Schizophrenia is a severe mental disorder that affects as many as 1 in 100 people at some point in their lives. In addition to “positive” symptoms such as hallucinations and delusions, many people also experience varying degrees of loss of energy and motivation, impaired attention, and other so called negative symptoms.
Although treatment with antipsychotic drugs reduces the positive symptoms of schizophrenia and decreases the likelihood of relapse, it has little impact on negative symptoms. Psychological and social interventions are widely used in combination with drugs in an effort to further improve the health and social outcomes of people with schizophrenia, and several interventions have been shown to be effective.
The possibility that involvement in creative activities can improve health has often been discussed but rarely examined.5 It has been argued that for people with severe mental disorders such as schizophrenia, art therapy has advantages over other treatments because the use of art materials can help people to understand themselves better while containing powerful feelings that might otherwise overwhelm them.
Few attempts have been made to examine the effectiveness of group art therapy as an adjunctive treatment for people with schizophrenia,7 but the results of a pilot trial suggested that it may help bring about clinically important reductions in negative symptoms of schizophrenia. Findings of this study, together with those of trials of other creative therapies, have resulted in the inclusion of arts therapies in national treatment guidelines, which recommend that clinicians consider referring all people with schizophrenia for arts therapies, particularly for the alleviation of negative symptoms of the disorder.
Those randomized to group art therapy were offered weekly sessions of 90 minutes’ duration for an average of 12 months. Art therapy was carried out in keeping with recommendations of the British Association of Art Therapists11 and aimed to enhance self expression, improve emotional health, and help people develop better interpersonal functioning. Patients were given access to a range of art materials and encouraged to use these to express themselves freely. Art therapists generally adopted a supportive approach, offering empathy and encouragement.
They rarely provided psychotherapeutic interpretations of interpersonal process or images. They did, however, frequently discuss these processes in supervision. Within this framework, therapists employed specific therapeutic interventions considered appropriate to individual needs and circumstances (wingate.edu). This approach is in keeping with recommendations for the pragmatic evaluation of complex interventions in which individual therapists are encouraged to apply treatment principles flexibly to fit with the needs of participants.
Activity groups also took place on a weekly basis and were made available to participants for an average of 12 months. Facilitators of these groups encouraged participants to agree activities collectively; these included playing board games, watching and discussing DVDs, and visiting local cafes. The use of art materials was prohibited. Group facilitators were asked to refrain from exploring the thoughts and feelings of study participants or offering psychotherapeutic interventions.
All art therapy and activity groups were co-facilitated by a member of staff or volunteer who received training in the trial and intervention. During the treatment phase of the trial, art therapists and activity group facilitators received monthly group supervision from a senior practitioner with relevant expertise.
Recordings of each supervision session were reviewed by a senior member of the study team who provided feedback to supervisors about adherence to agreed guidelines for the delivery of respective interventions. Standard care involved follow-up from secondary care mental health services, care coordination, pharmacotherapy, and the option of referral to other services as clinically indicated, except other creative therapies, which participants agreed not to undertake until completion of follow-up.
In another secondary analysis we examined the impact of the uptake of the interventions on our primary outcomes using two stage least squares estimates. This analysis is based on instrumental variable methods and avoids the selection bias of per protocol or as treated analysis. The approach assumes that the effect of allocation to treatment has no effect on the outcome if the patient does not receive the treatment.
See this page for more. As there are no data to suggest that there is a minimum number of sessions of art therapy that someone needs to attend to derive benefit from this intervention, we used this approach to estimate the benefit per session, assuming it is proportional to the number of sessions attended, when adjusted for site, sex, and age. All P values were two sided and considered significant when less than 0.05.