Research ArticleArt therapy drawing protocols for chronic pain: Quantitative results from a mixed method pilot study
Section snippets
Risk factors and protective resources
There are bidirectional relationships between pain and life experiences, social engagement and psychological and physiological functions. Adverse childhood experiences, which negatively impact relational security and social connectivity throughout the life span, have been shown to increase the risk of chronic pain (Jones, Power, & Macfarlane, 2009), and contribute to heightened perceptions of threat and pain (Nelson, Cunningham, & Kashikar-Zuck, 2017). Medically, low social support at the time
Memory reconsolidation
Memory Reconsolidation (MR) is considered a common factor of change for psychotherapy (Ecker, Ticic, & Hulley, 2015; Lane, Ryan, Nadel, & Greenberg, 2015) and art therapy (Hass-Cohen & Clyde Findlay, 2019; Hass-Cohen, 2016). MR occurs when retrieved memories are updated with new information and reconsolidated. During recall, there is a destabilization of proteins in the memory and fear brain areas, while a re-synthesis occurs within a 4 -h time frame (Nader, Schafe, & LeDoux, 2000). For
Hypotheses
It was hypothesized (H1) that there would be significant differences over time for the outcome variables of pain and psychological factors (RQ1a, RQ2a). The second hypothesis (H2) was that the three-drawing protocol would have better outcomes than the four-drawing protocol, due to reduced burden from testing fatigue and emphasis on changing the perception of the problem rather than the perception of self (RQ1b, RQ1d, RQ2b, RQ2d). Thirdly (H3), it was hypothesized that the MR condition that
Research design
A mixed-method pilot study using a pre-test post-test experimental control group design included quantitative data from the assessment of pain and psychosocial factor ratings and frequencies. Because there are many research questions and hypotheses, there were limits to statistical conclusion validity, as power was moderate; however, it was important to explore all possible outcomes due to the exploratory nature of this pilot study. Qualitative data will be reported elsewhere.
Participants
There were 34
Analyses
Data was screened for missing data and outliers, and three extreme univariate outliers were removed. Assumptions were checked, such as reliability for standardized measures (Cronbach’s alpha), normality of distributions (square root transformations were used for five positively skewed variables), sphericity (Mauchly’s test of sphericity), homogeneity of variance (Levene’s test), and homogeneity of variance-covariance (Box’s M test).
Mixed within-between repeated measures analysis of variances
Discussion
This pilot study demonstrated the potential of both the three- and four-drawing protocols with or without a resource reminder for the psychological treatment of chronic pain, and associated factors: anxiety, depression, fear, anger, relationship problems, and helplessness. Furthermore, results suggested the protocol’s potential to instigate and maintain affective, cognitive, behavioral intrapersonal changes, and social interpersonal changes. Both online and in-person administrations were
Limitations
Some of the limitations included small sample size, moderate statistical power, lack of a no treatment control group, and a large number of outcome variables. Future studies should reduce the outcome variables to anxiety, depression, and trauma, as those seem to be consistently improved by the protocol intervention. The research team adapted implementation of the protocol online due to the impact of the COVID-19 pandemic however, this change also allowed for an expansion of data collection and
Conclusion
Participation in the three- and four-drawing protocols resulted in a significant reduction in negative affect, specifically as it is related to anxiety and depression; thus, suggesting the utility of participation in the drawing protocol for clinical applications. Exploratory analyses revealed that the drawing protocol could be equally effective before and during the COVID-19 pandemic for online and in-person participation. Partial funding provided by Noah Hass-Cohen's Silver Rawley Research
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A year later: The pain protocol study findings and memory reconsolidation factors
2022, Arts in PsychotherapyCitation Excerpt :The pain protocol study results showed significant quantitative improvements in ratings of pain, depression, anxiety, relationship quality, and helplessness, as well as frequency of pain, depression, fear, anger, relationship problems, and endorsement of resources. Reported efficacy was similar for participants who participated in the three- and four-drawing protocols with or without a reminder of the resources that they drew, as well as for participants who received the protocol in-person pre-COVID-19 pandemic and participants who participated in the protocol online during the COVID-19 pandemic (Hass-Cohen et al., 2021). This follow-up study included interviews that were conducted a year after participants completed the pain protocol study.
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