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  3. Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomised trial
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Research

Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomised trial

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e846 (Published 28 February 2012) Cite this as: BMJ 2012;344:e846
  1. Mike J Crawford, professor in mental health research1,
  2. Helen Killaspy, reader in rehabilitation psychiatry2,
  3. Thomas R E Barnes, professor of clinical psychiatry1,
  4. Barbara Barrett, lecturer in health economics3,
  5. Sarah Byford, reader in health economics3,
  6. Katie Clayton, head of arts therapies4,
  7. John Dinsmore, research associate5,
  8. Siobhan Floyd, research associate6,
  9. Angela Hoadley, research associate2,
  10. Tony Johnson, senior statistician7,
  11. Eleftheria Kalaitzaki, medical statistician8,
  12. Michael King, professor of primary care psychiatry2,
  13. Baptiste Leurent, medical statistician8,
  14. Anna Maratos, head of arts therapies9,
  15. Francis A O’Neill, senior clinical lecturer5,
  16. David P Osborn, senior clinical lecturer2,
  17. Sue Patterson, research associate1,
  18. Tony Soteriou, director of research and development6,
  19. Peter Tyrer, professor of community psychiatry1,
  20. Diane Waller, honorary professor of art psychotherapy1
  21. on behalf of the MATISSE project team
  1. 1Centre for Mental Health, Department of Medicine, Imperial College London, Claybrook Centre, London W6 8LN, UK
  2. 2Unit of Mental Health Sciences, Faculty of Brain Sciences, University College London, London, UK
  3. 3Centre for the Economics of Mental Health, Health Service and Population Research Department, King’s College London, London UK
  4. 4Camden and Islington NHS Foundation Trust, London, UK
  5. 5Centre for Public Health, Queen’s University, Belfast, UK
  6. 6Avon and Wiltshire Mental Health Partnership NHS Trust, Chippenham, UK
  7. 7MRC Biostatistics Unit, Cambridge, UK, and MRC Clinical Trials Unit London, UK
  8. 8MRC General Practice Research Framework, London, UK
  9. 9Central and North West London NHS Foundation Trust, London, UK
  1. Correspondence to: M J Crawford m.crawford{at}imperial.ac.uk
  • Accepted 7 December 2011

Abstract

Objectives To evaluate the clinical effectiveness of group art therapy for people with schizophrenia and to test whether any benefits exceed those of an active control treatment.

Design Three arm, rater blinded, pragmatic, randomised controlled trial.

Setting Secondary care services across 15 sites in the United Kingdom.

Participants 417 people aged 18 or over, who had a diagnosis of schizophrenia and provided written informed consent to take part in the study.

Interventions Participants, stratified by site, were randomised to 12 months of weekly group art therapy plus standard care, 12 months of weekly activity groups plus standard care, or standard care alone. Art therapy and activity groups had up to eight members and lasted for 90 minutes. In art therapy, members were given access to a range of art materials and encouraged to use these to express themselves freely. Members of activity groups were offered various activities that did not involve use of art or craft materials and were encouraged to collectively select those they wanted to pursue.

Main outcome measures The primary outcomes were global functioning, measured using the global assessment of functioning scale, and mental health symptoms, measured using the positive and negative syndrome scale, 24 months after randomisation. Main secondary outcomes were levels of group attendance, social functioning, and satisfaction with care at 12 and 24 months.

Results 417 participants were assigned to either art therapy (n=140), activity groups (n=140), or standard care alone (n=137). Primary outcomes between the three study arms did not differ. The adjusted mean difference between art therapy and standard care at 24 months on the global assessment of functioning scale was −0.9 (95% confidence interval −3.8 to 2.1), and on the positive and negative syndrome scale was 0.7 (−3.1 to 4.6). Secondary outcomes did not differ between those referred to art therapy or those referred to standard care at 12 or 24 months.

Conclusions Referring people with established schizophrenia to group art therapy as delivered in this trial did not improve global functioning, mental health, or other health related outcomes.

Trial registration Current Controlled Trials ISRCTN46150447.

Footnotes

  • We thank Sakina Hossany, Aimee Ayton, and Martin Keats for helping to coordinate the study and enter and manage study data; the Mental Health Research Network for supporting the recruitment and follow-up of participants; and patients and staff who took part in the study. A more detailed account of the study methods and findings will be published in full in Health Technology Assessment in 2012.

  • Contributors: MJC, HK, and DW are coprincipal investigators of the MATISSE trial, had full access to all of the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. EK designed the statistical analysis plan with guidance provided by TJ. Outcome data were analysed by BL with guidance from TJ. DW, KC, and AM provided clinical expertise on arts therapies. DPO led the training of activity group facilitators. The principal investigators at each centre were MJC, HK, TS, and FAO’N. SP, AH, SF, and JD recruited and followed up participants. MK, BB, SB, TREB, and PT provided expertise in trial methods, including input to the planning of the study and the data analysis plan. All study authors contributed to the preparation of this report. MJC is the guarantor.

  • Funding: The project was funded by the National Institute for Health Research Health Technology Assessment programme (project No 04/39/04) and received financial support from Avon and Wiltshire Mental Health Partnership NHS Trust, Belfast Health and Social Care Trust, Camden and Islington NHS Foundation Trust, and Central and North West London NHS Foundation Trust. The sponsors of the study played no part in the preparation of this paper. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Health Technology Assessment programme, the National Institute for Health Research, or the Department of Health.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; DW, AM, and MJC are executive members of a non-profit organisation (the International Centre for Research in Arts Therapies) that aims to promote research and development of arts therapies in health and social care.

  • Ethical approval: This study was approved by the Huntingdon research ethics committee (06/Q0104/82).

  • Data sharing: No additional data available.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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