Effectiveness of trauma-focused art therapy (TFAT) for psychological trauma: study protocol of a multiple-baseline single-case experimental design.

INTRODUCTION: Treatments such as eye movement desensitisation and reprocessing and (narrative) exposure therapies are commonly used in psychological trauma. In everyday practice, art therapy is also often used, although rigorous research on its efficacy is lacking. Patients seem to benefit from the indirect, non-verbal experiential approach of art therapy. This protocol paper describes a study to examine the effectiveness of a 10-week individual trauma-focused art therapy (TFAT) intervention. METHODS AND ANALYSIS: A mixed-methods multiple-baseline single-case experimental design will be conducted with 25-30 participants with psychological trauma. Participants will be randomly assigned to a baseline period lasting 3-5 weeks, followed by the TFAT intervention (10 weeks) and follow-up (3 weeks). Quantitative measures will be completed weekly: the Beck Depression Inventory-II, the Mental Health Continuum Short Form, the Resilience Scale, the Rosenberg Self-Esteem Scale and the Self-expression and Emotion Regulation in Art Therapy Scale. The Post-Traumatic Stress Disorder Checklist-5 will be completed at week 1 and week 10. Qualitative instruments comprise a semistructured interview with each individual patient and therapist, and a short evaluation for the referrer. Artwork will be used to illustrate the narrative findings. Quantitative outcomes will be analysed with linear mixed models using the MultiSCED web application. Qualitative analyses will be performed using thematic analysis with ATLAS.ti. ETHICS AND DISSEMINATION: This study has been approved by the ethics committee of the HAN University of Applied Sciences (ECO 394.0922). All participants will sign an informed consent form and data will be treated confidentially. Findings will be published open access in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05593302.

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

Introduction: Personality disorders can be characterized by emotion regulation problems, difficulties in self-regulation and by dichotomous, black-and-white thinking. Dealing with opposites as a mechanism of change used by art therapists might be beneficial for people diagnosed with a personality disorder. This study examined the overall question if and in what way dealing with opposites in art therapy is a mechanism of change in achieving personal therapeutic goals. Method: A convergent parallel mixed-methods pilot study was performed among patients with a personality disorder (N = 32). Participants received four sessions of art therapy focused on opposites. They completed questionnaires on emotion regulation, positive and negative affect and sense of emotional balance before and after each session. Additionally, they completed a questionnaire on self-expression before and after the four sessions. Furthermore, 10 interviews (eight patients/two therapists) were conducted. Results: Quantitative results comparing baseline versus after the four sessions showed a significant change indicating that there might be a positive change regarding self-expression and emotion regulation (t = -2.45, p = 0.02, ES d = 0.30). A significant change was measured in acceptance of emotional responses (Z = -2.66, p = 0.01) and the state of emotion was rated as more balanced (Z = -2.19, p = 0.03). No further significant changes were found. Qualitative results showed that using opposites in art therapy often helped to gain insight, self-exploration and self-awareness and could facilitate confrontation as well as acceptance although sometimes it was (too) confronting. Discussion: Integration of conflicting emotions, behaviors, and thoughts were promoted by the explicit use of opposites and supporting coherent representation. Practice based recommendations are therefore to make more explicit use of dealing with opposites as a theme in art therapy. Also, we recommend more research on different mechanisms of change to refine the theory of change that provides an underpinning rationale and structure for art therapy. The results of this research should be regarded as exploratory given the small sample size and limited amount of therapy sessions.