RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARANATAKA, BANGALORE.

PRO-FORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE Ms. SHOBHA.G CANDIDATE AND Ist Year M.Sc Nursing COLUMBIA COLLEGE OF NURSING ADDRESS: # 84/1, 5TH MAIN ROAD, OMBR LAYOUT, BANASAWADI, BANGALORE -43

2. NAME OF THE COLUMBIA COLLEGE OF NURSING TH INSTITUTION: # 84/1, 5 MAIN ROAD, OMBR LAYOUT, BANASAWADI, BANGALORE -43

3. COURSE OF STUDY AND M.Sc. NURSING , 1ST YEAR, SUBJECT: PSYCHIATRIC NURSING

4. DATE OF ADMISSION TO THE COURSE: 05-06-2010 5. TITLE OF THE TOPIC: “ A STUDY TO EVALUATE THE EFFECTIVENESS OF ART THERAPY ON STRESS AMONG THE FACULTY OF NURSING IN SELECTED NURSING INSTITUTIONS, AT BANGALORE.”

1 6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Each and every individual wants to lead their life without illness.

They consider “health is wealth”- Health is a basic need for every one. It

provides happiness to all. Many illnesses are man made. Stress is the main cause

for all the illness. Human beings are the greatest creation of god. Each organ in

our body has its unique function towards successful maintenance of health. WHO

defines “health is a state of complete physical, mental, and social wellbeing not

merely an absence of disease or infirmity”6.

Stress is a biological term for the consequences of the failure of human

being to respond appropriately to emotional or physical threats, whether actual or

imagined. Modern life is full of hassles, deadlines, frustrations, and demands. For

many people, stress is so commonplace that it has become a way of life. Stress

isn’t always bad. In small doses, it can help you perform under pressure and

motivate you to do your best .But when you’re constantly running in emergency

mode, your mind and body pay the price. With so many different forms of therapy

today it’s tough to know which are the most effective for which condition, but art

therapy enjoys great success in helping people suffering from a collection of

conditions that are both physical and mental9.

Art therapy is a form of expressive therapy that uses art materials, such as

paints, chalk and markers etc. Art therapy is based on the idea that art is a means

2 of symbolic communication. This approach, often referred to as art psychotherapy, emphasizes the products like drawings, paintings, and other art expressions as helpful in communicating issues, emotions, and conflicts. The art image becomes significant in enhancing verbal exchange between the person and the therapist and in achieving insight, resolving conflicts, solving problems and formulating new perceptions that in turn lead to positive changes, growth, and healing3.

In mental health profession, art therapy is employed in many clinical settings with diverse populations, closely related in practice of mental health counseling.

Art therapists work with children, adolescents, and adults and provide services to individuals, couples, families, groups, and communities. One of the more fascinating measures taken for stress relief can be had with an art therapy. If people are looking for an exciting method for relieving stress, art therapy is a good option. Receiving art therapy can be done at their own place. This is great for those who have families and can’t change their lives. Art therapy will help people to get a better understanding of themselves and their lifestyle. It is a great way for them to find and get rid of the problems that they may be facing. Many hospitals and doctors offices would recommend art therapy. People don’t necessarily have to be a perfect artist to benefit from this type of therapy, however it helps to use this therapy as a means of expressing themselves. It is a great resource for getting out those feelings which can often be harmful when not expressed. Art has always been used as a way to express oneself .so people must make it as a part of their stress relief regimen2.

If people are having a hard time dealing with their everyday stresses and if they are wondering what they can do to help ease their stresses, they should

3 consider art therapy as a means of helping them. With alternative medicine

becoming a preferred way to dealing with life’s problems, art therapy is just a

drug free method of controlling the stress which can also help to reduce many of

your common illnesses14.

Art therapy is a simple, low cost and effective technique for stress

reduction and stress management and also to prevent stress among the faculty of

nursing.

6.1 NEED FOR STUDY:

“Every artist dips his brush in his own soul, and paints his own nature into his pictures” -Henry ward Beecher. Faculty those who are working in colleges have enormous number of problems that leads to stress, but they don’t have adequate opportunity to express or reveal it. One of the reasons that clinical art therapy is effective is that the act of drawing and creating art can help to relieve stress. Numerous surveys and studies confirm that occupational pressures are the leading source of stress for people and that these have steadily increased over the past few decades. Well-designed, organized and managed work helps to maintain and promote individual health and well-being. But where there has been insufficient attention to job design, work organization and management, the benefits and assets associated with ‘good work’ could be lost. One common result is work-related stress 12. Workplace stress is the harmful physical and emotional response that occurs when there is a poor match between job demands and the capabilities, resources, or needs of the worker. Recent statistics confirm that work-related stress is widespread in the working population and is not confined to particular sectors or high risk jobs or industries. Stress is a prevalent and costly problem in today's workplace. About one-third of workers report high levels of stress. One- quarter of employees view their jobs as the number one stressor in their lives. Three-quarters of employees believe the worker has more on-the-job stress than a

4 generation ago. Evidence also suggests that stress is the major cause of turnover in organizations (world population)26. National institute of occupation safety and health (2001) conducted a study on Job stressors among teachers engaged in nursing activity were compared with those among teachers not engaged in nursing activity. Male and female teachers engaged in nursing activity had a significantly higher level of job stressors for physical work load and job control compared with those not engaged in nursing activity2.

This information was obtained in large surveys by Northwestern National Life Insurance Co, Princeton Survey Research Associates, Yale University and The Families and Work Institute (2000) states that, 40% of workers reported their job was very or extremely stressful, 25% view their jobs as the number one stressor in their lives, Three fourths of employees believe that workers have more on- the-job stress than a generation ago, 29% of workers felt quite a bit or extremely stressed at work, 26 percent of workers said they were "often or very often burned out or stressed by their work”, Job stress is more strongly associated with health complaints than financial or family problems2. Women, in these days, have a lot of balancing to do between home and workplace, including balancing between social and personal requirements. The issues of maternity, menopause, parenthood, gender roles, conditions at home and workplace, familial and social support, often blight women’s lives in the long run. Misra et al, (2000) found that, women experienced a greater number of academic stressors than did men. In particular, women had higher scores on reported self-imposed stressors than did men. Women tended to incorporate more activities into their schedules, such as academics, employment, and family responsibilities3. Majority of the faculty of nursing are women, and more chances to get stress. They would use many techniques to reduce stress. Now a day, they prefer techniques like yoga, meditation, music, play and pet therapy etc.. But Art therapy would be simple and effective to manage and to prevent stress, so they should make it a part of their stress relief regimen. APA-International Journal of Stress Management is the official journal of the International Stress Management Association (ISMA), this journal provides information regarding life's stresses in the workplace, in the home, or in personal relationships is increasing day-by-day

5 and effective methods of coping with the complexities of stress should be made26. According to a survey conducted by the National Life Insurance Co., four out of ten employees state that their jobs are "very" or "extremely" stressful. Those in high stress jobs are three times more likely than others to suffer from stress-related medical conditions and are twice as likely to quit. The study states that women, in particular, report stress related to the conflict between work and family. So, in our day-to-day life to manage and prevent stress we need some technique, Art therapy would be one of the easy and effective method indeed. So, the investigator felt that this study need to be conducted to determine the effectiveness of Art therapy on stress among the faculty of nursing in selected nursing institutions27.

REVIEW OF LITERATURE:

6.2 Review of literature provides a basis for future investigation, justifies the need for replication, throws light on the feasibility of the study, initiate ways to improve the efficiency of data collection and obtain useful advice to increase the effectiveness of data analysis (Abdullah & Levine 1965)5.

The investigator has done the extensive review of literature to obtain comprehensive knowledge base and in depth information about Art therapy on stress among the faculty of nursing in selected nursing institutions. The review of literature were presented under the following headings, 6.2.1 Literature related to Art therapy. 6.2.2 Literature related to Art therapy and stress.

REVIEW RELATED TO ART THERAPY.

6.2.1 Deane K (2008) conducted a study on Art therapy in assisting cancer patients to visually express their cancer experience on several levels like physical, psychosocial, and spiritual. This approach promotes the act of "seeing" as an essential ingredient in gaining objectivity and bringing unconscious thoughts into consciousness. The importance of social and emotional support in the way of art

6 therapy in addition to medical care is emphasized. Through art therapy, cancer patients are benefited to discover ways to face pain and misfortune and be creative in their "art of living”35. Perry C (2008) conducted a study in Art therapy on postnatal depression among the mothers with children under two years of age, who were experiencing mild to moderate postnatal depression. More recently, the use of complementary therapies in the treatment of depression has been explored and it has been reported that the arts can have positive effects on patients with mental health problems. This study found that the Art therapy created a relaxed, safe space which was experienced as supportive by women who participated in the sessions. Workers in various areas of mental health care suggest that creative arts can be effective and valuable for women with postnatal depression4. Biley FC (2007) found that various manifestations of the arts have been employed in mental health care as successful diversional and therapeutic interventions, and as an adjunct to mental healthcare professional education. Author pointed out the potential ability of the arts that can be used to re-humanize the world of health and social care and highlighted the nature and relevance of this more aesthetic movement and its potential to enable meaningful engagement with people in order to facilitate shared understandings of concretely lived experiences. The wholeness and essence of human being can be revealed or shown through art and helped the mentally illness client3. Frisch MJ (2007) conducted a study in art therapy in the treatment of eating disorders. Arts-based therapies are increasingly being employed in the treatment of eating disorders. Treatment programs were contucted to provide information regarding arts-based therapy utilization. Nineteen members were participated in this study, all incorporate arts-based therapies on at least a weekly basis in the treatment of eating disorders. Narrative reflections on arts-based therapies and eating disorders imply a generally positive outcome40. Schmitt B (2007) specifics that creative art therapies aim at activating the creative potential of the patients in the sense of acceptance, orientation and coping with dementia and at improving their quality of life. Creative art therapies in the treatment of dementia offer the advantage of working with these patients, whose cognition and often also verbal communication skills are affected. This article presents a systematic review of studies and case studies, which could be

7 found on the subject of the implementation of active creative art therapy. This study on creative art therapy for patients with dementia shows positive effects like the improvement of interaction skills19. Spandler H (2007) conducted a qualitative study that was undertaken as part of a national research study to assess the impact of participatory arts provision for people with mental health needs. It explores how arts and mental health projects may facilitate some of the key elements of what has been termed a 'recovery approach' in mental health. The elements like fostering of hope, creating a sense of meaning and purpose, developing new coping mechanisms and rebuilding identifies13. Massimo LM (2006) conducted a study on art therapy in children with cancer. In addition to verbal language itself, art therapy is the preferred and ideal means to communicate following the rules of "narrative-based medicine", and to understand children. In this study spontaneous drawings of 50 children affected by cancer in different stages were evaluated at the outpatient clinic of G. Gaslini Children's Hospital. Ages ranged from 4 to 14 years. Their pictures reflected not only their current state of mind, but also past experiences and future prospects. Art therapy proved to be a vitally important means of "narrative" communication for severely sick children in hospital. This research confirms that art therapy has to be included in the total care of a severely ill child while in hospital. Drawings accompanied by comments certainly provide a broader approach to better understanding the child's anxiety and feelings23. Waller D (2006) stated that aim of art therapy is to facilitate positive change through engagement with the therapist and the art materials in a safe environment. This study explored how art therapy is used to help children with emotional, developmental and behavioral problems and how change occurs during the process of physical involvement with the materials through the making of a significant art through sublimation of feelings into the images and through communication with the therapist via the art objects11. Sundaram R (2005) conducted a study on art therapy with a hospitalized child. Art therapy can help pediatric patients communicate their feelings about being in the hospital and cope with their illness or injury. This study shows how the art therapy process helped child to cope with his injury and subsequent 14-day hospitalization. Client was able to use artwork as a

8 communicative channel to express painful injury. Quality of the art therapy lowered his inhibitions and served as an outlet for his feelings18. Stern RS (2004) conducted a study in art therapy on children. They used the visual arts, children find in it the pleasure, stimulation, fun, and communication that may be missing from other aspects of their world. The creative art therapy helped the children. Most exciting is the ability of the creative art therapy to unlock the child’ sinner world and bring new vitality to children and families alike. The creative art therapy is an important and unique tool among the constellation of health services4.

REVIEW RELATED TO ART THERAPY AND STRESS.

Walsh et al (2008) conducted a study among the family caregivers of 6.2.2 patients with cancer, the study supported that art therapy was effective to reduce stress, decrease anxiety, and increase positive emotions. The results of this study can be used to support the group's utilization project to promote and educate nurses about the importance of creative arts programs with patients and family members and ways to help establish a creative arts program1. Walsh SM (2007) conducted a study to test the effects of an art-making class (AMC) on reducing stress and anxiety among family caregivers of patients with cancer, using a pretest and post-test quasi-experimental design. A residential care facility near tertiary treatment centers in the southeastern United States. There were 69 family caregivers aged between 18 to 81 years. Participants completed a demographic data survey and a Beck Anxiety Inventory (BAI). Researchers collected a saliva sample from each participant to measure salivary cortical, which indicates stress levels. Following pretesting, a two-hour AMC was delivered. Post-tests included a repeat BAI and a second saliva sample. Stress and anxiety was significantly reduced after AMC. The AMC appeared to reduce anxiety and stress. Family caregivers may benefit from participation in art-making interventions9. Oster I (2006) conducted a study, in which art therapy reduces stress and improves coping resources in Women with breast cancer. Research in art

9 therapy has shown outcomes such as an increase in self-esteem and cohesion, significant improvement in global health, and a decrease in anxiety and depression. The results from a study including 41 women, aged between 37 to 69 years. They were randomized to a study group (n = 20) with individual art therapy for 1 h/week during postoperative radiotherapy or to a control group (n = 21). The study focuses on changes in coping resources, as measured by the Coping Resources Inventory (CRI). There was an overall reduction in stress levels and increase in coping resources among women with breast cancer after taking part in the art therapy intervention. Significant differences were seen between the study and control groups. This study shows that individual art therapy in a clinical setting can give beneficial support to women with primary breast cancer undergoing radiotherapy, as it can reduce stress and improve their coping resources16. Corbin DE (2005) identifies that there is a general trend in education today to stress "the basics," often defined as reading, writing and arithmetic. Health-related professionals have made a valid case that health may be more "basic" than any of these areas. And professionals in the arts have good historical evidence that art, dance and music are "basic" to human existence. The intent of this study is to show how "basics" can be used in an interdisciplinary approach to help teach children. Using art to teach about health could be an effective and interesting way to promote health discussions34. Walsh SM (2005) conducted a study on art intervention among the baccalaureate nursing students, were to provide an opportunity for students to participate in an experimental research study, and test the effect of a creative arts intervention on student’s stress, anxiety, and emotions. Students designed, participated in, and analyzed the results of the project. The intervention significantly shows reduction in stress and anxiety levels and increased positive emotions in this student population23. Webster S (2005) conducted a study on occupational stress on the unit highlighted that, staff valued the importance of the Art process in reducing their stress levels. It is apparent that the arts project has been more than just a creative activity; it has had wider implications for both staff and service users in reducing stress. The arts project promotes well-being and lifelong learning for the ward community through meaningful engagement in creative activity25.

10 Barber CF (2004) found that for many centuries various aspects of healing have been linked to the use of the arts, in particular color because of their innate ability to bring about a mental, emotional and physical calmness. This study examines color as relaxants by briefly describing the neurological and physical mechanisms that bring about the effect of relaxation. This helped to provide ideas for a more peaceful and relaxing environment for an adult with learning disabilities who also has autism and exhibits severe challenging behavior29. Pratt RR (2004) stated that Art therapy is a significant part of complementary medicine in the twenty-first century. These creative art therapies contribute to all areas of health care and are present in treatments for most physiologic illnesses. The art therapy also contribute significantly to the humanization and comfort for health care institutions by relieving stress, anxiety, and pain of patients and caregivers. Art therapy will greatly expand their role in the health care practices in the twenty-first century14. Walsh S M (2004) conducted a study to test the efficacy of a creative arts intervention (CAI) with family caregivers of patients with cancer using a pre-post test quasi-experimental design. The 6-month study was implemented at a regional cancer treatment center with family caregivers. Forty family caregivers reported significantly reduced stress, lowered anxiety, and increased positive emotions following CAI participation. Caregivers also increased positive communication with cancer patients and health care providers while expressing delight over their handmade arts27. Breslow DM (2003) found that art that heals, developed five programs at the UCLA Medical Center/Cancer Center which used arts interventions to reduce stress and facilitate coping with hospitalization. These experiences were well received by patients and nursing staff. Educational modules were developed so that others may learn from these program models. It helps to reduce stress and to improve the coping skills32.

STATEMENT OF THE PROBLEM :

“A study to evaluate the effectiveness of Art therapy on stress among the

11 Faculty of Nursing in selected nursing institutions at Bangalore”. 6.3 OBJECTIVES OF THE STUDY :

 To assess the level of stress among the Faculty of Nursing.  To evaluate the effectiveness of art therapy on stress among the Faculty.  To find out the association between the level of stress among the Faculty of Nursing and their selected demographic variables. 6.4 OPERATIONAL DEFINITIONS :

Faculty of Nursing Faculty those who are working in nursing institutions and ability to act or perform, whether inborn or cultivated. Art therapy Is an excellent conventional method of treatment which creates a more balanced life with a holistic wellness by implementing automatic drawing, free drawing and drawing completion. Stress Stress is a biological term for the consequences of the failure of a human being to respond appropriately to emotional or physical threats, whether actual or imagined. Effectiveness It refers to the significant reduction of stress level as determined by the differences between pre test and post test stress scores.

12 6.5 LIMITATIONS:

 The study is limited to 30 samples.  The study period is limited to 4 weeks of duration. PROJECTED OUTCOMES

1. The findings of the study will help nurses to practice Art therapy. 2. The findings of the study will help the health professional to plan for further research. 3. The study allows the development of practical guide of Art therapy for nurses. 7.0 MATERIALS AND METHODS : 7.1 SOURCES OF DATA The data will be collected from the Faculty of Nursing in selected nursing institutions in Bangalore. 7.2.1 Sample Criteria  Inclusion Criteria  Both male and female Faculty.  Those who have completed B.Sc, (N) programme.  Faculty who are willing to participate in the study.  Faculty of all age group.

 Exclusive Criteria  Part- time Faculty.

 Faculty of Nursing who were previously exposed to Art therapy. 7.2.2 Research Design Pre-experimental design 7.2.3 Variable under study

Independent variable Art therapy Dependent variable Level of stress among the Faculty of Nursing

13 Attributable variable Data’s of Faculty of Nursing 7.2.4 Settings The Setting of the study is selected Nursing institutions in Bangalore. 7.2.5 Sampling Technique The technique adopted for the this study is convenience sampling technique. 7.2.6 Sampling Size The proposed sample size of the study is 30. 7.2.7 Tool for Research Section I: Demographic variables questionnaire prepared by the investigator.

Section II: A self administered questionnaire with four points rating scale is used to assess the level of stress among the Faculty of Nursing. 7.2.8 Collection of Data 1. The investigator will administer the self administered questionnaire on the first-day to assess the stress level among Nursing Faculty.

2. Art Therapy will be given to them from the next day after the pre-test.

3. The post-test will be administered to the samples after completion of Art Therapy. 7.2.9 Data Analysis method The investigator will obtain by using descriptive and inferential statistics and plan of data analysis will be followed.  The data analysis will done by using descriptive and inferential statistics.  Demographic information will be calculated by using frequency and percentage.

14  The effectiveness of Art therapy will be determined by paired-‘t’- test.  The association between the stress and the demographic variables will be analyzed by chi-square analysis. 7.3 Does the study require any investigations (or) interventions to be conducted on patients (or) other human (or) animals? If so, please describe briefly.

Yes the study requires administration of self-administered questionnaire and art therapy to the nursing faculty in selected Nursing colleges of Bangalore.

Has ethical clearance been obtained from your institution in 7.4 case of 7.3?

Yes, informed consent will be obtained from the selected nursing college authority and subject. Privacy, confidentiality and anonymity will be guarded. Scientific objectivity of the study will be maintained with honesty and impartiality.

8. LIST OF REFERENCES :

1. Allen, P. (1999). The Sabbath bride: An example of art-based research. Proceedings of the 30th Annual Conference of the American Art Therapy Association, Lake Buena Vista, Florida. Mundelein, IL: American Art Therapy Association. 2. Betts, D. J., & Laloge, L. (2000). Art therapists and research: A survey conducted by the Potomac Art Therapy Association. Art Therapy, 17(4), 291-295. 3. Biley FC, (2007) The Arts in Psychotherapy, art in spiritual care ,

15 hospice clients. 4. Bloomgarden. J., & Netzer, D. (1998). Validating art therapists' tacit knowing: The heuristic experience. Art Therapy: Journal of the American Art Therapy Association, 15(1), 51-54. 5. Denise F Polit and Bernadette and Hungler, “Nursing Research Principles and Methods”, 6th Edition, New Delhi: Mosby Company 1999. 6. Dr. (Mrs.) Lalitha K. “Mental Health and Psychiatric Nursing An Indian Perspective”, 2nd Edition, VMG Book House Bangalore, 2007, pp 387- 429. 7. Edwards, D. (1993). Why don't arts therapists do research? In H. Payne (Ed.), Handbook of inquiry in the arts therapies: One river, many currents. (pp. 715). London: Jessica Kingsley Publishers. 8. Edwards, American Art Therapy Association. (1999). Art Therapy Research Initiative [Brochure]. Mundelein, IL. 9. Eisner, E.W. (1981, April). On the differences between scientific and artistic approaches to qualitative research. Educational Researcher, 10(4), 5-9. 10. Franklin, M., & Politsky, R. (1992). The problem of interpretation: Implications and strategies for the field of art therapy. Arts in Psychotherapy, 19, 163-175. 11. Gilroy, A., Hoskyns, S., Jenkyns, M., Lee, C., & Payne, H. (Eds.) (1989). Arts therapies research. Proceedings of the First Arts Therapies Research Conference. City University, London. 12. Hagood, M. M. (1990, Spring). Art therapy research in England: Impressions of an American art therapist. Arts in Psychotherapy, 17(1), 75-79. 13. Henzell, J. (1995). Research and the particular: Epistemology in art and psychotherapy. In A. Gilroy & C. Lee, (Eds.) Art and music: Therapy and research (pp. 185-205). London: Routledge. 14. Henzell, J. (1995). Research and the particular: Epistemology in art and psychotherapy. 132-140. 15. In A. Gilroy & C. Lee, (Eds.) Art and music: Therapy and research (pp. 185-205). London: Routledge.

16 16. Julliard, K. (1998). Outcomes research in health care: Implications for art therapy. Art Therapy, 15(1), 13-21. 17. Julliard, K., Gujral, J., Hamil, S., Oswald, E., Smyk, A., & Testa, N. (2000).. Art Therapy, 17(2), 118-124. 18. Junge, M. (1989). The heart of the matter. Arts Art-based evaluation in research education in Psychotherapy, 16, 77-78. 19. Junge, M. B., & Linesch, D. (1993). Our own voices: New paradigms for art therapy research. Arts in Psychotherapy, 20(1), 61-67. 20. Kapitan, L. (1998). In pursuit of the irresistible: Art therapy research in the hunting tradition. Art Therapy: The American Art Therapy Association, 15(1), 22-28. 21. Kaplan, F. (1998). Scientific art therapy: An integrative and research- based approach. Art Therapy, 15(2), 93-98. 22. Kaplan, F. (2001). Areas of inquiry for art therapy research. Art Therapy, 18(3), 142-147. 23. Linesch, D. (1992). Research approaches within master's level art therapy training programs. Art Therapy, 9(3), 129-34. 24. Linesch, D. (1994). Interpretation in art therapy research and practice: The hermeneutic circle. Arts in Psychotherapy, 21(3), 185-195. 25. Linesch, D. (1995). Art therapy research: Learning from experience. Art Therapy: Journal of the American Art Therapy Association, 12(4), 261- 65. 26. Allen, P. (1999). The Sabbath bride: An example of art-based research. Proceedings of the 30th Annual Conference of the American Art Therapy Association, Lake Buena Vista, Florida. Mundelein, IL: : Journal of American Art Therapy Association. 27. American Art Therapy Association. (1999). Art Therapy Research Initiative [Brochure]. Mundelein, IL. 28. Anderson, F. (2001). Benefits of conducting research. Art Therapy: Journal of the American Art Therapy Association, 18(3), 134-141 29. Barber CF. (2004) color therapy as a behavior modifier, Journal of the American Art Therapy Association.23.. 30. Betts, D. J., & Laloge, L. (2000). Art therapists and research: A survey conducted by the Potomac Art Therapy Association. Art Therapy:

17 Journal of the American Art Therapy Association, 17(4), 291-295. 31. Bloomgarden. J., & Netzer, D. (1998). Validating art therapists' tacit knowing: The heuristic experience. Art Therapy: Journal of the American Art Therapy Association, 15(1), 51-54. 32. Breslow DM. (2003) Art that Heals, UCLA Medical Center/Cancer Center. The Arts in Psychotherapy, Journal of the American Art Therapy Association. 33. Carolan, R. (2001). Models and paradigms of art therapy research. Art Therapy: Journal of the American Art Therapy Association, 18(4), 190- 206. 34. Corbin DE. (2005) art as intervention. American Art Therapy Association.USA.50-55, 35. Deane K, (2008) Art therapy and research : Journal of the American Art Therapy Association,USA.12. 36. Deaver, S. P. (2002). What constitutes art therapy research? Art Therapy: Journal of the American Art Therapy Association, 19(1), 23- 27. 37. Edwards.D (2001), Journal of the American Art Therapy Association, 12(4), 218-219. 38. Eisner, E. W. (1981, April). On the differences between scientific and artistic approaches to qualitative research. Educational Researcher, Journal of the American Art Therapy Association 10(4), 5-9. 39. Franklin, M., & Politsky, R. (1992). The problem of interpretation: Implications and strategies for the field of art therapy. Arts in Psychotherapy, Journal of the American Art Therapy Association 19, 163-175. 40. Frisch MJ,(2007)art-based therapies in the treatment of eating disorders. Journal of the American Art Therapy Association, USA. 41. Gantt, L. M. (1998). A discussion of art therapy as a science. Art Therapy: Journal of the American Art Therapy Association, 15(1), 3-12. 42. Gilroy, A., Hoskyns, S., Jenkyns, M., Lee, C., & Payne, H. (Eds.) (1989). Arts therapies research. Proceedings of the First Arts Therapies Research Conference. City University, London. 43. Hagood, M. M. (1990, Spring). Art therapy research in England:

18 Impressions of an American art therapist. Arts in Psychotherapy, 17(1), 75-79.

44. Julliard, K. (1998). Outcomes research in health care: Implications for art therapy. Art Therapy: Journal of the American Art Therapy Association, 15(1), 13-21.

19 9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF 11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE

12. REMAKRS OF THE CHAIRMAN/PRINCIPAL

12.1 SIGNATURE

20