تبدیل آثار هنری بصری و تصویرسازی هدایت شونده به عنوان راهی برای کاهش استرس مربوط به کار: مطالعه کمی خلبان

This paper explores ways of transforming stress related visual images for health care professionals who are exposed to stressful images in their work. Transformation of these images is conducted using changes of compositional elements such as shape, color, size and texture – through harnessing the power of creativity and imagination to transform an image that is drawn or imagined. We hypothesize that subjective discomfort levels (SUDS) will be reduced by visually transforming their images. We also assume that similar elements of color, size shape and texture will be drawn and imagined. Thirty-six health professionals participated in a five hours workshop that took place in two consecutive days. SUDS levels were calculated and were found to be reduced following image transformation in both art and imagery. On a comparative level, the elements of ‘shape ‘size’ and ‘color’, were highly used in both techniques and did not differ statistically significantly.

This paper suggests that it is a timely moment to search for a short term and self-initiated arts based technique of stress reduction that will access health professionals’ creative recourses as an antidote to stress at work. Health care professionals are often exposed to disturbing visual images in their work (Laws, 2001 and Rubino et al., 2009) and thus using the arts to deal with stress related visual images would seem to be an appropriate method to reduce work stress related stress. To elaborate, previous studies have shown that visual images, which contain emotional content, are encoded in memory more rapidly and intensely than images devoid of emotional content (Bocanegra and Zeelenberg, 2009 and Phelps et al., 2006). Thus, visual images are an accessible source for retrieval of experiences (Sarid & Huss, 2010). Retrieval of these images enables their continuous recreation and thus re-interpretation by adjusting their meaning and significance through verbal and visual techniques. Numerous studies focus on the hermeneutic and semantic meaning that images initiate (Huss et al., 2010, Kaye and Bleep, 1997, Malchiodi, 2012 and Huss and Sarid, 2012). This process of image transformation includes observation of the content and composition of the image and encouragement of alternative and varying interpretations. This is in accordance with additional arts conceptualizations, such as the theory of art therapy, visual culture, and guided imagery (Eisner, 1997, Harrington, 2004, Johnson, 1999 and Shank, 2005). Health care professionals’ mental stress is documented as a major issue for the individual practitioner and for the organization as well as for the quality of care received by patients (Bourbonnais et al., 2011 and Shapiro et al., 2005). Previous studies suggest that even the short term exposure to patients’ distress and pain can provoke occupational stress related symptoms such as elevated blood pressure, anxiety and depressive symptoms, among health professionals (Figley, 2002, Rabin et al., 2011 and Rubino et al., 2009). Over the long-term, such responses can cause disease of a physical, psychological or behavioral nature (Bourbonnais et al., 2011). Reduction of health care professionals’ mental stress is generally addressed by integrating occupational health and safety, health promotion, and psychosocial intervention (Hall, Doran, & Pink, 2008). Psychological interventions mainly consist of occasional educational programs (Krasner et al., 2009), and cognitive–behavioral interventions that focus on attenuating pathological symptoms (Sarid et al., 2012 and Shapiro et al., 2005). The emerging field of arts and health care as well as guided imagery may be helpful directions, because they utilize recalled visual images and their creative transformation (Huss et al., 2010, Kaye and Bleep, 1997, Malchiodi, 2012 and Sarid et al., 2012). Following on these findings, this study hopes to deepen the focus on the transformation of images rather than their verbal elaboration, as exemplified by our inborn visual ability to change composition, by quickly separating a threatening element from its background (Barrett, 2005, Haijiang et al., 2006 and Lang and Bradley, 2010). The process of transforming an image includes recalling a stressful visual image, reflecting on the elements that comprise this image and then working on changing these compositional elements. For example, this process of change can include separating, uniting or differently organizing shapes and colors. In art, this process is conducted using art materials and the visual elements of a disturbing image are thus transformed within the art work. Compared to this, in guided imagery, a disturbing image is recalled and its’ elements are adjusted within the mind (Huss and Sarid, 2012). According to guided imagery theory (Bandler, 1985) then, transforming of images links to transforming of subjective emotional states. The above described process of image transformation can provide an alternative and more enabling emotional state that is not linked to the original stress (Huss & Sarid, 2012Kaye and Bleep, 1997, Rubin, 2001 and Silver, 2005). The plastic arts help to concretize this process. This paper will explore the above described less semantic and a more visual approach. The focus of our technique is to adjust elements that comprise the image. This includes compositional elements such as shape, size, color, texture and placement of objects (Huss & Sarid, 2010, 2012). The use of these basic elements can occur in both an imagined and a concrete image. However, we expect to find certain elements that will differentiate between image transformation on the paper and in the mind. For example, we assume that addition and omission of objects is more easily done on the paper than in the mind. In a previous qualitative study, working with visual images on the paper was an effective technique for reducing occupational stress among social workers in war time (Huss et al., 2010). In the current study health professionals comprise the target population in need and the method of image transformation is comparatively explored through drawing and imagining. Understanding these differences can further elucidate how people can transform their stressful images and can be of practical help in choosing the most appropriate intervention. It also may help to conceptually connect between art therapy and guided imagery. Thus, the first of aim of this study is to compare how elements of shape, size, color and texture are used in the mind as compared to in a drawing. The second aim is to enquire which technique is most effective in reducing subjective work related stress.

The first aim of the study was to compare which compositional elements were used when transforming an image in the mind and in the drawing. From Table 2 we can see that in both techniques the elements of ‘shape’, ‘size’ and ‘color’ had high frequency of usage and the element of ‘texture’ has a relatively low usage of about 40%. The use of the above elements did not differ statistically significantly between the two interventions. It is interesting to note, that the elements of ‘addition of objects’ and ‘omission of objects’ were used statistically significantly more in drawing than in imagery (χ2 = 8.61 (df = 1), p = 0.03, and χ2 = 7.56 (df = 1), p = 0.04, respectively). Table 2. Elements used within drawing versus imagery percentages (frequency), χ2. Compositional elements Drawing percentages (n) Imagery percentages (n) χ2 (df = 1) Shape 71.4 (25) 82.4 (28) 0.85 Size 71.4 (25) 71.4 (25) 0.15 Color 91.4 (32) 71.4 (25) 0. 52 Texture 40.0 (14) 40.0 (14) 0.28 Addition of objects 40 (14) 14.3 (5) 8.61* Omission of objects 28.6 (10) 14.3 (5) 7.56** * p = 0.03. ** p = 0.04. Table options At the individual level the average use of each compositional element was compared between drawing and imagery using paired t-test (see Table 3). No statistically significant differences were found in the average use of ‘shape’, ‘size’, ‘color’ and ‘texture’ between the two interventions. However, participants who had higher mean values of ‘addition of objects’ and ‘omission of objects’ in their drawing had lower mean values of these elements in their imagination (t-test = 3.27 (df = 1), p = 0.03, and t-test = 2.03 (df = 1), p = 0.04, respectively). Table 3. Average use of elements: drawing versus imagery (means (SD), Student t-test). Compositional elements Drawing mean (SD) Imagery mean (SD) t-test (df = 1) Shape 0.67 (0.47) 0.82 (0.38) −1.3 Size 0.73 (0.44) 0.70 (0.46) 0.37 Color 0.28 (0.45) 0.14 (0.35) 1.96 Texture 0.40 (0.49) 0.37 (0.45) 0.27 Addition of objects 0.42 (0.49) 0.11 (0.32) 3.27* Omission of objects 0.88 (0.32) 0.68 (0.47) 2.03** * p = 0.03. ** p = 0.04. Table options The second aim of this study aimed to compare between the overall effectiveness of transforming compositional elements within guided imagery versus drawing in reducing subjective work related stress. In drawing, the SUDS mean values taken before the intervention were 7.0 (SD = 0.5). After transforming the picture, the SUDS mean values were reduced to 3.0 (SD = 0.5). Effect size, calculated using Cohen d, was large (0.97). In imagery, the SUDS mean values taken before the intervention were 8.0 (SD = 0.5). After transforming the image in the mind the SUDS mean values were reduced to 4.0 (SD = 0.5). Effect size, calculated using Cohen d, was large (0.97). From these findings we can see that transforming compositional elements within a drawing and in the mind reduced SUDS levels by four units.