A Pilot RCT of Psychodynamic Group Art Therapy for Patients in Acute Psychotic Episodes: Feasibility, Impact on Symptoms and Mentalising Capacity
Open accessAbstract
UNLABELLED: This pilot study aimed to evaluate the feasibility of an assessor-blind, randomised controlled trial of psychodynamic art therapy for the treatment of patients with schizophrenia, and to generate preliminary data on the efficacy of this intervention during acute psychotic episodes. Fifty-eight inpatients with DSM-diagnoses of schizophrenia were randomised to either 12 twice-weekly sessions of psychodynamic group art therapy plus treatment as usual or to standard treatment alone. Primary outcome criteria were positive and negative psychotic and depressive symptoms as well as global assessment of functioning. Secondary outcomes were mentalising function, estimated with the Reading the mind in the eyes test and the Levels of emotional awareness scale, self-efficacy, locus of control, quality of life and satisfaction with care. Assessments were made at baseline, at post-treatment and at 12 weeks' follow-up. At 12 weeks, 55% of patients randomised to art therapy, and 66% of patients receiving treatment as usual were examined. In the per-protocol sample, art therapy was associated with a significantly greater mean reduction of positive symptoms and improved psychosocial functioning at post-treatment and follow-up, and with a greater mean reduction of negative symptoms at follow-up compared to standard treatment. The significant reduction of positive symptoms at post-treatment was maintained in an attempted intention-to-treat analysis. There were no group differences regarding depressive symptoms. Of secondary outcome parameters, patients in the art therapy group showed a significant improvement in levels of emotional awareness, and particularly in their ability to reflect about others' emotional mental states. This is one of the first randomised controlled trials on psychodynamic group art therapy for patients with acute psychotic episodes receiving hospital treatment. Results prove the feasibility of trials on art therapy during acute psychotic episodes and justify further research to substantiate preliminary positive results regarding symptom reduction and the recovery of mentalising function. TRIAL REGISTRATION: ClinicalTrials.gov NCT01622166.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The empirical base for AVAT's effectiveness is rather fragmented; many (often smaller) studies examined the effect of very specific kinds of AVATs, with a narrow focus on certain conditions.
“Even though AVAT is a popular treatment method, the empirical base for its effectiveness is rather fragmented; many (often smaller) studies examined the effect of very specific kinds of AVATs, with a narrow focus on certain conditions [2, 7, 55, 56].”
From The effect of active visual art therapy on health outcomes: protocol of a systematic review of randomised controlled trials (2022) · cites this paper as [55]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Baron‐Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00715 · Cited by 4,555 · see citing works
Baron‐Cohen, S., Wheelwright, S. J., Hill, J., Raste, Y., & Plumb, I. (2001) · PubMed · Cited by 4,313 · see citing works
Structured Clinical Interview for DSM-IV Axis I Disorders
Spitzer, R. L., First, M. B., & Gibbon, M. (1997) · Medical Entomology and Zoology · Cited by 3,582 · see citing works
The role and interpretation of pilot studies in clinical research
Leon, A. C., Davis, L. L., & Kraemer, H. C. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2010.10.008 · Cited by 1,917 · cited 1× · see citing works
“Results may therefore only give a very rough indication of the direction of the treatment effect but cannot serve to confirm or reject our hypotheses, and even results on feasibility might not generalise [78].”
The prevention and treatment of missing data in clinical trials
Little, R. J., D'Agostino, R., Cohen, M. L., Dickersin, K., Emerson, S. S., Farrar, J. T., Frangakis, C., Hogan, J. W., Molenberghs, G., Murphy, S. A., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmsr1203730 · Cited by 1,884 · see citing works
Scale for the Assessment of Negative Symptoms
Andreasen, N. C. (1982) · PsycTESTS Dataset · doi:10.1037/t12696-000 · Cited by 1,878 · see citing works
Reading literary fiction improves theory of mind
Kidd, D. C., & Castano, E. (2013) · Science · doi:10.1126/science.1239918 · Cited by 1,642 · see citing works
SPSS for intermediate statistics : use and interpretation
Leech, N. L., Barrett, K. C., Morgan, G. A., Clay, J. N., & Quick, D. (2005) · Cited by 1,569 · see citing works
Structured Clinical Interview for DSM-III-R Personality Disorders
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2012) · PsycTESTS Dataset · doi:10.1037/t07827-000 · Cited by 1,403 · see citing works
DIFFERENTIATING AMONG INTERNALITY, POWERFUL OTHERS, AND CHANCE
Levenson, H. (1981) · Research with the Locus of Control Construct · doi:10.1016/b978-0-12-443201-7.50006-3 · Cited by 1,078 · see citing works
"Theory of Mind" in Schizophrenia: A Review of the Literature
Brune, M. (2005) · Schizophrenia Bulletin · doi:10.1093/schbul/sbi002 · Cited by 1,044 · see citing works
Theory of mind in schizophrenia: Meta-analysis
Sprong, M., Schothorst, P., Vos, E., Hox, J., & Van Engeland, H. (2007) · British Journal of Psychiatry · doi:10.1192/bjp.bp.107.035899 · Cited by 832 · see citing works
(1987) · American Journal of Psychiatry · doi:10.1176/ajp.144.2.133 · Cited by 813 · see citing works
The Levels of Emotional Awareness Scale: A Cognitive-Developmental Measure of Emotion
Lane, R. D., Quinlan, D. M., SCHWARTZ, G. E. R., Walker, P. A., & Zeitlin, S. B. (1990) · Journal of Personality Assessment · doi:10.1080/00223891.1990.9674052 · Cited by 797 · see citing works
Post-randomisation exclusions: the intention to treat principle and excluding patients from analysis
Fergusson, D., Aaron, S. D., Guyatt, G., & Hébert, P. (2002) · BMJ · doi:10.1136/bmj.325.7365.652 · Cited by 708 · see citing works
Multiple choice vocabulary test MWT as a valid and short test to estimate premorbid intelligence
Lehrl, S., Triebig, G., & Fischer, B. (1995) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.1995.tb07018.x · Cited by 619 · see citing works
Moritz, S., & Woodward, T. S. (2007) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e3282f0b8ed · Cited by 525 · see citing works
Affektregulierung, Mentalisierung und die Entwicklung des Selbst
Fonagy, P., Gergely, G., Jurist, E. L., et al. (2023) · doi:10.5771/9783608206715 · Cited by 409 · see citing works
(1989) · PubMed · Cited by 298 · see citing works
Brüne, M., Abdel-Hamid, M., Lehmkämper, C., & Sonntag, C. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2007.01.006 · Cited by 288 · see citing works
SPSS for Intermediate Statistics
Leech, N. L., Barrett, K. C., & Morgan, G. A. (2004) · Routledge eBooks · doi:10.4324/9781410611420 · Cited by 276 · see citing works
Vauth, R., Rüsch, N., Wirtz, M. A., & Corrigan, P. W. (2004) · Psychiatry Research · doi:10.1016/j.psychres.2004.05.018 · Cited by 255 · see citing works
Montag, C., Dziobek, I., Richter, I. S., Neuhaus, K., Lehmann, A. I., Sylla, R., Heekeren, H. R., Heinz, A., & Gallinat, J. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2010.09.006 · Cited by 239 · see citing works
Self-citationCrawford, M., Killaspy, H. T., Barnes, T. R. E., Barrett, B. M., Byford, S., Clayton, K., Dinsmore, J. G., Floyd, S., Hoadley, A., Johnson, T. L., et al. (2012) · BMJ · doi:10.1136/bmj.e846 · Cited by 231 · see citing works
Subič-Wrana, C., Bruder, S., Thomas, W., Lane, R. D., & Köhle, K. (2005) · Psychosomatic Medicine · doi:10.1097/01.psy.0000160461.19239.13 · Cited by 190 · see citing works
Lysaker, P. H., Buck, K. D., Carcione, A., Procacci, M., Salvatore, G., Nicolò, G., & Dimaggio, G. (2010) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608310x520436 · Cited by 186 · see citing works
Bora, E., Yücel, M., & Pantelis, C. (2009) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2009.01414.x · Cited by 177 · see citing works
Intention-to-treat approach to data from randomized controlled trials: a sensitivity analysis
Wright, C. C., & Sim, J. (2003) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(03)00155-0 · Cited by 171 · see citing works
Röhricht, F., & Priebe, S. (2006) · Psychological Medicine · doi:10.1017/s0033291706007161 · Cited by 167 · see citing works
Theory of Mind and Emotional Awareness Deficits in Patients With Somatoform Disorders
Subič-Wrana, C., Beutel, M. E., Knebel, A., & Lane, R. D. (2010) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181d35e83 · Cited by 167 · see citing works
No words for feelings: alexithymia in schizophrenia patients and first-degree relatives
van 't Wout, M., Aleman, A., Bermond, B., & Kahn, R. S. (2007) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2006.07.003 · Cited by 158 · see citing works
Music therapy for schizophrenia or schizophrenia-like illnesses
Gold, C., Heldal, T. O., Dahle, T., & Wigram, T. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004025.pub2 · Cited by 153 · see citing works
Neural correlates of metaphor processing in schizophrenia
Kircher, T. T. J., Leube, D., Erb, M., et al. (2006) · NeuroImage · doi:10.1016/j.neuroimage.2006.08.044 · Cited by 153 · see citing works
Analysis of Variance of Multiply Imputed Data
van Ginkel, J. R., & Kroonenberg, P. M. (2014) · Multivariate Behavioral Research · doi:10.1080/00273171.2013.855890 · Cited by 152 · see citing works
Mo, S., Su, Y., Chan, R. C. K., & Liu, J. (2007) · Psychiatry Research · doi:10.1016/j.psychres.2006.04.002 · Cited by 151 · see citing works
Prinzhorn, H. (1922) · Springer eBooks · doi:10.1007/978-3-642-64934-9 · Cited by 149 · see citing works
Art as therapy: an effective way of promoting positive mental health?
Heenan, D. (2006) · Disability & Society · doi:10.1080/09687590500498143 · Cited by 142 · see citing works
Attachment states of mind, mentalization, and their correlates in a first‐episode psychosis sample
MacBeth, A. M., Gumley, A. I., Schwannauer, M., & Fisher, R. (2011) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608310x530246 · Cited by 140 · see citing works
Art therapy for schizophrenia or schizophrenia-like illnesses
Ruddy, R., & Milnes, D. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003728.pub2 · Cited by 127 · see citing works
Korver‐Nieberg, N., Berry, K., Meijer, C. J., & de Haan, L. (2013) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12010 · Cited by 121 · see citing works
Psychodynamic treatment of schizophrenia: is there a future?
Mueser, K. T., & Berenbaum, H. (1990) · Psychological Medicine · doi:10.1017/s003329170001758x · Cited by 120 · see citing works
Harrow, M., Hansford, B. G., & Astrachan-Fletcher, E. B. (2009) · Psychiatry Research · doi:10.1016/j.psychres.2008.06.002 · Cited by 116 · see citing works
Ulrich, G., Houtmans, T., & Gold, C. (2007) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2007.01073.x · Cited by 113 · see citing works
Exploratory RCT of art therapy as an adjunctive treatment in schizophrenia
Richardson, P. H., Jones, K., Evans, C., Stevens, P., & Rowe, A. (2007) · Journal of Mental Health · doi:10.1080/09638230701483111 · Cited by 104 · see citing works
Müller, M. J., Marx-Dannigkeit, P., Schlösser, R. G. M., Wetzel, H., Addington, D. E., & Benkert, O. (1999) · Journal of Psychiatric Research · doi:10.1016/s0022-3956(99)00018-7 · Cited by 80 · see citing works
Mentalization‐based psychodynamic psychotherapy for psychosis
Brent, B. K. (2009) · Journal of Clinical Psychology · doi:10.1002/jclp.20615 · Cited by 80 · see citing works
How can art therapy contribute to mentalization in borderline personality disorder?
Springham, N., Findlay, D., Woods, A., & Harris, J. (2012) · International Journal of Art Therapy · doi:10.1080/17454832.2012.734835 · Cited by 76 · see citing works
Group Art Therapy as an Adjunct to Treatment for Chronic Outpatients
Green, B. L., Wehling, C., & Taisky, G. J. (1987) · Psychiatric Services · doi:10.1176/ps.38.9.988 · Cited by 72 · see citing works
Arts therapies for people with schizophrenia: an emerging evidence base
Crawford, M., & Patterson, S. (2007) · Evidence-Based Mental Health · doi:10.1136/ebmh.10.3.69 · Cited by 70 · see citing works
The design and conduct of clinical trials to limit missing data
Little, R. J. A., Cohen, M. L., Dickersin, K., Emerson, S. S., Farrar, J. T., Neaton, J. D., Shih, W. J., Siegel, J. P., & Stern, H. S. (2012) · Statistics in Medicine · doi:10.1002/sim.5519 · Cited by 70 · see citing works
Art Therapy With Serious Juvenile Offenders
Persons, R. W. (2008) · International Journal of Offender Therapy and Comparative Criminology · doi:10.1177/0306624x08320208 · Cited by 68 · see citing works
Baslet, G. C., Termini, L., & Herbener, E. S. (2009) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181b3b20f · Cited by 65 · see citing works
Patterson, S., Crawford, M., Ainsworth, E., & Waller, D. (2011) · International Journal of Art Therapy · doi:10.1080/17454832.2011.604038 · Cited by 63 · see citing works
Franklin, M. J. (1992) · Art Therapy · doi:10.1080/07421656.1992.10758941 · Cited by 63 · see citing works
Teglbjaerg, H. S. (2011) · Psychopathology · doi:10.1159/000325025 · Cited by 57 · see citing works
Art, Psychotherapy and Psychosis
Killick, K., & Schaverien, J. (2010) · Routledge eBooks · doi:10.4324/9780203437599 · Cited by 52 · see citing works
The image, mentalisation and group art psychotherapy
Franks, M., & Whitaker, R. (2007) · International Journal of Art Therapy · doi:10.1080/17454830701265188 · Cited by 50 · see citing works
Clay sculpting of mother and child figures encourages mentalization
Or, M. B. (2010) · The Arts in Psychotherapy · doi:10.1016/j.aip.2010.05.007 · Cited by 48 · see citing works
Waller, D. (1992) · Medical Entomology and Zoology · Cited by 44 · see citing works
Levels of Emotional Awareness Scale (LEAS)
Subič-Wrana, C., Thomas, W., Huber, M., & Köhle, K. (2001) · Psychotherapeut · doi:10.1007/s002780100157 · Cited by 40 · see citing works
Subič-Wrana, C., Beutel, M. E., Garfield, D., & Lane, R. D. (2011) · The International Journal of Psychoanalysis · doi:10.1111/j.1745-8315.2011.00392.x · Cited by 40 · see citing works
Provision and practice of art therapy for people with schizophrenia: Results of a national survey
Patterson, S., Debate, J., Anju, S., Waller, D., & Crawford, M. (2011) · Journal of Mental Health · doi:10.3109/09638237.2011.556163 · Cited by 37 · see citing works
Künstlerische Therapien bei schweren psychischen Störungen
Gühne, U., Weinmann, S., Arnold, K., Ay, E., Becker, T. M., & Riedel-Heller, S. G. (2012) · Der Nervenarzt · doi:10.1007/s00115-011-3472-7 · Cited by 35 · see citing works
Heubrock, D. (1992) · Zeitschrift für Differentielle und Diagnostische Psychologie · Cited by 30 · see citing works
Art and mental illness: where is the link?
Spaniol, S. E. (2001) · The Arts in Psychotherapy · doi:10.1016/s0197-4556(01)00108-3 · Cited by 27 · see citing works
[Quality of life. Construct validation and the development of a modular system].
Pukrop, R., Möller, H. J., Sass, H., et al. (1999) · PubMed · doi:10.1007/s001150050399 · Cited by 27 · see citing works
Short-term day hospital treatment for personality disorders: Benefits of the therapeutic components.
Karterud, S., & Pedersen, G. (2004) · Cited by 24 · see citing works
Riedel-Heller, S. G., Gühne, U., Weinmann, S., & Becker, T. M. (2012) · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie · doi:10.1055/s-0032-1327676 · Cited by 12 · see citing works
GROUP INTERVENTION FOR SCHIZOPHRENIA INPATIENT WITH ART AS MEDIUM
Peixin, M., Ri-chang, Z., Zhuoji, C., et al. (2005) · Acta Psychologica Sinica · Cited by 12 · see citing works
Brooker, J., Cullum, M., Gilroy, A., et al. (2007) · Goldsmiths Research Online · Cited by 11 · see citing works
What aspects of an art therapy group aid recovery for people diagnosed with psychosis?
Greenwood, H. (2015) · Art therapy online · doi:10.25602/gold.atol.v3i1.297 · Cited by 11 · see citing works
Art, Psychotherapy and Psychosis
Schaverien, O. (2013) · Cited by 4 · see citing works
[Ethical problems in biomedical research with cognitively impaired elderly patients].
Helmchen, H., & Lauter, H. J. (1995) · PubMed · Cited by 3 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- [11]Sarra N (1998) Connection and disconnection in the art therapy group. Working with forensic patients on the locked ward. In: Skaife S, Huet V, editors. Art psychotherapy groups. Between pictures and words. London: Routledge.
- [45]Schmidt J, Lamprecht F, Wittmann WW (1989) Zufriedenheit mit der stationären Versorgung. Entwicklung eines Fragebogens und erste Validitätsuntersuchungen. Psychother Psychosom Med Psychol 39: 248– 255. 2762479
Cited by
Sorted by citations
ChatGPT outperforms humans in emotional awareness evaluations
Elyoseph, Z., Hadar-Shoval, D., Asraf, K., & Lvovsky, M. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1199058 · Cited by 324 · see citing works
Lutgens, D., Gariepy, G., & Malla, A. (2017) · British Journal of Psychiatry · doi:10.1192/bjp.bp.116.197103 · Cited by 181 · see citing works
Levels of Emotional Awareness: Theory and Measurement of a Socio-Emotional Skill
Lane, R. D., & Smith, R. (2021) · Journal of Intelligence · doi:10.3390/jintelligence9030042 · Cited by 163 · see citing works
Art therapy in mental health: a systematic review of approaches and practices
Van Lith, T. (2016) · The Arts in Psychotherapy · doi:10.1016/j.aip.2015.09.003 · Cited by 140 · see citing works
Joschko, R., Roll, S., Willich, S. N., & Berghöfer, A. (2022) · Systematic Reviews · doi:10.1186/s13643-022-01976-7 · Cited by 19 · see citing works
“Even though AVAT is a popular treatment method, the empirical base for its effectiveness is rather fragmented; many (often smaller) studies examined the effect of very specific kinds of AVATs, with a narrow focus on certain conditions [2, 7, 55, 56].”
Background
- Authors
- Montag, C., Haase, L., Seidel, D., Bayerl, M., Gallinat, J., Herrmann, U., & Dannecker, K.
- Affiliations
- Charité – Universitätsmedizin Berlin (DE)
- Kunsthochschule Berlin-Weißensee (DE)
- Corresponding author
- Montag, Christiane
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-11-13
- Volume
- 9
- Issue
- 11
- Pages
- e112348
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4231093
- OpenAlex
- W2163035077
- Cited by
- 97
- References
- 73
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 15 · 2023: 10 · 2022: 11 · 2021: 8 · 2020: 4 · 2019: 9 · 2018: 6 · 2017: 11 · 2016: 4 · 2015: 4 · 2014: 1
- FWCI
- 122.72
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Refubium (Universitätsbibliothek der Freien Universität Berlin) (submittedVersion, cc-by)
- Topics
- Social Sciences › Arts and Humanities › Conservation › Art Therapy and Mental Health
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- group art therapy, schizophrenia, acute psychosis, positive symptoms, negative symptoms, depressive symptoms, emotional awareness, psychosocial functioning, psychiatric inpatient care, treatment feasibility
- MeSH terms
- Adult, Art Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pilot Projects, Psychotherapy, Group, Psychotic Disorders, Quality of Life, Schizophrenia, Treatment Outcome, Psychotherapy, Psychodynamic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
