Group Art Therapy for Patients With Traumatic Brain Injuries: A Pilot Study Thesis Study by Gretchen Graves

Introduction Every year 70,000-90,000 people in the United States are permanently impaired due to a traumatic brain injury. Survivors often show few physical signs of an injury consequently may not receive appropriate treatment for the impairments that will follow. A wide range of behavioral symptoms may occur as a result of a brain injury. Many cognitive functions are disrupted.

Every year 70,000-90,000 people in the United States are permanently impaired due to a traumatic brain injury.

Survivors often show few physical signs of an injury consequently may not receive appropriate treatment for the impairments that will follow.

A wide range of behavioral symptoms may occur as a result of a brain injury.

Many cognitive functions are disrupted.

And….. Greater need for medical and emotional attention. Life change causes anxiety.

Greater need for medical and emotional attention.

Life change causes anxiety.

Functional Results of Brain Injury Concentration Idea of abstraction Learning from mistakes Problem solving-unrealistic Memory Hippo-campal sensitive to damage Short term memory Performance of tasks Cognition Various functions affected Perception Fragmented approach to tasks

Concentration

Idea of abstraction

Learning from mistakes

Problem solving-unrealistic

Memory

Hippo-campal sensitive to damage

Short term memory

Performance of tasks

Cognition

Various functions affected

Perception

Fragmented approach to tasks

Statement of Problem In the past brain-injured patients were considered poor patients for psychotherapy (Ball, 1988). Interventions should be done by persons who are knowledgeable about cognitive disturbances as well as psychotherapy (Prigatano, 1999). Many studies in projective art assessments with brain-injured people, but few or none involving an intervention (Garner, 1996).

In the past brain-injured patients were considered poor patients for psychotherapy (Ball, 1988).

Interventions should be done by persons who are knowledgeable about cognitive disturbances as well as psychotherapy (Prigatano, 1999).

Many studies in projective art assessments with brain-injured people, but few or none involving an intervention (Garner, 1996).

Why Art Therapy Art allows the use of motor skills, cognitive functions, and psychosocial skills (Poldinger & Krambeck, 1987) Art allows retraining of brain functions and an accumulation of data to document effects (Garner, 1996) Details are more easily remembered when organized into a structured form (Silver, 1978) Offers non-aggravating, activity-centered treatment that will induce personal expression with out raising defenses.

Art allows the use of motor skills, cognitive functions, and psychosocial skills (Poldinger & Krambeck, 1987)

Art allows retraining of brain functions and an accumulation of data to document effects (Garner, 1996)

Details are more easily remembered when organized into a structured form (Silver, 1978)

Offers non-aggravating, activity-centered treatment that will induce personal expression with out raising defenses.

Rehabilitation using Art Therapy Concentration Increase in organizational skills Following directions Choice making Memory Material is comprehended and retained Improve patients self-identity. Cognition Gain insight Sequential steps Much to learn Perception 3D vs. 2D Exploring themes in life

Concentration

Increase in organizational skills

Following directions

Choice making

Memory

Material is comprehended and retained

Improve patients self-identity.

Cognition

Gain insight

Sequential steps

Much to learn

Perception

3D vs. 2D

Exploring themes in life

Benefits of an Art Therapy Intervention Reduce behavioral problems-art as an emotional outlet Formation of adequate emotional response to injury (depression and anxiety) Increase motivation for rehabilitation (depression) Improve self-identity-hard to achieve due to lack of access to recent memory (short term memory deficit) Aid in reduction of cognitive confusion Increase socialization through group awareness Increase organizational skills

Reduce behavioral problems-art as an emotional outlet

Formation of adequate emotional response to injury (depression and anxiety)

Increase motivation for rehabilitation (depression)

Improve self-identity-hard to achieve due to lack of access to recent memory (short term memory deficit)

Aid in reduction of cognitive confusion

Increase socialization through group awareness

Increase organizational skills

Hypothesis of Study Depression would decrease Anxiety would decrease Stress would decrease Socialization Skills would improve

Depression would decrease

Anxiety would decrease

Stress would decrease

Socialization Skills would improve

Methodology Pre/Post-Intervention Inventory {Depression Anxiety and Stress Scales (DASS)} Five 1 hour art therapy sessions Six subjects – ages 24 – 71 Post-Intervention Interview

Pre/Post-Intervention Inventory {Depression Anxiety and Stress Scales (DASS)}

Five 1 hour art therapy sessions

Six subjects – ages 24 – 71

Post-Intervention Interview

Art Therapy Tasks Designed for easy execution Allowed for a wide range of expressive potential Did not include drawing tasks

Designed for easy execution

Allowed for a wide range of expressive potential

Did not include drawing tasks

Self-collage Low anxiety task Trust building exercise Self- Expression Self-identity

Low anxiety task

Trust building exercise

Self- Expression

Self-identity

Torn Paper Collage Low anxiety task Success oriented Self-expression Enhance ability for abstraction Enhance discussion of group

Low anxiety task

Success oriented

Self-expression

Enhance ability for abstraction

Enhance discussion of group

Printmaking Low anxiety task Success oriented Self-expression Enhance exploration of materials Increase concentration and structure Connect cognitive function with emotions

Low anxiety task

Success oriented

Self-expression

Enhance exploration of materials

Increase concentration and structure

Connect cognitive function with emotions

3-D animals Low anxiety task Success oriented Self-expression Foster sense of control Increase self-esteem Foster group cohesion Increase awareness of anxiety stress reducing strategies

Low anxiety task

Success oriented

Self-expression

Foster sense of control

Increase self-esteem

Foster group cohesion

Increase awareness of anxiety stress reducing strategies

Animal Environment Low anxiety Success oriented Group cohesion

Low anxiety

Success oriented

Group cohesion

Results of DASS 4/6 decreased depression (66 % improvement) 3/6 decreased anxiety (50 % improvement) 5/6 decreased stress (83 % improvement)

4/6 decreased depression (66 % improvement)

3/6 decreased anxiety (50 % improvement)

5/6 decreased stress (83 % improvement)

Subject A Scores indicated depression both pre & post Suffered visual impairments due to BI Art was uncomplicated yet gave subject feeling of satisfaction Art upbeat & reflected a happy-go-lucky personality Playful & unrealistic

Scores indicated depression both pre & post

Suffered visual impairments due to BI

Art was uncomplicated yet gave subject feeling of satisfaction

Art upbeat & reflected a happy-go-lucky personality

Playful & unrealistic

Subject K Pre-depression & anxiety were close to clinical: Post-demonstrated no depression or anxiety Verbal associations to art indicated that patient understood life had changed Art contained much self-expression and memories

Pre-depression & anxiety were close to clinical: Post-demonstrated no depression or anxiety

Verbal associations to art indicated that patient understood life had changed

Art contained much self-expression and memories

Subject L (injured at age 14) Pre & post scores indicate great levels of depression Outline of collage shape of head Many photos in it typical of adolescent images

Pre & post scores indicate great levels of depression

Outline of collage shape of head

Many photos in it typical of adolescent images

Subject T Pre scores indicate clinical levels of depression Post level scores decreased dramatically Interpersonal level increased a great deal Adolescent type art in printmaking Torn paper collage- passive/defiant

Pre scores indicate clinical levels of depression

Post level scores decreased dramatically

Interpersonal level increased a great deal

Adolescent type art in printmaking

Torn paper collage- passive/defiant

Subject V Scores for depression & anxiety went up from pre to post test Difficulty motivating Difficulty connecting emotions to art

Scores for depression & anxiety went up from pre to post test

Difficulty motivating

Difficulty connecting emotions to art

Subject R Scores pre were low and dropped post Spouse helped with tasks great deal in beginning but towards end of intervention worked more independently Increased confidence & became less hesitant to create

Scores pre were low and dropped post

Spouse helped with tasks great deal in beginning but towards end of intervention worked more independently

Increased confidence & became less hesitant to create

Post Intervention Interview Questions How did the participants feel about the art therapy intervention Feelings about the group and working together Answers Helped use emotions Relaxed & Calming Got along better with everyone towards the end of the intervention

Questions

How did the participants feel about the art therapy intervention

Feelings about the group and working together

Answers

Helped use emotions

Relaxed & Calming

Got along better with everyone towards the end of the intervention

Ideally….. More meetings Longer period of time Different time of Day-not when rides might come, etc. Comparison group Size of groups good

More meetings

Longer period of time

Different time of Day-not when rides might come, etc.

Comparison group

Size of groups good

Conclusion Objectives were achieved, although not statistically significant Therapeutic art intervention for people with brain injury could be very beneficial: Help reworking the brain Decreasing anxiety, depression, & stress Increase memory & socialization skills

Objectives were achieved, although not statistically significant

Therapeutic art intervention for people with brain injury could be very beneficial:

Help reworking the brain

Decreasing anxiety, depression, & stress

Increase memory & socialization skills

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