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Bildterapi vid bröstcancer: Kvinnors berättelser i ord och bild
Umeå University, Faculty of Medicine, Omvårdnad.
2007 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aims of this thesis are to describe women’s experiences of breast cancer from a gender perspective, describe women’s experiences of an art therapy intervention and the effects of an art therapy intervention on self-rated coping resources and quality of life. The thesis presents results from a study with 42 women with primary breast cancer without distance metastasis who participated in a randomized intervention study with art therapy carried out between 2001 and 2004. All women were recruited as they were referred to the Department of Oncology at Umeå University Hospital in northern Sweden for postoperative radiotherapy. They were randomized to an intervention group (n = 20) with individual art therapy for 1 hour/week during postoperative radiotherapy, or to a control group (n = 22). The women were between 37–69 years old and had a range of educational and socioeconomic backgrounds. All 42 women completed questionnaires in connection with three interview occasions during six months: at baseline (start of radiotherapy), two and six months later. The questionnaires assessed coping resources, quality of life, symptoms, and self-image. In addition, all women were interviewed about their experiences, and were asked to write a weekly diary about their experiences of breast cancer during the six months of participation. All women signed a written consent form in which they were assured voluntariness and that ending their participation would not affect the care or medical treatment in any way. The study protocol was approved by the Umeå University Ethical Committee at the Medical Faculty (archive number 99-386). In this thesis, part of results from the study is reported.

The results presented in the first study show an overall increase in coping resources as measured by the Coping Resources Inventory (CRI) among women with breast cancer after taking part in the art therapy intervention. Significant differences were seen between the study group and the control group in the total score on the second occasion and in the social domain on the second and third occasions.

The second study reports results of the art therapy intervention, with regard to quality of life aspects as measured by the instruments WHOQOL-BREF and EORTC QLQ-BR23, at baseline (start of radiotherapy) and two and six months later. Significant increases in total health, total quality of life, physical health and psychological health were found in the art therapy group compared to the control group. A significant positive difference was also found within the intervention group, concerning future perspectives, body image and systemic therapy side effects.

The third study builds on previous quantitative results, drawing on gender theories and, taking a discursive approach in analyzing the women’s use of interpretative repertoires in diaries and interviews. The results show a connection between participation in art therapy, talking about protecting one’s own boundaries, and scoring higher on the CRI compared to the control group. A connection between the control group, repertoire conflicts, and lower scores on the CRI was also found.

The fourth study presents further knowledge about women’s trajectories, in art therapy, towards helpful management of restraining boundaries. We were inspired by discursive psychology and the analytic concept of subject position. The result shows that art therapy helped women to get access to subject positions that enabled them to protect and strengthen their boundaries and put forward their own needs.

Taken together, the results from all four studies support art therapy as a valuable complement in oncology care and rehabilitation of women with primary breast cancer in similar contexts.

Place, publisher, year, edition, pages
Umeå: Omvårdnad , 2007. , 67 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1111
Keyword [en]
Art therapy, breast cancer, caring, coping resources, Coping Resources Inventory, diary, discursive psychology, EORTC QLQ BR23, gender, interviews, quality of life
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-1429ISBN: 978-91-7264-382-6 (print)OAI: oai:DiVA.org:umu-1429DiVA: diva2:141024
Public defence
2007-11-30, Aulan, Vårdvetarhuset, Umeå universitet, 90187 Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2007-11-13 Created: 2007-11-13 Last updated: 2009-04-08Bibliographically approved
List of papers
1. Art therapy improves coping resources: a randomized, controlled study among women with breast cancer.
Open this publication in new window or tab >>Art therapy improves coping resources: a randomized, controlled study among women with breast cancer.
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2006 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 4, no 1, 57-64 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Women with breast cancer suffer from considerable stress related to the diagnosis, surgery, and medical treatment. It is important to develop strategies to strengthen coping resources among these women. Research in art therapy has shown outcomes such as an increase in self-esteem and cohesion, significant improvement in global health, and a decrease in anxiety and depression. The aim of the present article was to describe the effects of an art therapy intervention program on coping resources in women with primary breast cancer. METHOD: In this article, we report some of the results from a study including 41 women, aged 37-69 years old, with nonmetastatic primary breast cancer, referred to the Department of Oncology at Umeå University Hospital in Sweden for postoperative radiotherapy. The women represented various socioeconomic backgrounds. They were randomized to a study group (n = 20) with individual art therapy for 1 h/week during postoperative radiotherapy or to a control group (n = 21). The article focuses on changes in coping resources, as measured by the Coping Resources Inventory (CRI) before and 2 and 6 months after the start of radiotherapy. The study protocol was approved by the Umeå University Ethical Committee at the Medical Faculty (archive number 99-386). RESULTS: There was an overall increase in coping resources among women with breast cancer after taking part in the art therapy intervention. Significant differences were seen between the study and control groups in the social domain on the second and third occasions. Significant differences were also observed in the total score on the second occasion. SIGNIFICANCE OF RESULTS: This study shows that individual art therapy provided by a trained art therapist in a clinical setting can give beneficial support to women with primary breast cancer undergoing radiotherapy, as it can improve their coping resources.

Keyword
Art therapy, breast cancer, coping, gender, support
Identifiers
urn:nbn:se:umu:diva-20858 (URN)10.1017/S147895150606007X (DOI)16889324 (PubMedID)
Available from: 2009-03-27 Created: 2009-03-27 Last updated: 2017-12-13
2. Art therapy improves experienced quality of life among women undergoing treatment for breast cancer: A randomized controlled study
Open this publication in new window or tab >>Art therapy improves experienced quality of life among women undergoing treatment for breast cancer: A randomized controlled study
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2009 (English)In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 18, no 1, 69-77 p.Article in journal (Refereed) Published
Abstract [en]

Women with breast cancer are naturally exposed to strain related to diagnosis and treatment, and this influences their experienced quality of life (QoL). The present paper reports the effect, with regard to QoL aspects, of an art therapy intervention among 41 women undergoing radiotherapy treatment for breast cancer. The women were randomized to an intervention group with individual art therapy sessions for 1 h/week (n = 20), or to a control group (n = 21). The WHOQOL-BREF and EORTC Quality of Life Questionnaire-BR23, were used for QoL assessment, and administrated on three measurement occasions, before the start of radiotherapy and 2 and 6 months later. The results indicate an overall improvement in QoL aspects among women in the intervention group. A significant increase in total health, total QoL, physical health and psychological health was observed in the art therapy group. A significant positive difference within the art therapy group was also seen, concerning future perspectives, body image and systemic therapy side effects. The present study provides strong support for the use of art therapy to improve QoL for women undergoing radiotherapy treatment for breast cancer.

Place, publisher, year, edition, pages
John Wiley & Sons Inc., 2009
Keyword
Breast cancer, quality of life (QoL), art therapy, gender
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-2758 (URN)10.1111/j.1365-2354.2008.00952.x (DOI)
Note
Article first published online: 16 OCT 2008Available from: 2007-11-13 Created: 2007-11-13 Last updated: 2017-12-14Bibliographically approved
3. Art therapy for women with breast cancer: the therapeutic concequences of boundary strenghtening
Open this publication in new window or tab >>Art therapy for women with breast cancer: the therapeutic concequences of boundary strenghtening
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2007 (English)In: The arts in psychotherapy, ISSN 0197-4556, E-ISSN 1873-5878, Vol. 34, no 3, 277-288 p.Article in journal (Refereed) Published
Abstract [en]

Between 2001 and 2004, 42 women with breast cancer (20 women in the study group and 22 women in the control group) participated in an intervention study involving art therapy. This article elaborates on previous quantitative results, taking a discursive approach and drawing on gender theories in analyzing the women's use of interpretative repertoires in interviews and diaries and their answers on single items of the Coping Resources Inventory (CRI). The aim was to inquire into whether and, if so, how and with what consequences women with breast cancer who participated in art therapy improved their access to beneficial cultural interpretative repertoires, compared to a control group. The results showed a connection between participation in art therapy, talking about protecting one's own boundaries, and scoring higher on the CRI compared to the control group. There was also a connection between the control group, repertoire conflicts, and lower scores on the CRI. Our interpretation is that art therapy became a tool the women could use to distinguish cultural understandings about boundaries and, through image making and reflections, to give higher legitimacy to their own interpretations and experience.

Place, publisher, year, edition, pages
Fayetteville, N.Y.: Ankho international, 2007
Keyword
art therapy, breast cancer, coping, discourse, gender, narrative
Identifiers
urn:nbn:se:umu:diva-2759 (URN)10.1016/j.aip.2007.04.003 (DOI)
Available from: 2007-11-13 Created: 2007-11-13 Last updated: 2017-12-14Bibliographically approved
4. Women with breast cancer and gendered limits and boundaries: Art therapy as a safe space for enacting alternative subject positions
Open this publication in new window or tab >>Women with breast cancer and gendered limits and boundaries: Art therapy as a safe space for enacting alternative subject positions
2009 (English)In: The arts in psychotherapy, ISSN 0197-4556, E-ISSN 1873-5878, Vol. 36, no 1, 29-38 p.Article in journal (Refereed) Published
Abstract [en]

This article takes its starting point from certain results from our randomized study on art therapy with women with breast cancer. Previous results from this study showed significant benefits on coping, quality of life, and symptoms for women who participated in an art therapy intervention. Analyses of interviews and diaries showed that especially women from the intervention group had distanced themselves from traditionally gendered understandings about cultural limits and boundaries. The aim of this study was to gain further knowledge about how women with breast cancer who participated in the art therapy intervention gave meaning to the gendered limits and boundaries in their daily lives, and to trace their trajectories, in therapy, towards helpful management of restraining boundaries. When analyzing the women's verbal reflections on the therapy sessions, we discerned five subject positions, defining them as follows: being someone who reacts to violation attempts; actively connecting body and self; actively locating oneself and moving forward; being in a position to see important connections throughout life; and being able to acknowledge and harbour conflicting emotions. The results of the study suggest that art therapy served as a tool that helped the women to get access to subject positions that enabled them to protect and strengthen their boundaries. This involved challenging dominating discourses and reacting against perceived boundary violations. Art therapy offered a personal, physical, and pictorial “safe space” with opportunities to deal with complex existential experiences and issues, and also make important connections throughout life. Looking back and summarizing important experiences acted as a way to prepare oneself for the future and moving forward.

Place, publisher, year, edition, pages
Elsevier Inc., 2009
Keyword
Art therapy, Breast cancer, Discourse, Gender, Subject positions
Identifiers
urn:nbn:se:umu:diva-2760 (URN)10.1016/j.aip.2008.10.001 (DOI)
Available from: 2007-11-13 Created: 2007-11-13 Last updated: 2017-12-14Bibliographically approved

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