An Experimental Comparative Study on the Effect Times of Three Art Based Psychotherapies in a Medical Setting

Document Type : Original Article


1 Department of Psychology, University of Tehran, Tehran, Iran

2 Department of Pediatrics, School of Medicine, Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Psychology, Tarbiat Modares University, Tehran, Iran


Introduction: Recently, a short-term hospitalization policy has been implemented to reduce the psychosocial consequences of illness. Nonetheless, psychosocial problems in patients persist. Therefore, in addition to the necessity of providing psychological services, the necessity of brief interventions is also important. So, the aim of the present study was to compare the effect times of the three psychotherapies. Method: The present research was undertook in an ex post facto design. After designing the art therapy, psychodrama and psycho-art-drama comparable protocols for the present study, 15 hospitalized children with cancer admitted to Children Medical Center (CMC) from November 2018 to February 2019 were selected based on the inclusion and exclusion criteria. Each of the protocols were applied for five participants. The measures of the present study included the Children’s Depression Inventory (CDI), the Child Pain Anxiety Symptoms Scale (CPASS), and the checklist of Bio-Psycho-Social Expressions of Incompatibility in Hospital (BPSEIH). The data analysis was performed by ANOVA test for comparing the effect times. Results: The findings revealed that psychodrama is the fastest psychotherapy with a lower effect time. Conclusion: It can be stated that considering the effect time is necessary to select a psychotherapy as well as the effect size.


1.         Dekker, J. and V. de Groot, Psychological adjustment to chronic disease and rehabilitation–an exploration. Disability and rehabilitation, 2018. 40(1): p. 116-120.
2.         Cukor, D., et al., Psychosocial aspects of chronic disease: ESRD as a paradigmatic illness. Journal of the American Society of Nephrology, 2007. 18(12): p. 3042-3055.
3.         Greenberg, T.M., The psychological impact of acute and chronic illness. 2007: Springer.
4.         Nasif, J., The emotional impact of chronic illness. Journal of Psychology & Clinical Psychiatry, 2015. 3(6): p. 177-180.
5.         Gledhill, J., L. Rangel, and E. Garralda, Surviving chronic physical illness: psychosocial outcome in adult life. Archives of disease in childhood, 2000. 83(2): p. 104-110.
6.         Hickman Jr, R.L. and S.L. Douglas, Impact of chronic critical illness on the psychological outcomes of family members. AACN advanced critical care, 2010. 21(1): p. 80.
7.         Northam, E., Psychosocial impact of chronic illness in children. Journal of paediatrics and child health, 1997. 33(5): p. 369-372.
8.         Perrin, J.M., S. Gnanasekaran, and J. Delahaye, Psychological aspects of chronic health conditions. Pediatrics in Review, 2012. 33(3): p. 99-109.
9.         Schulte, F., et al., Screening for psychosocial distress in pediatric cancer patients: An examination of feasibility in a single institution. Pediatric hematology and oncology, 2019: p. 1-13.
10.       Reisi-Dehkordi, N., H. Baratian, and A. Zargham-Boroujeni, Challenges of children with cancer and their mothers: A qualitative research. Iranian journal of nursing and midwifery research, 2014. 19(4): p. 334.
11.       Ertezaee, B., et al., The Mediating Role of Pleasant Activities in Cognitive Behavioral Therapy for Depressed Adolescents. International Journal of Behavioral Sciences, 2019. 13(1): p. 33-39.
12.       Juul, S., et al., Short-term versus long-term psychotherapy for adult psychiatric disorders: a protocol for a systematic review with meta-analysis and trial sequential analysis. Systematic reviews, 2019. 8(1): p. 169.
13.       Berg, R.C. and B. Høie, Effectiveness of psychotherapy for adults with depression: a systematic review of the best available evidence. Procedia-Social and Behavioral Sciences, 2010. 5: p. 2194-2200.
14.       Bhar, S.S., et al., Is longer-term psychodynamic psychotherapy more effective than shorter-term therapies? Review and critique of the evidence. Psychotherapy and Psychosomatics, 2010. 79(4): p. 208-216.
15.       Knekt, P., et al., Effectiveness of short-term and long-term psychotherapy on work ability and functional capacity—a randomized clinical trial on depressive and anxiety disorders. Journal of affective disorders, 2008. 107(1-3): p. 95-106.
16.       Knekt, P., et al., The outcome of short-and long-term psychotherapy 10 years after start of treatment. Psychological medicine, 2016. 46(6): p. 1175-1188.
17.       Gussak, D. and M.L. Rosal, The Wiley handbook of art therapy. 2016: Wiley Online Library.
18.       Orkibi, H. and R. Feniger-Schaal, Integrative systematic review of psychodrama psychotherapy research: Trends and methodological implications. PloS one, 2019. 14(2): p. e0212575.
19.       Dehnavi, S., S.-F. Hashemi, and A. Zadeh-Mohammadi, The effectiveness of psychodrama on reducing depression among multiple sclerosis patients. International Journal of Behavioral Sciences, 2016. 9(4): p. 32-35.
20.       Purrezaian, H., Clinical Planning/Trial of the Family-based Art Therapy and Psychodrama for Psychological Treatment and Adaptation of Children with Cancer, in Psychology and Educational Science Faculty. 2020, University of Tehran: Tehran, Iran.
21.       Councill, T., Art therapy with pediatric cancer patients: Helping normal children cope with abnormal circumstances. Art Therapy, 1993. 10(2): p. 78-87.
22.       Nesbitt, L.L. and K. Tabatt-Haussmann, The Role of the Creative Arts Therapies in the Treatment of Pediatric Hematology and Oncology Patients. Primary Psychiatry, 2008. 15(7).
23.       Menichetti Delor, J.P., et al., Adjustment to cancer: exploring patients' experiences of participating in a psychodramatic group intervention. 2015.
24.       Domnick, M., et al., Evaluation of the effectiveness of a multimodal complementary medicine program for improving the quality of life of cancer patients during adjuvant radiotherapy and/or chemotherapy or outpatient aftercare. Oncology, 2017. 93(2): p. 83-91.
25.       Abdulah, D.M. and B.M.O. Abdulla, Effectiveness of group art therapy on quality of life in paediatric patients with cancer: A randomized controlled trial. Complementary therapies in medicine, 2018. 41: p. 180-185.
26.       Favara‐Scacco, C., et al., Art therapy as support for children with leukemia during painful procedures. Medical and Pediatric Oncology: The Official Journal of SIOP—International Society of Pediatric Oncology (Societé Internationale d'Oncologie Pédiatrique, 2001. 36(4): p. 474-480.
27.       Gold, C., et al., Individual music therapy for mental health care clients with low therapy motivation: Multicentre randomised controlled trial. Psychotherapy and psychosomatics, 2013. 82(5): p. 319-331.
28.       Massimo, L.M. and D.A. Zarri, In tribute to Luigi Castagnetta—drawings: A narrative approach for children with cancer. Annals of the New York Academy of Sciences, 2006. 1089(1): p. xvi-xxiii.
29.       Rollins, J.A., Tell me about it: Drawing as a communication tool for children with cancer. Journal of Pediatric Oncology Nursing, 2005. 22(4): p. 203-221.
30.       Teglbjaerg, H.S., Art therapy may reduce psychopathology in schizophrenia by strengthening the patients’ sense of self: a qualitative extended case report. Psychopathology, 2011. 44(5): p. 314-318.
31.       Woodgate, R.L., C.H. West, and K. Tailor, Existential anxiety and growth: an exploration of computerized drawings and perspectives of children and adolescents with cancer. Cancer Nursing, 2014. 37(2): p. 146-159.
32.       Zeeck, A., et al., Inpatient versus day clinic treatment for bulimia nervosa: a randomized trial. Psychotherapy and psychosomatics, 2009. 78(3): p. 152-160.
33.       Grange-Segeral, E. and A. Griot, Hospitalization seen as a psychodrama or" the unplaceable Mr B.". EVOLUTION PSYCHIATRIQUE, 2012. 77(4): p. 642-651.
34.       Iren Akbiyik, D., H. Soygur, and E. Karabulut, Strengthening mental health in psycho-oncology and family practice: perceived social support and psychodrama group psychotherapy. Anadolu Psikiyatri Dergisi-Anatolian Journal of Psychiatry, 2012. 13(3): p. 205-209.
35.       Lamiani, G., I. Fossati, and E. Vegni, Between life and death: clinical study on the psychodramatic therapy of two oncological patients. RICERCHE DI PSICOLOGIA, 2016(4): p. 611-634.
36.       Menichetti, J., et al., Adjustment to cancer: exploring patients' experiences of participating in a psychodramatic group intervention. European journal of cancer care, 2016. 25(5): p. 903-915.
37.       Kovacs, M. and A.T. Beck, An empirical-clinical approach toward a definition of childhood depression. Depression in childhood: Diagnosis, treatment, and conceptual models, 1977: p. 1-25.
38.       Masip, A.F., et al., Psychometric properties of the Children's Depression Inventory in community and clinical sample. The Spanish journal of psychology, 2010. 13(2): p. 990-999.
39.       Ivarsson, T., P. Svalander, and O. Litlere, The Children's Depression Inventory (CDI) as measure of depression in Swedish adolescents. A normative study. Nordic Journal of Psychiatry, 2006. 60(3): p. 220-226.
40.       McCracken, L.M. and L. Dhingra, A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Research and Management, 2002. 7(1): p. 45-50.
41.       Pagé, M.G., et al., Development and preliminary validation of the Child Pain Anxiety Symptoms Scale in a community sample. Journal of pediatric psychology, 2010. 35(10): p. 1071-1082.
42.       Pagé, M.G., et al., Reliability and validity of the Child Pain Anxiety Symptoms Scale (CPASS) in a clinical sample of children and adolescents with acute postsurgical pain. Pain, 2011. 152(9): p. 1958-1965.
43.       Aichinger, A. and W. Holl, Group Therapy with Children: Psychodrama with Children. 2017: Springer.