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Brief Cognitive Behavioral Art Therapy for Anxiety Disorders

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by

Frances Morris

on 7 July 2014

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Transcript of Brief Cognitive Behavioral Art Therapy for Anxiety Disorders

Methods
Brief Cognitive Behavioral Art Therapy for Anxiety Disorders
by Frances Morris, MS
Should art be integrated in cognitive behavioral therapy (CBT) for Panic Disorder with Agoraphobia (PDA) and Generalized Anxiety Disorder (GAD)?
Design?
A-B single subject experimental design.
2-week baseline, 7-week intervention.
Weekly, one-hour sessions (Marchand et al., 2007) and manual (Craske et al., 2000).
Instruments?
Ratings diary to track
symptoms (De Beurs et al., 1997):
What's GAD?
Question?
Introduction
Watercolor relaxation
Cognitive Restructuring
Interoceptive Exposure
Imaginal exposure
In vivo exposure
Relapse Prevention
Participants?
Case 1, Jessica
22 year-old white female law student
PDA
History of trauma and family issues
19 year-old white female
student at teaching zoo college
GAD
Partial criteria for ADHD
Psychoeducation
ID of support systems
Cognitive Restructuring
Watercolor relaxation
1) Road trip -->
2) Riding in someone else's car -->
3) Going in an unfamiliar bar
Imaginal exposure
1) Talking to someone in class
2) Meeting someone new through
a friend in a public situation
3) Talking to a stranger in a public situation
Unable to attend due to family issues
Did ride in someone else's car and was planning a road trip
In vivo exposure
Mastery Image
1) Talking to someone in class
Artwork helpful in externalizing fears & decreasing feeling of unreality
Previous pieces, i.e. "unlikely" cognition, look less severe
Unable to create bridge drawing due to shortened session
Relapse Prevention
Case 1
panic attacks
daily fear of fear
daily quality of life
daily agoraphobia
Case 2
daily quality of life
mandalas
Case 2, GAD Mandalas
Evaluations?
reduction in panic attacks and depersonalization
art shows progress and makes cognitions tangible
breathing retraining and mandalas were particularly helpful
Case 2, GAD
Increased understanding of anxiety triggers and coping skills
Art showed improvement and positive mindset
Cognitive restructuring and mandalas were particularly useful
Need for more general anxiety skills
Hypothesis 1a?
Met.
maximum fear of panic and
agoraphobic anxiety marginally
significant (.10 level)
No change in agoraphobic inconvenience.
Hypothesis 1b?
Not met.
No change in quality of life measures: general anxiety or
general feelings of goodness.
Hypothesis 2?
Met.
No change in general feelings of goodness.
Significant change (.05 level) in...
Marginally significant difference (.10 level) in...
Generalizable?
Brief CBAT may be effective for PDA
Brief CBAT/Internet sessions may be effective for GAD
Art may provide tangible record of progress and alternate learning route
Limitations?
Future Research?
Threats to internal validity
Low external validity
Need group efficacy studies with controls or comparisons to traditional CBT
Suggestions?
Directives on all levels of the ETC
Empower clients to find their own solutions
Be flexible and increase accessibility
Progressively encourage the facing of fears and structure
What's PDA?
panic attacks
fear of fear
significant distress
agoraphobia
Disproportionate worry
Difficult to control
Variety of life areas
Why?
CBT is the most effective and long-lasting treatment for PDA and GAD
CBT is underutilized: too verbal, abstract and inaccessible
Art activities could give concrete foundation and alternate route of learning, expression
Avoiding imagery central to anxiety (Craske & Barlow, 1988).
Case 2, Aurelia
Hypotheses?
Case 1, PDA
1a. panic, fear of fear, and
agoraphobia
1b. quality of life
Case 2, GAD
2. quality of life
Review
CBT?
Cognitive and behavioral therapy
beliefs + situation =
behavior
25 studies show it's most effective for PDA (Marchand et al., 2007)
13 studies show its most effective for GAD (Borkovec & Ruscio, 2001)
Art therapy & everyday anxiety?
Art therapy anxiety in college students (Sandmire et al., 2012).
Mandalas anxiety in college students (Curry & Kasser, 2008; Van der Vennet & Serice, 2012)
Art therapy anxiety comorbid with other disorders (Chambala, 2008).
Art therapy & anxiety disorders?
Painting + autogenic relaxation=
interpersonal skills (Albertini, 2001)
Existential art therapy= positive thinking (Crystal, 2001)
No testing on PDA symptoms
No integration into full CBT model
CBAT?
For specific phobia (DeFrancisco, 1983).
For anxiety-provoking emotions related to eating disorders (Matto, 1997).
For empathy in juvenile sex offenders (Gerber, 1994).
For grief (Reynolds, 1999).
Quantitative
Qualitative
Case 1, Session 1
Case 2, Session 1
Three Components
"My Panic Cycle"
"My Panic Cycle"
Three Components
Psychoeducation
Response piece
Case 1, Session 2
Breathing retraining
Case 2, Session 2
Case 1, Session 3
Breathing retraining
Case 2, Session 4
Case 1, Session 4
Case 2, Session 3
Case 1, Session 5
Case 2, Session 5
Case 1, Session 6
Case 2, Session 6
Case 1, Session 7
Case 2, Session 7
Case 1, PDA
Discussion
Questions?
Look for the article in an
upcoming issue of
The Arts in Psychotherapy
.

To view the presentation or bibliography, visit
francesjmorris.com
or contact me at
frances.johanna.morris@gmail.com
.
"Unlikely" cognition
"Unlikely"
"Likely"
Rapid drawing/ Muscle rigidity
Mandala/ Deescalation
Running painting/ Increased heart rate
Bridge drawing
Full transcript