Effects of clay art therapy on adults outpatients with major depressive disorder: A randomized controlled trial

The effects of visual art therapy on adults with depressive symptoms: A systematic review and meta-analysis

Depression constitutes a pervasive global mental health concern and stands as a principal determinant of elevated suicide rates worldwide. Recent empirical investigations have showcased the significant potential of visual art therapy (VAT) in ameliorating symptoms among individuals with depression. Nevertheless, specific studies have yielded findings marked by inconclusiveness, underscoring the imperative need for further research to comprehensively establish its efficacy. This study is a systematic review and meta-analysis of extant research, to ascertain the efficacy and effect size of VAT as an intervention for adults with depressive symptoms. A comprehensive search was conducted across 10 databases. The search encompassed articles published from the inception of these databases up until October 18, 2023. Two researchers screened the literature in accordance with inclusion and exclusion criteria and performed a thorough quality assessment. The original data and the data obtained from the literature were extracted for further analysis. The statistical analysis of the data was performed using Stata 17.0 software. fifteen studies were included, encompassing a total of 932 participants. The outcomes of meta-analysis unveiled a statistically significant effect of VAT in diminishing depressive symptoms among adults (SMD = -0.73; 95% CI, -1.07 to -0.39; p < 0.001; 15 randomised controlled trials (RCTs); low-quality evidence). The subgroup analysis indicated that VAT exhibited heightened effectiveness among adults below 65 years of age, with interventions lasting ≤12 weeks demonstrating superior efficacy. Additionally, sensitivity analysis underscored the robustness and reliability of the findings. VAT appears to alleviate depressive symptoms among adults. Existing research indicates that the effectiveness of VAT is influenced by factors, such as intervention population characteristics and intervention duration. However, to comprehensively probe the efficacy of VAT, future studies should strive for larger sample sizes, multicentre collaborations, and long-term follow-ups.

Group-based active artistic interventions for adults with primary anxiety and depression: a systematic review

OBJECTIVES

This systematic review examined the potential benefit of all group-based performing arts interventions for primary anxiety and/or depression.

SETTING

Scholarly literature from any country or countries globally.

DATA SOURCES

Three key bibliographic databases, Google Scholar and relevant citation chasing.

PRIMARY AND SECONDARY OUTCOME MEASURES

Depression and/or anxiety symptom severity, well-being, quality of life, functional communication or social participation.

RESULTS

Database searches returned a total of 63 678 records, of which 56 059 remained following dededuplication. From these database searches, a total of 153 records proceeded to full-text screening. These were supplemented by 18 additional unique full-text screening records from Google Scholar searches and citation chasing (12% of total). From a total of 171 records at the full-text screening stage, 12 publications (7%) were eligible for inclusion in this systematic review, each reporting on a separate study. Published from 2004 to 2021, these studies involved a total of 669 participants with anxiety and/or depression from nine countries and covered five broad artistic modalities: dance, music therapy, art therapy, martial arts and theatre. Dance was the most studied artistic modality (five studies), while there were three studies on art therapy, two on music therapy and one each on martial arts and theatre. The evidence was clearest for a benefit of arts therapies on depression and/or anxiety symptoms.

CONCLUSIONS

This systematic review addresses all group-based active arts interventions in a focused population of primary anxiety and/or depression. The evidence suggests that the arts may be a useful therapeutic medium in this population. However, a substantial limitation of the evidence base is the lack of studies directly comparing different artistic modalities. Moreover, not all artistic modalities were assessed for all outcome domains. Therefore, it is not currently possible to determine which artistic modalities are most beneficial for which specific outcomes.

Creative Art Therapy for Improving Depression, Anxiety, and Stress in Patients with Stroke: A Quasi-Interventional Study

Introduction

Creative art therapy is a psychotherapeutic approach used to enhance the mental health status of patients.

Objectives

This study aimed to evaluate the effect of creative art therapy on the levels of depression, anxiety, and stress in Jordanian patients following stroke.

Methods

One-group pretest-posttest design was used; it included four sessions of creative art therapy which were conducted as two sessions for two weeks. This study recruited 85 participants who were within three months poststroke diagnosis. The Depression, Anxiety, and Stress Scale was used to assess the levels of psychological reactions pre and post creative art therapy intervention.

Results

The data showed that there was a statistically significant improvement in the levels of depression (t = 37.98; p < .001), anxiety (t = 20.59, p < .001), and stress (t = 35.52, p < .001) post-intervention. There was a statistically significant improvement in the study-related psychological aspects following creative art therapy.

Conclusion

The findings of this study suggest that creative art therapy is a valuable method to complement other types of treatments among patients with stroke, resulting in positive patient mental health outcomes. Creative art therapy could be used as a psychotherapeutic approach to manage mental health complexities among patients with stroke. Health policymakers are invited to use the findings of this study to establish tailored counselor services using this new psychotherapeutic approach.

The Effects of Adding Art Therapy to Ongoing Antidepressant Treatment in Moderate-to-Severe Major Depressive Disorder: A Randomized Controlled Study

This randomized controlled study aimed to investigate the effects of art psychotherapy on moderate-to-severe major depressive disorder (MDD). Forty-two MDD patients were recruited from a psychiatric outpatient clinic in Seoul, the Republic of Korea. Participants were allocated on a randomized, open-label basis to either an experimental group, wherein they were treated with art psychotherapy added to pharmacotherapy, or a control group, wherein they were treated with pharmacotherapy alone. Pre- and post-test measures of the Hamilton Depression Rating Scale, Beck Depression Inventory-II, and remission rates were measured. The results indicate that patients treated with art psychotherapy and ongoing pharmacotherapy showed slightly greater improvement when compared with pharmacotherapy alone in moderate-to-severe MDD. These results suggest that art psychotherapy could be an effective add-on strategy for the treatment of moderate-to-severe MDD. However, a rigorous test would facilitate a better understanding of art psychotherapy as an add-on strategy for MDD treatment.

Community mental health interventions for people with major depressive disorder: A scoping review

People with major depressive disorder continue to be marred by chronically pernicious yet preventable outcomes in the biopsychosocial aspects. With the reallocation of healthcare resources towards the fight against the coronavirus 2019 pandemic, much emphasis has been placed on existing community mental health interventions to ameliorate the disruption of mental health services. Moreover, the recent propulsion of community mental health services by the World Health Organization Mental Health Action Plan 2013-2030 ignited the need to bolster existing community interventions by providing comprehensive, responsive and integrated mental healthcare. The enhanced emphasis on mental healthcare in the community and the heightened demands of people with major depressive disorder underscores the need to explore the current state of community mental health interventions. This scoping review examined 51 primary studies published from year 2010 to 2020 using Arskey & O'Malley's five-stage framework and provided an overview of the impact of existing community mental health interventions for people with major depressive disorder. Findings using thematic analysis have recommended the adoption of person-centred community mental healthcare via the biopsychosocial approach for people with major depressive disorder. Enablers of community mental health interventions were driven by culturally appropriate care and augmented by technology-driven modalities. Challenges and gaps of community mental health interventions include the perpetuation of stigma and misconception, complex demands of persons with major depressive disorder and lack of holistic and long-term outcomes. Given the impact of major depressive disorder on the various biopsychosocial aspects, it is envisioned that our insights into the enablers and barriers of community mental health interventions will guide prospective interdisciplinary and nurse-led interventions in holistically improving the care of persons with major depressive disorder in the community settings.

[Art therapy : Current developments in research and training]

Art therapy is the intentional therapeutic use of the fine arts. Like music, dance, poetry and theater therapy, it is assigned to artistic therapy. This article provides an overview of general and recent developments as well as the state of the art in teaching in the discipline art therapy. Furthermore, two art therapeutic forms of intervention, the body outline image method (KUM) and Photo-Art-Therapy, are introduced. The aim is to further standardize the education and further training landscapes of art therapy, not least in order to further increase patient safety. This includes, for example, conveying systematically checked interventional measures and manuals that the students learn both theoretically and in the form of self-awareness. For about 10 years now, more and more high-impact quality research studies have been carried out Further evaluation studies in this field are desirable.

A pilot randomized controlled trial of group-based indoor gardening and art activities demonstrates therapeutic benefits to healthy women

Background

There is mounting anecdotal and empirical evidence that gardening and art-making afford therapeutic benefits.

Objectives

This randomly controlled pilot study tested the hypothesis that participation in group-based indoor gardening or art-making activities for one hour twice a week for four weeks would provide quantifiably different therapeutic benefits to a population of healthy women ages 26–49.

Methods

A population of 42 volunteers was randomly assigned to parallel gardening or art-making treatment groups. A total of 36 participants initiated the treatment protocol and 32 (Gardening n = 15 and Art n = 17) received the interventions and completed all assessments. Treatments included eight one-hour group-based gardening or art intervention sessions. Self-report psychometric assessments were conducted for anxiety, depression symptomatology, mood disturbance, stress, satisfaction with discretionary social activities, and quality of life measures. Cardiac physiological data were also collected. Outcomes were measured at baseline, during, and post-intervention.

Results

Engaging in both gardening and art-making activities resulted in apparent therapeutic improvements for self-reported total mood disturbance, depression symptomatology, and perceived stress with different effect sizes following eight one-hour treatment sessions. Gardening also resulted in improvements for indications of trait anxiety. Based on time-course evidence, dosage responses were observed for total mood disturbance, perceived stress, and depression symptomatology for both gardening and art-making. However, gardening or art-making did not have an apparent influence on heart rate or blood pressure or result in marked improvement for satisfaction with discretionary leisure activities.

Conclusion

The data did not support the hypothesis of differential therapeutic benefits of gardening and art-making for healthy women. When taken together, group-based gardening or art-making can provide quantitatively measurable improvements in healthy women’s psychosocial health status that imply potentially important public health benefits.

Trial registration

ClinicalTrials.gov NCT03266120.

The effect of combined cognitive-behavioral psychoeducation and music intervention on stress, self-efficacy, and relapse rates in patients with alcohol and substance use disorders: A randomized controlled trial

PURPOSE

This study was conducted to determine the effect of psychoeducation and music intervention on stress, self-efficacy, and relapse rates in alcohol and substance use disorders.

DESIGN AND METHODS

This was a randomized controlled study. The study sample included 62 patients who met the inclusion criteria. For 3 weeks, the patients in the experimental group received eight sessions of psychoeducation and music intervention.

FINDINGS

The total mean Self-Efficacy Scale score of the participants in the experimental group significantly increased as compared with that of the control group. The experimental group's total mean Perceived Stress Scale score and relapse rate significantly decreased compared to that of the control group.

PRACTICE IMPLICATIONS

Psychoeducation and music intervention effectively reduced stress, increased self-efficacy, and prevented relapses.

Art Making as a Health Intervention: Concept Analysis and Implications for Nursing Interventions

Art making has been adopted across multiple disciplines as a health intervention. However, our understanding of art making as a health intervention and how it differs from art therapy is still limited. Therefore, we conducted a concept analysis to better understand art making as a health intervention guided by Walker and Avant's approach. We examined 85 studies in which we found 4 defining attributes, 4 antecedents, and physical, cognitive, emotional, and psychological consequences. We suggest several nursing research and practical implications for nurse researchers and clinicians to aid in designing and implementing art making health interventions.

Exploring Paternal Mentalization Among Fathers of Toddlers Through a Clay-Sculpting Task

This study explored parental mentalization processes as they unfolded during a sculpting task administered to fathers of toddlers. Parental mentalization-the parent's ability to understand behavior (his/her own as a parent and that of their child) based on its underlying mental states (Luyten et al., 2017)-is considered crucial within parent-child relationships (Fonagy et al., 1998) and child development (Steele and Steele, 2008). Eleven Israeli first-time fathers (n = 11) of children aged 2-3 (mean = 2.3) were asked to sculpt a representation of themselves with their child using clay. Following the task, the fathers were interviewed while observing the sculpture they had created. Qualitative thematic analysis integrated three types of data-video footage of the sculpting processes, the sculptures themselves, and the transcripts of the post-sculpting interviews. By focusing on data extracts relating to mentalization processes, three main aspects of the clay-sculpting task and interview were identified as processes that either preceded controlled mentalization instances and/or related to their underlying dynamics: (1) discussing the sculpting process elicited the father's curiosity and wonder; (2) observing the sculpture/sculpting process revealed gaps in paternal representations; and (3) the preplanning of the sculptures sparked non-verbal exploration of metaphors and symbolism. Special attention was given, in the analysis, to the interplay between verbal and non-verbal aspects of mentalization as they appeared in the metaphorical representations that arose through the sculpting process. Comparing this sample to a previous sample of mothers who were given the same task, similarities and differences were explored, with specific reference to topics of embodiment, gender roles, paternity leave, and an active approach in art therapy. The discussion indicates that clay sculpting may offer unique insight into implicit parental mentalization. Possible clinical applications are discussed, with reference to attachment theory and clinical art therapy approaches.

Art-based interventions during pregnancy to support women's wellbeing: An integrative review

BACKGROUND

The transition to motherhood is a dynamic experience. Antenatal care and education are designed to support women during pregnancy, however childbearing women often report a further need for emotional and social support beyond preparation for birth. Broadening routine antenatal care to included art-based interventions may offer women an opportunity to explore important aspects of the transition to motherhood.

AIM

The aim of this integrative review is to synthesise research regarding the use of art-based interventions with women during pregnancy.

METHOD

A systematic integrative review of the current evidence-base was conducted. A multi-database keyword search was implemented, and a total of six articles met inclusion criteria. Results were analysed using an inductive thematic analysis framework.

FINDINGS

Six studies met the inclusion criteria. Three major themes were generated: art-based engagements supported women to express complex emotion, fostered a sense of connection and strengthened personal resourcefulness.

DISCUSSION

Creative expression provided an opportunity to explore important aspects of the motherhood experience including, complex emotion, identity and bonding with the unborn child. Being in a group enhanced the health effects of art-making and the social connection felt supportive when role and identity was evolving.

CONCLUSIONS

Whilst research on the current topic is emergent, preliminary results suggest that facilitated art-based programs are valuable for pregnant women. Art-based experiences offer women a unique opportunity to explore the full dimensionality of the transition to motherhood which can contribute to improved health and wellbeing. These findings suggest that art-based programs may serve to complement existing antenatal care models.

Creative art therapy for mental illness

Creative art therapy (CAT) for severe mental illness (SMI) represents an extremely heterogenous body of literature that encompasses the use of a large variety of creative mediums (i.e. visual art, music, dance, drama, writing) in the treatment of mental disorders. The present review provides a narrative summary of the findings on the use of CAT for the selected SMI, being: schizophrenia, trauma-related disorders, major depression, and bipolar disorder. A database search of PubMed and the Cochrane Library was conducted related to the use of CAT in the treatment of mental disorders published between January 2008 and March 2019. A total of 9697 citations were identified to match the search criteria and 86 full-texts were reviewed. Although literature suggests CAT to be a potentially low-risk and high benefit intervention to minimize symptoms and maximize functioning in individuals living with SMI, the lack of methodological rigor, and inconsistency in study methods and outcome measures have prevented the advancement of CAT for use in SMI. Although creation of a single CAT regimen for all psychiatric disorders stands neither practical nor advisable, greater standardization of methods would improve evaluation of CAT interventions. Future research should elucidate biological mechanisms underlying CAT methods.

Harnessing the Four Elements for Mental Health

Humans are intimately connected to nature, and our physical and mental health is influenced strongly by our environment. The "elements," classically described in humoral theory as Fire, Water, Earth, and Air, all may impact our mental health. In a contemporary sense, these elements reflect a range of modifiable factors: UV light or heat therapy (Fire); sauna, hydrotherapy, and balneotherapy (Water); nature-based exposure therapy and horticulture (Earth); oxygen-rich/clean air exposure; and breathing techniques (Air). This theoretical scoping review paper details the emerging evidence for a range of these elements, covering epidemiological and interventional data, and provides information on how we can engage in "biophilic" activities to harness their potential benefits. Interventional examples with emerging evidentiary support include "forest-bathing," heat therapy, sauna, light therapy, "greenspace" and "bluespace" exercise, horticulture, clay art therapy activities, and pranayamic yoga breathing exercises. Further robust research is however required to firmly validate many of these interventions, and to establish their therapeutic applications for the benefit of specific mental health disorders.

Improving Chinese Teachers' Stress Coping Ability through Group Sandplay

Teachers are burdened by high work pressure, suggesting the need for an effective stress coping system to support them. The present study evaluated the effectiveness of coping strategies currently utilized by teachers and explored the potential contribution of group sandplay to coping. The study was led by a group of experienced therapists and sandplay practitioners. Two hundred teachers served as participants, equally divided into two groups: An experimental sandplay group (EG) and control group. Both groups received a 3-hour tutorial on the psychological pressure at work, reactions to it, and physical/mental symptoms resulting from overwhelming pressure, and were introduced to the working principles and process of sandplay. EG participants then engaged in group sandplay for three consecutive days. The Simplified Coping Style Questionnaire was used as an objective measure of participants' coping styles. Therapists' and practitioners' observations were used as subjective information, including the scenes and themes created by participants, individual performance during sandplay activities, and feedback regarding changes to stress coping strategies. We compared participants' pre-and post-test stress coping strategies. The results revealed a significant improvement in the EG sample at the shift from passive coping (pre-test M = 1.94, 95% CI [1.83-2.05]; post-test M = 0.96, 95% CI [0.92-1.00]) to active coping (pre-test M = 1.76, 95% CI [1.69-1.83]; post-test M = 2.41, 95% CI [2.29-2.53]). Overall, our findings support the conclusion that group sandplay effectively improved Chinese teachers' overall stress coping abilities.

A pilot study on the impact of a pottery workshop on the well-being of people with dementia

OBJECTIVE

This study seeks to assess the impact of a pottery workshop as a creative arts programme and discover the extent to which people with dementia taking part in an artistic and creative activity engage with it, experience a feeling of well-being, and improve their mood state. In addition, the study will seek to answer the question of whether taking part in a programme of creative activities improves the self-esteem of people with dementia.

METHOD

The research used an uncontrolled, repeated measures design. Thirty users of the National Reference Centre for Alzheimer's and Dementia care in Salamanca (Spain) in a moderate to advanced stage of dementia (Global Deterioration Scale 4, 5, or 6) were divided into five intervention groups that received ten 45-minute sessions in which they were helped by facilitators to make different ceramic pieces. The participants were assessed before and after the intervention with a self-esteem scale, and they rated their mood before and after the sessions on a graphic scale. During the art sessions, two observers recorded the presence of multiple indicators of well-being.

RESULTS

The intervention was found to have a significant impact on mood and self-esteem that was independent of the participants' Global Deterioration Scale. Regarding the tool used to observe well-being, the participants scored highly in the domains of sustained attention, pleasure, self-esteem, and normalcy, with low scores in negative affect and sadness.

CONCLUSIONS

Pottery may be a highly suitable activity for people with dementia, as they may enjoy both the activity and the creative process, with it triggering a positive mood during the sessions, providing psychological well-being and reinforcing their self-esteem.

Competence Enhancement Program of Expressive Arts in End-of-Life Care for Health and Social Care Professionals: A Mixed-Method Evaluation

In the recent decades, expressive arts (EXA) has been used in end-of-life care (EOLC) for facilitating the quality of life of the patients and the caregivers. However, it may not be practical for every EOLC service to dispense EXA activities solely by extensively trained art therapy specialists. There is currently a lack of brief training for nonart therapists, which may have stifled the application of the techniques in clinical settings. The current study therefore described and evaluated the effectiveness of a 2-day EXA training workshop in enhancing practice, knowledge, and self-competence among health and social care professionals working in EOLC using a mixed-method approach. The quantitative findings show significant improvement in perceived competence of providing services per holistic and person-centered EOLC objectives, nonpharmaceutical management of symptoms, and evidence-based psychosocial care as well as self-competence in death work (SCDW) after the workshop. The qualitative findings corroborated the quantitative results by suggesting that the improvement in competence could be associated with enhanced communication, meaning reconstruction, and therapeutic relationship with the clients as well as the improvement in mood, socialization, and self-esteem among the clients through the learned EXA activities. Our findings support the efficacy of a brief training of EXA activities for nonart therapists in enhancing multifaceted intervention competence. Further research on brief training will be needed to promote the use of EXA activities in the EOLC context.

The Applied Effectiveness of Clay Art Therapy for Patients With Parkinson's Disease

This study investigates how clay art therapy affects Parkinson's disease patients' overall mental and physical condition as well as future treatment potentiality. The research was nonequivalent control groups pre and post study. A total of 54 patients with Parkinson's disease (control = 28, experimental = 26) were recruited from 3 setting locations in South Korea. Test measures were completed before and after the 16 sessions. The experimental group received two 80-minute evaluations per week for 8 weeks. Demographic information: hand dexterity, self-expression, mood depression, and quality of life measurements. There were significant differences in hand dexterity ( t = 4.96, P < .001), self-expression ( t = 3.74, P < .001), mood depression ( t = -11.85, P < .001), and quality of life ( t = 8.07, P < .001) between the 2 groups. Further research and development of clay art therapy can advocate the benefits, highlight practicality and demonstrate the possibility for its usage as a treatment methodology.