Editorial: The State of the Art in Creative Arts Therapies

Structural and functional neuroplasticity in music and dance-based rehabilitation: a systematic review

BACKGROUND

Music- and dance-based rehabilitation has gained prominence in promoting social engagement and improving motor, cognitive, and mood domains in individuals affected by different neurological disorders.

AIM

This systematic review aims to synthesize existing evidence from randomized controlled trials (RCTs) investigating neuroimaging-based structural and functional neuroplasticity following music- and dance-based interventions among people with neurological disorders.

METHODS

Literature research was performed using PubMed (MEDLINE), Scopus, and Web of Science (WOS). A multidimensional approach was employed to assess the efficacy of music- and dance-based interventions, integrating neuroimaging and clinical assessments.

RESULTS

Out of a total of 2247 papers reviewed, 20 RCTs met the inclusion criteria for this review, with a total of 718 subjects. Among them, 88% underwent a neuroimaging investigation to evaluate structural or functional neuroplasticity. Six studies involved dance-based interventions, while 14 examined music-based rehabilitation. These interventions targeted cognitive, motor, and mood impairments in people at risk of dementia or with neurological disorders including Huntington's Disease, stroke, traumatic brain injury, spinal cord injury, and disorder of consciousness.

DISCUSSION

Overall, the selected studies demonstrated significant effects on behavioral and neuroimaging outcomes, showing structural and functional changes in critical areas for perception and memory in patients at risk of dementia, as well as in regions essential for language processing, emotional regulation, and motor control in patients with acute and chronic stroke. Nevertheless, several biases were identified, specifically related to neuroimaging biomarkers, such as a lack of baseline and between-group comparisons and a lack of prior registration of neuroimaging biomarkers investigated. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO), with registration number CRD42024574754.

Group arts interventions for depression and anxiety among older adults: a systematic review and meta-analysis

In this systematic review and meta-analysis, we assessed the efficacy of group arts interventions, where individuals engage together in a shared artistic experience (for example, dance or painting), for reducing depression and anxiety among older adults (> 55 yr without dementia). Fifty controlled studies were identified via electronic databases searched to February 2024 (randomised: 42, non-randomised: 8). Thirty-nine studies were included. Thirty-six studies investigated the impact of group arts interventions on depression (n = 3,360) and ten studies investigated anxiety (n = 949). Subgroup analyses assessed whether participant, contextual, intervention and study characteristics moderated the intervention-outcome relationship. Risk of bias was assessed with appropriate tools (RoB-2, ROBINS-1). Group arts interventions were associated with a moderate reduction in depression (Cohen's d = 0.70, 95% confidence interval (CI) = 0.54-0.87, P < 0.001) and a moderate reduction in anxiety (d = 0.76, 95% CI = 0.37-1.52, P < 0.001), although there was publication bias in the depression studies. After a trim and fill adjustment, the effect for depression remained (d = 0.42; CI = 0.35-0.50; P < 0.001). Context moderated this effect: There was a greater reduction in depression when group arts interventions were delivered in care homes (d = 1.07, 95% CI = 0.72-1.42, P < 0.001) relative to the community (d = 0.51, 95% CI = 0.32-0.70, P < 0.001). Findings indicate that group arts are an effective intervention for addressing depression and anxiety among older adults.

Telehealth in arts therapies for neurodevelopmental and neurological disorders: a scoping review

Background

Arts therapies, encompassing art therapy, music therapy, drama therapy, and dance movement therapy with the broader practice of expressive arts therapies, have demonstrated positive outcomes in the treatment of neurodevelopmental and neurological disorders (NNDs). Integrating arts therapies into telehealth has become increasingly important to improve accessibility for people with mobility impairments or those living in remote areas. This study aims to map the existing body of literature to provide an in-depth overview of telehealth in arts therapies for individuals with NNDs.

Methodology

This scoping review followed the PRISMA guidelines. Six databases were systematically searched, with 2,888 articles screened for eligibility. Inclusion criteria focused on primary research peer-reviewed articles in English that addressed telehealth arts therapies for NNDs.

Results

Seventeen telehealth studies published between 2009 and March 2024 were included, with a notable increase in publications after 2020. The studies covered various neurodevelopmental disorders, including autism spectrum disorders, attention deficit hyperactivity disorder (ADHD), Rett syndrome, and neurological disorders such as stroke, epilepsy, cerebral palsy, central nervous system (CNS) tumors, dementia, Alzheimer's disease, Parkinson's disease, spinal cord injuries, and mild cognitive impairment. Music therapy was the most widely studied modality. Interventions ranged from therapeutic singing and songwriting to virtual reality experiences. Different platforms and specialized virtual environments were used alongside pre-recorded sessions. Positive benefits included psychological enrichment, social connectivity, cognitive improvements, and brain changes, although some studies reported mixed or no significant effects in certain areas.

Conclusion

Telehealth in arts therapies significantly benefits individuals with NNDs, improving accessibility and providing psychological, emotional, social, and cognitive benefits. The positive benefits observed highlight the potential of these interventions to improve overall well-being and daily functioning. Future research may focus on high-quality qualitative studies and neuroimaging assessments to further validate the impact of telehealth arts therapies.

Evaluation of an online arts-based platform to support the health and well-being of older adults during the COVID-19 pandemic: a cross-sectional survey

OBJECTIVES

The objective of this study was to conduct a formative evaluation of the Art Your Service (AYS) arts-based program to determine the program's potential for improving the social and physical well-being of older adults during the COVID-19 pandemic.

DESIGN, SETTINGS AND PARTICIPANTS

An online questionnaire was administered to the AYS members who consented to be invited to participate in the study. Questionnaire items consisted of a Likert scale and open-ended questions delivered using an online platform (SurveyMonkey). Participants provided feedback on their perceptions and experiences of the AYS program, such as its impact on their health and well-being during the COVID-19 pandemic, the benefits and challenges of participating, and any suggestions for program improvement.

OUTCOME MEASURES AND ANALYSIS

Quantitative data were analyzed using descriptive statistics (frequencies, means with standard deviations), and open-ended questions (qualitative data) were analyzed using content analysis. Outcomes included participant demographics, perceptions about the program, usability (System Usability Scale [SUS]), eHealth literacy (eHealth Literacy Scale), and social isolation (Lubben Social Network Scale; LSNS-6).

RESULTS

Program participants revealed consistent patterns of their perceptions and experiences about the program, including a high satisfaction rate (95%) and a perceived positive impact on participants' health and well-being. The program sessions were perceived to be a well-organized, convenient, and safe way to engage with one another socially during the COVID-19 pandemic. The program usability was also perceived to be high (SUS mean score 86.2). Participants felt a sense of connectedness and had reduced feelings of social isolation. Most participants (75%) reported that the program improved their physical health.

CONCLUSIONS

Findings from this formative evaluation study identified key strengths and opportunities to improve the Art Your Service arts-based program, which can be used to help enhance the program's functioning and long-term sustainability potential.

Acting and Dancing during the COVID-19 Pandemic as Art Therapy for the Rehabilitation of Children with Behavioural Disorders Living in Socially Disadvantaged Environments

Art therapy is employed in numerous ways in rehabilitation. This study focuses on an art and movement therapy project carried out during the COVID-19 pandemic. Acting and dancing methods were adapted to produce a short musical film series for ten children from disadvantaged social backgrounds displaying nonorganic behavioural disorders. The aim was to acquire novel ways of expression on the part of the participants to release painful emotions in a safe setting using the method of catharsis through acting and dancing, triggering relaxation as a physiological response and improving their attitude. This study retrospectively analyses the changes in the children's behaviour and their active participation in the project through quantitative and qualitative research. The children improved their attention and self-esteem, their behaviour became less aggressive and impulsive, and half showed increased empathy. The active participation rate during the project was 82%.

Impact of Teaching Palliative Psychology with Psychodrama and Arts Therapies on Psychology Students in Klagenfurt

The Erasmus+ project "Death Education for Palliative Psychology" (DE4PP) under the coordination of the University of Padua investigated the effects of teaching palliative psychology with psychodrama and arts therapies, as positive effects on students' attitudes towards life and death were suspected through the use of these forms of treatment. Five countries participated in this project funded by the European Commission (Austria, Israel, Italy, Poland, and Romania). In Klagenfurt (Austria), 34 students from the University of Klagenfurt completed the pilot course entitled "Palliative Psychology" generated by the project partners. Course participants filled out psychological and satisfaction questionnaires at the beginning and end of the course, to measure the impact of teaching palliative psychology with psychodrama and arts therapies. The research involved a control group. In addition, six participants in the course participated in a focus group interview at the end, which included questions about their experience of the course; the impact of arts therapies and psychodrama techniques; experiences of verbal and artistic processing of death anxiety; and the meaning of life and death, representation of death, and associated feelings. The results, in summary, showed that processing of life and death had occurred in the participants due to the course they had completed. As part of the course, creative arts and psychodrama were bridges to death. Filling out satisfaction questionnaires, photovoice assignments, role reversal, and visualizing a personal social atom were seen by students in Klagenfurt as particularly effective methods for self-reflection.

New developments during the COVID-19 pandemic: Drama therapy as an online psychological intervention tool

The COVID-19 pandemic has caused many art therapists and psychotherapists to change their practice modes and workplace setup. As a creative arts therapy (CAT), drama therapy has also shifted to an online mode-a shift that has been highly consequential for practice. This paper reviews the existing practice of tele-CAT and tele-drama therapy, explores the advantages and disadvantages of online drama therapy as a psychological intervention tool, and puts forward some developmental suggestions for online drama therapy.

Loss, Adaptation and Growth: The Experiences of Creative Arts Therapists during the Covid-19 Pandemic

Since the outbreak of the COVID-19 pandemic in March 2020, mental health professionals have been called upon to cope with various challenges, including the shift to telehealth without prior training, overload in the workplace, increased risk of infection, and personal stressors relating to the pandemic. This article presents the qualitative findings of a larger international mixed-method study that explored the experiences of creative arts therapists around the globe during the first year of the pandemic (Feniger-Schaal et al., 2022). Twenty creative arts therapists were interviewed between July 2020 and March 2021. Transcriptions of the interviews were qualitatively analyzed through reflexive thematic analysis. Three main themes were identified: an experience of processing the losses caused by the pandemic, a restorative orientation that focused on adaptations the therapists made, and innovations that lead to personal and professional growth. Artistic engagement and creativity were found to be a resource when coping with losses and helped therapists adapt to the shift to tele-creative arts therapies (tele-CAT). Although this shift can lead to advances in the field of creative arts therapies, it requires further consideration, including the need for ethical guidelines, specific training, the development of digital methods that support the creative process, and dedicated supervision for therapists. The findings also point to the importance of psychological support to mitigate the burden therapists experience during stressful events.

Spirituality During the COVID-19 Pandemic: An Online Creative Arts Intervention With Photocollages for Older Adults in Italy and Israel

The present study aimed to examine how expressions of spirituality were stimulated and reflected in an online creative arts intervention for older adults during COVID-19 lockdowns. The online process focused on the creation of digital photocollages together with narrative elements of dignity therapy. Twenty-four Israeli and Italian community-dwelling older adults aged 78–92 participated in a three-session online intervention involving the production of three photocollages. The visual and verbal data (participants’ chosen photos and photocollages, and transcripts of the sessions) were qualitatively analyzed within an abductive framework. Four themes were generated, representing the four domains of spirituality that were stimulated by and expressed in the process: (1) Connectedness with the self, (2) connectedness with others, (3) connectedness with the environment, and (4) connectedness with the transcendent. The findings show how photographs can serve as projective visual stimuli which elicit personal content through spontaneous thinking, and they reveal the multifaceted nature of spirituality, wherein each domain nourishes the others. Overall, the findings illustrate how creative arts intervention guided by the tenets of dignity therapy can contribute to the spiritual care of older adults during periods of social isolation, or to the spiritual support provided in palliative care.

Shifting to tele-creative arts therapies during the COVID-19 pandemic: An international study on helpful and challenging factors

The COVID-19 pandemic has led to an unprecedented shift to online treatment. For the creative arts therapies (CATs) - a healthcare profession that involves the intentional use of the visual art, drama, music, dance, and poetry within a therapeutic relationship - this shift has been highly consequential for practice. This study examined (a) how the COVID-19 pandemic has impacted clinical practice in the CATs, and (b) the features characterizing online practice in an international sample of 1206 creative arts therapists aged 22-86 (92% female). It aimed to identify changes in the use of the arts in therapy, resources that contributed to the delivery of therapy, and the role of therapists' creative self-efficacy in adapting to these changes. Respondents completed close and open-ended questions providing examples of what does and does not work in online practice. The results indicate that creative self-efficacy plays a meaningful role in buffering the impact of therapists' computer comfort on their perceived difference in online clinical practice; confidence in one's abilities positively contributed to their adaptation to online practice. The qualitative analysis yielded four main categories: the challenges of tele-CATs, continuing the therapeutic process through tele-CATs, adaptations for tele-CATs, and future directions. Overall, the results present a timely report on the inevitable transition of the CATs to online practice.

Children as innovators: harnessing the creative expertise of children to address practical and psychosocial challenges of the coronavirus disease 2019 (COVID-19) pandemic – COVISION study protocol

Background: We are currently in a period of transition, from the pre-COVID-19 (coronavirus disease 2019) era and the initial reactive lockdowns, to now the ongoing living with and potentially the after COVID-19 period. Each country is at its own individual stage of this transition, but many have gone through a period of feeling adrift; disconnected from normal lives, habits and routines, finding oneself betwixt and between stages, similar to that of liminality. Children and young people have been particularly affected.

Aim: To increase the understanding of home and community-based strategies that contribute to children and young people’s capacity to adjust to societal changes, both during and after pandemics. Moreover, to identify ways in which children’s actions contribute to the capacity of others to adjust to the changes arising from the pandemic. The potential for these activities to influence and contribute to broader social mobilisation will be examined and promoted.

Research design: To achieve the aim of this study, a participatory health research approach will be taken. The overarching theoretical framework of the COVISION study is that of liminality. The study design includes four work packages: two syntheses of literature (a rapid realist review and scoping review) to gain an overview of the emerging international context of evidence of psychosocial mitigations and community resilience in pandemics, and more specifically COVID-19; qualitative exploration of children and young people’s perspective of COVID-19 via creative outlets and reflections; and participatory learning and action through co-production.

Families and Collective Futures: Developing a Program Logic Model for Arts-Based Psychosocial Practice With South African Rural Communities

Aim: This aim of this study is to describe the development of a program logic model to guide arts-based psychosocial practice delivered in rural South African farming communities affected by transgenerational traumas. Background: The rationale for developing a program logic model for arts-based psychosocial practice in South Africa was based on the lack of evidence for effective community arts-based psychosocial interventions for collective trauma, unknown consensus about best practices and the need for developing cogent collective psychosocial practices. Further to this, the aims and benefits of the practice required clarity given the psychosocial complexity of the environment within which the practices for this population are being offered. The logic model offers a valuable resource for practitioners, participants and funders to understand the problem being addressed, how practice is defined, as well as the impact of practice and on intermediate and longer term goals. Methods: The authors used a systematic iterative approach to describe the operationalization of arts-based psychosocial practice. This resulted in the design of the logic model being informed by data from focus groups, an overview of the literature regarding transgerenational trauma in this population, operational policies and organizational documents. The development of the logic model involved actively investigating with practitioners their work with remote farming communities. We thematised practitioners practice constructs to identify salient practice elements and their relationship to perceived benefits and lastly feedback from practitioners and participants following implementation to make adjustments to the logic model. Results: The results were clearly identified in the form of visual mapping using the design of a program logic model. The logic model was divided into 5 parts and was verified by practitioners following implementation. The parts of the program logic model are (Part 1) main presenting problem, (Part 2) operational processes, (Part 3) practice elements, (Part 4) benefits, and impact and (Part 5) review.

Crafting Life Stories in Photocollage: An Online Creative Art-Based Intervention for Older Adults

Creative arts therapies (CAT) provide a safe and creative environment for older adults to process life experiences and maintain personal growth while aging. There is a growing need to make creative arts therapies more accessible to the aging population, as many have limited access to these services. This need has been catalyzed by the advent of the COVID-19 pandemic. Tele-CAT offers a possible solution. This study explored the experiences of older adults who participated in an online creative process of digital photocollage based on CAT. Twenty-four Italian and Israeli community-dwelling older adults aged 78 to 92 participated in this research through Zoom teleconferencing software. Transcriptions of the sessions and the art produced through the photocollage were qualitatively analyzed through Thematic Analysis. The findings show that the projective stimuli of digital photographs supported older adults' narratives and engaged them in a more embodied emotional experience. Participant experiences involved artistic enjoyment within a positive and safe interaction with therapists. The creation of digital photocollages allowed the participants to process their life experiences and create an integrative view of their life, a vital developmental task in late life. These results point to the advantages and challenges of tele-CAT for older adults.

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.

Children as innovators: harnessing the creative expertise of children to address practical and psychosocial challenges of the coronavirus disease 2019 (COVID-19) pandemic – COVISION study protocol

Background: We are currently in a period of transition, from the pre-COVID-19 (coronavirus disease 2019) era and the initial reactive lockdowns, to now the ongoing living with and potentially the after COVID-19 period. Each country is at its own individual stage of this transition, but many have gone through a period of feeling adrift; disconnected from normal lives, habits and routines, finding oneself betwixt and between stages, similar to that of liminality. Children and young people have been particularly affected. Aim: To increase the understanding of home and community-based strategies that contribute to children and young people’s capacity to adjust to societal changes, both during and after pandemics. Moreover, to identify ways in which children’s actions contribute to the capacity of others to adjust to the changes arising from the pandemic. The potential for these activities to influence and contribute to broader social mobilisation will be examined and promoted. Research design: To achieve the aim of this study, a participatory health research approach will be taken. The overarching theoretical framework of the COVISION study is that of liminality. The study design includes four work packages: two syntheses of literature (a rapid realist review and scoping review) to gain an overview of the emerging international context of evidence of psychosocial mitigations and community resilience in pandemics, and more specifically COVID-19; qualitative exploration of children and young people’s perspective of COVID-19 via creative outlets and reflections; and participatory learning and action through co-production.

Current Grief Support in Pediatric Palliative Care

Grief support changes as more is learned from current grief theory and research. The authors provide a comprehensive overview of current grief support as it relates to Pediatric Palliative Care (PPC). The following aspects of grief are addressed: (1) anticipatory grief: the nondeath losses that occur with a complex and chronic illness, as well as the time leading up to death; (2) grief around the time of death: the intense and sacred experience of companioning with a dying child; (3) grief after death: supporting bereavement and mourning through programing and other methods; (4) innovative approaches: the future of grief support. The contents of this article are meant to support and educate programs currently providing grief services and those aiming to begin the meaningful work of grief support.

"We're All in the Same Boat" - The Experience of People With Mental Health Conditions and Non-clinical Community Members in Integrated Arts-Based Groups

In recent decades there has been a significant increase in community rehabilitation programs for people with mental health conditions. One such nationwide programs is Amitim in Israel whose mission is to foster the psychosocial rehabilitation of people with mental health conditions in the community. Amitim’s flagship program consists of arts-based groups that integrate participants with mental health conditions and non-clinical community members. To better understand the experiences of participants in these arts-based groups, five focus groups were conducted with participants from 15 integrated arts-based groups. In total, 17 people with mental health conditions and 21 non-clinical community members were interviewed for this qualitative study. Three main themes emerged from the thematic analysis: creation and expression through the arts promote well-being, self-disclosure in a safe space encourages a sense of belonging, and “we are all in the same boat.” The participants underscored the role of creation and expression through the arts in facilitating emotional expression, self-discovery, interpersonal communication, and spiritual elevation. The findings suggest that the facilitators should instill a sense of equality by enabling intergroup acquaintances without labeling participants’ mental health status. Integrated arts-based groups should be accompanied by a mental health professional who can contain and work through complex emotional situations when needed. Arts therapists who specialize in both arts and mental health are particularly suitable for this role. Overall, the interviewees reported that participation in the integrated arts-based groups positively impacted their personal recovery processes by providing a corrective experience of equality as well as enhancing a sense of belonging to the community and social relationships. The participants also reported being empowered by the final artistic event that not only enhanced their sense of visibility, competence, and aspirations for future development in personal, interpersonal, and artistic realms, but also helped to combat both self- and public stigma.

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.

Impact of Group Art Therapy Using Traditional Chinese Materials on Self-Efficacy and Social Function for Individuals Diagnosed With Schizophrenia

The purpose of this study was to examine the effect of group art therapy using traditional Chinese materials on improving the self-efficacy and social function of individuals diagnosed with schizophrenia. In China, little research has been conducted on patients to measure the effectiveness of group art therapy, especially using traditional Chinese materials. To address this research gap, 104 individuals diagnosed with schizophrenia were tested in a group art therapy program that included 30 treatment sessions and used a wide variety of materials, including traditional Chinese materials, such as Chinese calligraphy, traditional Chinese painting, Chinese embroidery, and Chinese beads. The effect of art therapy was analyzed using the General Self-Efficacy Scale (GSES) and Scale of Social Skills for Psychiatric Inpatients (SSPI). This study demonstrates that group art therapy using traditional Chinese materials can improve self-efficacy and social function, reducing social and life function problems, and promote the recovery of individuals diagnosed with schizophrenia.

Conflicts Between Women's Religiosity and Sense of Free Will in the Context of Elective Abortion: A Qualitative Study in the Worst Period of Italy's COVID-19 Crisis

This qualitative study considers the relationship between abortion, bereavement, and the effects of the COVID-19 lockdown nine women who had undergone an elective abortion, which is voluntarily termination of a pregnancy at the woman's request. These women were interviewed in three time points (1 month, 6 months, and 1 year after the event) to consider the possible evolution of their experience. The third phase was concurrent with the COVID-19 pandemic and particularly with Pope Francis's Easter declaration against abortion. All the interviews were conducted and analysed through qualitative research in psychology. Results showed that the abortion experience led to physical, relational, and psychological suffering, similar to perinatal grief. Participants were non-practising Catholics and religiosity did not help them to overcome their sorrow. Though religiosity is a possible resilience factor in other stressful conditions, in this case it is a factor that aggravated suffering. Finally, we discuss the difficulties experienced by Catholic women who choose to have an abortion and assert the necessity of psychological and spiritual interventions to support these women.

The COVID-19 Disappeared: From Traumatic to Ambiguous Loss and the Role of the Internet for the Bereaved in Italy

In Italy, in the very first phase of the COVID-19 pandemic there was a dramatic rise in mortality. However, families were forbidden because of lockdown regulations to be with their loved ones at their deathbeds or to hold funerals. This qualitative study examined bereavement experiences among family members, how they processed their grief, and how they used social networks in particular by uploading photographs during the working-through of bereavement. The sample was composed of 40 individuals aged 23-63 (80% women) from different Italian cities severely impacted by the virus, including a subgroup from the province of Bergamo, which was the city with the highest mortality rate during that time. All interviews were conducted by phone, Skype, or Zoom. Then, the transcriptions underwent a thematic analysis using Atlas.ti. The main themes that emerged were: abandonment anger and guilt, dehumanized disappeared, derealization and constant rumination, and social support and the importance of sharing photos on Facebook. Importantly, the use of social networks proved to be a valuable source of support and photographs were a powerful tool in facilitating the process of mourning by encouraging narration and sharing. Grief had a complex profile: on the one hand, it was traumatic and characterized by all the risk factors causing mourners to experience prolonged grief, but on the other, some features were similar to ambiguous loss (that occurs without closure and clear understanding) because of the impossibility to be with their relatives in their final moments. The possible relationships between ambiguous loss, the use of internet, and the risk of prolonged grief are discussed.

Playback theatre in adult day centers: A creative group intervention for community-dwelling older adults

The literature indicates that theatre and drama-based interventions have the potential to improve older adults' well-being and health. The goal of the current study was to characterize the process of a creative group intervention in adult day centers (ADCs), which integrates playback theatre and life-review principles. Our objective was to provide an evidence-informed framework for drama therapy interventions, which would allow older adults to bring up and explore their life-stories in a dramatic creative process in their own community. A total of 27 participants ranging in age from 63 to 91, took part in one of three playback theatre groups. The playback theatre group intervention comprised 12 weekly sessions. All sessions were videotaped to capture the lived experience of the creative process and were analyzed in post-intervention interviews. In addition, focus group meetings were conducted with 13 ADC staff members to decipher further the effects of the participation as perceived by people outside the groups. Three types of potential transformation were identified in the qualitative analysis: the evolution of life stories, evolution of playfulness, and expansion of social engagement. The results indicate the potential of the integrative framework to serve as a creative intervention in ADC communities, as well as its potential to bring about a personal transformation and expand it to enable a person's social engagement in the community. The findings imply the potential benefits of using playback theatre groups to supplement the routine care provided in ADCs.

"Art, Colors, and Emotions" Treatment (ACE-t): A Pilot Study on the Efficacy of an Art-Based Intervention for People With Alzheimer's Disease

Increasing evidence suggests that non-pharmacological therapies impact on neuropsychiatric symptoms and quality of life in people with Alzheimer’s disease. Among these, art-based interventions seem particularly suitable for elders’ rehabilitation as they act both on cognitive functions and quality of life. However, their benefits are not yet appropriately explored. The main aim of this quasi-experimental study was to test the feasibility and the likely efficacy of a novel multi-dimensional visual art intervention for people with Alzheimer’s disease (PWAD), named Art, Colors, and Emotions treatment (ACE-t). A group of PWAD (N = 10) was recruited from the Memory Clinic of Don Gnocchi Foundation to take part in the ACE-t. A historical control group that followed a usual care program (N = 10) was used for comparison. We considered both feasibility output (adherence and acceptability) and efficacy outcome measures (neuropsychological and neurobehavioral scales). We observed a good adherence to and acceptability of the ACE-t. The following significant intervention-related changes were also observed in ACE-t with respect to usual care: improvement in general cognition, as assessed with the Alzheimer’s Disease Assessment Scale–Cognitive, amelioration in language, and in executive functions, and reduction in Neuropsychiatric Inventory Scale score. In conclusion, ACE-t could be considered as a suitable intervention for the rehabilitation of PWAD, with positive effects on the cognitive and the behavioral status. ACE is a promising new art-based intervention that merits further research, including confirmatory trials of our preliminary results.