Provider Perspectives on Rapid Treatment Initiation Among People Newly Diagnosed With HIV: A New Message of "Urgency"?

BACKGROUND: Early initiation of antiretroviral therapy improves human immunodeficiency virus (HIV) outcomes. However, achieving earlier treatment initiation is challenging for many reasons including provider awareness and clinic barriers; this study sought to understand perceptions of an early initiation program. METHODS: We interviewed 10 providers from 3 HIV clinics in North Carolina (October-November 2020). We asked providers about overall perceptions of early initiation and the pilot program. We developed narrative summaries to understand individual contexts and conducted thematic analysis using NVivo. RESULTS: Providers believed earlier initiation would signal an "extra sense of urgency" about the importance of antiretroviral therapy-a message not currently reflected in standard of care. Safety was a consistent concern. Cited implementation barriers included transportation assistance, medication sustainability, and guidance to address increased staff time and appointment availability. CONCLUSION: Our qualitative findings highlight the need for training on the safety of early initiation and addressing staffing needs to accommodate quicker appointments.

Doctor and clinic staff perspectives on a program to immediately start HIV treatment among patients newly diagnosed with HIVTreating human immunodeficiency virus (HIV) is easier than ever. Starting newly diagnosed persons on HIV medication as soon as possible is a now recommended goal. However, starting patients right away can be challenging. This study interviewed doctors and clinic staff to better understand their perspectives prior to implementing a program that would provide newly diagnosed patients with HIV treatment immediately. Results showed that some doctors are worried patients will not return after receiving their medications. Providers want support for linking patients to the clinic and ensuring they will be able to receive their next dose of medication when they come in. Other providers saw the benefits of reducing HIV stigma if the program can more quickly start patients on treatment. Some providers explained that when you go to the doctor and are sick you receive medications immediately, yet for newly diagnosed patients living with HIV, patients can be told to come back a month later to start treatment. Some providers believe shifting this messaging may also help patients take their medications better. Most providers saw the need for clinics to have more same-day appointment availability to meet the needs of the new program. Overall, providers were excited about the opportunity to improve the HIV care by offering HIV medications to newly diagnosed patients immediately.

The use of creative art therapy to address the mental health of refugee adolescents: a systematic review.

INTRODUCTION: Creative art therapy (CAT) has become increasingly popular as a means of promoting positive mental health among adolescent refugees when accompanied by interdisciplinary interventions that engage families and communities. In this pre-registered systematic review (PROSPERO: CRD42022372538), we evaluated and synthesized the available literature reporting the use of CAT as a diagnostic, treatment and mental health promotion intervention with adolescent refugees, aged 10-24 years. METHODOLOGY: We conducted a systematic search of the grey and black literature published in English and Arabic between 2012 to 2022 on 10 databases. RESULTS: Systematic database searches revealed 397 articles but only 5 met our inclusion criteria. These studies reported some positive outcomes but the evidence supporting the effectiveness of CAT as a diagnostic, treatment and mental health promotion intervention with adolescent refugees, aged 10-24 years is inconclusive. CONCLUSION: The findings of this review point to the need for more methodologically robust studies that describe the intervention, implementation, and therapeutic approaches in greater detail to strengthen the evidence for the use of CAT with adolescent refugees.

Effects of a nurse-led staged integral art-based cognitive intervention for older adults on the Alzheimer's disease spectrum: A randomized controlled trial.

BACKGROUND: Combined art activities can improve the neural network function within various brain regions involved in emotions, cognition, and behavior, thereby preventing or reversing cognitive decline. However, few studies have systematically examined its effects. Furthermore, the impact of nurse-led art-based cognitive intervention on cognitive and psychological health is unclear. OBJECTIVE: To evaluate the effects of a nurse-led staged integral art-based cognitive intervention in older adults on the Alzheimer's disease spectrum. DESIGN: This was a randomized wait-list controlled trial with allocation concealment and blinding of outcome assessors and data analysts. All data were collected between April 2021 and January 2023 and analyzed from January to March 2023. SETTING: One memory clinic and four medical partnership communities. PARTICIPANTS: A total of 144 participants with subjective or objective memory decline (aged ≥60 years). METHODS: Participants were randomized into an intervention group (n = 72) and a wait-list control group (n = 72), in a 1:1 ratio. The intervention group underwent a 16-week, 24-session nurse-led staged integral art-based cognitive intervention program, which was based on neurocognitive function training patterns. The control group underwent the program after the follow-up assessment. General and specific domains of cognitive function and other health-related outcomes were measured at baseline (T0), immediately after the intervention (T1), and at the 6-month follow-up (T2). RESULTS: Of the 144 participants (mean [SD] age, 71.6 [5.8] years; 50 [34.7 %] males and 94 [65.3 %] females), 130 and 115 completed the questionnaires at T1 and T2, respectively. The average attendance rate in the intervention group was 86.0 %. At T1, the intervention group showed greater improvement than the control group did in general cognitive functions (MoCA, between-group mean difference, 1.4 [95 % CIs, 0.4 to 2.5], p = 0.009). Additionally, the intervention group demonstrated statistically significant improvement compared to the control group in language, memory, quality of life, sleep quality and physical activity level at T1. Statistically significant group differences remained in sleep quality (PSQI, between-group mean difference, -1.3 [95 % CIs, -2.5 to -0.1], p = 0.035) at the 6-month follow-up. CONCLUSIONS: In this randomized controlled trial of a nurse-led staged integral art-based cognitive intervention program, older adults on the Alzheimer's disease spectrum who participated in the program experienced improved cognition and psychological health. REGISTRATION: This study was registered with ChiCTR.org (ChiCTR2100044959) on April 3, 2021. TWEETABLE ABSTRACT: A nurse-led staged integral art-based intervention for older adults on the Alzheimer's disease spectrum experienced improved cognition and psychological health.

The effect of mindfulness-based art therapy (MBAT) on the body image of women with polycystic ovary syndrome (PCOS): a randomized controlled trial.

BACKGROUND: The prevalence of polycystic ovary syndrome (PCOS) has increased in the last decade, resulting in enduring psychological effects, including negative body image. This study explored the effect of mindfulness-based art therapy (MBAT) on body image in women with PCOS. METHODS: In a randomized, single-blind, controlled trial conducted in Kerman, Iran, women of reproductive age (18-45) who were diagnosed with PCOS and met specific inclusion criteria were randomly allocated to either the MBAT intervention group or a control group placed on a therapy waiting list. The main focus of the study involved evaluating alterations in body image scores as the primary measure. Additionally, the study assessed secondary outcomes, which encompassed various domains of the Multidimensional Body-Self Relations Questionnaire (MBSRQ) before, immediately after, and one month after the intervention. The trial is registered with www.irct.ir (Registration code (25/01/2020): IRCT20170611034452N9). RESULTS: Between August 2020 and January 2021, 66 participants were randomly assigned to the MBAT or waiting list group, and the study was completed by 60 women. At the end of the intervention, body image (adjusted mean difference from baseline (AMD) of 29.22 [95% CI 19.54, 38.90], P < 0.05) and at the one-month follow-up (AMD of 34.77 [95% CI 24.75, 44.80], P < 0.05) were greater in the MBAT group than in the waiting list group. At certain time points, some MBSRQ domains, including body area satisfaction (BASS) (p < 0.05), appearance evaluation (p < 0.05), fitness orientation (p > 0.05), health orientation (p < 0.05), and self-classified weight (p > 0.05), had higher scores than did the control group. However, only BASS had a conclusive effect size (large). Additionally, appearance orientation (p > 0.05), illness orientation (p > 0.05), health evaluation (p < 0.05), fitness evaluation (p > 0.05), and overweight preoccupation (p < 0.05) had lower scores with variable and inconclusive effect sizes. CONCLUSIONS: The MBAT has potential as an effective approach for enhancing body image in women with PCOS. However, some MBSRQ domain results were inconclusive, likely due to the small sample size. Therefore, further research with a larger sample size is recommended.

Efficacy of a Virtual Reality Rehabilitation Protocol Based on Art Therapy in Patients with Stroke: A Single-Blind Randomized Controlled Trial.

BACKGROUND: Art therapy has a long history of applications in cognitive and motor rehabilitation. More recently, a growing body of scientific literature has highlighted the potential of virtual reality in neurorehabilitation, though it has focused more on the technology itself than on the principles adopted in digital scenarios. METHODS: This study is a single-blind randomized controlled trial conducted on 40 patients with stroke, comparing conventional therapy (physical therapy for the upper and lower limbs, for posture and balance, cognitive therapy, occupational therapy, speech therapy, and specific therapy for swallowing, bowel, and bladder dysfunctions) to a protocol in which the upper limb physical therapy was substituted with art therapy administered by means of virtual reality exploiting the so-called Michelangelo effect. RESULTS: After 12 sessions, patients in the virtual art therapy group showed a significantly greater improvement in independence in activities of daily living, as assessed by the Barthel Index (interaction of time and group: p = 0.001). Significant differences were also found in terms of upper limb muscle strength (Manual Muscle Test, p < 0.01) and reduction in spasticity (Ashworth scale, p = 0.007) in favor of the experimental group. In the virtual art therapy group, the effectiveness of the intervention was significantly correlated with patient participation (Pittsburgh Rehabilitation Participation Scale: R = 0.41), patient satisfaction (R = 0.60), and the perceived utility of the intervention by the therapist (R = 0.43). CONCLUSIONS: These findings support the efficacy of virtual art therapy leveraging the Michelangelo effect. Further studies should also focus on cognitive domains that could benefit from this type of approach.

A Theoretical Model of Emotional Processing in Visual Artmaking and Art Therapy.

Current theoretical models of emotional processing rely mainly on detecting emotional processing through verbal, conscious, and cognitive processes. However, artmaking can potentially reveal embodied and implicit processes that may otherwise remain hidden in verbal expression. This paper attempts to close the scholarly gap by introducing a novel art-based emotional processing model that integrates emotional processing and art therapy literature, incorporating emotional meaning-making, awareness, acceptance, and memory consolidation. The art-based EP model explains the processes through which art creation may benefit emotional processing. It also elucidates the ways in which art therapy can be used to enhance therapeutic outcomes.

Redemption or Manipulation? Revisiting the Art of a Serial Killer-A Dialogue.

This article revisits an ongoing dialogue between the co-authors, examining their divergent perspectives on whether the art of serial killers was used to perpetuate their psychopathic cycles after their murderous sprees were interrupted, or whether the art-particularly a piece done by one serial killer, Glen Rogers-reflects remorse and redemption. The two art therapists draw from their own clinical and professional experiences to argue their respective outlooks. After explaining what art therapy is, re-examining the concept of murderabilia, and underscoring psychopathy, this article provides an in-depth evaluation of two art pieces done by the serial killer through both of their viewpoints. Ultimately, while neither author completely changed their overall conclusions, elements from both sides of the argument were found relevant. Ultimately, this article emphasized the chaotic and messy connections between art and violence, yet through new perspectives explored on the complexities and motivations within the mayhem, mutual understandings emerged.

Conversations in Content and Context: Can We Teach AI to Chat About Drawings?

An innovative chatbot incorporates a drawing tool allowing users to draw pictures that symbolise the nature of their chronic pain. Rather than simply ask 'What did you draw?" what if the chatbot could engage the user to provide insight into symbols and images related to pain and suffering? The system was tested on images that included features of clinical interest in a first step toward a chatbot able to 'see' and discuss visual input. Such a chatbot has the potential for retrospective and prospective applications. *Contains childhood sexual abuse references.

Creative puppet therapy reduces hallucinations in patients diagnosed with schizophrenia: Preliminary findings.

Anomalous experiences and hallucinations characterize schizophrenia. This study aimed at determining the efficacy of creative puppet therapy (CPT; creation of a puppet with malleable DAS) to reduce severe anomalous experiences and hallucinations among patients diagnosed with schizophrenia. Double-blinded, controlled trials were performed on a convenience sample of 24 patients from a mental health center. The intervention group of 12 patients (who created puppets) and the pseudo-treatment group of 12 patients (who were involved in outdoor leisure trips) were compared to the control group of 12 control participants (who created puppets). Cardiff Anomalous Perceptions Scale (CAPS) assessed hallucinations; Emotional Expression Inventory (EEXI) assessed the emotional expression of one's own puppet. Puppet facial features were measured. Results showed that CPT effectively reduced (d = -4.00) hallucination frequency in patients. Hallucination reduction occurred across all sensory modalities, but touch and bodily interoception. Exteroceptive vs. interoceptive hallucinations was the most valuable classification in patients. Compared to controls, puppets created by patients expressed more negative emotions and had larger eye diameters, shorter noses, and larger whole face width. Eye diameter was correlated with fear, sadness, anger, and disgust, and whole face width with boredom. Fragmented-self integration of schizophrenia through CPT treatment might exploit aggregative dominance of the patient's own body.

Effect of creative art therapy (CATs) on depressive symptoms and quality of life among Jordanian community-dwelling older people: an experimental study.

BACKGROUND: There are a lack of studies examining the effect of creative art therapy on older people. This study aimed to evaluate the effect of creative art therapy on reducing depressive symptoms and improving the quality of life among Jordanian older people. METHODS: A one-group time-series design (pretest, posttest, and follow-up) was adopted between June 2021 and April 2022 on 102 community-dwelling older people who suffered from depressive symptoms and low quality of life in Amman Governorate. FINDINGS: Significant differences were found among older people in pre-, post-, and follow-up therapy for depressive symptoms and quality of life. Post hoc tests showed a statistically significant reduction in symptoms and an improvement in quality of life from pre to post-intervention, which was sustained at follow-up. CONCLUSION: Results suggested that using creative art therapies as a therapeutic intervention for older persons was effective in minimizing depressive symptoms and improving quality of life.

Are Art-Based Interventions Effective in Improving Psychological Well-Being Among Informal Caregivers of Cancer Patients? A Systematic Review.

Objectives: To systematically synthesize the current evidence on the effects of art-based interventions on improving anxiety, depression, stress, sleep, and well-being of cancer caregivers. Design: A systematic review. Methods: We searched PubMed, EMBASE, Web of Science, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials databases from their inception up to April 2024. Studies exploring the effects of art-based interventions on the psychological symptoms of cancer caregivers were included. We did not restrict the publication to the particular study designs, including randomized controlled trials, quasiexperimental studies, and qualitative studies. Results: Fifteen studies of 607 participants were identified in this systematic review. Overall, the existing studies provided preliminary evidence to suggest that art-based interventions may benefit cancer caregivers in improving anxiety, depression, stress, caregiver burden, and quality of life. However, the relatively low quality of the current evidence limits the efficacy of these findings. Conclusions: According to the existing evidence, the therapeutic benefits of using art-based interventions for improving the psychological well-being of cancer caregivers are uncertain. More high-quality and well-designed studies are still required to confirm the psychological effectiveness of art-based interventions for cancer caregivers in the future.

The effect of Zentangle on cognitive focus, emotional well-being, and stress levels: A neural perspective.

PURPOSE: This study aimed to assess how a Zentangle intervention influences cognitive focus, emotional well-being, stress levels, and neural activity patterns across brain regions and frequency bands. METHOD: A cohort of 30 healthy adults, all without prior Zentangle experience, participated in this study. Electroencephalography (EEG) was used to measure their brain activity, and self-reported data were collected through questionnaires to assess subjects' concentration levels, emotional calm, and stress and anxiety. FINDINGS: Participants reported enhanced cognitive focus and emotional well-being, evidenced by increased self-reported concentration and emotional calmness, and reduced stress and anxiety levels during the intervention. EEG analyses revealed notable changes in neural activity patterns, including decreased delta power and increased theta, alpha, beta, and gamma bands. Functional connectivity analysis also highlighted alterations in the brain's functional connectivity, suggesting potential effects on neural communication and information processing. CONCLUSION: This study provides compelling evidence of Zentangle's impact on EEG data, aligning it with equanimity and tranquility consistent with previous mindfulness research. These findings underscore Zentangle as an effective mindfulness practice, potentially enhancing cognitive focus and emotional well-being, and emerging as a valuable intervention for improving mental health and overall well-being.

Art and mentalizing in early intervention psychosis: rationale and therapist insights on a new psychoeducational course.

In this paper, we explore the rationale for a combined art therapy and mentalization-based treatment (MBT) group course for those experiencing a first episode of psychosis (FEP). We discuss the theoretical background for how art and MBT theory can help us better understand and work with groups of individuals experiencing FEP, particularly focusing on avoidance and insecure attachment styles. We outline the delivery of a ten-week psychoeducational Art MBT course within an Early Intervention in Psychosis (EIP) Service and discuss our experiential insights into this new modality as co-therapists. We conclude by proposing that art therapy and mentalizing practice together offer an accessible, useful and practical group structure for EIP services, which could improve individuals' mentalizing capacity and overall social functioning.

The effect of group art therapy on the stress coping ability of Chinese international students in South Korea: using the person-in-the-rain test.

Introduction: This study aimed to determine the effectiveness of group therapy on the stress coping skills of Chinese students in Korea using a pre-test post-test control group design. Methods: Thirty participants were randomly placed into an experimental group (EG; n = 15) and a control group (CG; n = 15). The EG completed eight 120-min sessions of group art therapy. The Person-in-the-Rain (PITR) drawing test was conducted with both groups before and after the EG completed art therapy. Results: The test revealed that EG members demonstrated lower stress and significantly higher stress resources and coping abilities than the CG members after the intervention. The group art therapy program improved the EG participants' ability to deal with stress. Discussion: This study's findings may offer insights useful for determining how best to provide psychological and emotional support to international students who have left their home countries and are continuing their academic journeys abroad.

Creative Arts Therapies in Rehabilitation.

Appreciation for the utility of creative arts therapy in rehabilitation is on the rise. The limitations of conventional approaches to address posttraumatic stress disorder and co-occurring traumatic brain injury is spurring the development and increased use of creative arts therapies, especially in US military health care systems. However, emerging applications of creative arts therapies in rehabilitation extend well beyond posttraumatic stress disorder/traumatic brain injury and military populations to span the continuum of care, from the intensive care unit, postoperative recovery unit, acute inpatient medical and surgical wards, outpatient clinics, and home health, as well as in traditional long-term care and psychiatric settings. Critical steps to more fully integrating creative arts therapies in rehabilitation include the following: (1) incorporation of education about creative arts therapies into the curricula across rehabilitation disciplines; (2) alteration of national and state policies to promote greater inclusion of creative arts therapies as reimbursable treatments for a wide array of clinical diagnoses and conditions; and (3) significant expansion of creative arts therapies' evidence base. This can be achieved by increasing funding levels to encourage rigorously designed and controlled studies to determine the efficacy, populations, diagnoses and conditions, cofactors, and the mechanisms of action of creative arts therapies. The time has come for a concentrated effort from the community of rehabilitation professional associations, advocacy organizations, and practitioners to promote the advancement and inclusion of creative arts therapies into appropriate clinical settings to optimize outcomes for patients.

The effectiveness of expressive art therapy on infertile women undergoing surgery: study protocol for a randomized controlled trial.

BACKGROUND: Infertility produces infertility-related stress in both members of infertile couples, especially for infertile women. Some studies verified the negative relationship between infertility-related stress and outcomes of infertility treatments. Effective mental health care during fertility treatment is urgently needed, but there has been a lack of efficient support services. To reduce the infertility-related stress of infertile women, expressive art therapeutic schemes will be organized and implemented by certified international expressive art therapists. METHODS: This study is a randomized controlled trial. Participants in the intervention group will receive expressive art therapies after the baseline investigation. Expressive art therapies will be led by the certified international expressive art therapist. The interventions include progressive muscle relaxation training, music meditation and drawing therapy. Participants in the control group will receive routine care. The Hospital Anxiety and Depression Scale (HADS) and Fertility Problem Inventory (FPI) will be used to investigate the anxiety, depression, and infertility-related stress of all participants at admission and at discharge. DISCUSSION: This study will verify the effectiveness and efficiency of expressive art therapies for infertile women. The results will provide new knowledge on mental health care strategies for infertile women. TRIAL REGISTRATION: ChiCTR, ChiCTR2300070618. Registered 14 April 2023.

Creative art therapy for postpartum depression： A systematic review and meta-analysis.

OBJECTIVE: This study aims to ascertain the effectiveness of creative art therapy (CAT) in alleviating symptoms of postpartum depression (PPD). METHODS: A systematic review of all randomized controlled trials of CAT for PPD was conducted. Eight bibliographic databases, namely, PubMed, The Cochrane Library, Embase, Web of Science, CNKI, Wanfang Database, VIP Database, and China Biomedical Literature Database were searched digitally, while Google Scholar database was searched manually for a comprehensive literature search. The search period is from the establishment of the database to May 2024. Literature screening and data extraction were conducted independently by two researchers, and the risk of bias in the included studies was evaluated. Finally, RevMan5.3 software and STATA 15.1 software were used for meta-analysis. RESULTS: Twelve studies, including 1633 patients, were included in this review. The results of our meta-analysis revealed that the intervention group was significantly better than the control group in depression [SMD = -0.882, 95 % CI: -1.256 to -0.508, P ＜ 0.001][WMD = 0.680, 95 % CI: 0.407-0.953, P ＜ 0.001], anxiety [SMD = -0.712, 95 % CI: -1.405 to -0.019, P = 0.044], and personal state [WMD = -5.180, 95 % CI: -5.869 to -4.491, P ＜ 0.001][SMD = 0.388, 95 % CI: 0.132-0.643, P = 0.003], and the difference was statistically significant. Sensitivity analysis revealed that the above results were stable. CONCLUSION: CAT (music and creative games) was found to be effective in relieving depression, anxiety, and personal state in patients with PPD. Though CAT appears to be worthy of clinical application, more high-quality and large-sample studies are required to explore various aspects in the current context.

Art Therapy for Paediatric Pain: A Scoping Review.

Pain is common in paediatric populations and is best treated with a multi-disciplinary approach. Art therapy interventions are gaining popularity in paediatrics; however, there is limited evidence on its impact on pain outcomes in children and adolescents. The objective of this scoping review is to map current research on art therapy's impact as an intervention in paediatric populations experiencing any type of pain (i.e., acute, recurrent, and chronic). Electronic searches were conducted by a medical librarian to identify studies that used art therapy interventions in paediatric populations with pain as an outcome measure. Four reviewers independently screened and selected articles for extraction using Covidence and data were extracted from articles using study objectives. There were five studies that met the inclusion criteria. Four of the five studies reported on pain intensity and all studies reported on emotional functioning. Findings suggest art therapy interventions can be helpful for reducing pain, anxiety, stress, and fear associated with treatment. Further, there is emerging evidence that art therapy can support the management of acute and procedural pain in children. Future research should examine the impacts of integrating art therapy interventions into the multidisciplinary management of paediatric pain.