An exploration of the qualities and features of art apps for art therapy

Using a participatory design (PD) approach, this study explored the qualifying features and qualities of digital art materials, specifically art apps on iPads, for art therapy use. The qualitative study included a questionnaire survey of 4 art therapists using iPads with clients in therapy and four separate focus groups with 15 art therapist participants. The focus group participants engaged in art directives with nine art making apps identified as potentially useful in art therapy. The results revealed that while no single commercial art app satisfied the needs of all art therapists and potential clients, three distinct qualities and six concrete features of an “ideal” art app for art therapy emerged. These desirable criteria of an art app can be used in the future development of a customized art app for art therapy. In addition, these findings may expand the parameters of art therapy's art making practice and artistic vocabulary by illustrating the potential therapeutic and expressive use of digital art media. While the findings reveal unlimited possibilities for the meaningful use of digital art media in art therapy, they also acknowledge how the unique characteristics of digital art media will require carefully considered limitations and restrictions.     

The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

Post-traumatic stress disorder (PTSD), a diagnosis that may follow the experience of trauma, has multiple symptomatic phenotypes. Generally, individuals with PTSD display symptoms of hyperarousal and of hyperemotionality in the presence of fearful stimuli. A subset of individuals with PTSD; however, elicit dissociative symptomatology (i.e., depersonalization, derealization) in the wake of a perceived threat. This pattern of response characterizes the dissociative subtype of the disorder, which is often associated with emotional numbing and hypoarousal. Both symptomatic phenotypes exhibit attentional threat biases, where threat stimuli are processed preferentially leading to a hypervigilant state that is thought to promote defensive behaviors during threat processing. Accordingly, PTSD and its dissociative subtype are thought to differ in their proclivity to elicit active (i.e., fight, flight) versus passive (i.e., tonic immobility, emotional shutdown) defensive responses, which are characterized by the increased and the decreased expression of the sympathetic nervous system, respectively. Moreover, active and passive defenses are accompanied by primarily endocannabinoid- and opioid-mediated analgesics, respectively. Through critical review of the literature, we apply the defense cascade model to better understand the pathological presentation of defensive responses in PTSD with a focus on the functioning of lower-level midbrain and extended brainstem systems.     

Suitability of the art therapy room and changes in outcome measures in the education system

This study examined the relationship between art therapists’ perceptions of their art therapy room in schools, and related outcome measures for 55 students. We posited that there would be a positive correlation between art therapists’ satisfaction and their perception of the suitability of the rooms in which they provide therapy, and their clients’ outcome measures. Thirty-six therapists completed a questionnaire about their perceptions of their therapy room. Students completed questionnaires on self-perception and loneliness, and their parents and homeroom teachers reported on behavioural problems before and after therapy. There were no correlations between the art therapists’ perceptions of the room and the outcome measures. However, there were correlations between improvement in outcome measures as reported by parents and teachers and single items; e.g. the location of the room, the suitability of its equipment, and perceiving the material and furnishings as positive.

Plain-language summary

• The art therapy room provides a framework for therapeutic work and is designed to meet the needs of the theoretical approach and personality of the therapist, the characteristics of the client population, and the institution in which the therapy takes place. The therapy room has a crucial impact on the initial relationship between the therapist and the client and is perceived as an environment that acts as both container and containment during the therapeutic process. Although the physical conditions of the therapy room are likely to play a role in the success of therapy, scant research has explored this issue, in particular in the school setting. The current study examined the relationship between art therapists' perceptions of their art therapy room in schools, and related outcome measures for 55 1st to 7th graders. We expected a positive correlation between art therapists' satisfaction and their perception of the suitability of their therapy rooms and their clients' outcome measures. We asked 36 therapists to complete a questionnaire on the physical conditions of their therapy room. Their student clients completed questionnaires on self-perception and loneliness, and their parents and homeroom teachers reported on behavioural problems before and after therapy. No main correlations were found between the art therapists' perceptions of the room and the outcome measures. However, there were correlations between improvement in outcome measures as reported by parents and teachers and single items, including the location of the room, the suitability of its equipment, and perceiving the material and furnishings as positive.

     

标准外伤大骨瓣开颅术在重型颅脑损伤中的应用

目的 探讨及评价标准大骨瓣开颅术在交通事故性重型颅脑损伤中的应用价值.方法 采用标准大骨瓣开颅术治疗交通事故后46例重型颅脑损伤患者,对其相关的临床资料进行分析总结,3个月后采用GOS评定治疗效果.结果 随访3个月后,患者恢复良好23例,中残5例,重残或植物生存8例,死亡10例.结论 标准外伤大骨瓣手术是治疗交通事故性重型颅脑损伤的有效方法,它具有操作方便、彻底减压的优点,能明显提高治愈率,减轻后遗症,提高患者生存质量.     

重型颅脑损伤呼吸功能监测的意义

目的　探讨系统的呼吸功能监测在重型颅脑损伤救治中的意义。方法　对８７ 例重型颅脑损伤（ＧＣＳ≤８ 分）行系统的呼吸功能监测（ 包括血气分析、经皮血氧饱和度、呼气末二氧化碳分压、氧合指数）,据此对持续低氧血症４８ 例行气管切开,２８ 例随后再行机械通气治疗。将其疗效与无系统呼吸监测的传统治疗组（９４ 例） 比较。结果　监测组有呼吸功能障碍的５６ 例中死亡１８ 例（３２－１ ％ ） ,传统治疗组有呼吸功能障碍的６９ 例死亡３２ 例（４６－４ ％ ）,前者病死率明显降低（ Ｐ＜０－０５） 。结论　对重型颅脑损伤者系统的呼吸功能监测有利于及早发现呼吸功能障碍,指导和及时调整治疗措施,对于降低此类伤员的病死率有重要意义。     

Photography and art therapy: An easy partnership

Photography is a visual medium. It would seem natural for art therapists to consider its therapeutic use and potential. Paradoxically, however, there are only rare instances where art therapists have explored the use of photography. The aim of this article, therefore, is to stimulate thinking about photography from an art therapeutic stance that involves its use in clinical practice.

A wide range of therapeutic factors implied in the taking and perceiving of photographs are presented. Additionally, a variety of creative activities based on photography are described. Case illustrations demonstrate different forms of thematic group activities and contexts where photographic pictures may be used.     

Long term individual art psychotherapy. Art for art's sake: The effect of early relational trauma

Abstract

This is a retrospective analysis of individual art therapy lasting six years. Outcome measures, patient ratings and feedback, and the opinion of the therapist indicated improvement that was maintained up to three years follow-up. Process data, consisting of sessional outcome measures, indicated the severity of problems and a wide and dramatic fluctuation on a weekly basis. The examination of art work alongside data from researchers illustrated a series of phases in therapy. This material has been previously published and a summary is presented here. Given the patient's presentation, the long length of therapy was unexpected. In this paper the art therapist offers a formulation of the patient's problems and considers why art therapy was helpful when the patient had failed to improve from previous therapies. Concepts of attachment theory linked to neuroscience are used to enlighten the understanding of this case.     

Digital culture and art therapy

This essay outlines the relevance of digital culture to art therapy, including native skills and activities that art therapists must grasp to become culturally competent with increasing numbers of clients. Because digital media use has expanded into daily life, the effects can be seen in routine communication and behaviors as well as influences in our language and thought processes. Children, youth, and adults are affected as ‘computer commons’ affiliation has increased for the general population of American society. Art therapists use digital media, both as tools of professional practice such as email, archiving, research, personal creativity, networking, and advertising practices, and as clinical tools including photography, animation, video, digital tablets, and augmented-reality software for therapeutic processes and outcomes. The author draws attention to digital divides previously identified in art therapy that illustrate ambivalence toward this media, including perceptions of traditional versus synthetic materials use, affordability and access issues, and a paucity of graduate education opportunities for adaptation and skill-building. Multicultural lenses of generational evolution, reactionary bias against technology, perils of colonized economy divides, and extreme responses including blind resistance or gullible adaptation to new media all provide arguments for art therapists to build ongoing competencies in and comprehension of computer technologies. Research and education can evolve to support art therapists’ informed and developmental learning with digital media in order to remain contemporary and to participate in ever-expanding creative palettes and conscious human–technology interfaces.     

The Role of the Creative Process in Holding and Facilitating Traumatic Experience

Dissociative self states related to early traumatic experience may be elicited through the creative act, visual images, dreams, enactments, and affective collisions in the analytic dyad. In the following article, the author will describe her work with a visual artist and how the creative process, along with affect sharing and facilitation, helped open pathways to hold and communicate traumatic memories and self states.     

The value of art therapy in antenatal and postnatal care: A brief literature review with recommendations for future research

There is a very small body of literature addressing the use of the arts or art therapy in antenatal and postnatal care, and much of it is qualitative, including some rich and complex data which are worthy of discussion and consideration. Overall, it points to a promising use of supportive and therapeutic arts in this area. This article presents some background on the use of the arts specifically focusing on postnatal depression and birth trauma. It then moves on to present a brief survey of literature in the field, followed by some further reflections and discussion about further research needed to establish clinical utility and economic viability.     

Jungian theory and its use in art therapy in the viewpoints of Israeli Jungian art therapists

The present study explored Jungian art therapists’ perceptions of Jungian theory (JT) and its use in art therapy (AT). Fifteen experienced Israeli Jungian art therapists took part in semi-structured interviews. The findings describe the participants’ conceptualizations of the Jungian approach as it is evolving within AT. Thematic analysis yielded two main dimensions: (1) JT and its uses by art therapists and (2) clinical implications, leading to distinct interplay of JT and AT practice. The therapeutic processes and considerations underlying these themes are affected by JT, which assumes that the client constructs meaning unconsciously and through symbolic processes. The findings point to the importance of understanding the role of theoretical models in art therapists’ perceptions and their ways of participating in therapeutic process.     

Membrane damage in acute brain trauma

Among a number of biochemical disturbances occurring in the acute phase of brain insults, the destruction of membrane phospholipids and its consequences on the function of membrane-bound proteins is likely to be one of the most important. In the cryogenic type of injury which is classically considered as a relevant animal model of brain contusive lesions in human traumatology, the initial attack of membranes could consist in a peroxidative damage triggered by blood ferrous compounds. This in turn would lead to an activation of phospholipase A₂. As a consequence of phospholipid disruption a number of enzymes involved in energy production within the mitochondria are severely impaired. Nevertheless, the level of available ATP within the cell remains normal and even higher than normal. This paradoxical finding suggests that energy utilization is even more lowered than energy production. In fact, the Na⁺−K⁺-ATPase activity which normally utilizes approximately 70% of the total amount of cellular energy is severely reduced. We assume that Na⁺−K⁺-ATPase impairment is directly responsible for the retention of intracellular Na⁺ accompanied by osmotically driven water, though admittedly other biochemical disturbances, including tissue acidosis and liberation of excitatory amino-acids, would contribute to the same result [2, 9, 16]. Lastly, a striking feature of these biochemical events is the early activation of those enzymes necessary for phospholipid resynthesis. This should mean that repair processes are at work immediately after the insult allowing resumption of Na⁺−K⁺-ATPase function, clearing up of brain edema and restoration of cation exchanges essential for brain work.

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Sommario Fra le alterazioni biochimiche che si verificano nella fase acuta degli insulti cerebrali, una delle più importanti è la distruzione dei fosfolipidi di membrana. Nell'insulto di tipo criogeno, che è considerato un modello animale di lesione contusiva cerebrale nella traumatologia umana, il primo attacco delle membrane potrebbe consistere in um danno perossidativo determinato dai composti ferrosi del sangue. Ciò determinerebbe una attivazione della fosfolipasi A2. Come conseguenza della distruzione dei fosfolipidi si verifica un grave danno di numerosi enzimi impegnati in produzione di energia all'interno dei mitocondri. Pur tuttavia il livello dell'ATP disponibile all'interno della cellula rimane normale e persino più elevato del normale. Questo dato paradossale sembra suggerire che l'utilizzazione energetica è persino più ridotta della produzione di energia. Difatti l'attività delle Na⁺−K⁺ ATPasi che normalmente utilizzano circa il 70% del totale dell'energia cellulare è notevolmente ridotta. Noi pensiamo che l'interessamento delle NA⁺−K⁺ ATPasi è direttamente responsabile della ritenzione di NA⁺ intracellulare associato all'acqua regolata in modo osmotico, anche se altri disturbi biochimici, tra i quali l'acidosi tissulare e la liberazione di aminoacidi stimolanti, potrebbero contribuire alla medesima conseguenza. Per ultimo una caratteristica di questi eventi biochimici è l'attivazione precoce di questi enzimi necessari per la resintesi fosfolipica. Questo sta a significare che i processi riparativi sono in atto immediatamente dopo l'insulto permettendo la ripresa funzionale della NA⁺−K⁺ ATPase, la risoluzione dell'edema e la riattivazione degli scambi cationici essenziali per l'attività cerebrale.

     

亚低温治疗重型颅脑损伤外周血WBC的变化及其临床意义

目的探讨外周血白细胞及中性粒细胞对亚低温治疗重型颅脑损伤的临床疗效评估。方法120例经手术治疗后的重型颅脑损伤患者,随机分为亚低温组和对照组。亚低温组于手术后予亚低温治疗,直肠温度降至33～35℃,对照组体温维持存36.5～37.5℃。共治疗3～7 d,分别于术后第1 d和第8 d对两组患者的外周血WBC及中性粒细胞进行检测和GCS进行评估,6个月后进行GOS预后评估。结果亚低温组和对照组在术后第1 d的GCS和WBC及中性粒细胞没有显著性差异,但到第8 d则表现出明显的差异性,亚低温组的GCS及WBC和中性粒细胞均优于对照组(P<0.01或P<0.05);随访6个月亚低温组GOS预后显著优于对照组(P<0.01)。结论亚低温是治疗重型颅脑损伤的有效手段之一,并且外周血WBC及中性粒细胞的变化是评估颅脑创病人预后的客观指标之一。     

Use of the Adult Attachment Interview to measure process and change in psychotherapy

Abstract

The Adult Attachment Interview (AAI), developed and extensively tested in the domain of developmental psychology, has relevance to psychotherapy research. The authors compare and contrast the ways that social psychologists and developmental psychologists have operationalized the concept of attachment security and discuss corresponding implications for psychotherapy research. In addition, they provide an overview of the AAI and its development, reliability, and validation in developmental psychology and summarize recent work linking AAI responses with distinctive types of psychopathology. A summary of recent work showing the AAI to be a useful indicator of positive outcome in psychotherapy for adults with diverse problems, including depression, borderline personality disorder, and posttraumatic stress disorder, is provided.     

The CARE-AAT Guideline: Development and testing of a consensus-based guideline for case reports in anthroposophic art therapy

ABSTRACT

Anthroposophic art therapists (AATs) report individual cases in narratives of poor scientific quality. Good quality case reports are an important factor in the development of evidence-based practice. A guideline for scientific case reports could contribute to this. However, the recently published guideline for medical case reports (the CARE Guidelines, covering diagnosis, treatment and outcomes) is not completely suitable for AAT. This study aimed at the development of a guideline for AAT case reports. The CARE Guidelines were adjusted following the recommended steps for health reporting guidelines. The proposed adjustments are based on AAT literature and expert opinions. The face validity of the new CARE-AAT Guideline was judged by an international group of 35 AATs and 3 experts on case study methodology. Seven items of the CARE Guidelines needed specification or addition. One item (Treatment Objectives and Plan) had to be added and six items could be used without change. The face validity of the new guideline is good. The CARE-AAT Guideline is suitable for scientific case reporting of AAT practice. It is assumed to be suitable for art therapy case reporting as well. Future use of the guideline will show whether further optimisation of the guideline is needed.     

Mass violence and mental health: Attachment and trauma

This article focuses on post-traumatic stress disorder (PTSD) as both one of the most important mental health consequences of mass violence and as the manifestation of a disrupted human attachment system. The implications are many in terms of treatment and prevention. For instance, since the vulnerability to PTSD appears to be transmitted down the generations via the psychobiological manifestations of the parents’ attachment system, prevention requires the effective treatment of afflicted communities within a context of strong social support. More specific guidelines for intervention are outlined focusing on the role of psychosocial workers and their need to be carefully selected, trained and supervised. Failure to tackle the effects of mass violence and to prevent further psychological damage through political action has serious implications in terms of the future of mankind.     

高氧液对重型颅脑损伤后血流动力学影响的实验研究

目的观察高氧液对颅脑损伤后血流动力学的影响,评价其用于颅脑外伤急性期的治疗价值。方法对符合重型颅脑损伤诊断标准的患者60例,接受高氧液(1000ml/d,静脉输注)2周,在治疗前和治疗2周后进行血流动力学测定比较。结果经过2周的高氧液治疗,全血粘度、血浆粘度显著降低,反映红细胞变形能力的TK值减少,血沉减慢,反映红细胞聚集性的红细胞电泳指数明显增大(P<0·05),红细胞压积有减少趋势,但无显著性差异(P>0·05)。结论早期使用高氧液可降低血液粘度,改善微循环,有助于改善脑组织缺血缺氧,减轻脑水肿。     

高氧液对重型颅脑损伤后血流动力学影响的实验研究

目的观察高氧液对颅脑损伤后血流动力学的影响,评价其用于颅脑外伤急性期的治疗价值.方法对符合重型颅脑损伤诊断标准的患者60例,接受高氧液（1000ml/d,静脉输注）2周,在治疗前和治疗2周后进行血流动力学测定比较. 结果经过2周的高氧液治疗,全血粘度、血浆粘度显著降低,反映红细胞变形能力的TK值减少,血沉减慢,反映红细胞聚集性的红细胞电泳指数明显增大（P〈0.05）,红细胞压积有减少趋势,但无显著性差异（P＞0.05）.结论早期使用高氧液可降低血液粘度,改善微循环,有助于改善脑组织缺血缺氧,减轻脑水肿.     

Childhood trauma,brain structure and emotion recognition in patients with schizophrenia and healthy participants

Childhood trauma, and in particular physical neglect, has been repeatedly associated with lower performance on measures of social cognition (e.g. emotion recognition tasks) in both psychiatric and non-clinical populations. The neural mechanisms underpinning this association have remained unclear. Here, we investigated whether volumetric changes in three stress-sensitive regions—the amygdala, hippocampus and anterior cingulate cortex (ACC)—mediate the association between childhood trauma and emotion recognition in a healthy participant sample (N = 112) and a clinical sample of patients with schizophrenia (N = 46). Direct effects of childhood trauma, specifically physical neglect, on Emotion Recognition Task were observed in the whole sample. In healthy participants, reduced total and left ACC volumes were observed to fully mediate the association between both physical neglect and total childhood trauma score, and emotion recognition. No mediating effects of the hippocampus and amygdala volumes were observed for either group. These results suggest that reduced ACC volume may represent part of the mechanism by which early life adversity results in poorer social cognitive function. Confirmation of the causal basis of this association would highlight the importance of resilience-building interventions to mitigate the detrimental effects of childhood trauma on brain structure and function.