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Group Art Therapy for Patients with TBI: A Pilot Study


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  • I am an art psychotherapist working in the UK. I work in the field of brain injury and found your presentation very interesting and helpful.
    kind regards
    Jilly Shore
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Group Art Therapy for Patients with TBI: A Pilot Study

  1. 1. Group Art Therapy for Patients With Traumatic Brain Injuries: A Pilot Study Thesis Study by Gretchen Graves
  2. 2. Introduction <ul><li>Every year 70,000-90,000 people in the United States are permanently impaired due to a traumatic brain injury. </li></ul><ul><li>Survivors often show few physical signs of an injury consequently may not receive appropriate treatment for the impairments that will follow. </li></ul><ul><li>A wide range of behavioral symptoms may occur as a result of a brain injury. </li></ul><ul><li>Many cognitive functions are disrupted. </li></ul>
  3. 3. And….. <ul><li>Greater need for medical and emotional attention. </li></ul><ul><li>Life change causes anxiety. </li></ul>
  4. 4. Functional Results of Brain Injury <ul><li>Concentration </li></ul><ul><ul><li>Idea of abstraction </li></ul></ul><ul><ul><li>Learning from mistakes </li></ul></ul><ul><ul><li>Problem solving-unrealistic </li></ul></ul><ul><li>Memory </li></ul><ul><ul><li>Hippo-campal sensitive to damage </li></ul></ul><ul><ul><li>Short term memory </li></ul></ul><ul><ul><li>Performance of tasks </li></ul></ul><ul><li>Cognition </li></ul><ul><ul><li>Various functions affected </li></ul></ul><ul><li>Perception </li></ul><ul><ul><li>Fragmented approach to tasks </li></ul></ul>
  5. 5. Statement of Problem <ul><li>In the past brain-injured patients were considered poor patients for psychotherapy (Ball, 1988). </li></ul><ul><li>Interventions should be done by persons who are knowledgeable about cognitive disturbances as well as psychotherapy (Prigatano, 1999). </li></ul><ul><li>Many studies in projective art assessments with brain-injured people, but few or none involving an intervention (Garner, 1996). </li></ul>
  6. 6. Why Art Therapy <ul><li>Art allows the use of motor skills, cognitive functions, and psychosocial skills (Poldinger & Krambeck, 1987) </li></ul><ul><li>Art allows retraining of brain functions and an accumulation of data to document effects (Garner, 1996) </li></ul><ul><li>Details are more easily remembered when organized into a structured form (Silver, 1978) </li></ul><ul><li>Offers non-aggravating, activity-centered treatment that will induce personal expression with out raising defenses. </li></ul>
  7. 7. Rehabilitation using Art Therapy <ul><li>Concentration </li></ul><ul><ul><li>Increase in organizational skills </li></ul></ul><ul><ul><li>Following directions </li></ul></ul><ul><ul><li>Choice making </li></ul></ul><ul><li>Memory </li></ul><ul><ul><li>Material is comprehended and retained </li></ul></ul><ul><ul><li>Improve patients self-identity. </li></ul></ul><ul><li>Cognition </li></ul><ul><ul><li>Gain insight </li></ul></ul><ul><ul><li>Sequential steps </li></ul></ul><ul><ul><li>Much to learn </li></ul></ul><ul><li>Perception </li></ul><ul><ul><li>3D vs. 2D </li></ul></ul><ul><ul><li>Exploring themes in life </li></ul></ul>
  8. 8. Benefits of an Art Therapy Intervention <ul><li>Reduce behavioral problems-art as an emotional outlet </li></ul><ul><li>Formation of adequate emotional response to injury (depression and anxiety) </li></ul><ul><li>Increase motivation for rehabilitation (depression) </li></ul><ul><li>Improve self-identity-hard to achieve due to lack of access to recent memory (short term memory deficit) </li></ul><ul><li>Aid in reduction of cognitive confusion </li></ul><ul><li>Increase socialization through group awareness </li></ul><ul><li>Increase organizational skills </li></ul>
  9. 9. Hypothesis of Study <ul><li>Depression would decrease </li></ul><ul><li>Anxiety would decrease </li></ul><ul><li>Stress would decrease </li></ul><ul><li>Socialization Skills would improve </li></ul>
  10. 10. Methodology <ul><li>Pre/Post-Intervention Inventory {Depression Anxiety and Stress Scales (DASS)} </li></ul><ul><li>Five 1 hour art therapy sessions </li></ul><ul><li>Six subjects – ages 24 – 71 </li></ul><ul><li>Post-Intervention Interview </li></ul>
  11. 11. Art Therapy Tasks <ul><li>Designed for easy execution </li></ul><ul><li>Allowed for a wide range of expressive potential </li></ul><ul><li>Did not include drawing tasks </li></ul>
  12. 12. Self-collage <ul><li>Low anxiety task </li></ul><ul><li>Trust building exercise </li></ul><ul><li>Self- Expression </li></ul><ul><li>Self-identity </li></ul>
  13. 13. Torn Paper Collage <ul><li>Low anxiety task </li></ul><ul><li>Success oriented </li></ul><ul><li>Self-expression </li></ul><ul><li>Enhance ability for abstraction </li></ul><ul><li>Enhance discussion of group </li></ul>
  14. 14. Printmaking <ul><li>Low anxiety task </li></ul><ul><li>Success oriented </li></ul><ul><li>Self-expression </li></ul><ul><li>Enhance exploration of materials </li></ul><ul><li>Increase concentration and structure </li></ul><ul><li>Connect cognitive function with emotions </li></ul>
  15. 15. 3-D animals <ul><li>Low anxiety task </li></ul><ul><li>Success oriented </li></ul><ul><li>Self-expression </li></ul><ul><li>Foster sense of control </li></ul><ul><li>Increase self-esteem </li></ul><ul><li>Foster group cohesion </li></ul><ul><li>Increase awareness of anxiety stress reducing strategies </li></ul>
  16. 16. Animal Environment <ul><li>Low anxiety </li></ul><ul><li>Success oriented </li></ul><ul><li>Group cohesion </li></ul>
  17. 17. Results of DASS <ul><li>4/6 decreased depression (66 % improvement) </li></ul><ul><li>3/6 decreased anxiety (50 % improvement) </li></ul><ul><li>5/6 decreased stress (83 % improvement) </li></ul>
  18. 18. Subject A <ul><li>Scores indicated depression both pre & post </li></ul><ul><li>Suffered visual impairments due to BI </li></ul><ul><li>Art was uncomplicated yet gave subject feeling of satisfaction </li></ul><ul><li>Art upbeat & reflected a happy-go-lucky personality </li></ul><ul><li>Playful & unrealistic </li></ul>
  19. 19. Subject K <ul><li>Pre-depression & anxiety were close to clinical: Post-demonstrated no depression or anxiety </li></ul><ul><li>Verbal associations to art indicated that patient understood life had changed </li></ul><ul><li>Art contained much self-expression and memories </li></ul>
  20. 20. Subject L (injured at age 14) <ul><li>Pre & post scores indicate great levels of depression </li></ul><ul><li>Outline of collage shape of head </li></ul><ul><li>Many photos in it typical of adolescent images </li></ul>
  21. 21. Subject T <ul><li>Pre scores indicate clinical levels of depression </li></ul><ul><li>Post level scores decreased dramatically </li></ul><ul><li>Interpersonal level increased a great deal </li></ul><ul><li>Adolescent type art in printmaking </li></ul><ul><li>Torn paper collage- passive/defiant </li></ul>
  22. 22. Subject V <ul><li>Scores for depression & anxiety went up from pre to post test </li></ul><ul><li>Difficulty motivating </li></ul><ul><li>Difficulty connecting emotions to art </li></ul>
  23. 23. Subject R <ul><li>Scores pre were low and dropped post </li></ul><ul><li>Spouse helped with tasks great deal in beginning but towards end of intervention worked more independently </li></ul><ul><li>Increased confidence & became less hesitant to create </li></ul>
  24. 24. Post Intervention Interview <ul><li>Questions </li></ul><ul><ul><li>How did the participants feel about the art therapy intervention </li></ul></ul><ul><ul><li>Feelings about the group and working together </li></ul></ul><ul><li>Answers </li></ul><ul><ul><li>Helped use emotions </li></ul></ul><ul><ul><li>Relaxed & Calming </li></ul></ul><ul><ul><li>Got along better with everyone towards the end of the intervention </li></ul></ul>
  25. 25. Ideally….. <ul><li>More meetings </li></ul><ul><li>Longer period of time </li></ul><ul><li>Different time of Day-not when rides might come, etc. </li></ul><ul><li>Comparison group </li></ul><ul><li>Size of groups good </li></ul>
  26. 26. Conclusion <ul><li>Objectives were achieved, although not statistically significant </li></ul><ul><li>Therapeutic art intervention for people with brain injury could be very beneficial: </li></ul><ul><li>Help reworking the brain </li></ul><ul><li>Decreasing anxiety, depression, & stress </li></ul><ul><li>Increase memory & socialization skills </li></ul>
  27. 27. Questions & Comments: