We sought to find answers to the question:
What changes in physical or mental health outcomes are experienced by subjects participating in creative arts programs?
Our initial purpose was to learn if Creative Arts Interventions can reduce symptoms of psychological distress and enhance the participant’s connection to the purpose of their work and to their peers.
Inclusion:
1. Staff who work at least part time in a hospital in the Denver Metro area, including all multidisciplinary professionals (i.e. doctors (MD and DO's); nurses; advanced practice practitioners; respiratory, physical, occupational, and speech therapists; pharmacists; dieticians; social work/behavioral health specialists; and family/patient engagement staff)
2. Positive symptoms of burnout using the Maslach Burnout Inventory (MBI): emotional exhaustion score of >17, depersonalization score of >7, or a personal accomplishment score of <31.
Exclusion:
1. Unwillingness to participate in any of the four creative arts interventions.
This initial study was conducted from September 2020 through July 2021, and included health care professionals employed at several Denver hospitals. The trial was approved by the Colorado Multiple Institutional Review Board study (COMIRB 18-2759) and was registered on clinicaltrials.gov (NCT04276922 on March 1, 2020) prior to the initiation of any study-related procedures.
After deemed eligible for the study, participants ranked the 4 CAT interventions according to their preferred intervention. All participants were randomized to either a CAT intervention or control group in a 4:1 randomization and met in person for a total of 12 consecutive weekly sessions. Each session lasted 90 minutes and were held in the late afternoon after the participant's regular workday had ended.
We conducted three more cohorts, from March 2022 through May 2024, focusing on non-patient facing healthcare workers across the Denver Metro area hospitals and the health campus of University of Colorado. Our goal with this research was to assess the effect of our Creative Arts Intervention protocol on a often understudied population in healthcare.
The intervention was developed by our creative arts therapists and writing experts using an iterative process. Each cohort had between 40 and 60 participants who were randomly assigned to 1 of 4 CAT interventions or a common control group. The 12 sessions for all 4 interventions followed a standard sequence that addressed 3 themes: creating safety, inviting vulnerability, and integrating into a transformative community. Participants were encouraged to continue their creative arts programs outside of the 90-minute sessions.
- In the art group, participants used a variety of materials from oil pastels to watercolors and photographs to create sequential pages in a blank sketchbook, developing an ability to depict and share experiences and emotional states within the group.
- In the music therapy group, participants engaged in a number of passive (music listening) and active (playing instruments) music directives.
- In the creative writing sessions, participants engaged in timed freewriting and journaling exercises but also participated in guided writing exercises that explored character development, writing in scene, using engaging sensory detail, dialogue, sound, and rhythm.
- In the dance/movement therapy group, participants engaged in low-impact physical warm-ups and relaxation, improvisational individual and group movement, structured movement directives highlighting nonverbal storytelling and relationships, and cocreated choreography centered on a theme or themes.
Based on the high attendance rates and excellent satisfaction scores, our study demonstrates that health care professional participation in a CAT program is both feasible and acceptable. In addition, the CAT program was associated with significant improvements in multiple measures of psychological distress including symptoms of anxiety, depression, PTSD, and all 3 domains of burnout. Participants also had improvements in positive affect and reductions in negative affect as assessed by the PANAS scoring instrument. As 1 out of 5 health care workers have left their profession already because of the COVID-19 pandemic, it is important to note that participants had significant improvements in their turnover intention scores.