Arts for the Blues is a new, collaborative and evidence-based creative psychological therapy for depression. The model was developed using a synthesis of current research, to respond to the need for an improved model of intervention for depression, for adults and children and young people down to age 11. Typically, therapy is based on talking and cognitive approaches – which is useful for many, but around 63% of clients drop out of NHS IAPT therapy (Improving Access to Psychological Therapy: NHS Digital 2020), indicating that plenty of people do not find this model helpful.
Arts for the Blues combines the expertise of multiple disciplines. The resulting creative psychological therapy uses speech, movement, visual arts, stories and writing, and includes an emphasis on connecting with the body using arts practices in expressing emotions, sharing with other participants, and integrating useful material back to everyday life.
“People have realised that you can have fun, and you can learn through playing games.” Caroline Cook, Senior Wellbeing Practitioner Mind and practitioner on the project
The researchers presented this month at our Greater Manchester Arts, Culture and Mental Health working group as part of their scaling up of the project across the Northwest with funding from the AHRC (Arts and Humanities Research Council), following three pilots. The team are currently gathering stakeholders, seek delivery partners, and will be offering training on delivery. The team are working towards an NIHR multi-site feasibility study. In addition, a project with funding from the Arts Council is about to start which will allow service users to share their experiences of therapy with the general public through an immersive performance.
For more information on design visit the website and specifically the blog ‘Workshop design and rationale’ or access the journal article from the British Journal of Guidance and Counselling http://bit.ly/2G7l8jB
To access Arts for the Blues papers, visit their Publications page.
Arts and other mental health conditions: what do we know?
While researchers have explored the roles of the arts in common mental health difficulties such as depression, anxiety, and addictions, those termed ‘severe mental illness’ (sometimes misleadingly, I have to say); psychosis, or schizophrenia, and bipolar disorder, have received less attention.
The Baring Foundation have recently reviewed what is known about the ways in which arts and creativity impact the lives of people with these diagnoses. The authors report that the arts and creativity play important roles for people with diagnoses of severe mental illness in terms of social connectedness, an identity beyond diagnosis, self-belief, and compassion (for self and others).
While the UK NICE guidelines recommend that all people with a diagnosis of schizophrenia are offered art therapies (regulated professions and intervention), the quality of the evidence has been contested, and most researchers call for more research. There are fewer arts and creative opportunities for people in this group, and, as a result, there are fewer studies investigating their effectiveness.
What do I know?
I studied creativity and extremes of mood after I was diagnosed with bipolar disorder aged 19. This diagnosis came with solemn advice to lower my ambitions and take medication. Once I began working in psychology research, I discovered that epidemiological studies show that most people with bipolar live well. The messages commonly given around bipolar diagnoses are unduly negative and based on skewed research. I am not suggesting that bipolar is not severe – only that is not always, and this reality is surely an important nuance, especially when newly diagnosed.
I didn’t believe that medication was the only, or best approach, but due to clinical guidelines I needed to resist this repeatedly. After group psychoeducation on self-management, reflection and experimentation, I learned to recognise and regulate moods, and have not experienced any episodes since age 27. I believe learning and playing music was a key to regulating my mood, although this, of course, is only my perception and anecdote. I am not, however, alone in this experience and the importance of creativity is common among people who experience extreme mood. Clinically, too, I noticed that creative absorption could foster positive results.
What the research says
Creativity has long been linked to bipolar, and Sheri Johnson at Berkley has done brilliant work in this area, for example this critical review of the evidence. I knew from experience, knowledge of the ‘grey literature’ and some rare research that people with bipolar report positive aspects of their moods and creativity – but this is not typically considered in clinical approaches to management.
In 2008, a self-selecting sample of 3330 adults with bipolar were surveyed. Only 54% said that they definitely would push a hypothetical button which would eradicate their extreme moods. Why is this? (Equilibrium: The Bipolar Foundation, 2008).
Research demonstrates a high prevalence of non-adherence to medication among people with bipolar, and this ambivalence might be better understood when the links between extreme mood and creativity are considered. My research has explored both the positive edge of the double edged sword that is bipolar, and the roles creativity plays for people living with extremes of mood, or bipolar disorder. As you might expect, activities varied and included photography, carving and sculpture, painting and creative writing.
Participants explained how their creative activity variously acted as a channel or outlet for high mood and associated creative thoughts and drives, and as a soothing and absorbing way to calm. Creativity offered a distraction for some, and even a way to reframe bipolar experiences. Each found that their creative activity aided them to monitor and regulate mood, which gave an increased sense control over mood.
Clinical services may usefully draw on creative resources to aid assessment and formulation, and even utilise the effects of creativity on the management of mood. Despite this, most of the participants reported that mental health professionals and services typically did not enquire about these activities.
Practice examples where arts meet mental health
Access the report Creatively Minded and Young by the Baring Foundation for a selection of arts and mental health projects with, by and for children and young people.
BeeWell dance and wellbeing project: Manchester Academy students got involved with the #BeeWell programme by creating this dance piece. They developed lots of ideas to engage with questions around mental health and wellbeing with Company Chameleon to provide a creative response to the #BeeWell survey findings.
The ICE Project is a series of free arts workshops and creative opportunities, for young people known to Hampshire CAMHS.
Place2Be: Art Room.
Previously featured in the blog:
Building resilience and overcoming adversity through dance & drama (BROAD), on what Dance Drama can do to impact people experiencing incarceration, trauma and other barriers.
References and further reading
Greenwood T. A. (2017). Positive Traits in the Bipolar Spectrum: The Space between Madness and Genius. Molecular neuropsychiatry, 2(4), 198–212. https://doi.org/10.1159/000452416
Jamison KR, Gerner RH, Hammen C, Padesky C. Clouds and silver linings: positive experiences associated with primary affective disorders. Am J Psychiatry. 1980 Feb;137(2):198-202. doi: 10.1176/ajp.137.2.198. PMID: 7352574.
Johnson, S. L. Murray, G., Fredrickson, B., Youngstrom, E., Hinshaw, S., Malbrancq Bass, J., Deckersbach, J., Schooler, J., Salloum, I. (2012) Creativity and bipolar disorder: Touched by fire or burning with questions? Clinical Psychology Review, 32(1), 1-12. https://doi.org/10.1016/j.cpr.2011.10.001
Lobban F, Taylor K, Murray C, Jones S. Bipolar Disorder is a two-edged sword: a qualitative study to understand the positive edge. J Affect Disord. 2012 Dec 10;141(2-3):204-12. doi: 10.1016/j.jad.2012.03.001. Epub 2012 Apr 1. PMID: 22472729.
Miller, N., & Perich, T., & Meade, T. (2019). Depression, mania and self-reported creativity in bipolar disorder. Psychiatry Research. 276. 10.1016/j.psychres.2019.05.006.
Murray, G., & Johnson, S. L. (2010) The clinical significance of creativity in bipolar disorder, Clinical Psychology Review, 30(6), 721-732, ISSN 0272-7358, https://doi.org/10.1016/j.cpr.2010.05.006.
Taylor K, Fletcher I, Lobban F. Exploring the links between the phenomenology of creativity and bipolar disorder. (2015) Journal of Affective Disorders.15(174):658-64. doi: 10.1016/j.jad.2014.10.040.
Taylor CL. (2017) Creativity and Mood Disorder: A Systematic Review and Meta-Analysis. Perspectives on Psychological Science. 12(6):1040-1076. doi:10.1177/1745691617699653