Functional near-infrared spectroscopy assessment of reward perception based on visual self-expression: Coloring, doodling, and free drawing

The effects of art therapy interventions on anxiety in children and adolescents: A meta-analysis

OBJECTIVE

This study aimed to assess the effects of art therapy on anxiety among children and adolescents.

METHODS

We searched several databases, including PubMed, Web of Science, Embase (via Ovid), PsychINFO (through EBSCO), and The Cochrane Library, comprising the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials. Additionally, Chinese databases such as CNKI (China National Knowledge Infrastructure) and Wan Fang Data were explored from their beginnings until October 22, 2023. Studies that investigated the impact of art therapy on anxiety compared to a control group were included. The methodological quality of these randomized controlled trials was evaluated using the Cochrane Handbook's risk of bias instrument.

RESULTS

Six studies involving 422 participants were included. The findings indicated a notable decrease in anxiety symptoms due to art therapy, with a Standardized Mean Difference (SMD) of -1.42, 95% Confidence Interval (95%CI -2.33, -0.51), p < 0.002. Notably, there was pronounced heterogeneity, as evidenced by Tau2 = 1.41, Chi2 = 101.19, df = 6, and I² = 94%, with Z = 3.06.

CONCLUSION

Art therapy significantly improved the anxiety symptoms of children and adolescents, positioning it as an effective means of treating anxiety.

Visual art- and music-based interventions as adjuvants in the treatment of eating disorders: a systematic review and a theoretical model

AIM

To assess the effect of visual art- and music-based interventions in the treatment of eating disorders.

METHODS

This study was registered in PROSPERO (CRD42020161503). Six databases (CINAHL, EMBASE, Lilacs, PsycINFO, PubMed and The Cochrane Library) were consulted. The searches were performed on 19 June 2019, and updated on 18 March 2022. No restriction on language, date, or publication status was applied. Methodological quality was assessed using Joanna Briggs Institute's instruments. All steps were performed by two independent reviewers and a third participated in the event of disagreement.

RESULTS

Eight studies were included. Few statistically significant results were found. Overall, both interventions might help to reduce negative emotional states.

CONCLUSION

Visual art- and music-based interventions present limited and inconclusive scientific evidence in patients with eating disorders and therefore their effectiveness is currently unknown. A theoretical model is proposed to guide future research. Further studies are needed to clarify their clinical relevance.

Filling the form: Expressive Therapies Continuum-guided treatment of narcissistic personality disorder

Sara was a 65-year-old Caucasian woman who requested art therapy after the death of her partner. She had experienced incest by her father and verbal abuse by her mother until she left home at 21. Her life was characterized by broken relationships due to alienating anger outbursts and an interrupted work history; she met three criteria for narcissistic personality disorder. Sara initially was socially isolated and intellectualizing. She desired recognition but was fearful of exposure. The Expressive Therapies Continuum (ETC) theoretical framework, which consisted of a gradual progression from cognitively-dominated sessions to more emotionally focused processing, guided the therapeutic work. The ETC theory encourages transparency and collaboration between therapist and client regarding therapeutic tasks and goals, and provides a framework for addressing and repairing ruptures in the therapeutic alliance. Art therapy began with the cognitive tasks which Sara completed relatively comfortably, then encouraged integration of emotion via expressive writing, diagrams, and body mapping. Through careful attention to repair of ruptures by directly discussing and adapting the direction and tasks of therapy, Sara slowly was able to experience emotions other than anger. She integrated cognitive and emotional insights about her life and developed empathy for her childhood self. At termination Sara had cultivated two friendships and met only one criterion of NPD. Limitations of this case study include a lack of research evidence for ETC-guided art therapy with NPD clients and by the retrospective approach. Future research efforts could provide this support by encouraging clinicians to conduct prospective case study research.

A conceptual framework for a neurophysiological basis of art therapy for PTSD

Post-traumatic stress disorder (PTSD) is a heterogeneous condition that affects many civilians and military service members. Lack of engagement, high dropout rate, and variable response to psychotherapy necessitates more compelling and accessible treatment options that are based on sound neuroscientific evidence-informed decision-making. Art therapy incorporates elements proven to be effective in psychotherapy, such as exposure, making it a potentially valuable treatment option. This conceptual paper aims to inform the neurophysiological rationale for the use of art therapy as a therapeutic approach for individuals with PTSD. A narrative synthesis was conducted using literature review of empirical research on the neurophysiological effects of art therapy, with supporting literature on neuroaesthetics and psychotherapies to identify art therapy factors most pertinent for PTSD. Findings were synthesized through a proposed framework based on the triple network model considering the network-based dysfunctions due to PTSD. Art therapy's active components, such as concretization and metaphor, active art engagement, emotion processing and regulation, perspective taking and reframing, and therapeutic alliance, may improve symptoms of PTSD and prompt adaptive brain functioning. Given the scarcity of rigorous studies on art therapy's effectiveness and mechanisms of alleviating PTSD symptoms, the suggested framework offers a neurophysiological rationale and a future research agenda to investigate the impact of art therapy as a therapeutic approach for individuals with PTSD.

Functional near-infrared spectroscopy approach to the emotional regulation effect of drawing: Venting versus distraction

BACKGROUND

Drawing can regulate emotions through venting or distraction. Distraction is more helpful for short-term emotion recovery; however, the sustainability of this difference is yet to be clarified. This study used functional near-infrared spectroscopy (fNIRS) to explore potential differences between venting and distraction.

METHODS

A total of 44 college students participated in the experiment. After inducing fear by video, they were divided into two groups: The venting group drew their emotional experience, and the distraction group drew a house. Subsequently, the participants were instructed to relax by a brief video.

RESULTS

Although the distraction group had a higher valence than the venting group at the end of the drawing activity, there was no difference between the two groups after a relaxation period. Additionally, the activation pattern of the prefrontal cortex differed between the two groups. Compared to the distraction group, the venting group had fewer channels with elevated prefrontal activity during drawing, suggesting less cognitive control, and had more channels with reduced prefrontal activity during relaxation, suggesting a higher level of relaxation. Drawing coding and fNIRS data were both associated with variations in valence.

CONCLUSION

The less the cognitive control over emotion and the more free the expression of emotion during drawing, the higher the increase in valence; inversely, the more the cognitive control over emotion and the less free the expression of emotion, the lower the increase in valence.

A pilot randomized clinical trial of biomedical link with mental health in art therapy intervention programs for alcohol use disorder: Changes in NK cells, addiction biomarkers, electroencephalography, and MMPI-2 profiles

OBJECTIVE

Alcohol intake is a major risk factor for various diseases. Elucidating alcohol use disorder (AUD) is important in preventing diseases and promoting health. We aimed to investigate the effect of art therapy on emotional (Minnesota Multiphasic Personality Inventory-2 [MMPI-2]) and physical (natural killer [NK] cell count, expression of stress-associated proteins [SAP], and electroencephalography) changes in patients with AUD.

METHODS

Participants were randomly divided into two groups (n = 35), with the experimental group undergoing art therapy involving weekly 60-min group therapy sessions for 10 weeks. Statistical analysis was performed using Ranked ANCOVA and Wilcoxon's signed rank test. Western blotting was performed to analyze serum SAP levels.

RESULTS

We observed an association between psychological mechanisms and stress proteins. There was an increased number of NK cells in the experimental group after the program. Moreover, compared with the control group, the experimental group showed significant changes in SAP expression. Further, the experimental group showed a positive change in the MMPI-2 profile, as well as a decrease in depression, anxiety, impulsivity, and alcohol dependence.

CONCLUSIONS

Continuous psychological support could be applied as a stress-control program for preventing stress recurrence and post-discharge relapse. Our findings strengthen the link between biomedical science and mental health in rehabilitation treatment for AUD.

COVID-19 Limitations on Doodling as a Measure of Burnout

Pre-COVID-19, doodling was identified as a measure of burnout in researchers attending a weekly, in-person health narratives research group manifesting team mindfulness. Under the group's supportive conditions, variations in doodling served to measure change in participants reported depression and anxiety-internal states directly associated with burnout, adversely affecting healthcare researchers, their employment, and their research. COVID-19 demanded social distancing during the group's 2020/21 academic meetings. Conducted online, the group's participants who chose to doodle did so alone during the pandemic. Whether the sequestering of group participants during COVID-19 altered the ability of doodling to act as a measure of depression and anxiety was investigated. Participants considered that doodling during the group's online meetings increased their enjoyment and attention level-some expressed that it helped them to relax. However, unlike face-to-face meetings during previous non-COVID-19 years, solitary doodling during online meetings was unable to reflect researchers' depression or anxiety. The COVID-19 limitations that necessitated doodling alone maintained the benefits group members saw in doodling but hampered the ability of doodling to act as a measure of burnout, in contrast to previous in-person doodling. This result is seen to correspond to one aspect of the group's change in team mindfulness resulting from COVID-19 constraints.

VR Health Experience: A Virtual Space for Arts and Psychomotor Therapy

Introduction: Mental health and well-being are under pressure because of the corona pandemic. Arts and psychomotor therapists said that they had almost no experience with working online, but despite the fact that they felt incapable, they were positive towards it.

Method: This qualitative action research was aimed at how arts and psychomotor therapists can become more skilled in offering online arts and psychomotor therapy and how they can methodically enlist the VR Health Experience (a virtual arts and psychomotor therapy space) in therapy. It is envisaged that the arts and psychomotor therapist could be telepresent in order to offer arts and psychomotor therapy remotely. In online training that made use of the Lean Startup Method, participants (n = 5) integrated their working knowledge with the VR Health Experience. The interventions were immediately tested by the participants and in practice. Participants were interviewed retrospectively and their experiences were thematically analysed.

Results: The VR Health Experience came forward as an innovative addition to the usual arts and psychomotor therapy. Often, clients were encouraged to play and experiment, and the VR world offered several options. The VR Health Experience lowered the threshold, expanded the training areas and held a great attraction for play.

Discussion: This project offered an innovative quality boost for arts and psychomotor therapy. Arts and psychomotor therapy have proven to be possible remotely via telepresence of the therapist. The therapist is present together with the client in the VR Health Experience, the virtual arts and psychomotor therapy space, where connectedness can be felt and new experiences can be gained. VR also offers further possibilities in arts and psychomotor therapy.

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.

Using mobile brain/body imaging to advance research in arts, health, and related therapeutics

The uses of mobile brain/body imaging (MoBI) are expanding and allow for more direct study of the neurophysiological signals associated with behavior in psychotherapeutic encounters. Neuroaesthetics is concerned with the cognitive and neural basis of art appreciation, and scientific correlations are being made in the field that might help to clarify theories claimed in the creative arts therapies. Yet, most neuroaesthetics studies are confined to the laboratory and do not propose a translation for research methods and clinical applications. The creative arts therapies have a long history of clinical success with various patient populations and will benefit from increased scientific explanation to support intervention strategies. Examining the brain dynamics and motor behaviors that are associated with the higher complex processes involved in artistic expression offers MoBI as a promising instrumentation to move forward in linking ideas from neuroaesthetics to the creative arts therapies. Tracking brain dynamics in association with behavioral change allows for more objective and quantitative physiological monitors to evaluate, and together with subjective patient reports provides insight into the psychological mechanisms of change in treatment. We outline a framework that shows how MoBI can be used to study the effectiveness of creative arts therapy interventions motivated by the 4E approach to cognition with a focus on visual art therapy. The article illuminates how a new partnership among the fields of art therapy, neuroscience, and neuroaesthetics might work together within the 4E/MoBI framework in efforts to advance transdisciplinary research for clinical health populations.

Integrating drawings into health curricula: university educators' perspectives

The literature has identified promising findings regarding the application of arts-based initiatives to enhance healthcare professional (HCP) training. Research shows that drawings offer a window into the authentic, insider view of health and illness, with potential to be a platform for healthcare student and HCP learning. In addition, drawings may also have a place in health communication. Our previous work provides support for the educational application of patients' drawings in bringing HCPs closer to the patient's lived experience. Subsequently, this study aimed to explore university educators' opinions regarding the implementation of drawings as an educational tool for higher education healthcare students. The objective of this study was to explore pathways for using drawings as an art form in an educational context, and provide recommendations for developing curricula and resources for further evaluation. Findings from focus group interviews with nine university educators revealed support for the use of drawings as a novel medium as they offer rich insights into the patient's perspective while encouraging creative and critical thinking. Key perceived benefits were that drawings foster student appreciation of (1) the holistic impact of illness, (2) the importance of patients' priorities and (3) the value of learning from the patient. Patients' drawings of their experiences would offer needed opportunities for students to explicitly reflect about the 'person' holistically rather than view the patient as a 'biomedical problem'. Shifting students' perspectives and possible assumptions to be better aligned with and appreciative of the patient's experiences was noted as central to adopting a person-centred approach to healthcare practice. Our findings suggest that incorporating drawings, or indeed other art forms, as educational tools would be a valuable addition to the health curricula.

Therapeutic psychological and biological responses to mindfulness-based art therapy

Stress and anxiety pose a threat to college students' academic performance as well as their long-term mental and physical health, but the time constraints of a rigorous academic schedule make it difficult to offer even brief mental health interventions. A convenience sample of full-time students at a public university was recruited for a 5-week study conducted mostly using an online platform. Participants were randomly assigned to a Mindfulness-Based Art Therapy (MBAT) intervention or a Neutral Clay Task (NCT). Anxiety, perceived stress, and salivary cortisol outcomes were measured. A total of n = 77 participants completed the study. The MBAT group experienced significant reductions in anxiety and perceived stress compared to the NCT group. Significant reductions in salivary cortisol were observed, but only time could be identified as a confounding variable. Art making alone is not enough to induce significant positive responses, but this study suggests MBAT can, and that an online intervention could offer feasible and accessible mental health services on college campuses. Further refinement of biological data collection and analysis is needed to determine what the mediating effects MBAT could have, if any, at the molecular level.

[Suicidal behavior in light of COVID-19 outbreak: Clinical challenges and treatment perspectives]

OBJECTIVE

The COVID-19 pandemic affected today more than 3,000,000 worldwide, and more than half of humanity has been placed in quarantine. The scientific community and the political authorities fear an epidemic of suicide secondary to this crisis. The aim of this review is to analyze the impact of the COVID-19 pandemic on the dimensions of the suicidal process and its interaction with the various risk factors. We also propose innovative strategies to manage suicidal behavior in the context of pandemic.

METHODS

We carried out a narrative review of international publications dealing with major pandemics (COVID-19, SARS) and their influence on suicidal vulnerability.

RESULTS

Many factors are likely to increase the emergence of suicidal ideation and suicide attempts during this crisis. Social distancing and quarantine could increase the feeling of disconnection and the perception of social pain in vulnerable individuals. Some populations at high suicidal risk could be further impacted by the current pandemic: the elderly, medical staff and individuals exposed to economic insecurity. Several innovative tools adapted to the constraints of social distancing and quarantine may prevent suicide risk: e-health, VigilanS, buddhist-derived practices and art engagement.

CONCLUSIONS

This unprecedented crisis may interact with certain dimensions of the suicidal process. However, it is time to innovate. Several suicide prevention tools all have their place in new modes of care and should be tested on a large scale.

Biobehavioral utility of mindfulness-based art therapy: Neurobiological underpinnings and mental health impacts

Mindfulness-based art therapy (MBAT) combines mindfulness practices with art therapy to promote health, wellness, and adaptive responses to stress. Mindfulness-based stress reduction programs have been demonstrated to reduce anxiety symptoms in people with generalized anxiety disorder and serious medical conditions such as cancer. However, the benefits of MBAT specifically—not just in clinical anxiety disorders, but also for routine day-to-day anxiousness—have received little attention until recently. In this mini-review, we summarize how several established mindfulness-based interventions affect mental health with a specific focus on MBAT. We also describe and evaluate data indicating involvement of specific neural circuits and neuroendocrine markers of stress and/or anxiety. Lastly, we suggest areas of focus for future rigorous research on MBAT interventions and propose multiple biobehavioral and physiological mechanisms through which therapeutic benefits may be achieved.

Impact statement

Recent studies demonstrate the therapeutic potential of intensive MBAT and other mindfulness-based interventions for severe health conditions including cancer, heart disease, and anxiety, with effectiveness that rivals and sometimes even exceeds cognitive behavior therapy. MBAT-based approaches appear to be poised to mature into large-scale, cost-effective therapies for mental health disorders and symptoms comorbid with other serious health issues. However, the field currently suffers from inconsistent deployment protocols and needs additional validation data—at the behavioral, neuroendocrine, and neural levels—in order to establish best practices.

WearLight: Toward a Wearable, Configurable Functional NIR Spectroscopy System for Noninvasive Neuroimaging

Functional near-infrared spectroscopy (fNIRS) has emerged as an effective brain monitoring technique to measure the hemodynamic response of the cortical surface. Its wide popularity and adoption in recent time attribute to its portability, ease of use, and flexibility in multimodal studies involving electroencephalography. While fNIRS is still emerging on various fronts including hardware, software, algorithm, and applications, it still requires overcoming several scientific challenges associated with brain monitoring in naturalistic environments where the human participants are allowed to move and required to perform various tasks stimulating brain behaviors. In response to these challenges and demands, we have developed a wearable fNIRS system, WearLight that was built upon an Internet-of-Things embedded architecture for onboard intelligence, configurability, and data transmission. In addition, we have pursued detailed research and comparative analysis on the design of the optodes encapsulating an near-infrared light source and a detector into 3-D printed material. We performed rigorous experimental studies on human participants to test reliability, signal-to-noise ratio, and configurability. Most importantly, we observed that WearLight has a capacity to measure hemodynamic responses in various setups including arterial occlusion on the forearm and frontal lobe brain activity during breathing exercises in a naturalistic environment. Our promising experimental results provide an evidence of preliminary clinical validation of WearLight. This encourages us to move toward intensive studies involving brain monitoring.

Patients' drawings of their asthma: adding qualitative specificity to a quantitative measure of illness perceptions

Objective: Patients' perceptions about their asthma can influence behavior, coping and outcomes. Previous studies have also identified that patients' views can differ significantly to that of healthcare professionals. Enhancing current understanding of patients' perceptions can assist in reducing this mismatch. We aimed to utilize the medium of drawings to add qualitative specificity and depth to a quantitative measure of illness perceptions exploring patients' perspectives of their asthma. Methods: Eighteen adults with asthma completed the Brief Illness Perception Questionnaire (BIPQ) and participated in a drawing activity. Analysis was based on the participants' transcribed descriptions of their drawing. A coding approach was used to map the data according to the BIPQ items. Results: The drawings and subsequent discussions specified the "what," the "how," and the "why" of the experience of living with asthma. Prominent emotional and social elements emerged, with evocative images coupled with expressive and profound language. Use of drawing also revealed additional representations which were outside of the BIPQ scope. Conclusions: Using qualitative methods to analyze a novel approach to understanding illness perceptions provided insight into how asthma affects patients' lives personally.

Summary of Twenty-First Century Great Conversations in Art, Neuroscience and Related Therapeutics

Transdisciplinary collaboration is the future of knowledge making in advanced post-industrial societies and there is a growing awareness that the most vexing problems we face cannot be solved by any single discipline. Best practices for complex and challenging physical and mental disorders require a multi-disciplinary approach, yet there is a void in bridging the gap between the most contemporary models. It is in this capacity that the Twenty-First Century Great Conversations in Art, Neuroscience, and Related Therapeutics serves as a missing link. It was with active minds and a collective spirit that artists, scientists, therapists, physicians, engineers, technology experts, healthcare practitioners, and researchers from across the globe transcended historical silos to explore the capacities for collaborative partnerships to influence the health of patients and the amelioration of disease. Hosted at Indiana University-Purdue University Indianapolis (IUPUI), presenters shared insights through didactic sessions and panel discussions aligned with three tracks led by prominent experts in their respective fields: (1) Neuroaesthetics, Anjan Chatterjee, MD; (2) Creativity and Consciousness, Arne Dietrich, PhD; and (3) Mobile Brain/Body Imaging (MoBI), Klaus Gramann, PhD. The goals for this symposium were developed from a vision which embraces cross-disciplinary intersectionality, a merging of viewpoints, and active dialogue surrounding the development of a common language with which to advance the Creative Arts Therapies and neurosciences. The goal was also to contribute to the development of a simplified roadmap to enhance and enrich the CATs with a greater understanding of neuroscience and the available technologies that can assist in research.