“I Feel Like I Am Finding Peace”: Exploring the Use of a Combined Art Therapy and Adapted Seeking Safety Program with Refugee Support Groups
Keywords:Seeking safety, mandala, art therapy, PTSD, trauma-exposed refugees, trauma symptoms
This paper describes the creation and implementation of a trauma support group intervention which combined aspects of the Seeking Safety model with an art therapy technique in an effort to reduce trauma-related symptoms in a population of refugees. A preliminary assessment was carried out to evaluate the potential effectiveness of the combined approach with trauma-exposed refugees. Based on facilitator notes from 8 sessions of two women’s refugee groups and one men’s group, three themes were identified: mandala creation enhanced the Seeking Safety content, language barriers impacted the potential for implementation, and the trauma support group was a means of personal growth for participants. Reports from facilitators and participants also suggested a reduction in trauma-related symptoms and an increase in participant use of safe coping skills as a result of group participation. While additional research is needed, these exploratory results suggest that this combined approach holds promise for positively impacting trauma symptoms in trauma-exposed refugees.
Allen, J. K. (2011). The effectiveness of mandala creation in alleviating traumatic symptoms in college students (Doctoral dissertation). Retrieved from ProQuest Dissertations & Theses Global. (3443798).
Babouchkina, A., & Robbins, S. J. (2015). Reducing negative mood through mandala creation: A randomized controlled trial. Art Therapy, 32(1), 34-39. doi: http://dx.doi.org/10.1080/07421656.2015.994428
Boden, M. T., Kimmerling, R. Jacobs-Lentz, J., Bowman, D., Weaver, C., Carney, D., Walser, R., & Trafton, J. A. (2012). Seeking safety treatment for male veterans with a substance use disorder and post-traumatic stress disorder symptomology. Addiction, 107(3), 578-586. doi: https://doi.org/10.1111/j.1360-0443.2011.03658.x
Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD checklist. Center for Stress & Anxiety Disorders, University at Albany, SUNY. Online: https://msrc.fsu.edu/system/files/Blanchard%20et%20al%201996%20Psychometric%20properties%20of%20the%20PTSD%20Checklist%20(PCL).pdf
Brown, V. B., Najavits, L. M., Cadiz, S., Finkelstein, N., Heckman, J. P., & Rechberger, E. (2007). Implementing an evidence-based practice: Seeking Safety group. Journal of Psychoactive Drugs, 39(3), 231-240. doi: https://doi.org/10.1080/02791072.2007.10400609
Carlson, E. B., & Putnam, F. W. (1993). An update on the dissociative experiences scale. Dissociation: Progress in the Dissociative Disorders, 6(1), 16-27.
Curry, N. A., & Kasser, T. (2005). Can coloring mandalas reduce anxiety? Art Therapy: Journal of the American Art Therapy Association, 22(2), 81-85. doi: https://doi.org/10.1080/07421656.2005.10129441
Delker, B. C., & Freyd, J. J. (2014). From betrayal to the bottle: Investigating possible pathways from trauma to problematic substance use. Journal of Traumatic Stress, 27, 576-584. doi: https://doi.org/10.1002/jts.21959
Dupont, H. J. B. H. M., Kaplan, C. D., Verbraeck, H. T., Braam, R. V., & van de Wijngaart, G. F. (2005). Killing time: Drug and alcohol problems among asylum seekers in the Netherlands. International Journal of Drug Policy, 16, 27-36. doi: https://doi.org/10.1016/j.drugpo.2004.06.002
Ehntholt, K. A., & Yule, W. (2006). Practitioner review: Assessment and treatment of refugee children and adolescents who have experienced war–related trauma. Journal of Child Psychology & Psychiatry, 47(12), 1197-1210. doi: https://doi.org/10.1111/j.1469-7610.2006.01638.x
Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. Lancet, 365, 1309-1314. doi: https://doi.org/10.1016/S0140-6736(05)61027-6
Gerteisen, J. (2008). Monsters, monkeys and mandalas: Art therapy with children experiencing the effects of trauma and fetal alcohol spectrum disorder. Art Therapy, 25(2), 90-93. doi: https://doi.org/10.1080/07421656.2008.10129409
Henderson, P., Rosen, D., & Mascaro, N. (2007). Empirical study on the healing nature of mandalas. Psychology of Aesthetics, Creativity and the Arts, 1(3), 148-154. doi: https://doi.org/10.1037/1931-3818.104.22.168
Hinton, D.E., Rivera, E.I., Hofmann, S.G., Barlow, D.H., & Otto, M.W. (2012). Adapting CBT for traumatized refugees and ethnic minority patients: Examples from culturally adapted CBT (CA-CBT). Transcultural Psychiatry, 49(2), 340-365. doi: https://doi.org/10.1177/1363461512441595
Lambert, J. E., & Alhassoon, O. M. (2015). Trauma-focused therapy for refugees: Meta-analytic findings. Journal of Counseling Psychology, 62(1), 28-37. doi: https://doi.org/10.1037/cou0000048
Lester, K., Resick, P. A., Young-Xu, Y., & Artz, C. (2010). Impact of race on early treat- ment termination and outcomes in posttraumatic stress disorder treatment. Journal of Consulting and Clinical Psychology, 78(4), 480-489. doi: https://doi.org/10.1037/a0019551
Lynch, S. M., Heath, N. M., Mathews, K. C., & Cepeda, G. J. (2012). Seeking Safety: An intervention for trauma-exposed incarcerated women? Journal of Trauma & Dissociation, 13, 88-102. doi: https://doi.org/10.1080/15299732.2011.608780
Naff, K. (2014). A framework for treating cumulative trauma with art therapy. Art Therapy: Journal of the American Art Therapy Association, 31(2), 79-86. doi: https://doi.org/10.1080/07421656.2014.903824
Najavits, L. M. (2002). Seeking Safety: A treatment manual for PTSD and substance abuse. New York: Guilford Press.
Najavits, L. M. (2009). Seeking Safety: An implementation guide. In A. Rubin & D.W. Springer (Eds.). The clinicians’ guide to evidence-based practice, (. 311-347). Hoboken, NJ: Wiley.
Najavits, L. M., Gallop, R. J., & Weiss, R. D. (2006). Seeking Safety therapy for adolescent girls with PTSD and substance use disorder: A randomized control trial. The Journal of Behavioral Health Services & Research, 33(4), 453-463. doi: https://doi.org/10.1007/s11414-006-9034-2
Najavits, L. M., Smylie, D., Johnson, K., Lung, J., Gallop, R. J., & Classen, C. C. (2013). Seeking Safety therapy for pathological gambling and PTSD: A pilot outcome study. Journal of Psychoactive Drugs, 45(1), 10-16. doi: https://doi.org/10.1080/02791072.2013.763557
Nickerson, A., Bryant, R.A., Silove, D., & Steel, Z. (2011). A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clinical Psychology Review, 31, 399-417. doi: https://doi.org/10.1016/j.cpr.2010.10.004
Palic, S., & Elklit, A. (2011). Psychosocial treatment of posttraumatic stress disorder in adult refugees: A systematic review of prospective treatment outcome studies and a critique. Journal of Affective Disorders, 131, 8-23. doi: https://doi.org/10.1016/j.jad.2010.07.005
Parris, J. M. (2008). The mandala as a visual ‘third space’ for work with trauma survivors. Creative Approaches to Research, 1(2), (online), ISSN: 1835-9434.
Schouten, K. A., de Niet, G. J., Knipscheer, J. W., Kleber, R. J., & Hutschemaekers, G. J. M. (2015). The effectiveness of art therapy in treatment of traumatized adults: A systematic review on art therapy and trauma. Trauma, Violence, & Abuse, 16(2), 220-228. doi: https://doi.org/10.1177/1524838014555032
Shannon, P. J., Wieling, E., Simmelink-McCleary, J., & Becher, E. (2015). Beyond stigma: Barriers to discussing mental health in refugee populations. Journal of Loss and Trauma, 20(3), 281-296. doi: https://doi.org/10.1080/15325024.2014.934629
Skeffington, P. M., & Browne, M. (2014). Art therapy, trauma and substance misuse: Using imagery to explore a difficult past with a complex client. International Journal of Art Therapy, 19(3), 114-121. doi: https://doi.org/10.1080/17454832.2014.910816
Slayton, S. C., D’Archer, J., & Kaplan, F. (2010). Outcome studies on the efficacy of art therapy: A review of findings. Art Therapy: Journal of the Art Therapy Association, 27(3), 108-118. doi: https://doi.org/10.1080/07421656.2010.10129660
Slegelis, M. H. (1987). The study of Jung’s mandala and its relationship to art therapy. The Arts in Psychotherapy, 14, 301-311. doi: https://doi.org/10.1016/0197-4556(87)90018-9
Sorkes, B. M. (1991). Art therapy with pediatric oncology patients and their siblings. Journal of Psychosocial Oncology, 9(2), 81-96. doi: https://doi.org/10.1300/J077v09n02_06
Steel, Z. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. The Journal of the American Medical Association, 302(5), 537-549. doi: https://doi.org/10.1001/jama.2009.1132
Stinley, N. E., Norris, D. O., & Hinds, P. S. (2015). Creating mandalas for the management of acute pain symptoms in pediatric patients. Art Therapy, 32(2), 46-53. doi: https://doi.org/10.1080/07421656.2015.1028871
Tay, A. K., Rees, S., Kareth, M., & Silove, D. (2016). Associations of adult separation anxiety disorder with conflict-related trauma, ongoing adversity, and the psychosocial disruptions of mass conflict among West Papuan refugees. American Journal of Orthopsychiatry, 82(2), 224-235. doi: https://doi.org/10.1037/ort0000126
United Nations High Commissioner for Refugees. (2015). UNHCR Mid-Year Trends 2015. Retrieved from doi: http://www.unhcr.org/56701b969.html
van der Vennet, R., & Serice, S. (2012). Can coloring mandalas reduce anxiety? A replication study. Art Therapy: Journal of the American Art Therapy Association, 29(2), 87-92. doi: https://doi.org/10.1080/07421656.2012.680047
Zlotnick, C., Najavits, L. M., Rohsenow, D. J., & Johnson, D. M. (2003). A cognitive-behavioral treatment for incarcerated women with substance abuse disorder and posttraumatic stress disorder: Results from a pilot study. Journal of Substance Abuse Treatment, 25, 99-105. doi: https://doi.org/10.1016/S0740-5472(03)00106-5