Indicated Stress Prevention Addressing Adolescents with High Stress Levels Based on Principles of Acceptance and Commitment Therapy: A Randomized Controlled Trial.

INTRODUCTION: Stress affects many adolescents and is associated with physical and mental health symptoms that can have a negative impact on normative development. However, there are very few evidence-based, specific treatment approaches. The aim of the study was to investigate an eight-session group intervention using components of Acceptance and Commitment Therapy (ACT) enriched with elements of CBT (psychoeducation, problem solving) and art therapy, compared to a waitlist control (WLC) group, regarding its efficacy in reducing stress and associated symptoms. METHODS: We conducted a randomized controlled trial in eight cohorts. Eligible participants were 13-18 years old with elevated stress levels. Via block-randomization (n = 70), participants were allocated to receive ACT (n = 38) or WLC (n = 32) and subsequent ACT. We used a multimodal assessment (self-reports, interviews, ecological momentary assessment, physiological markers) before treatment (T1), after the training of the ACT group (T2) and after subsequent training in the WLC group (T3). Primary outcome was perceived stress at T2 assessed with the Perceived Stress Scale. The trial was preregistered at the German Clinical Trials Register (ID: DRKS00012778). RESULTS: Results showed significantly lower levels of perceived stress in the ACT group at T2, illustrating superiority of ACT compared to WLC with a medium to large effect size (d = 0.77). Furthermore, the training was effective in the reduction of symptoms of school burnout and physical symptoms associated with stress. CONCLUSION: Indicated prevention, especially when based on the principles of ACT and CBT, seems efficient in significantly decreasing stress in adolescents with increased stress.

Visual art therapy and its effects in older people with mild cognitive impairment: A systematic review.

INTRODUCTION: Mild cognitive impairment (MCI) is a known risk factor for the development of dementia. The potential benefits on cognition from non-pharmacological measures such as art-based interventions are of increasing interest. This systematic review examines the evidence for the impact of one form of art-based intervention, visual art therapy (VAT), on the cognition and psychological wellbeing of older people with MCI. METHODS: Randomised controlled and quasi-experimental trials evaluating the efficacy of VAT in older persons aged over 60 years with MCI were included. A search was performed on electronic databases: MEDLINE, CINAHL, Embase and PsycINFO. Joanna Briggs Institute critical appraisal and extraction tools were utilised for risk of bias assessment and data extraction, respectively. A narrative descriptive approach was used to outline the findings. RESULTS: Seven studies were identified from 4311 articles screened. Improvement in cognition was reported in five studies, with two of these reporting sustained improvement at 6-9 months, while the remaining three studies showed improvement only at the immediate post-intervention period. A positive impact was reported in four of six studies that examined the effect of VAT on participant psychological wellbeing. The overall methodological quality of the studies ranged from moderate in four of five RCTs, to high in the quasi-experimental studies and one RCT. However, the low study power in the context of small sample sizes limits the applicability of these studies to the population of interest. CONCLUSIONS: VAT is potentially an effective non-pharmacological intervention that may enhance cognition and provide benefits for psychological wellbeing in older persons with MCI. Given the limited studies available, with the majority emerging over the last 5 years, further research is required to confirm these reported benefits, as well as to determine whether VAT impacts on the progression of cognitive decline in MCI.

Effectiveness of creative arts therapy for adult patients with cancer: a systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to assess the effectiveness of creative arts therapy (CAT) interventions on the health outcomes of adult patients with cancer. METHODS: A comprehensive search was conducted in six databases from their inception to June 10, 2023, with no restrictions on sex, age, cancer type, cancer stage, or treatment type. The Cochrane Risk of Bias (RoB2) tool for randomized controlled trials (RCTs) and the equivalent tool for non-RCTs (ROBINS-I) were used to assess the risk of bias. Meta-analyses were conducted to pool estimates of the effects of CAT on patients' health-related outcomes. A narrative synthesis of outcomes was performed where meta-analysis was not appropriate. RESULTS: A total of 25 studies (8 RCTs and 17 quasi-RCTs) involving 1489 cancer patients and survivors were included in the final data analysis. Most studies focused on patients with mixed cancer diagnoses who were undergoing active chemotherapy treatment. Most studies utilized painting, drawing, and/or sculpting as CAT interventions. The overall risk of bias in the included studies was moderate to high. Meta-analysis demonstrated a significant improvement in quality of life (SMD with 95% CI = 17.50, 10.05-24.95, P =.0000) and the social aspect of quality of life in cancer patients (SMD with 95% CI = 03.1 (0.06-0.55), P = .01), but no significant effects were found for depressive symptoms and coping strategies among patients who participated in CAT compared to control groups. Narrative analysis and non-RCTs suggested the potential of CAT in reducing levels of depression and anxiety, as well as improving self-image, hope, emotional expression/state, and processing in patients with cancer. However, inconsistent findings were reported regarding the effectiveness of CAT interventions on fatigue, spirituality, and psychosomatic distress/symptom intensity. CONCLUSION: The findings indicated significant and potential benefits of CAT for individuals with cancer, primarily related to quality of life. However, caution is needed in interpreting these findings due to limitations in the methodologies utilized in the included studies. Further large-scale RCTs are needed to examine the effectiveness of CAT on health outcomes, particularly in relation to self-image, hope, and emotional expression/state and processing among patients with cancer or those in palliative care.

The effects of art-making intervention on mind-body and quality of life in adults with cancer: a systematic review and meta-analysis.

PURPOSE: To investigate the effectiveness of art-making interventions on physical and psychological outcomes, as well as quality of life (QOL), in adult patients with cancer. METHODS: Seven English-language databases (PubMed, Academic Search Premier, EMBASE, CINAHL, PsycINFO, The Cochrane Library, and Web of Science) and three Chinese-language databases (CNKI, WanFang, and VIP) were searched up to and including May 1, 2023. We used the Cochrane Risk of Bias tool 2.0 and the Risk of Bias in Non-Randomized Studies-of Interventions to evaluate the certainty of evidence. The data were analyzed using Review Manager software 5.4. The study protocol was registered with PROSPERO (CRD42022321471). RESULTS: The studies predominantly focused on visual art (n = 21), two specifically used performing art (n = 2), and five integrated both forms of art-making (n = 5). The pooled results showed that art-making significantly improved anxiety (SMD = - 1.12, 95% CI [- 1.43, - 0.81], p < 0.01), depression (SMD = - 0.91, 95% CI [- 1.16, - 0.65], p < 0.01), distress (SMD = - 1.19, 95% CI [- 1.43, - 0.95], p < 0.01), psychological well-being (SMD = 0.41, 95% CI [0.02, 0.80], p = 0.04), societal well-being (SMD = 0.29, 95% CI [0.04, 0.54], p = 0.03), nausea (SMD = - 1.81, 95% CI [- 2.84, - 0.78], p < 0.01), physical well-being (SMD = 0.11, 95% CI [0.02, 0.20], p = 0.02), and QOL (SMD = 0.81, 95% CI [0.29, 1.33], p < 0.01). However, it did not significantly improve fatigue (SMD = - 0.28, 95% CI [- 0.75, 0.19], p = 0.24) and pain (SMD = - 0.18, 95% CI [- 1.97, 1.60], p = 0.84) in patients with cancer. CONCLUSIONS: Art-making interventions may boost psychological well-being, physical symptoms, and QOL among patients with cancer. More robust studies are necessary to overcome methodological limitations and promote wider adoption of these interventions. TRIAL REGISTRATION: Prospero registration number: CRD42022321471.

The effectiveness of therapeutic artmaking on depression, anxiety, quality of life, and psychological distress in cancer patients on chemotherapy: a systematic review of the literature.

OBJECTIVES: The purpose of this study was to evaluate the evidence of art therapy on depression, anxiety, quality of life, and mental distress in cancer patients undergoing chemotherapy. METHODS: A systematic literature search was conducted. A systematic search of online electronic databases including, PubMed/MEDLINE, Scopus Web of Science, PsycINFO, and EMBASE was performed using keywords extracted from Medical Subject Headings such as "Art Therapy," and "Neoplasms," "Cancer," and "Chemotherapy" from the earliest to January 11, 2023. A total of 3890 publications were assessed for relevance by title and abstract. The remaining 1298 articles were examined using three inclusion criteria: interventions were guided by an artist or art therapist, participants were actively involved in the creative process, and anxiety, depression, and/or quality of life were included as outcome measures. The methodological quality of the included studies was appraised using specific checklists. RESULT: A total of 495 patients with cancer undergoing chemotherapy participated in ten studies. Among the participants, 87.21% were female and 63.43% of them were in the intervention group. The mean age of the participants was 53.93 in five studies that reduced depression in cancer patients undergoing chemotherapy. Six studies investigated the effect of different art therapy methods on the anxiety of patients, which in four studies reduced their anxiety. Also, three studies investigated the effect of different art therapy methods on patients' distress, which in two studies reduced their distress. CONCLUSION: Art therapy had positive effects on depression, anxiety, quality of life, and psychological distress of cancer patients undergoing chemotherapy. Meanwhile, research on art therapy in cancer patients on chemotherapy is insufficient. We cannot conclude that art therapy benefits cancer patients on chemotherapy. More rigorous research is needed.

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.

The effect of mandala coloring and free coloring on the happiness in veterans with post-traumatic stress disorder in the Covid-19 pandemic: a randomized clinical trial.

BACKGROUND: Post-traumatic stress disorder (PTSD) can lead to complications such as depression and grief, which are more prevalent in veterans than in the general population. Recently, art-making, including mandala coloring, has gained attention as a potential treatment for PTSD patients. METHODS: This randomized clinical trial was conducted on 84 male veterans diagnosed with PTSD and hospitalized at the Milad Psychiatric Center in Tehran, Iran. The patients were recruited using a convenience sampling method and were assigned to either the mandala coloring group or the free coloring group. The Post-Traumatic Stress Disorder Checklist DSM-5 and the Oxford Happiness Scale were used to collect data. The intervention group colored mandala designs, while the control group colored squares freely. Coloring was done twice a week for three weeks. RESULTS: The mean baseline happiness scores did not differ significantly between mandala coloring group and free coloring group (p = 0.376). However, at the end of study, happiness scores were significantly higher in mandala coloring group than in free coloring group (p < 0.001). After the intervention, happiness score of both groups increased significantly (p < 0.001). CONCLUSION: Both coloring methods increased veterans' happiness scores; however, mandala coloring was more effective than free coloring. It is recommended that art-making be added to conventional treatments for veterans with PTSD. TRIAL REGISTRATION: This study was registered in Iranian Registry of clinical trials (No. IRCT20210604051491N1, 29/08/2021).

Psychological health in Palliative Care: Thematic analysis of a psychiatrist's and an art therapist's clinical reflexive journals.

BACKGROUND: Patients receiving palliative care often face psychological distress, which can be challenging for clinicians to manage. Therefore, reflexive and visual journaling can be used as powerful techniques for clinician selfreflection and personal development. These journals are a form of practice wisdom, providing insights into psychological health in palliative care. AIM: This study aims to describe how patients receiving palliative care experience psychological health, explore the meaning of a palliative care clinician's work and contribute to the understanding of psychological health in palliative care through the reflexive and visual journals of clinicians. DESIGN: Using Gibb's reflective cycle as a framework for journaling, this study employs reflexive and visual journaling through the lenses of a psychiatrist and an art therapist. Journal data were analysed using a thematic analysis approach. SETTING/PARTICIPANTS: The two first authors journaled 107 clinical encounters and created 36 pieces of response art detailing encounters with patients and their families, and clinical conversations in two palliative care centres. RESULTS: Patient attributes and the clinical environment were observed to influence psychological health in palliative care. The patient's ability to navigate dying, maintain personhood, exert resilience and experience satisfying relationships contribute to psychological health. A clinical environment comprising clinicians with holistic competencies, systems promoting interdisciplinary collaborations and a values-based culture that promotes patient centricity strengthens the delivery of psychological care. CONCLUSIONS: Good psychological health in palliative care extends beyond psychopathology and is influenced by the cardinal elements of being human, value systems and systemic elements in the therapeutic environment.

A Role for Visual Art Therapy in the Management of Migraine.

PURPOSE OF REVIEW: Migraine is a disabling disorder that adversely affects the whole person and requires multimodal management. Through a brief historical overview of migraine as a subject for visual art, benefits reported from art therapy used in the management of other types of chronic pain, and a summary of the limited research involving art therapy for migraine, we aim to provide support for art therapy's potential role in the management of migraine. RECENT FINDINGS: As art therapy has been shown to be effective in the management of other chronic pain conditions, providing insight into the individual's pain experience and perception of pain, ameliorating pain by means of distraction, and improving psychosocial health, by extension, it may be of benefit in the migraine population as well. Migraine is disabling, and previous literature has shown efficacy in lifestyle modifications as well as complementary and alternative medicine. Based on its efficacy in other pain conditions, we suggest art therapy as an additional tool for the preventive management of migraine.

The employment of art therapy to develop empathy and foster wellbeing for junior doctors in a palliative medicine rotation - a qualitative exploratory study on acceptability.

BACKGROUND: The interdisciplinary realm of medical humanities explores narratives and experiences that can enhance medical education for physicians through perspective-taking and reflective practice. However, there is a gap in comprehension regarding its appropriateness at the postgraduate level, especially when utilising art therapists as faculty. This study aims to assess the acceptability of an innovative art therapy-focused educational initiative among junior doctors during a palliative care rotation, with the goal of cultivating empathy and promoting well-being. METHODS: A qualitative research project was conducted at the Division of Supportive and Palliative Care (DSPC) in the National Cancer Centre Singapore (NCCS). The study involved the recruitment of junior doctors who had successfully completed a three-month palliative care rotation program, spanning from January 2020 to April 2021. In a single small-group session lasting 1.5 h, with 3 to 4 participants each time, the individuals participated in activities such as collage making, group reflection, and sharing of artistic creations. These sessions were facilitated by an accredited art therapist and a clinical psychologist, focusing on themes related to empathy and wellbeing. To assess the acceptability of the program, two individual interviews were conducted three months apart with each participant. An independent research assistant utilised a semi-structured question guide that considered affective attitude, burden, perceived effectiveness, coherence, and self-efficacy. Thematic analysis of the transcribed data was then employed to scrutinise the participants' experiences. RESULTS: A total of 20 individual interviews were completed with 11 participants. The three themes identified were lack of pre-existing knowledge of the humanities, promotors, and barriers to program acceptability. CONCLUSIONS: The participants have mixed perceptions of the program's acceptability. While all completed the program in its entirety, the acceptability of the program is impeded by wider systemic factors such as service and manpower needs. It is vital to address these structural limitations as failing to do so risks skewing current ambivalence towards outright rejection of future endeavours to integrate humanities programs into medical education.

Analysis of Effect of Music and Art Combined with Kinect Game Therapy in Improving the Cognitive Function and Alleviating Negative Emotions of Alzheimer's Disease Patients in a Residential Aged Care Facilities.

Background: Alzheimer's disease (AD) is a major disease that affects neurological, cognitive, and memory functions in older adults, and care for AD patients needs to be more specialized and targeted. Objective: To analyze the effect of music and art combined with Kinect game therapy as a special care on improving cognitive function and alleviating negative emotions in AD patients in a nursing facility. Methods: One hundred AD patients admitted to a residential aged care facility in Changsha, Hunan Province, China, from December 2020 to December 2022, were selected as the study subjects. They were divided into the observation group (OG; n=50) for special care of music art combined with Kinect game therapy and the control group (CG; n=50) for conventional care. The activities of daily living scale (ADL) and mini-mental state examination (MMSE) were used to assess the neurological and cognitive functional changes in the two groups before and after the nursing intervention. The Pittsburgh sleep quality index (PSQI) and self-rating scale of sleep (SRSS) were used to assess the quality of sleep in both groups, and the GQOL-74 scale was used to evaluate the quality of life before and after the intervention. The negative emotions were tested by the self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Finally, patient satisfaction with the care was investigated. Results: After the nursing intervention, scores of ADL, PSQI, SRSS, SAS and SDS of the OG were lower compared with the CG, while MMSE and GQOL-74 scores were higher (P < .05). The results of the nursing satisfaction survey were also higher in the OG than in the CG (P < .05). Conclusion: The combined music and art therapy with Kinect game therapy in elderly institutions can effectively enhance AD patients' neurological and cognitive functions, improve their sleep and quality of life, and alleviate negative emotions.

The Effect of Education and Art Therapy with Telehealth Method on Diet-Fluid Restriction and Anxiety in Hemodialysis Patients During the Covid-19 Pandemic.

Objectives: This study was conducted to evaluate the effect of telehealth education and art therapy on diet-fluid restriction and anxiety in hemodialysis patients during the COVID-19 pandemic. Methods: This randomized controlled study included 60 hemodialysis patients (30 in the intervention group and 30 in the control group). Data were collected using the Patient Information Form, Dialysis Diet and Fluid Non-Adherence Questionnaire, Beck Anxiety Inventory, and Modified Morisky Scale. Patients were educated about diet and fluid restriction according to their needs. The forms were applied to the patients at the first interview 6th week, and 12th week. Additionally, training on diet and fluid restriction was given at the first meeting, and an educational booklet was distributed to the patients. Thereafter, the patients were video-called one day a week for 12 weeks and the follow-up evaluation form was applied via telephone. The academician, who works at the University's Faculty of Education, Department of Fine Arts, assisted patients in drawing via video conference. Patients' drawing time is 60 minutes in total, two days a week, 30 minutes each time. Results: Following the education and drawing activity, systolic blood pressure, diastolic blood pressure, hemodialysis admission weight, creatinine values, frequency and degree of dietary non-compliance, frequency of non-compliance with fluid restriction, and anxiety levels of patients in the intervention group receiving hemodialysis treatment decreased (P < .05) and their compliance with treatment increased. Conclusion: Telehealth applications and art therapy are effective in improving compliance with diet and fluid restriction and controlling anxiety among hemodialysis patients. Since the use of telehealth methods to meet the educational needs of patients and integrative methods such as art therapy ensures the continuity of care services for patients during epidemic periods, it is recommended to be used in COVID-19 and other possible epidemics in the future.

Impact of Opera on Resilience and Thriving in Serious Mental Illness: Pilot Evaluation of The Center Cannot Hold Part 2 and Resilience Workshop.

There are few studies of impacts of arts on recovery in schizphrenia, on audience mood and social connection. We developed a pilot evaluation of opera performances in a university setting on Elyn Saks' journey from psychosis, teaching law and falling in love, coupled with pre-opera workshop on approaches to resilience. Using surveys, primary outcomes were pre and post affect (PANAS-X positive, negative; visual "affect grid" touchscreen for affective valence and arousal) and social connectedness with secondary outcomes of increasing understanding, reducing stigma and willingness to socialize or serve persons with mental illness. Of 107 live and 117 online attendees, 64 completed pre, 24 post, and 22 both surveys. Respondent characteristics were similar for those with pre and pre and post surveys: average age mid 50's, half female, 10% sexual minority, half White/Caucasian, 13% Hispanic/Latino, 11% Black/African American and 20% Asian; of 22 with pre and post, 9 (41%) were providers. There were significant post-pre increases in positive affect (PANAS-X) and arousal (visual grid) and social connectedness (Cohen's d = 0.82 to 1.24, each p < .001); and willingness to socialize with someone with schizophrenia (d = 0.68, p = .011). In this pilot evaluation of opera in a university auditorium, despite small sample sizes, there were significant post-pre increases in audience positive affect and social connection, which could reflect selection (those with positive response completing surveys) or may suggest that arts events promote well-being and connection, issues for future larger studies.

A visual art intervention program for older people with stroke in residential care settings: A feasibility study.

INTRODUCTION: Stroke poses challenges to the physiological, psychosocial and spiritual well-being of affected individuals. As the impacts of stroke might not be reversible, a shift in focus to providing care is desirable. Visual art interventions using visual and symbolic art can help participants to express their feelings, give them a sense of choice and the feeling that they are retaining a sense of control, promote insights, restructure their sense of cognition and instil hope. There have been few studies on visual art interventions involving older people with stroke and none in residential care homes (RCHs). Theoretical support and rigorous research designs on the subject are lacking. Thus, this study seeks to address this research gap by examining the feasibility of a visual art intervention for older people in RCHs and exploring the impacts on their holistic well-being. METHODS: This was a single-blinded, two-arm, randomised controlled feasibility study grounded on Watson's Caring Theory. The Holistic Well-Being Scale and Caring Factor Survey were used in the study, with three assessment time-points: before the intervention (T1), at the mid-point of the intervention (T2) and immediately after the intervention (T3). RESULTS: Sixty-one older people with stroke were recruited from 14 RCHs and randomised into the intervention and control groups. The recruitment rate was 44.53%, and the retention rate for the intervention group was 93.55%. Implementing the programme was affordable (at approximately US$126/head), the duration was acceptable (721 min) and the feedback from participants and staff of the RCHs was positive. CONCLUSIONS: The visual art intervention programme proved to be clinically feasible. This study adds new insights to the development of visual art interventions and to the caring sciences. The efficacy of the programme on holistic well-being has yet to be confirmed.

Arts and psychomotor therapies in personality disorder treatment: An appropriate therapeutic entrance to personal development: A commentary.

Personality disorders (PD) are based not just on maladaptive ideas about self and others, they also are grounded on embodied patterns of behaviors and reactions to interpersonal stressors. There is growing interest in working with the body and through the body so to address automatisms that lead to suffering and dysfunctional social action. In this issue of the Journal of Clinical Psychology: In-Session the use of art and psychomotor therapies for these patients was explored by seven different clinical perspectives. Patients described presented with different PD and associated symptoms. The arts and psychomotor therapies deployed in personality disorder treatment are: (visual) art therapy, music therapy, drama therapy, dance (movement) therapy, and psychomotor therapy making psychotherapeutic use of the different modalities: art, music, play, role-play, performance, improvisation, dance, body awareness and movement. Interventions provide kinesthetic, sensory, perceptual, and symbolic opportunities to invite alternative modes of meaning-making, accessing own needs and wishes, and communicating them to others. In this commentary we summarize some of the different topics covered by the clinical-based papers, including working mechanisms of arts and psychomotor therapies, the importance of bottom-up emotion regulation processes, how to treat trauma in the presence of a PD, how to integrate art and psychomotor therapies in a fine-grained formulation and how to understand the process of change. Although there is a need for more empirical research, we hope this issue makes a solid case that clinicians can effectively include art and psychomotor therapies when treating the full range of PD.

Making meaning of one's own life story in words and images: A narrative case report of personal recovery from personality disorder through the interventions "An Empowering Story" and art therapy.

Understanding and processing life experiences are essential in the treatment of personality disorders to promote personal recovery and psychological wellbeing. In this qualitative case report, drafted in co-creation between the client, clinical psychologist, and art therapist, individual treatment consisted of two psychotherapeutic interventions, "An Empowering Story" and life-story-focused art therapy, in 12 parallel sessions for 24 weeks. Hilda, 68 years of age, had been diagnosed with an unspecified personality disorder and various traits of borderline personality disorder. She experienced emotional exhaustion following long-term mental health problems rooted in a traumatic early childhood. This affected her ability to manage her emotions and social relations, resulting in the sense that her life had no meaning. Hilda was invited to reconstruct her life experiences, divided into the past, turning point, and present/future, in a written and a painted life story. This allowed for the integration of traumatic as well as positive memories, enhanced self-compassion, and meaning making. She developed self-reflection and integration of internal conflicts leading to a better emotional balance and self-understanding. Art therapy emphasizes bottom-up regulatory processes, while narrative psychology supports top-down regulatory processes. The combined approach effectively integrated bottom-up, experiential, sensory experiences with top-down, cognitive emotion-regulation processes. The results suggest that psychotherapeutic interventions involving a multi-pronged, complementary, and thus more holistic approach can support personal recovery in personality disorders.

Drawing your way out: Imagery rehearsal based art therapy (IR-AT) for post-traumatic nightmares in borderline personality disorder.

Posttraumatic nightmares (PTN) are a frequent symptom after a traumatic event and often play part in the psychopathology of patients with borderline personality disorder (BPD). Imagery rehearsal therapy (IRT) currently offers the best evidence for an effective treatment to reduce PTNs, although high drop-out rates are common. Art therapy in IRT may counteract this, by its indirect, nonverbal, and often playful approach that helps to break through avoidance. This case study focusses on the perception of a patient with BPD in an art therapy based IRT treatment for patients with PTNs. It tells the story of Aurelia, a 40-year-old woman who, within this treatment, processes traumatic contents of her childhood like physical and sexual violence, but also current interactional problems that manifest themselves in her nightmares. Following the IR-AT treatment for PTNs Aurelia noticed a reduction in her nightmares, was less afraid of them and felt calmer towards her trauma. She expressed herself in the art medium and by this developed more self-efficacy. Her process resulted in an integration of the trauma and a perceived decrease in borderline symptoms. Future research can build on this basis to further explore the mechanisms and effects of IR-AT for PTNs.

The effects of online art therapy on ego functions, emotion regulation, and interpersonal relationship styles in neurotic personality organization.

Art therapy, as an effective therapeutic intervention, is used to improve positive self-image and self-awareness, promote insight, and enhance therapeutic communication. This study aimed to evaluate the efficacy of art psychotherapy on ego functions, emotion regulation, and interpersonal relationship styles of individuals with neurotic personality organization. Using a quasi-experimental pretest-posttest design, 60 participants were assigned to intervention and control groups, each further divided into three subgroups (n = 10 per subgroup). The intervention group engaged in online art therapy sessions twice weekly over nine weeks, while the control group received no intervention. Data analysis involved descriptive statistics, paired samples t-tests, and independent t-tests. There was a significant decrease in the intervention group's judgmental subdimensions of the Ego Function Assessment Scale. A significant decrease was found in the intervention group in "awareness" (p < 0.01), "clarity" (p < 0.05), and "impulse" (p < 0.001) subdimensions and total scores of the Difficulties in Emotion Regulation Scale. There was no statistical difference between the intervention and control groups' mean pretests and posttests and comparing those groups with each other concerning IRSQ scores. The online group art therapy led to successful improvements in participants' ego functions and emotion regulations.

On the Effectiveness of Visual Arts Therapy for Traumatic Experiences: A Systematic Review and Meta-Analysis.

Arts therapy is a popular intervention used to work through the effects of traumatic experience. We evaluate previous reviews and report a meta-analysis of the effectiveness of arts therapy following trauma for reducing symptoms of PTSD, enhancing positive outcomes (e.g., quality of life) and decreasing negative outcomes (e.g., depression). Database searches identified 21 (N = 868) randomised controlled trials (RCTs). Outcomes were categorised as PTSD specific, positive non-PTSD specific and negative non-PTSD specific. Several moderators were tested: age, diagnosis type, trauma type, intervention instruction, control type, therapy mode and therapy duration. Overall, random-effects analysis indicated that arts therapy was favoured relative to control for positive non-PTSD-specific outcomes (g = 1.53, p < 0.001), but not for negative non-PTSD-specific (p = 0.069) or PTSD-specific outcomes (g = 0.89, p = 0.052). Regression analyses indicated that arts therapy was effective in reducing PTSD-specific outcomes in children (Z = 2.81, df = 1, p = 0.005), positive non-PTSD-specific outcomes in group-based arts therapy (Z = -2.40, df = 1, p = 0.016, I2 = 57.33) and for reducing negative non-PTSD outcomes following acute traumas (e.g., combat-related trauma or sexual abuse) (Q = 10.70, df = 3, p = 0.013, I2 = 77.09). We highlight the need for additional RCTs and standardised protocols to address heterogeneity. Our review provides an important benchmark for gauging the effectiveness of arts therapy in the treatment of trauma.

The Effect of Art on Premenstrual Syndrome Symptoms: A Randomized Controlled Study.

Art-based interventions can serve as a complementary and alternative method in managing various illnesses. This study aimed to investigate the impact of art-based interventions on symptoms of Premenstrual Syndrome (PMS). This study was conducted between September and December 2022, involving 72 midwifery students with PMS (37 in the experimental group [EG] and 35 in the control group [CG]). Art-based interventions were applied to the EG weekly for 8 weeks, while the students in the CG continued with their usual coping habits. The data were collected using the Personal Information Form and the Premenstrual Syndrome Scale (PMSS). At the end of 8 weeks, both the EG and the CG were reassessed with the PMSS. The students who participated in the study were similar in terms of sociodemographic, obstetric, and medical characteristics ( P > .05). Analysis of the difference between pre- and posttest measurements revealed that the PMSS scores of the EG significantly decreased ( P = .000), whereas the PMSS scores of the CG did not improve ( P = .000). The findings of the study demonstrate that art-based interventions had a therapeutic effect on PMS symptoms.