ABSTRACT
Approximately one-third of women coping with breast cancer experience persistent symptoms of depression,
pain and fatigue, which are not normative and are difficult to treat. Emotion approach coping, including
awareness, acceptance and expression of emotions is related to more rapid resolution of depressive symptoms
and improved health outcomes in breast cancer survivors. Since expression of emotion is inconsistent with social
norms in some ethnic minorities, specifically those from a more traditional background, BC survivors from these
ethno-cultural minorities are less likely to seek opportunities for emotional expression and support.
Art Therapy is a form of psychotherapy that uses visual art-making as a form of expression and
communication within a safe and supportive relationship, in a therapeutic setting. Art Therapy is documented in
cancer settings to alleviate psychological symptoms and to reduce physical complaints. BC survivors have
reported that art-making increased access to emotional content and its expression. Because Art Therapy
provides the opportunity for indirect expression, it may be particularly potent with individuals from traditional and
collectivist ethno-cultures. The purpose of this study is to examine emotional processing and cholinergic anti-
inflammatory processes through which an AT intervention may reduce depression, pain and fatigue.
To examine these emotional processing and cholinergic anti-inflammatory mechanisms, we have
designed a randomized controlled study with careful controls. Responsive to PAR-14-294 on Arts-Based
Approaches in Palliative Care for Symptom management, the research seeks to accomplish:
AIM 1: To examine two mechanisms: 1) emotional processing and 2) cholinergic anti-inflammatory processes,
through which Art Therapy reduces depression, pain and fatigue in Jewish and Arab BC survivors.
Hypothesis: Participants in Art Therapy (vs sham Art Therapy (Mandala)) will experience greater increases in
emotion processing (awareness, acceptance and expression), resting HRV, and regulatory cytokine expression
as well as a greater decrease in pro-inflammatory cytokine expression: which in turn will mediate the effect of
Art Therapy on depression, pain and fatigue.
AIM 2: To examine ethno-cultural differences in the effect of Art Therapy in women from a traditional collectivist
ethno-cultural background, compared to women from a more individualist western ethno-cultural background.
Hypothesis: Individuals from a traditional collectivist ethno-cultural group will demonstrate a more prominent
response to the Art Therapy intervention, compared to women in the more individualist western ethno-cultural
group, beyond differences in traditional values.
We will conduct a randomized controlled trial of 120 Jewish and 120 Arab women diagnosed with breast
cancer diagnosed within the last year, recruited in Israel and randomized to undergo an 8-week program of AT
compared to sham Art Therapy.
