How Can Art Therapy Contribute to Mentalization in Borderline Personality Disorder

Front end Psychol. 2020; xi: 686.

Benefits of Art Therapy in People Diagnosed With Personality Disorders: A Quantitative Survey

Suzanne Haeyen

^oneGGNet Centre of Mental Health, Apeldoorn, Netherlands

²KENVAK Research Centre for the Arts Therapies, Heerlen, Netherlands

³Department of the Arts & Psychomotor Therapies Education Plan, HAN Academy of Practical Sciences, Nijmegen, Netherlands

Farid Chakhssi

¹GGNet Centre of Mental Health, Apeldoorn, Netherlands

⁴Department of Psychology, Wellness and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands

Susan Van Hooren

²KENVAK Research Centre for the Arts Therapies, Heerlen, Netherlands

⁵Department of the Arts Therapies Teaching Program, Zuyd University of Applied Sciences, Heerlen, Netherlands

⁶Faculty of Psychology, Open up University of the netherlands, Heerlen, Netherlands

Received 2020 Jan 12; Accepted 2020 Mar 20.

Abstract

Art therapy is widely used and effective in the treatment of patients diagnosed with Personality Disorders (PDs). Electric current psychotherapeutic approaches may do good from this boosted therapy to improve their efficacy. Merely what is the patient perspective upon this therapy? This report explored perceived benefits of art therapy for patients with PDs to let the valuable perspective of patients be taken into account. Using a quantitative survey study over 3 months (Northward = 528), GLM repeated measures and overall hierarchical regression analyses showed that the majority of the patients reported quite a lot of benefit from fine art therapy (mean 3.70 on a 5-signal Likert calibration), primarily in emotional and social functioning. The improvements are concentrated in specific target goals of which the five highest scoring goals afflicted were: expression of emotions, improved (more stable/positive) self-image, making own choices/autonomy, recognition of, insight in, and changing of personal patterns of feelings, behaviors and thoughts and dealing with own limitations and/or vulnerability. Patients made it clear that they perceived these target areas as having been affected by art therapy and said so at both moments in time, with a higher score after three months. The extent of the perceived benefits is highly dependent for patients on factors such as a non-judgmental attitude on the part of the therapist, feeling that they are taken seriously, existence given sufficient liberty of expression but at the aforementioned time existence offered sufficient structure and an adequate basis. Age, gender, and diagnosis cluster did not predict the magnitude of perceived benefits. Art therapy provides equal advantages to a broad target grouping, and so this class of therapy can be broadly indicated. The experienced benefits and the increase over time was primarily associated with the caste to which patients perceive that they tin can give meaningful expression to feelings in their artwork. This provides an indication for the extent of the benefits a person can feel and tin also serve as a clear guiding principle for interventions by the art therapist.

Keywords: fine art therapy, personality disorders cluster B and C, quantitative survey, handling goals, indication, visual arts, benefits

Introduction

Personality disorders (PDs) are indelible and inflexible patterns of cognitions, emotions, interpersonal functioning or impulse command that lead to meaning distress or impairments with an impact on a broad range of personal and social situations (American Psychiatric Association, 2013; World Health Organisation, 2015). Recent meta-analyses take shown that psychotherapy is effective for reducing PD pathology, with significant but small to moderate effect sizes (Stoffers et al., 2012; Budge et al., 2013; Cristea et al., 2017), while psychosocial functioning seems to remain severely dumb in individuals with PDs, and subsequently forms a substantial risk factor for relapse, occurrence or recurrence of symptoms (Zanarini et al., 2009, 2010; Keuroghlian et al., 2013; Chakhssi et al., 2019). Thus, current psychotherapeutic approaches may benefit from additional therapies that may amend upon their efficacy.

Art therapy is one of the therapies that is widely used equally an additional therapy in the treatment of patients with PDs^¹. Fine art therapy is an experiential form of treatment that makes use of art media, creative processes, and the resulting artwork to improve a patient's symptomatic performance while enhancing their well-being. Fine art therapy is aimed at artistic self-expression and reflection of problematic feelings or themes and guided past an fine art therapist. These feelings or themes can exist explored without being directly expressed in words [e.g., Moschini, 2005; Schweizer et al., 2009; Malchiodi, 2012; American Fine art Therapy Clan, 2017; British Association of Art Therapists [BAAT]., 2017]. Difficulties with emotion-regulation are a central result for people diagnosed with a PD (Dixon-Gordon et al., 2017; Haeyen, 2018). Emotion regulation refers to the processes of how people influence experienced emotions: when we have emotions, how nosotros experience them and how we express them (Gross, 1998). The manner people express emotions plays an important role in social interactions (Gross, 2002). Art therapy may help patients to recognize difficult emotions, to integrate conflicting thoughts, feelings or behaviors, and to discover a more than constructive fashion of dealing with them (Eisdell, 2005; Simon, 2005; Haeyen, 2011b, 2018, 2019). Fine art therapy is an integrative wellness profession which has roots in the social sciences, medicine and art (Czamanski-Cohen and Weihs, 2016).

Art therapy for patients with PDs has shown to be effective in a randomized controlled trial, in which art therapy was compared to wait list control showing large furnishings on PD pathology (North = 74) (Haeyen et al., 2018). Additional analyses showed that art therapy contributed equally to decreasing symptoms and improving well-being (Haeyen et al., 2017b). Besides, in ii pilot studies, art therapy amongst patients with primarily antisocial PDs was effective in provoking experiences and feelings (mental states) and promoting a good for you developed mental attitude to these feelings and experiences. Information technology as well improved self-esteem and social relations (Greenish et al., 1987; van den Broek et al., 2011). Several smaller non-comparative quatitative studies written report positive results of art therapy regarding global functioning, handling adherence (Franks and Whitaker, 2007; Eren et al., 2014), sense of solitude and self-centered isolation (Gatta et al., 2014), distress tolerance, service apply (Springham et al., 2012), and expression of emotions (Haeyen, 2011a).

Despite the scarce evidence, this course of therapy is named in some national care guidelines (Landelijke Stuurgroep Multidisciplinaire Richtlijn ontwikkeling in de GGZ, 2008; Alliantie Kwaliteit in de geestelijke gezondheidszorg. [Akwa GGZ], 2017). While it seems to exist related to positive experiences in the practice of professionals and service users, there has been little specific enquiry of this course of therapy. RCTs and other outcome studies are important, just they mainly look at the degree of change in complaints and coping. That is not the whole story. How practise patients view the therapy? What do they retrieve of it themselves? So if we ask them explicitly, we can map out the valuable perspective of the patients and let have their opinion taken into account. This could also assistance to facilitate a better indication for art therapy.

The experiences of patients with PDs are of import, still, these have not been the subject of many studies. Of the few studies performed in samples of patients with PDs, patients perceived relatively more than benefits of fine art therapy than all other therapies (Group psychotherapy, cognitive group therapy, problem solving grouping, body-oriented group therapy, household grouping, and pharmaco therapy) and were given significantly college scores. Too, the perceived benefits of fine art therapy correlated significantly with the perceived overall benefits of the therapeutic program [Karterud and Pedersen, 2004 (Northward = 319)]. More recently, 2 qualitative studies [Haeyen et al., 2015 (Due north = 29); Haeyen et al., 2017a (N = eleven)], institute that participants experienced more insight in their problematic patterns of feelings, thoughts, and behavior, which had not been addressed before and that this process went beyond a conscious, cognitive level. However, these studies leave questions unanswered regarding the more specific benefits of art therapy for patients with PDs, which specific therapeutic goals are perceived, which factors are of import for increasing the do good of the therapy, and for whom art therapy shows the largest benefits. To the best of our knowledge, no study has explored whether PD patients' demographic or clinical characteristics, besides as fine art therapy elements, is associated with their perceived benefits of fine art therapy.

Therefore, the object of the present written report is to focus in depth on studying the personal benefits experienced past patients as a result of art therapy. If we know how patients feel art therapy, and so we can investigate whether the extent to which benefits are experienced is influenced by characteristics that take to practice with the therapist'southward attitude or the extent to which patients felt they were able to limited their feelings in the artwork. This study focuses on the questions: To what caste do patients diagnosed with a PD experience benefits from fine art therapy, does this contribute to perceived improved daily, emotional and/or social functioning and which treatment goals are addressed? Is the experienced benefit related to the extent to which patients can express their feelings in making artwork? This question was added because emotion-regulation problems are a central issue for people diagnosed with a PD. Furthermore, nosotros wanted to explore if some factors or patient characteristics are predictive. Is the extent of benefits gained related to the attitude of the therapist, and what conditions he or she creates? And is fine art therapy more benign for certain persons than for others, looked at from the perspective of age, gender and diagnosis cluster?

Materials and Methods

This report is a exercise-based, quantitative survey study with two assessments covering a period of three months.

Participants

The participants were patients (18+) with at least one DSM-5 PD (American Psychiatric Clan, 2013), who were undergoing specialized treatment as usual, and where art therapy was offered every bit an additional therapy. Exclusion criteria for the current study were the disability to read or speak the Dutch language.

Data were collected from 539 patients with a PD at measurement points one and two. In this group, 27.ane% were diagnosed with a Cluster B personality disorder (Borderline PD north = 116, Narcissistic PD n = 2), 30.1% were diagnosed with a Cluster C PD (Avoidant PD n = 95, Dependent PD north = 13, Obsessive compulsive PD n = 23), and 34.v% with PD not otherwise specified. Almost patients, 78.six%, were women. Age ranged from 19 to 65 (mean: 35.67, SD: 10.12). In a number of cases (northward = 104) diagnostic information was missing. These cases were still included in the analyses because the patients were in treatment in PD specialized care units, which always requires a PD diagnosis. Finally data from 528 of the 539 patients were analyzed based on the completion of the questionnaires at both T1 and T2.

Survey

The survey contained viii questions and xiii statements about perceived benefits from art therapy, associated factors and patient characteristics.

Benefits

The possible benefits from fine art therapy were evaluated with a question nigh the extent to which patients had benefited from the treatment (detail: "Have you benefited from fine art therapy?") and iii sub statements on improvement in their daily/emotional/social functioning during treatment thanks to art therapy (detail example: "My daily functioning has improved through art therapy." The overall question was formulated following the report of Karterud and Pedersen (2004). In this report every patient was asked "how much do good did you gain from therapy x?" We added the three sub statements focused on daily/emotional/social operation based on the practice based classification of treatment goals used in a pinnacle clinical institute for PDs. The question and the statements were scored on a five-signal Likert scale from "(1) none" to "(five) a lot." The Cronbach's alpha of this scale was 0.88, minimum 2.86, maximum 3.55, a range of 1.06, variance of 0.24 and a mean of 3.55. Exam–retest reliability with boilerplate interval of two weeks showed a Pearson'due south correlation of r = 0.89 for the overall question, r = 0.79 for the item about daily functioning, r = 0.79 for emotional, and r = 0.72 for social functioning.

Perceived benefits related to treatment goals were and so examined using ix items which asked whether art therapy had contributed to a specific treatment goal such every bit a clearer self-epitome, increased self-conviction/cocky-esteem, or the expression of feelings/showing emotions ("Which personal areas have improved through art therapy?" Particular examples: "Clearer cocky-image (who I am, what I desire, what I tin do)" or "Making your own choices and self-determination"). This pick of specific treatment goals emerged in previous inquiry as relevant for this target grouping (Haeyen et al., 2015). The diverse treatment goals were evaluated by participants with a dichotomous scale request participants to bespeak for each goal whether or non it had been achieved in art therapy. The internal consistency of these items was 0.82 measured with Cronbach's alpha. The test–retest reliability with average interval of 2 weeks of each item/each handling goal varied from 0.51 to 0.seventy measured with Spearman's rho (ρ). These items were analyzed on a single item level and because we wanted to explore each goal by itself and therefore were non considered equally a scale.

Associated Factors

The factors related to art therapy and the therapist's attitude were examined using five independent statements: – the relationship with the therapist, in which the therapist adopted a non-judgmental attitude (particular: "The art therapist responds to me in a non-judgmental manner"); – the feeling that patients were taken seriously (particular: "I feel that I am taken seriously in art therapy"); – the degree of structure offered (item: "I receive sufficient guidance to create artwork during the sessions"); – the level of freedom offered in the therapy (item: "I have sufficient freedom to express myself through working in art"). These aspects were scored on a v-point Likert scale from "(1) never true" to "(5) almost always true." 1 item asked almost the extent to which a person could express his or her feelings in creating artwork in the art therapy sessions, for which the same Likert calibration was used (item: "I am able to express my feelings through the procedure of making art"). These items were analyzed on a unmarried item level because we wanted to have a specific look at the content of each detail. Test–retest results showed a Pearson'south correlation in the range of r = 0.50 to 0.85. More specifically: Non-judgmental therapist r = 0.60, Feel taken seriously r = 0.fourscore, Sufficient freedom for expression r = 0.50, Sufficient guidance r = 0.70 and Expression of feelings in the fine art piece of work r = 0.85.

Patient Characteristics as Predictors

In club to investigate which participant reported more benefits than for others, the following aspects were examined: age (continuous), gender (male/female person), and diagnosis cluster. Diagnosis cluster was divided into the subgroups of cluster B, cluster C, and PD (not otherwise specified), since these were the most frequent diagnoses within the unabridged grouping. The partitioning in clusters was too based on meaningful clinical groups with a large enough sample to exist looked at separately. These aspects were variables on a single item level.

Procedure

The participants were recruited past 18 fine art therapists working in specialized departments for PD handling at six big mental health care institutions in Netherlands in order to obtain a nationwide representative sample. All treatments were multidisciplinary, with a grouping form of art therapy (and to a much lesser extent, private therapy) as boosted therapy. Participants agreed to their participation past ways of an informed consent form and and then completed the questionnaire at the first measurement point (after at to the lowest degree 3 sessions) and at a second measurement bespeak, subsequently 3 months. The first and second writer are working in 1 of these wellness care institutions. Since the data collection was performed in 6 institutions, we consider there was no conflict of interest. At that place seems to be no question of effects of social desirability bias considering data drove was performed in vi institutions and the questionnaire was handed out by the therapist or by colleagues, but in any case by persons other than the researchers.

The procedure for data handling was as follows: we prevented as much as possible missing data past collecting a big part of the survey digitally and missing data were non accepted to the completion of the questionnaire. For the other part, the survey was offered paper and pencil wise. If just very few missing data occurred in a questionnaire, the mean value of a variable was used in identify of the missing data value for that same variable (mean exchange). The mean is a reasonable guess for a randomly selected observation from a normal distribution. The sample seems large plenty and power does non seem an issue.

Data Assay

Data were analyzed with IBM SPSS 24 (International Business Machines [IBM], 2013). Firstly, we investigated the level of reported benefit from art therapy (research question 1) (overall and in the case of daily, emotional and social functioning) and alter over fourth dimension using GLM repeated measures process with time as a inside-subject field gene. The 9 items referring to specific treatment goals and whether these inverse over fourth dimension were examined based on chi square tests.

In order to examine the research question 2, we correlated the associated factors with the overall perceived benefits and three sub questions: benefits for daily, emotional, and social functioning.

For research question three "to examine whether differences in patient characteristics could predict the magnitude of perceived benefits" (patient characteristics as predictor), we used Pearson correlations for historic period and chi square for gender and diagnosis. In overall hierarchical regression analyses we too tested whether benefits afterwards three months could be predicted past benefits experienced at T1, the specific treatment goals, associated factors, age and gender, and PD diagnosis cluster. This model (see Figure 1) was tested for overall benefits and for the 3 domains, i.e., daily, emotional, and social functioning. It was tested in five steps using the enter method, i.due east., pace 1, perceived benefits at T1; step 2, specific treatment goals at T1; step 3, associated factors; pace four, age and gender; and step v, cluster of PD diagnosis. This model was tested for overall benefits equally well every bit the three domains of daily, emotional, and social operation.

An external file that holds a picture, illustration, etc. Object name is fpsyg-11-00686-g001.jpg

Frequencies of specified benefits of fine art therapy (%) (N = 528).

Results

Research Question i: Reported Benefits of Art Therapy

The majority of patients reported that they had quite a lot of benefits from art therapy in general with a mean of 3.seventy (SD = 0.99) on T2 (T1: fifty.iii%; T2: 56.4%). Only 2.ii% (T1) and one.5% (T2) of patients reported that they perceived no benefits in general. For benefits relating to emotional functioning, 25.2% of the patients reported these benefits at T1 and 31.8% reported this at T2. For daily and social functioning the percentages were lower (daily functioning, T1: 14.iii% and T2: xvi.5%; social functioning T1: 12.1% and T2: 16.9%). The results of the GLM repeated measures showed that the reported overall benefits increased afterwards three months of art therapy F(1,527) = 13.05, p < 0.001. This was also the example for benefits in emotional functioning F(1,526) = half-dozen.262, p < 0.05 and in social operation F(one,527) = 5.73, p < 0.05, see Table 1.

Table 1

Benefits of art therapy, GLM repeated measures analyses (N = 528).

	T1 mean (SD)	T2 mean (SD)	Df* T1, T2	F	Sig.	Partial eta squared η²
Benefit – overall	3.56 (1.04)	3.70 (0.99)	one, 527	thirteen.05	0.00	0.024
Daily functioning	ii.57 (one)	2.57 (1.02)	1, 526	0.008	0.93	0.000
Emotional functioning	2.88 (i.06)	3.00 (1.06)	1, 526	6.262	0.01	0.012
Social functioning	2.50 (0.97)	two.60 (0.99)	ane, 527	5.73	0.02	0.011

As to whether art therapy contributed to specific treatment goals, a similar pattern over time was seen, encounter Figure 1. At both points, the most oft reported specific treatment goals were expression of emotions (T1: 71.v%; T2: 76.1%), improved (more than stable/positive) self-image (T1: 69.2%; T2: 73.one%), making ain choices/autonomy (T1: 68.three%; T2: 72.7%), recognition of, insight in and irresolute of personal patterns of feelings, behaviors, and thoughts (T1: 62.vii%; T2: 71.2%) and dealing with own limitations and/or vulnerability (T1: 62%; T2: 67.5%). Using chi square, it was shown for each specific treatment goal that it was more frequently reported at T2 than at T1 (p < 0.01).

Enquiry Question 2: Associated Factors

Pearson'due south correlation coefficient (r) was used to examine whether the reported benefits were associated with specific factors relating to the therapist'south mental attitude or the extent to which patients were able to experience expressing their feelings in the artwork in the art therapy sessions (see Table 2). The various aspects proved to correlate with the degree of perceived benefits. Specially the extent to which a person can express his or her feelings in the artwork showed a high correlation (ranging from r = 0.47 for social operation to r = 0.72 for overall benefit).

Table ii

Pearson correlation (r) betwixt benefits and a number of variables at T2 (N = 528).

Items	Did you benefit from art therapy?	My daily functioning improved thanks to art therapy	My emotional functioning improved thank you to fine art therapy	My social performance improved thanks to fine art therapy
Non-judgmental therapist	0.xviii**	0.16**	0.14**	0.07
Being taken seriously	0.39**	0.29**	0.29**	0.24**
Sufficient freedom of expression	0.32**	0.27**	0.27**	0.22**
Sufficient structure/adequate basis	0.33**	0.22**	0.26**	0.23**
Extent to which feelings could be expressed in the artwork in AT	0.72**	0.51**	0.60**	0.47**

Research Question 3: Patient Characteristics as Predictor

Diagnosis, age, and gender were non related to the reported benefits in general, nor to the benefits reported on daily, emotional, or social functioning; run across Tabular array 3. Only on the item "my social performance improved thanks to fine art therapy" did sixteen.1% of the women indicate more often than men (6.i%) that their social functioning had not improved cheers to art therapy. And 18.3% of the men stated more oftentimes than the women (12.5%) that their social functioning had improved thanks to art therapy.

TABLE three

Chi-square test on benefits and several variables on T2 (Northward = 528).

Items	Did you lot benefit from art therapy?	My daily functioning improved thank you to art therapy	My emotional functioning improved thanks to art therapy	My social functioning improved thanks to art therapy
Gender	0.72	0.12	0.84	0.03^a
Diagnosis cluster B, C, UPD^b	0.24	0.89	0.88	0.74

Testing the overall model using hierarchical regression analyses, it was shown that the increment in reported overall benefits at T2 is associated with the extent to which the patient experienced existence able to express his or her feelings in the artwork during the fine art therapy. The baseline values were predictive for increase in reported benefits of art therapy. No other specific do good, therapeutic or patient characteristic was found to be associated with this increase. A like blueprint was shown for the consequence of reported benefits on emotional performance. Only for social functioning, the increase in reported benefits was associated with whether art therapy focused on coping with limitations and/or vulnerability. Table 4 shows the results of these hierarchical regression analyses.

Tabular array 4

Hierarchical regression assay between perceived benefits at T2 and variables at T1 (N = 528).

	Overall benefits				Daily functioning				Emotional functioning				Social performance

	Δ R ²	B	SE	β	Δ R2	B	SE	β	Δ R2	B	SE	β	Δ R2	B	SE	β
Footstep ane: Experienced benefits on T1	0.49^∗∗	0.52	0.07	0.54^∗∗	0.32^∗∗	0.45	0.07	0.44^∗∗	0.30^∗∗	0.39	0.07	0.39^∗∗	0.39^∗∗	0.49	0.07	0.50^∗∗
Step 2: Specific benefits on T1	0.01				0.05^∗				0.03				0.04^∗
Expression of emotions		0.xi	0.13	0.05		0.08	0.14	0.03		0.11	0.xvi	0.05		0.xviii	0.thirteen	0.08
Self image		–0.15	0.21	–0.07		0.07	0.13	0.03		–0.29	0.fifteen	–0.12		–0.12	0.13	0.03
Ain choices/autonomy		0.16	0.12	0.07		0.00	0.14	0.00		0.thirteen	0.fifteen	0.05		0.07	0.13	0.03
Recognition, insight and changing patterns		–0.03	0.11	–0.02		–0.x	0.12	–0.05		–0.03	0.14	–0.01		0.09	0.12	0.05
Dealing with limitations/vulnerability		–0.10	0.11	–0.05		–0.28	0.12	–0.14		–0.17	0.xiv	–0.08		–0.27	0.12	−0.13^∗
Self-conviction		–0.02	0.12	–0.01		–0.22	0.xiii	–0.11		–0.thirteen	0.fifteen	–0.06		–0.22	0.13	–0.11
Focused attending to ain actual signals		0.xvi	0.x	0.08		–0.01	0.11	–0.01		0.07	0.12	0.03		–0.07	0.11	–0.03
Addressed traumatic experiences		0.13	0.xi	–0.06		0.03	0.12	0.02		0.14	0.13	0.06		0.01	0.11	–0.00
Improved social functioning		0.06	0.10	0.03		–0.14	0.eleven	–0.07		–0.03	0.12	–0.02		0.02	0.eleven	0.01
Footstep 3: Associated factors	0.02^∗				0.01				0.03^∗				0.01
Non-judgmental therapist		–0.03	0.08	–0.02		–0.04	0.09	–0.03		–0.14	0.10	–0.08		–0.05	0.08	–0.03
Existence taken seriously		0.07	0.08	0.05		0.fourteen	0.09	0.10		0.04	0.10	0.03		–0.03	0.08	–0.02
Liberty of expression		–0.05	0.07	–0.04		–0.13	0.08	–0.10		–0.01	0.08	–0.01		–0.05	0.07	–0.04
Structure/adequate ground		0.04	–0.05	0.04		0.03	–0.06	0.02		–0.01	–0.06	–0.01		0.06	–0.05	0.05
Extent to which feelings could be expressed in the artwork in AT		0.21	0.06	0.21^∗∗		0.03	0.07	0.03		0.23	0.08	0.21^∗		0.12	0.06	0.13^∗
Stride 4: Gender/historic period	0.00				0.00				0.00				0.00
Gender		–0.01	0.10	–0.01		–0.13	0.12	–0.05		–0.12	0.thirteen	–0.05		–0.05	0.xi	–0.02
Historic period		–0.00	0.01	–0.04		–0.00	0.01	–0.02		–0.00	0.01	–0.03		0.00	0.01	0.03
Step 5: Diagnosis cluster	0.00	0.07	0.05	0.06	0.00	0.08	0.06	0.07	0.00	0.05	0.06	0.04	0.00	0.02	0.05	0.02

Discussion

This study investigated the extent to which patients who have been diagnosed with a PD experienced benefits from fine art therapy, and whether it contributed to the improvement of their daily, emotional, and/or social operation. It as well looked at the correlation with the extent to which people can limited their feelings in making artwork, with the conditions created by the therapist, and whether some persons reported more benefits from art therapy than others.

The bulk of patients in the group studied (mainly Deadline, Avoidant, and PDs not otherwise specified) reported that they had gained quite a lot of benefits from art therapy in general with a hateful of 3.70 (SD = 0.99) on T2 (T1: l.iii%; T2: 56.iv%). The greatest positive change could exist seen in answer to the overarching question equally to overall do good. Benefits in emotional functioning and social performance also showed significant improvements, whereas any benefit to daily functioning did non involve a pregnant modify. This fits the expectation that fine art therapy is focused on emotional aspects and considering art therapy is more often than not in a group, it also affects social functioning. The improvements are concentrated in specific target goals of which the five highest scoring goals affected were: expression of emotions, improved (more than stable/positive) self-image, making own choices/autonomy, recognition of, insight in and changing of personal patterns of feelings, behaviors and thoughts and dealing with own limitations and/or vulnerability. Patients made it clear that they perceived these target areas as having been affected by fine art therapy and said so at both moments in fourth dimension, with a college score afterwards 3 months.

These findings are in correspondence with previous studies in which art therapy came forward as highly suitable for and appropriate to the key problems of patients with PDs, that information technology offers a well-defined route to a stronger emotional sensation and contributes to constructive emotion regulation (Green et al., 1987; Franks and Whitaker, 2007; Eren et al., 2014; Haeyen et al., 2015, 2017a,b, 2018). Besides, the nowadays study looked into the interplay betwixt the caste of do good and various factors: the specific treatment goals, associated factors, historic period and gender, and PD diagnosis cluster.

A strong correlation was found betwixt the level of benefit reported and factors such equally a not-judgmental attitude on the part of the therapist, feeling that one was taken seriously, having sufficient freedom of expression, while at the same fourth dimension offering sufficient structure and an adequate basis. Particularly, the extent to which patients tin express their feelings in their artwork shows a stiff correlation with social functioning, and is highest for overall benefit. And so, when patients feel they tin can express themselves in the art work, they also feel they tin share this experience with others. Doing and so, it also affects social aspects, which fits the idea that making meaningful fine art in the presence of others can function equally a span for communication most emotion related themes between the patient and others, including therapists.

Factors that did not prove any meaning correlation were age and gender. Art therapy in this study came forward as not primarily benign for men or for women, for younger or older people. Simply the aspect "improved social functioning" scored somewhat higher for men than for women. This might indicate that the women see this less as a goal for themselves, whereas the group of men finds but the opposite. There was no difference between extent of benefit and the various diagnostic clusters. And then in this study information technology made no deviation whether a person had a diagnosis in the categories cluster B, cluster C, or PDs not otherwise specified. For each of these diagnostic clusters, art therapy was every bit beneficial.

What ultimately came forrard is that the increase in reported overall benefits is associated with the extent to which a patient has experienced that he or she can express his or her feelings in the artwork during the art therapy. No other specific benefit, therapeutic characteristic or patient feature was found to be associated with this increase. A like design was shown for reported benefits on emotional functioning. For daily and social operation, the increase in reported benefits was associated with coping with disability and/or vulnerability. This does not mean that only patients are indicated for art therapy who take previous experience with expressing themselves in art or have the expectation that they will be able to express their feelings in art. Being able to express feelings in art is a skill that can be stimulated in art therapy, for which coming out of their comfort zone is therapeutic and triggering this possibility for self-expression in culling way next to exact expression.

This written report has a number of limitations. Firstly, the dropouts from art therapy were not included in the analyses since no data were known at the time of measurement ii. This may have affected the results. Even so, the sample involved was large enough to be concerned representative. A second limitation is that the menstruation of 3 months was a period in the class of an ongoing treatment. A clearly defined starting point might yield a clearer image or clearer results. Withal, the start of a specialized treatment is seldom a clear starting signal in the aid and support programs of the patients in this target group, who have oftentimes had to deal with issues in various fields of life for many years, and have oftentimes been through numerous therapy processes, often resulting in few, temporary or variable furnishings. Later all, their issues often consist of persistent patterns that take long existed and are typical of this diagnosis.

A third limitation is that art therapy is not isolated in this study. Information technology was generally offered as part of a broader handling program, so that changes in benefits might exist dependent on several factors, and not but on art therapy. An statement against this is that this survey posed specific questions with a focus on art therapy. Still, this report does non have a control group so cause and consequence conclusions are non possible and the repeated measures analyses yielded results with small effect sizes. A quaternary limitation is that this study did not look at the relationship between the experienced benefits and aspects such as culture or IQ. These aspects might also be of influence, and it is recommended that they be included in subsequent studies. Lastly, this study gives no insight into how do good from fine art therapy is achieved, what factors are operative in art therapy and what interventions are decisive in this regard. This study primarily looked at secondary factors.

The strengths of this study are that it was conducted in the target group concerned, it was close to daily exercise and involved a large group of participants, meaning that a sample of sufficient size could be assumed every bit the starting point. Equally far as we know, a study of art therapy of this telescopic inside this specific target group was not conducted previously. In improver, often the participants in this study could non specifically choose art therapy, but it was a standard part of a broader, multidisciplinary handling plan. This does not mean that only participants with an affinity for art therapy took office, but that a considerable number of participants may have had piffling or no affinity with art therapy or artwork. In do, patients often say that art therapy is outside their condolement zone. Because the study did not involve merely participants with leanings toward artwork, the results would probably give a more objective moving-picture show if this had been the example.

Conclusion

Patients diagnosed with a PD indicated that they experienced quite some benefit from art therapy. This is primarily shown in learning to limited emotions, reinforcing and stabilizing their self-paradigm, learning to brand their own choices and strengthen their autonomy, recognizing, gaining insight into and changing their own patterns in feeling, thinking and acting. They likewise regarded learning to deal with their ain limitations and/or their ain vulnerability every bit an important goal of therapy. These target areas are perceived at the outset by patients equally applicative in art therapy, and afterward a while it is seen even more strongly in this light.

The extent of the perceived benefits is highly dependent for patients on factors such equally a non-judgmental mental attitude on the part of the therapist, feeling that they are taken seriously, being given sufficient freedom of expression but at the same time being offered sufficient structure and an acceptable footing. Age, gender, and diagnosis cluster brand no difference for the extent of the benefits experienced by a person. Art therapy provides equal advantages to a wide target group, and and so this course of therapy can be broadly indicated. What does come up forward is that the extent to which people perceive that they can give meaningful expression to feelings in their artwork is decisive. This provides an indication for the extent of the benefits a person can feel and tin can too serve every bit a articulate guiding principle for interventions past the art therapist.

Data Availability Statement

The datasets generated for this study are bachelor on asking to the corresponding author.

Ethics Statement

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this written report.

Author Contributions

SH developed the research design, conducted the research, and first authored this article. SH and SV performed the statistical analysis. SV supervised the evolution of the research blueprint and research process. SV and FC co-authored this article.

Conflict of Interest

The authors declare that the inquiry was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors would like to thank all participating patients, fine art therapists, and mental wellness care institutions for their cooperation. Thanks are also due to Arjan Doolaar for the APA check, and Ballad Stennes for the translation.

Footnotes

ⁱFine art therapy is an integral part of the treatment for personality disorders in many larger national healthcare institutes in Netherlands, due east.g., GGNet/Scelta, De Viersprong, Mediant, GGZ Friesland, Mondriaan, ProPersona, Synaeda, University Medical Center Groningen, GGZ Noord Holland Noord, GGZ Drenthe, GGZ Oost Brabant, Dimence and Lentis.

References

Alliantie Kwaliteit in de geestelijke gezondheidszorg. [Akwa GGZ] (2017). Zorgstandaard Persoonlijkheidsstoornissen. Utrecht: Akwa GGZ. [Google Scholar]
American Art Therapy Association (2017). What is Art Therapy?. Available online at: http://arttherapy.org/ (accessed March 15, 2017). [Google Scholar]
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders , fifth Edn Washington, DC: Author. [Google Scholar]
British Association of Fine art Therapists [BAAT]. (2017). Habitation. Available online at: http://world wide web.baat.org/ (accessed March xv, 2017). [Google Scholar]
Budge S. L., Moore J. T., Del Re A. C., Wampold B. East., Baardseth T. P., Nienhuis J. B. (2013). The effectiveness of evidence-based treatments for personality disorders when comparing treatment-as-usual and bona fide treatments. Clin. Psychol. Rev. 33, 1057–1066. 10.1016/j.cpr.2013.08.003 [PubMed] [CrossRef] [Google Scholar]
Chakhssi Yard., Zoet M., Oostendorp J., Noordzij Yard. L., Sommers-Spijkerman M. (2019). Issue of psychotherapy for borderline personality disorder on quality of life: a systematic review and meta-analysis. J. Personal. Disord. 0 1–15. 10.1521/pedi_2019_33_439 [PubMed] [CrossRef] [Google Scholar]
Cristea I. A., Gentili C., Cotet C. D., Palomba D., Barbui C., Cuijpers P. (2017). Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry 74, 319–328. 10.1001/jamapsychiatry.2016.4287 [PubMed] [CrossRef] [Google Scholar]
Czamanski-Cohen J., Weihs K. L. (2016). The bodymind model: a platform for studying the mechanisms of modify induced past fine art therapy. Arts Psychother. 51 63–71. 10.1016/j.aip.2016.08.006 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Eisdell N. (2005). A conversational model of fine art therapy. Psychol. Psychother. 78, 1–19. 10.1348/147608305X40840 [PubMed] [CrossRef] [Google Scholar]
Dixon-Gordon K. L., Turner B. J., Rosenthal M. Z., Chapman A. L. (2017). Emotion regulation in borderline personality disorder: an experimental investigation of the effects of instructed credence and suppression. Behav. Ther. 48 750–764. ten.1016/j.beth.2017.03.001 [PubMed] [CrossRef] [Google Scholar]
Eren N., Öğünç North. Eastward., Keser V., Bıkmaz Due south., Şahin D., Saydam B. (2014). Psychosocial, symptomatic and diagnostic changes with long-term psychodynamic art psychotherapy for personality disorders. Arts Psychother. 41 375–385. x.1016/j.aip.2014.06.004 [CrossRef] [Google Scholar]
Franks Chiliad., Whitaker R. (2007). The epitome, mentalisation and grouping art psychotherapy. Int. J. Art Ther. 12 3–sixteen. 10.1080/17454830701265188 [CrossRef] [Google Scholar]
Gatta M., Gallo C., Vianello M. (2014). Art therapy groups for adolescents with personality disorders. Arts Psychother. 41 1–6. 10.1016/j.aip.2013.11.001 [CrossRef] [Google Scholar]
Greenish B. 50., Wehling C., Talsky G. J. (1987). Group art therapy every bit an adjunct to treatment for chronic outclients. Hosp. Commun. Psychiatry 38 988–991. 10.1176/ps.38.ix.988 [PubMed] [CrossRef] [Google Scholar]
Gross J. (2002). Emotion regulation: affective, cognitive, and social consequences. Psychophysiology 39 281–291. [PubMed] [Google Scholar]
Gross J. J. (1998). The emerging field of emotion regulation: an integrative review. Rev. Gen. Psychol. 2 271–299. 10.1037/1089-2680.2.3.271 [CrossRef] [Google Scholar]
Haeyen S. (2011a). De verbindende Kwaliteit van Beeldende Therapie: Effecten Van Beeldende Therapie in de Behandeling van Persoonlijkheidsstoornissen [The Connecting Quality of Art Therapy: Effects of fine art Therapy in the Treatment of Personality Disorders]. Antwerpen: Garant. [Google Scholar]
Haeyen S. (2011b). "Vaktherapie: De kracht van de ervaring [art therapy: the ability of feel]," in Handboek borderline persoonlijkheidsstoornis [Deadline Personality Disorderhandbook] , eds Ingenhoven T., van Reekum A., van Luyn B., Luyten P. (Utrecht: De Tijdstroom; ), 215–227. [Google Scholar]
Haeyen S. (2018). Furnishings of Fine art Therapy. The Example of Personality Disorders cluster B/C. Doctoral dissertation, Raboud University, Nijmegen. [PubMed] [Google Scholar]
Haeyen Due south. (2019). Strengthening the healthy adult self in art therapy: using schema therapy as a positive psychological intervention for people diagnosed with personality disorders. Front. Psychol. 10:644. 10.3389/fpsyg.2019.00644 [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]
Haeyen Southward., Kleijberg One thousand., Hinz Fifty. D. (2017a). Fine art therapy for clients with personality disorders cluster B/C: a thematic analysis of emotion regulation from client and art therapist perspectives. Int. J. Art Ther. 23 156–168. x.1080/17454832.2017.1406966 [CrossRef] [Google Scholar]
Haeyen S., van Hooren S., van der Veld Westward., Hutschemaekers G. (2017b). Promoting mental health versus reducing mental illness in fine art therapy with clients with personality disorders: a quantitative report. Arts Psychother. 58 11–16. 10.1016/j.aip.2017.12.009 [CrossRef] [Google Scholar]
Haeyen S., van Hooren S., Hutschemaekers G. (2015). Perceived effects of fine art therapy in the treatment of personality disorders, cluster B/C: a qualitative study. Arts Psychother. 45 one–10. ten.1016/j.aip.2015.04.005 [CrossRef] [Google Scholar]
Haeyen S., van Hooren S., van der Veld Westward., Hutschemaekers K. (2018). Efficacy of art therapy in individuals with personality disorders cluster B/C: a randomized controlled trial. J. Personal. Disord. 32 527–542. 10.1521/pedi_2017_31_312 [PubMed] [CrossRef] [Google Scholar]
International Business organisation Machines [IBM] (2013). IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: Author. [Google Scholar]
Karterud S., Pedersen K. (2004). Short-term day infirmary treatment for personality disorders: benefits of the therapeutic components. Ther.Commun. 25 43–54. [Google Scholar]
Keuroghlian A. S., Frankenburg F. R., Zanarini M. C. (2013). The relationship of chronic medical illnesses, poor health-related lifestyle choices, and wellness care utilization to recovery status in borderline patients over a decade of prospective follow-up. J. Psychiatr. Res. 47 1499–1506. [PMC free article] [PubMed] [Google Scholar]
Landelijke Stuurgroep Multidisciplinaire Richtlijn ontwikkeling in de GGZ (2008). [National Advisory Commission Regarding Multidisciplinary Guidelines for Evolution in Mental Healthcare]. Multidisciplinaire Richtlijn Persoonlijkheidsstoornissen: Richtlijn voor de diagnostiek en behandeling van volwassen patiënten met een persoonlijkheidsstoornis [Multidisciplinary Guideline for Personality Disorders: Guideline for the diagnosis and treatment of adult clients with personality disorder]. Utrecht: Trimbos Found. [Google Scholar]
Malchiodi C. (2012). Handbook of Art Therapy (2nd Edn). New York, NY: Guildford Press. [Google Scholar]
Moschini L. B. (2005). Cartoon the Line: Fine art Therapy With the Hard Client. Hoboken, NJ: John Wiley. [Google Scholar]
Schweizer C., Bruyn J., Haeyen South., Henskens B., Rutten-Saris M., Visser H. (2009). Handboek beeldende therapie: Uit de verf [Handbook of Art Therapy: Limited Yourself]. Houten, Netherlands: Bohn Stafleu van Loghum. [Google Scholar]
Simon R. Yard. (2005). Cocky-Healing Through Visual and Verbal Art Therapy. London, United kingdom: Jessica Kingsley. [Google Scholar]
Springham Due north., Findlay D., Forest A., Harris J. (2012). How tin art therapy contribute to mentalization in deadline personality disorder? Int. J. Art Ther. 17 115–129. 10.1080/17454832.2012.734835 [CrossRef] [Google Scholar]
Stoffers J., Vollm B., Rucker G., Timmer A., Huband North., Lieb K. (2012). Psychological therapies for people with borderline personality disorder. Cochrane Database Syst. Rev. 8:CD005652. 10.1002/14651858.CD005652.pub2. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
van den Broek East., Keulen-de Vos G., Bernstein D. P. (2011). Arts therapies and Schema Focussed therapy: a pilot written report. Arts Psychother. 38 325–332. 10.1016/j.aip.2011.09.005 [CrossRef] [Google Scholar]
World Health Arrangement (2015). International Nomenclature of Diseases, Tenth Revision, Clinical Modification (ICD-ten-CM). Geneva: Author. [Google Scholar]
Zanarini Thousand. C., Frankenburg F. R., Reich D. B., Fitzmaurice G. (2010). The ten-twelvemonth course of psychosocial functioning among patients with borderline personality disorder and centrality II comparison subjects. Acta Psychiatr. Scand. 122 103–109. [PMC gratis article] [PubMed] [Google Scholar]
Zanarini M. C., Jacoby R. J., Frankenburg F. R., Reich D. B., Fitzmaurice G. (2009). The 10-year form of social security disability income reported past patients with deadline personality disorder and axis Two comparison subjects. J. Personal. Disord. 23 346–356. [PMC gratis commodity] [PubMed] [Google Scholar]

Articles from Frontiers in Psychology are provided hither courtesy of Frontiers Media SA

fleenoriltor1986.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174707/