PMC6949689_01
Charcoal drawings of the form modelled during session 2 and 3. Emphasis was given to the presence of light and dark, proportions and the correct representation thereof (a) and the surroundings of the form.
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The therapist provided technical support to obtain the correct proportions and a sense of 3D by exploiting the continuum between black and white (Figure 2). This time it was to be drawn "in negative": only the surroundings of the form were to be drawn (Figure 2). Inhibition is presumably trained in the various assignments in which gradual changes from black to white were explicitly made (Figures 3, 5, and 6) and the various assignments that aimed for the correct presentation of reality (Figures 2 and 4 and the personal photograph).
Charcoal drawing of interconnected squares. Emphasis was given to darkening of the squares and the gradual enlightenment of the connections between adjacent squares.
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She succeeded in gradually changing the dark into the light (Figure 3). Inhibition is presumably trained in the various assignments in which gradual changes from black to white were explicitly made (Figures 3, 5, and 6) and the various assignments that aimed for the correct presentation of reality (Figures 2 and 4 and the personal photograph).
Charcoal copy of a photograph. Emphasis was given to the correct observation by turning the photograph upside down.
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At the end of the drawing process the drawing (Figure 4) was turned and compared to the original. Inhibition is presumably trained in the various assignments in which gradual changes from black to white were explicitly made (Figures 3, 5, and 6) and the various assignments that aimed for the correct presentation of reality (Figures 2 and 4 and the personal photograph).
Charcoal drawing. Emphasis was given to the fluent change in darkness from the convex bottom to the top.
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As in the previous session Dewi experienced difficulties in drawing the dark bottom and diminishing the dark fluently into the light (Figure 5). Inhibition is presumably trained in the various assignments in which gradual changes from black to white were explicitly made (Figures 3, 5, and 6) and the various assignments that aimed for the correct presentation of reality (Figures 2 and 4 and the personal photograph).
Charcoal assignment. Black dots were placed randomly on a sheet of paper and were faded out to the periphery (van den Berg, 2007).
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Hence, an alternative charcoal assignment was performed to further practice shading (Figure 6). Inhibition is presumably trained in the various assignments in which gradual changes from black to white were explicitly made (Figures 3, 5, and 6) and the various assignments that aimed for the correct presentation of reality (Figures 2 and 4 and the personal photograph).
Drawings of a cave/outside world using charcoal and soft pastels. The cave (a) was drawn according to Dewi's own imagination in all drawings. In (b), trees are visible at the horizon and birds in the sky. In (c) Dewi drew a fisherman's wife on the right-hand side and in (d) a sunset in the sea is visible.
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The outside world appeared calm and still (Figure 7(a)). The outside world looked warm and inviting as trees appeared at the horizon and birds flew in the sky (Figure 7(b)). During the session Dewi's attention changed from the inside to the outside world (Figure 7(c)). She enjoyed herself and admired the drawing and the outside world she created, its space and its calmness (Figure 7(d)). Acceptance of emotions has probably received (un) conscious attention in sessions 7 and 9 and in the cave series (Figures 7(a)-7(d)).
Weekly scores of Dewi's major complaints in time. Dewi gave (VAS) scores at the beginning of every session with respect to the mean experienced levels of anxiety, tension and hypochondria the week before scoring. 0: not present, 10: highest level thinkable.
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Dewi mentioned: anxiety, tension and hypochondria. During AAT the severity of these complaints were weekly scored using visual analogue scales (VAS) (Figure 8). The painting shows precisely and carefully painted (curved) stripes (Figure 8). Average scores for the week were given (Figure 8).
Outcomes of anxiety. Scores of Dewi are shown at T0, prior to therapy; and T1, after art therapy. The dotted black line represents norm scores in healthy population (n = 103).
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AAT (T0) were used to quantify symptom severity (Table 2). A clear decrease in anxiety symptom severity (LWASQ) is shown. All subscales (somatic, behavioral and cognitive) showed clinically relevant improvements and approach norm scores after therapy (T1) (Table 2, Figure 9).
Subscales of DERS. Scores of Dewi are shown at T0, prior to therapy; and T1, after art therapy. The dotted black line represents norm scores in female population (n = 260).
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Access to ER strategies improved the most (Table 2, Figure 10). ER, of which acceptance of emotions, access to ER strategies and goal-oriented action approached the norm scores (Table 2, Figure 10). EF scores were lower after therapy but remained overall in the clinical range, except for inhibition and self-monitoring which showed clinically relevant improvements.