Research | Psychological Sciences Research Group (PSRG) blog

From community choirs and dance programmes to arts in hospitals and museums, arts-based activities are increasingly being recognised as valuable tools for supporting health and wellbeing. The field of the arts and health has grown rapidly in recent years, bringing together researchers, practitioners and artists from around the world to explore how and why arts-based methods can make a difference. This blog post introduces the Routledge Handbook of Arts and Health, the first handbook to synthesise work across this emerging field and offer a critical overview of its development.

Introduction

As a psychology undergraduate with a love of the arts, I spent much of my spare time painting, singing and creative writing. At the time, I never imagined that these personal interests would one day lead me to edit a collection of research exploring the impact of the arts on health and wellbeing.

Yet this is exactly where my journey has taken me with the Routledge Handbook of Arts and Health, a volume that brings together international perspectives on how arts-based methods can support health and wellbeing.

Working with co-Editors (Victoria Tischler, Sofia Vougioukalou and Elisabetta Corvo) and 76 international colleagues, this was a three year-long process, beginning with working out how to scaffold the content and what topic areas to cover. Inviting authors, reviewing and editing chapters, was a time consuming but enjoyable process, working with experts from across the globe and weaving together a text that will hopefully be useful for this emerging field.

The process also involved deeper reflection on the field, noticing patterns, complexities, issues of contention, debates, perspectives, gaps and trending directions, and writing about these in the book’s conclusion. In this way, developing the handbook, deepened my own understanding and insights about the arts and health.

In the following sections, I will briefly describe the main contents of the book by Section. Each summary is accompanied by a visual display of images from the book.

Section One: Historical and Contemporary Contexts of the ‘Arts and Health’

The first section of the handbook aims to lay out the field, exploring both the contexts and definitions of arts and health. Chapters examine the use of the arts for health and wellbeing from a historical perspective, reminding us that these practices are not entirely new. Key terms, such as “arts and health,” are defined, and frameworks for how the arts are used in different formats and settings are explored.

This section also situates the field within its contemporary context. In recent years, major evidence reviews on arts and health have been produced and disseminated by organisations such as the World Health Organisation, the European Union and the National Centre for Creative Health in the UK. At the same time, different organisations have highlighted the need for greater critical rigour and broader global perspectives. Reflecting this moment in the field, this section synthesises existing evidence to provide an overview of the current research base, while also highlighting gaps in knowledge. It encourages critical appraisal of the evidence, identifies key weaknesses, and draws attention to inequalities in research and the need to better represent knowledge and practice from the global majority.

Images from Chapter Four (Global perspectives on creative health) by Ranjita Dhital. On the left are photographs of Creative Health Nepal: Community Festival, Siddartha Art Gallery, Babar Mahal Revisited, Kathmandu, Nepal (November 2024). On the right are sculptures and paintings ‘Trigunas’ by Om Prakash Shrees (2024).

Section Two: Domains of ‘Arts and Health’: Impact and Practice

The arts are, by definition, varied, and here we explore this, focusing on how different art modalities can be used for health and wellbeing, chapters examine:

Visual arts and crafts – from arts in counselling to needlework for craftivism
Music – from music therapy to community choirs
Drama – from puppetry for public health messaging to psychodrama
Dance – from youth dance groups to dance interventions for Parkinson’s
Creative writing – from expressive writing to bibliotherapy

These overviews illustrate that the arts form a diverse and versatile toolkit, that can be applied for different outcomes across a range of settings, from everyday life (individual) to clinical care.

EPICS framework (image from Chapter 6)

For example, the EPICS framework above illustrates how the visual arts can affect wellbeing and health through: Exposure (e.g., viewing artwork displayed in hospitals); Psychotherapy (e.g., using the visual arts as an expressive medium in counselling); Individual (e.g., crafting, painting or colouring in everyday life as a hobby); Communication (e.g., to convey the nature of pain through drawings in a health consultation); and Social (e.g., community art, such as social prescribing groups). Similarly, Chapter 10 presents a framework for the different ways and settings in which theatre and drama are used for health and wellbeing. It presents a spectrum of “severity,” from everyday life activities like storytelling to clinical applications such as psychodrama.

There is a great deal of heterogeneity in both the applications and the effects of arts-based interventions, reflecting the richness of the field. Although the arts are frequently used in combination, this section also highlights the distinct qualities of each artistic domain, which can influence wellbeing in different ways, whether through the visual pleasure of colour and form, the uplifting resonance of music, reflective meaning-making through words, exploration via role play, or expressive movement of the body.

Top left: Needlecraft (crochet) by Sophie Olson; Top right: Participants in the You Can Make Some Noise program, SONY You Can Centre, Brisbane from Chapter Seven (Music, health and wellbeing) by Genevieve Dingleand Christa Powell; Bottom left: photograph from Dance to Health, a dance programme for prevention of falls, from Chapter 9 (Dance, health and wellbeing) by Angela Pickard; Bottom right: Basavaraju and his team perform Corona-Maariacross tribal hamlets (a theatre public health strategy in Chamarajanagar, India) from chapter Ten (Theatre, health and wellbeing) by Nisha Sajnaniand colleagues.

Selected images from the book: Top left: Needlecraft (crochet) by Sophie Olson; Top right: Participants in the You Can Make Some Noise program, SONY You Can Centre, Brisbane from Chapter Seven (Music, health and wellbeing) by Genevieve Dingleand Christa Powell; Bottom left: photograph from Dance to Health, a dance programme for prevention of falls, from Chapter 9 (Dance, health and wellbeing) by Angela Pickard; Bottom right: Basavaraju and his team perform Corona-Maari across tribal hamlets (a theatre public health strategy in Chamarajanagar, India) from chapter Ten (Theatre, health and wellbeing) by Nisha Sajnani and colleagues.

Section Three: Across the Lifespan: ‘Arts and health’ practice with specific populations

This section focuses on specific populations and the way that the arts can be used to help with different issues experienced across the lifespan. This begins with perinatal mental health (where, for example, singing with babies may increase bonding) and ends with palliative care (where the arts have been used to support individuals to review their life story). It considers how the arts can be used with children and young people, adults in the workplace, adult mental health, in the context of migration, trauma, and with older adults (where there are promising outcomes relating to cognition, agency and communication). It also covers the use of the arts in the context of noncommunicable diseases (e.g., cardiovascular disease and cancer) and for supporting individuals living with chronic conditions.

From Chapter 12 (Creativity, arts and the mental health of young people) by Katherine Boydelland colleagues, “Creating in response to deep looking at artworks”; Top right, from Chapter 16 (The arts in the prevention and management of chronic health conditions) by Jennifer Baxley Leeand colleagues, “Painting: University of Florida Health Shands Arts in Medicine program”. Bottom left: From Chapter 13 (From the edge: using excessive arts for mental health support of forcibly displaced people) by Lydia Gitau& Caroline Hochstetter, “Bilateral Drawing with Music”. Bottom right: From Chapter 11 (Arts and perinatal mental health) by Rosie Perkinsand Kate Rose Sanfilippo, Artwork from The Birth Project.

Images: Top left: From Chapter 12 (Creativity, arts and the mental health of young people) by Katherine Boydell and colleagues, “Creating in response to deep looking at artworks”; Top right, from Chapter 16 (The arts in the prevention and management of chronic health conditions) by Jennifer Baxley Lee and colleagues, “Painting: University of Florida Health Shands Arts in Medicine program”. Bottom left: From Chapter 13 (From the edge: using excessive arts for mental health support of forcibly displaced people) by Lydia Gitau & Caroline Hochstetter, “Bilateral Drawing with Music”. Bottom right: From Chapter 11 (Arts and perinatal mental health) by Rosie Perkinsa nd Kate Rose Sanfilippo, Artwork from The Birth Project.

Section Four: The Arts within Allied Health and Other Professions

Here we focus on specific health and allied professions – where the arts are used within existing professional frameworks or settings. This shows the broad range of applications of the arts for health and their use in major institutions in society, including criminal justice settings, hospitals, schools, museums and by the media. We also look at the use of the arts in occupational therapy, psychiatry, public health and social prescribing (other texts exploring the use of the arts in psychotherapy in depth).

Top left, from Chapter 23 (Arts in hospital) by Marion Lynchand colleagues, The Art of Healing, Lagos, Nigeria (Photo by Jochi Photography). Top right, from Chapter 20 (Arts in psychiatry and mental health research) by Kamaldeep Bhui andcolleagues: Artwork from the ATTUNE programme. Bottom left, from Chapter 24 (Arts in Criminal Justice) by Laura Caulfield: Display of artwork by children from Sandwell Youth Justice Service at the Southbank Centre London as part of the Koestler Awards. Bottom right: from Chapter 24 (Arts in education) by Penny Hay, “School Without Walls”.

Images: Top left, from Chapter 23 (Arts in hospital) by Marion Lynch and colleagues, The Art of Healing, Lagos, Nigeria (Photo by Jochi Photography). Top right, from Chapter 20 (Arts in psychiatry and mental health research) by Kamaldeep Bhui andcolleagues: Artwork from the ATTUNE programme. Bottom left, from Chapter 24 (Arts in Criminal Justice) by Laura Caulfield: Display of artwork by children from Sandwell Youth Justice Service at the Southbank Centre London as part of the Koestler Awards. Bottom right: from Chapter 24 (Arts in education) by Penny Hay, “School Without Walls”.

Section Five: Theoretical issues and perspectives

This final section reviews models and mechanisms, and looks the arts and health from different theoretical perspectives: sociology, psychology, biology and epidemiology. This section stands out as one of the most innovative in the handbook, presenting first-time overviews of key areas in arts and health and charting the field’s development. Chapters explore both theoretical perspectives and emerging insights into how and why the arts impact wellbeing, moving towards a deeper, process-level understanding. In addition to theory, this section highlights practical developments essential for advancing the field, supporting effective, ethical practice and best practice, alongside rigorous and equitable evaluation and research.

Conclusions

The arts and health is a burgeoning field, with lots of work to do, conflicting positions (e.g., advocacy and critique) and interdisciplinary perspectives to navigate. We hope that this collection of works represents this complexity and develops shared understanding of different assumptions, methods, and approaches. Gaps, debates and issues for further research are discussed in the book’s conclusion. For example, there is a need for more consideration of the limits and potential risks of the arts. Not all activities are beneficial for everyone, some may increase stress, provoke anxiety, or fail to communicate health messages effectively. Music or other creative interventions can sometimes heighten sadness or rumination, and social factors such as difficult group dynamics can make experiences negative. For this reason, arts-based interventions need to be used thoughtfully and ethically, supported by research and careful evaluation. Transparent reporting, including negative or null findings, helps identify what works, for whom, and in which contexts, ensuring the arts are applied safely and effectively to support health and wellbeing.

We hope that the handbook supports and encourages both the use of the arts for health and critical reflection on the field and will be useful for practitioners, researchers, policymakers, and students.

Finally, to watch a short video on the Handbook click here.

Links to the Routledge Handbook of Arts and Health

Routledge Handbook of Arts and Health – 1st Edition – Nicola Holt – Vi
Link for UWE staff and students: Routledge Handbook of Arts and Health – University of the West of England (UWE)

Further resources

Arts and Health journal: https://www.tandfonline.com/journals/rahe20
WHO report: What is the evidence on the role of the arts in improving health and well-being? A scoping review
EU report: CultureForHealth report — CultureAndHealth Platform
National centre for Creative Health Review: National Centre for Creative Health
Critical Appraisal for Arts and Health Research (INCAAHR): International Network (INCAAHR) – Verein der Freunde der Kinder- und Jugendpsychiatrie
Global Arts and Health Alliance: GAHA | Global Arts & Health Alliance

Explore the Handbook

Many chapters then Routledge Handbook of Arts and Health are available on ResearchGate, where authors may share copies privately upon request:

(PDF) Introduction: Charting areas of the arts and health

Section One

History of the arts in health

Positioning the arts and health: Models and frameworks | Request PDF

The role of the arts in supporting our minds, bodies, brains, and behaviours | Request PDF

The need for a critical perspective on arts and health research and evidence reviews | Request PDF

Global perspectives on creative health

Section Two

(PDF) Using the visual arts and crafts for health and wellbeing

Music, health, and wellbeing | Request PDF

(PDF) Words as therapy

Dance, health, and wellbeing

Theatre, health, and wellbeing

Section Three

Arts and perinatal mental health

Creativity, arts, and the mental health of young people | Request PDF

From the edge (Using Expressive Arts for Mental Health Support of Forcibly Displaced People)

Arts in the context of trauma

Arts and health in the context of adult mental health | Request PDF

Arts and health for older adults | Request PDF

End-of-life review

Section Four

Occupational Therapy and Arts | Request PDF

Arts in psychiatry and mental health research | Request PDF

The arts as a public health and health promotion tool

(PDF) The arts in social prescribing

Arts in hospital | Request PDF

Arts in criminal justice

Arts in education

The role of museums and galleries in promoting health and wellbeing

Arts and the media – Space 22 | Request PDF

Section Five

Building a meta-theory on arts and health | Request PDF

The epidemiology of arts and health | Request PDF

The psychobiology of art | Request PDF

Sociological theory and arts and health | Request PDF

(PDF) Unpacking the creativity advantage

Ethics in arts and health practice

Research and evaluation in arts and health | Request PDF

(PDF) Conclusion: Reflections on the arts and health as a field

Note: Access to full PDFs may require contacting the author directly via ResearchGate.

Exploring university student perspectives of a challenge-based curriculum

Psychological Sciences Research Group | 29 January 202629 January 2026

Climate breakdown represents an existential threat – and is just one of the many challenges facing students, universities and the wider world. Within education, there is increasing talk of adjusting our traditional subject-based curricula so students are more able to learn about the challenges we all face – and how to tackle them.

Dr Miles Thompson, Professor Alpesh Maisuria and their student co-researchers recently published a new study exploring university students’ views on:

the importance of different global and local challenges
if students feel their current curricula will help them meet these challenges
whether they would like optional challenge-based learning
how this learning should be delivered

Data was collected from 61 students who rated 30 statements representing global and local challenges from previously published research (Thompson et al., 2023). Statements were rated in terms of both: i. their importance, and ii. the extent to which current learning will help students understand and tackle the challenges.

All 30 challenges were, on average, rated as important. The challenges rated highest in terms of importance concerned:

mental health and well-being
prejudice, intolerance and inequality
the climate and wider ecological emergencies

Despite high importance ratings, students were generally less sure that their current curricula would help them understand and tackle these challenges. In a similar way, while students were clear that they wanted to explore more challenge-based learning, there was no consensus on what format this learning should take.

Interestingly, multiple challenges had noticeable gaps between their: i. importance and ii. learning will help ratings. It is possible this is because our “current learning will help” question asked about both whether learning will: i. help them understand and ii. help them tackle the challenges. These are potentially quite different things. In terms of climate breakdown, students may understand the topic more, but understanding by itself will not resolve the issue. There are multiple, complex issues at play.

This taps into the potential importance of broader economic, systemic and political factors that are central to many challenges and their solutions. This echoes Markwick and Reiss (2025) who, in a recent review that sought to reconceptualise the school curriculum to better address global challenges, spoke of the importance of moving beyond “powerful knowledge” to increasing “knowledge of the powerful” (p.5).

Some of these broader factors were explicitly represented in the challenges rated by students. Indeed, a cluster of 5 of them fell within the bottom 7 items in terms of their overall importance ratings. They involved areas such as: capitalism / neoliberalism; distrust in politics; populism and the far-right and; an increase in individualism. These relatively lower importance ratings highlight the potential significance of ensuring all of us are better able to “read the world” in order that we are more able to change it (Freire, 1970/2005, p.26).

In another sign of the importance of explicitly exploring both power and politics some of the qualitative comments highlighted the wider political context both of individuals, and of higher education itself. Reflecting on the list of challenges, two participants suggested there was a left-wing bias in the survey. In terms of universities being able to tackle such challenges, another participant wondered if universities are able to tackle these challenges as they are run as businesses.

Universities position themselves both as global and local challenge solvers – and are commercial businesses operating in a competitive, international, corporate marketplace. Does this create tensions about what challenges can be tackled and through what means?

The Markwick and Reiss review mentioned earlier concludes by saying: “we need an urgent educational reform that formulates and delivers curricula that engage students in acknowledging and exploring current and potential global issues” (p.11). Adding to the quote above, Thompson and Maisuria wonder: do we just need learning that increases understanding? Or do we also need learning that helps lead to meaningful positive change in the real world?

The open-access article is freely available to read and download from the following link.

References:

Freire, P. (2005). Pedagogy of the oppressed. Penguin Books. (Original work published 1970).

Markwick, A., & Reiss, M. J. (2025). Reconceptualising the school curriculum to address global challenges: Marrying aims-based and ‘powerful knowledge’ approaches. The Curriculum Journal, 36(1), 1–14. https://doi.org/10.1002/curj.258

Thompson, M., Blumer, Y., Gee, S., Waugh, L., & Weaver, Z. (2023). Climate change and community psychology: Exploring environmental and wider social challenges. Psicologia di Comunità / Journal of Community Psychology, 1, 13-33. https://doi.org/10.3280/PSC2023-001002

Thompson, M. Maisuria, A., McCartney, S., & Hamilton, R. (in press). Exploring university student perspectives of a challenge-based curriculum. The Curriculum Journal, 1–16. https://doi.org/10.1002/curj.70013

Who is responsible for tackling our environmental and wider social challenges?

Psychological Sciences Research Group | 15 October 202517 October 2025

A new study explores who is responsible for tackling our environmental and wider social challenges – with the data suggesting governments are most responsible. The study, led by Dr Miles Thompson from UWE Bristol (University of the West of England), has been published in a new volume from Springer entitled: “Community, Psychology and Climate Justice”.

Set against the backdrop of the climate and ecological emergencies, the research drew upon the results of previously published research where academics and young people generated lists of environmental and wider social challenges.

In this new study, participants rated a subset of 62 different challenges (31 environmental, 31 wider social) according to the degree to which they see: i. Individuals; ii. Businesses and Corporations; or iii. Governments as being responsible for tackling them.

More than 200 participants took part, rating responsibilities for tackling each challenge on a 5 point scale from 1 – ‘not at all responsible’; 3 -‘somewhat responsible’ (the midpoint); and 5 ‘extremely responsible’.

Collapsing the data into averages, individuals received the lowest responsibility scores, (3.35 environmental; 3.36 wider social); then businesses and corporations (4.03 environmental; 3.54 wider social), with governments getting the highest scores (4.25 environmental; 4.06 wider social). The results further explore statistical differences and also examine the data more descriptively. Throughout, the general pattern described above holds.

The discussion draws upon the book ‘Kick-starting Government Action Against Climate Change: Effective Political Strategies’ by Professor Ian Budge. In this work, Budge argues that while the climate science is clear, as are the details of many of the things that need to be done, much less is written on how to make sure what needs to happen actually happens. Budge highlights ways to push our governments to take necessary climate actions whilst also ensuring a just transition.

Commenting on this new study, Dr Miles Thompson notes: “It should be remembered that this study does not suggest that individuals have no responsibility for tackling these challenges. The average responsibility score for individuals was above the midpoint. It is just that, according to this data, businesses and corporations and governments have even more responsibility”.

It is worth noting that while the study separated out individuals; businesses and corporations and governments – the authors argue that, in reality, these are inter-related sectors. For example, government policy is influenced by corporate lobbying and we all influenced by the wider tides of capitalism and neoliberalism.

The authors also suggest, that while future research could and should seek to replicate these findings, we also need to be focusing efforts on more directly addressing the many challenges we face – especially in term of the climate and ecological emergencies – and holding those to account who have the most responsibility for tackling these challenges.

Anyone wanting to see the chapter can visit the publishers website (here), or simply contact Miles Thompson for a copy.

Reference:
Thompson, M., Jønholt, L.-A., Nevin, S., & Selih, I. (2025). Who is responsible for tackling our environmental and wider social challenges? Participant data and reflections for community psychology. In B. R. Barnes, M. Fernandes-Jesus, C. D. Trott, & G. Barnwell (Eds.), Community, Psychology and Climate Justice (pp. 45-62). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-99223-0_3.

Arts on Prescription: Insights, Evidence and Future Directions

Psychological Sciences Research Group | 23 May 202515 October 2025

By Nicola Holt. Image above: “Tapestry” from a city-wide arts on referral project in Bristol led by CreativeShift, which was exhibited at Arnolfini gallery

Arts on prescription is expanding, with policy recommendations and schemes spreading globally, along with expectations of its positive impact on individual and community wellbeing. But what is art on prescription and what does the research on its efficacy suggest? In this blog post I will share the different strands of research that I have conducted with colleagues over the past few years, examining the impact of art on prescription, potential mechanisms for change, and systemic challenges with arts on prescription schemes. I hope that this blog post will be useful, condensing and sharing this body of work that can inform future arts on prescription delivery and research.

What is arts on prescription?

Arts on prescription (AoP), sometimes called ‘art on referral’, is one of the core pillars of social prescribing. In social prescribing schemes, people are ‘referred’ by trusted individuals (e.g., doctors, social workers) to relevant support or participation in community activities (e.g., cookery classes, nature walks) with the hope that this will improve their psychosocial wellbeing. In the case of arts on prescription these activities are art based, most typically the visual arts (e.g., painting, drawing, collage, clay work) but also music, singing, theatre or dance. Programmes of weekly art workshops vary in length, typically being between 6 and 12 weeks long. People are typically referred to arts on prescription programmes to help with experiences of loneliness, social isolation, low wellbeing, low to moderate levels of depression and anxiety, and chronic illness (e.g., chronic pain). Arts on prescription is part of an individualised pathway rather than an intervention (e.g., people may have several meetings with a link worker, choosing community activities, and may return to discuss progress with the link worker subsequently). It is supplementary to ongoing treatment (sometimes the metaphor ‘culture vitamins’ is used to convey this).

Arts on prescription workshops have specific aims – to facilitate ‘playing’ with art materials, and enjoying the artistic process in a safe and supportive environment, free from judgement. Unlike art classes, the emphasis is not on skill development, and unlike art psychotherapy, making art is not used as a tool to explore, express and share emotions. Arts on prescription is an invitation to take part in art activities with others, led by an arts for health professional.

Arts on prescription: Evidence and mechanisms of change

Several years ago, I met with Julie Matthews from CreativeShift to talk about ways to evaluate the wellbeing impact of their arts on prescription programmes. Julie was interested in the longitudinal impact of their programmes, and needed reliable methods to capture impact to help secure funding for future delivery. I had already worked with Julie’s co-director, Barbara Disney, the preceding year, where, with Finn White (Community Engagement Officer at M Shed) and participants of her ‘move on’ group at the M Shed, Bristol, we co-produced a method to evaluate the impact of the art workshops on wellbeing. Over several years, we slowly collected different sets of data with CreativeShift, asking different questions and conducting different analyses. This has led to the following outcomes and insights:

Increases in wellbeing and reductions in loneliness: The self-reported wellbeing of participants was, on average, at low levels before participation in arts on prescription programmes. Wellbeing increased significantly over time (after both 6 and 12 weeks of participation). Likewise, feelings of loneliness reduced over the course of programmes.

Mechanisms of wellbeing change: No previous work had looked at the immediate impact of participating in arts on prescription. This data showed improvement in mood after taking part in art workshops: participants reported feeling happier, less tense/anxious and more energised; as well as feeling less lonely. Improvements in ‘in-the-moment’ factors predicted who reported the most wellbeing benefits over time. Three potential ‘mechanisms’ for wellbeing change were identified: anxiety reduction; feeling less lonely after the workshops; and being in a state of ‘flow’ (attentional absorption) during the workshops.

Participants’ perceptions of change: Interviews with participants (conducted with myself and analysed by Caroline Elliott), explored how and why arts on prescription worked for them. Three themes were: “the embrace,” “the journey”, and “the ripple effect”. “The embrace” highlighted the supportive role of facilitators, and the crucial role they played in creating a ‘safe space’, where creativity could flourish and friendships could develop. This was perceived as crucial to the personal transformation experienced by participants. Participants described feeling empowered and more socially connected (along “the journey”), with many reporting that the benefits extended beyond the workshops into their daily lives (“the ripple effect”).

Longitudinal analyses: With Bethan Zalantai, we collected follow-up data one year after participating in arts on prescription. This suggested that wellbeing was maintained longitudinally, but that this was concurrent with being able to continue with art making and attending ‘follow-on’ art groups.

Participant quotes (Holt, Baber & Elliott, 2023)

Move-on groups: The ‘mothership’

Having a space and the opportunity to continue with artmaking is important to maintaining wellbeing after Arts on prescription, and the ArtShed programme at M Shed provides such a space in Bristol. Evaluation using the questionnaire methods described above, suggested that attendance helped to improve wellbeing, and interviews with participants illustrated the importance of the museum space itself. This was described by one participant as ‘the mothership’—a space in which they felt contained, safe, able to be creative, and also a space that offered both an aesthetic boost (with views over the harbourside), alongside a sense of pride and privilege—being able to explore the Museum when it was closed to the public, the day on which the art workshops were held.

Participant quote (Holt, Baber & Elliott, 2023)

Can the Arts on prescription model work in Hospitals?

Working with Donna Baber at FreshArts, Southmead Hospital, we extended our research into clinical settings. Participants were referred from hospital departments to tailored arts on prescription groups for chronic pain, cancer, chronic breathlessness, drug and alcohol and weight management. Our findings echoed our community findings—improved wellbeing, mood and attentional absorption. However, interviews revealed that arts on prescription also transformed participants’ perceptions of clinical care. Participants described how engaging with FreshArts on Referral changed their relationship with the hospital—feeling cared for in a more personal way, feeling like the hospital was a kinder place—humanising their experience.

Participant quote (Holt, Baber & Elliott, 2023)

Remote delivery: Arts on prescription during lockdown

During the coronavirus lockdowns the arts on prescription teams at CreativeShift and FreshArts changed their practices to continue delivering arts on prescription remotely, creating arts interventions using Zoom, phone calls, and for people with no digital access, postal art activities. Likewise, I shifted our evaluation practices from paper and pencil to online mood and wellbeing forms, that could be accessed through links or QR codes. We still found that remote delivery had beneficial impacts on mood and wellbeing, and the success of this impacted future delivery, where, for some participants (e.g., when experiencing social anxiety, transport or mobility difficulties) having the option to access arts on prescription remotely is beneficial, and a step on the pathway to further involvement with arts on prescription.

Examples of participants’ artwork from an ‘exquisite corpse’ postal intervention (Holt, Baber, Matthews, Lines & Disney, 2022)

Feeding research back into practice

Working with FreshArts and CreativeShift, we held a staff training day with artist facilitators, where I discussed the outcomes of our evaluations, focusing on the ‘mechanisms of change’: relaxation, flow and social connection. We spent the afternoon working in groups on each ‘mechanism’, discussing how artists worked to create the conditions for each in their practice. It was useful to consider how these factors were facilitated during arts on prescription workshops and to share best practice. This then fed into training programmes for new artist facilitators.

Thriving Communities: Developing culturally inclusive arts on prescription programmes

A further strand of work, led by Lerato Dunn from Bristol Culture, piloted culturally inclusive arts on prescription programmes in urban settings across Bristol. Working with local communities and cultural institutions (e.g., Arnolfini), these programmes included: drama in nature for children and young people, body movement and art for women, child and carer art groups, and art making in nature. The findings underscored the importance of cultural relevance, intent, and location in shaping outcomes. Once again, therapeutic relationships and safe spaces were described by participants as central to effectiveness. Arts on prescription workshops were described as spaces where moments of joy, awe, escape, relaxation and flow could occur. However, challenges were identified in the wider evaluation that related to scalability, inclusivity, and long-term funding. In particular, it was emphasized that the work of the artist facilitators (e.g., in carefully working with participants, sometimes over a long period of time before they even felt able to attend a workshop), was not fully recognised in the planning and funding of social prescribing services.

Participant quote from the arts in nature group (Holt & Dunn, 2023)

Addressing challenges: A critical review of arts on prescription

Despite the encouraging findings about the efficacy of AoP, there are numerous problems with both practice and the evidence base, which are crucial to consider. With Hilary Bungay (Anglia Ruskin University) and Anita Jensen (Lund University) we conducted a review of such issues. A lot of the communication about arts on prescription does not consider issues critically, hence, we sought to redress this.

Our review identified numerous challenges with delivery, such as inconsistent referral practices, varying levels of awareness among healthcare providers about arts on prescription, and the need for better training for artist facilitators. There is a crucial need to develop consistent best practice across arts on prescription programmes and support for artist facilitators. We know that engagement with the arts is not always positive, e.g., group dynamics can cause feelings of exclusion rather than inclusion, and art activities can be perceived as stressful if scaffolded inappropriately. This needs to be acknowledged in order to develop guidelines and training for arts in health facilitators. These insights, and others, are vital for refining arts on prescription models to ensure they are accessible, effective, and sustainable.

Collective evidence: Systematic review and meta-analysis

Since there was no overview of the existing research on arts on prescription, again, with Hilary Bungay and Anita Jensen, we conducted a systematic review of the literature. We assessed 25 studies across multiple countries, including the UK, Australia and Sweden, analysing the data from all of these studies together. The findings suggested that arts on prescription programmes lead to significant improvements in individual wellbeing. Participants reported enhanced social connections, and increased psychological wellbeing, including confidence and self-esteem, as well as arts on prescription opening new opportunities. These outcomes underscore the potential of arts on prescription as a viable component of public health strategies.

However, the review also highlighted problems with the existing evidence base, including a reliance on pre-post designs (measuring wellbeing at the start and end of programmes) with no control or comparison groups, making it difficult to attribute the wellbeing change to the programmes. There was also a lack of follow-up data, making the long-term impact of attending programmes unclear. Another problem was a lack of specific health outcome measures (overly relying on generic wellbeing measures), meaning that it is not clear whether arts on prescription is useful to help with specific symptoms or experiences, like social isolation, managing pain or anxiety and depression. Additional issues with the evidence base were highlighted, such as a lack of demographic diversity in attendees, and barriers to access for people who may benefit from arts on prescription the most (e.g., people experiencing multiple challenges).

Forest plot illustrating mean wellbeing change (and confidence interval) for each study in the meta-analysis and estimated overall effect size (Jensen et al., 2024)

Narrative reviews: So much work to do!

Further narrative reviews of the literature with colleagues (Julie Matthews, Caroline Elliott, Sofia Vougioukalou [Cardiff University], Helen Chatterjee [UCL]), have expanded on these critical issues, considering possible future directions in research (e.g., using the experience sampling method to track longitudinal wellbeing), and the need to further research of the benefits of arts on prescription for specific groups, e.g., children and young people and older adults. There is so much work to do and issues to address, to:

Improve the existing evidence base: especially for specific outcomes (e.g., anxiety and depression, pain management, loneliness) and longitudinal impact.
Disseminate and share best practice and training: often research papers do not explain what arts on prescription practitioners actually do (meaning that impact may be inconsistent across programmes).
Develop inclusive and culturally relevant programmes: currently arts on prescription has a limited demographic reach.
Improve systemic practices: along the referral pathway (e.g., it is not always clear who holds health responsibility for participants along their journey, and outcomes from participation are not always fed back to referrers).

Conclusion

The research that I have been involved with has hopefully helped to validate and expand the role of the arts in social prescribing. The work not only evidences the positive impacts of arts on prescription on individual wellbeing but also provides critical insights into optimizing programme delivery and accessibility. As arts on prescription continues to gain recognition within public health frameworks, I hope that these contributions help to shape effective, inclusive, and culturally sensitive interventions using the arts to improve health and wellbeing. However, there is much work to be done, and a need to consider evidence and practice critically, to ensure best practice and improve the quality and specificity of the evidence base.

References

Bungay, H., Jensen, A., & Holt, N. (2024). Critical perspectives on arts on prescription. Perspectives in Public Health, 144(6), 363-368. https://doi.org/10.1177/17579139231170776

Holt, N. J. (2020). Tracking momentary experience in the evaluation of arts-on-prescription services: using mood changes during art workshops to predict global wellbeing change. Perspectives in Public Health, 140(5), 270-276. https://doi.org/10.1177/1757913920913060

Holt, N. J. (2023). The impact of remote arts on prescription: Changes in mood, attention and loneliness during art workshops as mechanisms for wellbeing change. Nordic Journal of Arts, Culture and Health, 5(1), 1-13. https://doi.org/10.18261/njach.5.1.1

Holt, N., Baber, D., & Elliott, C. (2023). Arts on referral at Fresh Arts: A mixed-methods report on the efficacy of arts on prescription in a hospital setting for people experiencing chronic health conditions. UWE Bristol. https://uwe-repository.worktribe.com/output/12712211/arts-on-referral-at-fresh-arts-a-mixed-methods-report-on-the-efficacy-of-arts-on-prescription-in-a-hospital-setting-for-people-experiencing-chronic-health-conditions

Holt, N., Baber, D., Matthews, J., Lines, R. & Disney, B. (2022). Art on referral: Remote delivery in primary and secondary care during the coronavirus pandemic. UWE Bristol.https://uwe-repository.worktribe.com/output/9852574/art-on-referral-remote-delivery-in-primary-and-secondary-care-during-the-coronavirus-pandemic

Holt, N., & Dunn, L. (2023). Thriving communities Bristol evaluation report. Bristol Culture. https://uwe-repository.worktribe.com/output/11603659/thriving-communities-bristol-evaluation-report-2023

Holt, N., Elliot, C., & Jenkinson, E. (2021). Nobody can fail at it, everybody succeeds”: Perceived processes of change following attendance at an arts on prescription programme. In Culture, Health and Wellbeing International Conference Research Proceedings (pp. 66-68). https://uwe-repository.worktribe.com/output/7240845

Holt, N., Matthews, J., & Elliot, C. (in press). Art on prescription: practice and evidence In P. Crawford and P. Kadetz (Eds.). Palgrave Encyclopedia of the Health Humanities. Cham: Springer International Publishing. https://www.researchgate.net/publication/345501419_Art_on_prescription_Practice_and_evidence

Holt, N., Vougioukalou, S., & Chatterjee, H. (in press). The arts in social prescribing. In (Eds.) Holt, N. Tischler, V., Vougioukalou, S., & Corvo, E., Routledge Handbook of Arts and Health.

Jensen, A., Holt, N., Honda, S., & Bungay, H. (2024). The impact of arts on prescription on individual health and wellbeing: a systematic review with meta-analysis. Frontiers in Public Health, 12, 1412306. https://doi.org/10.3389/fpubh.2024.1412306

Zalantai, B., Holt, N., Chase, M., & Jenkinson, E. (2021). A mixed-methods evaluation of the longitudinal impact of arts on prescription. In Culture, Health and Wellbeing International Conference Research Proceedings. https://uwe-repository.worktribe.com/output/7240027

Gaining prescription rights: a qualitative survey mapping the views of UK counselling and clinical psychologists

Psychological Sciences Research Group | 8 August 20248 August 2024

Dr Alice Horton, one of our counselling psychology alumni, has recently published the research she carried out for her Doctorate in the journal: Advances in Mental Health. The research was supervised by PSRG members: Miltos Hadjiosif and Miles Thompson.

The research is titled: Gaining prescription rights: a qualitative survey mapping the views of UK counselling and clinical psychologists. It explores whether clinical and counselling psychologists should be able to prescribe medication for mental health conditions. In the UK, this is currently something that only psychiatrists and other non-medical prescribers can do. However, psychologists gaining prescription rights is something that the British Psychological Society (BPS) has been exploring. As a result, this mainly qualitative study surveyed UK-based, qualified counselling and clinical psychologists to gather their views on this possibility.

The study collected data from 82 participants, of whom 37 were counselling and 45 were clinical psychologists. Participants completed an online survey to gather their thoughts and feelings on this important issue. Providing a snapshot of their overall views, one question asked ‘Overall, do you think psychologists should gain prescription rights?’ Of the 82 participants: 18 (22%) answered yes; 42 (51.2%) answered no; and 22 (26.8%) were unsure. While most participants answered no, just over a fifth answered yes, with a quarter remaining unsure.

More nuanced feedback is found in the three themes reported in the study:

Theme 1: Prescription rights: A crossroads in our identity
Theme 2: If the drugs (don’t) work, I should(n’t) prescribe them
Theme 3: The cost of power

In short, theme 1 explores how gaining prescription rights would be a significant departure from current practice. It would have implications for who psychologists are, what they do, and the values that underpin the profession. The theme discusses how psychologists grapple with their professional identity within structures dominated by the medical model of distress, and how various framings of the prescription rights debate point towards a crossroads for both discipline and profession.

Theme 2 explores participants’ views about psychiatric drugs and how they seem to serve as a springboard for their views on the prescription rights debate. In other words, participants’ assumptions about psychiatric drugs seem to influence whether or not they believe psychologists should gain prescription rights.

Finally, theme 3 examines how gaining prescription rights might mean psychologists gain increased status and power in the workplace and wider society. The theme also discusses the current level of confidence (or lack of) in the profession and what might be gained or lost as a result of gaining these rights.

In the discussion, the authors advocate for increased criticality in how UK psychology continues to consider this issue. They note that wider issues like understaffed mental health services and broader social issues such as income inequality contribute heavily to the burden of mental health and are unlikely to be shifted by the profession gaining prescription rights.

They note that relational therapeutic work calls for disentanglement from both the mainstream medical model and the ‘expert/doctor’ position. And that prescribing psychologists risk becoming further entrenched in both if the profession goes down that route.

They also highlight the risk of taking an “optionality approach”. If psychologists do take on prescribing rights, it will be an option, requiring individuals to pursue further training. Those who want to do it can, those who don’t, won’t have to. While this sounds like a sensible individual choice – the authors worry about the wider implications for the entire profession, and how over time, it may mean that all psychologists have to gain prescription rights to remain competitive for job roles.

The published article is open access, so it can be freely read and downloaded by anyone at this link.

Why do so few researchers examine actual encounters when trying to improve communication in healthcare?

Psychological Sciences Research Group | 2 July 20242 July 2024

By Maddie Tremblett, Jude McClellan, Charlotte Albury, Shoba Dawson, Brian McMillan, and Rebecca Goulding

Communication is central to the delivery of healthcare. From patients requesting an appointment, explaining what symptoms they have been experiencing and what they are concerned about, to staff asking for more information, delivering diagnoses and prognoses, and explaining different treatment options, clear understandable communication is core.

Most major investigations into failures in the UK NHS highlight communication as a key area where something has gone wrong^1,2,3.

Researchers endeavour to improve healthcare communication, with journals dedicated to investigations into how this can be improved (e.g. Patient Education and Counselling, Qualitative Health Communication, Health Communication). However, so much of this research entails retrospective post hoc interviews on the experience of communication, which faces issues with our ability to effectively remember what happened in a conversation to build practical advice for change.

Government recommendations for healthcare delivery rarely cite the evidence base for any communication guidelines. The focus by researchers on retrospective accounts and lack of evidence in clinical guidelines is a puzzle. Methodology is available to systematically build evidence on effective communication practices in healthcare, based on actual clinical encounters – including conversation analysis.

Conversation analysis, with its origins in sociology, uncovers the normative rules and structures that we abide by during conversations. Unlike the messy disordered talk we all think we take part in, decades of research have demonstrated that talk is structured and ordered, with rules we tend to abide by (e.g. one speaker talks at a time⁴). This micro analytic technique has been harnessed by healthcare researchers and applied to clinical encounters as diverse as end of life care discussions⁵, healthy behaviour talk in primary care⁶ and medical emergency calls⁷.

At the same time as being a burgeoning field, it is a puzzle why the study of actual healthcare encounters is not embraced more often throughout healthcare research, and systematically used to develop solutions to known issues in healthcare communication.

We are a group of researchers and clinicians, who have, or have attempted to, examine actual healthcare encounters. We were bought together by a need to solve this puzzle – and help improve communication in healthcare, by enabling the generation of the gold standard of evidence through the recording and analysis of actual healthcare encounters.

Preliminary findings from our survey of UK researchers with experience of recording or attempting to record healthcare encounters for research speak to the causes of this puzzle. Content analysis was applied to responses from 24 participants, recruited between April – May 2024.

Time

Research projects are timebound. Funding is provided in a limited capacity with an expectation that goals are achieved in a quick and cost-effective way.

A lack of understanding by funders for how long it takes to build an in-depth analysis meant that time for analysis was often cut before the project even began, limiting the scope of the resulting evidence base.

Bureaucracy

Bureaucratic systems that researchers must navigate were perceived as a major hurdle for completing this type of research.

Ethical approval is essential for all research, but ethics committees often lack understanding of this methodology, and the ways of managing anonymity and confidentiality when voices can never be entirely anonymised. Explaining and answering queries on the methodology from committees takes significant time.

Information governance was an even bigger reported issue for most researchers. Each place that you want to do research in (e.g. hospital/primary care setting), has different gatekeepers that need extra applications for approval to conduct research there, eating up more projects time.

Along with impacting the time for the work, gatekeepers often demand changes to the way the project was designed. Compromises are often made, with researchers reporting that requirements imposed can be arbitrary, constraining, or even prohibitive.

“Governance offices in hospitals making us add a statement saying they could get access to the data if required, meaning clinicians refused to be recorded for fear of repercussions”
Participant 1, Academic Researcher

Approval processes used by different gatekeepers are perceived as overly subjective and open to variation according to the individual officer.

“I have found heterogeneity though across gatekeepers in IG in different provider trusts… so you have figured out what way of dealing with someone or a group that is more likely to enable … making videos in healthcare”
Participant 2, Clinician Researcher

As a result, there can be a variation in procedures dependent on the location, potentially effecting how the results can be interpreted.

Recruitment

Recruitment of patients was only perceived as problematic when there was a very limited pool of participants available due to the study focus (e.g. a focus on clinical communication about a rare condition). However, it was highlighted that clinicians were often reluctant to take part.

“Recruitment of clinicians has been the biggest challenge I’ve faced.”
Participant 3, Academic Researcher

Practicalities

Additional challenges were experienced due to the complexity of most healthcare settings, where multiple different parties may be present for the recording, and when appointments are ad hoc or in emergency settings.

“We had multiple participants in any single recording. Some had given ‘higher’ levels of consent than others (e.g. consented (or note) to using anonymized photos, video, etc. in dissemination) …We had to decide how to use each recording based on the ‘lowest’ level of consent from participants in each recording.”
Participant 4, Academic Researcher

“Getting consent from the practices, all members of the [ ] team and the patients and their chaperones before audio recording of urgent [ ] appointments. This is a lot of people who all need to agree”
Participant 5, Academic Researcher

The logistics of getting good quality recordings in healthcare settings, which were at times chaotic, were perceived as further challenges. Funding may not stretch to the ‘best’ equipment, and the practicalities of setting up multiple cameras to fully capture all the interactions can be complex.

“one camera and little time to set up, getting good quality recordings with everyone’s face in them can be tricky… Multiple cameras of course helps this, but adds lots of levels of complexity”
Participant 6, Academic Researcher

“the suction pump kicking in upstairs can have a real impact”
Participant 5, Academic Researcher

Bringing researchers into the healthcare setting to help with the set up and the recording is one way to get better quality recordings but were reported as leading to other challenges that researchers were not sure on how to manage.

“Some patients would speak to the researcher within their consultations (despite instructions to act as if we were not there), particularly if they had spoken to us a few times before”
Participant 7, Academic Researcher

Equally the increasing use of telehealth consults were perceived to impact time on a project, as researchers had to learn how best to capture these interactions with new technology.

So, what next?

These preliminary findings give an idea of what might need to happen to make recording and analysing actual healthcare encounters an accessible method to build evidence based clinical guidelines.

Communication may be the key. Communication to regulatory authorities about this type of methodology, and how it can safely protect data, might speed up initial approval processes. Communicating to get consistency throughout healthcare settings for how requirements are applied would mean protocols can be easily transferred to different settings. Working with these bodies to establish a framework that everyone agrees on could be an option. Researchers using established ways of communicating the power of this type of research to clinicians and working with healthcare teams to enable suitable set up of equipment could make for good quality of recordings.

Our group hopes to establish further projects to show how this communication puzzle can be solved. Exploring these issues faced by researchers, but also in the future patients and those working in healthcare settings, we hope to establish a range of resources for researchers, funders and gatekeepers in the process. Establishing guidelines for smoother processes and methods will not only make researchers lives easier, it will have real world impact. Rather than relying on what we think might work to enable good communication in healthcare, we could rely on an evidence base of what is demonstrated to actually work. Healthcare communication, and its impact on patients’ lives, are too important to do otherwise.

References

¹ Walsh, K. (2003). Inquiries: Learning from failure in the NHS? The Nuffield Trust. Retrieved from: https://www.nuffieldtrust.org.uk/sites/default/files/2017-01/inquiries-learning-from-failure-nhs-web-final.pdf

²Powell, M. (2019), Learning from NHS Inquiries: Comparing the Recommendations of the Ely, Bristol and Mid Staffordshire Inquiries. The Political Quarterly, 90: 229-237. https://doi.org/10.1111/1467-923X.12697

³NHS England, (n.d.). Improving safety critical spoken communication. Retrieved from: https://www.england.nhs.uk/patient-safety/improving-safety-critical-spoken-communication/

⁴Sacks, H., Schegloff, E., & Jefferson, G. (1974). A Simplest Systematics for the Organization of Turn-Taking for Conversation. Language, 50(4), 696-735.

⁵Parry, R. (2024). Communication in Palliative Care and About End of Life: A State-of-the-Art Literature Review of Conversation-Analytic Research in Healthcare. Research on Language and Social Interaction, 57(1), 127–148. https://doi.org/10.1080/08351813.2024.2305048

⁶Albury, C., Hall, A., Syed, A., Ziebland, S., Stokoe, E., Roberts, N., Webb, H., & Aveyard, P. (2019). Communication practices for delivering health behaviour change conversations in primary care: a systematic review and thematic synthesis. BMC Family Practice, 20(1), 111. https://doi.org/10.1186/s12875-019-0992-x

⁷Riou, M. (2024). Communication in Prehospital and Emergency Care: A State-of-the-Art Literature Review of Conversation-Analytic Research. Research on Language and Social Interaction, 57(1), 55–72. https://doi.org/10.1080/08351813.2024.2305044

Teaching students open science practices can contribute to their understanding of research

Psychological Sciences Research Group | 9 May 20249 May 2024

Dr Kait Clark, lead of the Applied Cognition and Neuroscience theme of the Psychological Sciences Research Group (PSRG) is the senior author of an Registered Report in Advances in Methods and Practices in Psychological Science: “Evaluating the pedagogical effectiveness of study preregistration in the undergraduate dissertation.” The lead team includes external collaborators Dr Madeleine Pownall, Dr Charlotte Pennington, and Dr Emma Norris, and co-authors include UWE collaborators Dr Jemma Sedgmond and Dr Iris Holzleitner.

Dr Clark is UWE’s Local Network Lead for the UK Reproducibility Network, and alongside her research in cognitive neuroscience, she also conducts meta-research (research on research). She is a passionate advocate of responsible research practices, research integrity, and reproducibility and aims to instil these principles in her students; however, previous research has shown that undergraduate students often use questionable research practices in their final-year dissertations.

In the years following the recent “replication crisis” in psychology, researchers have begun to adopt open science practices to conduct more robust and reproducible research, and we are also beginning to teach these methods to our students – the researchers of the future. Preregistration (specifying hypotheses and planned analyses on a time-stamped document prior to data collection) is one open science practice used to mitigate questionable research practices, but the efficacy of preregistration as a pedagogic tool had yet to be explored empirically.

Dr Clark and her team recruited 89 UK psychology students who either did (N = 52) or did not (N = 37) preregister their undergraduate dissertation projects and measured their attitudes toward statistics and open science before and after their project completion. Although preregistration did not impact the students attitudes toward statistics or acceptance of questionable research practices, students who preregistered gained a greater understanding of open science over the course of their dissertations compared to students who did not. Students who preregistered also reported that engaging with the practice improved the clarity and organisation of their dissertations. The results contribute to the ongoing discussion of incorporating open science into the undergraduate curriculum.

It’s time to change how we think about families.

Psychological Sciences Research Group | 1 December 20231 December 2023

By Lucy Blake

Growing up, I had always thought of my family as being different from other people’s families. In comparison to other people’s family trees, which I imagined to be strong, tall and wide, I felt like my own small, family shrub was inferior. Thankfully, my job has changed the way that I think about families: both other people’s and my own. My PhD and postdoctoral research involved travelling all over the UK, conducting interviews and observations with parents and children in their homes, community centres and children’s hospitals. These experiences changed me; they opened my eyes, challenged my assumptions, and expanded my heart. These experiences also allowed me to appreciate that my family tree was more like other people’s families than I thought – complex, messy, and always changing.

My research on estrangement has also changed the way that I think about family relationships. Ten years ago, I could only find one or two academic papers on this topic. So in 2014, I jumped at the opportunity to work with a new charity that aimed to support individuals experiencing family estrangement, Stand Alone. The “Hidden Voices” report summarised the findings of an online survey of approximately 800 individuals who were members of the Stand Alone community. The report found that many factors contributed to family estrangement, with the most common being emotional abuse, a clash in personality and values and having mismatched expectations about family roles and relationships. We also found that the nature of estrangement was often cyclical, involving periods of estrangement and periods of reunification.

In publishing my first piece of research on this topic, I also learned that estrangement is a topic that affects many people’s lives, and people want to talk about it. A literature review that I published in 2017 was mentioned in a piece in the New York Times, attracting hundreds of comments, which then led to an invitation to write a book about estrangement. Whilst I wanted to write about what I had learned about this topic, I also wanted to acknowledge that those feelings that typically accompany estrangement, like shame, pain and isolation, are also common to those who wouldn’t categorise themselves as being estranged, such as those who are navigating the fractures that can accompany divorce. These kinds of experiences affect people’s lives and their relationships in different ways and to different extents. But what I wanted to emphasise was this: when it comes to the perfect plotlines of the family story, many people feel like they are outside, looking in.

“It’s the most wonderful time of the year…”

It feels particularly important to talk about the complexity of family life during November and December, when families are expected to be together during celebrations like Diwali, Hanukkah and Christmas. Images on social media show snapshots of parents and children in matching pyjamas around Christmas trees. Adverts show grandparents, parents and grandchildren sitting around tables groaning with food. Whilst many will enjoy feelings of peace and connection during this holiday, the reality of family life is more varied than we might think.

Although we don’t see it on our social media feeds, arguments between family members are common. As much as we often feel alone in our pain, distress or sadness over the holidays, there are millions of people who feel the same way. Family relationships are complex and always changing, and if there are family arguments, tensions or stress, it doesn’t mean that we’re defective, or that our families are “bad”.

I have set out to share the lessons that I had learned about families in my book, “Home Truths: The Facts and Fictions of Family Life”. These are the lessons that have allowed me to develop a kinder voice in my head when thinking about families, and my hope in sharing them is that those who read it might develop a kinder voice too. This book is unlikely to appear in an article listing the “top 10 things to buy your family member this Christmas”; whether we are conscious of it or not, it can be easier to think of families as being perfect than being real. But the lessons that I share in it have certainly felt like a gift to me.

Standards and profits in academic publishing – all publishers and open access arrangements are not the same.

Psychological Sciences Research Group | 10 October 20238 August 2024

By Miles Thompson and Kait Clark

Below is an extended version of a piece first published on the UWE Bristol Library Research Blog. It explores issues around publishing academic articles and books, different open access arrangements, maintaining academic standards and the profit levels of academic publishers.

In short, in terms of journal articles, UK universities, including UWE, have open access arrangements with academic publishers. These agreements reduce or remove Article Processing Charges (APCs) for authors. While this might sound like a universally good thing, authors still need to carefully consider the quality of the publication process before choosing an outlet for their work. Growing numbers suggest: i. being wary of MDPI, Frontiers and others in term of standards, while also ii. being aware of even more established publishers in terms of their profit margins.

In terms of academic book publishing, we explore the #ebookSOS campaign – another issue questioning the charges levied by publishers. We also provide some pointers towards the growing number of truly open access routes for academic chapters and books (no charges for authors or readers of digital versions).

Journal articles

Things are not clear cut in academic publishing. There are not predatory publishers on one side and perfect publishers on the other. There are large areas of grey.

Predatory publishing

Most of us are aware of straightforward predatory publishers. They will publish any article for money, with no or minimal review, and few if any academic standards. The Think Check Submit checklist is a good guard against this trap.

Profitable publishing

But increasing numbers suggest that even traditional academic publishers can be bad for science (see here and here). Academic publishing used to incur appreciable costs in terms of typesetting articles, producing physical copies of journals and distributing them around the world. More recently, desktop publishing software and online articles have reduced these costs considerably. Today, the academic publishing industry reports profit margins of around 40%. A New Scientist leader article argues it is the most profitable business in the world.

While the business model of academic publishing is extremely profitable for the publishers, it is extractive in terms of the academic labour involved (see here and here). Academics write articles for free, associate editors find reviewers for free, peer reviewers critique the articles for free, and even many editors in chief guide the whole process for free. All the while, some publishers are making huge profits.

New publishers

Traditional publishers like Elsevier, Wiley, Taylor & Francis, Springer Nature and SAGE are arguably the biggest and oldest fish in the academic publishing pond. But that pond now contains many other fish. And, if there is room for big, old fish who focus on profit while hopefully keeping academic standards high (…but keep reading) – is it any surprise there might also be room for smaller, younger fish, whose academic standards and processes might be more malleable to enable them to make their profits?

For example, multiple concerns have been raised about MDPI (Multidisciplinary Digital Publishing Institute), see here, here and here.

Some are worried by them charging high APCs. (However, it must be noted that Nature itself has been called out for charging APCs of £8,490 per article for Gold Open Access).

Some are worried by a seemingly unsustainable increase in journal output. This can often be through a focus on special issues or guest editors. We are sure many academic colleagues have been invited by e-mail to edit a special issue for some of these publishers, perhaps on a topic that fell outside your area of expertise. It is often the case that your article would be published for free, but you would also commission other articles from colleagues who would then need to pay APCs.

Some raise concerns around tight turnaround times between submission and acceptance. It seems to raise concerns that reviews might be less than ideal or not be overseen by subject experts.

Relatedly, some are worried by concerns over pressure on editors or interference in their work. For example: reviewer recommendations or editorial decisions are ignored and articles appear in print anyway (see here, here, here and here).

Some similar concerns have been raised about the publisher Frontiers. Yet, both MDPI and Frontiers also have open access agreements with UWE and other universities, offering a 10% APC reduction.

Not just MDPI and Frontiers

Recently, Clarivate delisted more than 50 journals from the Web of Science for failing to meet its quality criteria. Two of these were owned by MDPI, including the International Journal of Environmental Research and Public Health which previously had an impact factor of 4.614. But 19 were owned by Hindawi, which itself is now owned by Wiley, a traditional publisher. And one was directly owned by Springer Nature (see more details here and here).

Wiley itself, has noted that some of the previously listed Hindawi journals had become “paper mills” (see here). Paper mills are outlets which allow the publication of fabricated content through manipulations of the identities of authors, guest editors and reviewers, which the special issue or guest editor model probably makes more likely.

Academic books and chapters

So far, this blog has focused on issues concerning APCs, profits, and standards in and around the publishing of journal articles. But what about academic books and chapters? Many of the biggest publishers of academic journals also publish academic books. What are some issues in this field?

#ebookSOS

One of the main areas of contention is highlighted by the #ebookSOS campaign. It focuses on the availability and cost to university libraries of e-books and e-textbooks. Firstly, many publishers won’t make their books available to university libraries in digital versions. Secondly, if they do, they might only be available as part of a bundle. So, if you want to offer one book to your students, you have to buy hundreds of others. Thirdly, you might have to keep paying the publisher for that same e-book year after year. Fourthly, the digital protections around these books can make them difficult to use for those with accessibility needs. For example, they can be hard to read for those using screen readers.

But undoubtedly the most stand out issue is the prohibitive costs involved. Libraries do not pay the same price as students or members of the public for a digital version. They pay institutional costs. This can mean a book may cost £36.99 in print, but £480 for the equivalent e-book. And the publisher can still stipulate it can only be read by one student at a time. See these articles in the BBC, Guardian and Times Higher for more details and other examples of the prices charged.

Visibility and digital open access platforms

In the past, some have argued that academic books, especially chapters in edited books were less visible and accessible than journal articles. For example, back in 2012, after examining the citations of her own work, Dorothy Bishop memorably wrote: “if you write a chapter for an edited book, you might as well write the paper and then bury it in a hole in the ground“. She notes that to be cited, any work needs to visible, accessible as well as well-written. However, many chapters in edited books lacked visibility and accessibility. Today, writers argue that digital open access platforms offer the possibility for academic chapters to be more discoverable, visible, accessible and promotable. And yet tons of books and chapters still sit behind paywalls or involve the issues highlighted by the #ebookSOS campaign above.

“A” & “B” PCs?

Whereas academic articles have APCs article processing charges (APCs) books have, you guessed it, BPCs (Books Processing Charges). Of course, we acknowledge that publishing books incurs more costs than publishing articles. This is even more the case if someone wants to access a physical copy of the work. See here for a breakdown of potential costs incurred from an open book publisher. But like APCs, there is considerable variation in BPCs. As Frances Pinter wrote in 2018: “There is the sense that BPCs are arbitrary and do not relate to real costs”. This was backed up by her survey of eight European countries, including the UK, where she found BPC’s ranging from €500 to €18,500.

Ways forward?

A few years ago, struggling with the landscape of academic book publishing, one of the authors of this blog created a nano academic publishing press and published a two volume, eight word (yes, eight word) treatise on the topic (see here, here and here). It was not designed to change the world or have any impact. And, in that regard, successfully did nothing.

But other individuals, groups and organisations have done much better at both creating and promoting truly open access publishing routes for academic books and chapters. Routes which can mean no BPCs for authors and no costs for readers who download digital versions of the work.

Since 2008, Cambridge based Open Book Publishers have been an independent open access academic press that does not charge its authors to publish. In the US, Punctum books, was founded in 2011. And in 2015, UCL Press became the UKs first fully open access university press. Today, UCL are also developing a range of open access e-textbooks.

Like with journals, as open access routes grow in academic books so does the variety of options and questions are raised over the legitimacy of some outlets in the marketplace. See here and here for examples. But it is also becoming easier for us to learn more. For example, the Open Access Publishing in European Networks (OAPEN) promote and support the movement towards truly open access academic books, including a useful toolkit to help educate the open access book authors of the future. They also provide a directory of over 70,000 academic, peer reviewed open access books (DOAB).

More broadly there is, the Open Access Books Network, the Open Access Scholarly Publishing Association (OASPA), the Open Book Collective and the Radical Open Access Collective. Drawing in other stages of education and wider learning, there is also OER Commons, the free ebook foundation and many more.

In short, the list of options for open access academic books which do not need to levy a charge directly to authors or the readers of digital versions are increasing.

To conclude, across both journals and books it seems timely for us to become more informed about all the problems and possibilities and to consider looking beyond the big name and/or big profit publishing outlets when thinking about where we place both our academic articles and our academic books. With energy and effort we can be part of bringing about a more truly open access future.

Welcome to our new PSRG Members!

Psychological Sciences Research Group | 17 October 202217 October 2022

Dr Amelia Baldwin

I am a Senior Lecturer in Counselling Psychology and a BPS Chartered and HCPC registered counselling psychologist. I have worked in various capacities including the voluntary sector, advocacy, NHS services, academia and private practice.

My first degree was in Computer Science and I completed a second BSc Honours degree in Psychology whilst working as a computer software developer. I began my psychotherapy training in 2003 at the University of Bristol on a Certificate in Counselling qualifying as a therapist in 2007 on completion of a MSc in Counselling Psychology at UWE.

I am the module leader for the Systemic Thinking and Practice in Counselling Psychology and co-module leader for the Principles in Counselling Psychology.

I have lectured, led training and developed policy and support on issues of working relationally with difference, anti-racism and EDI. This includes lecturing at UWE since 2012 on undergraduate and doctoral psychology programmes in the areas of ‘race’, privilege, transcultural counselling and feminist approaches to therapy.

My master’s research was an investigation of the experience of helping relationships in Asian cultures. My doctoral research was a qualitative exploration of British Women’s Experiences of Racist Hate Crime. I have a special interest in spirituality, intersectionality, social justice, the therapeutic relationship, discrimination, hate crime and feminist psychology.

I am a member of Promoting Psychological Health (PPH) theme of the Psychological Sciences Research Group (PSRG). And I supervise counselling psychology doctorate trainees and undergraduate dissertation students.

Dr Bruna Da Silv a Nascimento

I’ve recently joined UWE as a Senior Lecturer in Psychology and will co-lead the Identities in Psychology Module. My main research interests lie in the areas of human sexuality and interpersonal relationships, and I often combine evolutionary and cross-cultural approaches in my research. Specifically, I am interested in understanding how individuals protect their romantic relationships against the threat of infidelity as well as factors that contribute to relationship satisfaction and conflict between romantic partners, with a particular focus on intimate partner violence (IPV).

I hold a BSc in Psychology (2012, Federal University of Piaui, Brazil), and an MSc in Social Psychology (2015, Federal University of Paraiba, Brazil). In 2015, I moved to the UK to start my PhD, funded by Capes Foundation, supervised by Dr Anthony Little at the University of Bath. My thesis explored individual and cultural predictors of relationship maintenance strategies by combining experimental and correlational designs. Alongside my PhD, I also worked as a Teaching Assistant (TA) at the University of Bath and supported teaching and learning in the Undergraduate (UG) and Postgraduate (PG) psychology programmes.

After I received my PhD in 2019, I worked as a Research Fellow at Kingston University London on several projects exploring predictors of antisocial behaviour among children and adolescents in the UK and Qatar, as well as contributed to their UG and PG psychology programmes as a TA. In July 2020, I joined the Centre for Culture and Evolution at Brunel University London as a Lecturer in Psychology, where I could develop my cross-cultural research programme on sexuality and relationships. At Brunel, I taught on both UG and PG psychology programmes, and led the individual differences module of the Psychological Sciences (conversion) MSc.

At UWE, I’d like to expand my current research programme into interpersonal relationships and I look forward to establishing new collaborations with the PSRG members.

Dr Kayleigh Easey

I have recently joined UWE as a Senior Lecturer in Psychology, and am an Epidemiologist and Psychologist. At UWE I will be leading the Psychopharmacology module within the BSc Psychology programme.

Prior to this, I worked as a Genetic Epidemiologist at the University of Bristol working in the Integrative Epidemiology Unit (IEU), where my research focused on potentially modifiable health behaviours (e.g., alcohol, tobacco, caffeine, physical activity) during pregnancy and their potential intergenerational impact on offspring outcomes. This research had a particular focus on causal effects and the role of paternal as well as maternal health behaviours in and around pregnancy. Prior to this, I completed my PhD at the University of Bristol, where I investigated offspring mental health outcomes associated with maternal prenatal alcohol use.

Before my PhD, my background mainly focused on mental health research. After completing my undergraduate degree in Psychology, I gained experience within the NHS as an Assistant Clinical Psychologist. This allowed me initially to conduct clinical research within mental health departments across Devon, and eventually led me to train as a mental health therapist. I became further interested in the causal nature of mental health problems and how we may be able to improve outcomes, which ultimately led me back into research. I then completed a MSc in Health Psychology at the University of Bath, and afterwards began working as a Research Associate within the Tobacco and Alcohol Research Group (TARG) at the University of Bristol.

I have a particular interest in substance use, mental health, women’s health and perinatal health, and I am keen to conduct further interdisciplinary research to investigate these topics. I currently also supervise doctoral students at the University of Bristol, focusing on pharmacoepidemiology in pregnancy, as well as alcohol use in autistic people.

I’m looking forward to being a part of PSRG as a multidisciplinary research team.

Dr Charlotte Flothman n

I’m excited to have recently joined the UWE profdoc team in Counselling Psychology! This year I’m teaching the first year students Principles of Counselling Psychology and Personal and Professional Development, as well as a few other bits and pieces! I’m really passionate about promoting inclusive and culturally-sensitive practice, and have especially focused on learning from refugees and asylum seekers about their experiences before, during and after migration. This crosses over into my clinical work of course, and currently I am working for a complex trauma service in Bath which supports victims of abuse and trafficking.

Prior to coming to UWE, I taught at Bristol University for several years and worked in clinical practice throughout this time for a number of local charities as well as an international NGO. My work is widely inter-disciplinary and I have given trainings and consultancy especially on migration related trauma to professionals in many fields and across the world. I really enjoy teaching and learning from students, and have found this to be hugely beneficial to my clinical work (which of course in turn enriches my teaching)! Before deciding to become a psychologist (I trained at the City in London), I was a language teacher in Central America, where I started to gain some insight into the impact of forced migration.

My research interests centre around informing therapeutic and education practice to best engage and support people who are most marginalised in our society, and in particular thinking about the experience of asylum seekers and refugees in the UK. At the moment I am working with local schools to understand the needs of recently arrived young people from Ukraine and hope to develop training materials for staff and families to share best practice.

Rob Hutton

I joined UWE summer 2022 as a Lecturer in Occupational and Business Psychology. My area of interest is in all things ‘cognitive work’. I have spent my career trying to understand skilled performance in the mental activities of decision making, sensemaking, and planning by individuals and teams in their work contexts. I have been involved in the development of cognitive field research methods which allow analysts to understand the challenges of complex work and the application of knowledge and experience to the assessments, judgments and decisions required to perform effectively and safely.

I spent the early part of my career (1991-2008) in the U.S. doing work primarily for the Department of Defence, initially as a grad student at Wright Patterson Air Force Base (Dayton, OH) looking at pilot-cockpit interaction (visual and haptic), followed by applied research for a small applied cognitive research company working all over the U.S. from the big cities (New York, Seattle, San Diego) to the smaller military outposts like Killeen, TX and Dothan, AL (you have to add the State letters after those small towns otherwise… where?). When I moved back to the UK, I still did a lot of work in defence and security, but have also been involved recently in leadership development for World Health Organisation (WHO) and incident investigations and analysis for Healthcare Safety Investigation Branch (HSIB).

From the perspective of ‘the psychology’, I have utilised ideas of ecological explanations of visual perception to inform the design of digital displays and visualisations, to models of recognition-primed decision making to support the training of situation assessment skills and developing mental models to support rapid decision making. I have also been involved in the development of knowledge elicitation and cognitive task analysis methods to support designers’ understanding of the complex cognitive requirements for cognitive skills training, decision support technologies, knowledge management systems, and ways of working.

I am often driven by applied needs that require an understanding of cognitive work, applying cognitive ergonomics or cognitive engineering approaches. Current interests include the underlying psychology of cognitive agility in decision making, the ‘design of time’ in time and event driven work contexts, and the requirements for the human-machine interface between operators (e.g. drivers) and autonomous or remote robotic systems (e.g. ‘driverless’ cars).

Please get in touch if you want to discuss anything ‘cognitive work’, whether it’s looking for examples of cognitive challenges in complex work environments or discussing models of macrocognition!

Dr Jemma Sedgmond

I have recently joined UWE as a Senior Lecturer in Psychology. I will be co-leading the Psychology Project module and teaching across several undergraduate modules including research design and analysis, biological psychology, and cognitive neuropsychology.

I completed my undergraduate degree in Psychology at the University of Chester, before moving to Bangor University to complete an MSc in Clinical Neuropsychology. I then joined the School of Psychology at Cardiff University as a Brain Stimulation Lab Manager. During this time I was involved in research projects exploring the concurrent use of TMS and MRI, TMS methods, Open Science, and food addiction.

I completed my PhD at Cardiff University’s Brain Research and Imaging Centre (CUBRIC), where I investigated the use of non-invasive brain stimulation and cognitive control training in modifying automatic response to food cues. Throughout my PhD I was a champion for Open Science; pre-registering, and sharing data and study materials for all of my projects.

After my PhD I spent two years at Bath Spa University as a Lecturer in Psychology where I was module lead for Advanced Cognitive and Biological Psychology, and taught on modules including Research Methods and Health Psychology.

My research focuses on the determinants of food choice and consumption. I am interested in the social, biological, and cognitive determinants of eating behaviour. I am also particularly interested in the risk factors for under-fueling and disordered eating in endurance athletes; particularly triathletes.

D r Kayleigh Sheen

I have recently joined UWE as a Senior Lecturer in Psychology, where I will lead the Clinical Aspects of Mental Health module and co-lead People and Social Sciences (Foundation). My research intercepts clinical and health psychology, with a broad focus on psychology in the context of childbirth and reproductive health. I use both quantitative and qualitative approaches in my research, often combining both.

Prior to this, I was a Senior Lecturer at Liverpool John Moores University (LJMU) where I developed teaching from foundation level through to MSc. I was also responsible for the supervision of research at undergraduate, MSc and doctoral level. I am currently supervising/ co-supervising several doctoral projects including investigations into the psychological predictors of fear of childbirth, and the mental health of student midwives and nurses.

I completed both my undergraduate (2010) and PhD (2014) degrees at the University of Sheffield, before moving to the University of Liverpool (2013-2018). Much of my time at the University of Liverpool was spent continuing research into the impact of work-related trauma on maternity staff (a programme of work initiated by my PhD). I was also involved in research investigating fear of childbirth, which included developing a new measurement tool to measure fear in maternity care. As I move to UWE, I am about to lead an NIHR funded bid to continue this work, where we will validate this tool and examine feasibility of routine use as part of antenatal care.

On a broader level, I am a committee member for the Society for Reproductive and Infant Psychology (SRIP) where I oversee the allocation of research development funding and lead Society communications.

I’m really pleased to join PSRG, UWE, and to be exploring new collaborations in the South West!

Dr Joe Walsh

I have recently joined UWE from Bath Spa University as a Senior Lecturer in Psychology. At UWE, I will be co-leading the Research Design and Analysis 1 module and teaching across a number of undergraduate and postgraduate modules in Psychology at UWE.

I received my undergraduate degree in Psychology from the University of Hull, before moving to the University of Bath to complete an MSc in Health Psychology, and then transitioning to a PhD in the Centre for Pain Research. My PhD was funded by a Graduate School Scholarship, and focused on investigating how we communicate pain nonverbally, with a particular focus on body posture, as well as sex and gender differences in this communication process.

After my PhD, I held a post-doctoral position in the Bath Centre for Pain Research, working on the Bath-TAP project funded by Reckitt Benckizer, investigating the effect of pain on attentional processing. Following this, I took up a position as a lecturer in Psychology at Bath Spa University.

My research focuses on the pain experience and social pain perception, with a particular interest in pain communication, sex and gender-based variation in the pain expereince, and mechanisms through which pain influences cognitive processes, in particular attention. My work is primarily experimental, and I use a range of pain induction procedures in the research that I do. I already have some collaborations with members of the team at UWE, and I am looking forward to building more within PSRG.

Category: Research

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