Support for the restless patient through art therapy

Restlessness has many possible causes. It is therefore fundamental that the therapist, in the encounter with restless palliative patients, brings their own inner and outer calm into the patient's room. In supporting a person with art therapy, we focus on their individual situation – they are the centre of attention with their physical, emotional and cognitive needs and sensitivities. Not until the patient is bedded as comfortably as possible, has as little pain as possible (https://www.anthromedics.org/PRA-0929-EN), and when also basal needs such as thirst, warmth regulation or ventilation of the room are satisfied, can the therapeutic encounter begin. Most of the time the patient sits in bed when we paint, model or look at a picture together, on average for about 20 minutes.

Specific exercises with small amounts of clay or with watercolours and pastels on small-format paper reach out to the patient to guide themselves into calmness through art therapy. A sensory experience of colour or sound that is perceived as positive or meaningful reconnects the person with their own physical, emotional and/or spiritual world. Reflecting on a brief yet intense artistic experience can bring confidence, fulfilment and reassurance. In addition to active art therapy, receptive art therapy is also an option.

The true needs of patients in a palliative situation are not easy to identify, especially when they are very restless. On the other hand, the often existing emotional receptivity to offers of art therapy is a mandate for therapists to be especially attentive and mindful in creating opportunities that stimulate the patient's creative sources.

Therapeutic recommendations for mental restlessness

For obsessive thoughts, excessive brooding and nervousness related to the nervous and sensory system:

  • Place a small amount of clay in both hands and let the patient shape and turn it with the fingertips and gentle pressure. After a few minutes, a spherical shape emerges as if by itself. If possible, do this exercise with arms hanging down; this increases the dissipation of restlessness and nervousness.
    Working symmetrically, i.e. with both hands at the same time, furthermore has a stabilising effect. 
  • Place a small amount of clay in one palm (heart space of the hand) and ask the patient to alternately and rhythmically form a sphere with the gentle pressure of both palms. In doing so, hold the clay in the lap, in the centre of the body. "I made a sphere and was happy." (1)
  • A baking tray filled with sand as a basis for simple form "drawing" exercises, which also provide a haptic experience.

Stimulate sensory perception by touching, seeing, possibly smelling objects brought from nature such as flowers, leaves, shells, cones, stones .. .

Therapeutic recommendations for emotional restlessness

  • Painting with pastel chalk and fingertips , for which the chalk is handed to the patient in a small container sieved in advance. Paper size: 20 x 20cm.
    - Massage the blue tones into the paper in small, deliberate movements – circling towards oneself – and finish with a playfully formed blue colour centre. Many patients find the circular movements in the direction of their own heart region pleasant.
    - The exercise can also be carried out with red tones if patients want that and the generation of warmth is to be stimulated. 
    - Allow for free choice of colour, but we advise against using yellow as a single colour or many colours in restless patients. Yellow is an option to transform the created blue image into an invigorating green image.

  • Painting with watercolour on small paper size (e.g. 20 x 20cm). 
    - Painting blue tones (e.g. ultramarine) in slow horizontal movements helps to harmonise breathing. If necessary, intensify the colour at the lower edge of the picture and make it more transparent towards the top (see illustration below). 
    - Blue can also be painted as an envelope, with a surrounding application of paint intensifying the edge of the sheet. 
    - Both painting gestures can also be carried out with red tones if patients want that and the generation of warmth is to be stimulated. 
    - Allow for free choice of colour, but we advise against using yellow as a single colour or many colours in restless patients. Yellow is an option to transform the created blue image into an invigorating green image.

 

Ill.: Example of a picture for the exercise with blue watercolour in a small format

  • Picture dictation (2). The therapist does the painting for the patient, who chooses the colours and indicates their position in the picture. The creation of the picture benefits from the social interaction and human relationship, and reduces emotional restlessness.
  • Free painting. Depending on the type of restlessness, consider together as applicable whether it should be figurative – providing support in the motif – or non-figurative – liberating in the movement; this depends on the patient's capacities and the choice of material. If necessary, give support for simple choice of motif such as sky, green meadow or landscape.

Therapeutic recommendations for motor restlessness

  • Picture dictation (see above)
  • Receptive art therapy. Look at a picture together, for example with the questions "What do I see? What do I feel? What is the painter/motif saying in the painting or sculpture?" 
    Engaging with an artistic work through our own observation, sensitivity and questioning of its intention is one of the activities in the enjoyment of art.
    We ask the patient about a picture or a sculpture that may have had a special meaning for them in the course of their life. Alternatively, we offer works of art for observation that are known from art history or experience to have a healing effect or to give meaning. Thus the paintings of the Isenheim Altarpiece are just as suitable as the contemplative moods of the day or some of Caspar David Friedrich's landscapes, the pictorial meditations of Alexej Jawlensky, the richly symbolic paintings of Marc Chagall or also paintings by anthroposophical painters as well as the sculptures of Ernst Barlach. Naturally there are other appropriate artworks that art therapists should make use of based on their individual experience.

The receptive experience of art is attracting the interest of researchers. According to a longitudinal study published in 2019, regular enjoyment of music and art reduces mortality in older people by up to 31 percent (3).

1 Kleinrath U, Bertram M. "Ich habe eine Kugel gemacht und war glücklich". Die Kugel als Aufgabenstellung in der Kunsttherapie. In: Bertram M, Kolbe HJ (Eds). Dimensionen therapeutischer Prozesse in der Integrativen Medizin. Wiesbaden: Springer Fachmedien; 2016, p. 145-154.

2 Herborn E. Das Bilddiktat in der Kunsttherapie. In: Gruber H, Reichelt S (Eds). Kunsttherapie in der Palliativmedizin. Berlin: EB Verlag; 2016. 

3 Fancourt D, Steptoe A. The art of life and death: 14 year follow-up analyses of associations between arts engagement and mortality in the English Longitudinal Study of Ageing. British Medical Journal 2019; 367:l6377. DOI: https://doi.org/10.1136/bmj.l6377. [Crossref]


Research news

Anthroposophic Medicine is an evaluated part of CRF treatment   
Cancer-realted fatigue (CRF) is one of the most frequent and prevalent symptoms expressed by cancer patients and cancer survivors. A current systematic review aimed to identify different clinical evaluation scales and interventions available for fatigue associated with cancer. Therefore, 2611 research articles were screened and revealed also non-pharmacological interventions such as exercise, complementary therapies, nutritional and psychoeducational interventions, sleep therapy, Anthroposophic Medicine, and various pharmacological agents effective in managing CRF. The results are published open access: 
https://doi.org/10.25259/IJPC_455_20.
Supplementary note: The impact of misteltoe therapy in CRF has been evaluated by a research group at Havelhöhe Community Hospital: 
https://doi.org/10.1177/1534735420917211


Further information on Anthroposophic Medicine