Effects of Expressive Art Therapy Applied to Earthquake Victims Who Have Experienced Loss

Effects of Expressive Art Therapy Applied to Earthquake Victims Who Have Experienced Loss on Psychological Symptoms and Post-Traumatic Growth: A Randomized Controlled Study

Earthquakes can negatively affect individuals' mental health by creating serious traumatic effects on individual and societal levels. Traumatic experiences such as losing one's home or workplace, being injured, or losing a loved one cause individuals to develop long-term psychological symptoms. In this context, strengthening psychosocial support programs aimed at coping with psychological and social problems after an earthquake is of great importance. In this study, the effect of expressive art therapy applied to individuals who experienced losses due to the earthquakes centered in Kahramanmaraş on psychological symptoms and post-traumatic growth was examined.

Study Overview

• Status: Active, not recruiting
• Conditions: Earthquake Victims
• Intervention / Treatment: Other: Expressive Art Therapy

Detailed Description

A randomized controlled intervention design with pre-test-post-follow-up measurements was used, which is one of the quantitative research methods. In line with the power analysis, a total of 42 participants, 21 in each group, constituted the research sample. The distribution of participants to the intervention and control groups was made with stratified block randomization. The inclusion criteria of the study included being 18 years of age or older, knowing Turkish, and having experienced material and moral loss due to the earthquake; while the exclusion criteria were mental illness or receiving active psychosocial support. The Brief Symptom Inventory (BSI) and the Post-Traumatic Growth Scale (PTS) were used as data collection tools. The intervention process includes a six-session expressive arts therapy program. The scales will be administered online at pre-test, post-test and two-month follow-up. Data will be evaluated with repeated measures and two-way variance analyses. It is expected that this study will contribute to post-traumatic recovery processes and art-based psychosocial interventions.

• Study Type: Interventional
• Enrollment (Actual): 42
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Çankaya
    • Ankara, Çankaya, Turkey, 06500
      • Gazi University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Being 18 years of age or older,
• Being able to understand, speak and write Turkish,
• Having directly experienced the earthquakes centered in Kahramanmaraş, -
• Having experienced material and moral losses due to the earthquakes centered in Kahramanmaraş

Exclusion Criteria:

• Having a neurological disorder that prevents communication,
• Actively receiving any psychosocial support/counseling

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; After the pre-test, the intervention program was started for the intervention group. The expressive arts therapy program was applied in six sessions, each session lasting 60-90 minutes. All sessions were conducted online. Each session started with greetings and mood control, then a brief evaluation of the previous week was made. The sessions consisted of three stages: giving instructions by the researcher, participants performing artistic actions with appropriate art elements and techniques, and participants working on sharing their artistic stimulation and associations. A list of materials to be used in the session (pencils, paint, paper, play dough, etc.) was sent to the participants one week before the sessions and they were asked to provide them until the session.	Other: Expressive Art Therapy; As a strategy for coping with trauma, art production creates therapeutic effects on the individual with its sensory and physical aspects (Chapman, 2013; King-West and Hass-Cohen, 2008). When verbal expression is insufficient or carries the risk of re-traumatization, expressive art therapy offers a safe space through non-verbal expression (Talwar, 2007). It is stated that art production is effective in repairing self-integrity ruptures that occur in traumatic experiences (Harris, 2009). Through creative processes, the individual can restructure both internally and externally. Expressive art therapy, especially when applied in a group environment, creates a psychotherapeutic effect by providing participants with the opportunity to express their emotions, imagination and unconscious processes (Malchiodi, 2012; Kim et al., 2021). The commitment and reflective understanding that occur in group psychotherapy are among the factors that give hope and strength (Robb, 2017).
No Intervention: Control; No intervention was made to the control group. After the follow-up test was applied to the participants in the experimental group, a three-session expressive arts therapy program was applied to the control group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Brief Symptom Inventory (BSI)	It is a 53-item symptom screening scale developed by Derogatis. The scale consists of 9 subscales and 3 global indexes. The 9 subscales of the scale are, respectively, Somatization (S) (items 2, 7, 23, 29, 30, 33, 37), Obsessive-compulsive disorder (OCD) (items 5, 15, 26, 27, 32, 36), Interpersonal sensitivity (IS) (items 20, 21, 22, 42), Depression (D) (items 9, 16, 17, 18, 35, 50), Anxiety disorder (AD) (items 1, 12, 19, 38, 45, 49), Hostility (H) (items 6, 13, 40, 41, 46), Phobic anxiety (PA) (items 8, 28, 31, 43, 47), Paranoid ideation (PD) (items 4, 10, 24, 48, 51) and Psychoticism (P) (items 3, 14, 34, 44, 53). Additional items (EM) (items 11, 25, 39, 52) include items related to eating and drinking disorders, sleep disorders, death and thoughts about death, and feelings of guilt. The global indices are the Disorder Severity Index, the Symptom Total Index, and the Symptom Disorder Index, respectively.	Change from baseline to 6 weeks (also assessed at 14 weeks post-baseline)
Post-Traumatic Growth Scale (PTGS)	The Posttraumatic Growth Inventory was developed by Tedeschi and Calhoun (1996) to measure the development that occurs in individuals after trauma. The scale consists of 21 items and the items are scored on a 6-point scale from 0 to 5. The scores obtained from the scale vary between 0 and 105, and a high score indicates that the person has experienced a positive change, that is, growth, after the trauma. Factor analysis determined that the scale has 5 sub-dimensions (positive change in interpersonal relationships, awareness of new opportunities, understanding the value of life, increasing personal resilience, and strengthening spirituality). The internal consistency coefficient of the scale was reported as .93 (Kağan et al., 2012).	Change from baseline to 6 weeks (also assessed at 14 weeks post-baseline)

Collaborators and Investigators

• Sponsor: Merve Kızılırmak Tatu

Study record dates

Study Major Dates

• Study Start (Actual): June 15, 2024
• Primary Completion (Actual): January 15, 2025
• Study Completion (Estimated): June 15, 2025

Study Registration Dates

• First Submitted: May 30, 2025
• First Submitted That Met QC Criteria: May 30, 2025
• First Posted (Actual): June 8, 2025

Study Record Updates

• Last Update Posted (Actual): June 8, 2025
• Last Update Submitted That Met QC Criteria: May 30, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Keywords: Post-Traumatic Growth; Psychological Symptoms; Expressive Art Therapy; Earthquake Victims
• Other Study ID Numbers: 05.20.2024-E.950905

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Other researchers wiil be able to read detailed information such as the research method and results when the research is published. The "Research Protocol" will be available on this PRS page.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No