Towards a description of the elements of art therapy practice for trauma: a systematic review

ABSTRACT

Background

Post-traumatic stress disorder is a debilitating mental health condition that can occur when individuals are exposed to traumatic situations [American Psychiatric Association. (2013). Trauma- and stressor-related disorders. In Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub]. Art therapy has been growing in popularity and acceptance as a therapeutic intervention for trauma over the last 10 years [Nanda, U., Barbato Gaydos, H. L., Hathorn, K., & Watkins, N. (2010). Art and posttraumatic stress: A review of the empirical literature on the therapeutic implications of artwork for war veterans with posttraumatic stress disorder. Environment and Behavior, 42(3), 376–390. https://doi.org/10.1177/0013916510361874], however, there is a sparsity of rigorous, methodologically sound evidence supporting its use. One step towards developing rigorous effectiveness studies is to firstly consolidate an understanding of the elements of art therapy.

Method

A comprehensive systematic search of the literature was performed. Data was extracted to best understand the elements of art therapy using the elements articulated by Borrelli et al. (2005. A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research. Journal of Consulting and Clinical Psychology, 73(5), 852. https://doi.org/10.1037/0022-006X.73.5.852) which include: Design, Training, Delivery, Receipt, and Enactment. The elements were mapped and narratively described.

Findings

A total of 44 studies met eligibility criteria and were included for data extraction and coding. Publications reported study design, treatment enactment, and treatment receipt; however, gaps were seen in the reporting of provider training and the delivery of treatment, prominently the lack of reported treatment delivery guidelines.

Conclusion

This study demonstrated that there is a lack of consistency in the reporting and use of practice guidelines regarding art therapy for trauma, which severely impacts the ability to determine best practice. However, considering that art therapy is focused on consumer exploration with therapist support, it is possible that the lack of guidelines is intentional, rather than incidental. Exploring practitioners’ intent around selection and use of practice guidelines is needed to better understand this phenomenon.

Plain-language summary

Post-traumatic stress disorder is a debilitating mental health condition that can occur when individuals are exposed to traumatic situations. Art therapy has been growing in popularity and acceptance as a therapeutic intervention for trauma over the last 10 years, however, there is still hesitation when considering art therapy as a valid treatment for trauma. Given that funding bodies and medical advisory institutions around the world are increasing their focus on trauma treatments that can demonstrate effectiveness, we need to have a better understanding of what represents good practice for art therapy before we are able to investigate the effectiveness. Without benchmarks for what best practice art therapy looks like, we cannot perform the high-quality studies needed to investigate the effectiveness of art therapy as a trauma treatment. This study performed a systematic search of the academic literature to best understand the elements of art therapy practice for trauma with the aim of consolidating and understanding practice consistency and standardisations in five elements: Design, Training, Delivery, Receipt, and Enactment. A total of 44 studies were included. This study demonstrated that there is a lack of consistency in the reporting and use of practice guidelines regarding art therapy for trauma, which severely impacts the ability to determine best practice and, in turn, to perform studies of effectiveness. However, considering that art therapy is focused on individual exploration with therapist support, it is possible that the lack of practice guidelines is intentional, rather than incidental. By extension, having one singular treatment protocol may not be effective for this type of intervention, as it is impossible to create a treatment manual for such an individualised treatment. It is recommended that the intent behind art therapy practitioners’ reporting and use of practice guidelines is further explored to better understand this trend.

KEYWORDS:

• Art therapy
• treatment design
• clinical practice guidelines
• trauma
• research

Acknowledgements

HBS performed the searches. AW, EP, JJH, and HBS conducted article selection, with data extraction and coding conducted by RP, EP, JJH, and HBS. HBS wrote the first draft of the report with input from KB, JK, AB, MP, AW, RP, EP, & JJH.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Holly Bowen-Salter

Holly Bowen-Salter is the senior research officer for Military and Emergency Services Health Australia and a PhD Candidate at the University of South Australia. Their primary research focus involves the development, implementation and evaluation of interventions and preventative programs for trauma with Military and Emergency Services personnel and their families.

Ashley Whitehorn

Dr Ashley Whitehorn is a research fellow in transfer science at JBI, University of Adelaide. Her interests include evidence-based healthcare and knowledge translation, with experience in multiple synthesis methodologies including systematic and scoping reviews.

Rhianna Pritchard

Rhianna Pritchard is a recent graduate of the University of South Australia Bachelor of Health Sciences program with a professional interest in public health practice and research.

Jocelyn Kernot

Dr Jocelyn Kernot is a lecturer in the Occupational Therapy Program, Allied Health and Human Performance, University of South Australia. Her research interests include the design and evaluation of programs for children and adults that promote physical and mental health and wellbeing. Of particular interest is the translation of research to practice and working with industry partners and end user to design and evaluate programs which address an identified need or issue.

Amy Baker

Dr Amy Baker is a lecturer within the Occupational Therapy Program of the University of South Australia's Allied Health & Human Performance Academic Unit. Her research interests include mental health promotion and suicide prevention, particularly the use of creative arts, sensory and nature-based approaches to support mental health and wellbeing, explored through qualitative and mixed methods research.

Miriam Posselt

Dr Miriam Posselt is a Research Fellow with the University of South Australia and a Clinical Psychologist. Her research and clinical interests are in the areas of trauma and posttraumatic mental health, refugee and asylum seeker mental health, military and veteran health, child and adolescent mental health, suicide intervention and prevention, and the wellbeing and self-care of mental health professionals.

Ella Price

Ella Price is a research assistant at Military and Emergency Services Health Australia. Her primary research focus is the use of adjunct social and therapeutic interventions in service populations.

Jade Jordan-Hall

Jade Jordan-Hall is a research intern at Military and Emergency Service Health Australia. She is finishing her bachelor in health and medical science, majoring in public health. Her interests are health and well-being improvement strategies for Military and Emergency Service Personnel.

Kobie Boshoff

Dr Kobie Boshoff is a senior lecturer in the Occupational Therapy Program and the Director at the International Centre for Allied Health Evidence at the University of South Australia. She has particular expertise in systematic and scoping reviews, in complex program evaluations, mixed methods and qualitative research methods.