In 1942, British artist Adrian Hill discovered the benefits of painting and drawing while th recovering from tuberculosis. In the mid-20 century, art therapy was broadly accepted publicly as a therapeutic approach. Art therapy is a kind of therapy done under the guidance of a trained professional to relax or practice self-care by being creative. It can be beneficial to an individual or group in any sort of setting, be it hospitals, communities, home settings, or even school. This therapeutic process can be effective for a range of physical or mental health conditions, including specific health problems with ongoing daily challenges, and helps clients to live a better quality of life. Art therapy improves mood and reduces pain and anxiety when offered at the bedside during acute hospital treatment. Art therapy may be excellent for all patients, regardless of sex, gender, age, ethnicity, and diagnosis. The significant role of nurses is to implement different forms of art therapy on a daily basis, including the development of policies, as these interventions are often less expensive and easier to implement. Researchers want to do a systematic review and establish hospital protocols on art therapy for inpatient departments of hospitals. While providing mainstream treatments, hospital authorities and health care professionals can use forms of art therapy to optimize care and outcomes.

Keywords: Art Therapy, Healing Tool, Health Care, Mental Health, Nursing

Art therapy is an expression of the soul of a human being. Children are considered to have the purest souls, and they love to explore new ideas. These qualities of mind encourage researchers to work in this field.

A systematic review of art therapy sheds light on its benefits and effectiveness for mental and physical well-being.

Modern art therapy focuses on the creation of images or objects that enrich the personality. The art therapist and client establish a psychotherapeutic relationship through self-expression and reflection. Aesthetic outcomes are not expected outcomes of art therapy (Holttum, 2020). Art therapy mostly focuses on the thought process and feelings of the client through the process of creation.

The goal of therapeutic interventions is highly individual and parallel to the developmental needs of children (Rubin, 2005). Education and the learning process are the integrated approach to art therapy, which helps children gain confidence in their expression of feelings and increase their self- esteem.

Need

The term ‘Art therapy’ was coined in 1942 by British artist Adrian Hill, who discovered the benefits of painting and drawing while recovering from tuberculosis. In the mid-20th century, art therapy was broadly accepted publicly as a therapeutic approach. Art therapy is a kind of therapy done under the guidance of a trained professional to relax or practice self-care by being creative. It can be beneficial to an individual or group in any sort of setting, be it hospitals, communities, home settings, or even school. This therapeutic process can be effective for a range of physical or mental health conditions, including post-traumatic stress disorder (PTSD) or trauma, substance use disorder (addiction), dementia, cancer, Parkinson’s disease, stress and anxiety, elderly patients, eating disorders, and clients who have not been diagnosed with specific health problems but face ongoing daily challenges.

Art therapy has the potential to improve mental health, emotional state, and stress, as well as to help clients live a better quality of life.

There are several forms of art therapy, including painting, drawing, sculpture, collage, writing, photography, textiles, and digital media using graphic software or video editing software. In several forms of art therapy, painting plays an important role and can be used in several forms like watercolor, acrylic, spray painting, etc. Other creative therapies are music, dance, drama, poetry, etc. It is the responsibility of professionals to give the client direction toward the appropriate form of therapy. Techniques can vary depending on age, physical or mental abilities, and specific purposes. For example, in the case of children or clients with anxiety who are not able to draw or sketch properly, art therapists can use ‘collage’ techniques and use them for narration or stories. The use of different forms of art can play an important role in the thought process and feelings of an individual’s mind, thus improving mental health and well-being.

Electronic databases like Scopus and PubMed were searched. Systematic methods for study selection and data extraction were used.

Impact of art materials:

Art materials selection for art therapy is the key factor of outcome. Some materials (pointed pencil) provide us to achieve a sense of control, some (clay) gives space to express feeling. Artistic ability is not included in the process. Collage, cut, and paste are some methods that can be done for individuals who have doubts about their abilities.

Stages of art therapy for children with special needs:

Phase 1: The psychotherapeutic relationship with children is the main focus of this phase. A child needs to explore materials and play for 20 to 30 minutes. This will create a safe space to exchange emotions and feelings.

Phase 2: At this point, the child will begin consciously and thoughtfully interacting with the therapist, and the process of creation will begin.

Phase 3: In the final stage, children will be asked to choose preferred materials for creating objects (paper, paintbrush, color, or any other related materials). Therapists may guide patients in creating the desired object by explaining strokes and mixing colors. Therapists can combine the session with story, play, music, and movements. Before moving on to the more complex part of exploring emotions, children need to feel comfortable and safe with the therapist.

Diagram
1. Different aspects for deeper understanding of unfold emotions.

2. Nonverbal behavior of the child

3. Question to facilitate emotional process. 1. Art therapy will focus on certain important aspects to perceive the individual thought (Rubin, 2011).

1. Art therapy will focus on certain important aspects to perceive the individual thought (Rubin, 2011).

Feedback question for adult participants after attending sessions:
1) What feelings do you have with the art therapy treatment?
2) What you find beneficial in these sessions?
3) Is there anything that you feel was ineffective in the protocol?
4) Have you noticed any differences in your reactions to your daily experiences?

5) Have you experienced any differences in your personal relationships?
6) Reflecting back to when you began this process, what differences do you perceive in
your emotions? Daily functioning? Sleep quality? Appetite?
7) Rate your experience on a scale of 1-10 where 1 indicates poor and 10 indicates an
excellent experience?

This paper includes findings from the systematic review of art therapy interventions for different aspects like reduction of anxiety and depression of cancer patients, pain management, mental health issues, and paediatric patients.

In a systematic review by Effa, Dolgoy and McNeely (2020) on Resistance Exercise and Art Therapy on Body Image in Breast Cancer, it has been seen that resistance exercises and art therapy have a positive impact on breast cancer survivors. 08 studies they have reviewed and showed significant within group differences in body image scores.

In the therapeutic potential of bedside art observation in hematologic cancer inpatients: a randomized controlled pilot study by Gore et al., (2022) on 73 hematologic inpatients who engaged in art observation felt that the activity provided positive distraction (85.7%) and decreased boredom (79.6%), and many noted that it reduced feelings of anxiety (46.9%) and depression (24.5%).

Zhang et al., (2015) in their meta-analysis on Effectiveness of Mindfulness-based Therapy for Reducing Anxiety and Depression in Patients with Cancer 2015 stated that mindfulness-based therapy significantly improved anxiety for follow-up ≤12 weeks after the start of therapy of 419 cancer patient.

A single group pre-test posttest was carried out by Joshi et al., 2021 on Effect of Mindfulness-Based Art Therapy (MBAT) on Psychological Distress and Spiritual Wellbeing in 53 Breast Cancer Patients Undergoing Chemotherapy. Here it showed one week of MBAT intervention for breast cancer patients undergoing chemotherapy significantly decreased the psychological distress.

A mindfulness-based art therapy study protocol to determine efficacy in reducing college stress and anxiety by Van Lith et al., (2021) explained the efficacy of a low-cost and easily accessible mental health intervention targeting college students experiencing stress and anxiety. The study showed 73 percent of college students were experiencing at least one mental health crisis in their academic session.

O’Neill Haaga (2015) in her embedded mixed method design on “Effects of Art Therapy Intervention for Chronic Pain and Psychosocial Comorbidities” showed significant decreases in self-reported pain after each session with significant decreases in pain interference, depression, stress, and anxiety after the art therapy intervention. Session 4 was designed to teach relaxation and stress relief as coping strategies through the creation of healing mandalas. Significant findings of pain reduction after Session 4 (t(29) = 3.82, p = 0.001, d= 0.53) may provide evidence of the interplay between stress and pain, which would support current research findings that mandala art can reduce anxiety (Curry & Kasser, 2005).

To present a meaningful meta-analysis, art therapy should be performed by a licensed art therapist in a planned way on a large sample over a longitudinal period of time.

Art is a medium of communication and it enhances abilities to express thought, feeling in a constructive way. This art form can be practiced in an isolated form or combined with music, drama, dance etc. with a small group of neurotypical or neurodiverse children. Art therapy is not necessarily a means of assessing children and their abilities; rather, its therapeutic effects will enhance their confidence in problem solving and conflict resolution.

Implementation

The significant role of nurses is to implement different forms of art therapy on a daily basis, including the development of policies, as these interventions are often less expensive and easier to implement. They can get help from specialists to guide and support the clients in their healing phase. To become an art therapist, more practice is needed in terms of education, training, and professional credentials. In most cases, you may need to be a licensed clinical psychologist, professional counselor, or social worker to provide these services.

Researchers want to do a systematic review and establish hospital protocols on art therapy for inpatient departments. While providing mainstream treatments, hospital authorities and health care professionals can use different forms of art therapy to optimize care and outcomes.

The author is thankful for kind support from Netali Nagar College management for supporting and encouragement to complete the present article.

Curry, N. A., & Kasser, T. (2005). Can coloring mandalas reduce anxiety?. Art Therapy, 22(2), 81-85. https://doi.org/10.1080/07421656.2005.10129441

Effa, C. J., Dolgoy, N. D., & McNeely, M. L. (2020). Resistance exercise and art therapy on body image in breast cancer: a scoping review. Women’s Health Reports, 1(1), 424-435. https://doi.org/10.1089/whr.2020.0058

Gore, E., Daiss, S. D. P., Liesveld, J. L., & Mooney, C. J. (2022). The therapeutic potential of bedside art observation in hematologic cancer inpatients: a randomized controlled pilot study. Supportive Care in Cancer, 30(4), 3585-3592. https://doi.org/10.1007/s00520-021-06747-z

Holttum, S. (2020). BAAT Guidelines on Art Therapy for people with a psychosis-related diagnosis. https://www.academia.edu/44244883/BAAT_Guidelines_on_ Art_Therapy_for_People_with_a_Psychosis_Related_Diagnosis

Joshi, A. M., Mehta, S. A., Pande, N., Mehta, A. O., & Randhe, K. S. (2021). Effect of Mindfulness-Based Art Therapy (MBAT) on Psychological Distress and Spiritual Wellbeing in Breast Cancer Patients Undergoing Chemotherapy. Indian Journal of Palliative Care, 27(4), 552. https://doi.org/10.25259/IJPC_133_21

O’ Neill Haaga, Molly, “Effects of Art Therapy Intervention for Chronic Pain and Psychosocial Comorbidities” (2015). Expressive Therapies Dissertations. 79.

Rubin, J. A. (2005). Child art therapy: 25 anniversay edition. https://doi.org/10.1080/ 15401380802708783

Rubin, J. A. (2011). The Art of Art Therapy: What Every Art Therapist Needs to Know. Routledge. https://doi.org/10.4324/9780203893845

Van Lith, T., Cheshure, A., Pickett, S. M., Stanwood, G. D., & Beerse, M. (2021). Mindfulness based art therapy study protocol to determine efficacy in reducing college stress and anxiety. BMC Psychology, 9(1), 1-8. https://doi.org/10.1186/ s40359-021-00634-2

Zhang, M. F., Wen, Y. S., Liu, W. Y., Peng, L. F., Wu, X. D., & Liu, Q. W. (2015). Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer: a meta-analysis. Medicine, 94(45). https://doi.org/10.1097/ MD.0000000000000897