Moderating factors for the effectiveness of group art therapy for schizophrenia: secondary analysis of data from the MATISSE randomised controlled trial.

Baptiste Leurent,Diane Waller,David P Osborn,Helen Killaspy,Michael King,Angela Hoadley,Mike J Crawford

doi:10.1007/s00127-014-0876-2

Abstract

PurposeAlthough some studies suggest that art therapy may be useful in the treatment of negative symptoms of schizophrenia, a recent large trial of group art therapy found no clinical advantage over standard care, but the study population was heterogeneous and uptake of the intervention was poor. This study aimed to investigate whether art therapy was more effective for specific subgroups of patients.MethodsSecondary analysis of data from a randomised controlled trial of group art therapy as an adjunctive treatment for schizophrenia (n = 140) versus standard care alone (n = 137). Positive and Negative Syndrome Scale scores at 12 months were compared between trial arms. Interaction between intervention effect and different subgroups, including those with more severe negative symptoms of schizophrenia, and those who expressed a preference for art therapy prior to randomisation, was tested using a linear mixed model.ResultsThe clinical effectiveness of group art therapy did not significantly differ between participants with more or less severe negative symptoms [interaction for difference in PANSS = 1.7, 95 % CI (−8.6 to 12.1), P = 0.741], or between those who did and did not express a preference for art therapy [interaction = 3.9, 95 % CI (−6.7 to 14.5), P = 0.473]. None of the other exploratory subgroups suggested differences in intervention effect.ConclusionsThere was no evidence of greater improvement in clinical symptoms of schizophrenia for those with more severe negative symptoms or those with a preference for art therapy. Identification of patients with schizophrenia who may benefit most from group art therapy remains elusive.

Highlights

Schizophrenia is a severe mental illness affecting up to one in a hundred people at some point in their lives
Purpose some studies suggest that art therapy may be useful in the treatment of negative symptoms of schizophrenia, a recent large trial of group art therapy found no clinical advantage over standard care, but the study population was heterogeneous and uptake of the intervention was poor
There was no evidence of greater improvement in clinical symptoms of schizophrenia for those with more severe negative symptoms or those with a preference for art therapy

Summary

Introduction

Schizophrenia is a severe mental illness affecting up to one in a hundred people at some point in their lives. A recent large pragmatic randomised controlled trial, the ‘‘MATISSE’’ study (Multicentre study of Art Therapy In Schizophrenia; Systematic Evaluation), found no evidence of a population-level effect of group art therapy over treatment as usual in terms of global functioning or symptoms of mental illness [5]. Participant preference for the interventions offered in a randomised trial may influence recruitment, attrition and adherence [8, 9] It follows that those who are randomised to receive their treatment of choice may derive greater benefits than those with little interest in it, possibly through higher adherence to the intervention. It is possible that those who were more comfortable talking about their feelings and more interested in creative arts may have derived more benefit from the art therapy groups Those who are generally more adherent with their mental health treatment may have been more likely to engage constructively with the intervention. The participants recruited into the MATISSE trial had a median duration of illness of 15 years and it may be that the intervention has greater effectiveness at an earlier stage of the illness

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