Javascript required
Skip to content Skip to sidebar Skip to footer
Home / Evidence Based Articles on Arts and Music in Depression in Children

Evidence Based Articles on Arts and Music in Depression in Children

Introduction

The presence of expressive therapy programs in hospitals has become widespread in the 21st century. In a 2009 survey, the Club for the Arts in Healthcare reported that 45 percentage of the i,807 healthcare settings housed some kind of arts program (Americans for the Arts, 2009). Art therapists and music therapists often work jointly in medical settings, providing interventions that are complementary to typical medical interventions. Fine art and music therapists are oft tasked with collaborating in these settings, despite each modality having a singled-out expertise, training level, and method for engaging patients (Bar-Sela, Atid, Danos, Gabay, & Epelbaum, 2007). This study evaluated the effectiveness of fine art therapy and music therapy in reducing pain and/or improving mood in a pediatric medical setting.

Medical art therapy

Studies support the usefulness of art therapy in medical settings, with researchers cartoon connections betwixt art, healing, and public health measures (Stuckey & Noble, 2010). Hospitals are increasingly using art therapy to enhance health, with an "intentional shift from art on the walls to art for healing" (Lane, 2006, p. 71). In one study, clay work reduced negative moods in medical settings (Kimport & Robbins, 2012), and drawings increased children'south awareness of their health conditions and their capacity to problem solve and cope with their illnesses (Rollins, 2005). Madden, Mowry, Gao, Cullen, and Foreman (2010) similarly found that drawing activities enhanced communication, understanding of illness, coping, and the emotional expression of children, and parents reported a reduction in children's pain levels and nausea following art interventions in a transfusion room. Beebe, Gelfand, and Bender (2010) reported similar findings and observed that art therapy decreased anxiety for children suffering from asthma compared to the command grouping. Art therapy also reportedly reduced HIV/AIDS symptoms (Rao, Nainis, Langner, Eisine, & Paice, 2009), and a growing body of outcome studies support fine art therapy'due south effectiveness for cancer patients and their families across gender, historic period, and type/severity of illness (Czamanski-Cohen, 2012; Favaro-Scacco, Smirne, Schiliro, & Di Cataldo, 2001; Geue et al., 2010; Hart, 2010; Svensk et al., 2009; Walsh, Radcliffe, Castillo, Kumar, & Broschard, 2007).

Medical music therapy

Documentation of the use of music in hospitals tin be traced dorsum to the 1800s (Ghetti, 2015), and in the early 1900s, scientists discovered that sound could be used to suppress pain in the grade of sound analgesia. Recently, there has been a resurgence of involvement in the benefits of music in medical settings (Barrera, Rykov, & Doyle, 2002). While music therapy enquiry has traditionally focused on the physiological and behavioral impact of interventions, newer studies focus on the emotional elements of coping (Ghetti, 2015). Comeaux and Steele-Moses (2013) and Matsota et al. (2013), for example, constitute that the utilise of music with psychopharmacological treatment preoperatively and postoperatively improved pain management regimens and promoted well-beingness. Gutgsell et al. (2013) similarly constitute that music therapy interventions significantly lowered pain for palliative care patients. Barrera et al. (2002) institute that music therapy significantly improved children's mood ratings, while parents reported increased play. Colwell, Edwards, Hernandez, and Brees (2013) found that music therapy interventions improved positive coping skills for pediatric cancer patients.

The need for further understanding

Although these surveys and studies suggest that hospitals are increasingly offering art therapy and music therapy programs to support coping with medical procedures, it is non ever clear which services volition provide the most do good to the wide variety of patients and conditions treated in the facility. This paper attempts to measure out the effects of these two modalities, in the hope that improved understanding of their effects will permit art therapists, music therapists, and administrators to provide the most beneficial expressive therapy services to pediatric patients.

Methodology

Study design

This study used a pre/post comparison design to explore the efficacy of ii expressive modalities offered to children hospitalized at a large urban infirmary, the Children'due south Hospital Los Angeles (CHLA). Specifically, this study compared outcomes of art therapy (AT) and music therapy (MT) in terms of how the interventions impacted mood in 503 sessions (397 AT; 106 MT), and/or pain in 411 sessions (279 AT; 132 MT).

The program at CHLA includes not just art therapy and music therapy only too dance/motion therapy and trainees in the various disciplines. Due to the limited number of dance/movement therapy sessions, and omitting interns' reports, the findings in this paper are based on scores collected by iii art therapy and 3 music therapy practitioners. The report was designed and executed every bit an initiative of the directors of The Mark Taper-Johnny Mercer Artists Program at CHLA in consultation with an art therapy professor from Loyola Marymount University, and was exempted by the CHLA ethical review board (# CCI-12–00019).

Sampling and setting

CHLA is a nonprofit, academic, pediatric hospital. It is the only Level one Pediatric Trauma Heart in Southern California, and is recognized as a Magnet Hospital by the American Nurses Credentialing Heart. The hospital offers an extensive variety of services. Participants in the report were representative of the overall population of the hospital, ranging from 4–twenty years of age and covering nearly every department and diagnostic category. The Mark Taper-Johnny Mercer Artists' Plan at CHLA was established in 1991, and is funded past donors. The program became more clinically oriented in 2007, reducing its "artists in residence" and increasing the number of registered and lath-certified art and music therapists on staff. At the time of this report, the program employed music therapists (MT-BC), art therapists (ATR and ATR-BC), dance/movement therapists (BC-DMT), and trainees/interns.

Procedure

All expressive therapists at CHLA were trained to use the Wong-Baker FACES® Hurting Rating Scale for assessing hurting and mood. They were also asked to systematically use the scale at the showtime and conclusion of each session when at all possible. For purposes of this analysis, music therapists, art therapists, and dance/movement therapists nerveless information for this study over a period of two and a half years (2009–2011) and reported their scores weekly. Although the CHLA program employs fine art therapists, music therapists, dance-move therapists, and interns in each of the expressive modalities, there were a comparatively limited number of trip the light fantastic toe/motion therapy sessions reported and a large variability of interns' scores. Therefore, this analysis focused only on the scores collected by the iii art therapists and 3 music therapists for the period of the study, comparison and contrasting these two modalities.

The study design intentionally maintained regular clinical procedures. Rather, information technology explored the touch of current practices of music and art therapists within CHLA, comparing their respective effects on reported pain and mood. Sessions were generally conducted bedside, and more rarely in other areas of the infirmary. Therapists recorded patients' pain and mood before and after each individual fine art therapy or music therapy session. Patients chose whether to engage in the sessions, whether to report their hurting and/or mood, and whether to complete the session once started. However, merely sessions in which both pre and mail service scores were reported were used as information for this written report.

Instruments

The Wong-Baker FACES® Pain Rating Scale is a uncomplicated, valid, and reliable measure that allows a quick pre/post measure with near interventions, enabling patients to conspicuously and quantitatively communicate their well-beingness (Wong, Hockenberry-Eaton, Wilson, Winkelstein, & Schwartz, 2001) (run into Figure 1). This study used the Wong-Baker FACES® Pain Rating Scale to evaluate the pre and mail service session pain and mood of patients in a children'due south hospital.

Figure 1. The Wong-Baker FACES® Hurting Rating Scale.

The FACES scale offers three means to ask patient to scale their mood or pain. The scale offers (a) a nonverbal symbol (facial expression), (b) verbal phrasing (such every bit "no injure"), and (c) a quantitative (numerical) value, making the scale appropriate for almost developmental levels, while providing consequent and measurable information. In addition, nursing procedures at CHLA required patients to report their concrete comfort using this scale multiple times per day.

Although the scale was originally designed to measure pain and is used that mode at CHLA, studies have also utilized it as a measurement of mood (east.g., Madden et al., 2010), as we did in this report. Because of children's familiarity with this calibration in a infirmary setting, its noninvasive nature, and the ease of explaining the range pictorially where reading proficiency was low, the researchers received permission from Connie Baker, the scale's cocreator, to "apply the Wong-Bakery FACES® Pain Rating Calibration for the quantification of both mood and pain, fifty-fifty though the calibration should be used merely for pain assessment commonly" (C. Baker, personal advice, Feb. 13, 2015).

Notably, therapists modified the numerical measure of hurting (0 = no pain, and ten = maximum hurting) as a reverse scale when measuring mood (0 = worst mood and ten = all-time mood). The calibration'due south facial expressions facilitated this endeavour, and neither therapists nor participants reported defoliation.

Results

The principal questions of this study were:

  • Q1: Is there an overall effect from fine art and music therapy sessions in reducing pain?

  • Q2: Is there a divergence between the effect of music therapy and art therapy in reducing pain?

  • Q3: Is there an overall outcome from art and music therapy sessions in improving mood?

  • Q4: Is there a difference between the consequence of music therapy and art therapy in improving mood?

Overall effectiveness in reducing hurting (Q1)

When examining pre and postal service session pain scores of patients in the 411 sessions (279 AT; 132 MT) in which patients chose to study, the researchers constitute a statistically pregnant divergence betwixt pre and post measures, suggesting that pain does seem to decrease with both music therapy and art therapy (Q1). Specifically, a t-exam of hurting scores revealed statistically significant mean differences betwixt pre and post session pain scores (t = 0.64*; p = 0.0001), implying that patients' experienced pain was reduced from a mean of one.23 to 0.90 using the faces [pain] scale (see Table 1). The upshot size statistic calculated as the partial eta squared for the hateful differences suggested a small effect (d = 0.064).

Table 1. Pain measure out descriptive statistics.

Comparing effectiveness in reducing pain (Q2)

Although no significant overall difference was found with regard to reported pain pre and post measures (Q2), differences between the modalities warrant exploration. For example, patients experiencing higher pain levels seemed to be more willing to appoint in MT sessions, simply non in AT sessions. Also, the hateful pre session hurting scores for both of the modalities were lower than two.00, suggesting that patients declined to engage or complete therapy sessions with either modality when experiencing moderate or high levels of pain.

Overall effectiveness in improving mood (Q3)

Examination of the pre and post session mood scores of patients in the 503 sessions (397 AT; 106 MT) in which patients reported mood scores showed a statistically significant difference between the ii, indicating mood improvement beyond any specific expressive modality (Q3). Specifically, a t-test of overall changes in mood scores revealed statistically significant mean differences betwixt pre and post scores (t = one.31*; p = 0.000), suggesting that patients' moods improved, as evidenced by a change from a hateful of ane.32 to 0.74 using the faces [mood] scale (see Table 2). The effect size statistic calculated as the partial eta squared for the mean differences suggested a small result (d = 0.131).

Table 2. Mood measure descriptive statistics.

Comparison effectiveness in improving mood (Q4)

There was also a statistically significant difference between how fine art therapy and music therapy impacted mood. In curt, art therapy seemed to ameliorate reported mood more effectively than did music therapy (Q4). A t-test exploring the differences of mood scores between modalities revealed statistically significant differences between pre and post changes in mood when comparison art therapy to music therapy (t = 0.011*; p = 0.018), thereby suggesting that patients' reported mean mood scores improved more than later on fine art therapy sessions than after music therapy sessions (see Table 2). The event size statistic calculated equally the fractional eta squared for the mean differences suggested a small-scale issue (d = 0.011).

Interestingly, fine art therapy patients reported higher hateful scores of mood (worse mood) at the commencement of sessions relative to the hateful score of mood for those engaged in the music therapy sessions but reported a greater improvement in mood after fine art therapy sessions compared to music therapy. This finding might advise that art therapy improves mood more than than music therapy, and/or that patients do non choose to engage in music therapy sessions when they are in a relatively worse mood. When mood is considered, yet, the mean score for the pre session mensurate remained lower than 2.00 on the mood scale for both modalities, suggesting that patients might cull non to engage in sessions in either expressive modality when feeling poorly.

Case illustration

Joey (pseudonym), a 9-year-former male patient of Vietnamese descent, was being treated at the hospital for acute myeloid leukemia. His parents were very involved in his treatment. In fact, it was rare to enter Joey's room without one or both of his parents being present. Joey was identified during his first hospitalization equally a patient who might benefit from expressive art therapy services. During early sessions, Joey stated that he just wanted to "do something." He engaged with whatever song or instruments were brought by the music therapist and used art therapy sessions primarily to create gifts for his family members, nurses, and doctors, who seemed to bask his perpetually positive attitude (run into Effigy 2).

Figure 2. Begetter's 24-hour interval gift.

Equally his illness and treatments progressed, Joey would occasionally display moments of irritability or anxiety. Some months subsequently, he was recommended for a bone marrow transplant (BMT) treatment. This intensive treatment increases the take chances of infection, requiring BMT patients to alive in isolation bubbling. At the time, CHLA protocol was that whatsoever visitor to the unit had to undergo an extensive decontamination process, wear surgical hair-covering, mask, gloves, gown, and protective booties, and sterilize every object that might pass through the plastic pall walls.

The 24-hour interval before his transplant, Joey expressed marvel about his BMT donor. All he knew was that she was a female person in her 30s and that she did not want her name to be known. His interactive art from that day (Figure three) showed this marvel and what he imagined her to be similar. At the same time, the smiles were very different from other grin faces he had drawn, and more like grimaces, mayhap hinting of anxiety about the upcoming procedure.

Later that calendar week, when the music therapist visited him, Joey requested i of his favorite activities: songwriting. To the melody of "My Favorite Things," a song Joey liked, he wrote the following lyrics (emphasis added):

"My Favorite Things"

Lakers and basketball game and Kobe and Michael Jordan

They are my favorite players

Playing basketball outside with my dad

These are a few of my favorite things.

Rice with fish and craven with soup

Are my favorite things to consume

Eating my favorite food all day

These are few of my favorite things.

When the Lakers lose

When the market'south out of fish

When I have procedures

I simply remember at that place's e'er another gamble

And then I don't feel so depressed and stressed .

During this music therapy session, Joey expressed his need for condolement, home, and activities that fabricated him feel "normal." This theme evolved into an exploration of identity and coping strategies related to hurting direction expressed through lyric analysis and guided imagery in individual and family sessions. As his illness progressed, Joey began to accept "meltdowns," as his parents and nurses described them. The music therapist, who understood that these might be behavioral expressions of fear about his treatment and prognosis, engaged him in musical relaxation exercises, and reducing the furnishings of his intense medical isolation.

At the same time, the fine art therapist helped Joey "face" his fears through scribble drawings. In one such session, Joey and the art therapist alternated scribbling and "finding the film" in the scribbles. Through this process, Joey led the therapist downwards an emotional road of increasing threats. His offset motion picture was of a snail, smiling benignly under his protective firm. Of the next picture, a fish, Joey stated, "The fish is hiding in the plants," though he couldn't identify the chance that collection the fish to hide. And then came a dragon, breathing fire merely looking quite distressing and sorry. Next, a Venus flytrap, the flesh eating plant with jagged teeth. Finally, he created a "mean bird" that had attacked some other bird'south nest and was eating the eggs out of information technology (see Figure 4). Equally Joey projected these predators, high-danger situations, and even "attacks" during the art therapy sessions, he expressed the fears instigated by living with an affliction that was slowly attacking the healthy parts of his torso.

Effigy four. Predator and prey.

Joey's reported hurting and mood scores decreased significantly from starting time to end of each session. Given that anxiety often anticipates hurting perception (Bernatzky, Presch, Anderson & Panksepp, 2011), the combination of art and music therapy interventions were particularly effective for Joey.

Joey'south last remission lasted about iii years. When he passed away, his parents talked fondly of the art and music therapy services at the time, reporting that it helped them empathise what was going on with their son emotionally and helped them support him more effectively.

Discussion

This study examined the effectiveness of two expressive modalities—art therapy and music therapy—utilized with pediatric patients, and the differences between these modalities. The findings support expressive research (eastward.g., Bar-Sela et al., 2007; Geue et al., 2010) that presented both modalities as significantly effective in increasing the well-being of hospitalized patients. In this research, pre and post session reports of pain and/or mood by children patients demonstrated a meaning reduction in pain and an comeback of mood. Although both modalities significantly and positively impacted patients, the findings illustrated a possible difference betwixt art therapy and music therapy, equally mood scores had improved significantly more than after art therapy than subsequently music therapy sessions, supporting previous findings about fine art therapy equally particularly useful in improving mood (Thyme, Sundin, & Gustaf, 2007). Interestingly, while patients engaged in art therapy sessions when reporting worse pre session scores for mood in comparison to music therapy sessions, patients participated in music therapy when reporting higher mean pre session scores for pain. Because participation and completion of these sessions was completely voluntary, this finding suggests possible differences in what intuitively feels helpful for patients when experiencing pain versus mood-related triggers.

In pondering these findings, we contemplated the unlike training of music therapists and fine art therapists, and how therapists gear up for their roles, perform these sessions, and respond to patients' needs. Although music therapy has incorporated more relational considerations in recent years (Aigen, 2015; Stige, 2015), music therapists have frequently been called upon in hospital settings, oft focusing on alleviating pain and improving overall health (Bernatzky et al., 2011). Comparatively, fine art therapy programs practice not often train for work specifically in medical settings. In terms of media/musical instrument considerations, most art therapy interventions actively engage with patients (art making), whereas music therapy more frequently offers passive (listening) interventions equally well. Thus, fine art therapists may be more prepared to engage in insight-oriented, long-term work than in immediate mood or pain alteration—to which music therapists accept routinely responded (e.chiliad., Yuan-Chi, Lee, Kemper, & Berde, 2005). In medical settings, expressive therapy may exist viewed more as recreational therapy by medical staff and patients, improving general well-being and sensory-motor integration, whereas psychotherapeutic needs are traditionally assigned to social workers, psychologists, and psychiatrists (Rollins, 2005).

Clinical application

This study suggests possible benefits of developing protocols for assigning dissimilar expressive modalities in medical settings. These results may begin to clarify the relative strengths of each modality and assist administrators with disseminating referrals and measuring efficacy. Physical pain in this study seemed to operate differently than mental hurting/mood. Thus, applying these results could mean considering a referral to an AT when the patient is exhibiting a mood/emotional outcome, and to an MT when hurting management is the issue. Information technology could too mean that both music and art therapists need to discuss more than regularly the similarities and differences in responding to pain compared to mood challenges. As Edwards (2005) has suggested, the expressive therapist serves a role in managing psychological distress, assisting in pain management, and supporting the child'southward developmental needs.

The findings of this written report besides suggest that it might be important to consider when children are less likely to do good from therapy. Specifically, because patients more often engaged in sessions, completed sessions, and reported their pain/mood scores when their pain was low and their mood skillful, it may exist that art therapy and music therapy have limited efficacy when pain and poor mood are likely to exist high. Some expressive work may be better reserved for less acute settings, later on medical crisis and hospitalization accept passed. Based on the number of refusals or incomplete sessions of art therapy reported when a patient was experiencing medium or high levels of pain, care coordinators might consider referring to music therapy first, and then offering art therapy services when hurting levels are lower and the patient is able to physically and mentally appoint in the procedure. Alternatively, medical art therapists might consider creating more "passive" art therapy interventions (such every bit viewing and talking about fine art, making fine art for client or with client) for patients exhibiting high pain.

Study limitations

The pre/post measure used in this report was a subjective, self-study, and session-specific measure. Withal, it did business relationship for more longitudinal factors such as the course of medical treatment, patients' capacity for insight, relationship to the therapist, specific intervention used, and so forth. Similarly, therapists did non record age, diagnosis, gender, or other characteristics of the patients.

Although the Wong-Baker FACES® Pain Rating Scale is non typically enlisted to measure mood, we received permission to employ the scale for this project due to clinical and developmental fit, modifying it to assess mood-presented challenges. This modification of the calibration meant that zero indicates neutral mood, rather than positive or happy mood. While our clinicians did not written report challenges in the dual apply of this scale for mood and pain (patients seemed quite comfortable with this utilise and appeared to understand these 2 constructs as singled-out), it is yet possible that this utilize created some confusion and limitations to how well each construct was measured. The data nerveless compared larger art therapy pre and post scores with music therapy, possibly limiting the validity of the hypotheses testing. Finally, nosotros recognize that the effects, strengths, and limitations of fine art therapy and music therapy are multilayered and too complex to be evidenced by mood improvement or pain alleviation alone.

Conclusion

Art therapy and music therapy both testify some efficacy in altering pain and mood in a pediatric hospital. Significantly, patients seemed to be more willing to engage in music therapy than in fine art therapy when their pain rating was high. Even so, patients also reported greater mood improvement with fine art therapy than with music therapy. These findings might help hospital and other administrators when making decisions on how to incorporate these modalities into hospital services—and where these therapists tin can be used near finer.

tarczynskiupind1962.blogspot.com

Source: https://www.tandfonline.com/doi/full/10.1080/08322473.2016.1170496