Strengthening the Healthy Adult Self in Art Therapy: Using Schema Therapy as a Positive Psychological Intervention for People Diagnosed With Personality Disorders

Creative strengthening groups as a potential intervention to enhance job satisfaction and reduce levels of burnout in healthcare professionals: results from the randomized controlled trial UPGRADE

BACKGROUND

Healthcare professionals often face substantial work-related burdens. A large body of evidence has shown that poor working conditions can lead to low levels of job satisfaction, increased emotional stress and burnout. While symptom targeted interventions take effect after symptoms become manifest, preventive interventions are required to reduce the risk of work-related diseases. Therefore, the UPGRADE-trial aimed to evaluate the effectiveness of Creative Strengthening Groups as a potential intervention to enhance job satisfaction and work-related health. The German Innovation Fund (Innovationsfonds) funded the project.

METHODS

We conducted a randomized controlled trial and randomly assigned healthcare professionals to either the intervention or the control group. The intervention - Creative Strengthening Groups - consisted of two one-day classes. We evaluated the primary outcome job satisfaction and further work-related outcomes using standardized questionnaires. We collected data at baseline as well as after three and six months. The study was conducted between October 2019 to March 2023, including the pandemic period.

RESULTS

We enrolled 196 participants (intervention n = 88, control n = 108) with a mean age of 46.2 ± 12.1 years (84.5% female). 43.7% were nursing professionals. Job satisfaction in the intervention group increased from 55.47 ± 10.23 to 57.07 ± 11.65 after three months and decreased in the control group from 56.29 ± 19.69 to 53.47 ± 20.09. The difference between groups did not reach statistical significance. Additionally, change in patient-related stress significantly differed between groups (intervention: -3.9 ± 12.16 vs. control: 5.17 ± 17.43; p =.027) as well as personal burnout (intervention: -5.25 ± 13.1 vs. control: 4.35 ± 16.24; p =.011). Within the intervention group, we observed a greater improvement concerning work-related burnout in nursing staff in geriatric care than in hospitals (-15.27 ± 13.5 vs. +3.28 ± 13.7; p =.003).

CONCLUSION

Though the Covid-19 pandemic worsened working conditions for healthcare professionals, our results indicate that intervention has the potential to enhance job satisfaction and work related health. Notably, due to the overall workload and the pandemic restrictions, a high number of participants did not continually participate in both classes of the intervention and some did not return all questionnaires. As long as healthcare professionals in Germany are facing exceedingly bad working conditions, it is very difficult to support their resources such as self-efficacy, self-esteem, and optimism by health promotion interventions.

TRIAL REGISTRATION

The trial has been registered at the German Clinical Trials Register (DRKS; ID: DRKS00020908). Date of Registration: 2020-03-16.

Promoting psychological adaptability and well-being of patients with personality disorders with creative arts and psychomotor therapies: protocol of an intervention mapping study

INTRODUCTION

Personality disorders (PDs) cause much suffering. In treating patients with PDs, it is important not only to focus on reducing symptoms, but also on promoting psychological adaptability and well-being. The experiential nature of Creative Arts and Psychomotor Therapies (CAPTs) contributes to working on psychological adaptability and improving well-being, although more evidence is needed. This protocol paper describes a study to develop and evaluate a CAPTs-intervention aimed at promoting psychological adaptability and well-being in people with PDs.

METHODS AND ANALYSIS

The CAPTs-intervention will be developed using the Intervention Mapping method. A mixed method design will be used for the evaluation of this intervention, using a multiple baseline single case experimental design (MBSCED) with at least 17 participants with a PD included. Quantitative measures that will be completed weekly are the Generic Sense of Ability to Adapt Scale, the Self-Expression and Emotion Regulation in Art Therapy Scale and the Schema Mode Inventory (SMI, healthy adult and happy child). The Mental Health Continuum Short Form, the Brief Symptom Inventory and the SMI (complete) will only be completed at week 1 and 10 of the intervention. Qualitative instruments are an online survey for Experts by Experience, focus groups for CAPTs-therapists, psychologists, managers and referrers, and semi-structured interviews with patients. Quantitative outcomes will be analysed with linear mixed models. Qualitative analysis will be performed using thematic analysis.

ETHICS AND DISSEMINATION

This study has been approved by the Research Ethics Committee of the HAN University of Applied Sciences (ref: ECO 471.07/23). All participants will sign an Informed Consent and data will be treated confidentially. Study findings will be published Open Access in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

This study has been registered at https://www.

CLINICALTRIALS

gov (trial registration number NCT06219122).

The effects of online art therapy on ego functions, emotion regulation, and interpersonal relationship styles in neurotic personality organization

Art therapy, as an effective therapeutic intervention, is used to improve positive self-image and self-awareness, promote insight, and enhance therapeutic communication. This study aimed to evaluate the efficacy of art psychotherapy on ego functions, emotion regulation, and interpersonal relationship styles of individuals with neurotic personality organization. Using a quasi-experimental pretest-posttest design, 60 participants were assigned to intervention and control groups, each further divided into three subgroups (n = 10 per subgroup). The intervention group engaged in online art therapy sessions twice weekly over nine weeks, while the control group received no intervention. Data analysis involved descriptive statistics, paired samples t-tests, and independent t-tests. There was a significant decrease in the intervention group's judgmental subdimensions of the Ego Function Assessment Scale. A significant decrease was found in the intervention group in "awareness" (p < 0.01), "clarity" (p < 0.05), and "impulse" (p < 0.001) subdimensions and total scores of the Difficulties in Emotion Regulation Scale. There was no statistical difference between the intervention and control groups' mean pretests and posttests and comparing those groups with each other concerning IRSQ scores. The online group art therapy led to successful improvements in participants' ego functions and emotion regulations.

Understanding the reparative effects of schema modes: an in-depth analysis of the healthy adult mode

Objectives

Evidence in favor of schema therapy's effectiveness in treating personality disorders is growing. One of the central and recently popular concepts of schema therapy is schema modes [i.e., temporary emotional-cognitive-behavioral states resulting from the activation of early maladaptive schemas (EMSs)]. A key aspect herein is self-reparenting, i.e., a healing relationship between the healthy adult (HA, i.e., compassionate and healthy emotional states, and functional dealing with reality) and the child modes (i.e., representation of fragile and hurt feelings and dysfunctional coping). Through an in-depth qualitative analysis, we aimed to better understand the components of the HA that enable self-reparenting.

Method

Purposive sampling procedures were used to recruit eligible participants (n = 10) with relatively strong HA modes, as determined by high scores on positive affect and satisfaction with life measures and low scores on EMSs and psychopathological symptom measures. Semi-structured 45- to 60-min face-to-face interviews were conducted individually, in which individuals were asked to help the child modes reflected in the pictures. Interviews were then analyzed using deductive thematic analysis in MaxQDA.

Results and discussion

The analysis revealed three superordinate themes comprising of a total of 10 group themes: (1) bonding between HA and the vulnerable child modes ("Bond"); (2) balancing expression and inhibition of adult and child mode emotions ("Balancing"); and (3) opposing demanding and critical voices and maladaptive coping styles ("Battle"). Furthermore, a strong HA mode seems to have a reciprocal relationship with the child modes: the HA gives nurturance and protection to the child modes, and the child modes boost up the HA with spontaneity and happiness. In conclusion, emotional stability and resilience may be highest when HA-child mode interaction happens bidirectionally; when the child modes get reparented by the HA, and the HA is informed by the child modes.

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.

The Relationship between Sustainable Built Environment, Art Therapy and Therapeutic Design in Promoting Health and Well-Being

At present, a smart city from the perspective of the United Nations Sustainable Development Goals (SDGs) emphasizes the importance of providing citizens with promising health and well-being. However, with the continuous impact of coronavirus disease 2019 (COVID-19) and the increase of city population, the health of citizens is facing new challenges. Therefore, this paper aims to assess the relationship between building, environment, landscape design, art therapy (AT), and therapeutic design (TD) in promoting health within the context of sustainable development. It also summarizes the existing applied research areas and potential value of TD that informs future research. This paper adopts the macro-quantitative and micro-qualitative research methods of bibliometric analysis. The results show that: the built environment and AT are related to sustainable development, and closely associated with health and well-being; the application of TD in the environment, architecture, space, and landscape fields promotes the realization of SDGs and lays the foundation for integrating digital technologies such as Building Information Modeling (BIM) into the design process to potentially solve the challenges of TD; and the principle of TD can consider design elements and characteristics from based on people's health needs to better promote human health and well-being.

The effects of positive psychological intervention on obstetric surgery patients' mental states, pain levels, and quality of life

To explore the effect of positive psychological intervention (PPI) on the psychological state, pain levels, and quality of life of patients undergoing obstetric surgery. A total of 96 patients undergoing obstetric surgery in The Second Hospital of Shandong University from March 2018 to May 2019 were selected for this study. They were equally and randomly separated into a control and an observation group. We found the postoperative hospital stays, bleeding times, feeding times, and activity times of the observation group with PPI were shorter than they were in the control group without PPI (P<0.05). Moreover, the SAS and SDS scores, and the pain levels of the observation group were significantly lower than they were in the control group (P<0.05), resulting in improved quality of life scores in the observation group (P<0.05). Furthermore, the overall incidences of postpartum hemorrhage, infections, depression, constipation, and bedsores were significantly lower in the observation group than they were in the control group (25% vs 77.08%, P<0.05). In conclusion, PPI can improve the mental states of patients undergoing obstetric surgery and improve their quality of life.

Benefits of Art Therapy in People Diagnosed With Personality Disorders: A Quantitative Survey

Art therapy is widely used and effective in the treatment of patients diagnosed with Personality Disorders (PDs). Current psychotherapeutic approaches may benefit from this additional therapy to improve their efficacy. But what is the patient perspective upon this therapy? This study explored perceived benefits of art therapy for patients with PDs to let the valuable perspective of patients be taken into account. Using a quantitative survey study over 3 months (N = 528), GLM repeated measures and overall hierarchical regression analyses showed that the majority of the patients reported quite a lot of benefit from art therapy (mean 3.70 on a 5-point Likert scale), primarily in emotional and social functioning. The improvements are concentrated in specific target goals of which the five highest scoring goals affected were: expression of emotions, improved (more stable/positive) self-image, making own choices/autonomy, recognition of, insight in, and changing of personal patterns of feelings, behaviors and thoughts and dealing with own limitations and/or vulnerability. Patients made it clear that they perceived these target areas as having been affected by art therapy and said so at both moments in time, with a higher score after 3 months. The extent of the perceived benefits is highly dependent for patients on factors such as a non-judgmental attitude on the part of the therapist, feeling that they are taken seriously, being given sufficient freedom of expression but at the same time being offered sufficient structure and an adequate basis. Age, gender, and diagnosis cluster did not predict the magnitude of perceived benefits. Art therapy provides equal advantages to a broad target group, and so this form of therapy can be broadly indicated. The experienced benefits and the increase over time was primarily associated with the degree to which patients perceive that they can give meaningful expression to feelings in their artwork. This provides an indication for the extent of the benefits a person can experience and can also serve as a clear guiding principle for interventions by the art therapist.

Treatment of Trauma: Imaginative Minds of Dissociative Identify Disorder

If childhood trauma leads to dissociation, then this coping mechanism is powered by the imagination, creativity, consciousness, and similar areas of cognitive function. The goal of this article is to promote the treatment of trauma with particular emphasis on humanistic psychotherapy and behavioral therapy, such as “Play Therapy” for pediatric populations. It will thoroughly describe the multiple personality states within dissociative identity disorder, including the individualized sense of “self.” The diagnostic criteria of this mental disorder will be covered, along with assessment techniques that evoke a deeper understanding of dissociative disorders. It will also discuss comorbidities that present with dissociative disorders, such as posttraumatic stress disorder. This scholarly article suggests that dissociative disorders may result from experiencing tragic events and therefore need treatment for trauma to relieve negative symptoms of dissociation. The multidimensional aspects of dissociation are emphasized in their relation to the treatment of trauma.