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dc.contributor.authorCzamanski-Cohen, Johanna
dc.contributor.authorWiley, Joshua
dc.contributor.authorWeihs, KL
dc.identifier.citationCzamanski-Cohen, J., Wiley, J., & Weihs, K. L. (2020). Protocol for the REPAT study: role of emotional processing in art therapy for breast cancer palliative care patients. BMJ Open, 10(11), e037521.en_US
dc.description.abstractIntroduction Patients with breast cancer (BC) cope with depression which is linked to functional limitations in survivorship and to physical symptoms. Pain and fatigue are prominent symptoms that affect the well-being of cancer survivors. Emotional processing has been associated with improved physical and psychological health in survivors. Art therapy is a form of psychotherapy that involves the use of visual art-making for expression and communication. It encourages emotional processing and has been linked to symptom reduction in patients with cancer. This protocol is designed to examine two mechanistic changes: Emotional processing (awareness, expression and acceptance) and cholinergic anti-inflammatory processes (heart rate variability and cytokine expression) through which an art therapy intervention may reduce depression, pain and fatigue. In addition, we will examine ethnocultural differences in the effect of art therapy in women from different ethnocultural backgrounds. Methods and analysis A randomised controlled study with careful controls will randomise 240 patient with BC (50% Jewish and 50% Arab) to an 8-week group art therapy intervention or an 8-week Mandala colouring comparison group. This design will test the mechanisms of art therapy on the targeted outcomes beyond the effects of time with a group, focus on a task and engagement with art materials. We will examine two potential mechanisms: Emotional processing and cholinergic anti-inflammatory processes; of the intervention effects on depression, pain and fatigue and compare these effects in Arab versus Jewish women. Ethics and dissemination Participants will sign informed consent before participation and will be informed that they can leave the study at any point in time without effect on their medical treatment. The Helsinki committees of each participating hospital have approved the study. Data collected in this study will be published in peer-review journals, and we will use the platform of the study website ( for further dissemination to the general public. © 2020 Author(s). Published by BMJ.en_US
dc.description.sponsorshipNational Institute of Nursing Researchen_US
dc.publisherBMJ Publishing Groupen_US
dc.rights© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC.en_US
dc.subjectadult palliative careen_US
dc.subjectbreast tumoursen_US
dc.subjectcancer painen_US
dc.subjectcomplementary medicineen_US
dc.titleProtocol for the REPAT study: role of emotional processing in art therapy for breast cancer palliative care patientsen_US
dc.contributor.departmentDepartment of Psychiatry College of Medicine, University of Arizonaen_US
dc.identifier.journalBMJ Openen_US
dc.description.noteOpen access journalen_US
dc.description.collectioninformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at
dc.eprint.versionFinal published versionen_US
dc.source.journaltitleBMJ Open

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