[Arts therapies in severe mental illness: are they effective?]

Psychiatric rehabilitation patterns in Italy: Results from the Italian Society of Psychosocial Rehabilitation (SIRP) survey

INTRODUCTION

Psychiatric rehabilitation can be considered a bidirectional technique, designed to allow patients to achieve their personal target, focusing on the individuals' strengths and challenges related to these targets and also on the community organizations in which they will live them out. Unfortunately, psychiatric rehabilitation is too often not considered a first line treatment. Moreover, rehabilitation has been confused with a generic and rough practice, consisting of extemporary actions and aimless entertainments designed to fill "the time passing".

METHODS

The aim of this study was to increase the knowledge and awareness about the state of the art of different systems of management and funding of psychosocial rehabilitation in the Italian "real-world" rehabilitative settings, using a specifically developed questionnaire.

RESULTS

The data obtained are positive for some aspects of the rehabilitation interventions, in particular for the use of validated tools for the evaluation and revision of projects and for the trend to work on a team, even though the scarcity of evidence-based rehabilitation interventions applied in Italian psychiatric services is less encouraging.

CONCLUSION

This survey presents, at least partially, the "real-world" of rehabilitation in Italy so that we can lay the foundations for the definition of an updated, validated and shared network of what is implemented in the context of psychiatric rehabilitation.

Anger Experience and Anger Expression Through Drawing in Schizophrenia: An fNIRS Study

Differences in emotion experience and emotion expression between patients with schizophrenia and the healthy population have long been the focus of research and clinical attention. However, few empirical studies have addressed this topic using art-making as a tool of emotion expression. This study explores the differences in brain mechanism during the process of expressing anger between patients with schizophrenia and healthy participants using pictographic psychological techniques. We used functional near-infrared spectroscopy to fully detect changes in frontal cortex activity among participants in two groups-schizophrenia and healthy-during the process of experiencing and expressing anger. The results showed that there were no differences in the experience of anger between the two groups. In the process of anger expression, the dorsolateral prefrontal cortex, frontal pole, and other regions showed significant negative activation among patients with schizophrenia, which was significantly different from that of the healthy group. There were significant differences between patients with schizophrenia and the healthy group in the drawing features, drawing contents, and the ability to describe the contents of their drawings. Moreover, the effect size of the latter was greater than those of the former two. In terms of emotion expression, the drawing data and brain activation data were significantly correlated in each group; however, the correlation patterns differed between groups.

[Characteristics of art therapists in rehabilitative therapy]

Characteristics of art therapists in rehabilitative therapy Objectives: This study examines the sociodemographic, qualification- and activity-related characteristics of art therapists working in the field of rehabilitation.

METHODS

In 2013, an analysis of occupational groups was carried out in Germany, with the objective of describing the art therapists working there.A total of 2,303 complete datasets were submitted. From this group, those therapists mainly working in the field of rehabilitation/follow-up care/participation of disabled persons (according to Social Security Code VI and IX, n = 302) were selected and described.

RESULTS

Most art therapists are female (average age 45 years) and largelywork part-time. Music and art therapy are the most common venues.More than 80% have a graduate degree. Methods of quality management are used.More than half of the therapists working in rehabilitation hospitals are employed in the field of psychosomatic medicine. Both individual and group therapy (each patient attending 1-2 times a week) are common.

CONCLUSIONS

The results provide an overview of art therapy in the field of rehabilitation and show the spread in rehabilitation. Further research is indicated.

Provision of arts therapies for people with severe mental illness

PURPOSE OF REVIEW

Arts therapies are still inadequately regulated throughout the world despite a 100-year-long tradition, a vast number of academically trained therapists and importance in treating psychiatric patients. It is essential that more evidence-based studies are undertaken.

RECENT FINDINGS

Current international guidelines focus on the efficacy and effectiveness of arts therapies. New international evidence-based studies reporting clear-cut therapeutic effects of art therapy, music therapy and dance movement therapy are described here, with a focus on developments in Australia, Egypt and the United States.

SUMMARY

Further effort must be put into the development of evidence-based treatment programmes for all arts therapies, and effort needs to go into the establishment of arts therapists as a profession, with appropriate training standards.

A pilot RCT of psychodynamic group art therapy for patients in acute psychotic episodes: feasibility, impact on symptoms and mentalising capacity

This pilot study aimed to evaluate the feasibility of an assessor-blind, randomised controlled trial of psychodynamic art therapy for the treatment of patients with schizophrenia, and to generate preliminary data on the efficacy of this intervention during acute psychotic episodes. Fifty-eight inpatients with DSM-diagnoses of schizophrenia were randomised to either 12 twice-weekly sessions of psychodynamic group art therapy plus treatment as usual or to standard treatment alone. Primary outcome criteria were positive and negative psychotic and depressive symptoms as well as global assessment of functioning. Secondary outcomes were mentalising function, estimated with the Reading the mind in the eyes test and the Levels of emotional awareness scale, self-efficacy, locus of control, quality of life and satisfaction with care. Assessments were made at baseline, at post-treatment and at 12 weeks' follow-up. At 12 weeks, 55% of patients randomised to art therapy, and 66% of patients receiving treatment as usual were examined. In the per-protocol sample, art therapy was associated with a significantly greater mean reduction of positive symptoms and improved psychosocial functioning at post-treatment and follow-up, and with a greater mean reduction of negative symptoms at follow-up compared to standard treatment. The significant reduction of positive symptoms at post-treatment was maintained in an attempted intention-to-treat analysis. There were no group differences regarding depressive symptoms. Of secondary outcome parameters, patients in the art therapy group showed a significant improvement in levels of emotional awareness, and particularly in their ability to reflect about others' emotional mental states. This is one of the first randomised controlled trials on psychodynamic group art therapy for patients with acute psychotic episodes receiving hospital treatment. Results prove the feasibility of trials on art therapy during acute psychotic episodes and justify further research to substantiate preliminary positive results regarding symptom reduction and the recovery of mentalising function.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01622166.