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Art-based Interventions to Improve Mental Health and Well-Being of Adolescents: A Scoping Review
Intervensi Berasaskan Seni untuk Meningkatkan Kesihatan Mental dan Kesejahteraan Remaja: Sorotan Berbentuk Skop
TIFFANY CHAN WEN YING & GAN CHUN HONG
ABSTRACT
Increasing prevalence of mental distress among adolescents prompted growing concerns about their mental health and well-being as lasting negative effects experienced during adolescence may prolong to adulthood.
Creative art therapies (CAT) or art-based interventions represent innovative ways that may be helpful. To obtain an overview of the types of CAT and art-based interventions to improve mental health and well-being among adolescents, a scoping review is conducted with a search in the following databases: Scopus, JSTOR, PubMed, and Elsevier. Studies were included by employing Arksey and O’Malley’s (2005) five-stage framework. Seven studies were included, where one utilised visual art interventions, two used dance interventions, and four employed music interventions. Four studies utilised solely quantitative methods for outcome measures, two utilised solely qualitative methods for outcome measures and one involved both quantitative and qualitative methods. Three studies were randomised-controlled trials (RCT), three were non- randomised controlled trials and one did not utilise control trials. Studies reported benefits observed after art- based interventions were utilised for adolescents with mental disorders or adverse life experiences such as autism, depression, anxiety, hospitalisation, bullying, trauma, stammering and stress. Benefits for these adolescents include a significant reduction in mental health issues like trauma, depression, stress and a significant increase in well-being, especially in relation to their quality of life, peer relationships, peer support, self-esteem, and self-efficacy. However, there are limited studies in collectivistic countries as shown in this article where all the seven studies are in individualistic countries like Sweden, the United States of America, the United Kingdom, Austria, Scotland and Ireland.
Keywords: Art-based interventions, creative art therapies, mental health, well-being, adolescents
ABSTRAK
Peningkatan prevalens tekanan mental dalam kalangan remaja meningkatkan kebimbangan tentang kesihatan mental dan kesejahteraan mereka kerana kesan negatif dialami pada zaman remaja mungkin akan berlarutan sehingga zaman dewasa. Terapi seni kreatif (CAT) atau intervensi berasaskan seni mewakili pendekatan inovatif yang dikatakan membantu remaja. Untuk mendapatkan gambaran keseluruhan jenis CAT dan intervensi berasaskan seni dalam mempertingkatkan kesihatan mental dan kesejahteraan dalam kalangan remaja, sorotan berbentuk skop dijalankan dengan carian dalam pangkalan data berikut: Scopus, JSTOR, PubMed dan Elsevier.
Kajian telah dikenalpasti dengan menggunakan rangka kerja lima peringkat Arksey dan O'Malley (2005). Tujuh kajian telah dimasukkan, di mana satu menggunakan intervensi seni visual, dua menggunakan intervensi tarian dan empat menggunakan intervensi muzik. Empat kajian menggunakan kaedah ukuran hasil kuantitatif sahaja, dua menggunakan kaedah ukuran hasil kualitatif sahaja dan satu melibatkan kedua-dua kaedah kuantitatif dan kualitatif. Tiga kajian melibatkan ujian terkawal rawak (RCT) dan tiga melibatkan ujian terkawal bukan rawak dan satu tidak menggunakan ujian kawalan. Kajian-kajian tersebut melaporkan faedah selepas intervensi berasaskan seni digunakan untuk remaja yang mengalami kecelaruan mental atau pengalaman hidup yang mengganggu seperti autisme, kemurungan, anxieti, kemasukan ke hospital, buli, trauma, tergagap dan tekanan.
Faedah untuk remaja ini termasuk pengurangan ketara dalam isu kesihatan mental seperti trauma, kemurungan, tekanan dengan peningkatan kesejahteraan yang ketara, terutamanya berkaitan dengan kualiti hidup mereka, perhubungan rakan sebaya, sokongan rakan sebaya, harga diri dan keberkesanan diri. Walau bagaimanapun, kajian adalah terhad di negara dengan budaya kolektivistik di mana kesemua tujuh kajian dalam makalah ini adalah di negara individualistik seperti Sweden, Amerika Syarikat, United Kingdom, Austria, Scotland dan Ireland.
Kata kunci: Intervensi berasaskan seni, terapi seni kreatif, kesihatan mental, kesejahteraan, remaja
INTRODUCTION
According to the World Health Organization (WHO 2011) and the United Nations Children’s Fund (UNICEF 2021), adolescents include individuals ranging from age 10 to 19 and they make up 16% or 1.2 billion of the global population. It is the period from childhood to adulthood, which is an important transitional life stage marked by significant physiological, psychological and emotional changes (Rooijen, Junge & Kemner 2018). Thus, this population is also more sensitive to developments in social interactions and stress. The increasing societal demands may leave long-term negative psychosocial outcomes at age 30 like poor adjustments at work, problems with family relationships, less life satisfaction, poor coping skills and chronic stress (Essau et al. 2014).
According to the National Health Morbidity Survey 2015 (NHMS 2015), Malaysian adolescents may have less access to health services and support compared to other age groups. This may also contribute to the high prevalence of mental distress and disorders among adolescents, where a 2017 Adolescent Health Survey found the prevalence of mental disorders among Malaysian adolescents has increased from 12% in 2011 to 29% in 2017 (Essau, Conradt & Petermann 2000; Institute of Health 2017; Othman & Essau 2019). Therefore, innovative interventions are needed to improve the mental health and well-being of adolescents.
This is where Creative Art Therapies (CAT) and art-based interventions can be considered as a possible intervention to help the adolescent populations. The process of CAT involves the use of various artistic media like drama, art, dance or movement and music where clients are encouraged by the therapist to express through symbolic and/or non-verbal symbolic means so that they accomplish their individual personal and/or social therapy goals (Martin et al. 2018). This intervention requires a well-defined client-therapist relationship but it is different in terms of the use of artistic activities in more traditional therapy methods like medicine, counselling, psychotherapy or rehabilitation. CAT and art-based interventions are less restricted by their structured way and instead allow more artistic experiences and focuses on the process in expressing themselves therapeutically and this in turn facilitate changes in emotion or behaviour (Koch & Fuchs 2011). This process of engaging and creating through art provides clients with alternative coping resources and increase the sense of self-efficacy, empowerment and flexibility in managing their issues or concerns (Oepen &
Gruber 2014).
Due to the experiential nature of CAT and art- based interventions, studies in the past focused more on theories or case studies and there was a
lack of generalisable evidence-based studies. In recent years, there have been shifts that now a growing pool of literature for empirical or evidence-based studies on CAT and art-based interventions, which gives more credit to the generalisability and effectiveness of these interventions to improve mental health and well- being (Acolin 2016; Gruber et al. 2011). Nowadays, therapists who are licensed would apply CAT world-wide for various populations and circumstances as the healthcare sector is increasingly aware of the potential in using art mediums within therapeutic settings (Martin et al.
2018). However, there is limited review that studies specifically on the effectiveness of CAT and art- based interventions for the adolescent populations without involving adult or younger children populations. The latest study focusing on adolescent population was a systematic review investigating fourteen literatures from 1994 to 2004, which concluded that the overall synthesis of results was inappropriate due to heterogenous research and suggests that research at that time regarding the impact of performing arts on adolescents is at a relatively early stage (Daykin et al. 2008). Due to the different nature and needs between the adolescent population to other populations, this review aims to investigate the types and key-findings of art-based interventions that focuses on improving the mental health and well-being of adolescents.
METHODOLOGY
Scoping reviews have a wide variation in definition, such as a review to identify available key concepts and evidence (Arksey & O’Malley 2005) or synthesis and analysis of various research and non- research sources (Davis, Drey & Gould 2009). It is often utilised for a quick description and analysis of current literature in a specific area and used to identify the research design, best or policies practices, and locate research gaps in current literature (Grant & Booth 2009; Pham et al. 2014).
Therefore, the current review will utilise the scoping review as a methodology as it is suitable, in consideration of limited resources, to quickly map emerging literature in relation to art-based interventions among adolescents. A methodological framework by Arksey and O’Malley’s (2005) is used as it is one of the most commonly utilised framework in a scoping review (Pham et al. 2014).
This five-stage framework is employed to guide the current review work with the following steps: (1) identifying research questions, (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarising and reporting the data where with consultation with stakeholders is an optional component. This
scoping review explores existing research on art- based interventions for adolescents, which involves the following research questions:
(1) What are the types of art-based interventions used to facilitate better mental health or well-being among adolescents?
(2) What are the key findings or post- intervention outcomes from these art- based interventions?
SEARCH STRATEGY
Four databases from PubMed, SCOPUS, Elsevier and JSTOR were searched to identify publications from 2011 to 2022. A comprehensive search
strategy, with the use of Boolean operators was utilised for the current academic literature using general terms that represents the keywords of the research questions based on the domains stated in Table 1. These keywords were entered with the use of Boolean operators and the following database filters were applied: (1) English as language medium, (2) adolescents within demographic age 10-19, and (3) 2011/01/01 to 2022/02/01 as the publication range. The search terms and strategies were modified and adapted to match the specific structure of each database. Records were then exported to the Rayyan tool where duplicates were removed, and the titles and abstracts were screened by the first author based on the inclusion and exclusion criteria identified by the first author.
TABLE 1 Key terms of research
Domain Key terms
Adolescents teen, adolescent
Art-based interventions art-based intervention, art intervention, art therapy, creative intervention, creative therapy, dance, draw, paint, music, drama
Mental health and well-being mental health, well-being, psychology
The reviews were selected based on the following inclusion criteria:
1. Research involves adolescents (aged 10- 19);
2. The types of research studies included involves interventions and post- intervention outcomes which are comparative/quasi-experimental,
experimental study designs or mixed method designs;
3. The intervention or therapy must be creative art-based (such as drama, art, dance or movement and music);
4. The intervention or therapy must include a component specifically aimed at improving the mental health and/or psychosocial well-being of adolescents;
5. Research publication range is within 2011/01/01 to 2022/02/01.
Research were excluded based on the criteria below:
1. Research published in languages other than English;
2. Research did not include the type of intervention or therapy used, objectives, target population and outcome of interventions.
RESULTS
SEARCH RESULTS
Initial search of all databases yielded 854 articles.
A total of 781 were identified after removing duplicates. Titles and abstracts were then screened based on the study criteria which removed another 687 articles. Descriptions of interventions, populations and outcome in the remaining articles were then independently reviewed by first author to assess whether the inclusion and exclusion criteria were met. Seven studies were also excluded from this review because they involved children below the age of 10 and results were unable to be extracted for solely adolescent populations. The final results included seven studies fulfilling the inclusion criteria for this review. The searching and screening process of the articles were in accordance with PRISMA flow diagram for reporting systematic and meta-analysis (Fig. 1) (Moher et al.
2009). Data were extracted and charted in Table 2 according to the following extraction fields:
publication year and authors, country, population characteristics, sample size, creative intervention components, study design, outcome measures and findings. Based on the current literature, creative art interventions that were applied among adolescents were categorised into visual art, dance and music approach.
FIGURE 1 PRISMA flow chart Based on Table 2, it was found that there are
one study utilised visual art interventions (Vela et al. 2019), two studies used dance interventions (Duberg, Möller & Sunvisson 2016; Duberg et al.
2020) and four studies employed music interventions (Porter et al. 2017; Grebosz-Haring &
Thun-Hohenstein, 2018; Caló et al. 2020;
O’Donogue et al. 2021). Four studies utilised solely quantitative methods for outcome measures (Porter et al. 2017; Grebosz-Haring & Thun-Hohenstein, 2018; Vela et al. 2019; Duberg et al. 2020), two studies utilised solely qualitative methods for outcome measures (Duberg, Möller & Sunvisson 2016; O’Donogue et al. 2021) and one study uses a self-developed survey as the outcome measure, which involved both quantitative and qualitative methods (Caló et al. 2020). Three studies were randomised-controlled trials (RCTs) (Duberg, Möller & Sunvisson 2016; Porter et al. 2017;
Duberg et al. 2020), three studies were non- randomised-controlled trials (Grebosz-Haring &
Thun-Hohenstein, 2018; Vela et al. 2019; Caló et al.
2020), and one study did not utilise control trials
(O’Donogue et al. 2021). Out of the seven studies, two studies were located in Sweden (Duberg, Möller & Sunvisson 2016; Duberg et al. 2020). The remaining studies were located in other countries with one each at the United States of America (Vela et al. 2019), the United Kingdom (Porter et al.
2017), Austria (Grebosz-Haring & Thun- Hohenstein, 2018), Scotland (Caló et al. 2020) and Ireland (O’Donogue et al. 2021).
The majority of the studies involved both genders, with only three out of the seven studies involving only female adolescents (Duberg, Möller & Sunvisson 2016; Grebosz-Haring &
Thun-Hohenstein, 2018; Duberg et al. 2020).
Several studies had specific populations that were vulnerable to emotional distress such as hospitalised patients with mental disorders or adolescents with behavioural and emotional problems categorised between F00 and F99 of the ICD-10 classification (autism, anxiety or depression) (Porter et al. 2017; Grebosz-Haring
& Thun-Hohenstein, 2018).
TABLE 2 List of included articles and extracted data
Authors (Year)
Country Population Sample
size
Creative intervention components
Study design Quantitative Outcome measures
Findings
Visual art interventions (drawing, craft, etc.)
Vela et al., 2019
United States
High school Latin adolescents with mental health and academic needs with 24 males and 43 females and mean age of 15.27
n = 67 Creative journal art therapy including mandala, mask making and various visual art elements
Non- randomised controlled pre- posttest quasi- experimental design
Brief Resilience Scale, Recovery Assessment Scale, Center for Epidemiological Studies Depression-Scale
Interventions help participants decrease depressive symptoms and increasing resilience in school settings
Dance intervention Duberg,
Möller &
Sunvisson, 2016
Sweden Adolescent girls with internalising problems such as nervousness, stress, and anxiety aged 13 to 18
n = 112 Dance interventions with warm up, dance practice and relaxation by brief light massage in pairs and a reflection.
Participants are given a diary but not obliged to fill it
Randomised- controlled trials with qualitative interviews post- intervention
N/A Interventions suggest an increase
in self-trust, acceptance and emotional expression amongst participants. The supportive and non-judgmental
atmosphere creates a safe space and platform that allows more freedom and an escape from stress Duberg et
al., 2020
Sweden Adolescent girls with stress- related somatic and emotional distress aged 13 to 18
n = 112 Dance intervention Randomised- controlled pre- post trial with follow up at baseline and at 8, 12 and 20 months after baseline
Questionnaire with 5-point Likert Scale originating from Life and Health – Young People
Interventions bring significant decrease in somatic symptoms (like headache, stomachache, tiredness, vertigo, aching shoulders and backache) and emotional distress (stress, anxiety, nervousness, irritation, sadness and powerlessness) as compared to the control group
Music intervention
Porter et al., 2017
United Kingdo m
Children and adolescents of both genders aged 8 to 16 with behavioural and emotional problems
categorised between F00 and F99 of the ICD-10
classification (autism, anxiety or depression).
Participants separated into age groups of 8 to 12 and 13 to 16.
n = 181 (age 8 to 12, n = 71) (age 13 to 16, n = 110)
Alvin model of ‘Free Improvisation’ where participants are encouraged to create music and sound freely by using their voice, instrument or movement
Randomised- controlled pre- post trial with follow up at 13 weeks and 26 weeks
Social Skills Improvement System Rating Scales (SSIS), Rosenberg Self- Esteem Scale, Centre for Epidemiological Studies Depression Scale for Children (CES-DC), Child Behaviour Checklist, Family Assessment Device
Interventions reveal that social skills improve for adolescents aged 13 and above and there is an overall significant increase in self- esteem and significant decrease in depression scores
Grebosz- Haring &
Thun- Hohenstein, 2018
Austria Female hospitalised children and adolescents with mental disorders aged 11 to 18
n = 17 Music listening (Control) and singing interventions
(Experimental) combined with verbal relaxation techniques
Non- randomised controlled pre- post trial
Saliva samples for cortisol and IgA, Health-related Quality of Life (HRQOL) Pediatric Quality of Life Inventory 4.0 Generic Core Scale Child Self- Report Version (PedsQL), Multidimensional Mood Questionnaire (MDBF), Warwick-Edinburgh Mental Well-Being Scale (WEMWBS)
Singing interventions result in significantly larger mean drop in cortisol or decrease in stress than in music listening which also means a decrease in stress. Music listening has a significantly higher mean positive change in calmness than singing. Singing intervention also promotes higher quality of life while music listening promotes improvement in well- being
Caló et al., 2020
Scotland Adolescents from various deprived communities with adverse life experiences from both genders aged 12 to 17
n = 27 COOL Music project, a community-based participatory music making intervention
Non- randomised quantitative and qualitative pre- post trial
Good Childhood Index Interventions find participants feeling safer to express themselves and thus increasing their self- confidence, well-being and engagement
O’Donoghu e et al., 2021
Ireland Adolescents who stammer with 2 males and 2 females aged 11 to 15
n = 4 Music therapy involving listening to music, songwriting, singing and improvisation
Qualitative semi- structured interviews post- interventions
N/A Interventions find adolescents are
able to cope better with feelings of loneliness and isolation associated with stammering and
improvement are found in the themes related to friendship development, facilitating peer support, increase in self- confidence and self-expression
Other studies included adolescents who experienced other circumstances that elicit emotional distress like trauma, bullying, stress and stammering (Duberg, Möller & Sunvisson 2016;
Vela et al. 2019; Duberg et al. 2020; Caló et al.
2020; O’Donogue et al. 2021). One study recruited adolescents from public schools (Vela et al. 2019).
Three studies had total sample sizes of more than 100 (Porter et al. 2017; Duberg, Möller &
Sunvisson 2016; Duberg et al. 2020). Due to the limited study focused solely on adolescents, one research that also involved children under age 10 was included (Porter et al. 2017) in this review because the researchers have separated the results for the participants into two age groups, 8 to 12 years old and 13 to 16 years old respectively.
Therefore it made possible that this review extracted the results for the 13 to 16 age group for analysis.
DISCUSSION
The objective of this review was to determine the types and key findings of art-based interventions used amongst the adolescent populations to improve their mental health and well-being. It was found that visual art, music and dance interventions are the most commonly used approaches for adolescents. Outcomes were measured both quantitatively and qualitatively, with the majority utilising quantitative-based measures and thus gives more reliable empirical evidence in the effectiveness of art-based interventions among adolescent populations. Regardless of which art modality was used, it was found that art-based interventions can improve the mental health and well-being of adolescents (Duberg, Möller &
Sunvisson 2016; Porter et al. 2017; Grebosz-Haring
& Thun-Hohenstein, 2018; Vela et al. 2019;
Duberg et al. 2020; Caló et al. 2020; O’Donogue et al. 2021).
Many articles cited that the reason for considering creative art interventions is the participant characteristic which may include the short attention span, the need for interest and engagement, freedom for self-expression and limited verbal fluency (Duberg, Möller &
Sunvisson 2016; Vela et al. 2019; Duberg et al.
2020; O’Donogue et al. 2021). One of the main reasons identified for utilising art-based approaches was the ability of these methods to engage with adolescents who were hard to reach youth and/or possess challenging problems and adverse life situations (Caló et al. 2020). Creative methods were adopted in several articles due to noncompliance or adverse life experiences which makes these youths more vulnerable and unwilling to express their experiences in a direct verbal manner (Caló et al. 2020; O’Donogue et al. 2021).
Those that utilised group art-based interventions cited the rationale as peer support and friendship development as their main reason in which creative art interventions are helpful in establishing connections in a group (O’Donoghue et al. 2021).
Others cited the use of creative art intervention to increase self-esteem and self-efficacy among adolescents due to its non-judgemental and experiential nature (Duberg et al. 2020;
O’Donoghue et al. 2021). Some noted the overall health benefits of the art-based interventions, especially for those with mental disorders who were hospitalised (Grebosz-Haring & Thun- Hohenstein 2018). Researchers also noted to incorporate activities and pastimes that are familiar or interesting to provide better engagement with the participants (Porter et al. 2017; Caló et al. 2020).
As the creative art interventions were designed for specific populations, diverse approaches were utilised for the various youth populations depending on their needs, where articles often study the suitability and benefits of the interventions given to both children and adolescent populations. This also increased the difficulty to utilise randomisation in studies due to the specific nature of the populations (Caló et al. 2020;
O’Donoghue et al. 2021). A variety of benefits in relation to mental health and well-being were found after interventions were given to adolescents, regardless of art modality used as intervention.
Among those with adverse life experience like trauma and bullying, interventions brought about a significant decrease in emotional distress symptoms like trauma, depression and stress due to the aid of art in expressing difficult emotions and building resilience (Vela et al. 2019; Caló et al.
2020). Regardless of whether visual art, dance or music interventions were utilised, both adolescents with adverse life experiences and those who were suffering from emotional and behavioural issues such as stammering or somatic and emotional distress symptoms benefitted from the interventions (Vela et al. 2019; Porter et al. 2017; Grebosz- Haring & Thun-Hohenstein 2018; Caló et al. 2020).
Participating in art-based interventions also promote self-awareness and increase in self- efficacy or well-being after they felt safe enough to express their emotions and some mentioned how the group-based nature helped them in feeling less alone where they found strength in peer support with increase in engagement and self-acceptance (Caló et al. 2020). This is also applicable to adolescent populations with medical illness or disorder, for examples those with cerebral palsy and those who were hospitalised are found decrease in depression scores or stress but an increase in social skills and well-being (Porter et al. 2017;
Grebosz-Haring & Thun-Hohenstein 2018).
Adolescents are found to experience increase in self-efficacy or self-confidence, where the
satisfaction or accomplishments in art activities contribute to the decreased emotional distress and promote well-being and quality of life (Porter et al.
2017; O’Donoghue et al. 2021). More passive roles in relation to art such as listening to music is also shown to be capable of increasing well-being in terms of increasing calmness, while more active and creating roles played by participants in art engagement during interventions like singing would promote a higher quality of life and a decrease in emotional distress like stress (Grebosz- Haring & Thun-Hohenstein 2018). Adolescents found art-based methods to be creative, engaging, fun, interesting and helpful, which past literature suggested these were important aspects to consider for methods of engagement with young people (Duberg, Möller & Sunvisson 2016; Coholic, Schwabe & Lander 2020). Adolescents with communication or social skill challenges also find art-based interventions more feasible as compared to talk-based interventions where a high level of verbalisation and cognition is needed (Caló et al.
2020; O’Donoghue et al. 2021).
However, it was also found that all seven of these reviews were conducted in countries with individualistic oriented cultures and there is a lack of literature among countries which are collectivistic in orientation that commonly found among Asian countries (Eaton & Louw 2000; De Mooij & Hofstede 2010; Garcia-Gavilanes, Quercia & Jaimes 2013). Considering the cultural differences, further studies may be done on more collectivistic culture to assess its effectiveness. In addition, the current literature found limited studies that focused solely on adolescent populations.
Infact, this review noted one article that included both children and adolescents, where the data had to be extracted to focus on adolescent populations only. Considering the differing developmental needs, this reveals a need for further evaluation on the effectiveness of art-based interventions on solely adolescent populations. This is because there are unique developmental issues in adolescents especially issues related to identity formation, intimate relationships, career planning and preparation entering adulthood which are not commonly found in children that art-based therapy is thought to be able to address. Other than that, even though the search strategy had included drama as one of its keywords, there were no empirical- based research on this art-based intervention among adolescents found in the databases.
Therefore, further studies using evidence-based approach for drama intervention among adolescents can be considered in this field of study. This review found an emerging empirical-focused approach of studies on art-based interventions in regard to its effectiveness among adolescents, which revealed many benefits regardless of which art modality was utilised. Therefore, future studies in the art-based
interventions are suggested to draw on existent art- based interventions to generate a wider evidence base for the dissemination and study of these interventions that revealed promising benefits for adolescents rather than develop new programmes.
There were also several limitations noted. In particular, seven studies were excluded from this review solely because they involved children below the age of 10 and the results were unable to be extracted only for adolescent populations. Some articles were also eliminated due to the difficulty to determine and assess if the intervention utilised were art-based and which art modality was utilised as there were insufficient details about the intervention process.
CONCLUSION
In conclusion, this article found that regardless of which art-based modalities were utilised in various countries and types of adolescent populations, results empirically suggests that benefits were provided in terms of improving mental health and well-being of adolescents. However, results should be taken with caution as there is limited literature in collectivistic cultures and interventions for solely adolescent populations. It is believed that future studies can provide more evidence-based studies for existent interventions and more focus can be given in relation to how art-based interventions can be applied in the field of mental health and well-being for the adolescents in collectivistic cultures like the Asian countries.
ACKNOWLEDGEMENT
The authors would like to thank everyone involved in this scoping review study for their time and contributions. We would especially like to thank the reviewers for the valuable comments that help in improving this article significantly. Appreciation to Buletin Sains Kesihatan’s Editorial Team, in particular Ahmad Nazlim Yusoff and Nor Afifi Razaob, for their expert advice, time and effort placed into editing this review.
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Tiffany Chan Wen Ying
Clinical Psychology and Behavioural Health Programme
Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz,
50300 Wilayah Persekutuan Kuala Lumpur
Gan Chun Hong
Clinical Psychology and Behavioural Health Programme
Center for Rehabilitation and Special Needs, Faculty of Health Sciences,
Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz,
50300 Wilayah Persekutuan Kuala Lumpur
*Corresponding Author: Gan Chun Hong E-mail: [email protected] Tel: +603-92898121
Fax: +603-26989506 Received: 31 October 2022 Revised: 6 December 2022
Accepted for publication: 23 December 2022