BackgroundBurnout among healthcare professionals (HCPs) is a growing concern with wide-reaching implications. Manualised, evidence-based art therapy interventions offer a promising approach to staff support and have shown effectiveness in recent clinical trials. However, little is known about art therapists' experiences of delivering these structured models. Understanding these experiences is essential to inform future implementation and sustainability.AimsTo explore art therapists' lived experiences of delivering a manualised group art therapy intervention for HCPs at risk of burnout, and to identify factors influencing implementation.MethodsA qualitative study using Reflexive Thematic Analysis and Template Analysis was conducted. A focus group with four therapists who delivered the intervention was transcribed and analysed to explore personal, professional, and systemic influences on deliveryResultsThree interconnected domains were identified: (1) Art therapy groups as emotionally resonant, relational spaces that disrupted workplace hierarchies; (2) Therapist perspectives on balancing fidelity to the manual with flexible, relational practice; and (3) Organisational influences on delivery, including resource constraints and emotional labour. Therapists valued supportive relationships, the manual's containing function, and contextual knowledge. Embedded expertise enhanced delivery, while systemic barriers challenged sustainability.ConclusionsDelivering a manualised art therapy intervention in a medical setting was both meaningful and demanding. The structured framework supported emotional safety and creative expression, but long-term sustainability depends on organisational investment and integration into existing systems.ImplicationsFindings emphasise the need for dedicated art therapy roles, appropriate infrastructure, and further research into scalable implementation and long-term impact.Plain-language summaryThis study explored how art therapists experienced delivering a manualised group art therapy programme for healthcare professionals at high risk of burnout. Four art therapists who facilitated the sessions as part of a randomised controlled trial took part in a focus group to share their reflections. Transcripts of the discussion were carefully examined using thematic analysis to explore common themes and differences.Therapists described how working within a structured manual helped them feel organised and grounded in delivering the intervention. The manual provided a clear framework that was highly valued for keeping art-making central to the sessions, preserving the integrity of the model, and fostering authentic expression and connection. Therapists also highlighted the importance of remaining flexible and responsive to the needs of each group. Being open about the manual and the research context helped build trust and engagement with participants.Delivering the intervention was experienced as both professionally enriching and personally meaningful. However, therapists also identified challenges, including organisational pressures, unpredictable physical spaces, and the emotional demands of the work. Access to supervision, team support, and strong working relationships with clinical colleagues were seen as critical to sustaining therapist wellbeing and programme delivery.The study highlights that group art therapy was experienced as creating restorative spaces for healthcare professionals within hospital environments. To sustain programmes like this, healthcare organisations need to invest in supporting art therapists through dedicated roles, protected time, appropriate spaces, regular supervision, and opportunities for reflection and creativity. Future work should explore how to adapt and extend this kind of programme across different hospitals and staff groups while keeping its core relational and creative focus alive.Plain-language summaryThis study explored how art therapists experienced delivering a manualised group art therapy programme for healthcare professionals at high risk of burnout. Four art therapists who facilitated the sessions as part of a randomised controlled trial took part in a focus group to share their reflections. Transcripts of the discussion were carefully examined using thematic analysis to explore common themes and differences.Therapists described how working within a structured manual helped them feel organised and grounded in delivering the intervention. The manual provided a clear framework that was highly valued for keeping art-making central to the sessions, preserving the integrity of the model, and fostering authentic expression and connection. Therapists also highlighted the importance of remaining flexible and responsive to the needs of each group. Being open about the manual and the research context helped build trust and engagement with participants.Delivering the intervention was experienced as both professionally enriching and personally meaningful. However, therapists also identified challenges, including organisational pressures, unpredictable physical spaces, and the emotional demands of the work. Access to supervision, team support, and strong working relationships with clinical colleagues were seen as critical to sustaining therapist wellbeing and programme delivery.The study highlights that group art therapy was experienced as creating restorative spaces for healthcare professionals within hospital environments. To sustain programmes like this, healthcare organisations need to invest in supporting art therapists through dedicated roles, protected time, appropriate spaces, regular supervision, and opportunities for reflection and creativity. Future work should explore how to adapt and extend this kind of programme across different hospitals and staff groups while keeping its core relational and creative focus alive.Plain-language summaryThis study explored how art therapists experienced delivering a manualised group art therapy programme for healthcare professionals at high risk of burnout. Four art therapists who facilitated the sessions as part of a randomised controlled trial took part in a focus group to share their reflections. Transcripts of the discussion were carefully examined using thematic analysis to explore common themes and differences.Therapists described how working within a structured manual helped them feel organised and grounded in delivering the intervention. The manual provided a clear framework that was highly valued for keeping art-making central to the sessions, preserving the integrity of the model, and fostering authentic expression and connection. Therapists also highlighted the importance of remaining flexible and responsive to the needs of each group. Being open about the manual and the research context helped build trust and engagement with participants.Delivering the intervention was experienced as both professionally enriching and personally meaningful. However, therapists also identified challenges, including organisational pressures, unpredictable physical spaces, and the emotional demands of the work. Access to supervision, team support, and strong working relationships with clinical colleagues were seen as critical to sustaining therapist wellbeing and programme delivery.The study highlights that group art therapy was experienced as creating restorative spaces for healthcare professionals within hospital environments. To sustain programmes like this, healthcare organisations need to invest in supporting art therapists through dedicated roles, protected time, appropriate spaces, regular supervision, and opportunities for reflection and creativity. Future work should explore how to adapt and extend this kind of programme across different hospitals and staff groups while keeping its core relational and creative focus alive.Plain-language summaryThis study explored how art therapists experienced delivering a manualised group art therapy programme for healthcare professionals at high risk of burnout. Four art therapists who facilitated the sessions as part of a randomised controlled trial took part in a focus group to share their reflections. Transcripts of the discussion were carefully examined using thematic analysis to explore common themes and differences.Therapists described how working within a structured manual helped them feel organised and grounded in delivering the intervention. The manual provided a clear framework that was highly valued for keeping art-making central to the sessions, preserving the integrity of the model, and fostering authentic expression and connection. Therapists also highlighted the importance of remaining flexible and responsive to the needs of each group. Being open about the manual and the research context helped build trust and engagement with participants.Delivering the intervention was experienced as both professionally enriching and personally meaningful. However, therapists also identified challenges, including organisational pressures, unpredictable physical spaces, and the emotional demands of the work. Access to supervision, team support, and strong working relationships with clinical colleagues were seen as critical to sustaining therapist wellbeing and programme delivery.The study highlights that group art therapy was experienced as creating restorative spaces for healthcare professionals within hospital environments. To sustain programmes like this, healthcare organisations need to invest in supporting art therapists through dedicated roles, protected time, appropriate spaces, regular supervision, and opportunities for reflection and creativity. Future work should explore how to adapt and extend this kind of programme across different hospitals and staff groups while keeping its core relational and creative focus alive.

Objective To explore the impact of multiple long-term conditions (MTLCs) and a comorbid mental health condition on decision-making processes, attendance and engagement in NHS community-based therapy groups.Design Qualitative in-depth interviews analysed using reflexive codebook analysis as part of a study within a trial.Setting Secondary community mental health teams from two UK sites.Participants Purposive sample of 20 participants recruited to a randomised controlled trial of group therapies (arts therapies and counselling) holding a mental health diagnosis and self-reported as having at least one additional physical health condition.Results Six themes were constructed: (1) MLTCs influenced arts modality choices and goals; (2) importance of planning ahead to be organised; (3) the journey loomed over participants; (4) the impact of MLTCs on group attendance and participation; (5) the group was valued and important; (6) determination and fighting to get what I need.Decisions about arts modalities and group attendance were based on a self-perceived level of felt capability. It was important for participants to plan in advance and feel informed ahead of making commitments, enabling them to prepare and manage symptoms. Travelling to the groups was dreaded, and many participants required support with travel in order to attend. Managing symptoms during the journey and groups was challenging; however, participants had a strong determination to uphold the commitment to attend despite their difficulties, as the group was highly valued.Conclusions MLTCs have a large impact on people’s capacity to engage in community groups, requiring additional planning and effort. The scale of this impact is often not recognised. Despite this, the benefits of groups for people with MLTCs are especially important, including motivation to leave the house, opportunities for socialisation and a means of reaching one’s own goals. Clinicians are recommended to accommodate the needs of MLTCs when designing community group interventions and consider multiple attendees with MLTCs in the group composition to improve attendance and group engagement.Trial registration number ISRCTN88805048.

Interacting with or contemplating space or ‘dark nature’ can increase wellbeing through mechanisms such as increasing feelings of awe or wonderment. However, this has not been explored for people living with mild cognitive impairment or dementia in previous published research. 53 participants (56-90 years old, 39.6% female) with a self-reported diagnosis of mild cognitive impairment or dementia completed a one-off online/remote mixed-methods survey asking about their demographics, and views and experiences of space or ‘dark nature’, and space-related activities. Qualitative data was analysed via thematic analysis and quantitative data was analysed using Excel. Participants described space through physical and psychological/emotional/social aspects. Thinking about space and our place in the universe elicited feelings of awe for some participants. Participants were also concerned about space littering and preserving space. Though some participants described space as being mysterious and not fully knowing ‘what is up there’, others expressed excitement or contentment. Some participants felt more negative feelings such as anxiety, frustration and shame when thinking about space. Most of the participants (58.5%) said they would go stargazing now and 60.4% said they would attend a talk on space. Facilitators for space-related activities included an easy to travel to and accessible location, option to join remotely and low cost. This study provides novel insights into how people living with mild cognitive impairment or dementia conceptualise space or ‘dark nature’, and the universe. It suggests potential mechanisms of action for the positive effects of contemplating space or carrying out space-related activities, and barriers and facilitators to space-related activities. This could help future researchers develop space-related or ‘dark nature-based’ interventions tailored for this population.

Approximately 50% of UK dramatherapists deliver their work in schools. Despite this, little is currently known about the way in which school settings affect the dramatherapy that is delivered within them. This qualitative investigation utilised semi-structured interviews (N=12) and reflexive thematic analysis to identify the facilitators and barriers of providing dramatherapy in school settings. In addition, the unique experiences of working as a dramatherapist in a school setting were also investigated. Amongst others, the facilitators identified included school as an accessible and safe place for therapy to occur. In addition, the structure provided by the school’s daily and annual timetable, and the support of other school-based professionals and organisations were also identified. The barriers identified related to funding challenges, inappropriate referrals, schools seeking quick results and a lack of access to suitable spaces for therapy to occur. Regarding their experiences of employment, many dramatherapists spoke of working in multiple schools and, whilst some enjoyed the flexibility this offered, many found it challenging to become part of the school community and experienced a sense of isolation whilst working. Feeling like they are lower paid than clinical counterparts, such as colleagues in Child and Adolescent Mental Health Services (CAMHS), was also raised by those interviewed. These findings suggest that resource investment and investment into teachers’ and other school-based professionals’ knowledge of dramatherapy is warranted. In addition, dramatherapists who work in schools may benefit from community building. Future research, which explores the experience of dramatherapists in other settings is also encouraged.

Dramatherapy, a creative form of psychotherapy, is used as a treatment for children and young people (CYPs) who have common mental disorders including anxiety, depression and trauma. Although widely used, particularly in schools, little is known about the active ingredients of this intervention. A qualitative approach, triangulating both semi-structured interviews (N=11) and a focus group (N=5), was taken to elicit dramatherapists’ perspectives on the active ingredients of school-based dramatherapy. 11 active ingredients were identified. That dramatherapy fosters autonomy, freedom and agency (1), that experiences are processed creatively (2), that CYPs experience and express emotions (3) in dramatherapy, were found; dramatherapy’s person-centredness (4) and the use of structure (5) were also found. The creation of safety, in the therapeutic relationship (6) and space (7) and, the ability to develop meaningful social connections (8) via dramatherapy, were also identified as active ingredients, as were, dramatherapists’ use of theory (9), the importance of a systemic approach (10) and that therapeutic experiences are integrated into life beyond dramatherapy (11). This study is the first to explore the active ingredients of school-based dramatherapy for CYPs with emotional distress. The findings presented may inform further research, measuring mediators of change, and practice, which enhances symptom reduction.

The mental health recovery movement recognises the importance of expertise by experience held by service users alongside healthcare practitioners. Recovery has gained attention in music therapy but a situation prevails where practitioners and researchers set research agendas. A group of music therapists recognised the absence of service user voices in music therapy research, and in 2017 they established a network called the Alliance for Recovery Research in Music Therapy (ARRIMT). In 2020, they started to develop a multi-national platform to explore mental health recovery in relation to research. Service users and music therapists were invited from three countries including Ireland, Norway, and the United Kingdom (UK). Local meetings were held to introduce stakeholders from each country, followed by three online meetings. Music was central to each meeting and each built upon content from previous meetings. Our conversations opened up new possibilities for working together. Four priorities for practice and research were identified: Music as a connector; music between sessions; music technology; and, online music therapy. This report will share our process and what we learnt from working together. We contextualise our work within concepts of foregrounding and mattering and view this work as a crucial step towards meaningful co-production. We reflect upon the role of music in building group identity alongside the importance of careful curation. Finally, we present ideas for future music therapy and mental health research. Group Description In 2018 the Alliance for Recovery Research in Music Therapy (ARRIMT) was founded as an international group of music therapy service users, researchers and practitioners from Australia, Ireland, Norway, and the United Kingdom. Fundamental to this group is the concept of recovery where those who use and those who provide mental health services work together to share knowledge and experiences that can have a positive impact on mental health service delivery. Key to this is listening carefully to the voices of those who use music therapy so that their views and experiences influence how music therapy is offered in mental health services. The founders and coordinators of the group are Tríona McCaffrey, Hans Petter Paulen Solli, and Catherine E. Carr. Other members of the group are Cornelia Bent, Darmuid Boyle, Oda Bjørke Dypvik, Kenneth Dybdahl, Tommy Hayes, Lauren M. Hickling, Jane Fernandez, Anne Malerbakken, Brendan Ruddy, and Torgrim Vågan.

A developing evidence base suggests that dramatherapy, a creative form of psychotherapy, is a useful treatment for child and adolescent emotional disorders. However, little is known regarding the therapeutic benefits (“active ingredients”) of this intervention. A systematic search and meta-synthesis of secondary qualitative data reflecting participants’ perceptions of active ingredients of dramatherapy for symptoms of emotional disorders (anxiety, depression and trauma-related stress) was conducted. Six analytical themes emerged from eight studies. Dramatherapy as a learning (1) and social (2) experience and dramatherapy as a positive intervention (3) which supports self-expression (4) and emotion regulation (5) were identified as active ingredients. The skill and professionalism of dramatherapists (6) were also identified. This study is limited as the data available were not collected for the primary purpose of identifying active ingredients, more focused investigations may reveal different findings. In addition, studies contributed unequal amounts of data thus, findings may be skewed. The findings of this synthesis were benchmarked against other interventions commonly offered to children and young people with emotional distress. Three active ingredients (dramatherapy is fun, dramatherapy builds confidence, participants process difficulties through drama) were deemed unique to dramatherapy. Further research could employ mediation analysis to determine therapeutic mechanisms of change of this intervention.

This systematic review with narrative synthesis aimed to identify the forms of art therapy practice, types of studies conducted, outcomes reported, and experiences described in the literature for people with learning disabilities who also experienced mental distress. Papers in English, describing art therapy practice or therapeutic art interventions which addressed mental distress with adults with learning disabilities were included. Database searches were conducted using Healthcare Databases Advanced Search (HDAS), PubMed and American Psychological Association PsycInfo. Hand searches of grey literature were also conducted. Relevance and quality assessment ratings were carried out on each included paper. Results were discussed in terms of the four main questions of this review. Sixty-eight papers were included: 41 clinical practice and 27 research studies. Art therapy was most frequently provided on an individual basis, by qualified art therapists in community settings. Papers highlighted a broad range of adaptive practices, techniques and theoretical models used by practitioners when working with this population. Study outcomes varied, were predominantly behavioural and deficit focused. Data on the direct experiences of this population were limited but show promising areas for future research. This review identified that art therapy practice has evolved in response to diverse client needs and specific socio-cultural contexts across 40 years. Although there are no clearly defined models of individual or group art therapy for this population, practitioners employ their creative and therapeutic skills flexibly to meet this population's complex health and social needs. We recommend that future studies: employ robust and inclusive methodologies, measure resource-oriented outcomes and use established standards of reporting, to expand the evidence-base and to more accurately reflect the experiences of this population.

AbstractBackgroundDramatherapy, a creative form of psychotherapy, may be a useful treatment for child and adolescent mental health. As there is a growing evidence base, this systematic review sought to identify, describe and evaluate dramatherapy with children and adolescents who were experiencing emotional distress (anxiety, depression and trauma) in order to inform future research in this area.MethodsSeven databases (PsychInfo, PubMed, Scopus, Web of Science, CINAHL, EMBASE and Cochrane) were searched for peer‐reviewed articles exploring dramatherapy as a treatment for child and adolescent emotional distress. Hand searches of relevant journals were also conducted. Two reviewers coded articles for eligibility and independently appraised papers using the Joanna Briggs Institute Critical Appraisal Tools. Details relating to intervention and participant characteristics were extracted and, where data were available, effect sizes on measures relating to emotional distress were calculated.ResultsFifteen papers were included. Studies showed that dramatherapy was often delivered in schools (46%) and clinical settings (20%) and was more frequently delivered to adolescents (53%) (>11 years) than children (26%) (8–11 years). Dramatherapy was used as a treatment for diagnostically heterogeneous groups (40%), for emotional and behavioural difficulties (33%) and following a shared, traumatic, experience (20%). Seven papers reported relevant quantitative data however, just three of these studies were controlled and none were blinded. Pre‐to‐post intervention effect sizes ranged from d = 0.17 to d > 2 yet samples were small and participant response to treatment was not always consistent. The largest effects were seen in dramatherapy employed following trauma and in clinical settings. Medium to large effects were also seen in early intervention school‐based dramatherapy.ConclusionDespite promising results with regards to the treatment of child and adolescent emotional distress, the evidence base for dramatherapy is small and methodologically flawed. Larger, methodologically robust trials should test the efficacy of dramatherapy in future research.

Despite effective treatments, one fifth of patients develop chronic depression. Music therapy may offer a different approach. This study aimed to assess feasibility and acceptability of a music therapy intervention and trial methodology. A parallel two-arm randomised controlled trial with wait-list control, mixed feasibility/acceptability measures and nested process evaluation. Adults with long-term depression (symptom duration > 1 year) were recruited from community mental health services and computer randomised to 42 sessions of group music therapy with songwriting three times per week or wait-list control. Depression, social functioning, distress, quality of life, satisfaction and service use were assessed by blinded researchers at enrolment, 1 week and 3 and 6 months post-therapy. Outcomes were analysed descriptively, controlling for baseline covariates. Recruitment (number eligible, participation and retention rates) and intervention (fidelity, adherence) feasibility were assessed using pre-defined stop–go criteria. Attendance, adverse events, mood, relationship satisfaction and semi-structured interviews were analysed in a nested process evaluation. Recruitment processes were feasible with 421 eligible, 12.7

Background Arts therapies are widely but inconsistently provided in community mental health. Whilst they are appealing to patients, evidence for their effectiveness is mixed. Trials to date have been limited to one art-form or diagnosis. Patients may hold strong preferences for or against an art-form whilst group therapies rely on heterogeneity to provide a range of learning experiences. This study will test whether manualised group arts therapies (art therapy, dance movement therapy and music therapy) are effective in reducing psychological distress for diagnostically heterogeneous patients in community mental health compared to active group counselling control. Methods A pragmatic multi-centre 2-arm randomised controlled superiority trial with health economic evaluation and nested process evaluation. Adults aged ≥ 18, living in the community with a primary diagnosis of psychosis, mood, or anxiety disorder will be invited to participate and provide written informed consent. Participants are eligible if they score ≥ 1.65 on the Global Severity Index of the Brief Symptom Inventory. Those eligible will view videos of arts therapies and be asked for their preference. Participants are randomised to either their preferred type of group arts therapy or counselling. Groups will run twice per week in a community venue for 20 weeks. Our primary outcome is symptom distress at the end of intervention. Secondary outcomes include observer-rated symptoms, social situation and quality of life. Data will be collected at baseline, post-intervention and 6 and 12 months post-intervention. Outcome assessors and trial statisticians will be blinded. Analysis will be intention-to-treat. Economic evaluation will assess the cost-effectiveness of group arts therapies. A nested process evaluation will consist of treatment fidelity analysis, exploratory analysis of group process measures and qualitative interviews with participants and therapists. Discussion This will be the first trial to account for patient preferences and diagnostic heterogeneity in group arts therapies. As with all group therapies, there are a number of logistical challenges to which we have had to further adapt due to the COVID-19 pandemic. Overall, the study will provide evidence as to whether there is an additive benefit or not to the use of the arts in group therapy in community mental health care. Trial registration ISRCTN, ISRCTN88805048 . Registered on 12 September 2018.

Songwriting is widely used in individual music therapy but less often in groups. This article draws on the authors' experience of facilitating music therapy groups for adults with severe depression using songwriting. This work was part of the SYNCHRONY study, funded by the National Institute for Health Research, to assess the feasibility of conducting a randomised controlled trial of group music therapy with a songwriting component for patients with long-term depression (1 year or longer) within the community. The authors (all music therapists in the study) describe their experiences and reflections on the group processes and use of songwriting, drawing on semi-structured interviews conducted as part of the study. Themes of the work included pre-composed songs as a more accessible way to talk about difficult experiences, musical improvisation enabling an environment for songwriting, the impact of difficulties in attendance on group cohesion and the songwriting process, building confidence through song development and recording, and considerations around the end process and creating the song album. These are illustrated with clinical vignettes. Some recommendations for practice are also offered. The authors hope to identify the potentials and challenges of a songwriting approach in a community mental health context.

BackgroundBurnout and psychosocial distress are serious and growing issues for healthcare workers (HCWs) and healthcare systems across the globe. Exacerbated by changes in healthcare delivery during and following the Covid-19 pandemic, these issues negatively affect HCW wellbeing, clinical outcomes and patient safety. Art Therapy has demonstrated promise as a suitable but under researched intervention, warranting further investigation. This systematic review aims to ascertain what art therapy-based interventions used to address burnout and / or psychosocial distress in HCWs have been reported in the health and social care literature and how these have been evaluated.MethodsSix databases (PubMed, PsycINFO, MEDLINE, EMBASE, CINAHL, ProQuest Central), Google Scholar and three clinical trial registries (CENTRAL, ICTRP and ClinicalTrials.gov) were searched for studies using art therapy-based methods to engage with burnout risk or psychosocial distress in HCWs. Following screening for eligibility study characteristics and outcomes were extracted by two reviewers independently. Studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Outcomes were grouped for analysis. Quantitative and qualitative results were synthesised and integrated using narrative synthesis.ResultsTwenty-seven studies, drawn from thirteen countries, spanning five continents were selected for inclusion. Fifty percent were published in the last five years, indicating growing global research in the field. Fourteen studies used quantitative research methods and thirteen used qualitative methods. A total of 1580 participants took part in the studies, with nurses most broadly represented (59%). Interventions were mostly delivered in groups (95%) and by an art therapist (70%). Heterogeneity and insufficient randomised controlled trials precluded the possibility of meta-analysis. However, a review of available data showed evidence of medium to large effects for emotional exhaustion (burnout), work-related stress and common mental health issues. A content analysis of qualitative data of perceived effect complemented quantitative findings.ConclusionGlobal research into the use of art therapy-based methods to address burnout and psychosocial distress in HCWs is growing. Whilst further high-quality evidence such as randomised controlled trials would be beneficial, findings suggest that art therapy-based methods should be strongly considered as an acceptable and effective treatment for symptoms of emotional exhaustion (burnout) and psychosocial distress in HCWs.

People with learning disabilities are often excluded from society. This is changing; however, discrimination persists. Language is one way in which people can be excluded. In healthcare and research, the use of labels and jargon can be a barrier to inclusion. A group of artist-researchers from the UK, some with learning disabilities and some without, wanted to explore power and language in the lives of people with learning disabilities. The group included social change activists The Lawnmowers Independent Theatre Company - who identify as having learning disabilities, and arts therapist researchers working in the National Health Service (NHS). Using arts-based participatory action research methods, we held two co-produced workshops. The first, explore power, jargon and labels for people with learning disabilities and the second, with the arts therapists only, deepened our understanding of exclusion. We used a range of arts-based approaches including improvised performance and music, reflective art making and poetry writing. This article describes the process of working together and how the arts helped us to connect and explore challenging issues. We discuss the different ways labels impact who we are and the power they have to include or exclude people with learning disabilities from healthcare and research. Our participatory approach supported multifaceted knowledge to emerge, which both empowered participants and laid foundations for an ongoing social change partnership. We share our recommendations to make research and healthcare more accessible for people with learning disabilities.

OBJECTIVES:Cognitive Stimulation Therapy (CST) is an evidence-based group intervention shown to improve cognition and quality of life in dementia and is widely implemented across the NHS. However, no attempt has been made to understand the possible advantages, and/or disadvantages, of delivering CST in a group format. The main aim of the present study was to explore experiences of group interactions in CST and longer-term maintenance CST (MCST) groups.METHOD:A total of twenty-one semi-structured in-depth interviews were conducted across four separate groups delivered in London, the East Midlands, South West and South East of England; including two CST and two MCST groups. Group members with mild to moderate dementia and facilitators from these groups were interviewed. Thematic analysis was used to analyse the data using NVivo software.RESULTS:The final analysis identified six themes: 'benefits and challenges of group expression', 'importance of companionship and getting to know others, 'togetherness and shared identity', 'group entertainment', 'group support' and 'cognitive stimulation through the group'. The inter-connecting relationship between these themes are synthesised and summarised.CONCLUSION:Findings support the notion that therapeutic advantages inherent to the group format exist in group-based CST. New insights into the challenges related to a group format are also highlighted and discussed. Future research may benefit from exploring the relationship between the identified experiences of group interactions and clinical outcomes.

Arts therapies draw upon many theories and models of practice, but lack consensus in shared factors of their provision. In preparation for a randomised controlled trial involving art therapy, dance movement therapy and music therapy, we used experiential and practice-based methods to develop a model and manual for mixed diagnosis arts therapies groups in community mental health care. Six arts therapists met over the course of a year to explore commonalities and differences in art, dance movement and music therapy groups. Arts-based and consensus methods were used to develop practice principles, which were expanded through workshops with arts therapists working in mental health services. A model, manual, training and adherence guide were produced, which incorporated role-play and video-based reflection. The model is underpinned by transdiagnostic and contextual psychotherapy theories. The manual outlines ten core principles, alongside 19 practice principles. Fourteen scenarios where therapists commonly intervene informed ongoing therapist training and development. This is the first model to describe practice across three types of arts therapies for mixed diagnosis groups in community mental health care. Whilst overall manual utility (including adherence) and effectiveness is yet to be assessed, the development methods may be informative for wider arts therapies groups and clientele.

Patient preferences deserve consideration as they play a role in engagement with psychosocial interventions. This study sought to understand more about preferences and expectations of the arts therapies, in order to support informed decision-making. Semi-structured interviews were conducted with 17 participants in a trial of group music therapy, art therapy and dance-movement therapy. Audio recordings were transcribed. Data relating to the process of choosing their preferred arts therapies groups, expectations and experiences of the groups were analysed using framework analysis. Three overarching themes were found relating to the experience of choosing an arts therapies group and subsequently attending it: past experiences of the art forms, social interactions in the groups and expectations of helpfulness. Familiarity and perceived capability were important factors for the therapy experiences. Although each participant had a unique decision-making process, the themes offer understanding of common considerations when making a choice about engagement with the arts therapies. Clinicians should guide discussions around past experiences of the art forms, group dynamics and therapy aims during shared decision making for the arts therapies.

Service user preferences should be integrated into mental healthcare wherever possible, and providing information about the treatments on offer is essential for informed choice. Methods of presenting information about the arts therapies require consideration. This study sought to obtain service user opinions on three decision aids designed for the arts therapies. Five focus group workshops totalling 20 participants were conducted with service users in community mental health services. They were shown three decision aids for the arts therapies: leaflets, videos and taster sessions. Discussions were recorded, transcribed and analysed using framework analysis. Four themes were developed: Previous experiences of the arts shaped discussions; Aims of treatment are essential information; There were different expectations of each decision aid; The decision aids offered an evolving understanding of the art form in the workshops. These results imply that service users' previous experiences and expectations of the arts must be understood by clinicians when engaging in decision-making about treatment. Service users wanted to know explicit aims and goals of the arts therapies in all three decision aids. All decision aids were useful in different ways, therefore timing in the decision making process and physical location of the aids are worth considering.

Objectives The arts therapies include music therapy, dance movement therapy, art therapy and dramatherapy. Preferences for art forms may play an important role in engagement with treatment. This survey was an initial exploration of who is interested in group arts therapies, what they would choose and why. Design An online cross-sectional survey of demographics, interest in and preferences for the arts therapies was designed in collaboration with patients. The survey took 10 min to complete, including informed consent and 14 main questions. Summary statistics, multinomial logistic regression and thematic analysis were used to analyse the data. Setting Thirteen National Health Service mental health trusts in the UK asked mental health patients and members of the general population to participate. Participants A total of 1541 participants completed the survey; 685 mental health patients and 856 members of the general population. All participants were over 18 years old, had capacity to give informed consent and sufficient understanding of English. Mental health patients had to be using secondary mental health services. Results Approximately 60% of participants would be interested in taking part in group arts therapies. Music therapy was the most frequent choice among mental health patients (41%) and art therapy was the most frequent choice in the general population (43%). Past experience of arts therapies was the most important predictor of preference for that same modality. Expectations of enjoyment, helpfulness, feeling capable, impact on mood and social interaction were most often reported as reasons for preferring one form of arts therapy. Conclusions Large proportions of the participants expressed an interest in group arts therapies. This may justify the wide provision of arts therapies and the offer of more than one modality to interested patients. It also highlights key considerations for assessment of preferences in the arts therapies as part of shared decision-making.