Art Making/Art Therapy

Art Making/Art Therapy

PEP Topic 
Caregiver Strain and Burden
Description 

Art therapy encourages participants to express emotions through drawing and is aimed at triggering thoughts and feelings for communication. Trained art therapists assist participants to reflect on and explore the thoughts and feelings exposed in the creative expression. This activity is seen as promoting the participant's understanding of him- or herself and the situation encountered. Art therapy has been studied in patients with cancer related to management of anxiety and fatigue (Thyme et al., 2009).

Art making is the provision of the opportunity and materials for individuals to create various types of artistic items. Art making can be seen as a diversional activity. It differs from art therapy because it does not involve interaction with a trained art therapist and does not necessarily engage the participant in exploring thoughts and feelings through the creative expression.

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Effectiveness Not Established

Research Evidence Summaries

Walsh, S.M., Martin, S.C., & Schmidt, L.A. (2004). Testing the efficacy of a creative-arts intervention with family caregivers of patients with cancer. Journal of Nursing Scholarship, 36, 214–219.

doi: 10.1111/j.1547-5069.2004.04040.x
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Study Purpose:

To test hypotheses that family caregivers would experience reduced stress and anxiety and have increased positive emotions from an art-making intervention

Intervention Characteristics/Basic Study Process:

Art-making supplies were taken to patients’ bedsides or to the outpatient chemotherapy site to show patients and caregivers items that could be made. Caregivers decided on one or more activities that they could do with or without the patients’ involvement. Caregivers were given supplies and shown how to complete the activity. The artist–nurse intervention team then left the area and returned to monitor progress and offer assistance every 15–30 minutes. Participants completed study questionnaires prior to and immediately after the intervention.

Sample Characteristics:

  • The sample was comprised of 40 family caregivers.
  • Mean caregiver age was 51.43 ± 15.38 years.
  • Of the sample, 78% were the primary caregivers for the patients, 75% were women, and most were spouses.
  • Most caregivers had provided care for six months or less.

Setting:

  • Single site 
  • Multiple settings
  • Florida, United States

Phase of Care and Clinical Applications:

Mutliple phases of care

Study Design:

A pretest/post-test quasi-experimental design was used.

Measurement Instruments/Methods:

  • Mini Profile of Mood States (miniPOMS)
  • Beck Anxiety Inventory
  • Derogatis Affects Balance Scale

Results:

The presession stress score mean was 13.27 ± 6, and the postscore was 9.85 ± 5.84 (p < 0.001). Cohen’s d calculation on stress scores was d = 0.44, suggesting a large effect size. Postintervention anxiety scores declined but were not reported to be statistically significant. Significantly more positive emotions were reported in the post-test evaluation  (p < 0.001). It was noted that individuals who participated in the hospital inpatient units had multiple interruptions.

Conclusions:

Involvement in art making was associated with reduction in stress and increased positive emotions immediately after the involvement. Participation at the bedside in the inpatient area was complicated by multiple interruptions.

Limitations:

  • The sample was small, with less than 100 participants.
  • Risk of bias existed due to no control group, no binding, no random assignment, and no appropriate attentional control condition.
  • Whether the nature of art making itself, or any type of distracting activity, was responsible for the changes seen is not clear.

Nursing Implications:

Involvement in art making may be helpful for short-term stress reduction in caregivers of patients with cancer. Further well-designed research in this area is needed to evaluate this approach.

Walsh, S.M., Radcliffe, R.S., Castillo, L.C., Kumar, A.M., & Broschard, D.M. (2007). A pilot study to test the effects of art-making classes for family caregivers of patients with cancer. Oncology Nursing Forum, 34, 38.

doi:10.1188/07.ONF.E9-E16
Print

Study Purpose:

To test the effects of art-making classes to reduce anxiety and stress among caregivers of patients with cancer

Intervention Characteristics/Basic Study Process:

Art-making classes were offered as one part of an already established art program. The class involved with the research began with discussion of the study. Study participants completed self-report instruments and provided a saliva sample for cortisol testing. The art-making class was given over a two-hour period, and repeat questionnaires and saliva testing were done at the end of the session. Classes were delivered twice weekly by volunteer art interventionists in a residential facility. A variety of art-making projects were used in classes. Research team members attended each class and documented field notes during each session. Interventionists were trained in processes of caregiver experiences based on the end-of-life phase of experiential theory.

Sample Characteristics:

  • The sample was comprised of 69 caregivers (80% female, 20% male).
  • Mean caregiver age was 48 ± 14.47 (range = 18–81 years).
  • Disease types of patients were not stated.
  • Participants included Hispanics, Caucasians, Carribean Islanders, and individuals from other cultures.
  • Of the sample, 75% were the primary caregiver of the patient, 41% had provided care for six months to one year, and 56% had high school formal education or less.

Setting:

  • Single site
  • Other setting
  • Miami, Florida, United States

Phase of Care and Clinical Applications:

  • Late effects and survivorship
  • Palliative care

Study Design:

A pretest/post-test quasi-experimental design was used.

Measurement Instruments/Methods:

  • Beck Anxiety Inventory
  • Salivary cortisol
  • Field notes of participant comments

Results:

Anxiety measures showed a significant reduction in scores of the Beck Anxiety Inventory after the session, with preintervention of 7.28 ± 6.8 and postscore of 2.49 ± 4.5 (p < 0.01). No significant changes in cortisol level were reported. Field notes indicated that participants shared efforts, offered suggestions to each other, and became better acquainted. Numerous subjects refused to give samples for salivary cortisol.

Conclusions:

Art-making classes appeared to produce a short-term reduction in anxiety level among caregivers of patients with cancer.

Limitations:

  • The sample was small, with less than 100 participants.
  • Risk of bias existed due to no control group, no binding, no random assignment, and no appropriate attentional control condition.
  • Measurement validity and reliability are questionable.*
  • Other/*explanation: Cortisol levels can be expected to vary according to time of day. No information is available about the time of specimen collection in the study, and it is not known whether all patients had art-making sessions at the same time of day. Pre- and postanxiety inventory measures showed high variability, suggesting that mean scores may not be representative of the group. No information is available about how many sessions people attended. Sessions were also attended by individuals who were not part of the study or who had refused to provide consent for participation. Although numerous subjects refused to give salivary samples, the authors did not say how many refused or discuss relevant missing data. The authors noted lack of funds for creative approaches used. It is not clear if changes in anxiety were truly due to the use of art in these sessions, or the support group type of interactions that occurred among participants.

Nursing Implications:

Findings suggest that participation in art making may reduce anxiety among caregivers momentarily, and group participation can provide an avenue for supportive caregiver interactions.


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