Positive psychodrama: A framework for practice and research

The effect of psychodrama-based intervention on therapeutic communication skills and cognitive flexibility among nursing students: A 12-month follow-up study

AIM

This research aimed to evaluate the effect of the psychodrama-based intervention used in the communication course of 2nd year nursing students on their therapeutic communication skills and cognitive flexibility.

BACKGROUND

Psychodrama has been defined as a way of practicing living without being punished for making mistakes. The psychodrama-based interventions can be used as a novel teaching method to improve therapeutic communication skills and cognitive flexibility in education by allowing students to learn from their trials and errors before going into clinical practice and communicating one-on-one with the patient.

DESIGN

A single group, pretest-posttest with a follow-up quasi-experimental design was adopted.

METHOD

The participants were a convenience sample of 24 s-year undergraduate nursing students. Students attended a one-day in-a-week psychodrama-based communication course for 14 weeks. The data of the study were collected with the Demographic Information Form, the Therapeutic Communication Skills Scale and the Cognitive Flexibility Inventory. Outcomes were measured on the first day (baseline), at the end of the course and 6 and 12 months after completing the course. Outcomes were analyzed using descriptive and repeated measures analysis of variance, Friedman and Dunn tests.

RESULTS

It was determined that the nontherapeutic communication scores were significantly lower at the post-test, 6 months and 12 months than at baseline in participants. Therapeutic-one scores were significantly increased at the post-test compared with baseline in participants. Therapeutic-two scores were significantly increased at 6 months compared with baseline. There was no statistical difference in any measure in the cognitive flexibility inventory.

CONCLUSION

The psychodrama-based intervention in communication course significantly improved nursing students' therapeutic communication skills. It is also recommended to conduct studies with larger samples of nursing students from different institutions and also randomized controlled studies with control groups and qualitative studies. It is recommended to conduct studies evaluating an intervention that includes subheadings more related to cognitive flexibility which is an important nursing competency, as well as new studies that evaluate cognitive flexibility with different measurement tools.

Ventriloquist intervention prepared with drama technique in reducing pain, anxiety and fear in children during invasive procedures

INTRODUCTION

This study aimed to investigate the effects of a ventriloquist nursing intervention, incorporating drama techniques, on pain, anxiety, and fear experienced by children aged 5 to 10 years undergoing painful medical procedures.

METHODS

This study was designed as a time-series randomized controlled trial. Data were collected from the outpatient units of a Pediatric Hospital in a province in eastern Turkey between 24 May 2023 and 28 October 2023. This study involving a total of 72 children. Pain, anxiety, and fear levels were assessed before, during, and after intravenous cannula insertion.

RESULTS

Randomization ensured that both groups had similar demographics, with an average age of 7.50 ± 1.73 years and an equal distribution of gender. During the painful procedure, it was observed that both groups experienced an increase in pain, anxiety, and fear, though this increase was statistically less significant in the ventriloquist group. Ultimately, in the post-procedure period, children in the ventriloquist group exhibited lower levels of pain, anxiety, and fear compared to the control group (p < 0.05).

CONCLUSION

The findings of this study suggest that ventriloquist nursing interventions, utilizing drama techniques, can effectively reduce pain, anxiety, and fear in children undergoing painful medical procedures.

Assessing the impact of a community-based psychodrama intervention on mental health promotion of adolescents and young adults in Mozambique: A mixed-methods study

Background

While mental health is an emerging issue in low-income countries, its promotion remains poor, with little context-oriented evidence available. Here we aimed to assess the impact and acceptability/feasibility of a community-based psychodrama intervention involving both adolescents and young adults (AYA) living with HIV (AYALHIV) and without HIV (AYAHIV-).

Methods

We used a mixed-methods approach, where the quantitative part was based on pre/post questionnaires and the qualitative one on content analysis of semi-structured interviews. Trained community health care workers delivered psychodrama sessions involving AYAs aged 15-24 years once a week between July and August 2023 in Beira, Mozambique. The baseline assessment involved a sociodemographic and three mental health questionnaires: the Mental Health Knowledge Schedule (MAKS), Community Attitudes toward People with Mental Illness (CAMI27), and the Toronto Alexithymia Scale (TAS). We repeated all questionnaires after the intervention and conducted semi-structured interviews.

Results

We enrolled 354 AYAs (50.8% female, 45.5% AYALHIV) at baseline; 315 (89.0%) attended the sessions, with a mean participation rate of 94.4%. Overall, 281 (89.2%) completed the post-intervention assessment. MAKS score improved from 44.5 (95% confidence interval (CI) = 44.0-45.0) to 47.1 (95% CI = 46.4-47.7, P < 0.001). Total CAMI27 score showed no significant variation (P = 0.855). Total TAS score decreased from 57.3 (95% CI = 56.1-58.5) to 54.3 (95% CI = 53.0-55.6, P < 0.001). We found no statistically significant interactions between time and sex, age, or HIV serostatus in all questionnaires. For the qualitative part of the study, we analysed 37 semi-structured interviews (43.2% with females, 40.5% with AYALHIV). We identified four areas of intervention impact: peer-to-peer support (30.3%), social empowerment (24.7%), resilience (23.0%), and emotional skills (21.9%). Regarding acceptability/feasibility, perceived scalability (37.2%) and affective attitude (34.5%) were the sub-areas most frequently retrieved in the SSIs.

Conclusions

The community-based psychodrama intervention proved to be an effective tool in AYAs' mental health promotion, increasing knowledge and improving emotional awareness through group experience and interpersonal learning. The intervention also showed good acceptability and feasibility in the context of our study.

Italian adolescents' perception of tele-psychodrama treatment during the COVID-19 Pandemic

BACKGROUND

Psychodrama is an experiential group psychotherapy that is used to enhance adolescents' wellbeing. The COVID-19 pandemic forced the adaptation of this method to an online setting.

OBJECTIVE

This qualitative study investigated whether and how tele-psychodrama provides psychological support to adolescents, in order to better understand its strengths and weaknesses.

PARTICIPANTS

14 adolescents from Northern and Central Italy.

METHOD

14 interviews were conducted at the end of group tele-psychodrama treatment and were analysed with qualitative thematic analysis.

RESULTS

Three themes were identified: (1) contribution of tele-psychodrama to adolescents' well-being; (2) implementation of psychodrama to the online setting; and (3) (the) shortcomings of tele-psychodrama.

CONCLUSIONS

Despite the differences between online and in-person psychodrama, all the participants expressed their appreciation of group tele-psychodrama, which contributed to their overall psychological wellbeing and helped them process difficulties that emerged during the lockdowns.

Effect of social media-based psychodrama therapy on reduction in symptoms of postpartum depression in women with first birth experience: The contributing role of spousal support

We aimed to examine the impact of social media-based psychodrama therapy in reducing postpartum depression symptoms in first-time mothers. We conducted this study using a quasi-experiment with the use of pretest, posttest and follow-up evaluation after six months. We found a significant main effect of social media-based psychodrama therapy in reducing symptoms of postpartum depression in women F(1,503)= 713.413, p = 0.001, eta squared .441. We also found that this relationship is moderated by spousal support like physical, emotional and social support. Additionally, our results showed that first-time mothers experience PPD symptoms after childbirth more than experienced mothers. We equally found that psychodrama contributed in reducing symptoms of PPD in experienced mothers more than in first-time mothers. The implication of our result is that first-time mothers require more attention to assist them to recover from PPD symptoms than their experienced counterparts.

Psychometric Properties of the Spontaneity Assessment Inventory-Revised (SAI-R): The 3-Factor Hypothesis

Spontaneity and its connections to mental health and wellbeing are a central issue in both theory and practice of psychodrama, and the specialized literature sometimes even associates the presence of pathology to a lack of spontaneity. This paper describes spontaneity in Moreno's theory, its assessment, its association with other measures and concepts, and scientific advances in the field. Specifically, we present results obtained with the English and Portuguese-language versions concerning its assessment. The main purpose of this work was to study the spontaneity measure (SAI-R) in a 3 first-order factors version for a Portuguese sample of 439 subjects, divided into two independent samples. The mean age of participants was 25.6 years (SD = 10.2), and ages ranged between 18 and 64 years. Data was collected through an online platform of a Portuguese market research company. The results revealed that the 3-factor model has acceptable validity for items 1 ("Creative") and 7 ("Euphoric"), confirming the composite reliability, the convergent validity, but not the discriminant validity. Through multi-group analysis, the model proved to be stable. Notwithstanding the need for complementary studies, including clinical samples, the SAI-R is a short and valid instrument in clinical and non-clinical contexts when evaluating spontaneity.

Tele-psychodrama therapy during the COVID-19 pandemic: Participants' experiences

Italy was severely hit by the COVID-19 pandemic. In early March 2020, a series of legislative decrees have been issued, establishing the restrictions that all Italian citizens are required to respect, according to which it is strictly forbidden to leave the house if not for reasons of necessity, health, or work. This qualitative study investigated which aspects clients find helpful or hindering in shifting to group tele-psychodrama due to the COVID-19 pandemic, after participation in an in-person psychodrama group. Participants were 15 adults who were members of a pre-existing in-person psychodrama group that shifted to a tele-psychodrama group format facilitated by two psychodrama therapists. The Client Change Interview was used at the end of the tele-psychodrama as a post-treatment assessment. All the interviews were transcribed and then underwent a thematic analysis.

The analysis yielded six shared themes: the role of tele-psychodrama sessions during COVID-19 pandemic; perceived effectiveness of tele-psychodrama; main advantages of tele-psychodrama; limitations encountered during the online intervention; the termination of tele-psychodrama; and the relationship with the therapist. The findings provide preliminary evidence for the clinical practice of tele-psychodrama and lays the groundwork for further studies that can contribute to the use of electronic platforms in psychodrama interventions.

From Therapeutic Factors to Mechanisms of Change in the Creative Arts Therapies: A Scoping Review

Empirical studies in the creative arts therapies (CATs; i.e., art therapy, dance/movement therapy, drama therapy, music therapy, psychodrama, and poetry/bibliotherapy) have grown rapidly in the last 10 years, documenting their positive impact on a wide range of psychological and physiological outcomes (e.g., stress, trauma, depression, anxiety, and pain). However, it remains unclear how and why the CATs have positive effects, and which therapeutic factors account for these changes. Research that specifically focuses on the therapeutic factors and/or mechanisms of change in CATs is only beginning to emerge. To gain more insight into how and why the CATs influence outcomes, we conducted a scoping review (N_studies = 67) to pinpoint therapeutic factors specific to each CATs discipline, joint factors of CATs, and more generic common factors across all psychotherapy approaches. This review therefore provides an overview of empirical CATs studies dealing with therapeutic factors and/or mechanisms of change, and a detailed analysis of these therapeutic factors which are grouped into domains. A framework of 19 domains of CATs therapeutic factors is proposed, of which the three domains are composed solely of factors unique to the CATs: “embodiment,” “concretization,” and “symbolism and metaphors.” The terminology used in change process research is clarified, and the implications for future research, clinical practice, and CATs education are discussed.

Students' Confidence and Interest in Palliative and Bereavement Care: A European Study

As part of a European Erasmus Plus project entitled Death Education for Palliative Psychology, this study assessed the ways in which Master's Degree students in psychology and the creative arts therapies self-rated their confidence and interest in death education and palliative and bereavement care. In five countries (Austria, Israel, Italy, Poland, Romania), 344 students completed an online questionnaire, and 37 students were interviewed to better understand their views, interest, and confidence. The results revealed some significant differences between countries, and showed that older respondents with previous experience as formal caregivers for end-of-life clients showed greater interest in obtaining practical clinical competence in these fields. A mediation analysis indicated that students' previous care experiences and past loss experiences were related to students' current interest in death education and palliative and bereavement care through the mediation of their sense of confidence in this field. The qualitative findings identified five shared themes: life and death, learning about death, the psychological burden, personal experience and robust training, and four key training needs. Overall, students' interest in studying and working with terminal illness and death are rooted in internal resources, a preliminary sense of confidence, but also external requirements.

Hardships in Italian Prisons During the COVID-19 Emergency: The Experience of Healthcare Personnel

Background: The recent COVID-19 pandemic has highlighted the deficiencies that characterize the functioning of the Italian national health system. Prisons have always mirrored the most radical expressions of these weaknesses. During the early stages of the pandemic, prison facilities across Italy underwent a series of changes dictated by the need to ensure the safety of the prisoners and staff. The adoption of these rules contributed to a total or partial redefinition of many central facets of life in prison, such as intake procedures for new arrivals and the ways prisoners were allowed to communicate with their families.

Objectives: The aim of this qualitative study was to analyze the testimony of penitentiary healthcare workers in prisons throughout Italy to determine the impact of COVID-19 on their professional and personal lives.

Participants: Thirty-eight participants were contacted and 20 decided to participate in the interview. The sample was made up of 10 women and 10 men. All the participants were members of the healthcare staff of a penitentiary facility (psychologists, psychiatrists, physicians, and nurses). All were recruited through an Italian association whose mission is the development, promotion, and implementation of social solidarity projects including prisoners' social and health care. This study was facilitated through representatives serving in nine different regions of Italy. The participants were divided according to their professional roles in prisons.

Method: In-depth interviews were conducted by telephone or online using telecommunication platforms (e.g., Zoom, WhatsApp, and Skype). The transcribed texts underwent thematic analysis using the Atlas.ti software to identify patterns of meaning across the dataset.

Results: Four main themes emerged from the analysis: Interpersonal difficulties, management and operational difficulties, the personal distress and bereavement of healthcare workers, and the distress of inmates. The importance of relationship management skills when interacting with prisoners emerged as a key topic in many interviews, and the participants highlighted the need for adequate training. The increase in prisoners' anxiety made communication more difficult.

Conclusions: The findings suggest that healthcare workers in jails need emergency-oriented training. Participants described their feeling of loneliness and quasi-abandonment when carrying out their duties during the pandemic. In particular, they underscored the need for psychological guidance to better manage altered reactions with prisoners and colleagues as a result of heightened death anxiety and isolation.

Creative Adaptability: Conceptual Framework, Measurement, and Outcomes in Times of Crisis

This article presents the framework and explores the measurement, correlates, and outcomes of creative adaptability (CA), proposed here as the cognitive–behavioral-emotional ability to respond creatively and adaptively to stressful situations. Data collection was in April 2020, during the peak of the outbreak of the Coronavirus pandemic (COVID-19) in Israel. In Study 1, a sample of 310 adults completed the newly developed CA scale, as well as spontaneity, openness to experience, creative self-efficacy, and well-being measurements. The results of exploratory and confirmatory factor analyses corroborated the 9-item CA scale’s theorized underlying construct. The scale’s validity and reliability were also supported. Exploratory analyses suggested that the association between CA and well-being was mediated by creative self-efficacy and that CA may buffer the impact of individuals’ concern about Coronavirus on their well-being. In Study 2, short-term longitudinal data based on a sample of 71 students suggested that CA may predict lower psychological stress over time. Support for the CA scale’s internal consistency reliability was obtained and its test–retest reliability was established. Overall, the results shed light on this new construct as a potential protective factor. Implications for theory, research, and practice are discussed.