Art Making/Art Therapy

Art Making/Art Therapy

PEP Topic 
Depression
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 may promote the participant's understanding of him- or herself and the situation the participant is undergoing. Art therapy has been studied in patients with cancer as the intervention relates to the management of anxiety, depression, and fatigue.

Thyme, K.E., Sundin, E.C., Wiberg, B., Oster, I., Astrom, S., & Lindh, J. (2009). Individual brief art therapy can be helpful for women with breast cancer. A randomized controlled clinical study. Palliative and Supportive Care, 7, 87–95. doi:10.1017/S147895150900011X

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.

Effectiveness Not Established

Research Evidence Summaries

Bar-Sela, G., Atid, L., Danos, S., Gabay, N., & Epelbaum, R. (2007). Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy. Psycho-Oncology, 16, 980–984.

doi: 10.1002/pon.1175
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Intervention Characteristics/Basic Study Process:

The intervention consisted of once weekly art therapy sessions to teach patients to act in a more conscious way by painting with water-based paints. The intervention was provided by an art therapist. The duration of the sessions varied. Those who completed four or more sessions (n = 19) were compared to those who participated for two weeks or less (n = 41).

Sample Characteristics:

  • The sample was comprised of 60 adult ambulatory patients (77% female, 23% male) who were undergoing chemotherapy.
  • Mean age was 77 years (range 25–72).
  • Patients were excluded from the study if they had severe anemia; were treated with an epoetin; had changed their opiate, non-selective serotonin reuptake inhibitor (SSRI) antidepressant, or anxiolytic in the past three weeks; or had changed their SSRI antidepressant in the past six weeks.

Setting:

The study was conducted in an ambulatory setting of a cancer center in northern Israel.

Study Design:

The study used a single-arm, open-label design.

Measurement Instruments/Methods:

  • Brief Fatigue Inventory (BFI), competed weekly before each session
  • Hospital Anxiety and Depression scale (HADS), competed weekly before each session

Results:

  • Median BFI score decreased from 5.7 to 4.1 in the intervention group (p = 0.24).
  • Median HADS decreased from 9 to 7 in the intervention group (p = 0.21); anxiety was normal.

Limitations:

  • The control group had greater fatigue and may not have been able to participate.
  • The study lacked randomization.
  • The study did not provide control data related to patient drop-out or chemotherapy.
  • Cycle or day-in-cycle assumptions regarding mediating the effect of decreased emotional distress were untested.

Nursing Implications:

For treatment with art therapy, a patient requires referral to an art therapist.

Thyme, K.E., Sundin, E.C., Wiberg, B., Öster, I., Åström, S., & Lindh, J. (2009). Individual brief art therapy can be helpful for women with breast cancer: A randomized controlled clinical study. Palliative and Supportive Care, 7, 87–95.

doi: 10.1017/S147895150900011X
Print

Study Purpose:

To explore the responses, in terms of self-image and psychiatric symptoms, of women with breast cancer to an art therapy intervention

Intervention Characteristics/Basic Study Process:

The art therapy intervention consisted of five sessions in which participants were encouraged to express feelings and thoughts. Participants’ pictures were used as a mode of expression, followed by reflective dialog. Two experienced art therapists conducted interventions and patient interviews, so that the therapist did not function as both interviewer and therapist for the same patient. Art therapy sessions were provided during adjuvant radiation therapy. Study data were collected at baseline, after two months, and after four months.

Sample Characteristics:

  • The study reported on a sample of 41 patients.
  • Median patient age was 59 years, with a range of 37–69 years.
  • All the patients had breast cancer (100% female sample) and had received adjuvant radiation therapy. No other specific diagnostic information was provided.
  • No demographic data were reported (other than age). A few patients in both groups were receiving antidepressants. About 50% of patients had received chemotherapy prior to radiation therapy, and 41% had received hormone therapy.

Setting:

  • Single site
  • Outpatient setting
  • Sweden

Phase of Care and Clinical Applications:

  • Phase of care: active treatment
  • Clinical applications: late effects and survivorship

Study Design:

Randomized controlled trial with longitudinal analysis

Measurement Instruments/Methods:

  • Structural analysis of social behavior
  • Symptom Checklist-90 (provides symptom-subscale scores and measures of general severity)
  • Interview

Results:

At baseline, all participants had similar self-image scores and scores for depression, anxiety, and general symptom severity as a group of females undergoing radiation therapy for breast cancer who are otherwise healthy. Those who received art therapy showed a decrease in symptoms of anxiety and depression (p < 0.01). Control patients’ symptom levels remained essentially stable. Regression analysis showed that surgery, chemotherapy, parenthood, and study group were significant predictors of depression and anxiety as measured at the end of the study (p < 0.05). Axillary surgery and hormonal treatment predicted higher ratings of anxiety. Subjects’ positive and negative self-image scores were not different between study groups and did not differ significantly from healthy controls.

Conclusions:

Participation in art therapy was related to lower patient ratings of depression, anxiety, and somatic symptoms. Axillary surgery and hormonal treatment were predictive of higher levels of anxiety and depression.

Limitations:

  • The study had a small sample, with fewer than 100 participants.
  • No attentional control was provided.
  • It is unclear whether art therapy sessions were provided individually or in groups, a factor that could have affected results.
  • There was an overall drop-out rate of 24% from the initial randomized sample.
  • Baseline scores relating to depression and anxiety were actually lower in study patients than those of a healthy comparison group, leading one to question the clinical relevance of study findings overall.
  • Measurement methods used in the study did not include those commonly used in other research.
  • Authors reported minimal demographic informatio, a factor that may limit generalizability.

Nursing Implications:

Findings suggest that art therapy might be helpful in management of symptoms of depression and anxiety in women with breast cancer; however, the clinical relevance of findings is unclear. Further well-designed research is needed to confirm these preliminary findings.


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