Art psychotherapy with youth in homelessness hostels

Padala Olga, Krupa Adrianna, Putowski Maciej, Konopelko Michal, Piasek Ewa. The efficacy of art therapy in psychiatric patients. Journal of Education, Health and Sport. 2019;9(8):377-383. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.3376782 http://ojs.ukw.edu.pl/index.php/johs/article/view/7324 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Authors 2019; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.08.2019. Revised: 15.08.2019. Accepted: 23.08.2019. The efficacy of art therapy in psychiatric patients Padala Olga, olga.padala@gmail.com ORCID:0000-0003-1469-0877 1st Department of Psychiatry, Psychotherapy and Early Intervention Medical University of Lublin, Gluska Street 1, 20-439 Lublin, Poland Krupa Adrianna, adriannakrp@gmail.com ORCID:0000-0003-0866-3952 Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4 Street, 20-090 Lublin, Poland Putowski Maciej, putowski.maciek@gmail.com ORCID:0000-0002-7575-2456 Department of Experimental Hematooncology, Medical University of Lublin, Chodźki 1 Street, 20-093 Lublin, Poland Konopelko Michal, mm.konopelko@gmail.com ORCID:0000-0003-4103-7400 Department of Otolaryngology and Laryngological Oncology, Medical University of Lublin, Jaczewskiego 8, 20 954, Lublin, Poland Piasek Ewa, ewa.piasekk@gmail.com, ORCID:0000-0003-3344-4022 I Clinic of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego 8, 20 954, Lublin, Poland Abstract: Introduction: Art therapy is a form of psychotherapy that uses art media as its primary mode of expression and communication and enables individuals to use art to creatively express themselves. Art therapy is used to improve cognitive and sensorimotor functions, foster self-esteem and self-awareness, cultivate emotional resilience, promote insight, enhance social skills, reduce and resolve conflicts and distress. Purpose: The purpose of the review is to present the different uses of art therapy in psychiatric patients. State of knowledge: National Institute for Health and Clinical Excellence identifies that arts therapies, including art therapy or art psychotherapy, dance movement therapy, body psychotherapy, drama therapy and music therapy, are considered to improve negative symptoms of psychosis. Improved social skills are likely to be associated with increases in prosocial behaviours. Art therapy interventions are effective in reducing trauma symptom severity and anxiety in traumatized adults. Art and music therapy programs were effective in reducing the degree of depression. Summary: Art therapy is a part of therapy in many psychiatric diseases, including depressive disorders, post-traumatic stress disorder and psychotic disorders. Although the effectiveness of art therapy has been confirmed by some studies, this topic should still be investigated so that art therapy can become more effective and available for bigger group of patients. Key words: art therapy, PTSD, depression, psychotic disorder, schizophrenia

Art therapy and art psychotherapy are often offered in Child and Adolescent Mental Health services (CAMHS). We aimed to review the evidence regarding art therapy and art psychotherapy in children attending mental health services. We searched PubMed, Web of Science, and EBSCO (CINHAL®Complete) following PRISMA guidelines, using the search terms (“creative therapy” OR “art therapy”) AND (child* OR adolescent OR teen*). We excluded review articles, articles which included adults, articles which were not written in English and articles without outcome measures. We identified 17 articles which are included in our review synthesis. We described these in two groups—ten articles regarding the treatment of children with a psychiatric diagnosis and seven regarding the treatment of children with psychiatric symptoms, but no formal diagnosis. The studies varied in terms of the type of art therapy/psychotherapy delivered, underlying conditions and outcome measures. Many were case studies/case series or small quasi-experimental studies; there were few randomised controlled trials and no replication studies. However, there was some evidence that art therapy or art psychotherapy may benefit children who have experienced trauma or who have post-traumatic stress disorder (PTSD) symptoms. There is extensive literature regarding art therapy/psychotherapy in children but limited empirical papers regarding its use in children attending mental health services. There is some evidence that art therapy or art psychotherapy may benefit children who have experienced trauma. Further research is required, and it may be beneficial if studies could be replicated in different locations.

The Complexity of Complex PTSD

Posttraumatic stress disorder (PTSD) is one of the few psychiatric conditions in which a subjective decrease in emotional range serves as a diagnostic criterion. In order to investigate whether veterans with chronic PTSD also experienced objective limitations in emotional perception, the authors administered the Aprosodia Battery to a group of 11 veterans with chronic PTSD, nine subjects with right hemisphere damage, seven subjects with left hemisphere damage, and 12 comparison subjects. The patients with PTSD displayed significant deficiencies in the comprehension and discriminative components of affective speech, similar in severity and performance profile on the Aprosodia Battery to the individuals with focal right hemisphere damage due to ischemic infarction.

Distressing and intrusive reexperiencing of the trauma is a hallmark symptom of posttraumatic stress disorder (PTSD; American Psychiatric Association, 1994). However, unwanted memories of trauma are not a sign of pathology per se. In the initial weeks after a traumatic experience, intrusive memories are common. For most trauma survivors, intrusions become less frequent and distressing over time. A central question for understanding and treating patients with PTSD is therefore what maintains distressing intrusive reexperiencing in these people. Three factors appear to be important: (1) memory processes responsible for the easy triggering of intrusive memories, (2) the individuals’ interpretations of their trauma memories, and (3) their cognitive and behavioral responses to trauma memories.

Bringing arts-based therapies in from the scientific cold

Art therapy with infants, toddlers and their families is an exciting and developing area of practice. With contributions from Australia, the United Kingdom and Spain, Art Therapy in the Early Years has an international flavour. The authors describe clinical art psychotherapy practice with children under five and their families in settings that include children in care, mental health clinics, paediatric wards, pre-schools, and early intervention programs. Divided into three sections, Art Therapy in the Early Years presents different clinical environments in which art psychotherapy with this client group is found: • individual art therapy; • group art therapy; • parent-child dyad and family art therapy. The book proposes that within these different contexts, the adaptive possibilities inherent in art psychotherapy provide opportunities for therapeutic growth for young children and their families. Art Therapy in the Early Years will be of interest to art therapists working with children; students and practitioners from creative arts therapies; psychologists and psychotherapists; social workers; pre-school teachers; child psychiatrists, clinical supervisors, and other professionals working in the early years settings.

Review Question/s What is the impact of Art Therapy participation on the individuals’ wellness and emotional needs? What is the experience and meaningfulness of the aged person and their participation either in group Art Therapy situations or in one on one situations? Inclusion Criteria Types of Participants Participants will be people aged 65 years or over with no evidence of dementia or other cognitive disabilities. They will either be in nursing home care, community care, day care, residential, low-care, supported living or the medical home. They may have no family or other emotional support and be suffering from increasing introspection. Types of Interventions The intervention of interest will be Art Therapy with the focus on the visual arts. All available techniques will be considered, including for example, art therapy sessions using a variety of tools, drawing, painting, computer manipulated imagery, photography and any other mode of visual expression. Art Therapy techniques examined will be those used in the group situation or with the individual aged person. Examined will also be who runs the art therapy program, is it an artist, professional art therapist, general therapist, is the therapy self-directed, how long will the sessions run for, what time period are sessions conducted over? Are these programs six months, twelve months etc how do the frail aged cope with half hour sessions or one hour sessions. Types of Outcome Measures Quantitative outcomes will look at the measureable psychological and psychosocial outcomes and behavioural characteristics resulting from Art Therapy. Indicators will include measures of cognitive function, Quality of Life (QOL) scales, depression scales, frequency of participation in activities and art therapy assessment scales. What are the participants’ communicative skills, social interaction, and quality of social interaction, behavioural problems e.g. stereotypic behaviour, and attention and concentration skills? Do they have an improved cognitive abilities, do they cope with stress and adverse events more easily. Qualitative outcomes will be subjective from the patient’s point of view, how they react to what feelings and emotions they are experiencing from the therapy sessions. Does the reminiscing help or make them feel sad for what they’ve lost, or happy for what they’ve had in their past? Reasons for exclusion Studies will be excluded if they are about the performing arts - music, dance and drama. Participants will be excluded if they are under 65 years of age, and if they have been diagnosed with dementia, Alzheimer’s or other cognitive disorders. Editorials and opinion articles will be excluded.

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

Women in the criminal justice system are a diverse yet marginalised group, living with the most dangerous of intersectional oppressions. Women from the Global Majority face a "double disadvantage" (Agenda, 2017). Prison is evidenced as the least effective place for women, yet prison places have increased and gender-informed services are inadequate. These obstructions to healing from trauma have created a spiralling crisis, leading to preventable deaths and the destruction of families. As a white, female art therapist, I argue that an intersectional framework is critical to understanding and supporting this service-user group. I maintain the established perspective generated by Black feminists and marginalised groups, that focusing on the most ostracised and working from the ‘ground up’, is an effective way of tackling social injustice. A gap in research for art therapy with this service-user group and evidence of epistemological racism within the existing literature presents an opportunity for development and growth within the profession. I discuss the possibilities of using an intersectional framework as intertwined with this service-user group, and with re-establishing ways of knowing within art therapy to ensure anti-oppressive practices. Through a summary of the existing literature developed through research in my final year of training, I will demonstrate how resistance to art therapy occurs at systemic and individual levels and that this cannot be disentangled from the neoliberal status quo. A call to action is proposed for white art therapists to increase their curiosity about their complicity in white supremacy and find ways to develop alternative epistemologies. Plain-language summary The criminal justice system (CJS) provides care for people who are confined in institutions, such as prison or secure hospital, because they pose a significant risk to themselves or others. It also includes people who now live in the community but still need continued support when they leave hospital or prison. Most people in the CJS are men, and facilities have therefore been designed around male needs. The needs of women within the CJS have been persistently ignored by UK government, and women from the Global Majority – Black, Asian, Dual-Heritage, Indigenous and ‘Ethnic Minority’ communities (Campbell-Stephens MBE, 2020) – face particular disadvantages. Race, class and gender oppressions overlap and cause significant harm to the women and their families. Art therapy has been offered within these services for many years; however, there is not much research to support therapy with women in these settings. As an art psychotherapy trainee on placement at a hostel in the community for women leaving secure hospital, I wanted to find out what literature was available to support this work. I searched online databases and found only 24 published articles and book chapters. It was difficult to relate the findings to my community work as the literature was based mostly in high security settings. Most of the authors were white women in professional roles so other people’s perspectives were not represented. This meant that what I found was not a fair description and therefore, not very reliable. However, art psychotherapy was shown to offer positive benefits and respond to existing recommendations for this client group. This paper presents an argument for the need for art therapy services for women in forensic services and proposes a call to action for white art therapists to increase their curiosity about their complicity in white supremacy and find ways to develop alternative intersectional, anti-oppressive practices. The paper also highlights the need for more research from art psychotherapists from different backgrounds that is developed in collaboration with service-users.

Background The COVID pandemic has caused uncertainty, anxiety and instability. Within educational frameworks, many arts therapists needed to shift rapidly to working online. This abrupt transition has challenged their skills and professional confidence, and constitutes a risk factor for increased professional burnout. The Israel Ministry of Education took a series of steps, one of which was a 30-hour remote arts therapy course that was offered during one of the peak periods of the crisis. Aim The present study examined the ways in which this programme provided online skills and lessened the risk of burnout in arts therapists in the education system. Method Fifteen female arts therapists gave the research team access to the assignments they wrote at the beginning and end of the course. The data analysis was based on the principles of Consensual Qualitative Research. Results The analysis dealt with four main domains: (1) Participants’ expectations from the course. (2) Participants’ acquisitions and insights. (3) Participants’ feedback and recommendations. (4) Field applications. Overall, at the end of the course, the participants reported that they saw more possibilities in the remote arts therapy format. Conclusion Rapid and focused support contributed to the arts therapists’ sense of certainty, control, ability and flexibility in their work. Implications for practice Remote arts therapy is here to stay. Other similar courses should be offered for arts therapists working privately and publicly. Focused support during major changes in the therapeutic setting are recommended to prevent the risk of burnout and maintain the efficiency of therapy. Plain-language summary In the State of Israel, at the beginning of the COVID pandemic, more than 3,500 arts therapists employed in the education system were declared vital workers. These therapists have continued their therapeutic work with tens of thousands of children and adolescents across the country through remote arts therapy. The Israel Ministry of Education took a series of steps, one of which was a 30-hour remote arts therapy course that was offered during one of the peak periods of the crisis. The present study examined the ways in which this programme provided online skills and lessened the risk of burnout in arts therapists in the education system. The study involved 15 female arts therapists who participated in a remote arts therapy advanced training in the education system, which took place from October to December 2020. The participants gave the research team access to the assignments they wrote at the beginning and end of the course. The assignments made it possible to examine what the arts therapists learned from the training, the tools they acquired and whether and how they felt they had benefitted from it. Overall, advanced training programme allowed the participants to become familiarised with theory, and explore therapeutic practices and ways of using the arts in the online space. The training format also enabled the participants to share and help each other. Clearly, these courses specifically related to the online format are important and should be recommended in the future both for arts therapists in the education system and for graduate students as part of the curriculum.

The purpose of this study was to examine factors predicting the development of posttraumatic stress symptoms after a traumatic event, the 1991 Oakland/Berkeley firestorm. The major predictive factors of interest were dissociative, anxiety, and loss of personal autonomy symptoms reported in the immediate aftermath of the fire; contact with the fire; and life stressors before and after the fire. Subjects were recruited from several sources so that they would vary in their extent of contact with the fire. Of 187 participants who completed self-report measures about their experiences in the aftermath of the firestorm, 154 completed a follow-up assessment. Of these 154 subjects, 97% completed the follow-up questionnaires 7-9 months after the fire. The questionnaires included measures of posttraumatic stress and life events since the fire. Dissociative and loss of personal autonomy symptoms experienced in the fire's immediate aftermath, as well as stressful life experiences occurring later, significantly predicted posttraumatic stress symptoms measured 7-9 months after the firestorm by a civilian version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and the Impact of Event Scale. Dissociative symptoms more strongly predicted posttraumatic symptoms than did anxiety and loss of personal autonomy symptoms. Intrusive thinking differs from other kinds of posttraumatic symptoms in being related directly to the trauma and previous stressful life events. These findings suggest that dissociative symptoms experienced in the immediate aftermath of a traumatic experience and subsequent stressful experiences are indicative of risk for the later development of posttraumatic stress symptoms. Such measures may be useful as screening procedures for identifying those most likely to need clinical care to help them work through their reactions to the traumatic event and to subsequent stressful experiences.

Literature regarding the efficacy of treatment programmes for post-trauma pathologies is prolific; however, often little attention is given to the treatment of resistant and complex trauma. Many psychotherapists recognise that a trauma history may need to be considered and explored, particularly when working with complex clients. Avoidance of distressing thoughts, feelings and images can manifest in a range of symptoms and behaviours other than post-traumatic stress disorder (PTSD), including substance abuse and interpersonal problems. Creative therapies, such as art therapy, utilise the potentially unfamiliar language of imagery. Imagery, as an adjunct to a sense of safety and holding, in some cases has been shown to overcome therapeutic avoidance. This paper outlines the unveiling and recognition of intra-familial childhood trauma through Art Therapy with a highly articulate Australian woman battling binge drinking behaviours.

BackgroundIn public health emergencies, nurses are vulnerable to adverse reactions, especially job burnout. It is critical to identify nurses at risk of burnout early and implement interventions as early as possible.MethodsA cross-sectional survey of the hospitals in Xiangyang City was conducted in January, 2023 using stratified cluster sampling. Anonymized data were collected from 1584 working nurses. The Impact of Events Scale-Revised (IES-R) and the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS) were used to evaluate the post-traumatic stress disorder (PTSD) and burnout of nurses in public health emergencies. Logistic regression analysis was established to screen for risk factors of burnout, and a nomogram was developed to predict the risk of burnout. A calibration curve and the area under the receiver operating characteristic (ROC) curve were used to validate the nomogram internally.ResultsThis study showed that only 3.7% of nurses were completely free of PTSD during a public health emergency. We found that PTSD varied by age, marital status, procreation status, length of service, employee status, and whether working in the ICU. The nurses aged 30 ~ 40 years old, single, married without children, non-regular employees, worked for less than three years or worked in the ICU had higher levels of PTSD. Regarding the prevalence of burnout, 27.4%, 48.5%, and 18.6% of nurses had a high level of emotional exhaustion (EE), depersonalization (DP), and diminished personal accomplishment (PA), respectively. There, 31.1% of nurses had more than two types of job burnout. The number of night shifts, the type of hospital, marital status, and the severity of PTSD were all associated with higher rates of exhaustion among nurses. As a graphical representation of the model, a nomogram was created and demonstrated excellent calibration and discrimination in both sets (AUC = 0.787).ConclusionsThis study confirmed the PTSD and burnout are common problems for in-service nurses during public health emergencies and screened out the high-risk groups of job burnout. It is necessary to pay more attention nurses who are single and working in general hospitals with many night shifts, especially nurses with severe PTSD. Hospitals can set up nurses’ personal health records to give timely warnings to nurses with health problems, and carry out support interventions to relieve occupational stress.

Background: Seven adults who attended six or more art psychotherapy sessions explore the role art psychotherapy played in their individual mental health recovery. Aims: For lived experience voices to speak to the value of art therapy, attending to what is useful to individuals at the time of therapy and beyond. Methods: A private practice art therapist shared information with service users regarding IJAT’s call for collaborative papers. The art therapist invited interested authors to focus on how one artwork from their time in therapy was useful to them in their personal journey. Authors used their artworks and personal writings to explore the unique ways they used creativity to express hidden and sometimes unspoken aspects of their experiences. Results: Authors drew a variety of conclusions regarding the impact of their art making. The authors explore using their art as a way of making meaning and gaining a greater understanding of themselves and their lived experiences of adversity. Conclusions: The impact of art making in the context of art psychotherapy is useful in supporting individuals to create meaning and self-awareness in relation to adverse experiences. Authors conclude that their art had positive impacts at the time of therapy and beyond, creating support and meaning over time. Implications: The value of follow-up research after a person has attended therapy is implied in the reflections shared by the authors. The relevance over time of a particular piece of artwork or imagery undertaken in art therapy is an area for further research. Plain-language summary The authors consist of seven people who attended art psychotherapy sessions and one therapist. The seven authors with lived experience of a range of adverse experiences have contributed personal written works and images; the therapist has contributed research and reflection. Authors have chosen a single piece of artwork undertaken at some point in the course of their art psychotherapy journey with the art therapist. The authors have written about what this artwork meant to them, both at the time of the therapy and upon reflection. The authors explore themes of: making meaning from visual expression, new understandings of life experiences and the long-term role imagery can play in recovery. The authors explore the ways that art making undertaken in art psychotherapy sessions impacted them as individuals and helped them to make meaning in mental health recovery. The therapist has chosen supportive literature from the field of fine art and art psychotherapy that highlights the observations and experiences made by the authors. The contributing art therapist adds discussion about the capacity for art psychotherapy processes to create meaning from adverse experiences.