The arts and wellbeing: A burgeoning research area

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By Nicola Holt

“I am happy to be alive as long as I can paint.” Frida Kahlo, artist

“To write poetry is to be alive.” Rainer Maria Rilke, poet

The therapeutic role of the arts in fostering healing, growth, well-being and emotional expression is well-attested and long-standing. Whether painting, creative writing, crafting, singing or colouring, arts-based approaches are beginning to be recognised as credible and effective ways to promote good psychological health for all.

There is currently a burgeoning of research on the arts and health, that is impacting policy and treatment. For example, recent research has suggested that singing can help reduce post-natal depression and improve lung-functioning, dance can help improve the balance and gait of people with Parkinson’s disease, poetry therapy can be a useful intervention for patients recovering from anorexia, expressive writing can decrease stress and improve immune system functioning, art making can help to reduce pain and distress in cancer patients, improve mental health and enable positive experiences such as happiness and mindfulness. Bodies such as the All-Party Parliamentary Group on Arts, Health and Wellbeing  have assimilated such findings, and, based on these have made policy briefings recommending the increased commissioning of the arts to improve health and wellbeing (including ageing well, mental health, and the self-management of chronic conditions). While this may be having some impact (for example, the Government’s recent plans to increase access to arts on referral), caveats remain. There are limitations with the evidence base and numerous questions about the efficacy of the arts remain unanswered. For example, effects require replication, many reviews include heterogenous interventions, groups of people and wellbeing outcomes. This can make it difficult to know which art treatments work best for whom, and why. It is also unclear how interventions should best be delivered, for example, the number of sessions required and the optimal spacing between them. The long-term benefits of arts interventions are also little known. Much profitable research has yet to be conducted on the arts and health, which will help to answer such questions.

I became interested in the arts and wellbeing when studying for an MSc in consciousness studies twenty years ago. I became interested in the shifts in conscious experience (e.g., perception, attention, cognition, mood, awareness of body, time and agency) that I personally experienced while painting and began to explore the literature for explanations, leading to an MSc thesis and a PhD on consciousness and creativity. One common type of experience, described by humanistic psychologists such as Rollo May and Abraham Maslow as a form of ‘peak experience’ or ‘creative attitude’, and popularised by Mihaly Csikszentmihalyi, is the ‘flow state’, involving detachment from time and space, absorption in the activity of the present moment, deep fascination and concentration. The accounts given by Marion Milner, in her book ‘On not being able to paint’, were my favourite ones at the time, for example, she described what she called moments of ‘creative participation’ in the following way:

“The process always seems to be accompanied by a feeling that the ordinary sense of self had temporarily disappeared, there had been a kind of blanking out of ordinary consciousness; even the awareness of blanking out had gone, so that it was only afterwards when I had returned to ordinary consciousness that I remembered that there had been this phase of complete lack of self-consciousness.” (Milner, 1950, p. 152)

Indeed, my recent research suggests that ‘flow’ might be one mechanism to explain the health benefits of engaging with the arts. The arts might offer people the opportunity to experience degrees of absorption or flow in their daily lives, in a way that promotes wellbeing, either by being temporarily distracted from one’s pain or worries, or through engagement, joy and a consequent sense of mastery. Various crafts and arts activities might facilitate this experience, including drawing, knitting, and colouring. Colouring is an and accessible art activity that has been increasingly advocated for wellbeing, and evidence supports its use as a stress-reduction tool for University students. Recent research that I have conducted at UWE, with students on our undergraduate psychology programme, suggests that, not only might colouring, temporarily, at least, improve mood and promote the flow state, but might also improve cognitive functioning – both selective attention and creativity, potentially helping students to solve problems in everyday life.

Of course, the flow state can be experienced in many activities in everyday life, and a range of other mechanisms have been proposed to explain the health benefits of art-making, some specific to particular forms of art. For example, it has been proposed that expressive writing may reduce cognitive rumination and anxiety following stressful events, creating a meaningful and more manageable narrative, impacting both psychological and long-term physical wellbeing (by improving immune system functioning). Further, many art groups perform an important social function, helping to reduce feelings of loneliness and isolation and improving people’s ability to relate to and communicate with others. Research on the mechanisms behind any wellbeing effect is important because we can help to identify to active ingredients of arts for health interventions (e.g. type of art, skills of the arts practitioner, group interaction) and modify these accordingly to optimise wellbeing.  

In the Faculty of Health and Social Sciences at UWE we have a number of academics interested in the arts and health, including our music therapy team. Academics from different disciplines come together as a teaching team on the Level Three Psychology module, The Arts and Mental Health, led by myself, delivering an exciting and diverse array of topics, including art psychotherapy, music therapy, music in prisons, poetry therapy, craftivism, and the arts and dementia. As a next step I have begun a multidisciplinary Special Interest Research Group at UWE with Dr Liz Jenkinson, hoping to facilitate research collaborations on the arts and health, within and beyond UWE. This is entitled DRAW: Developing Research on the Arts and Well-being, housed within the Promoting Psychological Health strand of PSRG (Psychological Sciences Research Group). Interests of DRAW include developing new arts interventions, evaluating existing arts interventions, researching mechanisms to explain the health benefits of engagement with the arts and the use of the arts in creative research methods.

The members of DRAW bring together a diverse range of knowledge and expertise and we are looking forward to collaborating and extending our research and evaluation of arts for health. For instance, Dr Liz Jenkinson and the health psychology team at UWE are experts in understanding patient experiences of acute and chronic health conditions, and the design and evaluation of effective psychosocial support. The use of the arts in health care as a therapeutic tool in promoting good psychological and physical health is an area in which DRAW has begun to collaborate with organisations such as Fresh Arts, who provide arts-based interventions for patients at Southmead Hospital, including arts on referral for cancer patients. Liz is also working with colleagues at UWE in Visual Culture and the Arts with the aim of developing a new arts for health intervention with young mums. Another DRAW member, Dr Mike Chase has over 20 years of experience of working and researching in the voluntary and statutory community sector, and has been using mixed-methods to evaluate the use of music and arts interventions in community settings, including the Outsider Gallery, in London. Mike hopes to extend this collaboration further, for example taking arts and music interventions to young people’s forensic units in Bristol.

At DRAW we have also been evaluating whether ‘prescribing’ a course of art workshops to people experiencing depression, anxiety or loneliness can improve wellbeing. ‘Arts on prescription’ or ‘arts on referral’ forms part of the wider remit of social prescribing, where doctors, nurses or other primary care professionals prescribe non-clinical activities (including nature walks, cooking or singing workshops) with the expectation that this will improve the health of participants. Although the Government plans to increase the use of social prescribing in the NHS, including arts on prescription, there is only a limited, but encouraging, evidence base for its efficacy. I have been working with the recently formed Bristol Arts on Referral Alliance (BARA) to help contribute to the evidence base for arts on prescription. BARA provides 13 art workshops across Bristol, and 6 follow-on groups, embedded within a larger social prescribing scheme, funded by Bristol City Council, Bristol CCG and charitable foundations. We have been using a mixed methods design, including semi-structured interviews with participants, and drawing on existing pre-post intervention evaluation frameworks. Further, based on my research using the experience sampling method, participants have been tracking their mood over time, for the duration of each 12-week-long art course. Indeed, this has become a meaningful part of the art workshops for participants, reflecting on their current mood at the start and end of each workshop. This data will enable us to test whether any increases in wellbeing at the end of each course are predicted by reductions in stress, increased energy and happiness, directly following making art. The first round of data collection is now complete and will be analysed and disseminated over the next few months, some initial outcomes having been presented at the 1st International Social Prescribing Network Research Conference in June 2018.

The team at DRAW are interested in using the arts themselves as tools for collecting and disseminating data. Led by Victoria Clarke, and in collaboration with Psychologists at the Universities of Aston and Bath, Liz and I have received funding from the BPS to run a seminar series exploring the potential for creative and arts-based methods for applied psychological research. You can learn more about this venture here. We hope that this series will inspire us to use the arts more creatively, as a research tool, in future projects. Using the arts and evaluation tools might offer a creative, more empowering and enjoyable way for participants in arts for health interventions to communicate their experiences and to disseminate these to others.

These are exciting times to be conducting research on the arts and health, with potential for new and innovative projects and collaborations. We hope to grow our research and evaluation at UWE on this topic and develop collaborations with others, within UWE and beyond.  We welcome members to our new special interest group, DRAW, and hope you can join us for our upcoming seminar series which runs from May-July 2019. In the meantime, why not have a go at some arts for health activities – for example UWE’s Feel Good February events include crafting and creative writing!

The Power of Yoga: Using yoga to promote psychological and physical health

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By Emma Halliwell

I was 21, living in Brighton, studying and partying when went to my first yoga class. I was immediately hooked. I have been practicing yoga, with varying frequency, ever since. In those early days yoga helped me cope with the aftermath of late nights and exam stress. Over the subsequent two decades yoga has helped me cope with more serious health and emotional issues.  I can definitely attest to the ‘power of yoga’ in my own life.

Despite my long relationship with yoga, I’ve only begun to research yoga relatively recently. Fortunately, I have a brilliant yoga teacher, Sam Burkey, as a collaborator. She has a wealth of experience and expertise about the benefits of yoga. Together we take an evidence-based approach, integrating evidence from the academic literature, classic teachings and professional experience.

Yoga improves both physical and psychological health. It offers benefits for numerous health conditions including diabetes, cancer, anxiety and cardiovascular disease. Of course, beyond peer-reviewed research, there is also an extensive and rich literature on yoga. The seminal text, The Yoga-Sutra, was written two-thousand years ago (although references to yoga date back 5,000 years). Numerous texts have been published as guides to practice and as testament to the benefits of yoga. Based on these resources, we can draw some clear conclusions and also identify some significant challenges.

For many people yoga is a lifelong pursuit. The benefits of this sustained practice are well documented. These benefits also change and emerge in response to an individual’s own development. There is also evidence that relatively brief yoga courses improve health and wellbeing.

Currently, we are seeing an explosion in the types of yoga on offer, from the more traditional to the more bizarre. It is not clear whether positive impact of yoga extends to some of the more recent variants. Also, we are seeing the emergence of programs that seem to take yoga away from the basic philosophical routes of self-compassion and acceptance, e.g. “beach body yoga workout”.  These developments makes it more challenging to simply recommend yoga as a route to improve well-being.

Against this backdrop, our aim is to evaluate stand-alone yoga-based interventions that also provide a foundation for future practice that will support psychological and physical well-being. Specifically, we are developing brief yoga-based interventions that

  1. target and improve specific aspects of psychological and physical well-being and
  2. offer an informed entry route into yoga practice.

To date, we’ve delivered yoga interventions in schools and university. Our initial data indicates that our targeted yoga-based intervention approach is effective. For example, our yoga-based intervention led to sustained improvements in mood and body image among young women and 40% of them continuing yoga practice.

We have many other projects planned. Most imminently, with an extended cross-disciplinary project team, we are working on yoga programs for individuals who’ve experienced cancer.

So far, this research area has been extremely exciting and rewarding. The significant intervention effects are very promising. Of course, some of the most compelling evidence comes from qualitative feedback. In our most recent study, one participant reported…

“I have taken up yoga and want to do it forever”