Study challenges guidelines on art therapy for people with schizophrenia

Posted By News On February 29, 2012 - 12:01am

Referring people with schizophrenia to group art therapy does not improve their mental health or social functioning, finds a study published on bmj.com today.

The findings challenge national treatment guidelines which recommend that doctors consider referring all people with schizophrenia for arts therapies.

Schizophrenia is a severe mental disorder which affects as many as one in 100 people at some point in their lives. While antipsychotic medication can reduce symptoms, many people continue to experience poor mental health and social functioning.

Art therapy has been used as an additional treatment for people with schizophrenia, and is recommended in national treatment guidelines, but few studies have examined its clinical effects.

So a team of UK researchers set out to examine the impact of group art therapy for people with schizophrenia compared with an active control treatment and standard care alone.

The study involved 417 people aged 18 or over with a diagnosis of schizophrenia. Participants were split into three groups: 12 months of weekly group art therapy plus standard care; 12 months of weekly activity groups plus standard care; or standard care alone.

Art therapy patients were given access to a range of art materials and encouraged to use these to express themselves freely. Activity group patients were encouraged to take part in activities such as playing board games, watching and discussing DVDs, and visiting local cafes. The use of art materials was prohibited.

Outcome measures included global functioning (ability to carry out usual daily activities), mental health symptoms, social functioning and satisfaction with care. Levels of attendance at both art therapy and activity groups were low.

No differences in global functioning and mental health symptoms were found between the three groups, and no differences in social functioning and satisfaction with care were found between art therapy and standard care groups.

The authors conclude: "While we cannot rule out the possibility that group art therapy benefits a minority of people who are highly motivated to use this treatment, we did not find evidence that it leads to improved patient outcomes when offered to most people with schizophrenia."

However, they add that studies of other creative therapies for people with schizophrenia, such as music therapy and body movement therapy, are more promising, and that it may be only when such activities are combined with other interventions that benefits are seen.

In an accompanying editorial, Tim Kendall, Director at the National Collaborating Centre for Mental Health, suggests that art therapy is unlikely to be of clinical benefit for people suffering from schizophrenia, but it still has great potential for success in the treatment of negative symptoms.

Why would an art therapist ask a psychotic patient to "express himself freely"? I am disheartened that this study did not include a more realistic use of art therapy, which involves structured, ego-supportive tasks and sealing over. This outcome does not reflect the true benefits of art psychotherapy facilitated by a certified art psychotherapist.

I am a certified art therapist working at an inpatient and outpatient psychiatric hospital.I have worked in such hospitals for over 15 years in California and Arizona.I see the limitations of this study as being crucial to consider, specifically providing once a week art therapy sessions. I work with patients with schizophrenia and see them 3-5 times a week. Patients not only enjoy group art therapy they excel in it. Working with a variety of materials keeps them focused, encourages their creativity and appears to increase self-esteem. Some are proud to show their work, discuss it and see it displayed. Patients who are able, show their auditory or visual hallucinations, express feelings which are difficult for them to do verbally. It provides for safe release of strong emotions such as rage and has prevented them from hurting themselves, others or property. Many times their art work showed they may not be ready to be released due to their images or may need closer supervision. When patients brought their artwork to treatment teams their physician would at times change or adjust their medication from seeing and discussing their artwork with them. It would be a great dis-service to patients if this study influenced a cut-back in art therapy services for a population which benefits so much from it. I am especially concerned about the comment “our findings suggest it does not lead to improved patient outcomes when offered to most people with this disorder.” In my experience and I know many who work in this field would agree, patients with schizophrenia need more art therapy.

I'd like to clarify that it is this research study's "conclusion" and "findings" (which are also printed in their press release and above summary) that I am concerned about. These state: "While we cannot rule out the possibility that group art therapy benefits a minority of people who are highly motivated to use this treatment, we did not find evidence that it leads to improved patient outcomes when offered to most people with schizophrenia." This is too much of a generalization as this study only investigates art therapy delivered once a week and does not investigate "most people with schizophrenia".
According to the researchers their aim was to test the effects of group art therapy as it is currently delivered in the NHS in Britain. In fact, they also state in the study's conclusion, ”levels of attendance at art therapy may be higher when people are receiving inpatient treatment and the impact of art therapy delivered in this setting should be studied".
To me, the authors' conclusion in the abstract of the study is preferable to the conclusion in the study itself which is passed on in the press release, as it states:" Referring people with established schizophrenia to group art therapy as delivered in this trial did not improve global functioning, mental health, or other health related outcomes." This conclusion being more specific to their study and which doesn't make a global generalization is more appropriate as it is less likely to lead the reader to think art therapy is not helpful to most patients with schizophrenia in most settings.
I am of the belief it would be most helpful for the generalized conclusion on the study and press release summary to be replaced with the abstract's conclusion. I don't believe the researchers would want to have a negative impact on art therapy services which in many settings greatly benefit patients with schizophrenia and making the change I am suggesting could keep this potentially negative consequence of the study from taking place.

This study is biased in its research by assuming that all art therapy done with people who have schizophrenia is done in the same manner as the study's research. This is severely limiting to the use of art therapy. In my 17 years of work with people with schizophrenia, I rarely give them a range of art materials and have them "express themselves freely." Rather, I use directed art activities to increase the therapeutic value in the art process. Some of the participants with schizophrenia that I have worked with benefit greatly from the art process as a healing entity. One person with schizophrenia that has worked with me for over fourteen years has won numerous art awards, sold many works, and placed in Very Special Arts, increasing his self esteem and ego. He is one who actually can express himself freely using art to verify his life. Where would he fit in regards to this study?

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