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      Creative Arts Interventions for Stress Management and Prevention—A Systematic Review

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          Abstract

          Stress is one of the world’s largest health problems, leading to exhaustion, burnout, anxiety, a weak immune system, or even organ damage. In Germany, stress-induced work absenteeism costs about 20 billion Euros per year. Therefore, it is not surprising that the Central Federal Association of the public Health Insurance Funds in Germany ascribes particular importance to stress prevention and stress management as well as health enhancing measures. Building on current integrative and embodied stress theories, Creative Arts Therapies (CATs) or arts interventions are an innovative way to prevent stress and improve stress management. CATs encompass art, music, dance/movement, and drama therapy as their four major modalities. In order to obtain an overview of CATs and arts interventions’ efficacy in the context of stress reduction and management, we conducted a systematic review with a search in the following data bases: Academic Search Complete, ERIC, Medline, Psyndex, PsycINFO and SocINDEX. Studies were included employing the PICOS principle and rated according to their evidence level. We included 37 studies, 73% of which were randomized controlled trials. 81.1% of the included studies reported a significant reduction of stress in the participants due to interventions of one of the four arts modalities.

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          Most cited references65

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          Appraisal, coping, health status, and psychological symptoms.

          In this study we examined the relation between personality factors (mastery and interpersonal trust), primary appraisal (the stakes a person has in a stressful encounter), secondary appraisal (options for coping), eight forms of problem- and emotion-focused coping, and somatic health status and psychological symptoms in a sample of 150 community-residing adults. Appraisal and coping processes should be characterized by a moderate degree of stability across stressful encounters for them to have an effect on somatic health status and psychological symptoms. These processes were assessed in five different stressful situations that subjects experienced in their day-to-day lives. Certain processes (e.g., secondary appraisal) were highly variable, whereas others (e.g., emotion-focused forms of coping) were moderately stable. We entered mastery and interpersonal trust, and primary appraisal and coping variables (aggregated over five occasions), into regression analyses of somatic health status and psychological symptoms. The variables did not explain a significant amount of the variance in somatic health status, but they did explain a significant amount of the variance in psychological symptoms. The pattern of relations indicated that certain variables were positively associated and others negatively associated with symptoms.
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            Effects of Hatha yoga and African dance on perceived stress, affect, and salivary cortisol.

            Dance and yoga have been shown to produce improvements in psychological well-being. The aim of this study was to examine some of the psychological and neuroendocrine response to these activities. Sixty-nine healthy college students participated in one of three 90-min classes: African dance (n = 21), Hatha yoga (n= 18), or a biology lecture as a control session (n = 30). Before and after each condition participants completed the Perceived Stress Scale (PSS), completed the Positive Affect and Negative Affect Schedule, and provided a saliva sample for cortisol. There were significant reductions in PSS and negative affect (ps < .0001) and Time x Treatment interactions (ps < .0001) such that African dance and Hatha yoga showed significant declines, whereas there was no significant change in biology lecture. There was no significant main effect for positive affect (p = .53), however there was a significant interaction effect (p < .001) such that positive affect increased in African dance, decreased in biology lecture, and did not change significantly in Hatha yoga. There was a significant main effect for salivary cortisol (p < .05) and a significant interaction effect (p < .0001) such that cortisol increased in African dance, decreased in Hatha yoga, and did not change in biology. Changes in cortisol were not significantly related to changes in psychological variables across treatments. There was 1 significant interaction effect (p = .04) such that change in positive affect and change in cortisol were negatively correlated in Hatha yoga but positively correlated in Africa dance and biology. Both African dance and Hatha yoga reduced perceived stress and negative affect. Cortisol increased in African dance and decreased in Hatha yoga. Therefore, even when these interventions produce similar positive psychological effects, the effects may be very different on physiological stress processes. One factor that may have particular salience is that amount of physiological arousal produced by the intervention.
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              Stress: Appraisal and Coping

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                Author and article information

                Journal
                Behav Sci (Basel)
                Behav Sci (Basel)
                behavsci
                Behavioral Sciences
                MDPI
                2076-328X
                22 February 2018
                February 2018
                : 8
                : 2
                : 28
                Affiliations
                [1 ]Research Institute for Creative Arts Therapies (RIArT), Alanus University of Arts and Social Sciences, Alfter/Bonn, Villestr. 3, 53347 Alfter, Germany; Renate.Oepen@ 123456alanus.edu (R.O.); harald.gruber@ 123456alanus.edu (H.G.); sabine.koch@ 123456alanus.edu (S.C.K.)
                [2 ]Department for Therapy Sciences, SRH University Heidelberg, Maria-Probst-Str. 3, 69123 Heidelberg, Germany; katharina.bauer@ 123456hotmail.de
                [3 ]Robert-Bosch-Klinik, Auerbachstr. 110, 70376 Stuttgart, Germany; Alina.Nottensteiner@ 123456web.de
                [4 ]Schoen-Klinik, Hofgarten 10, 34454 Bad Arolsen, Germany; katja.mergheim@ 123456gmx.de
                Author notes
                Author information
                https://orcid.org/0000-0001-6206-3478
                https://orcid.org/0000-0003-0112-4091
                https://orcid.org/0000-0001-5161-2697
                Article
                behavsci-08-00028
                10.3390/bs8020028
                5836011
                29470435
                5c10ac9d-6459-4482-a400-ef2100368c84
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 07 December 2017
                : 13 February 2018
                Categories
                Review

                creative arts therapies,arts interventions,art,music,dance,drama,stress management,prevention,systematic review

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