Art Therapy in Acute Psychiatry

Study Overview
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Brief Summary
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Background: Given the complexity of this problem, psychiatric in-patients in the acute stage of their disease need different types of therapeutic programs to recover they mental health state. Usually they're submitted to systematic biological programs (namely psychopharmaceuticals), often considered a priority when compared to psychosocial programs. Among the different therapies that have been introduced in this context art therapy, also named creative therapy, can constitute a treatment that complements the allopathic treatments, providing improvements in self-esteem and self-efficiency, distraction and relief from concerns and negative thoughts. Scientific evidence on the effects of psychosocial programs in the context of hospitalization of acute cases is scarce. Aims: a) evaluate the effectiveness of a 3 session program of art therapy in changing emotional indicators, namely depression, anxiety, stress, and psychological well-being, in individuals with mental illness; b) analyze the meanings a person attributes to his creative self-expression. Method: This is a pre-experimental, prospective study, with a pre test-post test design without control group, with a mixed approach (quantitative and qualitative). The study was performed in the psychiatry unit (Psiquiatria B), in the Centro Hospitalar e Universitário de Coimbra - Portugal. The target population was composed by men (older than 18), hospitalized in this ward. The exclusion criteria were: individuals with active psychotic symptomology, in manic phase and/or refusing to participate. The instruments used to collect information were: Depression, Anxiety and Stress Scale [DASS-21]; Ryff Scales of Psychological Well-Being (SPWB - 18 item version) and a semi-structured interview. Data collection and the development of this study occurred in the following manner: Initial evaluation to verify the sample selection criteria in the first 48 hours after patient hospitalization; Obtain informed consent for the application of instruments and participation in the art therapy intervention program; Application of instruments (DASS-21 and SPWB-18 item version) before intervention; Development of the program applied as a group, during three weeks, one session a week, each lasting approximately 90 minutes and assisted by a specialist in plastic expression. Each session was held in an occupational therapy room, including all the material deemed necessary for the execution of some of the techniques introduced by the technician. After each session, a semi-structured interview was conducted with each participant in order to analyze the meanings attributed. In the end of the program, the same instruments were reapplied.

Official Title
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Art Therapy in Acute Psychiatry: a Psychosocial Intervention

Conditions
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Schizophrenia, Mood Disorders, Mental Disorder, Nurse-Patient Relations

Intervention / Treatment
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* Behavioral: 3 session program of art therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: men (older than 18), hospitalized in a psychiatric unit; capable of communicating and understanding communication; acceptance and commitment to participate in the study; signature of study informed consent. Exclusion Criteria: individuals with active psychotic symptomology, in manic phase and/or refusing to participate.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: 3 session program of art therapy<br>Development of the program applied as a group, during three weeks, one session a week, each lasting approximately 90 minutes and assisted by a specialist in plastic expression. Each session was held in an occupational therapy room, including all the material deemed necessary for the execution of some of the techniques introduced by the technician. After each session, a semi-structured interview was conducted with each participant in order to analyze the meanings attributed. | Behavioral: 3 session program of art therapy<br>* With this program, we expect to offer socio-emotional well-being in the psychiatric context, and creative self-expression through painting. In addition, we hope to provide contributions towards the creation of quality standards of the professional practice of nurses, within the context of implementing psychosocial programs in mental health.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in the participant's emotional states of depression, anxiety and stress | Outcome measure - Depression, Anxiety and Stress Scale [DASS-21] - (Lovibond et al.,1995 adapted by Apóstolo, Mendes & Azeredo, 2006) | Post-intervention assessment (week 3) | 
| Change from Baseline in the participant's psychological well-being | Outcome measure - Ryff Scales of Psychological Well-Being (SPWB - 18 item version) - (Ryff, 1989 adapted by Novo, Neto, Marcelino & Santo, 2006) | Post-intervention assessment (week 3) | 
| Semi-structured interview | Aim: explore in a psychiatric context [in the acute stage of the disease] the sick person's experiences related to expression by painting after each of three scheduled interviews, during hospitalization. | Post-intervention assessment (week 3) |