish and 50% Arab) to an 8-week group art therapy intervention or an 8-week Mandala colouring comparison group. This design will test the mechanisms of art therapy on the targeted outcomes beyond the effects of time with a group, focus on a task and engagement with art materials. We will examine two potential mechanisms: emotional processing and cholinergic anti-inflammatory processes; of the intervention effects on depression, pain and fatigue and compare these effects in Arab versus Jewish women.

ETHICS AND DISSEMINATION

Participants will sign informed consent before participation and will be informed that they can leave the study at any point in time without effect on their medical treatment. The Helsinki committees of each participating hospital have approved the study. Data collected in this study will be published in peer-review journals, and we will use the platform of the study website (http://repat.haifa.ac.il/en/) for further dissemination to the general public.

TRIAL REGISTRATION NUMBER

The study is registered in ClinicalTrials.gov: NCT03377816; Pre-results.

Art Therapy With Jewish Ultra-Orthodox Children: Unique Characteristics, Benefits, and Conflicts

The paper presents the potential benefits and conflicts of the encounter between Jewish ultra-orthodox (UO) children – belonging to a closed and segregated group – and art therapy – with its cultural, Western, secular, and professional characteristics. The paper describes the complex interface between the therapeutic use of art as a form of free expression and religious commandments and restrictions. The dialogue between art, therapy, and cultural religious boundaries is described through a case study of an 8-year-old UO boy and a secular female art therapist. Issues such as self-expression, gender roles, and identity exploration are discussed, emphasizing the unique characteristics, benefits, and conflicts of such an encounter.

Therapeutic psychological and biological responses to mindfulness-based art therapy

Stress and anxiety pose a threat to college students' academic performance as well as their long-term mental and physical health, but the time constraints of a rigorous academic schedule make it difficult to offer even brief mental health interventions. A convenience sample of full-time students at a public university was recruited for a 5-week study conducted mostly using an online platform. Participants were randomly assigned to a Mindfulness-Based Art Therapy (MBAT) intervention or a Neutral Clay Task (NCT). Anxiety, perceived stress, and salivary cortisol outcomes were measured. A total of n = 77 participants completed the study. The MBAT group experienced significant reductions in anxiety and perceived stress compared to the NCT group. Significant reductions in salivary cortisol were observed, but only time could be identified as a confounding variable. Art making alone is not enough to induce significant positive responses, but this study suggests MBAT can, and that an online intervention could offer feasible and accessible mental health services on college campuses. Further refinement of biological data collection and analysis is needed to determine what the mediating effects MBAT could have, if any, at the molecular level.

Effects of art therapy in cancer care: A systematic review and meta-analysis

OBJECTIVE

To evaluate the effect of art therapy on cancer patients' quality of life and physical and psychological symptoms.

METHODS

The databases PubMed, Embase, Web of Science, The Cochrane Library, Clinical Trial.gov, the China National Knowledge Infrastructure (CNKI), Wanfang and the Chinese Biomedical Literature Database (CBM) were searched from their inception up to 20 August 2019. Trials examining the effects of art therapy on physical and psychological symptoms and quality of life versus a control group were included. The methodological quality of the included randomised controlled trials was assessed using the risk of bias tool of Cochrane Handbook. Meanwhile, the Newcastle-Ottawa Quality Assessment Scale (NOS) was used to evaluate the methodological quality of the non-randomised studies.

RESULTS

Twelve studies involving 587 cancer patients were included. The results revealed that art therapy significantly reduced anxiety symptoms (standard mean difference [SMD] = -0.46, 95% confidence interval [CI] [-0.90, 0.02], p = .04), depression symptoms (SMD = -0.47, 95% CI [-0.72, 0.21], p < .01), and fatigue (SMD = -0.38, 95% CI [-0.68, -0.09], p = .01) in cancer patients. Art therapy also significantly improved the quality of life of cancer patients (SMD = 0.43, 95% CI [0.18, 0.68], p < .01).

CONCLUSIONS

Art therapy had a positive effect on quality of life and symptoms in cancer patients and can be used as a complementary treatment for cancer patients.