Therapeutic effects of clay art therapy for patients with depression

Abstract

Depression creates huge socioeconomic problems globally and will become the most serious cause of disability in 2030. Effective and community-based treatment methods are urgently needed to cope with critical issues affected by depression.

Recent neuroscience research has reexamined how affect mediates the responses between the mind and body. The discussion of the relationships between various neurological processes during clay art making established the underpinnings of adopting a body–mind and bottom–up integrated approach.

Clay art therapy (CAT) incorporated nonverbal and verbal; kinesthetic, sensory, and psychological components in treatment. The adoption of clay as the only art medium with the use of the Expressive Therapies Continuum (ETC) framework organized the intervention on the body and mind from a bottom-up hierarchy. All these have rarely been reported in art therapy and psychiatry literature and randomized controlled trial has never been conducted in this area.

This study adopted a mixed methods approach in which 100 patients with depression were randomly allocated into Clay Art Therapy (CAT) group and nondirective Visual Art (VA) control group in community setting. Both groups met for 2.5 hours weekly for six sessions. For quantitative method, an outcome study was applied to measure intervention effects with Beck Depression Inventory (BDI-II-C), General Health Questionnaires (GHQ-12), Body–Mind–Spirit–Well-Being Inventory (BMSWBI), and Toronto Alexithymia Scale 20 (TAS-20). Quantitative data were collected at baseline (T0), end of treatment (T1) and three weeks after (T2). A process study was conducted in which the participants in the CAT group were asked to fill out a form to record the ETC movements in the clay work processes. For qualitative method, art-based qualitative inquiry was adopted. Content analysis of codes derived from the semi-structured interview with participants conducted at T2 would be able to understand the participants’ experiences of the intervention.

Results of repeated measures MANCOVA showed significant improvement in depressive signs, general health, Body–Mind–Spirit–Well-Being, and ability to articulate inner process in CAT group compared with the control VA group across T0, T1, and T2. Univariate analyses revealed a significant effect for BDI-II-C, GHQ-12, and BMSWBI, but not on TAS-20 in CAT group compared with the control group across the time points. The CAT intervention was found to be more effective than the VA intervention in alleviating depressive signs, improving general health, daily functioning, and holistic well-being of the participants. Analysis of the ETC movement direction showed a coherent flow moving from the predominance of Kinesthetic–Sensory level (session 1-2), gradually transited to Perceptual–Affective level (session 3-4), and finally to Cognitive–Symbolic level (session 5-6). This supported the effects of CAT in progressively integrating the body and mind with a bottom–up approach. Qualitative results demonstrated various effects of CAT which included release of energy, relaxation, improvement in attention, balancing objective judgments with expression of feeling, enhancement of cognitive abilities, affirming self-identity, and strengthening of resilience to frustration.

This study demonstrated the benefits and practicability of an integrated arts therapy approach in treating depression. The community-based and strength-based intervention of CAT can supplement mainstream treatment and can be applied to other populations with other forms of affective disorders.