"My heart on this bit of paper": A grounded theory of the mechanisms of change in art therapy for military veterans

On the Effectiveness of Visual Arts Therapy for Traumatic Experiences: A Systematic Review and Meta-Analysis

Arts therapy is a popular intervention used to work through the effects of traumatic experience. We evaluate previous reviews and report a meta-analysis of the effectiveness of arts therapy following trauma for reducing symptoms of PTSD, enhancing positive outcomes (e.g., quality of life) and decreasing negative outcomes (e.g., depression). Database searches identified 21 (N = 868) randomised controlled trials (RCTs). Outcomes were categorised as PTSD specific, positive non-PTSD specific and negative non-PTSD specific. Several moderators were tested: age, diagnosis type, trauma type, intervention instruction, control type, therapy mode and therapy duration. Overall, random-effects analysis indicated that arts therapy was favoured relative to control for positive non-PTSD-specific outcomes (g = 1.53, p < 0.001), but not for negative non-PTSD-specific (p = 0.069) or PTSD-specific outcomes (g = 0.89, p = 0.052). Regression analyses indicated that arts therapy was effective in reducing PTSD-specific outcomes in children (Z = 2.81, df = 1, p = 0.005), positive non-PTSD-specific outcomes in group-based arts therapy (Z = -2.40, df = 1, p = 0.016, I2 = 57.33) and for reducing negative non-PTSD outcomes following acute traumas (e.g., combat-related trauma or sexual abuse) (Q = 10.70, df = 3, p = 0.013, I2 = 77.09). We highlight the need for additional RCTs and standardised protocols to address heterogeneity. Our review provides an important benchmark for gauging the effectiveness of arts therapy in the treatment of trauma.

The mySELF group: Recreation- and art-based group therapy as adjunct treatment for posttraumatic stress disorder

LAY SUMMARY

Military personnel and Veterans receiving psychotherapy for mental health diagnoses such as posttraumatic stress disorder (PTSD) often have only modest symptom improvement. The authors wondered whether participating in a therapeutic recreation and creative arts group along with psychotherapy would aid recovery. A 12-week program called the my Social life, Expression, Leisure and Food (mySELF) group was created that offered therapeutic recreation, art, and music therapy. A total of 36 clients, most with PTSD, who had been receiving psychotherapy for an average of three years completed the program and submitted pre- and post-group questionnaires. The authors examined leisure attitudes, quality of life, and mental health symptoms before, immediately after, and four months after the group. Results showed significant improvements in leisure attitudes, environmental quality of life and depression, anxiety, stress, and PTSD symptoms. These preliminary results suggest that therapeutic recreation, art, and music therapy are beneficial for military personnel, Veterans, and Royal Canadian Mounted Police receiving psychotherapy.

Dealing with opposites as a mechanism of change in art therapy in personality disorders: A mixed methods study

Introduction

Personality disorders can be characterized by emotion regulation problems, difficulties in self-regulation and by dichotomous, black-and-white thinking. Dealing with opposites as a mechanism of change used by art therapists might be beneficial for people diagnosed with a personality disorder. This study examined the overall question if and in what way dealing with opposites in art therapy is a mechanism of change in achieving personal therapeutic goals.

Method

A convergent parallel mixed-methods pilot study was performed among patients with a personality disorder (N = 32). Participants received four sessions of art therapy focused on opposites. They completed questionnaires on emotion regulation, positive and negative affect and sense of emotional balance before and after each session. Additionally, they completed a questionnaire on self-expression before and after the four sessions. Furthermore, 10 interviews (eight patients/two therapists) were conducted.

Results

Quantitative results comparing baseline versus after the four sessions showed a significant change indicating that there might be a positive change regarding self-expression and emotion regulation (t = -2.45, p = 0.02, ES d = 0.30). A significant change was measured in acceptance of emotional responses (Z = -2.66, p = 0.01) and the state of emotion was rated as more balanced (Z = -2.19, p = 0.03). No further significant changes were found. Qualitative results showed that using opposites in art therapy often helped to gain insight, self-exploration and self-awareness and could facilitate confrontation as well as acceptance although sometimes it was (too) confronting.

Discussion

Integration of conflicting emotions, behaviors, and thoughts were promoted by the explicit use of opposites and supporting coherent representation. Practice based recommendations are therefore to make more explicit use of dealing with opposites as a theme in art therapy. Also, we recommend more research on different mechanisms of change to refine the theory of change that provides an underpinning rationale and structure for art therapy. The results of this research should be regarded as exploratory given the small sample size and limited amount of therapy sessions.

Social and Psychological Rehabilitation of War Veterans

The subject of the study is determined by the need for effective rehabilitation of war veterans and the presence of many problems of sociopsychological recovery after being in the zone of active combat operations, and the need to develop an effective rehabilitation programme for this category of people. The purpose of the study is to conduct a comprehensive analysis of the features of socio-psychological rehabilitation, identify the relationship of physiological states with individual psychological components of the individual’s functioning in specific conditions of life, determine which measures are most effective for the establishment of areas of work in the aspect of socio-psychological rehabilitation of war veterans. The basis of the methodological approach in this study is the analysis and generalisation based on the results of the examination of scientific and theoretical material, which determines the establishment of conclusions and recommendations in the field under study. The following methods of scientific knowledge are used: dialectical, logical-semantic, system-structural, functional, and logicalnormative. The study proves the direct connection between the presence of a person in a war zone and their psychoemotional state. It is considered which psychophysiological disorders can be caused by involvement in armed conflicts. The conclusion is formulated that participants in military operations need social and psychological rehabilitation, and problematic issues and prospects for rehabilitation are outlined. Specific medical and socio-psychological aspects are highlighted, the avoidance or generation of which will help in the process of rehabilitation of military personnel and their families. It was identified that although psychological rehabilitation is generally conducted, it requires more government support, popularisation, and wider involvement of both war veterans and experts. Ways to improve approaches to providing psychological assistance to military personnel and their families in Ukraine are proposed. The conclusions of the study are of substantial importance for psychologists and social workers, psychology students and teaching staff of psychology faculties as a doctrinal basis for the educational process