Treating Psychosis: Can Art Therapy Effectively Reduce Problematic Symptoms Associated with Psychosis? 

Emily Weekes

Psychosis refers to a set of symptoms encompassing a distorted sense of reality (Schrimpf et al., 2018), accompanied by shifts in emotions, behaviours and cognitions – often present in schizophrenia and mood disorders such as bipolar disorder and major depressive disorder (National Institute for Health and Care Excellence, 2009).

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Individuals experiencing psychosis may encounter cognitive symptoms, such as hallucinations, and decreased memory and concentration, and behavioural symptoms, such as disorganised speech, social withdrawal and decreased interest in daily activities (American Psychiatric Association, 2000). These distressing symptoms, accompanied with statistical data indicating that around one in 150 people will be diagnosed with psychosis in their lifetime (Moreno-Küstner et al., 2018), highlight a need for research into treatment for psychosis. 

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Until recently, the predominant approach to treating psychosis has been bio-centric, focusing upon using antipsychotic medication to reduce hallucinations (Corstens et al., 2014). However, there has been a recent movement towards increased focus upon more holistic treatment options that aim to assist with the improvement in the quality of life and social reintegration of psychotic patients (Davies et al., 2023).

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Some researchers have investigated the impacts of psychodynamic art therapy (utilising creative activities to help explore thoughts and feelings – aiming to understand oneself better through artistic expression (Thyme, et al., 2007)) on patients with schizophrenia and reported results indicating that it may be a useful tool to alleviate hallucinations and improve the psychosocial functioning of patients experiencing psychosis (Montag, et al., 2014). However, findings in this domain remain limited, and occasionally contradictory. Some researchers argue that art therapy is no more effective than standard care (Crawford, et al., 2012). Chaidemenaki and Giannouli (2023) identified a specific gap in the literature for research into art therapy in Greece and aimed to contribute to the existing literature investigating the effectiveness of art therapy in treating psychosis.

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Summary of Chaidemenaki and Giannouli (2023) - No-man land art voices: A quasi-experimental pilot study on the effects of art therapy on psychotic patients of a Psychiatric Day Hospital in Greece.

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To investigate the effectiveness of art therapy in treating psychosis, Chaidemenaki and Giannouli (2023) implemented a 9-month group art therapy program within a psychiatric hospital's Day Hospital in Athens. They aimed to improve upon the methodology of previous research by employing a structured research design that allowed for measuring specific variables before and after the intervention to aim to mitigate the negative impacts of lacking a control group. Initially, 14 individuals joined the program, however, researchers were left with a sample of nine participants as four left before completion (leaving a sample of seven males and three females) and one did not provide sufficient data. The remaining participants had an average age of 38.4 years old. 

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Researchers ensured that all participants had a confirmed diagnosis of psychosis through a comprehensive screening process, using standardised diagnostic criteria such as the Diagnostic Statistical Manual of Mental Disorders. Participants were diagnosed with various conditions, including schizophrenia, bipolar disorder, and depression.

Participants engaged in a 24-week structured art therapy program led by two experienced therapists. Sessions occurred weekly and were split into three distinct phases:

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•  A 30-minute discussion segment, allowing participants to share personal experiences related to their psychosis. This served as a foundation for the subsequent creative phase.

• Core intervention: a 30-minute creative process, wherein participants utilised various art materials—such as paints, clay, markers, and pastels—to express themselves without constraints, allowing for the exploration of emotions and thoughts.

• A 30-minute shared reflection period in which participants showcased their artwork and discussed the thoughts and emotions within their artwork. Facilitators provided guidance but refrained from imposing interpretations to foster individualised expressions.

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Throughout the study, researchers used a range of questionnaires and measurements to evaluate different aspects of the participants' experiences. They utilized tools such as the Symptom Checklist 90-R (SCL-90R) to measure various psychological symptoms, the Global Assessment of Functioning Scale (GAF) to assess the severity of mental illness and daily functioning, and the Interpersonal Reactivity Index (IRI) to gauge empathy levels.

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Additionally, they employed the Occupational Abilities and Occupational Adjustment Scale (KIEEP) to evaluate participants' occupational performance. These assessments were conducted at the beginning of the intervention and again at the end to compare any changes or improvements.

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Results showed that while there was not a statistically significant reduction in psychiatric symptoms, there were notable improvements in interpersonal responsiveness and empathy. This suggests that art therapy positively affected their ability to understand and relate to others emotionally despite having psychiatric symptoms.

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More interestingly, the study found improvements in occupational functionality among participants. This improvement was evident in various skills essential for daily life, such as physical movement, attention focus, instruction following, cooperation, and time management, indicating that art therapy might help individuals with psychosis develop crucial life skills.

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However, there are some notable limitations of the study. Firstly, the small sample size and the absence of a control group restrict the extent to which these findings could be generalised. Additionally, the short duration of the program might have limited the depth of the observed effects, and the researchers suggested that longer-term interventions might yield more significant outcomes.

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In conclusion, while the study did not show significant changes in psychiatric symptoms, it revealed promising improvements in empathy and daily functioning among individuals with psychosis undergoing art therapy. The researchers highlighted the need for further extensive research with larger participant groups in different locations and longer intervention periods to solidify these findings.

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References

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American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. Fourth Edition, Text Revision (DSM-IV-TR). Washington DC: American Psychiatric Association.

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Chaidemenaki, L., & Giannouli, E. (2023). No-man land art voices: A quasi-experimental pilot study on the effects of art therapy on psychotic patients of a Psychiatric Day Hospital in Greece. The Arts in Psychotherapy, 86, 102093.

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Corstens, D., Longden, Е., McCarthy-Jones, S., Waddingham, R., & Thomas, N. (2014). Emerging perspectives from the Hearing Voices Movement: Implications for research and practice. Schizophrenia Bulletin, 40(10,suppl.4), 285–294.

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Crawford, M. J., Killaspy, H., Barnes, T. R., Barrett, B., Byford, S., & Clayton, K. (2012). Group art therapy as an adjunctive treatment for people with schizophrenia: A randomised controlled trial (MATISSE). Health Technology Assessment, 16(8).

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Davies, K., Grattan, S., Gott, C., Ellis, R., & Lappin, J. M. (2023). The tertiary service for psychosis: Holistic recommendations for people with complex psychosis. Australasian Psychiatry, 31(5), 591-597.

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Montag, C., Haase, L., Seidel, D., Bayerl, M., Gallinat, J., Herrmann, U., & Dannecker, K. (2014). A pilot RCT of psychodynamic group art therapy for patients in acute psychotic episodes: Feasibility, impact on symptoms and Mentalising capacity. PLoS One, 9(11).

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Moreno-Küstner, B., Martín, C., & Pastor, L. (2018). Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses (Public Library of Science). PLoS One, 13(4).

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National Institute for Health and Care Excellence. (2009). Schizophrenia: The NICE guidelines on core interventions in the treatment and management of schizophreia in adults in primary and secondary care. London: Author (CG82). Retrieved from https://www.nice.org.uk/guidance/CG82

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Schrimpf, L., Aggarwal, A., & Lauriello, J. (2018). Psychosis. Continuum (Minneap Minn). Behavioral Neurology and Psychiatry, 24(3), 845–860.

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Thyme, K. E., Sundin, E. C., Stahlberg, G., Lindstrom, B., Eklof, H., & Wiberg, B. (2007). The outcome of short‐term psychodynamic art therapy compared to short‐term psychodynamic verbal therapy for depressed women. Psychoanalytic Psychotherapy, 21(3), 250-264.

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