BackgroundDramatherapy, a creative form of psychotherapy, may be a useful treatment for child and adolescent mental health. As there is a growing evidence base, this systematic review sought to identify, describe and evaluate dramatherapy with children and adolescents who were experiencing emotional distress (anxiety, depression and trauma) in order to inform future research in this area.MethodsSeven databases (PsychInfo, PubMed, Scopus, Web of Science, CINAHL, EMBASE and Cochrane) were searched for peer‐reviewed articles exploring dramatherapy as a treatment for child and adolescent emotional distress. Hand searches of relevant journals were also conducted. Two reviewers coded articles for eligibility and independently appraised papers using the Joanna Briggs Institute Critical Appraisal Tools. Details relating to intervention and participant characteristics were extracted and, where data were available, effect sizes on measures relating to emotional distress were calculated.ResultsFifteen papers were included. Studies showed that dramatherapy was often delivered in schools (46%) and clinical settings (20%) and was more frequently delivered to adolescents (53%) (>11 years) than children (26%) (8–11 years). Dramatherapy was used as a treatment for diagnostically heterogeneous groups (40%), for emotional and behavioural difficulties (33%) and following a shared, traumatic, experience (20%). Seven papers reported relevant quantitative data however, just three of these studies were controlled and none were blinded. Pre‐to‐post intervention effect sizes ranged from d = 0.17 to d > 2 yet samples were small and participant response to treatment was not always consistent. The largest effects were seen in dramatherapy employed following trauma and in clinical settings. Medium to large effects were also seen in early intervention school‐based dramatherapy.ConclusionDespite promising results with regards to the treatment of child and adolescent emotional distress, the evidence base for dramatherapy is small and methodologically flawed. Larger, methodologically robust trials should test the efficacy of dramatherapy in future research.

A developing evidence base suggests that dramatherapy, a creative form of psychotherapy, is a useful treatment for child and adolescent emotional disorders. However, little is known regarding the therapeutic benefits (“active ingredients”) of this intervention. A systematic search and meta-synthesis of secondary qualitative data reflecting participants’ perceptions of active ingredients of dramatherapy for symptoms of emotional disorders (anxiety, depression and trauma-related stress) was conducted. Six analytical themes emerged from eight studies. Dramatherapy as a learning (1) and social (2) experience and dramatherapy as a positive intervention (3) which supports self-expression (4) and emotion regulation (5) were identified as active ingredients. The skill and professionalism of dramatherapists (6) were also identified. This study is limited as the data available were not collected for the primary purpose of identifying active ingredients, more focused investigations may reveal different findings. In addition, studies contributed unequal amounts of data thus, findings may be skewed. The findings of this synthesis were benchmarked against other interventions commonly offered to children and young people with emotional distress. Three active ingredients (dramatherapy is fun, dramatherapy builds confidence, participants process difficulties through drama) were deemed unique to dramatherapy. Further research could employ mediation analysis to determine therapeutic mechanisms of change of this intervention.

Dr Elizabeth Coombes is a music therapist with over 20 years of experience in the profession. She is the Course Leader of the MA Music Therapy at the University of South Wales. Her research interests include music and music therapy in infancy and early childhood as well as the identity of the C21st music therapist.

Background Burnout is a serious and growing issue for healthcare workers (HCWs) and healthcare systems across the globe. Art Therapy has demonstrated promise as a suitable intervention. This review aims to ascertain what art therapy-based interventions used to address burnout and / or psychosocial distress in HCWs have been reported in the health and social care literature and how these have been evaluated. Methods Six databases (PubMed, PsycINFO, MEDLINE, EMBASE, CINAHL, ProQuest Central), Google Scholar and three clinical trial registries (CENTRAL, ICTRP and ClinicalTrials.gov) were searched for studies using art therapy-based methods to engage with burnout risk or psychosocial distress in HCWs. Following screening for eligibility study characteristics and outcomes were extracted by two reviewers independently. Studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Outcomes were grouped for analysis. Quantitative and qualitative results were synthesised and integrated using narrative synthesis. Results Twenty-seven studies, drawn from thirteen countries, spanning five continents were selected for inclusion. Fifty percent were published in the last five years, indicating growing global research in the field. Fourteen studies used quantitative research methods and thirteen used qualitative methods. A total of 1580 participants took part in the studies, with nurses most broadly represented (59%). Interventions were mostly delivered in groups (95%) and by an art therapist (70%). Heterogeneity and insufficient randomised controlled trials precluded the possibility of meta-analysis. However, a review of available data showed evidence of medium to large effects for emotional exhaustion (burnout), work-related stress and common mental health issues. A content analysis of qualitative data of perceived effect complemented quantitative findings. Conclusion Global research into the use of art therapy-based methods to address burnout and psychosocial distress in HCWs is growing. Whilst further high-quality evidence such as randomised controlled trials would be beneficial, findings suggest that art therapy-based methods should be strongly considered as an acceptable and effective treatment for symptoms of emotional exhaustion (burnout) and psychosocial distress in HCWs.