This article is a critique of a peer-reviewed journal. This article is about Art therapy and how it improves mood and reduces pain and anxiety when offered at the bedside during acute hospital treatment.
Introduction and Goals
The problem is stated clearly, Shella (2018) that hospitalization can be a time of heightened anxiety and possible symptoms of depression as well as symptoms of pain. The author also addressed the effect art therapy can have by reducing distress in people with “cancer, HIV/AIDS, neurologically-based trauma, epilepsy” and stroke patients (pg.59). Shella gave examples of previous studies leading to the assumption that if art therapy reduced distress it might also reduce anxiety. Previous studies have looked at chronic pain and outpatients while this study looks at acute pain and inpatients. Theoretical and practical implications are that more research is needed to link anxiety, hospitalization, and the effect art therapy treatment has and the limited research that has been completed with acute pain in the inpatient’s settings. In this study, a ‘retrospective chart review’ was implemented by having patients rate mood, anxiety, and pain before and after art therapy. The primary or secondary hypothesis is not clearly found in the introduction of this article.
Theories Used
In this study, Shella (2018) used art therapy to improve psychological symptoms specifically focusing on anxiety. The Institutional Review Board (IRB) approved this study as a chart review and a waiver of informed consent was approved. The intervention used art therapy in all similar settings, averaging around 50 minutes, with one of the five art therapist/art therapy interns. Shella stated how she measured the patient’s mood, anxiety, and pain and explained how the scale was an appropriate tool to use and understand for all participants. Also stated was the primary medias used within the art therapy sessions. While overall the media were limited, suggestions were given of what patients could create. Nothing in this study was manipulated, only art therapy was implicated with participants that volunteered and before and after each session, data was recorded.
Sample/Population
The sample of this study was limited to inpatients located in an urban hospital, with 1000 inpatient beds, while only 195 individuals participated. Only 29 males participated in this study, which hurt the validity and generalizability. The article stated the age range and reasons for referrals. Also mentioned were the reasons participants were in the hospital and divided them into groups of causes. Patients who had documented before and after tests, at least once, were included which made me wonder if some of those participants, out of the already small sample, participated more than once. Shella did not percent the percentage of the sample that participated more than once or even mentioned how many sessions each participant completed, the ethnic or racial groups involved, the educational level of participants, or much description of the sample population at all other than gender and age.
Hypotheses
Within the method section, the hypotheses were addressed for the first time clearly in this article. The primary hypotheses suggest that since art therapy can reduce distress, it might also decrease symptoms of anxiety. The secondary hypotheses state those who participate in art therapy sessions for a minimum of 30 minutes and not more than 90 minutes, will have decreased anxiety and pain, and improved mood. More direction of how many sessions might have helped structure it more.
Gaps Addressed
One gap in this study is the predominant participant rate being only women. The lack of male findings hurts this study and does not make it generalizable. Shella (2018) stated that more women were willing to participate in the art therapy sessions and complete the before and after testing then men were and did not look further into it. This makes me ask, why women are more likely than men to participate, does gender identity and sexual orientation play a part in this, and should it have been looked at more closely within this study. With the sample size being 195 participants, one would expect women and men sample sizes to be similar to each other to provide the study with more validity. Overall the author stated that the question of whether art therapy would reduce anxiety was answered and mentioned that age and gender did not affect results.
Limitations
The only test giving in this study was Roger’s Happy Sad face scale, which each participant took to test mood, anxiety, and pain before and after each session (Shella, 2018). Limitations in the article were provided which stated that patients might also have felt pressure to please the therapist and report improvements causing possible bias to this study. The study had a specific goal to look at the inpatient settings leaving it ungeneralizable to other patients such as home or outpatients. The study was also limited by the amount of art therapy sessions themselves, looking at the effect of one session immediate effect, from different art therapists caused limitation to data and bias due to different approaches (Shella, 2018). Limitations in this article were reasonable and true to this study.
Future Research
In the introduction of this article Shella (2018) already stated that more research is needed on art therapy and its impact on inpatients that are hospitalized, as well as the connection between anxiety and inpatient hospitalization. The author mentioned some improvements that can be done for future studies that limited this study. A larger sample size and more variety in media used are two things that need to be implemented. Having more male participants as well as more demographical differences might make a study more generalizable across gender and populations. One thing not mentioned was the length of research, which I believe would provide different results.
Reference
Shella, T. A. (2018). Art therapy improves mood and reduces pain and anxiety when offered at the bedside during acute hospital treatment. The Arts in Psychotherapy, 57, 59-64. doi:10.1016/J.AIP.2017.10.003
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