Creative Arts Therapies as Temporary Home for Refugees: Insights from Literature and Practice

Animal-Assisted Interventions: Factors Affecting Donkey Behaviours and Attitude Toward Humans

The relationship between humans and donkeys has ancient origins. In recent years, donkeys' involvement in Animal-Assisted Intervention (AAI) has grown, raising major concerns about their welfare during these activities. We investigated the factors affecting donkeys' behaviour during an AAI programme for migrants. We observed an effect of human distance from the animal, the interaction mode, and food presence on the animals' behaviours and attitudes toward humans. Moreover, we provide preliminary evidence of the effect of AAI on migrants' welfare and prosocial behaviours and offer insights into the issues to address in future studies.

Examining Barriers to Rehabilitation and Addressing Rehabilitation Needs Among Persons With Forced Migration Experiences: Interdisciplinary Perspectives

Globally, human displacement is at a record high. According to the United Nations High Commissioner for Refugees, 110 million people have been forcibly displaced worldwide owing to persecution, mass conflict, or human rights violations. Conflicts continue to rage in different parts of the world such as Ukraine, Palestine, Sudan, and Tigray. Large-scale political upheaval is also on the rise in many countries such as Haiti, Venezuela, and Iran. Natural disasters fueled by climate change will further contribute to large-scale forced migration. Persons with forced migration experiences (PFMEs) tend to have significant rehabilitation needs because of high risk of physical injuries, mental trauma, and exacerbation of pre-existing health problems during displacement. Rehabilitation practitioners in host countries must be well equipped to address the complex needs of this population. However, there is currently limited literature to guide best practice. In this article, a group of interdisciplinary professionals examine rehabilitation needs among PFMEs, provide examples of established and emerging rehabilitation interventions with PFMEs in the context of asylum and resettlement, identify barriers to accessing rehabilitation services in host countries, and propose avenues for professional advocacy in this area.

Evaluating a Movement-Based Mental Health Promotion Intervention for Refugee Children in Uganda: A Quasi-Experimental Study

OBJECTIVE

Mental health promotion interventions are widely implemented in humanitarian settings and low- and middle-income contexts (LMICs), yet evidence on effectiveness is scarce and mixed. This study evaluated the movement-based mental health promotion intervention "TeamUp" in Bidibidi refugee settlement, in Northern Uganda.

METHOD

A quasi-experimental study including four schools (two per arm) assessed the outcomes of 10- to 15-year-old South Sudanese and Ugandan children (n = 549). Randomly allocated, they either participated in up to 11 TeamUp sessions (n = 265) provided by trained facilitators; or belonged to a control group, which continued care as usual (n = 284). Primary outcomes measured psychosocial wellbeing, friendships and attitude to school; secondary outcomes included traumatic distress, depressive symptoms, quality of life, physical health, bullying, interoceptive awareness, and irritability. Data were collected at baseline and endline.

RESULTS

Children joining TeamUp, showed significantly more improvements on primary outcomes: emotional and psychosocial wellbeing (Mdiff = -1.49, SE = 0.6, p = .01), satisfaction with and attitude toward school (-0.57, SE = 0.2, p = .004); and secondary outcomes: traumatic stress (2.64, SE = 0.8, p < .001), health-related quality of life (-1.56, SE = 0.4, p = .001), physical health (-0.78, SE = 0.3, p = .014) and the TeamUp mechanisms of action scale (-3.34, SE = 0.9, p < .001), specifically the subscales social connectedness (-0.74, SE = 0.3, p = .007) and sense of agency (-0.91, SE = 0.3, p = .005), compared to the control group. No significant differences were found on bullying, interoceptive awareness, irritability and depressive symptoms.

CONCLUSION

The results are promising for TeamUp as a mental health promotion intervention for children affected by armed-conflict, displacement and on-going adversity. Further research will need to assess the intervention's effectiveness.

"It will always be Temporary": A qualitative study of Syrian young adults expressing histories of collective violence and forced displacement in participatory theatre

Given the increased prevalence of mental health problems in Syrian refugee communities, there have been efforts to develop adequate mental health care for their well-being. Herein, clinical literature is increasingly emphasizing the importance of locating refugees' healing at the nexus of personal and social realities, understanding the process of trauma narration within social restorative spaces of witnessing and communal support. Alongside this debate, there is growing interest in the relevance of participatory theatre for refugees. This innovative approach understands how voicing narratives of life histories within a broader social sphere may support personal and socio-political transformation. In this article, we aim to further the understanding of participatory theatre's relevance to these issues, focusing on the reparative dimensions of trauma narration. Based on a case study of a theatre project with Syrian young adults resettled in Belgium, we explore the different ways participants expressed experiences of collective violence and displacement in dialogue with each other, their diasporic and home communities, and their host society, and consider how these processes relate to their construction and meaning and coping with trauma. In a final section, we discuss the implications of our findings, raising questions about the value of participatory theatre as a reparative space and outlining suggestions to introduce and mobilize reparative modes of trauma narration in therapeutic practices in refugee trauma care.

Trauma Aware and Anti-Oppressive Arts-Health and Community Arts Practice: Guiding Principles for Facilitating Healing, Health and Wellbeing

There is a growing call for arts-health and community arts professionals to work in 'trauma informed ways' to prevent re-traumatisation and promote healing. This paper reports on a scoping review of existing literature that deal with trauma aware and informed practice and its applications in arts-health and community arts. Trauma informed practice does not seek to target or treat trauma but, rather, seeks to provide a safer and more informed space for people who experience post-traumatic stress conditions and symptoms to engage in facilitated arts activities. We particularly examine the extent to which existing literature acknowledges the presence of oppression-related collective trauma - such as racial trauma - and offers appropriate creative, anti-oppressive and trauma aware practice approaches. A total of 19 articles were included following librarian input and team checking. Included articles were written in English, published in peer reviewed academic journals, included a creative arts component, and adopted an intentional trauma informed or aware approach to practice. An additional three sources were included as part of descriptive synthesis to foreground leading First Nations resources for practice. Although no specific guidelines for trauma aware practice in arts-health or community arts were found, findings are consolidated at the end of the paper to offer interim principles, values and activities for trauma aware and informed practice in arts-health and community arts. Findings can also inform general trauma related research and therapy by highlighting the growing role of arts and creativity in responding to diverse experiences of trauma and its effects.

The Effects of Art Therapy on Anxiety and Distress for Korean-Ukrainian Refugee: Quasi-Experimental Design Study

Since Russia invaded Ukraine in February 2022, there has been an urgent need to provide mental healthcare and share various practices for Ukrainian war refugees. This study urgently focuses on the need for art therapy to support the mental health of Ukrainian refugees, Koryo-saram, who are staying in the Republic of Korea due to the wartime emergency. It also examines the impact of art therapy intervention on anxiety and subjective stress. The single-session art therapy with the 54 Koryo-saram refugees aged 13-68 showed the effectiveness of the art therapy intervention. The results indicate that GAD-7 (t = 3.092, p = 0.003) and SUDs (t = 3.335, p = 0.002) were statistically significant within the intervention group. In addition, satisfaction assessments of the qualitatively analyzed participants showed that Ukrainian Koryo-saram had a positive experience of art therapy. Therefore single-session art therapy in this study demonstrated the efficacy of art therapy for the anxiety and subjective distress of Ukrainian Koryo-saram refugees. This result suggests that the intervention of art therapy as immediate mental healthcare for refugees facing war could benefit the mental health of Koryo-saram refugees.

The effectiveness of therapeutic interventions on psychological distress in refugee children: A systematic review

OBJECTIVE

To systematically review existing research exploring the effectiveness of psychological interventions in reducing symptoms of distress amongst refugee and asylum-seeker children.

METHOD

Six databases were searched to identify English studies presenting original empirical quantitative data (published before September 2022) testing the efficacy of psychological interventions for children from refugee and asylum-seeking backgrounds. Quality of studies were assessed through the Appraisal Tool for Cross-Sectional Studies as well as the Cochrane Risk of Bias Tool. Relevant data were extracted to facilitate a narrative synthesis.

RESULTS

Seventy-one eligible articles were identified (n > 10,000). A number of cognitive-behavioral, psychosocial, and trauma-focused interventions that catered specifically to children and their families were identified. A synthesis of these results suggest that interventions may assist in the reduction of various psychopathologies, although the effects were mixed across intervention types.

CONCLUSIONS

While the review yielded promising findings, most findings were derived from small pilot and empirical studies, leading to difficulties with drawing conclusions. There remains a need for studies using more rigorous research methodologies to expand and ratify this valuable knowledge base.

CLINICAL SIGNIFICANCE

 Forced displacement is at an all-time high. Many children are being forced to seek asylum and refuge, and they become vulnerable to the development of poor mental health, with limited understanding surrounding how to appropriately intervene. This review aims to equip clinicians with increased knowledge and confidence in working therapeutically alongside clients from refugee or asylum-seeking background, with the goal of fostering positive mental health and wellbeing.

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.

Neural Phenomenon in Musicality: The Interpretation of Dual-Processing Modes in Melodic Perception

The confluence of creativity in music performance finds itself in performance practices and cultural motifs, the communication of the human body along with the instrument it interacts with, and individual performers' perceptual, motor, and cognitive abilities that contribute to varied musical interpretations of the same piece or melodic line. The musical and artistic execution of a player, as well as the product of this phenomena can become determinant causes in a creative mental state. With advances in neurocognitive measures, the state of one's artistic intuition and execution has been a growing interest in understanding the creative thought process of human behavior, particularly in improvising artists. This article discusses the implementation on the concurrence of spontaneous (Type-1) and controlled (Type-2) processing modes that may be apparent in the perception of non-improvising artists on how melodic lines are perceived in music performance. Elucidating the cortical-subcortical activity in the dual-process model may extend to non-improvising musicians explored in the paradigm of neural correlates. These interactions may open new possibilities for expanding the repertoire of executive functions, creativity, and the coordinated activity of cortical-subcortical regions that regulate the free flow of artistic ideas and expressive spontaneity in future neuromusical research.

“Migrated onto the Screen:” The Impact of the COVID-19 Pandemic on the Clinical Practice of Drama Therapy

This article analyzes the impact of the COVID-19 pandemic on the clinical practice of Drama Therapy, considering how a forced shift to the online setting impacted drama therapy’s concepts and practice. Anchored in a qualitative analysis of 20 interviews with well-established drama therapy practitioners from 19 different countries, we put forward the notion of four positions of reaction to the online setting: resistance, anxiety, adjustment and fluency. Our discussion of the four positions aims to reflect a composite exploration of practitioners’ experiences during various phases of their online work. Importantly, we insist that movement between positions is fluid and dynamic. Building on a prior research examining the use of digital resources before March 2020, our analysis utilizes the metaphor of forced migration to consider the range of experiences and challenges that emerged when online work was no longer a choice amidst the spread of the coronavirus. We hypothesize that practitioners who were able to channel the discipline’s creative ethos and recognize that online drama therapy presents a qualitatively different phenomenon (vis-a-vis in-person practice) were best able to experience the fluency position. We speculate that “online drama therapy” may be different from “practicing drama therapy online,” wondering whether it will develop into a new brand of drama therapy, as more and more practitioners and clients “migrate onto the screen”.

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.

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.

"I didn't know I have the capacity to be creative": children's experiences of how creativity promoted their sense of well-being. A pilot randomised controlled study in school arts therapies

OBJECTIVES

Creativity has been found to be one of the key therapeutic elements in arts therapies. Arts therapies are psychotherapeutic approaches that aim to facilitate psychological change and personal growth through arts media, such as music, drama, dance, movement and virtual arts. This article presents the findings from children's experiences of participating in arts therapies, particularly those related to creativity.

STUDY DESIGN

This study followed a pilot randomised controlled design with embedded qualitative and arts-based methods. Sixty-two children with mild emotional and behavioural difficulties were recruited across four primary schools in North West England.

RESULTS

The creative activities with the greatest impact on children's health and well-being were as follows: a) story-making and story-telling; b) drawings; c) puppetry; d) songwriting; and e) empowerment activities. Based on the interviews with children, these activities led to emotional expression, group bonding, empowerment and optimism. The findings were discussed through the lenses of the empowerment theory and the PERMA theory of positive psychology.

CONCLUSIONS

Arts therapies allowed children to share experiences and emotions that they may not have otherwise expressed merely through verbal means. During a period where COVID-19 has disrupted academic schedules and sparked a transitional period at schools, opportunities for creativity and engagement with the arts may contribute significantly to support children's emerging health needs.