Care in the Creative Community A Resource Guide for Arts Engagement in the Treatment of Individuals Experiencing First Episode Psychosis Presented by Marissa Georgiou, MA in Counseling- Art Therapy Candidate Pennsylvania Western University Purpose Statement Limited research has been conducted on the intersection of First Episode Psychosis (FEP) care, Recovery-Oriented Cognitive Therapy (CT-R), Art Therapy, and Community Arts spaces. Existing evidence indicates that both creative arts therapies and community engagement may alleviate symptoms of psychosis. This research provides a resource guide for safe, purposeful, and effective integration of community arts interventions with FEP care in the CT-R treatment model. Justification First Episode Psychosis is a critical juncture for patients and families. Prolonged untreated psychosis leads to greater burdens on families and heightened risks for negative outcomes such as substance abuse and homelessness. Early intervention significantly improves outcomes. Engaging patients in community arts activities fosters acceptance and supports treatment progress, especially for those responsive to the arts. Art therapy interventions are also shown to enhance self-expression and wellbeing. Further research is essential to optimize the effectiveness of art therapy in this population. Terms Art Therapy Mania Art Therapy Interventions Museum-based Art Therapy Community Arts Spaces Negative Symptoms of Psychosis Coordinated Specialty Care (CSC) Positive Symptoms of Psychosis Delusions Psychosis First Episode Psychosis Recovery-Oriented Cognitive Therapy (CT-R) Hallucinations Tardive Dyskinesia Literature Review: Recovery- Oriented Cognitive Therapy (CT-R) ● Cognitive Behavioral Therapies (CBT) are effective for diverse mental health conditions, with offshoots like Dialectical Behavioral Therapy (DBT) and Cognitive Behavioral Therapy for Psychosis (CBTp) tailored to specific treatment populations. ● Recovery-Oriented Cognitive Therapy (CT-R) is a strengths-based approach derived from CBTp, focusing on empowering individuals with serious mental health conditions to lead meaningful lives. ● Throughout the CT-R program, goals may evolve, and clinicians continue to work with participants to develop aspirations and pursue growth in their lives and relationships. Literature Review: Recovery- Oriented Cognitive Therapy (CT-R) ● In CT-R, treatment planning involves four stages centered around activating "the adaptive mode," where individuals engage with positive thoughts, feelings, and actions unique to their interests. ● The first stage involves identifying activities that access the adaptive mode and engaging in them with patients. ● The second stage focuses on helping participants develop goals and aspirations, tapping into underlying meanings to foster feelings of hope and purpose. ● In the third stage, clinicians support individuals in actualizing the meaning behind their aspirations, enabling meaningful progress toward life goals. ● The fourth stage involves strengthening individuals' resilience to maintain the connection with the adaptive mode amid challenges and setbacks. Literature Review: First Episode Psychosis (FEP) ● First Episode Psychosis (FEP) marks the initial onset of symptoms consistent with psychosis, which can vary widely and indicate serious mental or physical health conditions. ● Psychosis involves a loss of contact with reality through changes in perception and thought, presenting with symptoms like delusions, hallucinations, and disorganized behavior. ● Diagnostic categories for Psychotic Disorders include Schizophrenia, Schizophreniform Disorder, Schizoaffective Disorder, and others. ● Early warning signs of psychosis, often missed or misunderstood, may include social withdrawal, reduced performance, suspiciousness, and unusual thoughts or perceptions. ● Early Intervention for FEP aims to help individuals understand their condition, strengthen coping skills, and engage with support structures to mitigate distress and promote recovery. Literature Review: First Episode Psychosis (FEP) Treatment ● Outcomes are significantly influenced by timely treatment. ● Specialized programs and theoretical care models have emerged to meet the needs of individuals experiencing FEP. ● Coordinated care settings centralize psychosis treatment, offering support for emotional, psychosocial, case management, and medical needs. ● Psychiatrists monitor symptoms and prescribe medication, therapists aid in understanding mental health conditions and developing coping skills, while case managers navigate medical and social service systems. ● Best practices for FEP care involve team-based treatment settings with youth-oriented approaches and dedicated key workers for each patient. ● Family engagement is integral to FEP recovery, given the often unavoidable connection with family members during the onset and aftermath of psychosis. ● Psychoeducation helps patients and families understand psychosis symptoms and presentations, facilitating better support and reducing stigma. Literature Review: Art Therapy for FEP ● First Episode Psychosis (FEP) patients face challenges in expressing their thoughts and feelings, which Art Therapy addresses by providing a non-verbal outlet for expression. ● Art Therapy has been used in the treatment of serious mental illnesses, with research focusing largely on chronically ill patients. ● The largest study on Art Therapy in psychosis care, the MATISSE study, found controversial results, with critiques of its methodology. ● Early intervention with Art Therapy in FEP care is an emerging area of research, with qualitative studies indicating its meaningful impact on both patients and practitioners. ● Grounded theory studies suggest that Art Therapy in early psychosis treatment enhances expression and communication, fosters connection, and reduces negative symptoms, warranting further investigation. Literature Review: Community Arts spaces in Art Therapy Practice ● Community-based arts organizations enrich communities through education, exhibitions, and public events, offering free admission compared to museums. ● Engagement with community arts can reduce negative symptoms of psychosis, with art therapy interventions in these settings yielding positive outcomes. ● Participatory arts interventions in community settings enhance agency, skill development, and socialization, benefiting groups such as people living with dementia and psychosis. ● Research across various countries demonstrates significant mental health benefits from interdisciplinary treatment involving art therapists and community arts organizations. Resource Guide Resource Guide ● Offers an introduction to the treatment space, with sections relating to First Episode Psychosis, Recovery-Oriented Cognitive Therapy, and art therapy practices based in community arts spaces. ● Outlines a Five Phase program for implementing community arts therapy interventions in FEP care ● Provides a case study with examples of how each phase was enacted at an outpatient FEP care site in a major metropolitan city Phase I: Research Gathering ● Learning about participants- What are their interests? What creative interventions would be the most beneficial for them? Are common themes emerging, common interests among participants? ● Learning about local arts resources- What cultural institutions exist in your area? Do they offer educational programs? Gather information and contacts for individuals at these sites. Phase II: Outreach ● Outreach to participants ○ Encourage engagement in programming through direct communication by phone, in person, and through intra-office announcements and flyers ● Outreach to local Arts Resources ○ Identify yourself and the agency you represent ○ Justify your desired collaboration- Why does this intervention make sense at this time, with these individuals and this arts organization? ○ Display an openness to answering questions about psychosis and mental healthcare. Psychosis can be poorly understood and stigmatized. Help community partners understand what your participants are experiencing and how community arts engagement can help them. Phase III: Intervention Planning ● Where are you going? ● What are you doing there? ● How will people be getting to and from the event? Phase IV: Implementation ● Getting there ● Learning, exploring, creating ● Processing the experience Phase V: Review and Future Planning ● How did it go? ● How can we make it even better? ● Closing the loop with community partners ● Expressing gratitude Case Study: The Program in Action Phase I: Research Gathering ● In the research phase, we gathered information from staff, participants, and the wider community ● Narrative artmaking was identified as a major interest among participants ● Themes identified for the group: storytelling, character creation, and connecting with like-minded individuals ● Research on local arts organizations prioritized venues accessible within a half-hour by walking, car, or public transportation Phase II- Outreach ● Identified participants interested in narrative artmaking and connected with them on-site and through communication channels. ● Scheduled a meeting for an art therapy group focusing on narrative artmaking. ● Sent announcements to interested participants and displayed posters in the office to reach others. ● Reached out to arts organizations within a half-hour travel radius via phone and email, incorporating elements of Identification, Justification, and Psychoeducation. Phase III: Intervention Planning ● Group facilitators identified potential interventions that could connect group participants with established community relationships ● Discussed a community arts space with participants to identify areas of interest ● Coordinated dates for the intervention and made plans for travel into the community ● Planned event structure, including travel time, art viewing, and a sharing conversation ● Shared information about the event with all staff and program participants to promote engagement Phase IV: Implementation ● Gathered participants at the office to ensure safe travel arrangements ● Provided a brief description of the event plan before heading into the community ● Received an introduction from creative community partners about available resources and the day's activity ● Program staff facilitated the therapy group, ensuring participants' safety and emotional processing ● Facilitated a group conversation to practice social skills and explore the intervention further ● Encouraged participants to develop their own creative aspirations during the event Phase V: Review and Future Planning ● Checked in with community partners to express gratitude and appreciation for their support and hospitality. ● Offered space for feedback and answered questions regarding group facilitation and psychosis care to foster further relationship development. ● Engaged with program participants post-event to gather feedback on their experiences. ● Solicited input on what aspects were effective and what could be improved. ● Utilized participant feedback to shape future community arts interventions. ● Participants reported improved mood, reduced psychosis symptoms, and increased feelings of future-oriented thinking regarding creative goals and aspirations. Limitations ● Limited research on Art Therapy within the CT-R treatment model and the intersection of FEP with Museum-Based Art Therapy interventions underscores the need for additional research to establish ethical treatment guidelines. ● Research focused solely on individuals experiencing FEP in a major metropolitan area, potentially limiting generalizability to smaller cities or towns with less access to the arts, where alternative approaches may be necessary. ● Programs were conducted in person, but remote options for care could expand opportunities for community arts collaborations. ● This research was developed in an Outpatient FEP program serving a diverse population aged 15-30, but approaches for individuals younger or older should be explored. ● Time-limited research lacked follow-up study, leaving long-term effects of interventions unknown Areas for Further Research ● Further study is recommended to better understand efficacy and long-term impacts of community arts intervention in FEP care. ● Additional guidelines are necessary for future studies to ensure standardization and repeatability for reliable findings. A standardized program could establish connections between interventions and outcomes. ● Remote arts interventions may broaden collaboration opportunities, especially for practitioners in smaller cities. ● Success of art therapy interventions in serious mental illnesses suggests applicability to conditions beyond FEP. ● Model could be adapted for younger or older participants, with adjustments in intervention frequency potentially yielding different outcomes. Final Thoughts ● First Episode Psychosis care is crucial for individuals and families, as untreated psychosis can disrupt various aspects of life and lead to poor outcomes such as homelessness and addiction. ● Recovery Oriented Cognitive Therapy focuses on activating the adaptive mode in patients, which can be achieved through engagement with participant interests like art. ● Art therapies have been shown to increase engagement and communication while reducing distress from psychosis symptoms. ● Community-based art therapy in the CT-R framework builds positive relationships between individuals and their communities. ● Limited research exists on this treatment niche, yet it holds potential for powerful intervention. ● This resource guide offers recommendations for implementing community arts interventions as part of CT-R treatment for FEP, providing a five-phase plan for collaboration with community arts partners. Questions? References American Psychiatric Association. (2013). 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