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

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

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

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

Psychodrama and Moviemaking in a Death Education Course to Work Through a Case of Suicide Among High School Students in Italy

This study describes the psychological effects of an experience of death education (DE) used to explore a case of suicide in an Italian high school. DE activities included philosophical and religious perspectives of the relationships between death and the meaning of life, a visit to a local hospice, and psychodrama activities, which culminated in the production of short movies. The intervention involved 268 high school students (138 in the experimental group). Pre-test and post-test measures assessed ontological representations of death, death anxiety, alexithymia, and meaning in life. Results confirmed that, in the experimental group, death anxiety was significantly reduced as much as the representation of death as annihilation and alexithymia, while a sense of spirituality and the meaning of life were more enhanced, compared to the No DE group. These improvements in the positive meaning of life and the reduction of anxiety confirmed that it is possible to manage trauma and grief at school with death education interventions that include religious discussion, psychodrama and movie making activities.

The Core Techniques of Morenian Psychodrama: A Systematic Review of Literature

The original theory of psychodrama proposed by Moreno in 1921 has been adjusted and re-interpreted by several authors over the last three decades. This resulted in the proliferation of techniques whose definitions and contexts of application are unclear and poorly documented in the literature. The purpose of this review was three-fold: (1) to identify the psychodramatic techniques currently used for research and clinical purposes, (2) to extract and create a list of core techniques which are consensually used by psychodramatists, and which reflect the main principles of the Morenian theory of psychodrama, and (3) to propose an operationalised definition of the core psychodramatic techniques identified. To achieve this, a systematic review was conducted, according to the PRISMA guidelines (Moher et al., 2009). The search was conducted between June and September of 2012 in the main electronic databases (e.g., PubMed, Embase, PsychINFO) and using the following keywords: "psychodrama," "group psychotherapy," "experiential psychotherapy," "Moreno," "intervention," and "techniques." Fifty-six techniques were extracted from the 21 papers selected for review. Of these, a preliminary list of 30 techniques was selected, which was reduced to a total of 11 core techniques: soliloquy, double, mirror, role reversal, resistance interpolation, sculpture, social atom, intermediate objects, games, sociometry, role training. The credibility of this final core list was first checked with an expert in Morenian psychodrama, and later discussed with a network of 22 European psychodramatists to ensure full consensus. Overall, this review provides a contemporary framework for psychodramatists that reconciles the current approaches to psychodrama with the core techniques proposed by Moreno, and updates the definitions of these techniques, by merging the interpretations of different experts in the field. To have a list of core techniques which is consensually accepted from an international point of view is paramount not only for future research, but also for training purposes. The implications of this review for clinical practice are also discussed.

In-session behaviours and adolescents' self-concept and loneliness: A psychodrama process-outcome study

As adolescents spend many hours a day in school, it is crucial to examine the ways in which therapeutic practices in schools promote their well-being. This longitudinal pilot study examined the contribution of school-based psychodrama group therapy to the self-concept dimensions and perceived loneliness of 40 Israeli adolescents (aged 13-16, 60% boys) in public middle schools. From a process-outcome perspective, we also examined the understudied trajectory of adolescents' in-session behaviours (process variables) and its associations with changes in their self-concepts and loneliness (outcome variables). Psychodrama participants reported increases in global, social, and behavioural self-concepts and a decrease in loneliness compared to the control group. In-session productive behaviours increased and resistance decreased throughout the therapy, but varied process-outcome relationships were found. The study suggests that conducting further research into the process-outcome relationships in psychodrama group therapy is warranted to pinpoint specific mechanisms of change. Suggestions for future studies are provided.

Beyond the Wall: Death Education at Middle School as Suicide Prevention

This study investigates the psychological effects of participation in Death Education (DeEd) by middle school children in two towns in northeast Italy in which suicides occur to a greater extent than in the rest of the region. The aims of the project "Beyond the Wall" were inherent to the prevention of suicide, address existential issues and enhance the meaning of life through positive intentions for the future and reflection on mortality. It involved eight classes (150 students in four classes in the experimental group; 81 in four classes in the control group) engaging with films, workgroup activities, photovoice and psychodrama. The constructs of resilience, emotional competency and psychological well-being were monitored with the Resilience Scale for Adolescents, the Hopelessness Scale for Children, the Alexithymia Questionnaire for Children and the Stirling Children's Well-being Scale. The DeEd intervention was found to be significantly related to some of the variables investigated, improving the students' ability to recognise emotions and communicate them verbally while maintaining stable initial characteristics, such as psychological well-being and positive expectations for the future.

The effects of the psychodrama in instilling empathy and self-awareness: A pilot study

This pilot study investigated the effects of psychodrama on the counseling skills (mainly empathy) and on increasing the self-awareness of 23 counseling undergraduate students. Participants attended 12 psychodrama sessions over 3 months. Data were gathered by using the Empathic Tendency Scale and a personal information form. The study used the mixed method research design, which combines qualitative and quantitative methods. The quantitative aspect of the study involved the use of pretest-posttest experimental and control group design with random assignment, while the qualitative aspect utilized the methods of case study, observation, and interview. The quantitative and qualitative results showed that psychodrama increased students' empathy, counseling skills, and self-awareness.

The Effectiveness of Trauma-Focused Psychodrama in the Treatment of PTSD in Inpatient Substance Abuse Treatment

This single group pretest-posttest study explores the effectiveness of trauma-focused psychodrama in the treatment of post-traumatic stress disorder (PTSD) at an inpatient addiction treatment center. The results contribute to the limited research bases of both psychodrama and PTSD treatment outcomes in inpatient addiction treatment. The present study supports the potential effectiveness of two trauma-focused psychodrama models, the Therapeutic Spiral Model and the Relational Trauma Repair Model. Findings of the research demonstrate clinically significant reductions in overall PTSD symptoms (over 25% change) and each PTSD symptom cluster (i.e., re-experiencing and intrusion, avoidance and numbing, and hyper-arousal). Additionally, patient satisfaction exit survey data support overall treatment effectiveness and highlight its tolerability, and capacity for establishing emotional safety, connection, and group cohesion. Patients even described the trauma-focused psychodrama treatment approach as enjoyable and helpful. Overall, the results of this study are promising, and support continued clinical application of trauma-focused psychodrama treatment with other subpopulations diagnosed with PTSD. However, the ability to isolate effects of trauma-focused psychodrama in this study is compromised due to the absence of a control group and participants' involvement in other inpatient treatment services.

"When You Thought That There Is No One and Nothing": The Value of Psychodrama in Working With Abused Women

This paper discusses how psychodrama methods and techniques can empower abused women and stimulate changes in their victim role. Through an in-depth exploration, we sought to gain an insider's perspective of the experiences of change and perceived outcomes for abused women, which could contribute to optimizing gender violence intervention. Theoretically, the study is grounded in the female co-responsibility and trans-generational transmission of women's victim role from mother to daughter. A mixed methods experimental design employing an explanatory sequential approach to data collection was implemented. A total sample of 33 abused women (15 in the experimental group, and 18 in the control group) was involved in studying the impact of a psychodrama intervention combined with an ecological intervention. Spontaneity and wellbeing, considered in this study as dimensions of empowerment, were measured. Phenomenological interviews were conducted with 7 women 3 months after the psychodrama intervention ended, and with 6 women 5 years later. Data was analyzed using the Interpretative Phenomenological Analysis method. The matrix of themes that emerged reflects four overarching themes: the victim, the group experience, the process of change, and the corollary of change. Benefits perceived by the women include trust, hope, increased self-esteem, empowering, and courage to make decisions and changes. Findings describe three paths of change for women who participated in an empowering-oriented psychodrama intervention program: the Proactive - Resilient type, the Active - Resistant type, and the Repetitive - Non-Resilient type. Role-reconstruction and the interruption of trans-generational victim pattern were clear for the proactive type and possible for the active type, while the repetitive type showed minor changes but remained stuck in the victim pattern. As no claims to generalizability can be made, further research is needed to verify the proposed typology on larger samples. Psychodrama, as an action method, can empower abused women and has the potential to stimulate action in women's lives and initiate adaptive coping strategies leading to resilience. The study ends with several suggestions for assisted resilience specialists.

Trust the Process: A New Scientific Outlook on Psychodramatic Spontaneity Training

Human mind is hypothesis-driven and our observations of the world are strongly shaped by preconceptions. This "top-down" principle is biologically driven and contraindicative to spontaneity, which is non-linear, condensed, and initially incomprehensible. My first argument is that spontaneity entails "bottom up" information processing, as articulated in the hierarchical neurocognitive model of perception. My second argument is that changing the balance between these two processes is important and feasible. Insights from psychodynamic transference and savant syndrome are presented to support these ideas. Uniting these contemporary notions with some essentials of J. L. Moreno's philosophy is my third goal. By violating predictions and expectations, psychodrama interferes with top-down "conserved" processing and cultivates here and now, stimulus-dependent spontaneous acts. Further evidence is presented in support of the claim that adult spontaneity leads to enhanced cognition and creativity through imitating the child's brain, as Moreno envisioned. Because spontaneity is formed before having the evidence for its truth or adequacy, it entails, in adults, overcoming apprehensions about acting without a theory in mind. This is what trusting-the-process means and it requires training, which psychodrama fosters on its stage laboratory.

Teaching-Learning Processes: Application of Educational Psychodrama in the University Setting

The use of effective teaching strategies should be developed from teachers’ reflections on educational needs. This study has a twofold objective: to identify needs in teaching-learning processes in the university setting as well as to present and examine the effectiveness of four psychodramatic techniques: psychodramatic images, soliloquy, role-playing and roda viva. A qualitative design using thematic analysis was followed. All 128 teachers participating in the Training in Teaching Skills: Educational Psychodrama (nine courses) were evaluated. Teachers (62.5% women) were from different disciplines. Two semi-structured group interviews were conducted using the focus group procedure. Focus groups were held at the beginning and end of each course (18 in total). The phases of thematic analysis were used as discourse analysis strategies. Teachers reported the need to develop active teaching practices with large groups, strategies to motivate students and skills for conflict resolution with students. Concerning psychodramatic techniques, emphasis was placed on the psychodramatic images to promote active learning and group construction of contents, exploring previous ideas and as an evaluation resource. In addition, the structured use of role-playing was positively assessed. These results identify specific teaching needs and support the use of psychodramatic techniques as a valuable educational resource in higher education.

Studying the Efficacy of Psychodrama With the Hermeneutic Single Case Efficacy Design: Results From a Longitudinal Study

Throughout the last decades, scientific and therapeutic communities have made common efforts to collect reliable information concerning the efficacy of psychotherapies. One of these initiatives has, recently, involved the psychodrama community and its desire to achieve progress in the validation of this therapy. Based on Robert Elliott's Hermeneutic Single Case Efficacy Design, we followed five participants (three women, two men, aged 27-48 years) of a psychodrama group over the course of their therapeutic process, which ranged from 24 months to 5 years. For the single case study, we selected the participant who had the longest data collecting record, including one follow-up. Participants generally reported improvement in their personal therapeutic goals, decrease in symptoms and life problems, and some showed a marked increase in spontaneity levels. In the single case, these results are confirmed, and following decision criteria it is possible to assert that the participant improved in all the variables assessed and that therapy is the main cause of these changes. Furthermore, the participant frequently rated psychodrama sessions as being helpful and stated they had a transformational impact on his life. This research contributes toward validating psychodrama as an efficient therapeutic method, hopefully stimulating practitioners to integrate therapy and research-which, for years, were considered independent and incompatible-and to facilitate their use in a complementary way.

The effects of using psychodrama on the psychological wellbeing of university students

PURPOSE

This study aims to investigate the effects of psychodrama group sessions on the psychological wellbeing of university students.

DESIGN AND METHODS

The study included a sample of 30 undergraduate students (divided into one intervention group and one control group). Data were collected using a Personal Information Form and the Psychological Wellbeing Scale.

FINDINGS

There was a statistically significant difference between the pretest and 12-month scores for participants in the psychodrama group within the "Environmental Mastery" dimension (P < .05).

PRACTICE IMPLICATIONS

Psychodrama group therapy can be used to improve psychological wellbeing levels among university students.

Concretization as a Mechanism of Change in Psychodrama: Procedures and Benefits

Concretization is a concept that has different meanings in different psychological theories and varying manifestations in different psychotherapies. In psychodrama, much of the available information on concretization draws on J. L. Moreno's initial conceptualization, descriptive case studies, and interpretations in the various approaches. However, concretization has not been empirically studied as a concept or as a therapeutic mechanism of change. Therefore, the purpose of this qualitative study was to generate an empirically based conceptualization and operationalization of concretization as well as to identify its clinical benefits in psychodrama. To this end, semistructured in-depth interviews were conducted with seven experienced psychodrama therapists. Using a grounded theory approach for the data analysis, the model that emerged consists of three pathways toward concretization: realistic concretization, symbolic concretization, and integrated concretization. The findings suggest a sequential multistep operation that can be linear or nonlinear, depending on the protagonist's need. The findings also underscore four benefits of concretization as a mechanism of change in psychodrama: reducing the ambiguity of the problem, externalizing the protagonist's problem, enhancing the therapist-protagonist therapeutic bond, and bypassing the protagonist's defense mechanisms. The model is discussed in light of the findings and the literature, and future directions are suggested.

Psychodrama's Role in Alleviating Acute Distress: A Case Study of an Open Therapy Group in a Psychiatric Inpatient Ward

Numerous studies point to the acute distress associated with experiencing severe mental illness and psychiatric hospitalization. Another strand of research describes how the unique features of psychodrama group therapy are useful in fostering spontaneity and creativity, and their benefits in treating particularly difficult populations where traditional psychotherapy is limited. This paper provides a framework for understanding the potential of psychodrama group therapy to alleviate the experience of loneliness and distress in psychiatric inpatients. A case study of an open inpatients psychodrama group in a psychiatric hospital in Israel demonstrates the role of therapeutic means such as the doubling technique and group sharing phase in creating and reinforcing empathy, relatedness, and support, which may offer at least partial relief of the distress and loneliness of psychiatric inpatients. The unique contribution of this study is the intimate encounter that it provides to researchers and practitioners with the processes that take place within the setting of inpatients therapy group.

Effects of the ACT OUT! Social Issue Theater Program on Social-Emotional Competence and Bullying in Youth and Adolescents: Protocol for a Cluster Randomized Controlled Trial

Background

Students in the United States spend a meaningful portion of their developmental lives in school. In recent years, researchers and educators have begun to focus explicitly on social and emotional learning (SEL) in the school setting. Initial evidence from meta-analyses suggests that curricula designed to promote SEL likely produce benefits in terms of social-emotional competence (SEC) and numerous related behavioral and affective outcomes. At the same time, there are often barriers to implementing such curricula as intended, and some researchers have questioned the strength of the evaluation data from SEL programs. As part of the effort to improve programming in SEL, this paper describes the protocol for a cluster randomized trial of the ACT OUT! Social Issue Theater program, a brief psychodramatic intervention to build SEC and reduce bullying behavior in students.

Objective

The objective of this trial is to examine if a short dose of interactive psychodrama can affect SEC metrics and bullying experiences in schoolchildren in either the short (2-week) or medium (6-month) term.

Methods

The ACT OUT! trial is a cluster randomized superiority trial with 2 parallel groups. The unit of measurement is the student, and the unit of randomization is the classroom. For each grade (fourth, seventh, and 10th), an even number of classrooms will be selected from each school—half will be assigned to the intervention arm and half will be assigned to the control arm. The intervention will consist of 3 moderated psychodramatic performances by trained actors, and the control condition will be the usual school day. Outcome data will be collected at baseline (preintervention), 2-week postintervention (short term), and 6-month postintervention (medium term). Outcomes will include social-emotional competency; self-reported bullying and experiences of being bullied; receptivity to the program; and school-level data on truancy, absenteeism, and referrals to school displinary action for bullying. A power analysis adjusted for clustering effect, design effect, and potential attrition yielded a need for approximately 1594 students, consisting of an estimated 80 classrooms split evenly into intervention and control arms.

Results

This study was funded in June 2019; approved by the Indiana University Institutional review board on September 17, 2019; began subject recruitment on November 5, 2019; and prospectively registered with ClinicalTrials.gov.

Conclusions

Many states have issued recommendations for the integration of SEL into schools. The proposed study uses a rigorous methodology to determine if the ACT OUT! psychodramatic intervention is a cost-effective means of bolstering SEC and reducing bullying incidence in schools.

Trial Registration

ClinicalTrials.gov NCT04097496; https://clinicaltrials.gov/ct2/show/NCT04097496

International Registered Report Identifier (IRRID)

PRR1-10.2196/17900

Helpful and Hindering Factors in Psychodrama Field Training: A Longitudinal Mixed Methods Study of Student Development

Although the literature indicates that students in mental health professions start to form their professional identity and competence in graduate school, there are few studies on the in-training experience of creative arts therapies students. This mixed methods study examined how five first-year students in a psychodrama master's degree program in Israel experienced their field training, with the aim of identifying the factors likely to promote or hinder the development of their professional identity and sense of professional ability. Longitudinal data were collected weekly throughout the 20-week field training experience. The students reported qualitatively on helpful and hindering factors and were assessed quantitatively on questionnaires measuring professional identity, perceived demands-abilities fit, client involvement, and therapy session evaluations. A thematic analysis of the students' reports indicated that a clear and defined setting and structure, observing the instructor as a role model, actively leading parts of the session, and observing fellow students were all helpful factors. The hindering factors included role confusion, issues related to coping with client resistance and disciplinary problems, as well as school end-of-year activities that disrupted the continuity of therapy. The quantitative results indicated that students' professional identity did not significantly change over the year, whereas a U-shaped curve trajectory characterized the changes in demands-abilities fit and other measures. Students began their field training with an overstated sense of ability that soon declined and later increased. These findings provide indications of which helping and hindering factors should be maximized and minimized, to enhance students' field training.

Psychodrama and the Treatment of Narcissistic and Borderline Patients

Psychiatric clinicians are faced with the challenge of remaining flexible and psychotherapeutically relevant to the broadening scope of patients with severe narcissistic and borderline personality disorders. Diagnostic sophistication among mental health professionals, increased availability of psychotherapy services, and economic pressures combine to cause the public to expect cost-effective, successful, and shorter duration of treatments. These treatment challenges are particularly poignant with the treatment of those narcissistic and borderline patients who have meager capacity for insight and limited verbal skills. This article describes the use of psychodynamically oriented and informed psychodrama for the treatment of narcissistic and borderline patients.

Empowering Through Psychodrama: A Qualitative Study at Domestic Violence Shelters

Psychodrama is a therapeutic method in which the stage is used to enact and reenact life events with the aim of instilling, among other positive changes, hope and empowerment in a wide range of populations suffering from psychological duress. The therapeutic process in psychodrama moves away from the classic treatment of the individual in isolation to treatment of the individual in the context of a group. In domestic violence situations, in which abusive men seek to socially isolate their victims from family and friends, the social support that psychodrama provides can positively influence the psychological health and well-being of the participants. This qualitative study examines the manner in which psychodramatic treatment can empower abused women residing in domestic violence shelters and help them regain control of their lives. An action research study of domestic violence survivors living in a women's shelter in Israel, over a 12-month period, demonstrates the role of psychodrama therapy in promoting the reduction of anxiety, stress, guilt, and self-blame, while reinforcing perceptions of self-worth and confidence. These findings contribute to our understanding of the potential of psychodrama in helping reshape life roles and reframe experiences within a creative process, with the aim of facilitating a transition from powerlessness to powerfulness among vulnerable populations.

[Unseen Suffering - Therapy for Traumatized Refugee Children]

Unseen Suffering - Therapy for Traumatized Refugee Children In March 2015 the psychological counselling service (Psychologische Familien- und Lebensberatung) of Caritas Ulm initiated a psychotherapy project for traumatized minor refugees. Besides individual and group therapy, networking and qualification of qualified personnel and volunteers, in autumn 2015 we started offering our services on-site in a large collective accommodation for asylum seekers in Ulm. This was mainly because - in contrast to unaccompanied, mostly adolescent, minor refugees - our services appeared to reach children only by chance. In our opinion this is mostly due to the fact that children's suffering is often far less noticed. This paper describes our first year's project work, followed by reports on the use of psychodrama groups with refugee children and on the therapeutic work in a collective accommodation for asylum seekers.

My Future: Psychodrama and Meditation to Improve Well-Being Through the Elaboration of Traumatic Loss Among Italian High School Students

This study was designed as an action research aimed to help students to elaborate their feelings of traumatic grief, due to a car accident and a suicide of two of their classmates, in an Italian high school. A death education project was realized in order to prevent the Werther effect. The intervention was based on psychodramatic techniques and meditation with Tibetan bells to encourage reflection on the suffering of traumatic loss, the sense of life, and their future. A total of 89 students from four classes (46 in the experimental group: two classes, 43 in the control groups: two classes) participated in the study, among which 82 (45 in the experimental group, 37 in the control group) completed the pre- and post-test survey. The intervention consisted of eight 2-h meetings, during which the themes of death and loss were dealt with through theoretical discussions, dramatization, and meditation. Two other classes which participated in the assessment as a control group did not attend the activities. The following instruments were used: Death Attitude Profile-Revised, which measures individual attitudes toward death; Psychological Well-being Scale, which measures a person’s psychological well-being; Resilience Scale for Adolescents, which measures the construct of resilience in adolescents; Self-Transcendence Scale, which measures self-transcendence; and Testoni Death Representation Scale, which measures the ontological representations of death. The results demonstrated that in the experimental group, there was a reduction in the fear of death and its avoidance, and that the students normalized the representation of death as something natural, thus improving their well-being. It is consequently possible to say that well-being is not simply the absence of suffering and worries, but rather, is rooted in the possibility of thinking of creative solutions to the trauma.

The Spread and Development of Psychodrama in Mainland China

The history of the popularization and research of psychodrama in the west has spanned more than 80 years since it was founded by J. L. Moreno in the 1930s. However, it was only in the 1990s that psychodrama was systematically introduced in mainland China. The historical process of the spread and development of psychodrama in China is complex; therefore, this study approached it from the perspectives of space and time and theoretical development. Considering four events as the critical time points, the history of psychodrama in China can be divided into four periods from a spatiotemporal perspective: pre-contact period, preparatory period, period of prosperity, and the period of new development. Based on the theoretical classification, three major branches of psychodrama in mainland China are represented by Gong Shu’s Yi Shu psychodrama, Katherine Hudgins’ therapeutic spiral model, and campus psychodrama developed by Chinese psychologists.

Psychodrama with persons with dementia on zoom: Proof of concept

COVID-19 pandemic and subsequent lockdowns created a global public health crisis generating mental health problems including social isolation, stress, and anxiety especially for persons with dementia and their carers. This article reports on the use of digital technology to maintain social connectivity via a virtual group session that focused on the topic of "what is home." Participants in this session included 16 day-care center clients representing an immigrant community identified with mild to moderate cognitive impairment. A trained psychodrama therapist conducted the virtual group meeting based on five key techniques: spectrogram, role reversal, doubling, mirroring, and soliloquy. The NVivo software was used for the qualitative analysis of the transcribed video recording to identify key themes based on grounded theory methodology. Zooming from home, clients engaged in significant social interaction. Findings of the NVivo analysis identified the following themes of "what is home": Emotions and home, Home is family, Home is community, and Reminiscence (with objects and traditions). Findings suggest that digital interactive technologies, like Zoom, enhance social connectivity thus mitigating the negative impact of social isolation for persons with dementia especially during pandemic lockdowns. Our pilot findings based on virtual group meetings from home demonstrate that participants can express significant emotive capacity and enhanced connectivity with one another despite a diagnosis of mild to moderate dementia. While larger studies are needed to confirm these findings, we suggest that this methodology may be used to support persons with dementia not only in times of pandemics but also as an addition to other community and home care services. Changes in reimbursement policies to include these innovative home services may be helpful in building more resilient communities for the more highly vulnerable populations.

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.