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.

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

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.

• 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.

• Single site
• Outpatient setting
• Sweden

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

Randomized controlled trial with longitudinal analysis

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

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.

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.

• 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.

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.