Fall 2017 Angie Blaser

EBP Project
I have an interest in creative expression through art and its therapeutic benefits. As I am
participating in a Level II fieldwork with local refugees, I decided to make my review applicable
to contribute to my utilization of evidence-based practice. For that reason, I developed my initial
question and search criteria. While some relevant research was found in my preliminary search,
the results were too limited. Literature reviews were also including relevant studies with
participants up to the age of 20. For those reasons I expanded my population and publication date
criterion.

Initial question: What are the therapeutic benefits of utilizing art therapy with refugee children?
• Databases: PubMed, Google Scholar
• Search terms: “art therapy” “refugee” “children” “efficacy”
• Inclusion: Refugee children, peer reviewed studies w/in past 10 years
• Exclusion: participants 18+

Revised question: What are the therapeutic benefits of utilizing art therapy with children who
have experienced trauma?
• Databases: PubMed, Google Scholar
• Search terms: “art therapy” “PTSD” “children” “trauma” “efficacy”
• Inclusion: Children who experienced trauma, peer reviewed studies since 2000
• Exclusion: participants 20+yrs old

Results

Author Population Intervention Time Tools/measures Results

Size and
characteristics
Pifalo 41 children Combined use 1 Trauma Pilot study
(2006) and of Structured hour/week Symptom showed
adolescents, Group Art for 8 Checklist for preliminary
ages 8-16, who Therapy & weeks Children evidence of
had been CBT in an 8 (Briere, 1995) reductions on 3
sexually wk pilot study TSCC subscales:
abused w/ 4 year anxiety, PTSD
follow up. and dissociation.
Therapeutic
group Follow up
sessions were showed:
separated by Statistically
age. significant
reduction on 9/10
Fall 2017 Angie Blaser

clinical TSCC
subscales.
Rousseau 138 immigrantUsed creative 12 week Achenback’s Children in the
et al. and refugee expression to program Teacher’s experimental
(2003) children, ages
bridge gap Report Form, group reported
7-13 yrs between Dominic Self- lower levels of
home-school Report, Peirs- both internalized
and past- Harris Self- and externalizing
present. Concept Scale symptoms &
Intervention higher levels of
was given in feelings of
Integrated and satisfaction an
regular popularity than
classes, with the control group.
experimental
n=73 &
control n=65
Kozlowska, 5 children ages Structured, 1 hr/wk Not specified Art therapy
& Hanney, 5-11 with low anxiety, for 7 provided a
(2001) PTSD interactive weeks desensitization of
symptoms group art anxiety and
resulting from therapy. unpleasant body
parental Creation of sensations, and
violence and and exposure improved the
separation to artwork. children’s ability
to articulate their
feelings verbally.
Rowe et al. 30 refugee Single group, 16 weekly Piers-Harris Results showed
(2017) participants, pre-post test. sessions, Self-Concept improvement in
ages 11-20, 50 Scale, Hopkins anxiety and self-
from Karen, Burma Art minutes Symptom concept, but no
Burmese, and Therapy each Checklist, statistically
Chin ethnic Program Harvard significant results
groups in (ATI), Trauma were found.
Burma or through the Questionnaire ATI clinicians
Thailand. Art Therapy reported that data
Participants Institute Each of these collection outside
had been in the were used of art therapy
U.S. for an outside of art sessions (without
average of 5 therapy aid of art
yrs. sessions to materials) was
gather data. challenging due
to language and
cultural barriers.
Clinicians also
reported that
Fall 2017 Angie Blaser

measures failed to
capture
therapeutic
effects “such as
the unique
experience of
growth and
building of
clients’ strengths”
Chapman 85 Utilized a 1 60- UCLA PTSD Children showed
et al. participants, specific minute Index (child, a reduction in
(2001) ages 7-17, intervention: session adolescent and acute stress and
with physical Chapman parent avoidant
traumatic Arts Therapy versions); symptoms, but no
injuries. Treatment PTSD significant
Intervention Diagnostic differences
Excluded: (CATTI) in a Scale, Family overall.
hospitalization level 1 Environment
< 24 hrs, and hospital Scale, &
injuries trauma unit. Nursing
sustained from Checklist
burns, child
abuse, and
severe head
injuries.
Lyshak- 29 inpatient Trauma 16 weekly UCLA PTSD Experimental
Stelzer, adolescents, focused group sessions Index, Milieu group showed
Singer, St. 13-18 years art therapy Behavioral statistically
John, & old, diagnosed (TF-ART) for Measures significant
Chemtob with PTSD. experimental reductions of
(2007) group, and trauma related
“treatment-as- symptoms, and a
usual” for trend of reduction
control group in seclusions and
behavioral
incidents.
Easton, Systematic Interventions Varied Reviewed case Review found
Doherty, Review of 12 ranged from from studies, that art therapy
and studies community weeks- prospective was used
Widrick utilizing the interventions months of randomized successfully in a
(2007) sole in war-torn or therapy cohorts, and variety of context
intervention of natural quasi- in treating
art therapy for disaster experimental traumatized
traumatized regions, studies with children. This
children. specific varied intervention was
structured art assessments. shows to be an
Fall 2017 Angie Blaser

therapy effective tool in

programs, and both establishing
formal art a therapeutic
therapy relationship and
treatment treating
programs in psychosocial
hospital consequences of
settings. childhood trauma.
Fall 2017 Angie Blaser

Interpretation

The body of evidence assessing art therapy shows significant improvements for children who

have experienced emotional, sexual, and physical trauma. Results show the reduction of PTSD

related symptoms with anxiety and avoidance symptoms being the most significant alleviations.

This would inform my future practice as I would consider this intervention for children who have

these specific barriers to their occupational performance. An improvement in self-concept and

communication, along with the establishment of a therapeutic relationship, are outcomes of this

intervention that I may utilize to cultivate a client-centered practice.

This review highlights the need for a repeated exposure to art intervention, as a single session

did not show significant results. No specific therapeutic art interventions were shown to be more

effective than informal group sessions. For that reason, when utilizing this intervention, I would

choose an approach that has research evidence showing usefulness with my client’s specific

demographic, condition, or type of trauma.

While most of the studies utilized measures that were specific to PTSD, or that measured

symptoms of trauma, the Rowe’s study (2017) highlighted the important need to measure

strength-focused outcomes with art based tools. It is also important to recognize that none of this

evidence is specific to Occupational Therapy, but was done by professionals in fields of Social

Work, Public Heath, and Psychology. While the evidence is pertinent to OT, none of the findings

are occupation based. If utilizing this intervention, it would be important to utilize practice based

evidence to collect occupation based data to contribute to the body of evidence. In addition to

utilizing art based tools, the measurement of occupational participation and performance

outcomes may contribute to quantifying the effectiveness of art therapy interventions.

Fall 2017 Angie Blaser

References
Chapman, L., Morabito, D., Ladakakos, C., Schreier, H., & Knudson, M. M. (2001). The
effectiveness of art therapy interventions in reducing post-traumatic stress disorder
(PTSD) symptoms in pediatric trauma patients. Art Therapy, 18(2), 100-104.
Eaton, L. G., Doherty, K. L., & Widrick, R. M. (2007). A review of research and methods used
to establish art therapy as an effective treatment method for traumatized children. The
Arts in Psychotherapy, 34(3), 256-262.
Kozlowska, K., & Hanney, L. (2001). An art therapy group for children traumatized by parental
violence and separation. Clinical Child Psychology and Psychiatry, 6(1), 49-78.
Lyshak-Stelzer, F., Singer, P., Patricia, S. J., & Chemtob, C. M. (2007). Art therapy for
adolescents with posttraumatic stress disorder symptoms: A pilot study. Art
Therapy, 24(4), 163-169.
Pifalo, T. (2006). Art therapy with sexually abused children and adolescents: Extended research
study. Art Therapy, 23(4), 181-185.
Rousseau, C., Lacroix, L., Bagilishya, D., & Heusch, N. (2003). Working with myths: Creative
expression workshops for immigrant and refugee children in a school setting. Art
Therapy, 20(1), 3-10.
Rowe, C., Watson-Ormond, R., English, L., Rubesin, H., Marshall, A., Linton, K., ... & Eng, E.
(2017). Evaluating art therapy to heal the effects of trauma among refugee youth: the
Burma art therapy program evaluation. Health promotion practice, 18(1), 26-33.