H.E.R.O. Unmasking: A mixed methods pilot study to explore the impact of a tele-drama therapy protocol on frontline healthcare workers during COVID-19 | Intellect Skip to content
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Volume 8, Issue 2
  • ISSN: 2054-7668
  • E-ISSN: 2054-7676

Abstract

H.E.R.O. (Helping Essential workers Reclaim roles Online) Unmasking was a virtual drama therapy protocol designed to support frontline healthcare workers (re)connect to part of their humanity overshadowed by the role of the Healthcare Hero during the COVID-19 pandemic. The intervention, grounded in Role Theory, sought to provide immediate relief and meaning making through embodied storytelling. This pilot study utilized a quasi-experimental mixed methods design to measure the effect of the protocol. The Integration of Stressful Life Experiences Scale-Short Form was implemented. A dependent -test did not yield statistical significance from pre-test (17.26) to post-test (20.47), although a medium effect size (0.64) was found. Post-test scores suggested that participants demonstrated more adaptive meaning making after the workshop. A small sample size ( = 19) likely impacted the ability to find statistical significance. Qualitative results produced prominent themes of transformation, connection and joy. Clinical implications and future directions are discussed.

Resumen

H.E.R.O. El desenmascaramiento fue un protocolo de dramaterapia virtual diseñado para ayudar a los trabajadores de la salud de primera línea a (re)conectarse con partes de la humanidad eclipsadas por el papel de héroe de la atención de la salud durante la pandemia de COVID-19. La intervención, basada en la teoría de los roles, buscó brindar alivio inmediato y creación de significado a través de la narración encarnada. Este estudio piloto utilizó un diseño de métodos mixtos cuasiexperimentales para medir el efecto del protocolo. Se implementó la Escala de Integración de Experiencias de Vida Estresantes-Forma Corta (ISLES-SF). Una prueba t dependiente no arrojó significación estadística desde la prueba previa (17.26) hasta la prueba posterior (20.47), aunque se encontró un tamaño de efecto medio (0.64). Las puntuaciones posteriores a la prueba sugirieron que los participantes demostraron una creación de significado más adaptativa después del taller. Un tamaño de muestra pequeño ( = 19) probablemente afectó la capacidad de encontrar significación estadística. Los resultados cualitativos produjeron temas prominentes de transformación, conexión y alegría. Se discuten las implicaciones clínicas y las direcciones futuras.

Résumé

H.E.R.O. Démasquer était un protocole de drama thérapie virtuel conçu pour aider les travailleurs de la santé de première ligne à se (re)connecter à des parties de l’humanité éclipsées par le rôle du héros de la santé pendant la pandémie de COVID-19. L’intervention, fondée sur la théorie des rôles, visait à apporter un soulagement immédiat et à donner du sens grâce à la narration incarnée. Cette étude pilote a utilisé une conception de méthodes mixtes quasi-expérimentales pour mesurer l’effet du protocole. Le questionnaire Integration of Stressful Life Experiences Scale-Short Form (ISLES-SF) a été mis en œuvre. Un dépendant n’a pas donné de signification statistique du pré-test (17.26) au post-test (20.47), bien qu’une taille d’effet moyenne (0.64) ait été trouvée. Les résultats du post-test suggèrent que les participants ont démontré une recherche de sens plus adaptative après l’atelier. Une petite taille d’échantillon ( = 19) a probablement eu un impact sur la capacité à trouver une signification statistique. Les résultats qualitatifs ont produit des thèmes importants de transformation, de connexion et de joie. Les implications cliniques et les orientations futures sont discutées.

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2022-10-01
2024-04-18
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References

  1. Adges, J.. ( 2020;), ‘ How to run a drama therapy group from your childhood bedroom: Reflections on working as a drama therapist during COVID-19. ’, Drama Therapy Review, 6:2, pp. 3337, https://doi-org/10.1386/dtr_00039_1. Accessed 30 January 2021.
    [Google Scholar]
  2. Ardebili, M.,, Naserbakht, M.,, Bernstein, C.,, Alazmani-Noodeh, F.,, Hakimi, H., and Ranjbar, H.. ( 2020;), ‘ Healthcare providers experience of working during the COVID-19 pandemic: A qualitative study. ’, American Journal of Infection Control, 49:5, pp. 54754, https://doi.org/10.1016/j.ajic.2020.10.001. Accessed 16 February 2021.
    [Google Scholar]
  3. Atsmon, A., and Pendzik, S.. ( 2020;), ‘ The clinical use of digital resources in drama therapy: An exploratory study of well-established practitioners. ’, Drama Therapy Review, 6:1, pp. 726, https://10.1386/dtr_00013_1. Accessed 31 January 2021.
    [Google Scholar]
  4. Beauregard, M.,, Stone, R.,, Trytan, N., and Sajnani, N.. ( 2017;), ‘ Systemic barriers in mental health care for LGBTQI and gender nonconforming drama therapists and clients. ’, Drama Therapy Review, 3:2, pp. 285312, https://10.1386/dtr.3.2.285_1. Accessed 5 March 2021.
    [Google Scholar]
  5. Cai, H.,, Tu, B.,, Ma, J.,, Chen, L.,, Fu, L.,, Jiang, Y., and Zhuang, Q.. ( 2020;), ‘ Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. ’, Medical Science Monitor, 26:e924171, pp. 115, https://doi.org/10.12659/MSM.924171. Accessed 16 February 2021.
    [Google Scholar]
  6. Campbell, J.. ( 2008), The Hero with a Thousand Faces, , 3rd ed.., Novato, CA:: New World Library;.
    [Google Scholar]
  7. Carlson, D.. ( 2014;), ‘ Stressful life events. ’, in A. C. Michalos. (ed.), Encyclopedia of Quality of Life and Well-Being Research, Berlin:: Springer, Dordrecht;, https://link.springer.com/referenceworkentry/10.1007/978-94-007-0753-5_2880#:~:text=Definition,usually%20signify%20major%20life%20changes. Accessed 1 June 2022.
    [Google Scholar]
  8. Cassidy, S.,, Gumley, A., and Turnbull, S.. ( 2014;), ‘ Core processes facilitating therapeutic change in drama therapy. ’, The Arts in Psychotherapy, 41:4, pp. 35365, https://doi.org/10.1016/j.aip.2014.07.003. Accessed 26 June 2020.
    [Google Scholar]
  9. Chen, Q.,, Liang, M.,, Li, Y.,, Guo, J.,, Fei, D.,, Wang, L.,, He, L.,, Sheng, C.,, Cai, Y.,, Li, X.,, Wang, J., and Zhang, Z.. ( 2020;), ‘ Mental health care for medical staff in China during the COVID-19 outbreak. ’, The Lancet Psychiatry, 7:4, pp. 1516, https://doi.org/10.1016/S2215-0366(20)30078-X. Accessed 17 January 2021.
    [Google Scholar]
  10. Chu, D.. ( 2020;), ‘ Online drama therapy: Part III. ’, YouTube, 23 March, https://www.youtube.com/watch?v=Hf3EBfB7Vsk. Accessed 17 January 2021.
    [Google Scholar]
  11. DeTore, N. R.,, Sylvia, L.,, Park, E. R.,, Burke, A.,, Levison, J. H.,, Shannon, A.,, Choi, K. W.,, Jain, F. A.,, Coman, D. C.,, Herman, J.,, Perlis, R.,, Fava, M., and Holt, D. J.. ( 2022;), ‘ Promoting resilience in healthcare workers during the COVID-19 pandemic with a brief online intervention. ’, Journal of Psychiatric Research, 146, pp. 22833, https://doi.org/10.1016/j.jpsychires.2021.11.011. Accessed 15 June 2021.
    [Google Scholar]
  12. DiPasquale, M.. ( 2020;), ‘ Breathe. ’, Drama Therapy Review, 6:2, pp. 14, https://doi.org/10.1386/dtr_00034_1. Accessed 19 January 2021.
    [Google Scholar]
  13. Domínguez, D. G.,, García, D.,, Martínez, D. A., and Hernandez-Arriaga, B.. ( 2020;), ‘ Leveraging the power of mutual aid, coalitions, leadership, and advocacy during COVID-19. ’, The American Psychologist, 75:7, pp. 90918, https://10.1037/amp0000693. Accessed 7 June 2021.
    [Google Scholar]
  14. Fink-Samnick, E.. ( 2022;), ‘ Collective occupational trauma, health care quality, and trauma-informed leadership: Intersections and implications. ’, Professional Case Management, 27:3, pp. 10723, https://10.1097/NCM.0000000000000559. Accessed 3 June 2022.
    [Google Scholar]
  15. Fish, J. N., and Mittal, M.. ( 2021;), ‘ Mental health providers during COVID-19: Essential to the US public health workforce and in need of support. ’, Public Health Reports, 136:1, pp. 1417, https://10.1177/0033354920965266. Accessed 16 February 2021.
    [Google Scholar]
  16. Galvin, G.. ( 2021;), ‘ Nearly 1 in 5 health care workers have quit their jobs during the pandemic. ’, Morning Consult, 4 October, https://morningconsult.com/2021/10/04/health-care-workers-series-part-2-workforce/. Accessed 18 January 2022.
    [Google Scholar]
  17. Hall, H.. ( 2020;), ‘ The effect of the COVID-19 pandemic on healthcare workers’ mental health. ’, Journal of the American Academy of Physicians Assistants, 33:7, pp. 4548, https://doi.org/10.1097/01.jaa.0000669772.78848.8c. Accessed 15 February 2021.
    [Google Scholar]
  18. Harnden, B.. ( 2014;), ‘ You arrive: Trauma performed and transformed. ’, in N. Sajnani, and D. R. Johnson. (eds), Trauma-Informed Drama Therapy: Transforming Clinics, Classrooms and Communities, Springfield, IL:: Charles C. Thomas;, pp. 12251.
    [Google Scholar]
  19. Herman, J. L.. ( 2002;), ‘ Recovery from psychological trauma. ’, Psychiatry and Clinical Neurosciences, 52:S1, pp. 98103, https://doi.org/10.1046/j.1440-1819.1998.0520s5S145.x. Accessed 12 November 2020.
    [Google Scholar]
  20. Hill, M. A.. ( 2020;), ‘ Finding my raison d’être: COVID-19 and the call to online therapy. ’, Drama Therapy Review, 6:2, pp. 6164, https://doi.org/10.1386/dtr_00044_1. Accessed 15 February 2021.
    [Google Scholar]
  21. Holland, J. M.. ( 2015;), ‘ Integration of Stressful Life Experience Scale (ISLES). ’, in R. A. Neimeyer. (ed.), Techniques of Grief Therapy: Assessment and Intervention, New York and London:: Routledge;, pp. 4650.
    [Google Scholar]
  22. Holland, J. M.,, Currier, J. M.,, Coleman, R. A., and Neimeyer, R. A.. ( 2010;), ‘ The Integration of Stressful Life Experiences Scale (ISLES): Development and initial validation of a new measure. ’, International Journal of Stress Management, 17:4, pp. 32552, https://doi.org/10.1037=a0020892. Accessed 3 June 2022.
    [Google Scholar]
  23. Holland, J. M.,, Currier, J. M., and Neimeyer, R. A.. ( 2014;), ‘ Validation of the Integration of Stressful Life Experiences Scale-Short Form in a bereaved sample. ’, Death Studies, 38:4, pp. 23438, https://doi.org/10.1080/07481187.2013.829369. Accessed 20 May 2022.
    [Google Scholar]
  24. Johnson, D. R.. ( 2010;), ‘ Performing absence: The limits of testimony in the recovery of the combat veteran. ’, in E. Leveton. (ed.), Healing Collective Trauma Using Sociodrama and Drama Therapy, New York:: Springer;, pp. 5580.
    [Google Scholar]
  25. Johnson, D. R.. ( 2014;), ‘ Trauma-centered developmental transformations. ’, in N. Sajnani, and D. R. Johnson. (eds), Trauma-Informed Drama Therapy: Transforming Clinics, Classrooms and Communities, Springfield, IL:: Charles C. Thomas;, pp. 6892.
    [Google Scholar]
  26. Johnson, D. R., and Pitre, R.. ( 2021;), ‘ Developmental transformations. ’, in D. R. Johnson, and R. Emunah. (eds), Current Approaches in Drama Therapy, , 3rd ed.., Springfield, IL:: Charles C. Thomas;, pp. 12361.
    [Google Scholar]
  27. Jones, P.. ( 2007), Drama as Therapy: Theory, Practice, and Research, , 2nd ed.., London:: Routledge;.
    [Google Scholar]
  28. Kirzinger, A.,, Kearney, A.,, Hamel, L., and Brodie, M.. ( 2021), KFF/The Washington Post Frontline Health Care Workers, Washington, DC:: Kaiser Family Foundation;.
    [Google Scholar]
  29. Landis ( 2014;), ‘ Drama therapy with newly-arrived refugee women. ’, in N. Sajnani, and D. R. Johnson. (eds), Trauma-Informed Drama Therapy: Transforming Clinics, Classrooms and Communities, Springfield, IL:: Charles C. Thomas;, pp. 287305.
    [Google Scholar]
  30. Landy, R. J.. ( 1993), Persona and Performance: The Meaning of Role in Drama, Therapy, and Everyday Life, New York:: Guilford Press;.
    [Google Scholar]
  31. Landy, R. J.. ( 2010;), ‘ Drama as a means of preventing post-traumatic stress following trauma within a community. ’, Journal of Applied Arts & Health, 1:1, pp. 718, https://doi.org/10.1386/jaah.1.1.7/1. Accessed 19 September 2021.
    [Google Scholar]
  32. Levanas, D.,, McAdam, L., and Powell, A.. ( 2021;), ‘ How close do I sound?. ’, Drama Therapy Review, 7:2, pp. 29398, https://doi.org/10.1386/dtr_00080_7. Accessed 15 June 2022.
    [Google Scholar]
  33. Liberati, E.,, Richards, N.,, Willars, J.,, Scott, D.,, Boydell, N.,, Parker, J.,, Pinfold, V.,, Martin, G.,, Dixon-Woods, M., and Jones, P. B.. ( 2021;), ‘ A qualitative study of experiences of NHS mental healthcare workers during the COVID-19 pandemic. ’, BMC Psychiatry, 21:1, p. 250, https://doi.org/10.1186/s12888-021-03261-8. Accessed 6 June 2022.
    [Google Scholar]
  34. Marvaldi, M.,, Mallet, J.,, Dubertret, C.,, Moro, M. R., and Guessoum, S. B.. ( 2021;), ‘ Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. ’, Neuroscience & Biobehavioral Reviews, 126, pp. 25264, https://doi.org/10.1016/j.neubiorev.2021.03.024. Accessed 5 January 2022.
    [Google Scholar]
  35. Mellins, C. A.,, Mayer, L. E. S.,, Glasofer, D. R.,, Devlin, M. J.,, Albano, A. M.,, Nash, S. S.,, Engle, E.,, Cullen, C.,, Ng, W. Y. K.,, Allmann, A. E.,, Fitelson, E. M.,, Vieira, A.,, Remien, R. H.,, Malone, P.,, Wainberg, M. L., and Baptista-Neto, L.. ( 2020;), ‘ Supporting the well-being of health care providers during the COVID-19 pandemic: The CopeColumbia response. ’, General Hospital Psychiatry, 67, pp. 6269, https://doi.org/10.1016/j.genhosppsych.2020.08.013. Accessed 30 January 2022.
    [Google Scholar]
  36. Milman, E.,, Neimeyer, R. A.,, Fitzpatrick, M.,, MacKinnon, C. J.,, Muis, K. R., and Cohen, S. R.. ( 2019;), ‘ Prolonged grief and the disruption of meaning: Establishing a mediation model. ’, Journal of Counseling Psychology, 66:6, pp. 71425, https://doi.org/10.1037/cou0000370. Accessed 11 January 2022.
    [Google Scholar]
  37. Muller, A. E.,, Hafstad, E. V.,, Himmels, J. P. W.,, Smedslund, G.,, Flottorp, S.,, Stensland, S. Ø,, Stroobants, S.,, Van de Velde, S., and Vist, G. E.. ( 2020;), ‘ The mental health impact of the COVID-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review. ’, Psychiatry Research, 293, p. 113441, https://doi.org/10.1016/j.psychres.2020.113441. Accessed 15 February 2021.
    [Google Scholar]
  38. Neimeyer, R. A.. ( 2006;), ‘ Widowhood, grief and the quest for meaning: A narrative perspective on resilience. ’, in D. Carr,, R. M. Nesse, and C. B. Wortman. (eds), Spousal Bereavement in Late Life, New York:: Springer;, pp. 22752.
    [Google Scholar]
  39. Neimeyer, R. A.,, Testoni, I.,, Ronconi, L.,, Biancalani, G.,, Antonellini, M., and Dal Corso, L.. ( 2021;), ‘ The Integration of Stressful Life Experiences Scale and the inventory of complicated spiritual grief: The Italian validation of two instruments for meaning-focused assessments of bereavement. ’, Behavioral Sciences, 11:149, https://doi.org/10.3390/bs11110149. Accessed 20 May 2022.
    [Google Scholar]
  40. North American Drama Therapy Association Research Committee ( 2019;), ‘ Compilation of Measures for drama therapy research. ’, https://www.nadta.org/research. Accessed 1 October 2021.
  41. Pappa, S.,, Ntella, V.,, Giannakas, T.,, Giannakoulis, V. G.,, Papoutsi, E., and Katsaounou, P.. ( 2020;), ‘ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. ’, Brain, Behavior, and Immunity, 88, pp. 90107, https://doi.org/10.1016/j.bbi.2020.05.026. Accessed 15 February 2021.
    [Google Scholar]
  42. Park, C. L.. ( 2010;), ‘ Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. ’, Psychological Bulletin, 136:2, pp. 257301, https://doi.org/10.1037=a0018301. Accessed 3 June 2022.
    [Google Scholar]
  43. Pendzik, S.. ( 2006;), ‘ On dramatic reality and its therapeutic function in drama therapy. ’, The Arts in Psychotherapy, 33:4, pp. 27180, https://doi.org/10.1016/j.aip.2006.03.001. Accessed 6 June 2021.
    [Google Scholar]
  44. Pendzik, S.. ( 2020;), ‘ The dialectics of technology in drama therapy. ’, Drama Therapy Review, 6:2, pp. 6973, https://doi.org/10.1386/dtr_00046_1. Accessed 30 January 2021.
    [Google Scholar]
  45. Ramsden, E., and Landy, R.. ( 2021;), ‘ Role theory and the role method. ’, in D. R. Johnson, and R. Emunah. (eds), Current Approaches in Drama Therapy, , 3rd ed.., Springfield, IL:: Charles C. Thomas;, pp. 82117.
    [Google Scholar]
  46. Regula, J.. ( 2020;), ‘ Developmental transformations over video chat: An exploration of presence in the therapeutic relationship. ’, Drama Therapy Review, 6:1 pp. 6783, https://doi.org/10.1386/dtr_00016_1. Accessed 3 February 2021.
    [Google Scholar]
  47. Sajnani, N.. ( 2017;), ‘ Relational aesthetics in the performance of personal story. ’, in S. Pendzik,, R. Emunah, and D. R. Johnson. (eds), The Self in Performance: Autobiographical, Self-Revelatory, and Autoethnographic Forms of Therapeutic Theatre, London:: Palgrave Macmillan;, pp. 8595.
    [Google Scholar]
  48. Sajnani, N., and Johnson, D. R.. (eds), Trauma-Informed Drama Therapy: Transforming Clinics, Classrooms and Communities, Springfield, IL:: Charles C. Thomas;.
    [Google Scholar]
  49. Schulte, E. E.,, Bernstein, C. A., and Cabana, M. D.. ( 2020;), ‘ Addressing faculty emotional responses during the coronavirus 2019 pandemic. ’, The Journal of Pediatrics, 222, pp. 1314, https://doi.org/10.1016/j.jpeds.2020.04.057. Accessed 15 February 2021.
    [Google Scholar]
  50. Stavrou, D.. ( 2020;), ‘ The medium is the message: The transformation of drama therapy practice during COVID-19. ’, Drama Therapy Review, 6:2, pp. 97101, https://doi.org/10.1386/dtr_00051_1. Accessed 1 February 2021.
    [Google Scholar]
  51. Substance Abuse and Mental Health Services Administration (SAMHSA) ( 2014;), ‘ SAMHSA’s concept of trauma and guidance for a trauma-informed approach. ’, HHS publication no. (SMA) 14–4884, Rockville, MD, https://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884. Accessed 10 June 2022.
  52. Trottier, D. G.,, Rodriguez-Perez, C.,, Regula, J.,, Richards, J.,, Brenner, E., and Murray, N.. ( 2020;), ‘ “Art is my language”: Expanding the role of creative arts therapy in a public health system during COVID-19. ’, Drama Therapy Review, 6:2, pp. 513, https://doi.org/10.1386/dtr_00035_1. Accessed 30 December 2021.
    [Google Scholar]
  53. Volkas, A.. ( 2014;), ‘ Drama therapy and the repair of collective trauma. ’, in N. Sajnani, and D. R. Johnson. (eds), Trauma-Informed Drama Therapy: Transforming Clinics, Classrooms and Communities, Springfield, IL:: Charles C. Thomas;, pp. 4167.
    [Google Scholar]
  54. Williams, B. M.. ( 2018;), ‘ Unapologetically black: Seven questions and poems that explore how race performs in clinical practice. ’, Drama Therapy Review, 4:2, pp. 22332, https://10.1386/dtr.4.2.223_1. Accessed 16 October 2020.
    [Google Scholar]
  55. Wood, L.,, White, S.,, Gervais, D.,, Owen, M.,, Moore, S.,, Boylan, Z.,, Cosby, O.,, Ansted, J.,, Capitman, J., and Ciempa, T.. ( 2020;), ‘ Challenges and strategies delivering group dramatherapy via telemental health: Action research using inductive thematic analysis. ’, Drama Therapy Review, 6:2, pp. 14965, https://doi.org/10.1386/dtr_00025_1. Accessed 15 February 2021.
    [Google Scholar]
  56. Zara, G.,, Settanni, M.,, Zuffranieri, M.,, Veggi, S., and Castelli, L.. ( 2021;), ‘ The long psychological shadow of COVID-19 upon healthcare workers: A global concern for action. ’, Journal of Affective Disorders, 294, pp. 22026, https://doi.org/10.1016/j.jad.2021.07.056. Accessed 30 January 2022.
    [Google Scholar]
  57. Rothman, Amanda,, Offerman, Elena, and Trottier, Dana George. ( 2022;), ‘ H.E.R.O. Unmasking: A mixed methods pilot study to explore the impact of a tele-drama therapy protocol on frontline healthcare workers during COVID-19. ’, Drama Therapy Review, 8:2, pp. 21333, https://doi.org/10.1386/dtr_00107_1
    [Google Scholar]
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