Integrative behavior
Related Terms
- Activity therapy, art dialogues, art stimulation, CAI, clay modeling, CMGT, computer projective drawing, creative arts intervention, creative expression, cross-modality grief therapy, drama therapy, free drawing, integrative behavior, music therapy, paraverbal therapy, play therapy, poetry therapy, rehabilitation psychiatry, visual art dialogues, visual distraction, visual stimulation.
- Not included in this review: Activity therapy, color therapy, drama therapy, music therapy, play therapy.
Background
- Art therapy became established as a mental health profession in the 1930s and is now practiced in hospitals, clinics, public and community agencies, wellness centers, educational institutions, businesses, and private practices. It involves the application of a variety of art modalities including drawing, painting, clay, and sculpture.
- Art therapy enables the expression of inner thoughts or feelings when verbalization is difficult or not possible. The aesthetic aspect of the creation of art is thought to lift one's mood, boost self-awareness, and improve self-esteem. Art therapy also allows the opportunity to exercise the eyes and hands, improve eye-hand coordination, and stimulate neurological pathways from the brain to the hands.
- Art therapy is commonly used in the treatment of anxiety, depression, and other mental and emotional problems; substance abuse and addictions; family and relationship issues; abuse and domestic violence; and coping with disability or medical illness.
- Art therapy may aid in stress reduction and relaxation.
- Art therapy may aid in both the assessment of problems and their treatment.
- Art therapy may take place individually with an art therapist or in a group setting. It may be conducted as a single session or as a series of sessions.
- The creation of art is itself considered therapeutic as a form of self-expression. However, the formal use of art therapy usually involves discussion and interpretation of the meaning of what the person has created with an art therapist, and possibly with peers in a group situation. Such discussion may foster helpful insights into what the work might reveal about the person's life, goals, aspirations, feelings, or needs.
Theory
- Art therapy is used as a complementary therapy in integrative medicine programs as a means to attain both the psychological and physiological benefits of self-expression. It is based on the principle that creative self-expression is inherently healing and life-enhancing. Therapists need not rely solely on verbal communication, but may gain additional insight from art therapy techniques used by both adults and children.
- Children are particularly responsive to art therapy. Drawing, painting, and constructing with an art therapist may help children communicate difficult issues, reconcile emotions, and reduce stress.
- Through creating and discussing art with an art therapist, one can increase awareness of self, cope with symptoms, cope with stress or trauma, enhance cognitive abilities, and enjoy the pleasures of artistic creativity.
- Self-expression is considered an essential process in psychotherapy with children, adolescents, and their families. Through the process of self-expression, art therapy is believed to help people organize their inner reactions to events in their lives. This enables them to understand and express their feelings more clearly. The organizing function served by art therapy enables people to find meaning in their experience. This in turn may aid them in defining goals and desired outcomes.
- In medical illness, research has established that emotional expression has positive benefits for the immune, nervous, and cardiovascular systems. The psychological and physiological benefits attained through art therapy may contribute to improved quality of life and, theoretically, to the medical course of illness.
Evidence Table
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. |
GRADE * |
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. |
GRADE * |
Art therapy may be an effective means of improving quality of life in the elderly. There is evidence that the non-directed use of visual art (pictures) as a means of encouraging communication among elderly nursing home residents may increase well-being, happiness, peacefulness, satisfaction, and calmness. It may also reduce blood pressure and improve medical health status with regard to reported dizziness, fatigue, pain, and the use of laxatives.
|
B |
Art therapy may be an effective means of improving quality of life in the elderly. There is evidence that the non-directed use of visual art (pictures) as a means of encouraging communication among elderly nursing home residents may increase well-being, happiness, peacefulness, satisfaction, and calmness. It may also reduce blood pressure and improve medical health status with regard to reported dizziness, fatigue, pain, and the use of laxatives.
|
B |
Art has been effectively used as an educational tool to foster the development of empathy and other caregiver qualities in nursing students.
|
B |
Art has been effectively used as an educational tool to foster the development of empathy and other caregiver qualities in nursing students.
|
B |
Art therapy may be an effective intervention for hospitalized, suicidal adolescents. There is evidence that it can be used to aid in developing a sense of identity and optimism about the future. It may also aid in relaxation and willingness to communicate, and may result in shorter hospitalization.
|
B |
Art therapy may be an effective intervention for hospitalized, suicidal adolescents. There is evidence that it can be used to aid in developing a sense of identity and optimism about the future. It may also aid in relaxation and willingness to communicate, and may result in shorter hospitalization.
|
B |
Immigrant and refugee children who are integrated into a new community and school system are at risk of emotional and behavioral problems. Some evidence suggests that a creative expression program involving art therapy may help alleviate these problems, increase self-esteem, and improve social functioning.
|
B |
Immigrant and refugee children who are integrated into a new community and school system are at risk of emotional and behavioral problems. Some evidence suggests that a creative expression program involving art therapy may help alleviate these problems, increase self-esteem, and improve social functioning.
|
B |
Art therapy has been used in only a few studies with AD patients, with some suggestion of benefit in alleviating negative emotions and minimizing problematic behaviors. However, further studies are needed for definitive conclusions.
|
C |
Art therapy has been used in only a few studies with AD patients, with some suggestion of benefit in alleviating negative emotions and minimizing problematic behaviors. However, further studies are needed for definitive conclusions.
|
C |
There is some evidence suggesting that art therapy may help bone marrow transplant patients to strengthen positive feelings, alleviate distress, and clarify their existential/spiritual issues. It may be beneficial for patients who need to deal with emotional conflicts and feelings about life and death.
|
C |
There is some evidence suggesting that art therapy may help bone marrow transplant patients to strengthen positive feelings, alleviate distress, and clarify their existential/spiritual issues. It may be beneficial for patients who need to deal with emotional conflicts and feelings about life and death.
|
C |
Limited evidence suggests that family caregivers of cancer patients may benefit from art therapy to help them cope with the stress of caregiving. Possible benefits include reduced stress, lowered anxiety, increased positive emotions, and increased positive communication with cancer patients and healthcare professionals. Art therapy may also reduce pain and other symptoms in cancer patients. More studies are needed to determine how best to use this form of intervention with this population.
|
C |
Limited evidence suggests that family caregivers of cancer patients may benefit from art therapy to help them cope with the stress of caregiving. Possible benefits include reduced stress, lowered anxiety, increased positive emotions, and increased positive communication with cancer patients and healthcare professionals. Art therapy may also reduce pain and other symptoms in cancer patients. More studies are needed to determine how best to use this form of intervention with this population.
|
C |
It is not clear if play with modeling clay is an effective therapeutic intervention in children with constipation and encopresis. In one study, play with modeling clay was associated with improvement in five of six children, but was limited by lack of a control group.
|
C |
It is not clear if play with modeling clay is an effective therapeutic intervention in children with constipation and encopresis. In one study, play with modeling clay was associated with improvement in five of six children, but was limited by lack of a control group.
|
C |
Art therapy combined with behavior therapy may help reduce the symptoms of mental distress and improve overall health in people experiencing grief reactions.
|
C |
Art therapy combined with behavior therapy may help reduce the symptoms of mental distress and improve overall health in people experiencing grief reactions.
|
C |
It is unclear whether art therapy is an effective intervention to help teenagers define themselves and their life goals or improve their sense of self-efficacy. More studies are needed to explore this use of art therapy.
|
C |
It is unclear whether art therapy is an effective intervention to help teenagers define themselves and their life goals or improve their sense of self-efficacy. More studies are needed to explore this use of art therapy.
|
C |
Art therapy may benefit children hospitalized with leukemia during and after painful procedures. One study suggests the therapy improves cooperation with treatment. Children requested art therapy again when procedures were repeated, and parents reported that children were more manageable after art therapy.
|
C |
Art therapy may benefit children hospitalized with leukemia during and after painful procedures. One study suggests the therapy improves cooperation with treatment. Children requested art therapy again when procedures were repeated, and parents reported that children were more manageable after art therapy.
|
C |
Limited evidence suggests that art therapy, in the context of group psychotherapy, may contribute to the reduction of symptoms of emotional distress in military personnel receiving mental health treatment.
|
C |
Limited evidence suggests that art therapy, in the context of group psychotherapy, may contribute to the reduction of symptoms of emotional distress in military personnel receiving mental health treatment.
|
C |
There is limited evidence suggesting that children with phonological disorders who receive art therapy might have improved phonological output and awareness skills, but more studies are needed to determine the meaning of these findings.
|
C |
There is limited evidence suggesting that children with phonological disorders who receive art therapy might have improved phonological output and awareness skills, but more studies are needed to determine the meaning of these findings.
|
C |
There is some evidence that art therapy combined with regular outpatient psychiatric treatment might enhance functioning of chronic psychiatric patients, at least in the short term. More studies are needed to establish this.
|
C |
There is some evidence that art therapy combined with regular outpatient psychiatric treatment might enhance functioning of chronic psychiatric patients, at least in the short term. More studies are needed to establish this.
|
C |
There is limited evidence suggesting that art therapy may aid in restoring communication in people suffering from schizophrenia, including in children. Some research suggests it may also help patients adhere to treatment more reliably. However, more studies are needed to determine the best use with this population.
|
C |
There is limited evidence suggesting that art therapy may aid in restoring communication in people suffering from schizophrenia, including in children. Some research suggests it may also help patients adhere to treatment more reliably. However, more studies are needed to determine the best use with this population.
|
C |
There is preliminary evidence suggesting that children with sickle cell disease may have improved coping and reduced healthcare visits following art therapy. More studies are needed to verify this.
|
C |
There is preliminary evidence suggesting that children with sickle cell disease may have improved coping and reduced healthcare visits following art therapy. More studies are needed to verify this.
|
C |
There is some evidence suggesting that art therapy may not benefit children with post-traumatic stress symptoms. More studies are needed to determine whether and how this approach may benefit children with PTSD.
|
D |
There is some evidence suggesting that art therapy may not benefit children with post-traumatic stress symptoms. More studies are needed to determine whether and how this approach may benefit children with PTSD.
|
D | * Key to grades
A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
| * Key to grades
A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
| Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Safety
Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.
Attribution
-
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Bibliography
Avrahami D. Visual art therapy's unique contribution in the treatment of post-traumatic stress disorders. J Trauma Dissociation 2005;6(4):5-38.
Broome ME, Maikler V, Kelber S, et al. An intervention to increase coping and reduce health care utilization for school-age children and adolescents with sickle cell disease. J Natl Black Nurses Assoc 2001;12(2):6-14.
Fassino S, Ferrero A. [Art therapy and chronic schizophrenia. Reflections on various aspects of social feelings and the creative self]. Minerva Psichiatr 1992;33(1):73-77.
Feldman PC, Villanueva S, Lanne V, et al. Use of play with clay to treat children with intractable encopresis. J Pediatr 1993;122(3):483-488.
Gabriel B, Bromberg E, Vandenbovenkamp J, et al. Art therapy with adult bone marrow transplant patients in isolation: a pilot study. Psychooncology 2001;10(2):114-123.
Nainis N, Paice JA, Ratner J, et al. Relieving symptoms in cancer: innovative use of art therapy. J Pain Symptom Manage 2006 Feb;31(2):162-9.
Ranmal R, Prictor M, Scott JT. Interventions for improving communication with children and adolescents about their cancer. Cochrane Database Syst Rev 2008 Oct 8;(4):CD002969.
Rousseau C, Drapeau A, Lacroix L, et al. Evaluation of a classroom program of creative expression workshops for refugee and immigrant children. J Child Psychol Psychiatry 2005;46(2):180-185.
Ruddy R, Milnes D. Art therapy for schizophrenia or schizophrenia-like illnesses. Cochrane Database Syst Rev 2005 Oct 19;(4):CD003728.
Schreier H, Ladakakos C, Morabito D, et al. Posttraumatic stress symptoms in children after mild to moderate pediatric trauma: a longitudinal examination of symptom prevalence, correlates, and parent-child symptom reporting. J Trauma 2005;58(2):353-363.
Schut HA, de Keijser J, van den BJ, et al. Cross-modality grief therapy: description and assessment of a new program. J Clin Psychol 1996;52(3):357-365.
Walsh SM. Future images: an art intervention with suicidal adolescents. Appl Nurs Res 1993;6(3):111-118.
Walsh SM, Martin SC, Schmidt LA. Testing the efficacy of a creative-arts intervention with family caregivers of patients with cancer. J Nurs Scholarsh 2004;36(3):214-219.
Wethington HR, Hahn RA, Fuqua-Whitley DS, et al. The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: a systematic review. Am J Prev Med 2008 Sep;35(3):287-313.
Wikstrom, BM. A picture of a work of art as an empathy teaching strategy in nurse education complementary to theoretical knowledge. J Prof Nurs 2003;19(1):49-54.