Using Drawings to Measure Emotional Processing in Breast Cancer Survivors and Its Association With Depression, Pain, and Fatigue

Background: Conscious and unconscious emotional processing (EP) may be related to breast cancer survivors' (BCS) response to the stress of dealing with cancer and its treatment, and often entails myriad psychological and physical symptoms. Aims: To examine the relationship between EP expressed by BCS in drawings made during art therapy and its relationship with depression, pain, and fatigue. Methods: This cross-sectional secondary analysis used data from the Role of Emotional Processing in Art Therapy study. BCS (N = 81) answered self-report questionnaires measuring depression, pain, and fatigue at baseline. Their drawings were coded for EP using the Drawing-Based Emotional Processing Scale (DRAWEP). Results: Levels of depression, pain intensity and interference, and fatigue, were high, and a substantial percentage of participants were beyond the cutoff scores for severe symptoms. Controlling for background variables, EP subscales of making sense and organization were negatively associated with pain intensity, pain interference, and depression, but not with fatigue. These relationships are demonstrated with selected drawings. Conclusions: Since drawing involves embodied processes and has the potential to capture latent aspects of EP, examining drawings can provide a means of investigating EP among BCS and its relationship to depression and pain and learn more about the emotional experiences of BCS. Implications for Practice: The DRAWEP can assist art therapists in increasing their awareness of EP, which may benefit their ability to identify women at risk. Moreover, this article can contribute to the development and enhancement of art therapists' awareness of EP.