Art making and expressive art therapy in adult health and nursing care: A scoping review

Evaluating the effectiveness of mandala coloring on post-operative anxiety in mothers of children undergoing congenital anomaly surgery: A randomized controlled clinical trial

PURPOSE OF RESEARCH

The purpose of this study was to investigate the effectiveness of mandala coloring on post-operative anxiety in mothers of children undergoing congenital anomaly surgery.

RESULTS

In this randomized controlled clinical trial, 92 mothers of children undergoing congenital anomaly surgery were randomly assigned to the intervention or control groups. Standard care was provided for both groups. The intervention group participated in a mandala coloring activity for 30 min/day for three consecutive days following their children's surgery. Anxiety levels were measured using the State-Trait Anxiety Inventory (STAI) before and after the intervention. The data were analyzed by SPSS-23. The mean state anxiety score in the intervention and control groups was 38.43 ± 6.76 and 51.65 ± 6.34, respectively, and subsequent to the intervention, the mean trait anxiety score in the intervention and control groups was 41.28 ± 8.71 and 47.07 ± 8.82, respectively. The study found that mothers who engaged in mandala coloring experienced a significant decrease in state and trait anxiety compared to the control group (p < 0.001). Large effect size (η2 > 0.14) indicates mandala coloring significantly reduced the anxiety of mothers of children with congenital disorders.

CONCLUSION

Mandala coloring appears to be an effective intervention for reducing anxiety level in mothers of children undergoing surgery for congenital abnormalities. The study suggests that therapeutic art activities can improve psychological well-being post-operatively, urging further research to explore their long-term effects.

Cognitive therapies and their impact on neuropsychiatric symptoms in mild cognitive impairment or dementia: a scoping review

To date, the impact of cognitive therapies on patients with dementia and mild cognitive impairment (MCI) has been studied in terms of cognition, quality of life and activities of daily living rather than in the context of neuropsychiatric symptoms (NPS). The objective of this scoping review was to collect evidence that different cognitive therapies affect the NPS of patients with MCI and dementia. A bibliographic search was conducted in the PUBMED, EMBASE, ISI WOS and SCOPUS databases through February 2025. After the elimination of duplicates, a total of 1,854 publications were identified. Among these, 42 articles were included in the analysis. These articles were reviewed by title and abstract, and then the full text was reviewed by two independent researchers with subsequent decisions about conflicts made in consultation with a third researcher. A sample of 4,089 participants was collected. All participants had undergone cognitive training interventions, cognitive rehabilitation, cognitive stimulation, art therapy, reminiscence therapy or psychobehavioural therapy and were evaluated for NPS. Depression was the most commonly analysed symptom (70% of the articles). The types of interventions that improved NPS the most were art therapy and reminiscence therapy (76 and 71% of the articles), whereas cognitive training (43%) was the least effective. While all types of therapy seemed to support the improvement of NPS, art therapy and reminiscence therapy were the most effective, especially for patients with MCI or dementia. However, studies that comprehensively evaluate the effects of cognitive therapy on NPS other than depression are lacking.

Effects of an art-based intervention in older adults with dementia: a randomized controlled trial

This study aims to evaluate the effects of a creative expressive art-based storytelling accompanied by caregivers (CrEAS-AC) program on reducing behavioral and psychological symptoms of dementia (BPSD) in older adults with dementia and caregiver burden compared to a general social contact (SC) control group. In this two-arm randomized controlled trial, dyads comprising participants with dementia and their caregivers were randomly assigned to the CrEAS-AC (n = 39) and SC groups (n = 39). Interventions were applied twice per week for 12 weeks. The primary outcomes were BPSD (NPI and AES-I) and caregiver distress, while secondary outcomes included communication ability (SFACS-S and SFACS-C), caregiver burden (CBI), and other health-related outcomes (activities of daily living and QOL-AD). All variables were measured at baseline, 12-week follow-up, and 24-week follow-up. Linear mixed model analyses indicated that participants in the CrEAS-AC group showed significantly lower scores on NPI, AES-I, caregiver distress, and CBI post-intervention at the 12-week follow-up, compared with the SC group. They also showed higher scores on QOL-AD, SFACS-S, and SFACS-C. Baseline characteristics did not modify the effects of the interventions, which were maintained until at least 24-week follow-up. The CrEAS-AC program, as an art-based intervention, is therefore potentially effective in reducing behavioral and psychological symptoms of dementia and improving communication ability and quality of life in older adults with dementia, as well as reducing caregivers' distress and burden.Trial registration: The study was registered in the Chinese Clinical Trials Registry (ID: ChiCTR2200064838) on 19/10/2022.

Interventions to Increase Thriving Amongst Older People in Care Homes and Factors Contributing to Their Thriving Experience-A Scoping Review

AIM

The aim was to map and describe the state of knowledge regarding interventions to promote thriving amongst older people in care homes and the factors that affect their experience of thriving.

DESIGN

A scoping review.

REVIEW METHODS

A scoping review based on the methodological framework by Arksey and O'Malley and presented following the PAGER (Patterns, Advances, Gaps, Evidence for Practice, and Research recommendations) framework.

DATA SOURCES

Five electronic databases were searched for studies published between 2012 and 2022. From a total of 185 studies found, 17 met the inclusion criteria.

RESULTS

This study recognised five factors that contribute to thriving: the resident's attitude towards living in a care home, the quality of care and caregivers, activities and interactions with others, qualities of the physical environment and health. Two studies reporting interventions were identified.

CONCLUSION

This scoping review highlights the scarcity of knowledge regarding older people's experience of thriving in care homes. The review results could contribute to our understanding of the factors involved and interventions needed to improve thriving.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The focus should be on education and the development of working methods that could improve thriving in care homes.

REPORTING METHOD

The Prisma ScR-checklist was used.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The associations between arts and humanities engagement and well-being in a representative sample of United States residents during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic led to widespread decreases in well-being, and people turned to various coping resources to mitigate declines in well-being.

METHOD

In a large (N = 873) representative US adult sample collected in the fall of 2020, we examined the degree to which people coped using the arts and humanities and the perceived impact of the pandemic and how these factors were associated with well-being.

RESULTS

We found coping with the arts was associated with many facets of well-being and, for many of these associations, the more people felt impacted by the pandemic, the stronger the relationship with coping with the arts. We further examined the nature of people's typical arts engagement (e.g. immersion, reflectiveness) with the use of arts to cope.

CONCLUSIONS

These findings suggest the arts may play a role in well-being experiences during challenging circumstances and the need for continued examination of the role the arts play in well-being.

The effect of listening to music and drawing on coping with dysmenorrhea complaints in nursing students: randomized controlled trial

AIM

To examine the effect of listening to music and drawing on coping with dysmenorrhea complaints of nursing students.

METHODS

The study was a double-blind, three parallel-group randomized controlled trial conducted between August 2023 and May 2024 at Bartın University, Faculty of Health Sciences, Department of Nursing. Ninety-six dysmenorrheic nursing students with regular menstrual cycles were included in the study and randomly assigned to three groups as drawing, music and control groups. Visual Analog Scale (100mmVAS of pain), Perceived Stress Scale (PSS) and Menstrual Symptoms Scale (MSS) were applied to the students at baseline, 1st and 2nd months. The interventions were as follows: the music group listened to a 29-minute and 32-second song three days before menstruation and on the first day of menstruation in the third month composed by Juan Sebastian Martin-Saavedra, while the drawing group created art for the same duration. The pain scores, perceived stress, and menstrual symptoms were measured in all groups after the interventions.

RESULTS

Pretest, 1st and 2nd months 100mmVAS of pain score averages were 7.16 ± 1.99, 7.16 ± 1.99 and 7.50 ± 1.98 for the control group, 7.22 ± 1.64, 4.84 ± 1.80 and 2.13 ± 1.45 for the music group and 6.69 ± 1.80, 5.09 ± 1.55 and 2.91 ± 1.33 for the drawing group, respectively. Pretest, 1st and 2nd months PSS score averages were 28.75 ± 3.71, 29.09 ± 3.87 and 30.03 ± 4.16 for the control group, 29.91 ± 3.98, 14.06 ± 4.06 and 3.59 ± 3.82 for the music group and 27.38 ± 3.63, 18.13 ± 5.60 and 8.34 ± 5.46 for the drawing group, respectively. Pretest, 1st and 2nd months MSS score averages were 79.25 ± 15.41, 88.00 ± 20.08 and 90.66 ± 19.13 for the control group, 85.41 ± 10.77, 62.41 ± 15.23 and 34.00 ± 12.62 for the music group and 80.69 ± 11.07, 65.53 ± 15.37 and 47.31 ± 15.11 for the drawing group, respectively. Mean menstrual pain intensity, mean perceived stress level, and mean menstrual symptoms level in the art and music group decreased significantly at 1st and 2nd months post-intervention (p < .001). A significant increase in score levels was observed in the control group.

CONCLUSIONS

Both art and music practices are effective in significantly reducing menstrual pain, perceived stress, and menstrual symptoms in nursing students with dysmenorrhea. It is important to include listening to music and drawing on women's health and disease nursing practices to control menstrual pain, perceived stress, and menstrual symptoms in dysmenorrhea.

CLINICAL TRIALS REGISTRATION NUMBER

https://clinicaltrials.gov identifier NCT06027489; registered August 30, 2023.

Efficacy of art therapy in enhancing mental health of clinical nurses: A meta-analysis

INTRODUCTION

Art therapy (AT) has been widely utilized as a therapeutic approach for clinical nurses. In recent years, more and more researchers have applied art therapy to enhance clinical nurses' mental well-being. However, many studies conducted in this area have suffered from limited sample sizes and insufficient research evidence.

AIM

This study aims to conduct a systematic evaluation of the efficacy of art therapy on the mental health of clinical nurses.

METHODS

RCTs on art therapy for clinical nurses were searched across databases such as PubMed, Embase, etc., the results were analysed using RevMan 5.3.

RESULTS

There were 19 RCTs encompassing 1338 clinical nurses involved in this analysis. The Meta-analysis revealed that art therapy exhibited a significant reduction in anxiety levels (measured by the SAS) among clinical nurses, as well as depression levels and perceived stress levels (measured by the CPSS). Furthermore, art therapy demonstrated a reduction in negative coping style and an improvement in positive coping style.

DISCUSSION

Findings indicate that art therapy can reduce anxiety, depression and stress levels in clinical nurses, while also enhance positive coping styles and promote mental well-being. Therefore, the widespread implementation of art therapy in this context is highly recommended.

DECLARATION

I hereby declare that my article is directly relevant to the field of mental health nursing. It highlights the critical importance of psychological well-being and supplements the evidence on The effects of art therapy on the occupational mental health of clinical nurses.

Experiences of Acquired Brain Injury as Expressed Through Mask-Making: A Qualitative Analysis

PURPOSE

Acquired brain injury (ABI) extends beyond the immediate aftermath, and understanding individual experience of ABI is paramount to providing effective support mechanisms. This study examined how people with ABI used mask-making to engage in self-expression.

METHOD

Publicly available data from the Unmasking Brain Injury Project website, an advocacy group for people with ABI, were analyzed. A qualitative approach with hybrid inductive/deductive analysis was used to explore how people with ABI use art to express their emotional experiences of ABI.

RESULTS

In total, 1,049 masks had narratives describing the visual components and meaning in the associated masks. Three major themes emerged: the multiplicity of experiences after ABI, including positive, negative, and mixed outcomes; the expression of emotional pain and living with loss through art; and the importance of positivity, purpose, and faith in the experience with ABI. Multiplicity was the central expression represented in the masks. The most commonly represented emotional experiences were: emotional pain and living with loss and positivity, purpose, and faith. The masks incorporated literal depictions of the ABI, visual metaphors, and intentional use of colors and shapes for self-expression.

CONCLUSIONS

These results support previous findings that emotional experiences after ABI are complex and often interlaced with several emotions. The most prominent feelings include emotional pain and living with loss, and positivity, purpose, and faith. Mask-making may be a particularly appropriate method for people with ABI to process or express emotional experiences, as well as to provide clinicians with visual records of sense of self, coping, or progress.

"When I go back to painting, I am 'Alice in Wonderland": older women coping with age-related crises through visual artmaking

BACKGROUND

The creative process of visual artmaking provides an opportunity for older women to express themselves and explore their emotions, thoughts, and experiences. This study examined the roles of visual artmaking in older women's lives in general and in relation to the ongoing challenges of aging.

METHODS

The sample was composed of 21 Israeli women aged 60-90, who indicated that they produced visual artworks on an ongoing basis. The participants' artworks were collected, and semi-structured in-depth interviews were conducted.

RESULTS

A thematic analysis of the interviews revealed 4 themes: visual artmaking to address the challenges of older women's lives, artwork as a framework for doing, visual artmaking to support the wellbeing of older women, artwork as channel of communication and stronger ties with family members.

CONCLUSIONS

The findings contribute to a better understanding of the roles of visual art in older women's lives, especially in times of crisis.

The Effects of Mandala Coloring and Free Coloring on Mindfulness and the Score of Posttraumatic Stress Disorder in Veterans: A Randomized Controlled Trial

Due to the nature of the events in war, posttraumatic stress disorder (PTSD) is more difficult to treat in veterans than in other people. Nowadays, using art-making methods such as mandala coloring has attracted the attention of researchers. This randomized controlled trial was conducted with 84 male veterans diagnosed with PTSD. Veterans were recruited by convenience sampling method and randomly assigned to an intervention group (n = 42) and a control group (n = 42). Participants in the intervention group colored a mandala, whereas the control group colored freely for 15 minutes 2 times a week for 3 weeks. All participants completed Brown and Ryan's Mindful Attention Awareness Scale and Posttraumatic Stress Disorder Checklist for diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Mean baseline mindfulness scores were not significantly different between the mandala coloring group and the free coloring group (41.73 ± 5.29 vs 40.23 ± 4.59, P = .169). After the intervention, the mean mindfulness score was significantly higher in the mandala coloring group than in the free coloring group (52.23 ± 5.89 vs 46.04 ± 7.28, P < .001). Mean baseline PTSD scores were not significantly different between the mandala coloring group and the free coloring group (65.45 ± 5.89 vs 67.47 ± 4.66, P = .085). After the intervention, the mean PTSD score was significantly lower in the mandala coloring group than in the free coloring group (47.21 ± 5.77 vs 52.38 ± 5.52, P < .001). Both mandala coloring and free coloring increase mindfulness and decrease PTSD symptom severity. However, the mandala coloring method was more effective.

The artistic image processing for visual healing in smart city

This study investigates the processing methods of artistic images within the context of Smart city (SC) initiatives, focusing on the visual healing effects of artistic image processing to enhance urban residents' mental health and quality of life. Firstly, it examines the role of artistic image processing techniques in visual healing. Secondly, deep learning technology is introduced and improved, proposing the overlapping segmentation vision transformer (OSViT) for image blocks, and further integrating the bidirectional long short-term memory (BiLSTM) algorithm. An innovative artistic image processing and classification recognition model based on OSViT-BiLSTM is then constructed. Finally, the visual healing effect of the processed art images in different scenes is analyzed. The results demonstrate that the proposed model achieves a classification recognition accuracy of 92.9% for art images, which is at least 6.9% higher than that of other existing model algorithms. Additionally, over 90% of users report satisfaction with the visual healing effects of the artistic images. Therefore, it is found that the proposed model can accurately identify artistic images, enhance their beauty and artistry, and improve the visual healing effect. This study provides an experimental reference for incorporating visual healing into SC initiatives.

The effectiveness of expressive art therapy on infertile women undergoing surgery: study protocol for a randomized controlled trial

BACKGROUND

Infertility produces infertility-related stress in both members of infertile couples, especially for infertile women. Some studies verified the negative relationship between infertility-related stress and outcomes of infertility treatments. Effective mental health care during fertility treatment is urgently needed, but there has been a lack of efficient support services. To reduce the infertility-related stress of infertile women, expressive art therapeutic schemes will be organized and implemented by certified international expressive art therapists.

METHODS

This study is a randomized controlled trial. Participants in the intervention group will receive expressive art therapies after the baseline investigation. Expressive art therapies will be led by the certified international expressive art therapist. The interventions include progressive muscle relaxation training, music meditation and drawing therapy. Participants in the control group will receive routine care. The Hospital Anxiety and Depression Scale (HADS) and Fertility Problem Inventory (FPI) will be used to investigate the anxiety, depression, and infertility-related stress of all participants at admission and at discharge.

DISCUSSION

This study will verify the effectiveness and efficiency of expressive art therapies for infertile women. The results will provide new knowledge on mental health care strategies for infertile women.

TRIAL REGISTRATION

ChiCTR, ChiCTR2300070618. Registered 14 April 2023.

Art Therapy as a Nursing Intervention for Individuals With Schizophrenia

The aim of the current study was to determine the effects of group art therapy on clinical symptoms, alexithymia, and quality of life among people with schizophrenia. This single-blinded, randomized controlled trial was performed with 66 individuals with schizophrenia from a community mental health center in western Turkey between September 2021 and February 2022. Following art therapy, the intervention group had lower severity of positive, negative, and general psycho-pathology symptoms; lower levels of alexithymia; and higher levels of psychological health, social relationships, and total quality of life than the control group; and the difference between groups was statistically significant (p < 0.05). Results reveal that art therapy combined with pharmacological therapy contributes to good clinical outcomes among individuals with schizophrenia. This evidence can guide psychiatric nurses to use art therapy to reduce psychopathology severity and increase functionality and quality of life among individuals with schizophrenia. [Journal of Psychosocial Nursing and Mental Health Services, 62(5), 29-38.].

ArtSpective™ for Perinatal Substance Use: Feasibility of an Arts-Based Intervention Addressing Stigma

OBJECTIVE

The purpose of this proof-of-concept pilot study was to test the initial feasibility and limited efficacy of ArtSpective™ for perinatal substance use (PSU), a novel, arts-based intervention designed to decrease stigmatizing attitudes toward PSU.

METHODS

Using a pre-post mixed methods quasi-experimental design, ArtSpective™ for PSU was pilot tested for proof of concept among a convenience sample of 11 undergraduate and graduate students with experience in maternal-infant nursing from a Midwestern U.S. nursing school. As a proof-of-concept pilot study, we evaluated feasibility (acceptability, demand, and implementation) and limited efficacy. Participants completed presurveys and postsurveys that included satisfaction items, demographic items, and an adapted version of the Attitudes About Drug Use in Pregnancy Scale and participated in a focus group. Focus group data were analyzed using constant comparative methods, and survey data were analyzed using descriptive statistics and Wilcoxon signed rank tests.

RESULTS

Participants reported high demand and satisfaction with the intervention and provided recommendations to improve scalability. ArtSpective™ demonstrated significant improvement in stigma toward PSU (pre vs. post: p = .003; d = .633).

CONCLUSION

ArtSpective™ for PSU demonstrated initial feasibility and limited efficacy for improving nurse attitudes toward PSU. Efforts are needed to further test this novel intervention, adapt it to augment existing educational interventions, and improve its scalability.

A scoping review of the use of creative activities in stroke rehabilitation

OBJECTIVE

Clarifying the distinctions between art-based creative activities in the domains of occupational therapy and art therapy in the context of stroke rehabilitation, while also describing the effects of art-based creative activities on stroke rehabilitation.

DESIGN

Scoping review.

DATA SOURCE

A systematic search was performed in nine databases (Web of Science, PubMed, EMBASE, Cochrane Library, CINAHL and four Chinese database) from their inception to December 2023.

REVIEW METHODS

The study included randomized and non-randomized controlled trials involving art-based creative activities, as well as qualitative research providing detailed intervention measures. The study focused on stroke patients, with primary outcomes related to patients' physiological recovery, psychological well-being, ADL, etc. Data extraction included information on intervention strategies and study results.

RESULTS

Seventeen studies were included, extracting six similarities and differences in creative activity between two domains. Creative activities were observed to have positive impacts on daily living activities, limb motor function, fine motor ability, and emotional well-being in stroke patients.

CONCLUSION

Creative activities, whether in occupational therapy or art therapy, involve providing participants with tangible crafting materials for the creation of artistic works. Future stroke rehabilitation practices should tailor activities and intervention focus based on patients' rehabilitation needs, preferences, and cultural background. The current comprehensive analysis provides initial support for the potential positive role of creative activities in stroke rehabilitation, but further in-depth research is needed to confirm their effectiveness.

Boosting Resilience: Photovoice as a Tool for Promoting Well-Being, Social Cohesion, and Empowerment Among the Older Adult During the COVID-19 Pandemic

This paper examines how older adults who participated in an online photovoice-based group intervention program reported their experience. In a qualitative-phenomenological study, in which 13 older-adult people participated, data were collected through semi-structured in-depth interviews and analyzed through content analysis. The findings point to three central themes: a) Challenges-technical difficulties, difficulties in finding a subject for photography, investing time in photography, and an emotional-intellectual effort to put their experience into photography; b) Growth: New knowledge and skills-acquiring new knowledge, acquiring skills, experiencing skills regardless of age, and empowerment; c) Meaning-reflexivity, the ability to project feelings onto images, connection to the outside world, mindfulness, ability to choose, creativity, and critical consciousness. The findings share the way in which the use of creative visual engagement with photography contributed to coping with various challenges and enabled various gains within the process among the older-adult participants.

"I made you a small room in my heart": how therapeutic clowns meet the needs of older adults in nursing homes

Therapeutic clowns are increasingly common in nursing homes, where residents often encounter factors that can undermine their quality of life and dignity. We aimed to understand the strategies of successful therapeutic clowning with a diverse older adult population, and the unique contributions of elder-clowning to the nursing home experience. Using an interpretivist descriptive methodology, twenty-three (n=23) experienced therapeutic clowns from eight countries were interviewed to understand the needs of nursing home residents met by elder-clowns, and strategies and techniques the clowns use to address them. Participants identified five major needs: to escape routine; for reassurance of worth; for meaningful, personalized social interaction unrestricted by communication barriers; to have culturally meaningful opportunities for reminiscence; and to have a space where residents could be unapologetically themselves. The artistic and emotional strategies used by the therapeutic clowns to address these needs illustrate how creativity, imagination and relational presence can provide nursing home residents with a sense of being known and belonging. Elder-clowns also positively affect the nursing home staff and enrich the interpersonal interactions in the residence. Through their focus on the social and emotional needs of residents, elder-clowns can play an important and distinct role in creating an optimal nursing home experience.

Effectiveness of museum-based participatory arts in mental health recovery

The World Health Organization encourages mental health services to adopt a strategic intersectoral approach by acknowledging the potential of the arts and the value of culture on the process of mental health recovery. The aim of this study was to evaluate the impact of participatory arts in museums on mental health recovery. A quasi-experimental, pre-post and multicentre study was carried out. By using a mixed methods evaluation at baseline and at 3 months, quantitative outcome measures were used to assess the changes in recovery and social support and qualitative interviews to explore the self-perceived impact on five processes of recovery. One hundred mental health service users participated for 3 years in the face-to-face programme RecuperArte, of which the data of 54 were analysed. The results indicate a significant increase in recovery measured with the QPR-15-SP (42 vs. 44; p = 0.034) and almost significant in functional social support measured with the DUKE-UNC (41.50 vs. 43.50; p = 0.052), with almost large (r = 0.29) and medium (r = 0.26) effect sizes, respectively. Participants perceived mostly an impact on the recovery process of Meaning in life 30/54 (55.56%), Hope and optimism about the future 29/54 (53.7%) and Connectedness 21/54 (38.89%), followed by Identity 6/54 (11.11%) and Empowerment 5/54 (9.26%). The findings contribute to the growing evidence of the potential of the arts as a therapeutic tool, the value of museums as therapeutic spaces and the role of nurses in intersectoral coordination, between the mental health and cultural sectors, as facilitators and researchers of these evidence-based practices.

Gamifying Cognitive Behavioral Therapy Techniques on Smartphones for Bangkok's Millennials With Depressive Symptoms: Interdisciplinary Game Development

BACKGROUND

There is serious concern over the annual increase in depressive symptoms among millennials in Bangkok, Thailand. Their daily routine revolves around the use of their smartphones for work and leisure. Although accessibility to mental health care is expanding, it cannot keep up with the demand for mental health treatment. Outside Thailand, multiple projects and studies have attempted to merge gamification mechanisms and cognitive behavioral therapy (CBT) to create mobile health intervention apps and serious games with positive feedback. This presents an opportunity to explore the same approach in Thailand.

OBJECTIVE

This study investigated the development process of gamifying CBT techniques to support game mechanics in a visual narrative serious game, BlueLine. The primary target of this research is Bangkok's millennials. In the game, players play as Blue, a Bangkok millennial who struggles to live through societal norms that influence his digital life and relationships. Through in-game scenarios, players will learn and understand how to lessen the impact of depressive symptoms via gamified interactions on their smartphones.

METHODS

First, this paper follows each development step of solidifying BlueLine's game structure by integrating the Activating Events, Beliefs, Consequences, Disputation of Beliefs and Effective New Approaches (ABCDE) model and narrative in games. Second, the approach to select CBT and related therapeutic elements for gamification is based on suitability to the game structure. Throughout the process, CBT experts in Thailand have reviewed these scenarios. The approach forms the base of the player's interactions throughout the scenarios in BlueLine, broken down into 4 types of gamified mechanisms: narrative, verbal interactions, physical interactions, and social media interactions.

RESULTS

With the game structure based on the ABCDE model, BlueLine scenarios implement gamified mechanisms in conjunction with the following CBT and related therapeutic elements: behavioral activation, self-monitoring, interpersonal skills, positive psychology, relaxation and mindful activities, and problem-solving. In each scenario, players guide Blue to overcome his triggered dysfunctional beliefs. During this process, players can learn and understand how to lessen the impact of depressive symptoms through gamified interactions.

CONCLUSIONS

This paper presents the development process of gamifying CBT and related therapeutic techniques in BlueLine game scenarios. A scenario can harbor multiple techniques, including behavioral activation, self-monitoring, interpersonal skills, positive psychology, relaxation and mindful activities, and problem-solving. BlueLine's game structure does not limit the fact that the same combination of CBT elements ties each gamified mechanism.

Complementary Medicine and Expressive Arts Therapy: Adjuvant for Recovery Following Neurosurgical Procedures

Art as a way of healing is primordial in many cultures. Expressive Arts Therapy (ExAT) uses art, music, dance, and writing to help individuals navigate their healing journey. Patient self-expression as a mode of recovery has been observed in patients with Parkinson’s disease, epilepsy, Amyotrophic Lateral Sclerosis (ALS) and cancer. Complementary medical approaches such as acupuncture and mindfulness have also demonstrated benefits in patients suffering from neurological injury. Complementary medicine and ExAT are not mainstream approaches following neurosurgical procedures. There are very few systematic studies evaluating the benefits of expressive arts in neurosurgery. Advances in telemedicine and mobile applications may facilitate the incorporation of complementary medicine and ExAT into patient recovery. The purpose of our study is to explore the use of complementary medicine and ExAT in neurosurgical recovery. We start with a brief introduction of ExAT followed by available treatments offered. We discuss the benefits of multidisciplinary care and emerging technologies and how they can facilitate incorporation of complementary medicine and ExAT in neurosurgery. Finally, we review several clinical studies that have demonstrated success in using complementary medicine. Our goal is to provide alternative approaches to neurosurgery recovery so that patients may receive with the best care possible.

The Psychological Recovery of Patients in the Context of Virtual Reality Application by a Complementary Medicine Scheme Based on Visual Art

Expressive art therapy, which originated from art therapy, uses visual art as a carrier and plays a complementary role in clinical medicine and psychological medicine in the healing process of mentally ill patients. With the rapid development of science and technology, expressive art therapy has also entered the field of technology-oriented virtual reality. This study aims to summarize the clinical psychology research of expressive art therapy based on virtual reality, to review the current state of the field, in order to provide detailed scientific research evidence summary for relevant content and complete knowledge reserve.

Role of Art Therapy in the Promotion of Mental Health: A Critical Review

Art therapy is used most commonly to treat mental illnesses and can aid in controlling manifestations correlated with psychosocially challenging behaviours, slowing cognitive decline, and enhancing the quality of life. Art therapy can help people express themselves more freely, improve their mental health, and improve interpersonal relationships. The basis of art therapy is established on the idea that people can recover and feel better via artistic expression. This review examines the current research on how active participation in the arts might improve mental health. A detailed literature search was carried out utilizing essential databases such as PubMed, the WHO's mental health database, and Google and Google Scholar. This review study looks into research done on art therapy and its potential advantages for adult mental health rehabilitation. It focuses on visual art therapy since it’s a key to reducing variation within the "creative arts" and defines the peculiar elements and effectiveness of art therapy used by mental health services. It was found that the use of art therapy as an adjunct treatment showed improved mental health in patients.

Women Supporting Women: The Use of Art With Anxious/Depressed, Urban, Impoverished, Ethnically Diverse Women

BACKGROUND: Depression and anxiety disproportionately affect urban, ethnically diverse, impoverished women-particularly when access to culturally sensitive care is limited. Using community-based participatory research in the context of long-term, academic/community partnerships, women supporting women, a supportive/educative group intervention piloting an art project, was offered. AIMS: The purpose of this study was to examine the impact of an artist book-making project on diverse women struggling with anxiety and depression. METHODS: A descriptive qualitative approach was used within this mixed-method study. Thirty-one participants, aged 18 to 86 years, were asked: (1) How does this book tell your story? (2) How did creating this book impact you personally? (3) How would you describe the experience of creating your book alongside women from our group? (4) How did this project help you with anxiety and depression? (5) What did you do with the book that you made? The framework method for analysis of qualitative data in multidisciplinary health research was used. RESULTS: Four themes, with corresponding subthemes, were identified: (1) personal story entailed expression of past, present, and future journey and mediums to depict the story; (2) method of coping included relaxation, diversion, and self-care; (3) creative impact encompassed affirmation of identity, empowerment, healing, pride in work, and a vehicle to connect; and (4) creating in community incorporated inspiration, sharing, and solidarity. CONCLUSIONS: These results suggest that an art project provides a culturally sensitive, clinically relevant, and cost-effective self-care intervention for vulnerable women struggling with anxiety and depression.

An Investigation into Art Therapy Aided Health and Well-Being Research: A 75-Year Bibliometric Analysis

Considering the physical, and psychological impacts and challenges brought about the coronavirus disease 2019 (COVID-19), art therapy (AT) provides opportunities to promote human health and well-being. There are few systematic analysis studies in the fields of AT, which can provide content and direction for the potential value and impact of AT. Therefore, this paper aims to critically analyze the published work in the field of AT from the perspective of promoting health and well-being, and provides insights into current research status, hotspots, limitations, and future development trends of AT. This paper adopts a mixed method of quantitative and qualitative analysis including bibliometric analysis and keyword co-occurrence analysis. The results indicate that: (1) the current studies on AT are mostly related to research and therapeutic methods, types of AT, research populations and diseases, and evaluation of therapeutic effect of AT. The research method of AT mainly adopts qualitative research, among which creative arts therapy and group AT are common types of AT, and its main research populations are children, veterans, and adolescents. AT-aided diseases are trauma, depression, psychosis, dementia, and cancer. In addition, the therapeutic methods are mainly related to psychotherapy, drama, music, and dance/movement. Further, computer systems are an important evaluation tool in the research of AT; (2) the future development trend of AT-aided health and well-being based on research hotspots, could be focused on children, schizophrenia, well-being, mental health, palliative care, veterans, and the elderly within the context of addressing COVID-19 challenges; and (3) future AT-aided health and well-being could pay more attention to innovate and integrate the therapeutic methods of behavior, movement, and technology, such as virtual reality and remote supervision.