Chronic Mental Illness Research Articles

Mental Health Challenges at Work

This symposium includes four papers that provide diverse yet complementary perspectives on mental health challenges at work. Whereas many employees face mental health challenges in the course of their employment—underscored by the fact that one in six employees have a mental illness—mental health challenges are persistently under-examined in management research. The papers in this session are diverse in their contextual focus, temporal focus (e.g., short-term challenges versus chronic mental illness) and analytic approach, yet have commonalities that serve to promote a cohesive multifaceted view of this topic. For instance, multiple papers in this session investigate the role of work-related antecedents to mental health challenges and the role of support in helping—or failing to help—those with mental health challenges. Of note, all these studies uncover nuanced and complex dynamics that underscore the futility of merely trying to “fix” employees’ mental health challenges with simplistic interventions. Following presentation of the papers, integrative commentary will be provided that suggests fruitful opportunities for future research on mental health challenges at work. Anger Trajectories and Resilience Among Combat-Deployed Soldiers Presenter: Jason Kautz; U. of Texas at Dallas Presenter: Laura Campbell-Sills; U. of California, San Diego Presenter: Paul Bliese; Darla Moore School of Business, U. of South Carolina Presenter: Robert Ursano; Uniformed Services U. Hidden from View: Leading with Depression and Anxiety Presenter: Sally Maitlis; U. of Oxford Consequences of Work Injuries on Mental Health: The Role of Social Support Presenter: Steve Granger; U. of Calgary Presenter: Nick Turner; U. of Calgary Presenter: Sandy Hershcovis; U. of Calgary Presenter: Patrick Bruning; U. of New Brunswick Social Support of Employees with Mental Illness Presenter: Emily Rosado-Solomon; California State U., Long Beach Presenter: Sherry M. B. Thatcher; U. of South Carolina Presenter: Sam Strizver; U. of South Carolina Presenter: Ron Capistrano; California State U., Long Beach

Counseling of Patients with Severe Psychiatric Conditions and Referral to Smoking Cessations Programs

Background: Cigarette smoking and Nicotine dependence are highly prevalent in patients with severe and chronic mental illness. Psychiatric patients consume more cigarettes than general population. Smokers with chronic mental illness can quit smoking with appropriate intervention by smoking cessations programs. These patients can benefit from pharmacotherapy, but consideration should be given for possible interaction with patients’ psychiatric medications. Tobacco use and dependence need to be formally documents on electronic medical records and be offered a referral to smoking cessations programs.
 Method: All patients in a community rehabilitation service ward in Northwest London were interviewed to identify the type, quantity, and duration of their tobacco. Their electronic clinical records were reviewed to confirm their age, ICD 10 Primary Diagnosis, ICD10 Tobacco dependence diagnosis, medications they take, record of ECG tests and presence of cardiopulmonary problems. Then their records were checked if they were given advice regarding their smoking habit, desire to quit smoking and agreement to be referred to a smoking cessation program.
 Results and Discussion: Half of the total number of patients in the community psychiatric rehabilitation were cigarette smokers. Majority of the smokers had history of polysubstance abuse. Recording of current smoking status were not regularly update. Patients who had recorded status of being a smoker were all referred to a smoking cessation program and majority had counseling by the healthcare professionals in their unit. Attending the smoking cessation program in those patients have as good outcomes as general population.
 Conclusions: A substantial number of patients in psychiatric rehabilitation units smoke cigarettes. If their smoking status is accurately documented, they would be referred to a formal smoking cessation program.

Factors associated with suicidal ideation among Chinese adults in the labour force

ABSTRACT This study aims to identify the risk factors of suicidal ideation (SI) in a large sample of Chinese adults in the labour force. A total of 4136 eligible participants in the labour force were recruited from the routine health check-up cohort. Univariate and multivariate logistic regression were used to identify the factors associated with 12-month and lifetime SI. 175 (4.2%) subjects reported SI in the past twelve months, and 223 (5.4%) reported SI during their lifetime. The results showed that being divorced or widowed, religious belief, personal history of chronic disease and mental illness, family history of mental illness and suicide, and self-assessed childhood happiness were associated with both 12-month and lifetime SI. Additional associations were found between 12-month SI and the following factors: working overtime frequently, low monthly income, and having bachelor’s degree. Moreover, being single is a risk factor of lifetime SI while not significant for 12-month SI. The present study identified several risk factors of 12-month and lifetime SI, which could potentially help develop targeted interventions for high-risk suicidal Chinese adults in the labour force.

Information and rational decision-making: explanations to patients and citizens about personal risk of COVID-19

On 16th March 2020, the UK government published “Guidance on social distancing for everyone in the UK”,1 which asked people in particular groups to be “particularly stringent in following social...

Refusing to be silenced: Claiming chaos narrative

AbstractIn theWounded Storyteller, Arthur Frank proposed three types of narrative told by people attempting to reclaim their voice and the body made alien by illness – restitution, quest, and chaos. Restitution narrative has dominated media; in it, the patient simply experiences the disease and is presented passively, and the medical community is presented as having agency. In quest narrative, the experiencer becomes their own hero; their suffering brings knowledge which is then shared with the audience who bears witness and is charged with learning the lesson the experience conveys. In quest narrative, while speakers have agency that they are often robbed of in the restitution narrative, they are saddled with the imperative to inspire others. This makes the narrator a hero, but we need to ask, where does the imperative come from that demands that the narrator become a hero and an example for others? If that imperative comes from the audience and market demands, we need to recognize how they are dictating the manner in which stories are told, determining which are selected by publishers and media venues to be disseminated. The third type, the chaos narrative, is rarely encountered by audiences because the chaos narrative is usually erased. This “anti-narrative” can only be lived and cannot be told. The individual living with chronic physical or mental illness or a disability, who cannot be stoic and turn their story into a quest narrative, is rendered mute. Since restitution narrative is also unavailable to these individuals, their stories are left unspoken or unwritten. Their stories have largely been controlled by external agents. Failure to meet normate expectations has meant rejection. How prescriptive norms arose that delegitimatized the authority of chaos narrative must be understood if authentic chaos narrative is to be spoken and written.

Same same-but different: using qualitative studies to inform concept elicitation for quality of life assessment in telemedical care: a request for an extended working model

BackgroundAlthough telemedical applications are increasingly used in the area of both mental and physical illness, there is no quality of life (QoL) instrument that takes into account the specific context of the healthcare setting. Therefore, the aim of this study was to determine a concept of quality of life in telemedical care to inform the development of a setting-sensitive patient-reported outcome measure.MethodsOverall, 63 semi-structured single interviews and 15 focus groups with 68 participants have been conducted to determine the impact of telemedical care on QoL. Participants were patients with chronic physical or mental illnesses, with or without telemedicine supported healthcare as well as telemedical professionals. Mayring's content analysis approach was used to encode the qualitative data using MAXQDA software.ResultsThe majority of aspects that influence the QoL of patients dealing with chronic conditions or mental illnesses could be assigned to an established working model of QoL. However, some aspects that were considered important (e. g. perceived safety) were not covered by the pre-existing domains. For that reason, we re-conceptualized the working model of QoL and added a sixth domain, referred to as healthcare-related domain.ConclusionInterviewing patients and healthcare professionals brought forth specific aspects of QoL evolving in telemedical contexts. These results reinforce the assumption that existing QoL measurements lack sensitivity to assess the intended outcomes of telemedical applications. We will address this deficiency by a telemedicine-related re-conceptualization of the assessment of QoL and the development of a suitable add-on instrument based on the resulting category system of this study.

Differentiation in Neurological Soft Sign Scores on Schizophrenic Patients with Antipsychotic Treatment

Background: Schizophrenia is a chronic mental illness that affects cognitive aspect of a patient which need long term care with antipsychotics. Long term use of antipsychotic itself causes neurobiological change in the brain which results in alteration of cognitive function. The latest research had demonstrated that NSS (Neurological Soft Sign) reflect a rather wide range of cognitive impairments in schizophrenia which was not accounted for by age, education or severity of global cognitive deficits. Therefore, we examined the effects and impact of antipsychotic Haloperidol and Risperidone treatment in schizophrenic patient using NSS scores. The Study showed that chronic schizophrenia patients had a higher NSS scores than acute patients. NSS also significantly associated with all neuropsychological domains of MMSE in both groups and were confirmed when age, education and severity of global cognitive deficits were not accounted for. This study also obtained a lower NSS score in patients who received Risperidone therapy compared to Haloperidol with p = 0.003. Out of 5 NSS domain in the Heidelberg scale, there was a significant improvement in motor coordination and motor sequencing (p = 0.004) and (p = 0.048) in patients who received Risperidone therapy compared to Haloperidol. There was an association between the chronicity of the disease and NSS, NSS also shows that it’s not influenced by age, education and severity of global cognitive deficits as a screening instrument. Finally the improvement of NSS scores in the Risperidone group was far superior compared to the Haloperidol group particularly in motor coordination and motor sequencing.

Psychotropic Medication Adherence in Children and Adolescents.

Researchers believe that almost 20% of children and adolescents struggle with chronic and persistent mental health concerns. Mental health is the leading cause of disability in the United States. Youth can struggle with several impairing mental health disorders, such as attention-deficit/hyperactivity disorder, mood disorders, psychotic disorders, and autism spectrum disorder. Inadequately treated chronic mental illnesses can adversely affect the growing brain profoundly, including academic decline, early school dropout, cognitive deficits, interpersonal relationship concerns, aggression, suicide attempts or completion, substance use disorders, frequent hospital admissions, and inability to maintain employment. Even if diagnosed early in their course of illness, many of these individuals struggle to continue medications as prescribed. The factors predicting adherence to medications are underresearched in children and adolescents. Psychotropic medication compliance is a complicated issue that is tied to various aspects of caring for a minor individual. Hence, it is relevant to discuss factors that are predicted to contribute to noncompliance in this age group. The purpose of this review is to carefully consider the gaps in knowledge, suggesting interventions by using established instruments and clinical strategies to resolve the identified barriers for improving medication adherence. Compliance should be targeted at various levels, including the entire family tree and the treatment team.

Whole Life: a feasibility study of a recovery-focussed intervention in patients with stabilised schizophrenia

Background: The Recovery Approach is about supporting people to live the best life they possibly can. This paper reports on a 2008-11 study of a recovery-focussed, one-to-one coaching programme called Whole Life (WL) in a group of people with stabilised schizophrenia. WL comprises 15 modules, each addressing an aspect of life that may pose challenges for someone with mental illness. It involves regular meetings with a coach, additional homework activities and lasts approximately one-year. This level of commitment requires participants to be motivated and enthusiastic. Methods: This was a non-randomised feasibility study, designed to assess acceptability and potential benefits of WL. The WL group was compared to another group of people with the same diagnosis, who received their usual treatment. This was not a strict control group. The primary outcome measure was the Social Adaptation Self-Assessment Scale. Results: Of those recruited to the WL group, 33/44 (75%) completed the full programme. WL participants showed an 11-point increase in mean SASS between baseline and Week 60. Subjective ratings showed benefits of WL at 3 and 6 months after the intervention had ceased, with most saying they felt better and none saying that they felt worse. The comparison group was more ill than the WL group at baseline and showed some improvement over the course of the study, albeit at a lower level than the WL group. However, controlling for baseline group differences meant that none of the outcome measures could reliably distinguish between WL and comparison groups. Conclusions: The study showed that WL is an acceptable and helpful intervention for motivated and enthusiastic individuals. It may have wider applicability for people with a less serious and chronic mental illness, although we do not know how it compares to other interventions. We discuss some methodological limitations of the study.

The mental health impact of pandemic COVID-19 crisis on university students in Saudi Arabia and associated factors

Introduction New Coronavirus (COVID-19) pandemic has multiple effects. We aimed in this study to assess anxiety, depression, and stress levels among university students in Saudi Arabia and associated factors. Method We collected 5,140 participations from universities for our cross-sectional study, responders completed the demographic questions, patient health questionnaire 9 (PHQ9) for depression, generalized anxiety disorder 7 (GAD7) for anxiety, and perceived stress scale (PSS) between 24th and 30th of April 2020. Result 80.99% were females and mean age was 21.85 years. 40.8% had significant symptoms of anxiety, 48.8% had significant symptoms of depression, and 86.7% had moderate to high perceived stress. Being Female, younger age, living in eastern region, had a relative or acquaintances with COVID-19, and had chronic medical or mental illness are associated factors with high levels of depression, anxiety, and stress. Discussion COVID-19 pandemic negatively affected the mental health of university students. Quick and effective interventions are mandatory.

SARS-CoV-2 infection in patients with serious mental illness and possible benefits of prophylaxis with Memantine and Amantadine.

Patients with serious mental illness are a high-risk category of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Patients with schizophrenia are not participatory and have increased mortality and morbidity, patients with dementia cannot be cared for while depression, anxiety, bipolar tubing are associated with low immune status. Social stress is amplified by social isolation, amplifying depression and the mechanisms of decreased immunity. Hygiene measures and prophylactic behavior are impossible to put into practice in conditions of chronic mental illness. In coronavirus disease 2019 (COVID-19), the risk for severe development is associated with the presence of comorbidities and immune system deficiency. Prothrombotic status, cytokine storm and alveolar destruction are mechanisms that aggravate the evolution of patients, especially in the context in which they have dysfunction of the autonomic system. The activity of proinflammatory cytokines is accentuated by hyperglutamatergia, which potentiates oxidative stress and triggers the mechanisms of neural apoptosis by stimulating microglial activation. Activation of M1-type microglia has an important role in pathogenesis of major psychiatric disorders, such as major depression, schizophrenia or bipolar disorder, and may associate hippocampal atrophy and disconnection of cognitive structures. Memantine and Amantadine, N-methyl-D-aspartate (NMDA) glutamate receptor inhibitors, have demonstrated, through their pharmacological profile, psychotropic effects but also antiviral properties. In the conditions of the COVID-19 pandemic, based on these arguments, we suggest that they can be associated with the therapy with the basic psychotropics, Memantine or Amantadine, for the control of neuropsychiatric symptoms but also as adjuvants with antiviral action.

English

BACKGROUND Mental health is an important aspect of health, and it should be cherished, promoted, and conserved, to the maximum. World-wide, around 450 million people suffering from mental illness and contributing to important causes for years lived with disability. Caring is a fundamental issue in the treatment of a patient with mental illness. Majority of patients stay with their families and they have been the mainstay of care giving for patients with mental illness. Taking care of chronic mentally ill patients puts stress and burden on the caregivers. Caregivers use different methods of coping. This study was conducted to assess burden among caregivers of chronic mentally ill patients. METHODS This is a hospital based cross-sectional study. A consecutive sample of 150 caregivers of both inpatients and outpatients who satisfy the inclusion criteria, attending psychiatry department were recruited in the study. Caregivers were assessed with socio-demographic proforma. The burden assessment schedule (BAS) developed by SCARF measures the burden experienced by caregivers of chronic mentally ill patients. Statistical analysis was done using statistical package for social sciences (SPSS). Categorical and quantitative variables were expressed as frequency (percentage) and mean ± SD respectively. Chi-square test was used to association between categorical variables. RESULTS Of the 150 participants, 16 % experienced mild burden, 57.3 % had moderate levels of burden and 26.7 % had severe burden levels. CONCLUSIONS This study concluded that caregivers of the mentally ill individuals do undergo a lot of burden or strain. Highest areas of burden were seen in the areas of physical and mental health, external support, and spouse related. The caregivers are in need of support and understanding. Clinicians dealing with the caregivers of patients with chronic mental illness must systematically assess the coping mechanisms of caregivers and encourage the use of adaptive and problem-focused coping mechanism to improve the caregiving and patient related outcome. Hence, there is a need to develop strategies that can help them such as providing them with a support structure as well as counseling services. KEYWORDS Caregiver, Burden, Mental Illness, Coping

Complicated Grief, Depression, Health and Attachment Style in First Degree Relatives of Individuals with a Chronic Psychotic Disorders.

Complicated grief (CG) is a form of unrelenting grief after the death of a loved one. However, family members of individuals who suffer from Schizophrenia, Schizoaffective disorders and Bipolar disorder may experience symptoms of CG even though their loved one is still alive. The present study assessed CG and risk factors for CG in first degree relatives of individuals with severe chronic mental illness. The incidence of CG was examined in 78 parents, siblings, adult children and spouses recruited through organizations and social media that provide support services for individuals suffering from mental illness and their families. High rates of CG (39.7%) were found in this group. CG was associated with a higher prevalence of posttraumatic and depression symptoms and poorer physical health. These findings may contribute to heightening therapists' awareness of the importance of assessing, acknowledging and resolving CG in the family members of patients with chronic psychotic disorders.

The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review.

BackgroundLittle is known about the prevalence and best management of needle fear in adults with chronic disease, who may experience frequent and long-term exposure to needles for lifesaving therapies such as renal dialysis and cancer treatment. Identifying interventions that assist in management of needle fear and associated distress is essential to support these patients with repeated needle and cannula exposure.MethodWe followed the PRISMA methodology for scoping reviews and systematically searched PsychINFO, PubMed (MEDLINE), ProQuest, Embase and grey literature and reference lists between 1989 and October 2020 for articles related to needle discomfort, distress, anxiety, fear or phobia. The following chronic diseases were included: arthritis, asthma, chronic back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, and mental illness, or kidney failure. Literature concerning dentistry, vaccination, intravenous drug users and paediatric populations were excluded.ResultsWe identified 32 papers reporting prevalence (n = 24), management (n = 5) or both (n = 3). Needle fear prevalence varied in disease cohorts: 17–52% (cancer), 25–47% (chronic kidney disease) and 0.2–80% (diabetes). Assessment methods varied across studies. Management strategies had poor evidence-base, but included needle-specific education, decorated devices, cognitive-behavioural stress management techniques, distraction, and changing the therapy environment or modality.ConclusionAlthough needle fear is common there is a paucity of evidence regarding interventions to address it among adults living with chronic disease. This scoping review has highlighted the need for improved identification of needle fear in adults and development of interventions are required for these cohorts.

Combined cortisol and melatonin measurements with detailed parameter analysis can assess the circadian rhythms in bipolar disorder patients.

ObjectivesBipolar disorder (BD) is a common chronic mental illness. The circadian clock disorder shows a significant correlation with the pathogenesis, phenotype and recurrence of BD. We aim to evaluate non‐invasive methods that can comprehensively assess the circadian rhythmicity in BD patients.MethodsWe non‐invasively collected salivary samples and oral epithelial cells from recruited subjects. Then the levels of cortisol and melatonin in saliva were measured and the circadian clock gene expressions (PER2 and BMAL1) of epithelial cells were analyzed. Due to the disease characteristics of the manic patients who were difficult to cooperate with the protocol, only one patient at manic episode was recruited. Besides, 11 patients at the depressive episode, 15 healthy controls and four patients at recovery stage were recruited.ResultsOur results exhibited that the peak phase of cortisol level mainly manifested around 8:00 a.m., and the maximal melatonin level reached around 5:00 a.m. The phase of cortisol in patients with depression did not change significantly, but the level of cortisol decreased significantly, while the phase of melatonin level moved forward about 2.5 hr. Furthermore, the levels and phases of cortisol and melatonin in recovery patients tended to be similar to those of healthy controls.ConclusionsWith detailed parameter analysis, the combined detection of melatonin and cortisol can better judge the biological clock disorder of bipolar patients. The circadian rhythms of patients at the recovery stage tend to be normal. The clock gene expression examination needs strict quality control and more investigations before being applied to assess human circadian rhythms.

A syndemics approach to exercise is medicine.

This paper offers new insights into the promotion of the Exercise is Medicine (EIM) framework for mental illness and chronic disease. Utilising the Syndemics Framework, which posits mental health conditions as corollaries of social conditions, we argue that medicalized exercise promotion paradigms both ignore the social conditions that can contribute to mental illness and can contribute to mental illness via discrimination and worsening self-concept based on disability. We first address the ways in which the current EIM framework may be too narrow in scope in considering the impact of social factors as determinants of health. We then consider how this narrow scope in combination with the emphasis on independence and individual prescriptions may serve to reinforce stigma and shame associated with both chronic disease and mental illness. We draw on examples from two distinct research projects, one on exercise interventions for depression and one on exercise interventions for multiple sclerosis (MS), in order to consider ways to improve the approach to exercise promotion for these and other, related populations.

Perinatal Complications as a Mediator of the Association Between Chronic Disease and Postpartum Mental Illness

Background: Chronic disease is associated with increased risk of postpartum mental illness, but the mechanisms underlying this association are unclear. Our aim was to explore the mediating role of perinatal complications in the association between chronic disease and postpartum mental illness. Materials and Methods: This was a population-based retrospective cohort study of all women in Ontario, Canada, from 2005 to 2015 with a singleton live birth and no recent history of mental illness during or 2 years before pregnancy. The outcome was mental illness diagnosis between delivery and 365 days postpartum, with perinatal complications, including pregnancy, delivery, and neonatal complications. Modified Poisson regression models were used to examine the association between chronic disease and perinatal mental illness, with generalized estimating equations for the calculation of total, direct, and indirect effects. All models were adjusted for sociodemographic characteristics and remote history of mental health care. Results: Of the 792,972 women, 21.1% had a chronic disease. Chronic disease was associated with an increased risk of postpartum mental illness (adjusted relative risk [aRR] 1.15 [95% confidence interval, CI 1.14-1.16]). There was no evidence of an indirect effect of chronic disease on postpartum mental illness via perinatal complications (aRR 1.003, 95% CI 1.002-1.003). Perinatal complications explained only 1.5% of the association between chronic disease and postpartum mental illness. Results were consistent by type of perinatal complication and chronic disease diagnosis. Conclusion: We observed no clinically meaningful mediating effect of perinatal complications in the association between chronic disease and postpartum mental illness. Future research should investigate alternative mechanisms explaining this association.

The Use of Telemedicine for Patients with Mental Illness and COVID-19 Infection

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the health of the public. Social distancing and quarantining during the pandemic have affected mental health as well. This study set out to determine the impact of COVID-19 and the use of telemedicine on managing patients with mental illness. It evaluates the impact of the COVID-19 infection on 403 patients who are United States military veterans: 160 patients with chronic mental illnesses and 243 without mental illness. The patients were observed remotely using a telehealth clinic until they were free of COVID-19 symptoms or tested negative for coronavirus RNA. Telemedicine was used successfully to manage patients with mental illness and acute COVID-19 infections. These patients maintained their therapeutic engagement using telephone or video-on-demand encounters. The use of this technology allowed for follow-up visits over an extended period of time, including resolution of their symptoms, re-test results, and management of their comorbidities. The outcomes of their infections mirrored those of patients without preexisting mental illness. They did require more intense psychiatric interventions, primarily with medications, but no hospitalizations for mental health occurred. Although the pandemic has several elements known to impact greatly on mental health (social illness, loneliness, fear, and uncertainty), the effect on patients with COVID-19 infection and mental illness diagnosis does not appear to cause psychiatric decompensation. Telemedicine offered a means for more intense engagement on follow-up of these patients, which may have played a role. Because of the small numbers in this study and the unique resources available for veterans, more extensive study is required to determine the effect of the pandemic in patients with mental illness who are not veterans. [ Psychiatr Ann . 2021;51(6):283–286.]

Adverse childhood experiences and asthma: trajectories in a national cohort

ObjectiveResearch has linked early adverse childhood experiences (ACEs) with asthma development; however, existing studies have generally relied on parent report of exposure and outcome. We aimed to examine the association...

Emotional Intelligence in Creative Process: Enhancing Values in KOMSAS Drama

Emotional intelligence (EI) is the ability to control and manage oneself and others in terms of feelings, emotions and behaviour (Goleman,1998). Malaysian National Health and Morbidity Survey (2015) showed that 600,000 children aged between 5 to 16 in Malaysia were diagnosed with mental health problems. Symptoms of mental illness if not treated early can lead to chronic mental illness. Changes in the way of learning in 21st-century learning require the current generation to equip themselves with EI to control feelings in a more challenging learning process (Mohd Faizul, 2017). Therefore, Malaysian Ministry of Education (MoE) is currently encouraging educators to incorporate these values into the teaching process to build a better future generation. In line with the 21st century learning skills communication, collaboration, critical thinking and creativity skills, along with values and ethic will be the focus in education. The purpose of this study is to explores the possibility of incorporating EI into the education syllabus through drama activities in Malay Literature Component known as KOMSAS (Komponen Sastera) for secondary school students. A survey was conducted among 20 experts who have been teaching Malay Language subject for more than 10 years. This preliminary study is aims to identify the understanding of teachers on the application of emotional values ​​and the process of creativity in learning. Moreover, it aims to identify how current educators apply these elements of value into their teaching and learning activities. The findings of this study showed that the teachers are aware of the EI as well as creativity in learning activities. However, the process of applying values ​​and activities happen unplanned and there is a need to design and develop a teaching module that incorporates creative process (CP) and EI in KOMSAS drama.