Effectiveness Of Group Arts Therapy Compared To Group Counselling For Diagnostically Heterogeneous Psychiatric Community Patients: Randomised Controlled Trial In Mental Health Services
A large-scale trial will test whether group arts therapies—music, art, and dance-movement therapy—work better than group counselling for NHS patients with a range of serious mental health conditions, including schizophrenia, mood disorders, and anxiety. Although some NHS services already offer arts therapies, provision is patchy and not based on robust evidence. Patients’ preferences for specific art forms are rarely considered. This trial aims to fill that gap by directly comparing 40 sessions of group arts therapy with 40 sessions of group counselling across multiple NHS sites, using blinded assessments and health-economic analysis. If the trial shows that arts therapies are more effective or more cost-effective than counselling, the NHS could begin offering them as a standard, evidence-based treatment option for patients with long-term mental illness. That would give patients a genuine choice between talking therapies and creative approaches, and could reduce the current inconsistency in how arts therapies are commissioned and delivered. The study will also generate data on whether patient preference for a particular art form affects outcomes, which could help tailor treatment to individual needs.
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Design: Two-arm, single-blinded, multi-site, pragmatic randomised controlled trial, with internal pilot. Setting: Secondary mental health out-patient services. Target population:Patients with different mental disorders in mental health services. Inclusion: Outpatient in secondary mental health care;motivation to attend group arts therapy for 5 months and expression of preference for one of the three forms;18+ years of age;primary diagnosis of ICD-10[1] F2 (schizophrenia and related psychotic disorders), F3 (mood disorders), F4 (anxiety and other non-psychotic disorders);at least moderate symptom level on BSI[2]; Exclusion: Primary diagnosis of organic, substance misuse or personality disorder;duration of current mental disorder <6 months (i.e. patients with short-term crises);physical condition that prevents attendance of groups;insufficient command of English for communication. Health technologies being assessed: Group arts therapies (art therapy, music therapy, dance-movement therapy), as compared to group counselling as an active control, both provided in 40 sessions over a 5 month period. Measurement of costs and outcomes: Costs of group arts therapies and the control condition will be documented by the study team; costs of other care will be calculated based on electronic medical records; Patient self-ratings and observer ratings will be obtained in interviews with blinded research assistants at baseline, end of treatment, 6 and 12 months post-intervention; ratings include symptoms on the Brief Symptom Inventory[2] and quality of life on the Manchester Short Assessment of Quality of Life[3] Sample size: 167 in 20 clusters in each arm, assuming an ICC of 0.01 and a co-efficient for variation of cluster size of 0.5, to detect an effect size of 0.5 on a 5% significance level with 90% power. Allowing for 15% drop out, we will require 2 x 197 patients. Allowing for the additional loss of one cluster (treatment group) in each arm, we will need to recruit 210 patients in each arm, i.e. a total of 420 patients. Difference between current and planned care pathways: Group arts therapies are already provided in some services in the NHS. Yet, provision is highly inconsistent, not evidence-based and rarely considers patient preferences. Project timetables including recruitment rate: Pre-study: All approvals Month 1-2: Trial set up and preparation Month 3-8: Recruitment of 180 patients for first groups in internal pilot across 3 sites, site recruitment rate 10 per month Month 9-13: Group therapies in internal pilot Month 10: Decision about moving to full trial Month 11-16: Recruitment of 240 patients in full trial across 3 sites, Recruitment rate 10 per month (Avon, Luton); 20 per month (London) Months 17-21: Group therapies in intervention and control arms in full trial Months 13-28: 6 month follow-ups (internal pilot and full trial), qualitative interviews Months 25-34: 12 month follow-ups (internal pilot and full trial) Months 34-39: Analysis, report writing and dissemination Study duration: 39 months Expertise in team: The team includes expertise in developing and evaluating complex interventions (Priebe, Carr), managing large multi-site trials in arts therapies (Priebe, Crawford), music therapy (Carr, Sandford), art therapy (Huet, Havsteen-Franklin), dance-movement therapy (Karkou, Feldtkeller), personal experience of arts therapies (Smith), bio-statistics (Hooper) and health economics (Mihaylova)
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