Drama therapy for schizophrenia or schizophrenia-like illnesses

Ruddy R, Dent-Brown K

Published Online:

July 16, 2008

Drama therapy is one of the creative therapies suggested to be of value as an adjunctive treatment for people with schizophrenia or schizophrenia-like illnesses. Randomised studies have been successfully conducted in this area but poor study reporting meant that no conclusions could be drawn from them. The benefits or harms of the use of drama therapy in schizophrenia are therefore unclear and further large, high quality studies are required to determine the true value of drama therapy for schizophrenia or schizophrenia-like illnesses.

Abstract (click to read)

Background:

Medication is the mainstay of treatment for schizophrenia or schizophrenia-like illnesses, but many people continue to experience symptoms in spite of medication (Johnstone 1998). In addition to medication, creative therapies, such as drama therapy may prove beneficial. Drama therapy is a form of treatment that encourages spontaneity and creativity. It can promote emotional expression, but does not necessarily require the participant to have insight into their condition or psychological-mindset.

Objectives:

To review the effects of drama therapy and related approaches as an adjunctive treatment for schizophrenia compared with standard care and other psychosocial interventions.

Search strategy:

We searched the Cochrane Schizophrenia Group's Register (October 2006), hand searched reference lists, hand searched Dramatherapy (the journal of the British Association of Dramatherapists) and Arts in Psychotherapy and contacted relevant authors.

Selection criteria:

We included all randomised controlled trials that compared drama therapy, psychodrama and related approaches with standard care or other psychosocial interventions for schizophrenia.

Data collection and analysis:

We reliably selected, quality assessed and extracted data from the studies. We excluded data where more than 50% of participants in any group were lost to follow up. For continuous outcomes we calculated a weighted mean difference and its 95% confidence interval. For binary outcomes we calculated a fixed effects risk ratio (RR), its 95% confidence interval (CI) and a number needed to treat (NNT).

Main results:

The search identified 183 references but only five studies (total n=210) met the inclusion criteria. All of the studies were on inpatient populations and compared the intervention with standard inpatient care. One study had drama therapy as the intervention, one had role-playing, one had a social drama group and two used psychodrama. Two of the included studies were Chinese and it is difficult to know whether psychodrama and indeed inpatient psychiatric care in China is comparable with the drama interventions and inpatient care in the other included studies. There were no significant findings about the value of drama interventions for keeping inpatients engaged in treatment. Due to poor reporting very little data from the five studies could be used and there were no conclusive findings about the harms or benefits of drama therapy for inpatients with schizophrenia.

Authors' conclusions:

Randomised studies are possible in this field. The use of drama therapy for schizophrenia and schizophrenia-like illnesses should continue to be under evaluation as its benefits, or harms, are unclear.

This record should be cited as:

Ruddy R, Dent-Brown K. Drama therapy for schizophrenia or schizophrenia-like illnesses. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD005378. DOI: 10.1002/14651858.CD005378.pub2

Assessed as up to date:

November 14, 2006

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Primary Review Group:

Schizophrenia Group

Health topics:

Mental health > Schizophrenia & psychosis > Therapy

Complementary & alternative medicine > Mental health > Schizophrenia & psychosis

Cochrane group topics:

Complementary Medicine > Mind-Body Interventions > Sensory art therapies > Drama therapy

Schizophrenia > Schizophrenia > State not described > Stage not described > Therapy > Activity therapy

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Drama therapy for schizophrenia or schizophrenia-like illnesses

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