Publications by authors named "Rebekka Dieterich-Hartwell"

5 Publications

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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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November 2021

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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November 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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March 2021

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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October 2019

Creative Arts Therapies as Temporary Home for Refugees: Insights from Literature and Practice.

Behav Sci (Basel) 2017 Oct 17;7(4). Epub 2017 Oct 17.

Research Institute of Creative Arts Therapies (RIArT), Alanus University, Alfter 53347, Germany.

One of the frequently overlooked psychosocial problems of refugees is the phenomenon of homesickness. Being forced into exile and unable to return home may cause natural feelings of nostalgia but may also result in emotional, cognitive, behavioral and physical adversities. According to the literature, the creative arts therapies with their attention to preverbal language-music, imagery, dance, role play, and movement-are able to reach individuals through the senses and promote successive integration, which can lead to transformation and therapeutic change. These forms of therapy can be a temporary home for refugees in the acculturation process, by serving as a safe and enactive transitional space. More specifically, working with dance and movement can foster the experience of the body as a home and thus provide a safe starting place, from which to regulate arousal, increase interoception, and symbolize trauma- and resource-related processes. Hearing, playing, and singing music from the home culture may assist individuals in maintaining their cultural and personal individuality. Creating drawings, paintings, or sculpturing around the topics of houses and environments from the past can help refugees to retain their identity through art, creating safe spaces for the future helps to look ahead, retain resources, and regain control. This article provides a literature review related to home and homesickness, and the role the arts therapies can play for refugees in transition. It further reports selected interview data on adverse life events and burdens in the host country from a German study. We propose that the creative arts therapies are not only a container that offers a temporary home, but can also serve as a bridge that gently guides refugees to a stepwise integration in the host country. Several clinical and research examples are presented suggesting that the support and affirmation through the creative arts can strengthen individuals in their process of moving from an old to a new environment.
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October 2017