A Critique

A Critique Of Two Journal Articles

Reconstructing the self with drama and creative arts therapies& Art therapies and dementia care: A systematic review

Introduction

The purpose of this paper is to present a critical evaluation of two journal articles by Catherine Chin (1996) and Renée L. Beard (2011). The paper discusses the two articles on various aspects including the journals they were published in to the future implications of the main findings of the research. Both of these articles focus on the treatment through art therapies of diseases like Alzheimer’s and dementia. Alzheimer’s is a disease, whose origin is still unknown and no definitive cure, and while there are medications that can slow its development at various stages, resulting in a better quality of life for the patient, family and caregiver, while which significantly reduces the cost of the disease. However, in parallel with drug therapy, a group of physicians from George Washington University began in the late eighties a program for Alzheimer’s patients based on the art and its possibilities and this paper critically analyses two of the many researchers in this field of study.

Summary of the Journals

The first article being critiqued in this paper is ‘Reconstructing the self with drama and creative arts therapies’ by Catherine Chin. The article is published in the American Journal of Alzheimer’s Disease and Other Dementias (AJA). (AJA), member of Committee on Publication Ethics (COPE), is for specialized personnel’s on the frontlines of Alzheimer’s care, dementia, and clinical dejection particularly psychiatrists, administrators, physicians, nurses, and other healthcare specialists who administer patients and their families with dementias. AJA is published six times annually and every issue of the journal is full of practical information about nursing, psychiatric and medical issues as well as diagnostic tools. The articles published in the journal also cover psychosocial issues and administrative and legal issues.

On the other hand, the second article of this paper, ‘Art therapies and dementia care: A systematic review’ by Renée L. Beard Dementia is published in Dementia, a journal published by the Alzheimer’s society in UK. Alzheimer’s Society generates a wide range of information for various audiences and in a range of systems. The aim of the information provided by the journals of the society is to support and inform people with dementia and their family. The Alzheimer’s society is committed in presenting the information in their journals that is not only clearly written but also accurate, reliable and well balanced. The writers of the journal strictly follow the guideline given by NICE, SCIE and Cochrane Collaboration or the Royal Colleges. The Alzheimer’s Society is certified by Cochrane Collaboration or the Royal Colleges and this is a quality assurance of the work they provide. Also, in 2011, the society was accredited under the Department of Health’s Information Standard, certifying the journals of the society as a trustworthy source in the field of health.

Author’s Aim

Conducting a research in the field of medicine is always challenging. It is important for authors and researchers to clearly understand their aims before conducting a research otherwise all their efforts will be blurred. Besides understanding the aims, it is also important to present those aim in the report that is being produced and published for the readers to provide the readers with an understanding of the essence of the research. Chin (1996) presented her aim of conducting the research as the purpose of the research was to provide an understanding of the positive impact on the patient journey of an early referral to arts therapies such as Drama Therapy. The research also aimed to list the benefits of the Drama therapies in Alzheimer patients.  However, Beard (2011), aimed to analyse this evidence base of arts therapies in curing AD, together with music, visual arts, drama, and dance/movement therapies between the years 1990 and 2010, and make propositions on how it can be fortified.

Reasons of Conducting Research

In past researches suggest that artwork helps Alzheimer’s patients. There is multiple small scale works published in journals assessing the effects of art therapy. According to experts of various disciplines, the arts, specifically the paint, is an activity that encourages imagination. That is one reason for the increasing attention to art for people with Alzheimer’s. Even as memory fades, the imagination is capable of strengthening. It is widely accepted that mood, stress and aggression have a major impact on physical health and the evolution of patients. This technique provides a channel of communication with the most primitive form of language and instinctive: the symbols. Art therapy is an opportunity for patients to express themselves even after they have lost some of their normal communication skills. For patients with movement problems, assistants guide them with their hand routing the effort to identify objects or reminding words to express their feelings. Art therapy growth responds to the recent trend of giving more relevance to the emotional aspects of the disease while serving the physiological side. And for the same reasons these studies were initiated.

Chin (1996) agrees that at the Primary Care level there has been a comparatively low level of recommendations to Arts Therapies. This journal article explains the growth of a drama group for nursing home residents with Alzheimer’s disease (AD).  Referrals were seen as a result of restricted relationships and in this reverence following a very ad hoc prototype. They were also seen as being through at a late stage in patient’s treatment, when other options had unsuccessful. One of the reasons to carry this research was to also put forward for the probable input that the addition of the Arts Therapies at early stages of the transfer process can have upon the HEAT Targets. The meticulous HEAT targets discussed narrate the contribution of the Arts Therapies towards the condition to decrease the instruction of drugs, the need to pressure re-admission percentage and the obligation to address early finding and treatment of dementia.

Beard (2011) in his research focuses on the multi sensory stimulation, Snoezelen, which provides sensory stimuli to stimulate all five primary senses, through lighting effects, tactile surfaces, meditative music and the odour of relaxing vital oils. The basis for this lies in the proposal that the stipulation of sensory surroundings for people with dementia places less stress on their thinking abilities but capitalizes on their remaining sensor motor aptitude. The clinical application of snoezelen varies in shape, nature, principles and procedures. These variations not only make the assessment of the therapeutic values of snoezelen difficult, but also impede the clinical development of snoezelen in dementia care.

Comparison with Other Researches

The studies analysed in this paper were not only informative but covered a wide variety of interesting facts about the Arts therapies for Alzheimer’s. These researches presented the first hand information from patients and their caregivers (Chin) as well as information based on the systematic review of several other researches in this regard (Beard). The research by Chin was one of its kinds as it was a narrated research that mentioned that importance of interrelation and intra relation between patients and their caregivers (residents). On the other hand, the study by Beard presented a variety of information and proof about the Shortcomings in dementia-specific research comprise a scarcity of accounts from participants, breakdown to expand therapies to individuals in the early stages, a need of application to those living at home, and often surface notice to the significant feature of doing art.

Main Findings

The study by Chin (1996) concluded that art therapy provision meet the needs of people with learning disabilities who have in the past used art therapy services and recommends changes to improve services. To find out more about if art therapy provision was meeting the needs of people with learning disabilities, the study collected information from previous service users regarding their experience of art therapy service provision. Hence, it was observed through the study that art therapies have a significant impact on the treatment of patients with psychological disabilities.

The study of Beard was mainly an expanded study of Baker (2003) and van Weert (2005). Both of these studies examined the short-term and longer-term effects of snoezelen on behaviour, mood, and communication of individuals with reasonable to stern dementia. The arrangement of execution was dissimilar in the two trials: one was 24-hour integrated snoezelen care (van Weert 2005) whilst the other was session-based snoezelen programme (Baker 2003). The study by Beard did not prove any impact on behaviour, mood, cognition and communication / interaction in the short term (during or immediately after sessions) or longer term (at post-intervention or 1-month post-intervention follow-up).

Researchers

The field of medical research extends from fundamental research, which includes the study of biological functions, clinical research and technological applications. The knowledge gained can then be applied to clinical research to help understand diseases and develop new treatments, care or prevention methods. The author, Chin C., is a drama therapist. The co-leader of the group, Chin explains her knowledge and opinion about the function of drama and ingenious arts therapies with people in the moderate and early stages of AD. Moreover, author Renée L. Beard received her degree in medical sociology from the Department of Social and Behavioural Sciences at the University of California. Her major areas of study are medical sociology and aging, including the senior rights movement, the bioethics of aging, arrange and specialist understanding, doctor-patient connections, and skewed understanding of illness and aging.

Type of Research

Both of the researches are Epidemiological in nature. Epidemiological research is apprehensive with the explanation of health and wellbeing in populations through the compilation of data connected to health and the incidence, sharing and determinants of disease in populations, with the aim of recovering health. Furthermore, the research by Chin is descriptive in nature as it diagnostic investigations, much of what is written on the social studies and personal observation. However, the study by Beard is based on interrelationships as it identifies the relationships between facts for true understanding of the phenomenon to be studied.

Methodological Approach

The approaches used in these researches were a mixed research method. Qualitative research was much more subjective than quantitative research, and uses varying methods of collecting information that could be both primary and secondary by nature. It was because of this method that the gaps of both the techniques could be filled up by each other, and the results generated from this research would be more valid and reliable for further studies. The research by Chin was mainly based on the analysis of her personal experience. However, Beard in his research included review of peer-reviewed literature that was already available on the topic from online resources and published journals. Mixed method approach helps in studying the phenomenon in the natural work settings and give answers to questions such as why and how. It sheds light and depicts what happens in real life and practically in organizations and at work.

Qualitative and Quantitative Research

Research can be of various types, and in that sense can be classified in different ways, however it is common in terms of their level, their design and purpose. However, given the complex nature of the phenomena studied, usually it is necessary to address apply not one but a mixture of different types of research. However, speaking broadly, a research is either qualitative or quantitative in nature. A quantitative research is the type of research in which the respondent is interrogated to respond by answering planned questions and a favoured format, for instance, Yes or No. This sort of research is manipulated to obtain a definite answer which could be presented with accurate evaluation. The methods to conduct this kind of information collection include Personal interview, mail or telephone interview. On the other hand, a qualitative research is follows a shapeless and unrestricted answer from the respondent. Qualitative research is also used in international market research to formulate and define a problem more clearly and to determine relevant questions to be examined in subsequent research.

The research conducted by Chin was qualitative in nature as it was a narrative style research report. As the article describes the development of a drama group for nursing home residents with Alzheimer’s disease, the author, who is a drama therapist and co-leader of the group, explains her knowledge and opinion about the role of drama and creative arts therapies with people in the moderate and early stages of AD. On the other hand, the research by Beard (2011) is quantitative in nature as the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG) along with various other literature sources were searched and used for the completion of the report.

Paradigm of the Research

Paradigm refers to a set of beliefs and attitudes, as a world view “shared” by a group of scientists that involves a particular methodology. The paradigm is a theoretical framework, or way of perception and understanding of the world, a group of scientists has taken. Furthermore the researches are categorised into positivist (Beard) and interpretive (Chile) paradigms. The characteristics of the two researches in terms of their paradigm are mentioned below:

Dimension Positivist (rational, quantitative) Beard’s research Positivist (rational, quantitative) Chin’s Research
Fundamentals Logical positivist. Empiricism Phenomenology. Interpretive Theory
Nature of reality Objective, static, single, given, fragmenting, convergent Dynamic, multiple, holistic, built, divergent
Purpose of the investigation Explain, predict, and control phenomena, test theories. Laws to regulate the phenomena Understanding and interpreting reality, the meanings of people, perceptions, intentions, actions
Subject – object Independence. Neutrality. Not affected. External researcher. Subject as “object” of research Unit. Affected. Researcher involvement. Interrelation
Values Neutral. Value-free research. Methods not guarantee objectivity Explicit. Influencing research
Theory – practice Dissociated, are separate entities. The theory, practice standard for Related. Mutual feedback
Quality Criteria Validity, reliability, objectivity Credibility, Confirmation, transferability
Techniques: Tools and Strategies Quantitative. Measurement of tests, questionnaires, systematic observation. Experimentation Qualitative, descriptive. Principal investigator instrument. Participants Perspectives
Data Analysis Quantitative: descriptive and inferential statistics Qualitative: Induction, analytical triangulation

Methods of data collection

Collecting the data is the most delicate part of the research as the whole study relies on this one step. The data not only needs to be authentic but also worth mentioning in the research. The data collection methods used by Beard in his research are Randomised controlled trials (RCTs). This measured non-pharmacological interference for demonstration in patients with dementia was entitled for addition. However, the research by Chin was based upon the data collected through interpersonal and intrapersonal connections of patients with AD and the residents and was purely based on observations by the researcher.

Advantages and Disadvantages of Researches

Through the research conducted by Chin the therapists provided the configuration needed to create and uphold the interpersonal and intrapersonal connections between patients and their caregivers. With the help of using reflective memory, patients were able to change into and alleviate identities. Also, by summoning up the intelligences and competencies that were available and useful to residents at an earlier stage of development, the therapists broaden the foundation for artistic problem solving. Moreover, the study conducted by Beard helped in understanding the sensory involvements as the only type of non-pharmacological intervention in older adults with dementia which demonstrated advantageous effects in eliminating agitation.

Data Analysis

Chin analysed the data gathered through her research on the basis of basis of dramatic theories and competencies including spatial, bodily-kinaesthetic, musical, personal, spiritual, and psychic intelligences. However, Beard used estimation of Summary standardized mean dissimilarities using random-effects models. Heterogeneity was evaluated using the X2 and I2 figures. Sensitivity analysis was performed without trials of inferior practical excellence.

Analysis of Findings

After thoroughly reading and analysing the two articles, I was able to get a better understanding of the impact of art therapies for Alzheimer’s patients. There are many diseases that affect memory such as Parkinson’s, dementia Lewy body or the best known, Alzheimer disease, causing significant brain damage. But there are other causes that can cause amnesia or memory loss. Alzheimer’s disease is the most common cause of dementia in degenerative elderly, a neurological disorder that causes progressive death of nerve cells in the brain. Gradually, patients lose their ability to think, understand and communicate, even to lose their identity. Generally, the Alzheimer’s starts gradually and its early symptoms are memory loss, but as the disease progresses, other skills are deteriorating as cognitive, preventing the patient’s activities of daily living. In “All about Alzheimer’s” (2004), explained that this disease damaged parts of the brain that control thought, memory and language. The Alzheimer’s causes memory deficits in the short and long term, causing an inability to learn new information and remember things that were known in the past. Patients have trouble speaking and communicate clearly, lead out motor activities, or even to recognize everyday objects (like a spoon).

Sometimes they can also suffer personality changes or symptoms Similar to depression. This disease has become a serious social problem for millions families and healthcare systems worldwide. It is a major cause of death in developed countries, with companies increasingly elderly. Without But what makes this dementia have such a strong impact on the system health and on society as a whole, is its irreversibility, the lack of a curative treatment and burden of affected families. However, although so far no cure has been found for this disease, they have been found by pharmacological treatment with an appropriate cognitive stimulation can slow the progression of symptoms. Thus, a greater intellectual development may delay Alzheimer’s, but this does not means that highly educated people cannot get the disease, but may develop later in life.

These researches helped me understand the use of creative therapies help in the treatment of patients with AD. The arts have been used as health promotion incorporating a new field of study called psychoneuroimmunology. This term refers to the influence of body or mind in the immune system, mediated through brain and central nervous system. We have found that making patients interested in challenging activities such as art, the brain can create new synapses, and thereby adapting and maintaining vital (brain plasticity). However, creative therapies, as mentioned by Beard, also affect sensory and affective experiences and help preserve and maximize the sense of self. For example, promotes nonverbal communication with the outside world, social skills, helps stimulate brain areas that are still working well, allows reminiscences or bring to mind past experiences, encourages autonomy and decision-making and encourages people to express their preferences and emotions. It is noteworthy that the responses mentioned can be achieved through various artistic mediums such as visual arts (art therapy), music (music therapy) and theatre (drama therapy as discussed by Chin).

In relation to art therapy itself, in which I am personally interested, is a good complement to diagnostic and cognitive assessment. For example, from a qualitative analysis of drawings by patients with progressive dementia, is common elements such as lines and scattered short, specific symbols and foremost, omissions drawings indicating organic changes in the brain which is thoroughly explained by Chin (2011).

Implications of the Study

Research conducted by Beard is following a variety of hopeful results for the treatment of dementia. Pharmacological interferences are available but have partial ability to cure many of the syndrome’s features. However the future implications of the study conducted by Chin can lead to a better way of curing AD with the help of drama therapy. Both of these researches have showed significant results that will be very helpful for future clinical researches.

Conclusion

Bread concluded his research by discussing the importance and need of more vigorous research methodology. Two new trials were evaluated. Meta-analyses could not be executed because of the restricted number of trials and dissimilar study methods of the available trials. Overall, there is no proof showing the effectiveness of snoezelen for dementia. There is a need for more dependable and sound research-based evidence to notify and defend the use of snoezelen in dementia care. On the other hand, Chin at the conclusion of her research has raised a question about the current precepts of AD therapies and strongly encourages further studies in the area of drama therapies being used to cure Alzheimer’s.

Overall Opinion

Personally, I was amazed by the information that was presented in these two papers. The researchers performed these studies in a tremendous manner making it not only worth reading but also worth referring to. The reason why I picked these two researches for the evaluation is because of the interesting material and information that is discussed in both articles. The articles are presented in simple language making it easier for their readers to understand the meaning behind the context. Usually in clinical papers, the language is often hard to understand with all the ‘medical’ terminologies. However this was not the case in the studies by Chin and Beard. Both studies were presented in easy language and clear format. Besides the language, the idea of the researches was clearly indicated by the researchers. There was no miss communication throughout the article and every part of the report was described in great detail.

Comparison of Researches

Both of the researches that are analysed in this paper were great contributions in the field of health and Alzheimer’s. These researches helped understand the different strategies of arts that can be used for effective curing of the patients suffering from AD and dementia. Comparing the two researches was quite a difficult task as both authors presented these researches with great knowledge and understanding. Beard manly focused on four questions throughout his systematic review which included empirical base of using art therapies, the design and evaluation of the studies conducted, potential of art therapies and the findings that are reported in the researches being reviewed. At one point there was a disagreement about the tools that were used by the author for the evaluation of the researches as it was clearly mentioned in the report that the quality of methodology and the reporting of the included studies were too poor to draw any useful conclusions.

However, on the other hand, the research conducted by Chin was not only brief but also interestingly presented.  The way these reports were presented was also appraisable. Nonetheless, in my personal opinion, I liked the research conducted by Chin more due to its unique format of personal narration. The format made the understanding of the report interesting and gave it a story-like structure.

Different Methodology

I believe that the study conducted by Beard could have been more impactful if there was a different methodological approach. As mentioned earlier that the methodological quality of the research was poor resulting in formatting a very poor conclusion. This could have been different with a slight addition in the methodology procedure. The studies that were selected by Beard were very useful and had a lot of information regarding AT and AD. However, a topic like this requires practical work to support the theory. Therefore, if I was conducting this research, with review the literature, I would also add some interviews from the patients who have received AT along with the therapists providing these therapies.

Ethical Consideration of Researches

The researchers were aware of any potential harmful effects; in such circumstances and the chosen methods were used after consultation with colleagues and other experts. The researchers had developed the topic with full consent from concerned authorities along with the required justifications. The researches were conducted in a competent way, as an objective, scientific project without bias. The researches were carried out in full compliance with, and awareness of, local customs, standards, laws and regulations. Informed consent was an important component of researches and was an integral part of the research process. Researchers should educate their participants in order to make an informed decision regarding their participation in the research. Participants must provide informed consent freely and without force and with clear comprehension of what participation entails. For the analysed study by Chin, the researcher implemented practical steps to ensure that all participants were educated about the proposed study in order to make an informed decision. However, Beard for his systematic review ensured that the sources that are used for gathering literature are authentic.

References

All about Alzheimer’s. (2004). Editorial Unit overview. Revised on 31 October, 2012, http://www.elmundo.es/elmundosalud/especiales/2004/04/alzheimer / quees.htm

Chin, C. (1996), Reconstructing the self with drama and creative arts therapies, American Journal of Alzheimer’s Disease and Other Dementias, January/February 1996; vol. 11, 1: pp. 36-42.

Renée L. Beard (2011), Art therapies and dementia care: A systematic review Dementia, September 2012; vol. 11, 5: pp. 633-656.

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