The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial.

OBJECTIVES: Art therapy (AT) as a treatment option for anxiety is regularly employed in clinical practice, but scientific evidence for its effectiveness is lacking, since this intervention has hardly been studied. The aim was to study the effectiveness of AT on anxiety in adult women. The specific type of AT studied was anthroposophic AT. METHODS: A RCT comparing AT versus a waiting list (WL) condition on anxiety symptom severity, quality of life, and emotion regulation. Factors influencing treatment outcome were additionally explored. Participants were women, aged 18-65 years, diagnosed with generalized anxiety disorder, social anxiety disorder or panic disorder, with moderate to severe anxiety symptoms. The trial was registered in the Dutch Trial Registration (NTR28143). RESULTS: Fifty-nine women were included, of which 47 completed the trial. Both per-protocol and intention-to treat analyses demonstrated effectiveness of AT compared to WL, showing a reduction in anxiety, an increase in subjective quality of life (both with large effects) and an improvement in accessibility of emotion regulation strategies (medium effect). Treatment effects remained after 3 months follow-up. Improved acceptance of emotions and improved goal-oriented action are aspects of emotion regulation that are associated with the decrease in anxiety level. CONCLUSION: AT is effective in reducing anxiety symptoms, improving quality of life and aspects of emotion regulation. Future RCTs should use active controls (treatment as usual) and study cost-effectiveness.

The Development of an Anthroposophic, Whole Medical System, Healthcare Program for Patients with Depressive Disorders.

OBJECTIVES: The aim of the study was to develop a whole medical system healthcare program as an alternative for group-oriented guidelines and as a basis for future studies on safety and (cost) effects. Mild to moderately severe depressive disorders were chosen as an illustrative example. DESIGN: Literature surveys, monodisciplinary expert interviews, and multidisciplinary panel discussions were employed to describe the whole medical system, its important elements, and the way the important elements are integrated in daily practice. RESULTS: The treatment of depressive disorders consists of four separate treatment phases in which 10 specific treatment goals are identified. Different disciplines may contribute to each goal. This gives an opportunity for the individualization of care. Within each discipline multiple options per goal are identified which leads to additional possibilities to individualize care. CONCLUSIONS: Individualized healthcare for patients with mild to moderately severe depressive disorders can be described in terms of treatment goals and treatment options to allow for personalization. The program may serve as the basis for future measurement of quality, cost effectiveness, and safety of provided care.

Isolation and characterisation of a class of carbohydrate oxidases from higher plants, with a role in active defence.

In a search for novel plant-derived antimicrobial proteins, we screened extracts from salicylic acid (SA)-treated lettuce and sunflower leaves. These extracts displayed very potent antimicrobial activity against a set of phytopathogens. Characterisation of these extracts revealed that in both extracts, proteins of approximately 60 kDa were responsible for the antimicrobial activity. Further characterisation of these proteins and cloning of the respective cDNAs revealed close homology to a range of (plant) oxidases. Dissection of the enzymatic activity of both proteins revealed them to be carbohydrate oxidases (Helianthus annuus carbohydrate oxidase (Ha-CHOX) and Lactuca sativa carbohydrate oxidase (Ls-CHOX)) with broad substrate specificity and with hydrogen peroxide (H(2)O(2)) as one of the reaction products. The sunflower transcript, in addition to being SA inducible, was also inducible by fungal pathogens but not by ethylene and jasmonate. To determine whether Ha-CHOX plays a role in pathogen defence, it was transformed into tobacco and the effect of resistance to Pectobacterium carotovorum ssp. carotovorum was examined. Transgenic plants overexpressing Ha-CHOX displayed enhanced resistance to infection by this pathogen, and the resistance level was proportional to enzyme expression.