Group Art Therapy for Patients with TBI: A Pilot Study

Copyright 2006 Gretchen Graves

Group Art Therapy for Patients With

Traumatic Brain Injuries: A Pilot Study

Thesis Study by Gretchen Graves


IntroductionEvery year 70,000-90,000 people in the United States are permanently impaired due to a traumatic brain injury.Survivors often show few physical signs of an injury consequently may not receive appropriate treatment for the impairments that will follow.A wide range of behavioral symptoms may occur as a result of a brain injury.Many cognitive functions are disrupted.


And…..Greater need for medical and emotional attention.Life change causes anxiety.


Functional Results of Brain InjuryConcentration Idea of abstraction Learning from mistakes Problem solving-unrealistic

Memory Hippo-campal sensitive to damage Short term memory Performance of tasks

Cognition Various functions affected

Perception Fragmented approach to tasks


Statement of ProblemIn the past brain-injured patients were considered poor patients for psychotherapy (Ball, 1988).Interventions should be done by persons who are knowledgeable about cognitive disturbances as well as psychotherapy (Prigatano, 1999).Many studies in projective art assessments with brain-injured people, but few or none involving an intervention (Garner, 1996).


Why Art TherapyArt allows the use of motor skills, cognitive functions, and psychosocial skills (Poldinger & Krambeck, 1987)Art allows retraining of brain functions and an accumulation of data to document effects (Garner, 1996)Details are more easily remembered when organized into a structured form (Silver, 1978)Offers non-aggravating, activity-centered treatment that will induce personal expression with out raising defenses.


Rehabilitation using Art TherapyConcentration Increase in organizational skills Following directions Choice makingMemory Material is comprehended and retained Improve patients self-identity.Cognition Gain insight Sequential steps Much to learnPerception 3D vs. 2D Exploring themes in life


Benefits of an Art Therapy Intervention

Reduce behavioral problems-art as an emotional outletFormation of adequate emotional response to injury (depression and anxiety)Increase motivation for rehabilitation (depression)Improve self-identity-hard to achieve due to lack of access to recent memory (short term memory deficit)Aid in reduction of cognitive confusionIncrease socialization through group awarenessIncrease organizational skills


Hypothesis of StudyDepression would decrease Anxiety would decrease Stress would decrease Socialization Skills would improve


MethodologyPre/Post-Intervention Inventory {Depression Anxiety and Stress Scales (DASS)}Five 1 hour art therapy sessions Six subjects – ages 24 – 71Post-Intervention Interview


Art Therapy Tasks Designed for easy executionAllowed for a wide range of expressive potentialDid not include drawing tasks


Self-collageSelf-collage

PLATE 2

61

PLATE 3

62

Low anxiety taskTrust building exercise

Self- ExpressionSelf-identity


Torn Paper CollageTorn Paper Collage

Low anxiety taskSuccess oriented Self-expressionEnhance ability for abstractionEnhance discussion of group

PLATE 6

65

PLATE 5

64


PrintmakingPrintmakingLow anxiety taskSuccess orientedSelf-expressionEnhance exploration of materialsIncrease concentration and structureConnect cognitive function with emotions

PLATE 9

68

PLATE 11

70


3-D animals3-D animalsLow anxiety taskSuccess oriented Self-expression Foster sense of controlIncrease self-esteemFoster group cohesionIncrease awareness of anxiety stress reducing strategies


Animal EnvironmentAnimal EnvironmentLow anxietySuccess orientedGroup cohesion

PLATE 15

74

PLATE 16

75


Results of DASS

0

5

10

15

20

25

30

35

40

La K L T V R

D-beforeD-AfterA-beforeA-afterS-beforeS-after

4/6 decreased depression (66 % improvement)3/6 decreased anxiety (50 % improvement)5/6 decreased stress (83 % improvement)


Subject AScores indicated depression both pre & postSuffered visual impairments due to BIArt was uncomplicated yet gave subject feeling of satisfactionArt upbeat & reflected a happy-go-lucky personalityPlayful & unrealistic


Subject KPre-depression & anxiety were close to clinical: Post-demonstrated no depression or anxietyVerbal associations to art indicated that patient understood life had changedArt contained much self-expression and memories


Subject L (injured at age 14)

Pre & post scores indicate great levels of depressionOutline of collage shape of headMany photos in it typical of adolescent images


Subject TPre scores indicate clinical levels of depressionPost level scores decreased dramaticallyInterpersonal level increased a great dealAdolescent type art in printmakingTorn paper collage- passive/defiant


Subject VScores for depression & anxiety went up from pre to post testDifficulty motivatingDifficulty connecting emotions to art


Subject RScores pre were low and dropped postSpouse helped with tasks great deal in beginning but towards end of intervention worked more independentlyIncreased confidence & became less hesitant to create


Post Intervention InterviewQuestions How did the

participants feel about the art therapy intervention

Feelings about the group and working together

Answers Helped use emotions Relaxed & Calming Got along better with

everyone towards the end of the intervention


Ideally…..More meetingsLonger period of timeDifferent time of Day-not when rides might come, etc.Comparison groupSize of groups good


ConclusionObjectives were achieved, although not statistically significantTherapeutic art intervention for people with brain injury could be very beneficial:

Help reworking the brain Decreasing anxiety, depression, & stress Increase memory & socialization skills


Questions & Comments:

Group Art Therapy for Patients with TBI: A Pilot Study

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