Therapy, Art, Friendship and Flourishing in Illness: A Mixed Methods Pilot Randomised Controlled Trial of an Art Therapy Group Intervention for Paediatric Patients with Chronic Illnesses

Abstract

Children diagnosed with long-term chronic illnesses and medical conditions are at increased risk of emotional and behavioural difficulties. Children frequently report feeling different to their peers, struggle with self-esteem and experience difficulties in peer relations. There is a recognised need for interventions that address the psychosocial needs of paediatric patients and prevent adjustment difficulties. Art therapy is an allied health profession that is increasingly being employed as part of a holistic approach to patient care to support children to cope with the challenges connected with physical illness and hospitalisation. However, evidence for the use of art therapy with paediatric patients is limited. A scoping review was undertaken to inform the development of this study. A novel art therapy group intervention was developed to address the psychosocial needs of children with chronic illnesses. A mixed methods pilot randomised controlled trial combining qualitative and quantitative methods was undertaken to examine the efficacy and acceptability of the intervention. N=29 patients aged 9-12 years old were randomised to an 8-week long art therapy group or waitlist control group. Quantitative methods involved an independent group design with two groups (intervention and waitlist control) assessing outcomes at three-time points (pre-, post-intervention and 6-month follow up). Qualitative methods involved focus groups with participants and with parents. Reflect Interviews (RI) and Audio Image Recording (AIR) were used to determine participant-valued change mechanisms. Findings from this study are mixed. Statistical analyses do not show that there was an advantage for the treatment group over the waitlist control group post therapy on outcomes of social functioning and positive psychological wellbeing. However, as a pilot trial the study did not have sufficient statistical power to detect clinically meaningful differences in effectiveness, should such differences exist, and there is some evidence that over time for the group as a whole there are some positive changes post therapy. Significant pre- to post-test score changes with a moderate effect size suggest the intervention might have improved levels of engagement. Significant within-subject tests at 6-month follow-up suggest improvements in parent-reported psychosocial behaviour. Post intervention questionnaires strongly indicate that the children experienced positive outcomes related to group therapeutic factors. Thematic analysis of focus groups determined participants valued the sensory art making experience, freedom to expresses themselves, peer support and an increased sense of belonging. Parents valued art therapy as a therapeutic modality, and the peer support and autonomy offered by the group. Positive impacts on homelife were described while a need for emotional supports for parents was highlighted. The following mechanisms of change were identified by participants; externalisation of feelings and containment in the artwork; affect regulation and experiences of flow; self-expression, symbolism and meaning making; pleasure, play and freedom of expression; relational aesthetics. The intervention was considered to be feasible and highly acceptable. Positive changes were qualitatively reported. Future research with a larger sample size would allow for more robust statistical conclusions on efficacy. The present study concludes that an art therapy group intervention can offer an acceptable, child-centred, feasible psychosocial support to paediatric patients living with long-term physical health conditions.