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Art therapy improves coping resources: a randomized, controlled study among women with breast cancer.
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Radiation Sciences. (Onkologi)
Umeå University, Faculty of Social Sciences, Centre for Women's Studies.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. (Psykoterapi)
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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.

Place, publisher, year, edition, pages
2006. Vol. 4, no 1, 57-64 p.
Keyword [en]
Art therapy, breast cancer, coping, gender, support
Identifiers
URN: urn:nbn:se:umu:diva-20858DOI: 10.1017/S147895150606007XPubMedID: 16889324OAI: oai:DiVA.org:umu-20858DiVA: diva2:209768
Available from: 2009-03-27 Created: 2009-03-27 Last updated: 2017-12-13
In thesis
1. Bildterapi vid bröstcancer: Kvinnors berättelser i ord och bild
Open this publication in new window or tab >>Bildterapi vid bröstcancer: Kvinnors berättelser i ord och bild
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
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:nbn:se:umu:diva-1429 (URN)978-91-7264-382-6 (ISBN)
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
2. What do you see?: studies on time-limited psychodynamic art psychotherapy
Open this publication in new window or tab >>What do you see?: studies on time-limited psychodynamic art psychotherapy
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main purpose of this thesis is to explore experiences of two different psychological interventions based on art psychotherapy in women with a psychological or physical illness. The two interventions are art psychotherapy and art therapy. The difference between these two interventions is that the art therapist works with the transference in art psychotherapy but not in art therapy. The thesis consists of two studies of art psychotherapy: An art psychotherapy intervention is evaluated in Study 1 (papers III and V) which examines a group of patients diagnosed with depression and Study 2 (paper II) which examines experiences in a group of six patients diagnosed with vulva vestibulitis. An art therapy intervention is evaluated in the third study (papers I and IV); where experiences in patients diagnosed with breast cancer are examined.

In Study 1, forty-three (n=43) depressed women were randomly assigned to either an intervention group or a control group (verbal psychotherapy). The aim was to examine the outcome of time limited psychodynamic art therapy compared to time-limited psychodynamic verbal therapy for patients with depressive symptoms. Interviews were performed before, immediately after, and three months after the termination of psychotherapy, and self-rating scales which focus on stress reactions, depression and symptoms as well as an observer rating scale on depression were used. The interviews and the art sessions were video-recorded, and the verbal psychotherapy was tape-recorded. The results showed that the art and verbal psychotherapies were comparable. The conclusion was that short-term psychodynamic art psychotherapy could be a valuable treatment for depressed women. In an in-depth content analysis, the method of scribbling was further investigated and exemplified with the therapies of two participants. In this study, the patients’ pictures and verbal expressions of progress, along with considerations of how to interpret the pictures were in focus. When leaving therapy the two patients took advantage of the paper, made complete forms, symbolised in words what they have expressed in pictures; in pace with psychotherapy the themes alter towards separation, individuation, and attempt to relate in a new way. The conclusion was that limelimited psychodynamic art therapy suggests giving a safer place for the self as the cohesion is firmer with better boundaries.

Study 2 is a pilot study, which involved six young patients newly diagnosed with vulva vestibulitis. The aim of the study was to investigate pain at vestibulum, mental health, and self-image after fifteen sessions of art psychotherapy. Five of the patients were judged to have less pain three months after termination of therapy. The conclusion was that art psychotherapy with its openness seemed to affect young women in their experiences of vulva vestibulitis in a positive direction.

Study 3 examined the potential benefit of art therapy for women with primary breast cancer. The sample comprised forty-one (n=41) patients who were randomly assigned either to an art therapy group or to a control group. The art therapy was going on during five weeks radiation treatment, one session per week. The aim was to investigate the outcome of art therapy, to quantify and compare the participant coping s, self-image, and the symptoms with the participant in the control group. Interviews were performed before, immediately after, and six month after inclusion. A set of self-rating scales was used: Coping Resources Inventory, the Structural Analysis of Social Behavior, and Symptom Check List – 90. The result showed that the patients in the art therapy group rated their coping s and especially their social s, higher than the control group, and that the average patients in the art therapy group improved in depressive symptoms and symptoms of anxiety, and that the general psychiatric symptoms improved as well. A linear regression analysis showed a tendency that the coping s increased in the art therapy group and decreased in the control group or even stagnated in the social domain. A second report on self-image, symptoms, treatment, and social variables showed that art therapy was related to lower ratings of depression, anxiety, and general symptoms after treatment; chemotherapeutic treatment predicted lower depressive symptoms and general symptoms in contrast to axilliary surgery and hormonal treatment. The results showed that art therapy could be valuable complementary therapy in routine oncology practise. The conclusion is that art therapy can have a positive long-term effect on the crisis following the primary breast cancer and its consequences.

Conclusion: The results show that time-limited psychodynamic art psychotherapy is valuable for depressed women; that it is a valuable complement for women with vulva vestibulitis; and that art therapy is a valuable complement in the care and cure of women with primary breast cancer.

Place, publisher, year, edition, pages
Umeå: Psykiatri, 2008
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1188
Keyword
Art psychotherapy, scribble, depression, anxiety, GSI, breast cancer, vulva vestibulitis, SASB, SCL-90, CRI, content analysis, phenomenology
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-1684 (URN)978-91-7264-570-7 (ISBN)
Public defence
2008-05-22, sal B, Tandläkarhuset, NUS, UMEÅ, 13:00 (English)
Opponent
Available from: 2008-05-29 Created: 2008-05-29 Last updated: 2011-04-08Bibliographically approved

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