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      Creative arts in psychotherapy for traumatized children in South Africa: An evaluation study

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Aim

          To evaluate the feasibility and effect of a 10-session creative arts in psychotherapy group programme on posttraumatic stress symptoms, behavioural problems, and posttraumatic growth, in children who experienced a traumatic event.

          Design

          A multicentre non-randomized controlled trial with a treatment and a control condition conducted in South Africa (4 sites).

          Methods

          125 children aged 7 to 13 years were assigned either to the treatment condition receiving creative arts in psychotherapy or a control condition with a low-level supportive programme without treatment. Attrition rates were 63.4% and in total 47 children completed the programme and questionnaires assessing posttraumatic stress, posttraumatic growth and behaviour problems both at baseline and follow-up; 23 in the treatment group and 24 in the control group. Adjusted mean differences were analysed using ANCOVA with bootstrapping.

          Results

          Results showed that both hyperarousal symptoms ( d = 0.61) and avoidance symptoms ( d = 0.41) decreased more in the treatment group compared to the control group. There was no significant effect of the intervention found for reported levels of behavioural problems and posttraumatic growth.

          Conclusion

          In spite of severe challenges implementing and executing this pioneering study in underprivileged areas of South Africa, support was found for creative arts in psychotherapy reducing hyperarousal and avoidance symptoms, but not for other symptoms. Valuable lessons were learned on feasibility of implementing this intervention in a developing context.

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          Violence and injuries in South Africa: prioritising an agenda for prevention.

          Mohamed Seedat, Ashley van Niekerk, Rachel Jewkes … (2009)
          Violence and injuries are the second leading cause of death and lost disability-adjusted life years in South Africa. The overall injury death rate of 157.8 per 100,000 population is nearly twice the global average, and the rate of homicide of women by intimate partners is six times the global average. With a focus on homicide, and violence against women and children, we review the magnitude, contexts of occurrence, and patterns of violence, and refer to traffic-related and other unintentional injuries. The social dynamics that support violence are widespread poverty, unemployment, and income inequality; patriarchal notions of masculinity that valourise toughness, risk-taking, and defence of honour; exposure to abuse in childhood and weak parenting; access to firearms; widespread alcohol misuse; and weaknesses in the mechanisms of law enforcement. Although there have been advances in development of services for victims of violence, innovation from non-governmental organisations, and evidence from research, there has been a conspicuous absence of government stewardship and leadership. Successful prevention of violence and injury is contingent on identification by the government of violence as a strategic priority and development of an intersectoral plan based on empirically driven programmes and policies.
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            The connection between art, healing, and public health: a review of current literature.

            Heather Stuckey, Jeremy Nobel (2010)
            This review explores the relationship between engagement with the creative arts and health outcomes, specifically the health effects of music engagement, visual arts therapy, movement-based creative expression, and expressive writing. Although there is evidence that art-based interventions are effective in reducing adverse physiological and psychological outcomes, the extent to which these interventions enhance health status is largely unknown. Our hope is to establish a foundation for continued investigation into this subject and to generate further interest in researching the complexities of engagement with the arts and health.
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              Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial.

              B Chow, Paula O′Shea, Patricia Resick … (2007)
              The prevalence of posttraumatic stress disorder (PTSD) is elevated among women who have served in the military, but no prior study has evaluated treatment for PTSD in this population. Prior research suggests that cognitive behavioral therapy is a particularly effective treatment for PTSD. To compare prolonged exposure, a type of cognitive behavioral therapy, with present-centered therapy, a supportive intervention, for the treatment of PTSD. A randomized controlled trial of female veterans (n=277) and active-duty personnel (n=7) with PTSD recruited from 9 VA medical centers, 2 VA readjustment counseling centers, and 1 military hospital from August 2002 through October 2005. Participants were randomly assigned to receive prolonged exposure (n = 141) or present-centered therapy (n = 143), delivered according to standard protocols in 10 weekly 90-minute sessions. Posttraumatic stress disorder symptom severity was the primary outcome. Comorbid symptoms, functioning, and quality of life were secondary outcomes. Blinded assessors collected data before and after treatment and at 3- and 6-month follow-up. Women who received prolonged exposure experienced greater reduction of PTSD symptoms relative to women who received present-centered therapy (effect size, 0.27; P = .03). The prolonged exposure group was more likely than the present-centered therapy group to no longer meet PTSD diagnostic criteria (41.0% vs 27.8%; odds ratio, 1.80; 95% confidence interval, 1.10-2.96; P = .01) and achieve total remission (15.2% vs 6.9%; odds ratio, 2.43; 95% confidence interval, 1.10-5.37; P = .01). Effects were consistent over time in longitudinal analyses, although in cross-sectional analyses most differences occurred immediately after treatment. Prolonged exposure is an effective treatment for PTSD in female veterans and active-duty military personnel. It is feasible to implement prolonged exposure across a range of clinical settings. clinicaltrials.gov Identifier: NCT00032617.
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                Author and article information

                Contributors
                Nadine van Westrhenen:
                ORCID: http://orcid.org/0000-0003-1624-9671
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Elzette Fritz: Role: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Adri Vermeer: Role: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Paul Boelen: Role: SupervisionRole: Writing – review & editing
                Rolf Kleber: Role: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Linda Chao: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 13 February 2019
                Publication date Collection: 2019
                Volume: 14
                Issue: 2
                Electronic Location Identifier: e0210857
                Affiliations
                [1 ] Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
                [2 ] Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
                [3 ] Department of Educational Psychology, University of Johannesburg, Johannesburg, South Africa
                [4 ] Department of Education and Pedagogics, Utrecht University, Utrecht, The Netherlands
                [5 ] Arq Psychotrauma Expert Group, Diemen, The Netherlands
                University of California, San Francisco, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-1624-9671
                Article
                Publisher ID: PONE-D-18-04537
                DOI: 10.1371/journal.pone.0210857
                PMC ID: 6374007
                PubMed ID: 30759101
                SO-VID: 737b5f67-4eea-42d7-a8e4-b1a60c48689b
                Copyright © © 2019 van Westrhenen et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 10 February 2018
                Date accepted : 3 January 2019
                Page count
                Figures: 2, Tables: 2, Pages: 15
                Funding
                The authors received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Children
                Subject: People and Places
                Subject: Population Groupings
                Subject: Families
                Subject: Children
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Mental Health Therapies
                Subject: Psychotherapy
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Neuropsychiatric Disorders
                Subject: Anxiety Disorders
                Subject: Post-Traumatic Stress Disorder
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Neuroses
                Subject: Anxiety Disorders
                Subject: Post-Traumatic Stress Disorder
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Behavior
                Subject: Social Sciences
                Subject: Psychology
                Subject: Behavior
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Mental Health Therapies
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Emotions
                Subject: Social Sciences
                Subject: Psychology
                Subject: Emotions
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: People and places
                Subject: Geographical locations
                Subject: Africa
                Subject: South Africa
                Custom metadata
                Data Availability De-identified datasets are available in the supporting information files. Further information regarding the data are available upon request from the authors ( nadinevanwestrhenen@ 123456live.nl ).

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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