Effects of Art Therapy Program on Anxiety and Depression among 6-12-Year-Old Burned Children
INTRODUCTION: There are various ways to relieve physical injuries, but less attention has been dedicated to the treatment of psychological injuries in burned children.
AIM: The present study was conducted to investigate the effects of art therapy using painting and music on reducing anxiety and depression in burned children.
MATERIALS AND METHODS: This study was a three-group randomized clinical trial with a pre-test-post-test design that was performed on 60 children aged 6â€“12 years. The patients were admitted to the Burn Center of Imam Reza Hospital, Mashhad, Iran, within 2018 were selected using convenience sampling method and randomly divided into three groups, namely, two intervention (subjected to art and music) and one control group. Ten 45-min-long art therapy sessions were conducted every day. Anxiety was measured with parent-version of the Spence Childrenâ€™s Anxiety Scale, and depression was measured using Maria Kovacs Childrenâ€™s Depression Inventory Questionnaire. The control group only benefited from the routine services of the center.
RESULTS: Before the intervention, the total mean scores of anxiety in the burned children in the painting, music, and control groups were measured at 90.4 Â± 5.4, 84.8 Â± 6.8, and 77.4 Â± 13.8, respectively. However, the total mean scores of anxiety after the intervention in the burned children in the painting, music, and control groups were estimated at 53.3 Â± 4.4, 45.9 Â± 8.4, and 72.4 Â± 12.9, respectively (p < 0.001). Furthermore, the mean of depression total score before the intervention was measured at 38.7 Â± 3.4, 32.8 Â± 5.4, and 28.9 Â± 5.4, for painting, music, and control groups, respectively (p < 0.001). Moreover, the total mean score of depression after the intervention in the painting, music, and control groups was obtained as 29.9 Â± 4.0, 19.3 Â± 3.8, and 25.2 Â± 4.9, respectively (p < 0.001).
CONCLUSION: Art therapy using painting and music led to the reduction of anxiety and depression in children with burns; therefore, it is recommended to use the technique for this population.
Plum Analytics Artifact Widget Block
World Health Organization. Burn Prevention: Success Stories and Lessons Learned. Geneva: World Health Organization; 2011.
Peck MD. Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns. 2011;37(7):1087-100. https://doi.org/10.1016/j.burns.2011.06.005 PMid:21802856
Mohebbi Z, Najafi S, Molazem Z, Setoodeh G. Epidemiology, causes and outcome of burns in women from Southern Iran: 2009-2011. Womens Health Bull. 2014;1(2):e20123. https://doi. org/10.17795/whb-20123
Kudchadkar SR, Aljohani OA, Punjabi NM. Sleep of critically ill children in the pediatric intensive care unit: A systematic review. Sleep Med Rev. 2014;18(2):103-10. https://doi.org/10.1016/j. smrv.2013.02.002 PMid:23702219
Norambuena C, YaÃ±ez J, Flores V, Puentes P, Carrasco P, Villena R. Oral ketamine and midazolam for pediatric burn patients: A prospective, randomized, double-blind study. J Pediatr Surg. 2013;48(3):629-34. https://doi.org/10.1016/j. jpedsurg.2012.08.018 PMid:23480923
Saxe GN, Stoddard F, Hall E, Chawla N, Lopez C, Sheridan R, et al. Pathways to PTSD, part I: Children with burns. Am J Psychiatry. 2005;162(7):1299-304. https://doi.org/10.1176/appi. ajp.162.7.1299 PMid:15994712
Tan X, Yowler CJ, Super DM, Fratianne RB. The efficacy of music therapy protocols for decreasing pain, anxiety, and muscle tension levels during burn dressing changes: A prospective randomized crossover trial. J Burn Care Res. 2010;31(4):590-7. https://doi.org/10.1097/bcr.0b013e3181e4d71b PMid:20498613
Branson SM, Boss L, Padhye NS, TrÃ¶tscher T, Ward A. Effects of animal-assisted activities on biobehavioral stress responses in hospitalized children: A randomized controlled study. J Pediatr Nurs. 2017;36:84-91. https://doi.org/10.1016/j. pedn.2017.05.006 PMid:28888516
Herndon D. Total Burn Care. 2nd ed. Londen: Saunders; 2012.
Palmu R, Suominen K, Vuola J, IsometsÃ¤ E. Mental disorders after burn injury: A prospective study. Burns. 2011;37(4):601-9. https://doi.org/10.1016/j.burns.2010.06.007 PMid:21081260
Alaghehbandan R, Lari AR, Joghataei MT, Islami A. The role of marital status, literacy, and urbanity in suicidal behavior by burns in the province of Khorasan, Iran. Community Ment Health J. 2011;47(2):181-5. https://doi.org/10.1007/s10597-010-9297-1 PMid:20130990
Arshi S, Sadeghi-Bazargani H, Mohammadi R, Ekman R, Hudson D, Djafarzadeh H, et al. Prevention oriented epidemiologic study of accidental burns in rural areas of Ardabil, Iran. Burns. 2006;32(3):366-71. https://doi.org/10.1016/j.burns.2005.10.026 PMid:16529866
Mirmohammadi SJ, Mehrparvar AH, Kazemeini K, Mostaghaci M. Epidemiologic characteristics of occupational burns in Yazd, Iran. Int J Prev Med. 2013;4(6):723-7. PMid:23930193
Li J, Zhou L, Wang Y. The effects of music intervention on burn patients during treatment procedures: A systematic review and meta-analysis of randomized controlled trials. BMC Complement Altern Med. 2017;17(1):158. https://doi. org/10.1186/s12906-017-1669-4 PMid:28302117
De Young AC, Kenardy JA, Cobham VE, Kimble R. Prevalence, comorbidity and course of trauma reactions in young burn-injured children. J Child Psychol Psychiatry. 2012;53(1):56-63. https://doi.org/10.1111/j.1469-7610.2011.02431.x PMid:21671940
Richardson P, Mustard L. The management of pain in the burns unit. Burns. 2009;35(7):921-36. https://doi.org/10.1016/j. burns.2009.03.003 PMid:19505764
Stoddard FJ, Saxe G, Ronfeldt H, Drake JE, Burns J, Edgren C, et al. Acute stress symptoms in young children with burns. J Am Acad Child Adolesc Psychiatry. 2006;45(1):87-93. https://doi. org/10.1097/01.chi.0000184934.71917.3a PMid:16327585
Holaday M, Terrell D. Resiliency characteristics and Rorschach variables in children and adolescents with severe burns. J Burn Care Rehabil. 1994;15(5):455-60. https://doi. org/10.1097/00004630-199409000-00017 PMid:7995822
Goldschmidt K, Woolley A. Using technology to reduce childrensâ€™ anxiety throughout the perioperative period. J Pediatr Nurs. 2017;36:256-8. https://doi.org/10.1016/j.pedn.2017.04.006132 https://www.id-press.eu/mjms/index PMid:28457695
Wiechman S, Saxe G, Fauerbach JA. Psychological outcomes following burn injuries. J Burn Care Res. 2017;38(3):e629-31. https://doi.org/10.1097/bcr.0000000000000549 PMid:28346301
Case C, Dalley T. The Handbook of Art Therapy. Abingdon, United Kingdom: Routledge; 2014.
Nissimov-Nahum E. Use of a drawing task to study art therapistsâ€™ personal experiences in treating aggressive children. Arts Psychother. 2009;36(3):140-7. https://doi.org/10.1016/j. aip.2008.12.001
Rubin JA. Child Art Therapy. New Jersey, United States: John Wiley & Sons; 2005.
Liebmann M. Art Therapy and Anger. London, United Kingdom: Jessica Kingsley Publishers; 2008.
Waller D. Group Interactive Art Therapy: Its Use in Training and Treatment. Abingdon, United Kingdom: Routledge; 2014.
Hamel NJ. Childrenâ€™s Understanding and Experience of Anger within their Peer Groups. Ontario: The University of Western Ontario; 2013.
Russell J. Art therapy on a hospital burn unit: A step towards healing and recovery. Art Therapy. 1995;12(1):39-45. https://doi. org/10.1080/07421656.1995.10759122
Keihani M, Shariatpanahi M. The effect of music on concentration and attention among students of Tehran University of medical sciences. Islam Azad Univ J Med Sci. 2008;18(2):101-6.
Kousha S, Varasteh A. The effectiveness of music therapy on depression, quality of life and happiness of women with depression. Frooyesh. 2018;6(4):149-70.
Liu Y, Petrini MA. Effects of music therapy on pain, anxiety, and vital signs in patients after thoracic surgery. Complement Ther Med. 2015;23(5):714-8. https://doi.org/10.1016/j.ctim.2015.08.002 PMid:26365452
McCaffrey R, Locsin RC. Music listening as a nursing intervention: A symphony of practice. Holist Nurs Pract. 2002;16(3):70-7. https://doi.org/10.1097/00004650-200204000-00012 PMid:11913230
Burns DS, Perkins SM, Tong Y, Hilliard RE, Cripe LD. Music therapy is associated with family perception of more spiritual support and decreased breathing problems in cancer patients receiving hospice care. J Pain Symptom Manage. 2015;50(2):225-31. https://doi.org/10.1016/j.jpainsymman.2015.02.022 PMid:25839735
Fredenburg HA, Silverman MJ. Effects of cognitive-behavioral music therapy on fatigue in patients in a blood and marrow transplantation unit: A mixed-method pilot study. Arts Psychother. 2014;41(5):433-44. https://doi.org/10.1016/j.aip.2014.09.002
Spence SH, Rapee R, McDonald C, Ingram M. The structure of anxiety symptoms among preschoolers. Behav Res Ther. 2001;39(11):1293-316. https://doi.org/10.1016/ s0005-7967(00)00098-x PMid:11686265
Kovacs M. The childrenâ€™s depression, inventory (CDI). Psychopharmacol Bull. 1985;21(4):995-8. PMid:4089116
Ghanbari S, Khanmohamadi M, Khodapanahi MK, Mazaheri MA, Lavasani MG. Study of psychometric properties of preschool anxiety scale (PAS). J Psychol. 2011;3(59):222-34.
Mirzaie P, Nazarian L, Zare H. Validation of the Maria Kovacs Childrenâ€™s depression inventory to assess depression among school children in Afghanistan. J Midwifery Reprod Health. 2019;7(3):1742-8.
Koolaee AK, Vazifehdar R, Bahari F. Impact of painting therapy on aggression and anxiety of children with cancer. Caspian J Pediatr. 2016;2(2):135-41.
Shirabadi A, Jani S, Pouresmali A. Effectiveness of art therapy based on painting therapy to reduce anxiety of children with stuttering. Sci J Ilam Univ Med Sci. 2015;23(2):53-60.
Beebe A, Gelfand EW, Bender B. A randomized trial to test the effectiveness of art therapy for children with asthma. J Allergy Clin Immunol. 2010;126(2):263-6, 266.e1. https://doi. org/10.1016/j.jaci.2010.03.019 PMid:20462632
Moghaddam HE, Badrizadeh A, Farhadi A. Study of anxiety symptoms in drawing-a-person test of Khorramabad 10 years old children. Yafteh. 2014;15(5):93-103.
Karami J, Alikhani M, Zakiei A, Khodadadi K. The effectiveness of art therapy (painting) in reducing the aggressive behavior of students with dyslexia. J Learn Disabil. 2012;1(3):105-17.
Rabiee MR, Mahmodi KM. The effect of music on the rate of anxiety among hospitalized children. J Gorgan Univ Med Sci. 2007;9(3):59-64.
Whitehead-Pleaux AM, Baryza MJ, Sheridan RL. The effects of music therapy on pediatric patientsâ€™ pain and anxiety during donor site dressing change. J Music Ther. 2006;43(2):136-53. https://doi.org/10.1093/jmt/43.2.136 PMid:16897906
Stratton VN, Zalanowski AH. The effects of music and paintings on mood. J Music Ther. 1989;26(1):30-41. https://doi. org/10.1093/jmt/26.1.30
Moammadi A, Raadin A. The effectiveness of art therapy on decreasing on depression, anxiety and aggression in preschoolers. J Anal Cogn Psycholoy. 2017;8(28):43-51.
Tahan YA, Moghpoo AJ. The effect of music therapy on stress, anxiety and depression in cancer patients. Indian J Palliat Care. 2018;7(3):186-93.
Jasemi M, Aazami S, Zabihi RE. The effects of music therapy on anxiety and depression of cancer patients. Indian J Palliat Care. 2016;22(4):455-8. https://doi.org/10.4103/0973-1075.191823 PMid:27803568
Copyright (c) 2020 Hossein Rezazadeh, Razieh Froutan, Ali Ahmad Abadi, Seyed Reza Mazloum, Kaveh Moghaddam (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All rights reserved.