اثر درمانهای هنرهای خلاق برای افزایش ابراز هیجانی، معنویت و سلامت روانی تازه تشخیص داده مبتلا به سرطان پستان مرحله و مرحله دوم: یک مطالعه مقدماتی

Abstract Breast cancer is the second most common type of cancer among women in the United States. The psychological impact of the disease may include adjustment disorders, depression, and anxiety and may generate feelings of fear, anger, guilt, and emotional repression. The purpose of this pilot study was to explore the efficacy of a complementary creative arts therapy intervention to enhance emotional expression, spirituality, and psychological well-being in newly diagnosed breast cancer patients. Thirty-nine women with Stage I and Stage II breast cancer were randomly assigned to an experimental group who received individual creative arts therapy interventions or a control group of delayed treatment. A series of analyses of covariance were used to analyze the results, which indicated the intervention was not effective in enhancing the emotional approach coping style of emotional expression or level of spirituality of subjects in this sample. However, participation in the creative arts therapy intervention enhanced psychological well-being by decreasing negative emotional states and enhancing positive ones of experimental group subjects. Recommendations for future research are discussed

Results A series of analyses of covariance (ANCOVA) were used to examine the effects of the individual creative arts therapy interventions on emotional expression, as measured by the Emotional Approach Coping Scale-emotional expression subscale, spirituality, as measured by the Expressions of Spirituality Inventory—Revised, psychological well-being as measured by the Profile of Mood States while controlling the covariates (i.e., POMS pretest total or relevant sub-scales scores), and clinical significance as reported in the Exit Interview questionnaire. Pretest measurements of the POMS were used as the covariate in order to control for any differences between treatment and control groups at pretesting. For emotional expression, as measured by the Emotional Approach Coping Scale, the covariate, pretest POMS total mood score made a significant adjustment (p < .01). However, the main effect (i.e., the experimental group of creative arts therapy interventions versus the control group of delayed treatment) did not reach statistical significance (p > .05). The spirituality dependent variable produced a similar pattern of results. Although the covariate, pretest POMS total mood score made a significant adjustment (p < .01), the main effect also did not reach statistical significance (p > .05) for the spirituality, as measured by the Expressions of Spirituality Inventory—Revised. These analyses with newly diagnosed Stage I and Stage II breast cancer patients showed that after statistical adjustment, the independent variable (creative arts therapy interventions) had a non-appreciable effect on clinical outcomes (i.e., emotional expression and spirituality). The psychological well-being dependent variable produced a different pattern of results. The Profile of Mood Scale (POMS) scale was used to measure the dependent variable, psychological well-being, in this study. The subscales of the POMS include tension–anxiety, depression–dejection, anger–hostility, vigor–activity, fatigue–inertia, and confusion–bewilderment. Comparisons of the mean and standard deviation scores of the creative arts therapy interventions group and the control group for the POMS subscales are presented in Table 1. The results of the analysis indicate that there are statistically significant differences between treatment and control groups on tension–anxiety [F(1, 36) = 5.41, p < .05, η2 = .13], depression–dejection [F(1, 36) = 9.23, p < .05, η2 = .20], anger–hostility [F(1, 36) = 7.31, p < .05, η2 = .17], and confusion–bewilderment [F(1, 36) = 6.42, p < .05, η2 = .15], when controlling for the covariate, POMS total mood pretest scores. More specifically, participants in the treatment group had significantly lower scores than those in the control group on tension–anxiety, depression–dejection, anger–hostility, and confusion–bewilderment after completing the creative arts therapy interventions. For vigor–activity and fatigue–inertia subscales, there were no statistically significant differences between treatment and control group. Table 1. Data analysis of Profile of Mood States Scores for creative art therapy and control group (n = 39) Subscale Treatment group (n = 20) mean (S.D.) Control group (n = 19) mean (S.D.) F ηp2 a Anger–hostility 15.79 (3.74) 19.10 (8.11) 7.31* .17 Confusion–bewilderment 14.25 (3.34) 16.47 (4.74) 6.42* .15 Depression–dejection 20.66 (4.74) 26.34 (8.48) 9.23* .20 Fatigue–inertia 15.58 (5.22) 17.80 (8.74) 0.47 .00 Tension–anxiety 17.31 (5.01) 20.32 (6.78) 5.41* .13 Vigor–activity 22.16 (5.92) 22.75 (5.24) 0.73 .00 a Partial η2 (effect size). * p < .05. Table options Clinical significance Results of clinical significance, obtained through the exit interview questionnaire, indicated that all women who received the creative art therapy experience found it helpful and would recommend it to others with a health problem. The women also reported that the most important happenings as a result of participating in the creative arts therapy interventions were: increased self-awareness, connected with feelings, discovered old issues that need attention, allowed time for self-care, reflection and quiet, helped connect with/express feelings, including ability to relax to communicate feelings through art, feel less hopeless, happier, and identified coping and stress management options, among others. Finally, the participants in this study perceived benefits from participating in the creative arts therapy interventions. Reported benefits were congruent with some of the statistical findings in that the therapy was perceived to reduce negative affective aspects of psychological well-being by providing a forum where the women could connect with and communicate or express feelings. The perceived beneficial aspects may have resulted from the therapeutic stance inherent in individual psychotherapy practices rather than from particular theoretical and applied techniques utilized in this preliminary study. Results of the exit interview questionnaire are presented in Table 2. Table 2. Clinical significance: summary of outcomes (n = 33; 20 treatment group and 13 control group delayed treatment participants) Exit interview questions Total, n = 33 (%) Was creative art therapy helpful? Yes 33 (100%) No 0 (0%) Would recommend creative art therapy? Yes 33 (100%) No 0 (0%) Most important thing happeninga Increased awareness of self/behaviors 7 (21%) Helped connect with/express feelings 6 (18%) Discovered old issues that need attention 6 (18%) Allowed time for self-care reflection and quiet 5 (15%) Relaxed to communicate feelings through art 5 (15%) Feel less hopeless/happier 4 (12%) Identified coping and stress management options 3 (9%) Realized importance of individual counseling 3 (9%) Creative art therapy powerful and healing 2 (6%) Saw importance of living in present moment 1 (3%) Feelings validated 1 (3%) Experienced relief/relaxation 1 (3%) Expressed inner thoughts 1 (3%) Increased creativity 1 (3%) Realized process more important than product 1 (3%) Changed perspective on breast cancer 1 (3%) With faith and good will all things are possible 1 (3%) Realized that God is a major part of my life 1 (3%) a Multiple responses.