Publications by authors named "Girija Kaimal"

24 Publications

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Staying active after rehab: Physical activity perspectives with a spinal cord injury beyond functional gains.

PLoS One 2022 23;17(3):e0265807. Epub 2022 Mar 23.

Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, PA, United States of America.

Lifestyle physical activity following spinal cord injury (SCI) is critical for functional independence, mental wellness, and social participation, yet nearly 50% of individuals with SCI report no regular exercise. The objective of this study was to better understand factors leading to this participation gap by capturing the physical activity perspectives of individuals living with SCI. We completed small group interviews with nine individuals living with SCI across the United States. Iterative thematic analysis systematically revealed meaningful core concepts related to physical activity engagement with SCI. Emergent themes revealed challenges to lifestyle physical activity behavior including gaps in physical activity education, isolation during psychological adjustment, and knowledge limitations in community exercise settings. A secondary theme related to the COVID-19 pandemic emerged, highlighting additional environmental constraints affecting participation. Our findings suggest that most physical activity education is delivered during inpatient rehabilitation and is related to physical function. Lifetime physical activity strategies are achieved through self-education and peer networking. Personal motivators for physical activity include secondary condition prevention, while social and emotional barriers prevent regular adherence. These findings can inform the development and delivery of physical activity programs to maximize physical activity engagement in individuals living with chronic SCI.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0265807PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942209PMC
March 2022

Art Therapy in Burn Cases: A Review and Case Examples.

Ann Plast Surg 2022 04;88(2 Suppl 2):S120-S127

From the Creative Arts Therapies Department, Drexel University, Philadelphia, PA.

Abstract: In this article, we provide an overview of the literature on contributions of art making and medical art therapy for patients with burn injuries. The potential value of art therapy in addressing the complex physical and psychosocial needs of burn patients is discussed through examination of 7 peer-reviewed articles. Two case examples of burn survivors, 1 pediatric and 1 adult, are included to demonstrate the use of art therapy in an inpatient and outpatient setting, respectively. Art therapy and other intervention strategies for overall psychosocial adjustment of burn patients are often underutilized. Further research in art therapy is needed to examine the psychosocial aspects of burns patients and the potential role that medical art therapy may have in a burn care center.
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http://dx.doi.org/10.1097/SAP.0000000000003103DOI Listing
April 2022

Art therapy in pediatric burn care: A conceptual framework for clinical practice.

Burns 2021 Oct 11. Epub 2021 Oct 11.

Creative Arts Therapies Department, Drexel University, Philadelphia, PA, USA.

Burn injuries are an unexpected traumatic event and can be physically and emotionally devastating for a child and their families. This article presents a conceptual framework for art therapy practice with pediatric burns, founded on the three stages of burn treatment- critical, acute, and rehabilitation. The framework is based on narrative synthesis of research on the psychosocial needs of children with burn injuries, art therapy literature on pediatric burn patients, as well as in medical settings. Based on the stages of burn recovery, and the role of other relevant stakeholders, the framework provides recommendations for clinical practice of art therapy with children sustaining burn injuries, their caregivers and siblings, and healthcare providers. Robust studies including art therapy as interventions are recommended to determine their effectiveness in addressing the specific psychosocial needs in different stages of pediatric burn care.
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http://dx.doi.org/10.1016/j.burns.2021.10.003DOI Listing
October 2021

Top Ten Tips Palliative Care Clinicians Should Know About Music Therapy and Art Therapy.

J Palliat Med 2022 01 19;25(1):135-144. Epub 2021 Oct 19.

Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA.

Palliative care is provided by an interdisciplinary team, including physicians, advanced practice providers, nurses, social workers, chaplains, and other disciplines based on need. Music therapists and art therapists are becoming increasingly available to palliative care teams and are advancing the diverse and unique clinical services available to effectively meet the holistic needs of patients with serious illnesses and their families. This article provides a concrete exploration of clinical music therapy and art therapy within palliative care and hospice paradigms, with discussion of therapists' training and expertise, therapeutic approaches within the setting of interprofessional team-based care, and discussion of evidence-based symptom management and outcomes supporting the inclusion of music and art therapies within medical education and clinical employment.
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http://dx.doi.org/10.1089/jpm.2021.0481DOI Listing
January 2022

From Therapeutic Factors to Mechanisms of Change in the Creative Arts Therapies: A Scoping Review.

Front Psychol 2021 15;12:678397. Epub 2021 Jul 15.

SRH University Heidelberg, Heidelberg, Germany.

Empirical studies in the creative arts therapies (CATs; i.e., art therapy, dance/movement therapy, drama therapy, music therapy, psychodrama, and poetry/bibliotherapy) have grown rapidly in the last 10 years, documenting their positive impact on a wide range of psychological and physiological outcomes (e.g., stress, trauma, depression, anxiety, and pain). However, it remains unclear and the CATs have positive effects, and which therapeutic factors account for these changes. Research that specifically focuses on the therapeutic factors and/or mechanisms of change in CATs is only beginning to emerge. To gain more insight into how and why the CATs influence outcomes, we conducted a scoping review ( = 67) to pinpoint therapeutic factors specific to each CATs discipline, joint factors of CATs, and more generic common factors across all psychotherapy approaches. This review therefore provides an overview of empirical CATs studies dealing with therapeutic factors and/or mechanisms of change, and a detailed analysis of these therapeutic factors which are grouped into domains. A framework of 19 domains of CATs therapeutic factors is proposed, of which the three domains are composed solely of factors unique to the CATs: "embodiment," "concretization," and "symbolism and metaphors." The terminology used in change process research is clarified, and the implications for future research, clinical practice, and CATs education are discussed.
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http://dx.doi.org/10.3389/fpsyg.2021.678397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336579PMC
July 2021

"When a Father feels Excluded": A Qualitative Study Exploring the Role of Fathers in the Women, Infants, and Children (WIC) Supplemental Nutrition Program.

Int J Qual Stud Health Well-being 2021 Dec;16(1):1932026

Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA.

: Evidence suggests that men can play a key role in influencing maternal health behaviours, potentially affecting birthing outcomes. However, that role may not be fostered in safety net programmes like the Special Supplemental Nutrition programme for Women, Infants, and Children (WIC), a programme for which men do not qualify.: The primary objective of this research was to explore the experiences, expectations, and attitudes of men towards WIC.: This qualitative study employed semi-structured interviews of couples recruited at Philadelphia WIC. Data were analysed using thematic analysis.: Eight couples completed the interviews (16 independent interviews). Among participating fathers, only two fully participated in WIC. Barriers to participation was the primary theme identified as participants shared challenges from multiple sources. Subthemes, including fears of coercion, masculinity, and the unacknowledged role of fathers illustrated that these barriers were both internal and external to WIC and in alignment with the framework of the social ecological model (SEM).: These findings indicate that paternal involvement is limited due to numerous barriers, including those attributable to WIC. Future research should investigate these barriers and their intersectionality, as well as the appropriateness of WIC as an organization to foster paternal involvement.
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http://dx.doi.org/10.1080/17482631.2021.1932026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221125PMC
December 2021

Collage-based graphic elicitation method for capturing the lived experiences of veterans with Gulf War illness.

Life Sci 2021 Nov 24;284:119656. Epub 2021 May 24.

Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, United States of America.

Aims: Graphic elicitation is an emergent data gathering approach in qualitative research. An overview of the development and application of a collage based graphic elicitation method in gaining greater understanding about the experience of Gulf War Illness (GWI) is presented in this paper. The unique contributions of this method are also discussed.

Main Methods: Fourteen veterans with GWI were interviewed and then invited to represent their experiences in a visual format through a collage graphic elicitation task. Interviews and collage artworks were coded and compared to both verbal and art responses during the graphic elicitation process.

Key Findings: Comparison of the content in the interview responses and collage artwork indicates that the graphic elicitation process resulted in three distinct responses: (1) Synthesis and confirmation of content articulated in the interviews, (2) focus on salient aspects of living with GWI, and (3) revealing previously unarticulated experiences.

Significance: This work demonstrates the unique contributions of collage graphic elicitation, including allowing for spontaneity, metaphorical thinking, enriching verbal explication, and uncovering lived experiences and new affective responses. The sample size was too small to make any generalizations, and more research is needed to further validate these initial findings.
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http://dx.doi.org/10.1016/j.lfs.2021.119656DOI Listing
November 2021

Outcomes of Visual Self-Expression in Virtual Reality on Psychosocial Well-Being With the Inclusion of a Fragrance Stimulus: A Pilot Mixed-Methods Study.

Front Psychol 2020 8;11:589461. Epub 2020 Dec 8.

Department of Psychology, The College of New Jersey, Ewing Township, NJ, United States.

Aims: In this pilot mixed-methods study, we examined the participants experiences of engaging in virtual drawing tasks and the impact of an olfactory stimulus (calming fragrance blend) on outcomes of affect, stress, self-efficacy, anxiety, creative agency, and well-being (satisfaction with life).

Methods: This study used a parallel mixed-methods, simple block randomization design. The study participants included 24 healthy adults aged 18 to 54 years, including 18 women and six men. The participants completed two 1-h immersive virtual art making sessions and were randomly assigned to receive either a fragrance or a non-fragrance condition for the first session. Quantitative (standardized self-report measures) and qualitative (open-ended survey responses and virtual artwork) datasets were collected concurrently and integrated during data analysis.

Results: The quantitative results indicated that the fragrance condition demonstrated a significant reduction in negative affect (e.g., feeling hostile, jittery, upset, distressed, etc.), namely, reduced feelings of negativity when compared to the non-fragrance condition. A trend toward improvement in self-efficacy was also seen in the fragrance condition. No significant changes were found for fragrance or non-fragrance conditions for positive affect, anxiety, and creative agency. The qualitative findings included five themes related to art making experiences in virtual reality in both conditions: fun and joy; novelty of virtual media, experimentation, and play; relaxation and calm; learning curve; and physical discomfort and disorientation. Four themes were identified for virtual art content and visual qualities: nature imagery, references to memories and personal symbols, fantasy and play within imagery, and depiction of everyday objects.

Conclusions: Overall, the participants reported positive responses to the novel virtual art making experiences which were further heightened by the inclusion of the fragrance stimulus for negative affect. These preliminary findings need to be replicated with larger sample sizes to confirm the outcomes and the trends that were seen in this pilot study. Further research is recommended to examine the differences between experiences of virtual and traditional art media and to examine different olfactory stimuli promoting focus and concentration.
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http://dx.doi.org/10.3389/fpsyg.2020.589461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793948PMC
December 2020

Grappling with Gulf War Illness: Perspectives of Gulf War Providers.

Int J Environ Res Public Health 2020 11 19;17(22). Epub 2020 Nov 19.

Creative Arts Therapy Department, Drexel University, Philadelphia, PA 19102, USA.

: Although the Gulf War occurred almost 30 years ago, the chronic symptoms of Gulf War illness (GWI), which include respiratory, gastrointestinal, and skin problems, as well as fatigue, pain, and mood alterations, currently affect over 200,000 veterans. Meanwhile, healthcare providers lack clear guidelines about how to best treat this illness. The objective in this study was to learn about the perceptions and experiences of healthcare providers of GWI veterans in terms of medical symptoms, resources for treatment, and quality of care. : We interviewed 10 healthcare providers across the United States and subsequently conducted a qualitative grounded theory study which entailed both systematic data analysis and generating a grounded theory framework. : Our findings indicated multiple challenges for providers of veterans with GWI, including gaps in knowledge about GWI, lack of treatment options, absence of consistent communication within the Department of Veterans Affairs (VA) system, and personalized care that was limited to validation. : While this study had several limitations, it supported the notion that healthcare providers have inadequate knowledge and awareness about GWI, which leads to continued uncertainty about how to best care for GWI veterans. This could be remedied by the creation of a comprehensive curriculum for a Massive Open Online Course (MOOC) to serve as an educational tool for those attending to this largely overlooked veteran population.
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http://dx.doi.org/10.3390/ijerph17228574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699279PMC
November 2020

Indigenous and Traditional Visual Artistic Practices: Implications for Art Therapy Clinical Practice and Research.

Front Psychol 2020 16;11:1320. Epub 2020 Jun 16.

Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States.

In this paper, we present a review of research on the role of traditional and indigenous forms of visual artistic practice in promoting physical health and psychosocial well-being, particularly as it relates to the discipline of art therapy. Using extant literature we present an overview of how art making has historically had a therapeutic role in human lives and how it can inform the modern interpretation and profession of art therapy. Thereafter, we provide a critical review of specific studies that reference traditional and indigenous art forms in art therapy in order to invite discussion, dialogue, and awareness of the role of the arts in human development and the therapeutic role of the arts. Gaps in research areas for further study are proposed. Implications for clinical practice including expanding the scope of traditional forms of creative self-expression and promoting an informed and respectful understanding of the role of these artforms in the profession of art therapy worldwide, are also discussed.
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http://dx.doi.org/10.3389/fpsyg.2020.01320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308491PMC
June 2020

Outcomes of Therapeutic Artmaking in Patients Undergoing Radiation Oncology Treatment: A Mixed-Methods Pilot Study.

Integr Cancer Ther 2020 Jan-Dec;19:1534735420912835

Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

A cancer diagnosis can be extremely stressful and life-altering for patients. Chronically high levels of stress can increase inflammation and affect the progression of the cancer. Psychosocial interventions could reduce stress and address cancer patients' emotional, psychological, and spiritual needs. This mixed-methods pilot study compared 2 single-session arts-based approaches for patients in active radiation treatment in a large urban hospital. Participants were assigned to either the active control of independent coloring or the therapeutic intervention of open studio art therapy. Participants completed pre-session and post-session saliva samples and standardized psychosocial measures of stress, affect, anxiety, self-efficacy, and creative agency. Both conditions significantly increased participants' positive affect, self-efficacy, and creative agency, and decreased negative affect, perceived stress, and anxiety. No changes of note were seen in the salivary measures. Participants' narrative responses corroborated the quantitative findings and highlighted additional benefits such as supporting meaning-making and spiritual insights. Both arts-based interventions can support the emotional, psychological, and spiritual needs of cancer patients while each has features that may be more suited to the needs of certain patients. Further replication of these findings could support our initial findings that suggest that patients could benefit from having art studio spaces with art therapists and choices of art materials available on the oncology unit.
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http://dx.doi.org/10.1177/1534735420912835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177989PMC
March 2021

Editorial: The State of the Art in Creative Arts Therapies.

Front Psychol 2020 5;11:68. Epub 2020 Feb 5.

Department of Creative Arts Therapies, Drexel University College of Nursing and Health Professions, Philadelphia, PA, United States.

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http://dx.doi.org/10.3389/fpsyg.2020.00068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012801PMC
February 2020

Outcomes of art therapy and coloring for professional and informal caregivers of patients in a radiation oncology unit: A mixed methods pilot study.

Eur J Oncol Nurs 2019 Oct 22;42:153-161. Epub 2019 Aug 22.

Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, TRC 2 West, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. Electronic address:

Purpose: Caring for cancer patients can be highly stressful for both family caregivers and oncology professionals. These high levels of stress can lead to poorer patient outcomes and increased risk of health problems for the caregivers themselves. Art therapy may help these caregivers as art-making can be a relaxing and enjoyable form of self-expression and art therapists can support individuals in expressing and processing challenging emotions. Research on art-making or art therapy with caregivers of cancer patients has shown some positive results, but its interpretation is limited by the use of multifaceted interventions.

Method: In this mixed-methods study we compared two brief arts-based approaches for both professional and informal caregivers: single sessions of coloring or open-studio art therapy, with a 45-minute session each. Assessments imcluded self-reports of affect, stress, self-efficacy, anxiety, burnout arnd creative agency alongside salivary biomarkers before and after the session. Open-ended questions, field notes and observations formed the qualitative part of the study.

Results: Thirty-four professional (n=25) and informal (n=9) caregivers participated. Participants in both conditions showed increases in positive affect, creative agency, and self-efficacy and decreases in negative affect, anxiety, perceived stress, and burnout. Participants in both conditions expressed enjoyment, relaxation, appreciation of time away from stressors, creative problem solving, a sense of flow, and personal and existential insight. The two approaches also elicited distinct experiences with participants reporting that they found improved focus in coloring and appreciated the support and freedom of expression in open studio art therapy.

Conclusions: These findings suggest that even brief art-making interventions can be beneficial for stressed caregivers of cancer patients. As experience with art-making increased the impact, repeated sessions may be even more useful. We recommend that oncology units have dedicated studio spaces with therapeutic support and different forms of art-making available to meet individual caregiver needs.
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http://dx.doi.org/10.1016/j.ejon.2019.08.006DOI Listing
October 2019

Approaches to Research in Art Therapy Using Imaging Technologies.

Front Hum Neurosci 2019 17;13:159. Epub 2019 May 17.

Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, United States.

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http://dx.doi.org/10.3389/fnhum.2019.00159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534043PMC
May 2019

Creative Arts Interventions to Address Depression in Older Adults: A Systematic Review of Outcomes, Processes, and Mechanisms.

Front Psychol 2018 8;9:2655. Epub 2019 Jan 8.

Music Therapy Lab, Faculty of Applied Social Sciences, University of Applied Sciences Würzburg-Schweinfurt, Würzburg, Germany.

Depression experienced by older adults is proving an increasing global health burden, with rates generally 7% and as high as 27% in the USA. This is likely to significantly increase in coming years as the number and proportion of older adults in the population rises all around the world. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama, and music modalities, are utilized internationally to target depression and depressive symptoms in older adults. This includes interventions led by trained arts therapists as well as other health and arts professionals. However, to date there has not been a systematic review that reports effects and examines the processes (why) and mechanisms (how) of creative arts interventions are used to address depression in this older age group. This systematic review of studies on creative arts interventions for older adults experiencing depression examined: outcomes of four creative arts modalities (art, dance movement, drama, and music); with particular attention paid to processes documented as contributing to change in each modality; and mechanisms considered to result from these processes. Our analysis of 75 articles (17 art, 13 dance, 4 drama, and 41 music) indicates mostly significant quantitative or positive qualitative findings, particularly for interventions led by creative arts therapists. Mechanisms of change gleaned from the studies that were common across modalities include physical (e.g., increased muscle strength; neurochemical effects, such as endorphin release), intra-personal (e.g., enhanced self-concept, strengthened agency and mastery; processing and communication of emotions), cultural (e.g., creative expression, aesthetic pleasure), cognitive (e.g., stimulation of memory), and social (e.g., increased social skills and connection), that were all considered to contribute to reduced depression and symptoms. Recommendations for future research includes stronger focus on testing of processes and mechanisms.
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http://dx.doi.org/10.3389/fpsyg.2018.02655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331422PMC
January 2019

'Master My Demons': art therapy montage paintings by active-duty military service members with traumatic brain injury and post-traumatic stress.

Med Humanit 2019 Dec 4;45(4):353-360. Epub 2018 Aug 4.

Creative Arts Therapies, Drexel University College of Nursing and Health Professions, Philadelphia, Pennsylvania, USA.

This study involved a thematic analysis of montage paintings and of related clinical records of 240 active-duty military service members collected during their art therapy treatment for traumatic brain injury and underlying psychological health concerns, including post-traumatic stress, at the National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA. Congruent with other research findings, the qualitative analyses of this study suggest that the group art therapy experiences fostered improvement in interpersonal relatedness, hopefulness and gratification for the service members in treatment, aiding in externalisation, progressive exposure and construction of a trauma narrative imperative for recovery. The mixed media nature of the montage painting supported the expression of a range of postcombat symptoms. Results from this study highlighted the complexity of military culture, necessitating a broader scope of analyses for how art therapy helps service members express and communicate their challenges to care providers, peers and family as well as regulate emotion in the short and long term.
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http://dx.doi.org/10.1136/medhum-2018-011493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029253PMC
December 2019

Observational study of associations between visual imagery and measures of depression, anxiety and post-traumatic stress among active-duty military service members with traumatic brain injury at the Walter Reed National Military Medical Center.

BMJ Open 2018 06 11;8(6):e021448. Epub 2018 Jun 11.

National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.

Objectives: The study aimed tocompare recurring themes in the artistic expression of military service members (SMs) with post-traumatic stress disorder (PTSD), traumatic brain injury and psychological health (PH) conditions with measurable psychiatric diagnoses. Affective symptoms and struggles related to verbally expressing information can limit communication in individuals with symptoms of PTSD and deployment-related health conditions. Visual self-expression through art therapy is an alternative way for SMs with PTSD and other PH conditions to communicate their lived experiences. This study offers the first systematic examination of the associations between visual self-expression and standardised clinical self-report measures.

Design: Observational study of correlations between clinical symptoms of post-traumatic stress, depression and anxiety and visual themes in mask imagery.

Setting: The National Intrepid Center of Excellence at the Walter Reed National Military Medical Center, Bethesda, Maryland, USA.

Participants: Active-duty military SMs (n=370) with a history of traumatic brain injury, post-traumatic stress symptoms and related PH conditions.

Intervention: The masks used for analysis were created by the SMs during art therapy sessions in week 1 of a 4-week integrative treatment programme.

Primary Outcomes: Associations between scores on the PTSD Checklist-Military, Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scale on visual themes in depictions of aspects of individual identity (psychological injury, military symbols, military identity and visual metaphors).

Results: Visual and clinical data comparisons indicate that SMs who depicted psychological injury had higher scores for post-traumatic stress and depression. The depiction of military unit identity, nature metaphors, sociocultural metaphors, and cultural and historical characters was associated with lower post-traumatic stress, depression and anxiety scores. Colour-related symbolism and fragmented military symbols were associated with higher anxiety, depression and post-traumatic stress scores.

Conclusions: Emergent patterns of resilience and risk embedded in the use of images created by the participants could provide valuable information for patients, clinicians and caregivers.
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http://dx.doi.org/10.1136/bmjopen-2017-021448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009636PMC
June 2018

Active-duty military service members' visual representations of PTSD and TBI in masks.

Int J Qual Stud Health Well-being 2017 Dec;12(1):1267317

a National Intrepid Center of Excellence , Walter Reed National Military Medical Center , Bethesda , MD , USA.

Active-duty military service members have a significant risk of sustaining physical and psychological trauma resulting in traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Within an interdisciplinary treatment approach at the National Intrepid Center of Excellence, service members participated in mask making during art therapy sessions. This study presents an analysis of the mask-making experiences of service members (n = 370) with persistent symptoms from combat- and mission-related TBI, PTSD, and other concurrent mood issues. Data sources included mask images and therapist notes collected over a five-year period. The data were coded and analyzed using grounded theory methods. Findings indicated that mask making offered visual representations of the self related to individual personhood, relationships, community, and society. Imagery themes referenced the injury, relational supports/losses, identity transitions/questions, cultural metaphors, existential reflections, and conflicted sense of self. These visual insights provided an increased understanding of the experiences of service members, facilitating their recovery.
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http://dx.doi.org/10.1080/17482631.2016.1267317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328376PMC
December 2017

Reduction of Cortisol Levels and Participants' Responses Following Art Making.

Art Ther (Alex) 2016 Apr 23;33(2):74-80. Epub 2016 May 23.

This quasi-experimental study investigated the impact of visual art making on the cortisol levels of 39 healthy adults. Participants provided saliva samples to assess cortisol levels before and after 45 minutes of art making. Participants also provided written responses about the experience at the end of the session. Results indicate that art making resulted in statistically significant lowering of cortisol levels. Participants' written responses indicated that they found the art-making session to be relaxing, enjoyable, helpful for learning about new aspects of self, freeing from constraints, an evolving process of initial struggle to later resolution, and about flow/losing themselves in the work. They also reflected that the session evoked a desire to make art in the future. There were weak associations between changes in cortisol level and age, time of day, and participant responses related to learning about one's self and references to an evolving process in art making. There were no significant differences in outcomes based on prior experiences with art making, media choice, or gender.
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http://dx.doi.org/10.1080/07421656.2016.1166832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004743PMC
April 2016

Emerging adulthood and the perception of parental depression.

Qual Health Res 2010 Sep 7;20(9):1213-28. Epub 2010 Jun 7.

Temple University College of Education, Ritter Annex 443,1301 Cecil B. Moore Ave., Philadelphia, PA 19122, USA.

Few studies have examined children's perceptions of parental depression. This study was a qualitative analysis of the changes in the perception of parental depression between the ages of 17 and 19 years. Archived interview narratives of 16 respondents from a longitudinal, preventive intervention study of depression in families were analyzed. The respondents were purposefully selected to represent both genders as well as higher and lower levels of family adversity. The perceptions of parental depression were found to fall into three categories: self-oriented perspectives (resistance and negativity), ambivalent perspectives, and, other-oriented perspectives (acceptance and compassion). Over time, respondents from the high-adversity families showed shifts from self-orientation to other-orientation, whereas the perspectives of respondents from low-adversity families remained unchanged. Some respondents with depression in both parents and/or siblings revealed changes in perception toward one parent but no change toward other family members with depression.
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http://dx.doi.org/10.1177/1049732310371625DOI Listing
September 2010

Parental narratives about genetic testing for hearing loss: a one year follow up study.

J Genet Couns 2007 Dec 16;16(6):775-87. Epub 2007 Aug 16.

Deafness and Family Communication Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Few studies examine whether and how parental attitudes towards genetic testing change over time. In this study we interviewed parents of 14 children with newly identified hearing loss at two time points: after referral to genetics and 1 year later. Qualitative analyses of parental narratives indicate that parental attitudes did not change significantly over this time. Parents who perceived genetic testing to be useful continued to value it after testing, while parents who did not perceive it as being useful for their child's future held the same view a year later. The only parents who changed their views regarding the usefulness of genetic testing for hearing loss were those who reported that their children underwent significant changes in their hearing loss or were faced with other life threatening conditions. Parents were also often unaware of the role of the genetic counselor and how genetic counseling could help address many of their lingering questions and concerns. These emergent themes indicate the need for geneticists and genetic counselors to be aware of and sensitized to the questions and attitudes that bring parents to a genetic evaluation, as well as the reasons why parents may not follow up with genetic testing for hearing loss when recommended.
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http://dx.doi.org/10.1007/s10897-007-9110-7DOI Listing
December 2007

Parental narratives of genetic testing for hearing loss: audiologic implications for clinical work with children and families.

Am J Audiol 2007 Jun;16(1):57-67

The Children's Hospital of Philadelphia, PA, USA.

Purpose: Few studies have examined how parents personalize the possibility of genetic hearing loss in their children and whether they actually intend to pursue testing for their child. This article addresses the audiologist's important role in the genetic testing referral and follow-up processes.

Method: Twenty-four parents whose children were referred to genetic testing for hearing loss were interviewed in depth. Parents were selected to include a diverse range of races, ethnicities, and socioeconomic levels. Interviews were coded and analyzed using qualitative methods.

Results: Parental associations with genetic testing included feeling personally responsible, feeling relief, and considering metaphysical attributions for their child's hearing loss. Parental attitudes were related to perceptions and experiences with deafness. Many misconceptions about genetics were also found.

Conclusions: Audiologists need to be sensitized to parents' personal and sociocultural contexts when discussing genetic testing and should tailor informational and emotional support to parents' requirements when confronting the possibility of their child having a genetic hearing loss.
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http://dx.doi.org/10.1044/1059-0889(2007/005)DOI Listing
June 2007

Assessing parental attitudes toward genetic testing for childhood hearing loss: before and after genetic consultation.

Am J Med Genet A 2007 Jul;143A(14):1546-53

Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA.

We report on the development of a Genetic Attitude Assessment Tool (GAAT) to measure parental attitudes in contemplating genetic testing for childhood hearing loss, and to examine the differences in assessments made before and after genetic counseling. The GAAT tool was administered to a convenient sample of 119 parents of children with bilateral sensorineural hearing loss. The respondents completed the survey either before (n = 77) or after (n = 42) genetic counseling. Exploratory Factor Analysis was applied to identify and quantify the underlying psychosocial structure. Our results showed the validated 54-item GAAT instrument contains six subscales: (1) "test intention," (2) "beliefs in non-genetic causes of hearing loss," (3) "deferral of decision to undergo genetic testing," (4) "appropriate use of genetic testing results," (5) "beliefs in the benefits," and (6) "concerns about stigma." The respondents who answered the survey after genetic counseling had higher "test intention" (P = 0.017) and endorsed to a greater extent "beliefs in the benefits" (P < 0.001). They believed to a lesser extent that childhood hearing loss was due to "non-genetic causes" (P < 0.001) and were less inclined to prefer "decision deferral" (P = 0.031). Respondents who themselves had a hearing loss expressed a significantly weaker belief in "non-genetic causes" of hearing loss (P < 0.0001). In conclusion the validated GAAT instrument is responsive to changes in parental attitudes after genetic counseling. The GAAT may be used to monitor parental attitudes serially, to further understand how parental attitudes change from pre genetic counseling, post genetic counseling, to post test result disclosure.
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http://dx.doi.org/10.1002/ajmg.a.31730DOI Listing
July 2007

Parental narratives on genetic testing for children with hearing loss: a qualitative inquiry.

Am J Med Genet A 2007 Jul;143A(14):1533-45

Deafness and Family Communication Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.

Studies on parental attitudes towards genetic testing for hearing loss have surveyed parents of newborns with hearing loss as well as deaf and hearing adults. Although research indicates that most people have positive attitudes about genetic testing, few studies examine parental narratives about the personal implications of genetic hearing loss in their children. In this qualitative study we conducted semi-structured interviews with 24 parents whose children had been referred for, but had not yet undergone, genetic testing for hearing loss. The parents were recruited to represent a diverse range of racial, ethnic, and socioeconomic groups. Genetics and genetic testing for hearing loss were poorly understood topics. Beyond supporting or opposing genetic testing for hearing loss, parents' construction of meaning included struggles to locate responsibility (metaphysical attributions, ascription or alleviation of parental responsibility) as well as questions about the usefulness and implications of genetic testing for hearing loss in their child. Based on the themes that emerged from this study, we highlight the need for healthcare professionals to be aware and sensitized to parents' narratives, personal meanings and socio-cultural context when referring them for genetic testing for hearing loss. Listening attentively to parental narratives can help minimize prevailing misconceptions among parents and enable appropriate medical care and education.
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http://dx.doi.org/10.1002/ajmg.a.31731DOI Listing
July 2007
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