CHICAGO (EGMN) – Whether the activity involves putting brush to paper or assembling images into a collage, expression through the visual arts can powerfully improve the quality of life for people with dementia and terminal illness, according to speakers at a joint conference of the American Society on Aging and the National Council on Aging.

Guided art activities can rekindle a sense of self in people with Alzheimer’s disease and other dementias by facilitating a reconnection with long-term memories, said Cordula Dick-Muehlke, Ph.D., executive director of the Alzheimer’s Family Services Center, Huntington Beach, California.

For hospice patients, art therapy can afford the opportunity to find meaning and closure through the concrete expression of personal accomplishments, important relationships, and cherished experiences, Katy Barrington, Ph.D., professor of art therapy at the Adler School of Professional Psychology, Chicago, said in a separate presentation.

Profound Meaning

“The process of dying is a unique and vulnerable time for anybody,” Dr. Barrington said, and art therapy can provide an excellent catalyst for the expression of thoughts and feelings as hospice patients near the end of life.

She presented the results of a qualitative study of three elderly female hospice patients in rural Wisconsin. The study was based on existential philosophy, which emphasizes the importance of individual responsibility, choices, actions, and self-examination.

With guidance from Dr. Barrington and a hospice social worker over the course of four visits, patients completed a collage in collaboration with a selected loved one based on a story about their lives. She also asked each selected individual to tell a highlighted story that included the patient. The collages were framed and presented to patients and their loved one in the final session.

The process of creating a piece about one’s life harmonizes with the goals and principles of hospice, which stress connectedness, dignity, respect for the patients’ choices, and giving patients as much control over their lives as possible as they attend to psychological, physical, social, and spiritual concerns, Dr. Barrington said.

Art therapy helps patients cope with anxiety about death and encourages meaningful reminiscence. The latter is particularly valuable because it enables patients to take stock of their contributions and legacies at a time when they might wonder whether they have accomplished anything worthwhile in their lives, she said.

Dr. Barrington analyzed the meaning in the finished art pieces using grounded theory, a qualitative research methodology in the social sciences in which data (in this study, patients’ comments) are coded and grouped into similar concepts to generate a theory.

She said that she anticipated having to “pull” stories out of the three patients. Instead, “all of them unloaded on me ... and I probably had 20 different stories. This tells me that confronting death is huge, and that there is a need to talk or bring it all together – to bring life together.”

Each of the three patients talked about mentors in their lives who had helped them deal with struggles and personal choices. Creativity (skill in embroidery, quilting, and sewing) had also played a prominent role in each woman’s life, providing a means of navigating hardships, developing pride and dignity, saving money, and improving the quality of life for themselves and others. Their skills were parts of their legacies.

Through the creative process, patients “recognized that their experience was valuable, that it constituted knowledge, and that meaning came from that knowledge,” Dr. Barrington said. The project gave patients “choices and decisions to make, which made them whole and made them feel they were contributing to bettering their own lives, even as they confronted death.”

Creativity Despite Dementia

For people with dementia, activities have a different value. While providing an excellent vehicle for emotional release and social connection, art also can enhance cognitive functioning by helping individuals tap into brain functions that remain relatively intact, including long-term memory systems, Dr. Dick-Muehlke said.

“When we talk about art, we always talk about the creative process and the emotional process ... but it’s important for us to recognize that art allows people with Alzheimer’s disease to use their preserved cognitive skills,” said Dr. Dick-Muehlke. She noted evidence that cognitive stimulation with medication might be more effective than medication alone (Dement. Geriatr. Cogn. Disord. 2006;22:339-45).

The neurodegenerative process of dementia impairs short-term memory, language, judgment, and visual spatial abilities. “We place a great deal of value on those [abilities] in our society. And we often forget about that other aspect of that person – the aspect of the person that is still so alive,” she said.

By tapping into what a person can still do and feel successful at, art helps individuals express essential features of themselves. Episodic autobiographical memories, such as “the day I got married” or “when I went to college,” as well as the long-term memories of skills and procedures called procedural memories often endure.

In addition, the “freedom from inhibition” that can accompany the neurodegenerative process in the frontal lobe can liberate patients from the psychological defenses that might have prevented them from being creative in art in the past, Dr. Dick-Muehlke noted. “It allows that other side of the person to come out.”

Painting or drawing provides a path for sharing oneself with the world as verbal skills decrease and language becomes more difficult, added Tonia Vojtkofsky, Psy.D., a dementia-education specialist at the Alzheimer’s Family Services Center.

Art also provides a way of expressing feelings that can no longer be articulated. “If you talk to someone about their grief or the emotional changes that are happening in them, it can be difficult for them to communicate or talk about those. ... I’ve seen many times people be able to draw or paint things that they would not be able to express verbally,” she said. “As the person is losing some means of communication, like language, this form of communication becomes that much more valuable.”

Dr. Vojtkofsky asks patients to share stories as they paint or soon after they finish. These opportunities provide an important source of social connection that can reduce loneliness and depression. Patients who at first may be too anxious to paint or draw anything are encouraged simply to observe and enjoy what others are doing.

The Alzheimer’s Family Services Center has used its art therapy program to increase community understanding of dementia. The center partnered with a local art center to assemble a traveling exhibit of the work of 24 artists that has appeared in five locations. “People are very surprised that people with dementia can create such beautiful art,” said Dr. Dick-Muehlke. “Every time you see someone’s mouth drop is a time that you decrease the stigma of what it means to have Alzheimer’s disease.”

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

芝加哥(EGMN)——绘画或拼图等通过视觉艺术表达活动能否有效提高痴呆症患者和晚期疾病患者的生活质量？美国老龄协会(American Society on Aging)与美国国家老龄委员会(National Council on Aging)联合会议的发言人提出了上述疑问。

 

加利福尼亚州汉廷顿海滩阿尔茨海默病家庭服务中心执行总监Cordula Dick-Muehlke博士说，指导下的艺术活动可通过促进与长期记忆中枢的再连结而使阿尔茨海默病及其他痴呆症患者重新找回自我感。

 

芝加哥Adler专业心理学院艺术治疗学教授Katy Barrington博士在另一次发言中指出，对于接受临床关怀的患者，艺术治疗可以通过增强个人成就感、重要关系及宝贵经验的表达而使患者发现生命的意义，走完一生。

 

意义深远

 

Barrington博士说：“临终的过程对于任何人而言都是一段特有的脆弱时间”，在接受临床关怀的患者临终过程中，艺术治疗会极大地促进其思想和情感的表达。

 

她展示了一项纳入威斯康辛州农村中3例接受临终关怀的老年女性患者的定性研究的结果。该研究以强调个人责任感、选择、行为及反省为重要性的生存哲学为基础。

 

在4次访视过程中，患者在Barrington博士和一位临终关怀社工的指导下，根据各自的一段生活故事选出喜爱的人合作完成了一幅拼贴画。她还要求每个被选出的人讲述一个包括患者本人的重要故事。最后，对拼贴画加框并送给患者及其所喜爱的人。

 

Barrington博士说，创造一件与个人生活有关的作品，这个过程与临床关怀的目标和原则一致，后者注重关联性、尊严以及对患者选择的尊重，并使患者在处理其心理、身体、社会及精神上的顾虑时能够尽可能多的掌控自己的生活。

 

她说，艺术治疗可帮助患者应对与死亡有关的焦虑，唤起有意义的回忆。后者尤为重要，原因是在患者想知道其生命中是否有所成就时，这种方法可以使其得以追忆其贡献和遗产。

 

Barrington博士采用扎根理论分析了完成的艺术品所蕴含的意义。扎根理论是社会科学中的一种定性研究方法，即对数据进行编码和归类，进而形成一种观点。

 

她说，她预料必须要从这3例患者中“拖出”故事。而事实相反，“所有患者均向我倾诉……我很可能有20个不同的故事。这让我知道面对死亡很艰巨，而且有必要讲述或将所有讲述的事情拼接起来——进而构成一生。”

 

这3例患者均谈及生命中曾帮助其奋斗及做个人抉择的引路人。创造力(擅长刺绣、制被及缝纫)在每位女性的生活中也发挥了重要作用，使其得以度过困境、建立自尊、省钱以及提高其本人及其他人的生活质量。她们的技能也是遗产的组成部分。

 

通过创造性过程，患者“认识到其经验之可贵，经验可构成知识，而生命的意义便源于这种知识。”Barrington博士说。该项目赋予患者 “选择权和决策权，使其生命更为完整，并使其感觉到自己正努力改善着自己的生活，甚至在面对着死亡之时。

 

尽管患有痴呆症，但仍富有创造力

 

Dick-Muehlke博士说，对于痴呆症患者而言，活动具有不寻常的意义。艺术治疗在为患者提供一个情感释放和社会联系极佳途径的同时，亦可以通过帮助个人开发大脑功能(保持相对完整的，其中包括长期记忆系统)而提高认知功能。

 

Dick-Muehlke博士说：“我们谈论艺术时，经常会谈及创造性过程和情感过程……但对于我们而言，重要的是认识到艺术可以使阿尔茨海默病患者运用其保留的认知能力。”她提出了认知刺激结合药物可能比单纯用药更为有效的证据(Dement. Geriatr. Cogn. Disord. 2006;22:339-45)。

 

痴呆症的神经退行性病变过程可以损害短期记忆、语言、判断及视觉空间能力。她说：“现今社会中我们极为珍视这些能力。我们经常忘记痴呆症患者的其他方面——这个人仍很活跃的方面。”

 

艺术可以通过开发一个人仍能够从事并有成就感的方面，帮助患者彰显其主要特质。片段性自传式记忆，如“我结婚的那天”或“我上大学的时候”，以及对技能和程序(即称为程序性记忆)的长期记忆常应坚持进行下去。

 

Dick-Muehlke博士另外指出，“不受抑制”能伴随着前叶的神经退行性病变过程，使患者摆脱心理防卫的束缚，在过去，心理防卫可能会妨碍患者发挥艺术创造力。“其会发掘人其他方面的潜能。”

 

阿尔茨海默病家庭服务中心痴呆症教育专家、心理学博士Tonia Vojtkofsky补充道，随着言语能力的降低及语言难度的增加，绘画可以为患者提供一个与世人一起赏识自己的途径。

 

艺术为不能口头表达的情感提供了一个表达途径。她说：“如果你与某人谈论其悲伤或其情感变化，他们会很难进行交流或谈论这些事情……而人们能够绘出他们可能无法用言语表达的事情，这种情况我见过很多次。由于患者将失去语言等某些交流方式，这种形式的交流逾显弥足珍贵。”

 

Vojtkofsky博士要求患者在绘画时或完成绘画后不久讲故事。这些机会为患者进行社会联系提供了一个重要渠道，可减少其孤独感和抑郁。有些患者最初可能因过于焦虑而无法绘出任何事物，对这部分患者可以鼓励他们单纯观察或欣赏其他人所绘制的东西。

 

阿尔茨海默病家庭服务中心利用艺术治疗项目增加社区对痴呆症的了解。该中心联合当地的一家艺术中心安排了一次巡回展，展出了24位画家的作品，这次展览已在5个地区举行。Dick-Muehlke博士说：“痴呆症患者能够创造出如此美丽的作品，人们对此大为惊叹。每次你看到某人惊掉下巴时，你便会减少患阿尔茨海默病的病耻感。”

 

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