Document Type : Research Paper

Authors

1 Ph.D. in Health Psychology, University of Tehran, Tehran, Iran.

2 Professor, Department of Psychology, University of Tehran, Tehran, Iran.

3 Assistant Professor, Department of Hematology & Oncology, Tehran University of Medical Sciences, Tehran, Iran.

4 Assistant Professor, Department of Psychology, Tarbiat Modares University, Tehran, Iran.

Abstract

The consequences of cancer do not just impact on the body only, but expands into the other levels of human existence, including psychological levels. Sometimes these consequences are even more painful and more destructive than physical harms, especially in children. Therefore, the use of psychotherapy for children, particularly art-based psychotherapies, is necessary. So, the main objective of the present research was to develop a new family-based art therapy for hospitalized children with cancer and to evaluation its effectiveness on the symptoms of depression (DEP) and pain anxiety (PA). Five hospitalized children with cancer, participated in this single-subject study (A-B type) accompanied with their mothers. The intervention was applied in eight sessions (30-60 minutes per session). Children’s depression and pain anxiety were measured repeatedly in two phases and data were analyzed by graphs and tables. The effect size (ES) and reliable change index (RCI) are also reported in addition to the customary values. The results showed that family-based art therapy was significantly effective in reducing the symptoms of depression and pain anxiety in all of the children. The findings indicate the effectiveness of family-based art therapy in helping to modify the psychological consequences of cancer, and clarify the need for this approach to be applied in similar conditions.

Keywords

Abdulah, D. M., & Abdulla, B. M. O. (2018). Effectiveness of group art therapy on quality of life in paediatric patients with cancer: A randomized controlled trial. Complementary therapies in medicine, 41, 180-185. doi:10.1016/j.ctim.2018.09.020
Aguilar, B. A. (2017). The efficacy of art therapy in pediatric oncology patients: an integrative literature review. Journal of pediatric nursing, 36, 173-178. doi:10.1016/j.pedn.2017.06.015
Bishop, K. (2012). The role of art in a paediatric healthcare environment from children's and young people's perspectives. Procedia-Social and Behavioral Sciences, 38, 81-88. doi:10.1016/j.sbspro.2012.03.327
Çavuşoğlu, H. (2001). Depression in children with cancer. Journal of pediatric nursing, 16(5), 380-385.
Chang, H. Y., Keyes, K. M., Mok, Y., Jung, K. J., Shin, Y.-J., & Jee, S. H. (2015). Depression as a risk factor for overall and hormone-related cancer: the Korean cancer prevention study. Journal of affective disorders, 173, 1-8. doi:10.1016/j.jad.2014.10.064
Colorectal cancer facts & figures. (2017). In. American Cancer Society: American Cancer Society Atlanta, GA.
Councill, T. (1993). Art therapy with pediatric cancer patients: Helping normal children cope with abnormal circumstances. Art Therapy, 10(2), 78-87. doi:10.1080/07421656.1993.10758986
Domnick, M., Domnick, M., Wiebelitz, K.-R., & Beer, A.-M. (2017). Evaluation of the effectiveness of a multimodal complementary medicine program for improving the quality of life of cancer patients during adjuvant radiotherapy and/or chemotherapy or outpatient aftercare. Oncology, 93(2), 83-91. doi:10.1159/000468939
Durualp, E., & Altay, N. (2012). A comparison of emotional indicators and depressive symptom levels of school-age children with and without cancer. Journal of Pediatric Oncology Nursing, 29(4), 232-239. doi:10.1177/1043454212446616
Favara‐Scacco, C., Smirne, G., Schilirò, G., & Di Cataldo, A. (2001). Art therapy as support for children with leukemia during painful procedures. Medical and Pediatric Oncology: The Official Journal of SIOP—International Society of Pediatric Oncology (Societé Internationale d'Oncologie Pédiatrique, 36(4), 474-480. doi:10.1002/mpo.1112
Gast, D. L. (2010). Single subject research methodology in behavioral sciences. New York and London: Routledge.
Gold, C., Mössler, K., Grocke, D., Heldal, T. O., Tjemsland, L., Aarre, T., . . . Assmus, J. (2013). Individual music therapy for mental health care clients with low therapy motivation: Multicentre randomised controlled trial. Psychotherapy and psychosomatics, 82(5), 319-331.
Goldman, P., Prochaska, E., Stacey, I., Miller, A., Merajver, S., Mosquera, J., . . . McInnis, M. G. (2015). Depression Risk and Cancer in Ecuador: The Protective Role of Social Support. Mental Health in Family Medicine. doi:10.25149/1756-8358.1102010
Gussak, D., & Rosal, M. L. (2016). The Wiley handbook of art therapy: Wiley Online Library.
Ivarsson, T., Svalander, P., & Litlere, O. (2006). The Children's Depression Inventory (CDI) as measure of depression in Swedish adolescents. A normative study. Nordic Journal of Psychiatry, 60(3), 220-226. doi:10.1080/08039480600636395
Khamechian, T., Alizargar, J., & Mazoochi, T. (2013). Prevalence of depression in patients with Cancer. Middle East Journal of Scientific Research, 15(9), 1311-1315.
Malchiodi, C. A. (2007). Art therapy sourcebook: McGraw Hill Professional.
Malchiodi, C. A. (2011). Handbook of art therapy: Guilford Press.
Masip, A. F., Amador-Campos, J. A., Gómez-Benito, J., & del Barrio Gándara, V. (2010). Psychometric properties of the Children's Depression Inventory in community and clinical sample. The Spanish journal of psychology, 13(2), 990-999. doi:10.1017/S1138741600002638
Massie, M. J. (2004). Prevalence of depression in patients with cancer. JNCI Monographs, 2004(32), 57-71.
Massimo, L. M., & Zarri, D. A. (2006). In tribute to Luigi Castagnetta—drawings: A narrative approach for children with cancer. Annals of the New York Academy of Sciences, 1089(1), xvi-xxiii. doi:10.1196/annals.1386.020
McCracken, L. M., & Dhingra, L. (2002). A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Research and Management, 7(1), 45-50. doi:10.1155/2002/517163
McCracken, L. M., Zayfert, C., & Gross, R. T. (1992). The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain. Pain, 50(1), 67-73. doi:10.1016/0304-3959(92)90113-P
Menichetti Delor, J. P., Giusti, L., Fossati, I., & Vegni, E. (2015). Adjustment to cancer: exploring patients' experiences of participating in a psychodramatic group intervention.
Mercadante, S. (2013). Cancer pain. Current opinion in supportive and palliative care, 7(2), 139-143.
Merskey, H., & Bogduk, N. (1994). International Association for the Study of Pain. Task Force on Taxonomy. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Seattle; IASP Press.
Money, S., & Garber, B. (2018). Management of cancer pain. Current Emergency and Hospital Medicine Reports, 6(4), 141-146.
Nesbitt, L. L., & Tabatt-Haussmann, K. (2008). The Role of the Creative Arts Therapies in the Treatment of Pediatric Hematology and Oncology Patients. Primary Psychiatry, 15(7). Retrieved from http://primarypsychiatry.com/the-role-of-the-creative-arts-therapies-in-the-treatment-of-pediatric-hematology-and-oncology-patients/
Pagé, M. G., Campbell, F., Isaac, L., Stinson, J., Martin-Pichora, A. L., & Katz, J. (2011). Reliability and validity of the Child Pain Anxiety Symptoms Scale (CPASS) in a clinical sample of children and adolescents with acute postsurgical pain. Pain, 152(9), 1958-1965. doi:10.1016/j.pain.2011.02.053
Pagé, M. G., Fuss, S., Martin, A. L., Escobar, E. M. R., & Katz, J. (2010). Development and preliminary validation of the Child Pain Anxiety Symptoms Scale in a community sample. Journal of pediatric psychology, 35(10), 1071-1082. doi:10.1093/jpepsy/jsq034
Purrezaian, H. (2020). Clinical Planning/Trial of the Family-based Art Therapy and Psychodrama for Psychological Treatment and Adaptation of Children with Cancer. (Ph.D.). University of Tehran, Tehran, Iran.
Riley, S., & Malchiodi, C. A. (2003). Family art therapy. In C. A. Malchiodi (Ed.), Handbook of art therapy (pp. 380-392). New York: Guilford Press.
Rollins, J. A. (2005). Tell me about it: Drawing as a communication tool for children with cancer. Journal of Pediatric Oncology Nursing, 22(4), 203-221. doi:10.1177/1043454205277103
Sadock, B., & Ruiz, P. (2015). Kaplan & Sadock's synopsis of psychiatry: behavioral sciences: Walters Kluwer.
Teglbjaerg, H. S. (2011). Art therapy may reduce psychopathology in schizophrenia by strengthening the patients’ sense of self: a qualitative extended case report. Psychopathology, 44(5), 314-318. doi:10.1159/000325025
Woodgate, R. L., West, C. H., & Tailor, K. (2014). Existential anxiety and growth: an exploration of computerized drawings and perspectives of children and adolescents with cancer. Cancer Nursing, 37(2), 146-159. doi:10.1097/NCC.0b013e31829ded29
Zeeck, A., Weber, S., Sandholz, A., Wetzler-Burmeister, E., Wirsching, M., & Hartmann, A. (2009). Inpatient versus day clinic treatment for bulimia nervosa: a randomized trial. Psychotherapy and psychosomatics, 78(3), 152-160.