Painting from Within : Developing and Evaluating a Manual-based Art therapy for Patients with Depression

Abstract: Aim: The overall aim was to develop and evaluate a manual-based art-therapy programme for patients with depression, and hence, to clarify treatment effects and to describe participants’ experiences of the treatment. The specific aims were: (I) To explore and describe how art therapy works in relation to therapeutic factors, clinical application, and circumstances in the experimental situation, for patients with depression; (II) To explore what experts in the field of art therapy consider to be the main aspects of treatment for patients with depression in clinical practice; (III) To investigate the effects of manual-based Phenomenological Art Therapy in addition to treatment as usual (PATd/TAU) compared with only treatment as usual (TAU) for patients diagnosed with moderate to severe depression; and (IV) To describe and explore the significance of manual-based Phenomenological Art Therapy as experienced by patients diagnosed with moderate to severe depression. Methods: (I) Systematic literature review according to Realist review; (II) Expert survey according to the Delphi technique (Studies I and II were used as a foundation for developing the manual-based Phenomenological Art Therapy for patients with depression (PATd)); to evaluate the effect and experience of PATd, (III) a randomized controlled trial (RCT) with intention-to-treat design was performed; and, thereafter, an interview study with (IV) a Phenomenological approach, according to Reflective Lifeworld Research. Results: (I) eight therapeutic factors were identified: self-exploration, self-expression, communication, understanding and explanation, integration, symbolic thinking, creativity, and sensory stimulation; (II) resulting in four main aspects of art therapy for patients with depression; expression through art-making and verbal communication concerning, depressive thoughts, feelings, life experiences, and physical symptoms. (III) PATd in addition to Treatment As Usual (TAU) showed a significant reduction of depression and an improved return to work compared to participants receiving only TAU. Self-esteem significantly improved, and suicide ideation did not change for either groups. (IV) PATd facilitates meeting oneself in an inner dialogue between the evident and the unaware. The art-making and describing that experience makes oneself and the situation visible, opening up and altering understanding through the inner dialogue. Conclusions: manual-based PATd seems to work as intended, being an effective treatment, and contributes to recovery for patients with moderate to severe depression.