This quarter POI focuses on the use of art therapy in the treatment of trauma and dissociation, with a selection of recent publications. Articles include pilot studies, group programs, a case study and even case studies of online programs, illustrating the range of work and publications in this growing area of work. Note that the first two articles on the list are available free to members. I hope you enjoy reading this. If you have any ideas for themes for POI make sure you let me know at katemcmaughpsychology@gmail.com. Also note that we are looking for an editor for this feature – see the details at the end of the article.
Tripp, T., Potash, J.S. & Brancheau, D. (2019). Safe Place collage protocol: Art making for managing traumatic stress, Journal of Trauma & Dissociation, 20:5, 511-525, DOI: 10.1080/15299732.2019.1597813
Abstract: The Safe Place collage protocol is an intervention developed by an art therapist that offers clients a structured method for acknowledging and managing both comfortable and disturbing emotional experiences simultaneously. The objective of this pilot study was to determine: 1) the effectiveness of this protocol in reducing anxiety for clients who experienced trauma and 2) their experience of the protocol. This study utilized a practice-oriented research design methodology that incorporated both quantitative and qualitative evaluations. The State-Trait Anxiety Inventory (STAI) measured the degree to which the Safe Place affected anxiety. For the 22 participants in an art therapy clinic who completed the intervention, the results indicated a statistically significant decrease in anxiety. Qualitative analysis identified three art making strategies: negating, tolerating, and integrating. Analyzing the STAI scores of these three groups indicated that participants who utilized an integrating strategy had the greatest reduction in anxiety. The Safe Place collage protocol may be a useful intervention for helping clinicians assess readiness for trauma therapy, as well as aiding clients in addressing traumatic material and managing distressing experiences.
Schoute, K.A., van Hooren, S. Knipscheer, J.W. Kleber, R.J. & Hutschemaekers, G.J.M (2019) Trauma-Focused Art Therapy in the Treatment of Posttraumatic Stress Disorder: A Pilot Study, Journal of Trauma & Dissociation, 20:1, 114-130, DOI: 10.1080/15299732.2018.1502712
Abstract: Research showed that more than 30% of patients with Posttraumatic Stress Disorder (PTSD) do not benefit from evidence-based treatments: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or Eye Movement Desensitization and Reprocessing (EMDR). These are patients with prolonged and multiple traumatization, with poor verbal memory, and patients with emotional over-modulation. Retelling traumatic experiences in detail is poorly tolerated by these patients and might be a reason for not starting or not completing the recommended treatments. Due to lack of evidence, no alternative treatments are recommended yet. Art therapy may offer an alternative and suitable treatment, because the nonverbal and experiential character of art therapy appears to be an appropriate approach to the often wordless and visual nature of traumatic memories. The objective of this pilot study was to test the acceptability, feasibility, and applicability of trauma-focused art therapy for adults with PTSD due to multiple and prolonged traumatization (patients with early childhood traumatization and refugees from different cultures). Another objective was to identify the preliminary effectiveness of art therapy. Results showed willingness to participate and adherence to treatment of patients. Therapists considered trauma-focused art therapy feasible and applicable and patients reported beneficial effects, such as more relaxation, externalization of memories and emotions into artwork, less intrusive thoughts of traumatic experiences and more confidence in the future. The preliminary findings on PTSD symptom severity showed a decrease of symptoms in some participants, and an increase of symptoms in other participants. Further research into the effectiveness of art therapy and PTSD is needed.
Joseph, M. & Bance, L.O. (2019). A pilot study of compassion-focused visual art therapy for sexually abused children and the potential role of self-compassion in reducing trauma-related shame. Indian Journal of Health & Wellbeing, 10 (10-12), 368-372.
Abstract: In contemporary India, the increase in child sexual abuse is an endemic. The high prevalence of CSA and adverse consequences of sexual abuses in children warrants an increased investment in the development of preventive and therapeutic strategies. The purpose of this study was to develop an intervention program for sexually abused female children on enhancing self-compassion and reducing trauma-related shame and to pilot test its feasibility and usability in the clinical practice. Development of the program involved the integration of qualitative and quantitative research designs. Self-Compassion Scale (SCS) and Trauma-Related Shame Inventory (TRSI) were used to measure the level of self-compassion and trauma-related shame among the participants. Interviews and Focused-Group Discussions were carried out to get a better understanding of the severity of these problems. Basing on these, a thirteen modular intervention was developed integrating the Self-compassion theory, Shame Resilience Theory, Compassion-focused Therapy and Art Therapy. The program was subjected for validation of interdisciplinary experts and pilot tested to ten sexually abused female children. The intervention was positively received by the participants and the results of the pilot test showed improvement in the level of self-compassion and reduction in trauma-related shame among the children.
Sagan, O (2019). Art-Making and its Interface With Dissociative Identity Disorder: No Words That Didn’t fit, Journal of Creativity in Mental Health, 14:1, 23-36, DOI:10.1080/15401383.2018.1499062
Abstract: Studies point to promising developments in expressive arts therapy work with clients who experience dissociation as one of a constellation of symptoms of trauma. Individuals diagnosed with Dissociative Identity Disorder, however, may be hesitant to engage with long-term therapy and its relationship. This article presents the case of one such individual, a participant in a narrative phenomenological study who was able to develop her own visual art-making practice. Reflections on this practice revealed that it offered a safe place for her to explore the voice of her “parts” hitherto silenced. Her narrative has implications for professionals working in the expressive and talking therapies.
Spooner, H., Lee, J.B., Langston, D.G., Sonke, J., Myers, K.J. & Levy, C.E. (2019). Using distance technology to deliver the creative arts therapies to veterans: Case studies in art, dance/movement and music therapy. The Arts in Psychotherapy, 62, 12-18.
Abstract: Three case studies of veterans are presented who received either art therapy, dance/movement therapy or music therapy via in-home, synchronous clinical video telehealth through a VA medical center in the southeastern United States. As the use of distance technology becomes more widely implemented within healthcare, it becomes increasingly important for providers to receive adequate training and develop comfort and confidence in adapting their practices to distance delivery. Case studies are one way for creative arts therapists to conceptualize and demonstrate how their in-person practices can be adapted for distance delivery via telehealth.
Lobban, J. & Murphy, D. (2019). Understanding the role art therapy can take in treating veterans with chronic post-traumatic stress disorder. The Arts in Psychotherapy, 62, pp 37-44 https://doi.org/10.1016/j.aip.2018.11.011https://doi.org/10.1016/j.aip.2018.11.011.
Abstract: Individuals who are highly avoidant and/or have dissociative post-traumatic stress disorder (PTSD) presentations may be less likely to engage in evidence-based trauma treatments, and consequently are more likely to drop out of therapy. These individuals may benefit from approaches that provide alternatives to verbal or cognitive processes to achieve therapeutic outcomes. In recent years, a number of research studies have been undertaken at the UK veterans’ mental health charity Combat Stress to try to understand the role art therapy can take in treating veterans with chronic PTSD. An overview of the findings is presented, along with suggested treatment and ethical guidelines, and recommendations for innovative ways to conduct research on the value of art therapy for veterans. Art therapy is shown to offer promise as a treatment for the overcoming of PTSD-related avoidance symptoms and for increasing self-awareness. Furthermore, the work created in sessions captures snapshots of meaning that veterans can use as a form of communication outside of the art therapy space, as active working documents. In this way, art therapy can assist veterans to understand and communicate their inner experiences, and to engage in trauma therapy.
Ram-Vlasov, N., Goldner, L. Lev-Wiesel, R. (2019) Preliminary validation of the peri-traumatic dissociation trauma drawing assessment (PDTDA): The case of military trauma. The Arts in Psychotherapy, 62, 68-76.
Abstract: The Peri-Traumatic Dissociative Traumatic Drawing Assessment (PDTDA) is an art-based assessment technique developed to evaluate peri-traumatic dissociation subsequent to traumatic events, based on the trauma resolution and time perception literature. To validate the PDTDA, associations between six drawing feature scales; namely, the participants’ peri-traumatic dissociation, persistent dissociation, post-traumatic stress symptoms and history of traumatic events were assessed in a sample of 49 Israeli adults who experienced military trauma. Bivariate correlation analyses indicated that peri-traumatic dissociation negatively correlated with the presence of a boundary line between the event and coping, but positively correlated with new distress symbols. A history of traumatic events negatively correlated with new resource symbols, whereas post-traumatic stress symptoms positively correlated with new distress symbols. The clinical implications are discussed in light of these preliminary findings.
Editing Opportunity Available:
We are currently looking for a volunteer assistant editor to coordinate and collate Publications of Interest four times a year. If you enjoy looking up recent publications in our fields this is a great opportunity to help out ISSTD while you learn. This role would suit a student or someone with access to an academic publication database.