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Application of the MARI Card Test on Women with Eating Disorders

PSYA 651-1 Advanced Art Therapy Research in Individual and Family Therapy

Christine Park

on 13 June 2013

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Transcript of Application of the MARI Card Test on Women with Eating Disorders

Application of the MARI Card Test
on Women with Eating Disorders

Brenda Maltz
Devin McCabe
Christine Park
Lindsey Schoeneman

medical conditions
Table 3. List of MARI post-test interview questions

1. Can you please explain why you chose this card as your preferred card?
2. Can you please explain why you chose this color to accompany your preferred card?
3. Can you please explain why you chose this card as your rejected card?
4. Can you please explain why you chose this color to accompany your rejected card?
5. What is it about the “healing” color that makes your rejected card more acceptable to you?
6. Is there anything you would like to share with me about your mandala?
7. How was this experience for you?
future research
previous MARI research
... not much.
MARI research and eating disorders
1) The most common preferred cards on the MARI Card Test will be chosen
from the second quadrant of the Great Round.

2) The most commonly rejected card on the MARI Card Test will be Stage 11.
data analysis
this concludes our presentation.
(1) females at least 18 years old
(2) able to understand MARI® Card Test instructions, as delivered in English
(3) diagnosed by a medical provider with an eating disorder, as described in the DSM-IV-TR
(4) undergoing treatment in eating disorder programs in King County, Washington
(1) males
(2) persons under the age of 18
•IRB approval
•Participant selection and screening
•Administration of the assessment
•Creation of a mandala
•Information recorded and coded
•Original design: 39 design cards, 40 color cards.
Select 6 preferred designs and colors, 1 rejected design and color, 1 healing color.
•Modification: 13 designs cards, 13 color cards.
Select 1 preferred design and color, 1 rejected design and color, 1 healing color.
Modeled after Bruscia et al. (2007) study.
•White paper and oil pastels provided to create mandala
•Post-test interview
qualitative analysis
Table 4. List of emergent themes

Card Type Master Themes Participant Examples

Preferred card Complexity I like the spirals
Partial to paisley-looking things
Chaotic but not confined
Relating to nature Organic flow to it
The dots remind me of clouds
Night and moon and clouds
Preferred color Soothing Calm in the chaos
Resembles happiness
Organic and natural
Reminded of trees
Appropriate pairing Looked cool underneath [card]
It matches
Looks brightest and best
Rejected card Feelings of discomfort No way of getting out
Not easy to look at
Reminds me of death
Makes me mad
Rejected color Unpleasant Tacky, overboard
Not a color I would pick
Made card look worse
Bad association Too violent
Bad memories of this color
Death and darkness
Healing color Soothing Serene
Mellow, non-threatening
Less intense
Relating to nature Coral is like a flower
Innate healing powers
Evokes wholeness and connectedness

“Traditions which interact in partnership with nature regard the natural world with respect, appreciation, and awe. People who follow this perspective learn to treat everything in nature with care because of their awareness of the wholeness of all life in nature” (Burkhardt, 2000, p. 37).
nature: an emergent theme
Quadrant 2 vs. Quadrant 1
color swatch
financial burden
(& cupcakes!)
mandala images
eating disorders
Anorexia Nervosa
Bulimia Nervosa
Eating Disorder Not Otherwise Specified
Binge Eating Disorder
restricting type; binge-purging type
: cardiovascular problems, hypothermia, impaired renal function, osteoporosis, yellowing of the skin, dry skin, lanugo, peripheral edema, anemia, impaired cognitive functioning
: loss of dental enamel, increased incidences of cavities, menstrual irregularity or amenorrhea, fluid and electrolyte disturbances, rectal prolapse, esophageal tears, gastric rupture, cardiac arrhythmias
attachment theory + EDs
EDs associated with three types of insecure attachment styles: avoidant, ambivalent, and disorganized (Tasca, Ritchie, & Balfour, 2011)
Affect regulation and coping style, shown to be related to attachment, seems to be a key component in ED behavior (Barth, 2008)
randomized controlled studies
... none.
0.067 > 0.05
not statistically significant enough to reject the null hypothesis
small sample size
type I error
new alpha level = 0.10
0.067 < 0.10
statistically significant enough to reject the null hypothesis
HP Q1:Q2:Q3:Q4:S0 23:38:15:15:8
not statistically significant enough to reject the null hypothesis =
second hypothesis was supported
0.195 > 0.05
HP Q1:Q2:Q3:Q4:S0 = 23:38:15:15:8
HR S0:S1:S2:S3:S4:S5:S6:S7:S8:S9:S10:S11:S12 = 7:7:7:7:7:7:7:7:7:7:7:15:7
Bruscia, K., Shultis, C., & Dennery, K. (2007)
threats to validity
threats to reliability
general concerns
o Small sample size (n = 8)
o One eating disorder clinic
o No control group (and therefore no normative data)
o No comparison with established attachment measure
o Confounding variables: comorbidity, discrepancies in stage and intensity of treatment
o Test-retest: moment-to-moment measure, may not apply
o Interrater: differing clinical interpretations
o Trained MARI professionals can minimize threats to clinical interpretations
o What construct(s) does the MARI assessment actually measure?
o The MARI’s ability to tap into the expansiveness of human experience offers important
insight on many levels, but does not seem to have an explicit and precise aim
Improving the present study’s research design:
o Control groups to establish normative data
o Pair the MARI with an attachment measure
o Larger sample from multiple ED clinics
o Data collected consistently over the course of treatment (from intake to discharge)
from the same participants - broader and more generalizable patterns
o Address comorbidity
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