Effectiveness of art therapy interventions for treating pain and anxiety in adolescents in the emergency department.

OBJECTIVE: To evaluate the effectiveness of art therapy in reducing pain and anxiety in adolescents with painful conditions treated in the ED. METHODS: We conducted a prospective pilot study of patients 12-18 years old presenting with a painful condition to a tertiary-care children's hospital ED. Primary outcome was pain intensity measured using the Verbal Numerical Rating Scale (scored 0-10); a decrease of ≥ 20% was clinically significant. Anxiety was measured using the short-form six-item State-Trait Anxiety Inventory (scored 20-80: 20-40 = zero-low anxiety; 41-60 = moderate anxiety; 61-80 = high anxiety); a change from higher to lower category was clinically significant. Outcomes were measured at baseline, immediately after, and 1 h after art therapy completion. A standardized interview was conducted immediately after art therapy completion. RESULTS: We enrolled a convenience sample of 50 patients. Mean duration of art therapy was 34.7 min. Mean baseline pain was 6.2 and decreased by 23.2% (95% CI 14.9-31.5) and 28.6% (95% CI 9.2-48), immediately after and 1 h after art therapy completion, respectively. Mean baseline anxiety was 48 (moderate) and decreased to 38 (low) and 43 (moderate) at the same time points, respectively. Forty-eight patients (96%) reported feelings of relaxation, decreased pain intensity, and/or empowerment (e.g., "Very relaxing"; "I didn't feel as much pain"; "Really showed my emotions"; "A way to explain to doctors what I'm feeling and what parts hurt"). CONCLUSION: Art therapy may be associated with clinically significant decreases and qualitative improvements in pain and anxiety in adolescents with painful conditions being treated in the ED. This novel treatment may improve the holistic care of adolescents with painful conditions in the ED.

ABSTRAIT: OBJECTIF: Évaluer l'efficacité de l'art-thérapie dans la réduction de la douleur et de l'anxiété chez les adolescents atteints de troubles douloureux traités à l'urgence. MéTHODES: Étude pilote prospective de patients âgés de 12 à 18 ans se présentant avec une affection douloureuse à un service d'urgence pour enfants de soins tertiaires. Le critère de jugement principal était l'intensité de la douleur mesurée à l'aide de l'échelle d'évaluation numérique verbale (cote de 0 à 10); une diminution de 20 % était cliniquement significative. L'anxiété a été mesurée à l'aide du questionnaire abrégé à six éléments State-Trait Anxiety Inventory (score 20-80 : 20-40 = zéro-faible anxiété; 41-60 = anxiété modérée; 61-80 = anxiété élevée); un changement de la catégorie supérieure à la catégorie inférieure était cliniquement significatif. Les résultats ont été mesurés au départ, immédiatement après et une heure après la fin de l'art-thérapie. Une entrevue normalisée a été menée immédiatement après la fin de l'art-thérapie. RéSULTATS: Nous avons recruté un échantillon de commodité de 50 patients. La durée moyenne de l'art-thérapie était de 34,7 minutes. La douleur moyenne au départ était de 6,2 et diminuait de 23,2 % (IC à 95 % 14,9-31,5) et de 28,6 % (IC à 95 % 9,2-48), immédiatement après et 1 heure après la fin de l'art-thérapie, respectivement. L'anxiété moyenne au départ était de 48 (modérée) et a diminué à 38 (faible) et 43 (modérée) au même moment, respectivement. Quarante-huit patients (96 %) ont signalé des sentiments de relaxation, une diminution de l'intensité de la douleur et/ou de l'autonomisation (p. ex., « Très relaxant ¼; « Je n'ai pas ressenti autant de douleur ¼; « Vraiment montré mes émotions ¼; « Une façon d'expliquer aux médecins ce que je ressens et ce qui fait mal ¼). CONCLUSIONS: L'art-thérapie peut être associée à des diminutions cliniquement significatives et à des améliorations qualitatives de la douleur et de l'anxiété chez les adolescents atteints de troubles douloureux traités à l'urgence. Ce nouveau traitement peut améliorer les soins holistiques des adolescents souffrant de troubles douloureux aux urgences.

Emotional Freedom Techniques (EFT) Tapping for Pediatric Emergency Department Staff During the COVID-19 Pandemic: Evaluation of a Pilot Intervention.

Objective: Emergency-department (ED) staff may experience psychologic distress due to the stressful nature of their work. The COVID-19 pandemic exacerbated this distress. Emotional Freedom Techniques (EFT) tapping, a somatic psychophysiologic intervention combining vibratory acupressure with elements of cognitive-behavioral and exposure therapies, can reduce psychologic distress. This study tested the short-term effect of 10-minute EFT tapping on the psychologic distress of pediatric ED staff responding to COVID-19. Materials and Methods: During the COVID-19 pandemic, diverse staff in the pediatric ED of a New York City teaching hospital participated in this single-group study. A licensed creative arts therapist led participants in 10-minute EFT tapping sessions. A self-report questionnaire with 7 items based on the Trauma Exposure Response framework was administered immediately pre- and postintervention. Standardized mean differences between both timepoints were calculated. Results: There were statistically significant reductions for 6 of the 7 items studied, including stress (3.32-2.14), obsessive and intrusive thoughts (2.50-1.85), feelings of pressure (3.20-2.17), loneliness (1.84-1.44), and emotional and physical pain (2.28-1.70); all P < 0.001. No significant changes in professional satisfaction were reported following the intervention. Conclusions: Despite the limitations of a single-arm study design, a 10-minute brief EFT tapping session was a promising way to reduce short-term psychologic distress in pediatric ED health care workers. Future studies, including rigorous randomized controlled trials, are needed to evaluate the effectiveness of brief EFT tapping interventions in other settings.

The Development of a Multidisciplinary Support Network to Support Hospitalized Pediatric Patients, Their Families, and Hospital Staff During the COVID-19 Pandemic.

Background: The COVID-19 pandemic led to emotional and behavioral challenges for hospitalized pediatric patients, their families, and staff. Visitor restrictions, closure of patient lounges and playrooms, masking requirements, and enhanced isolation rules resulted in limited access to typical sources of psychosocial support during this traumatic event. Complementary and integrative health therapies such as acupuncture and related therapies are well suited to provide the humanitarian support patients and families need during times of crisis. Objective: The Multidisciplinary Support Network (i.e., Network) was formed to redesign the delivery of acupuncture and other integrative therapies alongside psychosocial support for hospitalized children, their families, and staff. Intervention: Network members represented a broad range of previously siloed disciplines including integrative therapies, art therapy, child life, nursing, pastoral care, adolescent medicine, pediatric hospital medicine, psychology, and child and adolescent psychiatry. The Network aimed to identify gaps in service and create resources to support children and families during this challenging time. Results: The Network compiled existing complementary and integrative services, provided training on integrative therapies to staff, pediatric trainees, and faculty, developed the Comfort Box containing items to provide symptom relief including pain, anxiety and difficulty sleeping, as well as closed-circuit programming, a pediatric companionship program connecting medical student volunteer companions with pediatric patients, and a well-being workbook. Conclusion: Collaborative teamwork across disciplines using integrative therapies was key to humanitarian efforts to support hospitalized children and their families during this crisis.

The Elephant in the Room: The Need for Increased Integrative Therapies in Conventional Medical Settings.

Pediatric integrative therapy programs are essential to the treatment and well-being of patients. Identifying an effective integrative therapy model within conventional pediatric medical settings, however, often proves difficult. Our goal in this article is to explore varied solutions to increase access and inclusion of integrative therapies in an effort to promote best practice and holistic care. The main methods applied in this article are vignettes that illustrate how the integrative therapies in a metropolitan academic hospital successfully treat the patient by complementing conventional medicine. This leads to comprehensive care. The central finding of the article proposes viable solutions to increase interdisciplinary collaboration both internally within the institution and externally. Integrative therapists detail how they were able to increase visibility and yield best practice through increased educational initiatives and interdisciplinary collaboration.