Modified Mindfulness-Based Art Therapy for High School Teachers Promoting Emotional Well-Being in the Post-COVID-19 Time ()
1. Introduction
After two years of the COVID-19 worldwide outburst, people have become adapted to live with the novel coronavirus under different countries’ policies, although there are still challenges and difficulties. Studies and systematic reviews, have shown a marked increase in stress and burnout involving anxiety and depression in school teachers (García-Álvarez, Soler, & Achard-Braga, 2021), and online teaching has become one factor that decreases the well-being, positive emotions, and motivation of teachers (Panadero et al., 2022). In particular, Brooks, Creely, and Laletas (2022) indicated that the pandemic evoked stress and further intensified the fear of unknown and intense emotions for teachers during their teaching experience. Essentially, teachers’ well-being was found to be associated with teaching effectiveness, student outcomes, school improvement, educational reforms, and psychological aspects, including emotions, satisfaction, resilience, flourishing, stress, and burnout (Hascher & Waber, 2021). Among the above, positive emotion was found to increase cognitive function, which was crucial to effective teaching (Albuquerque et al., 2011). However, teachers’ emotions received less attention than students’ emotions (Panadero et al., 2022). In addition to the complex construct of teachers’ well-being, teachers’ emotional well-being could be emphasized. Specifically, emotional well-being, as one general component of subjective well-being defined by Veenhoven (1984), consists of positive and negative effects (Albuquerque et al., 2011). Positive affects (PA) reflect positive mood states in which persons experience enthusiastic, active, and alert moods, and conversely negative affects (NA) reflect aversive mood states in which persons experience distress and are unpleasurable, including anger, contempt, disgust, guilt, fear, and nervousness (Albuquerque et al., 2011). Therefore, under the environmental effect of COVID-19, teachers’ emotional well-being could be improved for development and sustainability via interventions because of their reactivity and openness to regulation (Talbot & Mercer, 2018).
Overall, teachers experience various emotions daily, and management and regulation are crucial for both their emotional well-being and professional performance (Lee et al., 2016). It is important to provide coping strategies for teachers dealing with stress and negative emotions instead of avoidance coping (Panadero et al., 2022). To promote emotional well-being for teachers, a variety of approaches and theories have been researched, such as positive psychology and cognitive-behavioral thinking. However, limited research on sustainability and long-term implementation has been presented, and there is a lack of experience and capacity to confront a crisis such as COVID-19 (March et al., 2022; Sipeki et al., 2022). Previous studies found that mindfulness-based interventions (MBIs) could be applied to teachers due to their effectiveness with significant improvements in depressive symptoms (Schroevers et al., 2016), and the mindfulness curriculum is acceptable and engaging in reducing stress and anxiety, which is generally suggested to be effective under COVID-19 for well-being in the workplace (Strauss et al., 2021). Meanwhile, MBIs, as a relapse prevention program for anxiety and depression could provide skills for long-term well-being (Segal et al., 2002). Concisely, the mindfulness concept refers to awareness and attention to the present, moment to moment without judgment developed by Jon Kabat-Zinn, which is widely applied to address various physical and psychological health issues (Baer, 2003). In detail, MBIs provide emotion awareness enhancement by cultivating meta-awareness with emotional recognition and cognition (Wielgosz et al., 2019). Promisingly, significant engagement rates indicating high accessibility in real-world settings prove its safety and reliability (Tickell et al., 2019). While taking into account how emotional well-being could be pointed to be enhanced, MBIs seem to be insufficient. However, several studies have shown that MBIs seem to be effective in clinical and nonclinical conditions of distress and negative emotions (Guendelman, Medeiros, & Rampes, 2017) as one emotion regulation strategy in reducing negative components of emotion. Relatively few MBI studies have been conducted on teachers’ well-being (Hwang et al., 2017). Furthermore, Klingbeil and Renshaw (2018) conducted the first meta-analysis review that synthesized the effects of MBIs on teachers, in which the results showed small-to-medium effects on theorized mechanisms of mindfulness compared to the self-reported mechanisms. Simultaneously, there were other reviews revealed the rich description of MBIs with different definitions, characteristics, and components, and the variety became a concern (Davidson & Kaszniak, 2015; Klingbeil & Renshaw, 2018; Hwang et al., 2017).
On the other hand, emotion could be regulated via all conscious and nonconscious strategies to increase, maintain or decrease one or more components of emotional responses (Guendelman, Medeiros, & Rampes, 2017). Alternatively, Art therapy (AT), as a form of psychotherapy rooted in psychoanalysis using art expression, reflects individuals’ unconscious with the importance of showing one’s internal world (Malchiodi, 2012). Originally, AT was based on the idea that art-making was a creative process with psychological theory and experience of the therapeutic relationship, which were applied to increase the quality of life in individuals, families, and communities (American Art Therapy Association, 2018). AT is a creative art therapy that uses drawing, painting, collage, and sculpting to elicit processes of changing, developing, and accepting (Schouten et al., 2014). Spontaneously, AT was brought to make unconscious content accessible with communication through art and symbolic expression (Malchiodi, 2012). The findings of studies have demonstrated that AT could ease stress and burnout at work when facing daily challenges and crises (Regev & Cohen-Yatziv, 2018). Moreover, AT was found to be effective in facilitating self-exploration and self-awareness (Sherman, 1996). Although it was hard to examine the effectiveness of AT through randomized controlled trials in reducing anxiety symptoms (Abbing et al., 2018). Communication via art mode could be less intimidating and contain intrinsic therapeutic properties (Beerse et al., 2019). Moreover, AT combined with other interventions was suggested to be more effective than AT applied separately (Schouten et al., 2014).
Thus, the current study assumed that emotional well-being could be affected by including both conscious and unconscious emotion regulation strategies. In combination with MBIs and AT, mindfulness-based art therapy (MBAT) was developed by Rappaport to integrate art expression into mindfulness skills training. MBAT as a group intervention was suggested to increase health-related quality of life as well as decrease psychological distress and medical symptoms. In particular, the group structure to enhance support was innovated for cancer patients (Monti et al., 2006). Based on the theoretical framework of cultivating mindful awareness and presence through the expressive arts, the role of witnessing and immersion was highlighted in the moment of AT experience (Rappaport, 2013). Witnessing as a process in reflection of being conscious of the present moment has been facilitated via arts becoming an effective way (Rappaport, 2013), which could be applied under complexity. Fundamentally, MBAT as a multimodal intervention was developed to accelerate verbal and nonverbal expression (Monti et al., 2006), and much of the research found this intervention available for individuals with physical illnesses (Hinchey, 2018). Whereas, there is a lack of application and research on utilizing MBAT in nonclinical conditions, which may limit its extensive use and capacity. In the present study, the MBAT approach was modified and applied to a population with mild or even no physical or mental distress. In contrast to MBAT, in which art expression simply provides nonverbal expression, for the nonclinical adult population, verbal expression could amplify the strength of art intervention. Besides, the format of the modality could accumulate advantages. MBAT with a group format was designed to create a supportive and expressive environment facilitating internal connections within and among groups. Accordingly, the uncertainty could be undermined via a group program that emphasizes the power and essence of group processes with a supportive and normalizing environment (Cormack et al., 2017). The perspective of mindfulness would help teachers with self-compassion in which empathy, assertiveness, and stress management could be strengthened in the group form. Additionally, the study indicated the same effectiveness as an individual program, in which mindfulness-based group intervention might be extraordinarily advantageous (Cormack et al., 2017). Adherently, Group AT could help provide empathy from group members, develop interpersonal communication and socialization skills as well as personal insight, and identify problems by using art expression (Sherman, 1996).
For teachers’ emotional well-being promotion, interventions should be applied specifically to cope with complicated and integrated factors. Presumably, a modified approach based on MBAT was hypothesized to effectively address these aspects as emotion regulation acting on PA and NA. Thus, the present study aims to propose an intervention of modified MBAT in which AT would be utilized not only as a way of expression but also as an intervention topic, and focuses on how it promotes teachers’ emotional well-being. The main environmental factors of the pandemic crisis led to disrupting teachers’ emotional well-being with challenges for individuals. Hypothetically, modified MBAT with improvement and upgrades would have intensified impact, which needs to be analyzed with feasibility and practicability.
2. Method and Procedure
This small case study was embedded in a group approach to inspect and discuss its efficacy and process for future implications. The study was conducted in the RF high school in Beijing, China. This middle and high school has approximately 1700 students from the year 7 to 12 and 293 teachers and staff.
To establish the mindfulness club, the psychology teacher (psychological teaching & research and counselling team leader) applied to the school union with descriptions. The composition of the current workshop with recruitment above 3 under 8 members, teachers and staff could sign up via the WeChat mini program (the union helped operate) or contact the psychology team. Participants were invited to take part in this workshop voluntarily once a week during a lunch break for 1 hour and 20 minutes 8 times during one semester. For each session, there would be two instructors guiding the team in preparing the materials and explaining the process. In addition, the procedures above would be repeated to apply and recruit for the mindfulness workshop in the second semester.
During the workshop, the process of each session was recorded with notes by one of the researchers. After the workshop, there would be face-to-face interviews separately within a short time and online questionnaires after one year for each participant. Obviously, permission was obtained from the participants. All notes, interviews, and questionnaires were transcribed, including verbal and nonverbal reactions and behaviors.
2.1. Prior Survey
The survey of teachers’ mental well-being skills training needs was designed for the research to understand deeply about teachers and staff’s genuine thought in advance. The full questionaire have 7 single and multiple choices questions gathering opinions in Appendix 3. The online questionnaire was answered by all staff within the school on the needs for mental well-being and psychological skills. Relatively, the survey indicated that 34.55% of staff would like to spend 2 - 8 hours per semester learning psychological well-being skills (see Figure 1(a)). The contents of self-exploration and stress reduction, as well as identification and coping with mental problems in well-being skills, were most preferable (see Figure 1(b)). Finally, 44.2% of staff chose the offline workshop as the most preferable format to join (see Figure 1(c)). As a result, well-being promoting skills and emotion regulation were most preferable for teachers and staff with offline workshop modalities in the short term, no longer than 8 hours for one semester.
2.2. Participants
In total, 8 participants were taking part in this workshop, including teachers and administrative staff. Half of them were year 7 - 9 teachers of geography, computer, English, and morality. The other half are administrative staff working for the school office, printing room, foreign teacher department, and purchasing department. Small sampling restrained the variation over the following characteristics: sex (all female), married (all), and a university degree (seven bachelor’s and above degrees). Notably, one participant was pregnant at approximately 4 months at the beginning of the workshop. Additionally, two participants with emotional disturbance suffered from depression related to their physical condition (see Table 1 for the participant characteristics).
Figure 1. Teachers’ preferences regarding the content, format, and time for mental well-being.
Table 1. Participants’ characteristics.
Characteristics of participants (n = 8) |
Demographic characteristics |
Female (%) |
8 (100) |
Age (in years) |
|
M (SD) |
41.9 (5.9) |
Range |
34 - 53 |
Married/cohabiting (%) |
8 (100) |
University degree (%) |
7 (87.5) |
Physical characteristic |
|
Current physical illness (%) |
3 (37.5) |
Current pregnancy (%) |
1 (12.5) |
Psychological characteristic |
|
Emotional disturbance (%) |
5 (62.5) |
Burnout (%) |
1 (12.5) |
2.3. Ethics
Participants in this workshop provided informed consent about the intervention and the nature of the study. They were invited to have feedback with personal reflections on their experiences in the mindfulness workshop, and all the names were given as pseudonyms for anonymity. Considering the dual roles of psychology teachers as both instructors and colleagues working in the same school, one author was invited outside the school, not as a staff member.
2.4. Settings
To provide a safe, undisturbed and confidential environment for participants, we booked the lounge that school staff used during the lunch break and free time every Wednesday. Meanwhile, we would arrange the tables and chairs in specific following our topics and give the notice to remind participants every time in advance. After all the team members arrived, we would lock the door to prevent interruption and create a comfortable place for the activities.
Subsequently, we started the mindfulness workshop in the first semester when the school began resuming offline studying after the COVID-19 lockdown in September 2020. The present study of the mindfulness workshop had been proceeded for 2 semesters until June 2021. There were approximately four months of one semester, except for the winter vacation, public holiday, midterm, and final exam weeks, and 8 sessions were prepared for one semester. However, we would cancel some of the workshop sessions and send messages to inform the notice when participants were less than 3, given that some members could run into urgent work situations taking time off in the WeChat group. Since the activities were not compulsory, if there were continuously fewer than 3 participants, the workshop would be terminated. Thus, we decided to have 8 sessions arranged for one semester as a baseline, maintaining an appropriate schedule.
Additionally, although we made plans for each session, there would be adjustments during the progress according to the practical factors. After every workshop, the instructor team discussed the process and content with the evaluation and summary for improvement. On the other hand, one author, Ye Dong, was under the supervision offered by Monash University for sessions, and the supervisor provided some ideas and suggestions for modification. Specifically, we would brainstorm and pull all the feedback together to alter the activities for group culture and individual variance.
2.5. Schedule
The group approach contained the MBCT delivering the manualized training program for learning mindfulness skills as well as AT delivering instructions with art material following different aspects for emotional expression. In detail, the rules and contents of art interventions were applied in Appendix 1. The instructions for mindfulness exercises are from The Mindful Way Workbook: An 8-week Program to Free Yourself from Depression and Emotional Distress, under the sound of sea waves for a relaxing environment. Also, the schedule of this workshop was applied explicitly with different topics about each stage’s content as planning (see Table 2).
Table 2. Workshop schedule.
First stage—Warm-up Topic—exposure to modified MBAT and ice breaking |
Session 1 |
Introduction and informed consent |
Session 2 |
Modified MBAT introduction |
Session 3 |
Mindfulness of the Breath (10-Minute Sitting Meditation)
and painting experience |
Session 4 |
MBCT psychoeducation (automatic pilot) and body scan practice |
Second stage—Development Topic—self-exploration |
Session 5 |
Painting and 3-Minute Breathing Space (Regular Version) |
Session 6 |
MBCT psychoeducation (safe behavior) and Stretch and Breath Meditation |
Session 7 |
Creating artwork and 3-Minute Breathing Space (Responsive Version) |
Session 8 |
Oh card and Raisin Practice |
Third stage—Enhancement Topic—interaction of self and others (families, friends and colleagues) |
Session 9 |
MBCT psychoeducation (doing and being mode) with hearing activity and Mindfulness Seeing |
Session 10 |
Emotional card game and Mindful Movement |
Session 11 |
Magazine collage |
Session 12 |
Magazine collage |
Fourth stage—Completion Topic—integration of self and external system |
Session 13 |
Sharing self-mindfulness and Sitting Meditation |
Session 14 |
Story cube and Body Scan Practice |
Session 15 |
Mirroring activity and Working with Difficulty Meditation |
Session 16 |
Stretch and Breath Meditation and Mandala |
2.6. Data Analysis
Along with the content above for each stage, there were more details, changes, and challenges during the workshop in practice that would be kept in notes. Except for the exploration and sharing of feedback during the workshop, participants were interviewed individually with the same questions after the workshop completion. The interview was focused on three aspects of evaluation, experience, and impact from participants with questions in Appendix 2. After one year, an online questionnaire was administered to participants via a mini program for long-term impact analysis. The questions draw attention to the definition, contents, and long-term impact of the workshop. First, the answer to the question indicated what aspect this workshop focuses on from participants’ perceptions and experiences. Second, the impression of the specific contents of this workshop suggested the innovation of the MBAT. Finally, the comparison of participants’ conditions via scaling and mindfulness practice after the workshop implied the long-term impact of the promotion.
All the data above were collected, and the transcripts were read repeatedly by researchers. Comments and conceptual categories were generated following the theme of emotional well-being and modified MBAT with subcomponents identified. Data were coded in regard to the underlying question of this research.
3. Results
To assess and discover the efficacy and possibilities of the modified MBAT for high school teachers’ emotional well-being, components of stage evolution during sessions, interview feedback immediately after the workshop, and questionnaire feedback one year after the workshop were analyzed. Based on the theory of Gross in 1998, emotion regulation involves the process by which individuals influence what emotions they have when they have them and how they experience them. Specifically, the PA and NA aspects are ready to be changed by strategic interventions, including adapting events for increasing emotional well-being (Talbot & Mercer, 2018). In addition, the PA would be increasing and maintaining contrast to NA would be reducing and accelerating the adaptation to it (Talbot & Mercer, 2018). There were influences on PA and NA as stages evolved with modified MBAT contents and group setting facilitation derived from various components. The modified MBAT as one emotion regulation was hypothesized to be developed and improved for long-term emotional well-being promotion. In this section, attention is given to the impact of the workshop on PA and NA from different perspectives, attendance of sessions, long-term impact scaling, and improvement.
3.1. Contributing PA
Adherently, the findings have been organized to present the impact of contributing positivity, which is empowerment for prolonging PA. Initially, along with the proceeding, supportive, equal, and reliable rapport was gradually established as stage evolvement to empower participants. The first warm-up stage as the embarking stage is to ensure safety and comfort. During this stage, participants gradually broke the ice, established acquaintances with each other, and conveyed their curiosity and expectations toward this workshop. Second, the development stage with four sessions on different topics tried to assist participants in actively interacting. Participants became more familiar with each other, interacted more genuinely and supportive, and adapted to the group environment during this stage. For stage 3 of enhancement, as maintaining the positivity from previous stages, the interaction became mutual with deeper self-exploration. Group culture and group cohesion were strengthened when instructors blended into the workshop in the discussion. Furthermore, unstructured discussions occurred frequently and openly, in which instructors’ roles became less active and members became more skilled. The relationship became independent and free during the workshop process, and the autonomy of both participants and instructors evolved. The last stage of completion was approached the end of this workshop with complex emotions involving warmth, sadness, and achievement. This stage was derived from a shared journey and community via verbal interaction and nonverbal experiences in connectedness and solidarity. The group environment developed with empathy that group motivation and energy were created during the shared journey by sharing and magnifying positives. The role of instructors in this stage is important by emphasizing the embodiment and empowerment of the group.
Participants shared the common trouble of being busy with work and family as well as being upset by relationship issues and behaving mechanically frequently. And they expected to learn something from the workshop. They built deep bonds with all members in this group, it was a secret garden to experience peace and calm (All participants)
One participant cried and shared her pressure from financial difficulties for fostering a second child and the grief that she lost her father when she was 18. Another participant tried to conform the crying participant to her childhood experience of being poor. She studied hard to change her destiny due to her high self-esteem and self-requirement. (Participant Gao, Participant Z)
Subsequently, the specific contents of modified MBAT were vital in contributing positivity by empowerment. Mindfulness practice and AT activities as a combined coping strategy were provided to participants utilizing it in various conditions. As mindfulness concepts and exercises were fostered and consolidated with comprehension, participants experienced being present and aware of self-compassion in a secure and relaxed environment. It assisted participants in creating their own peace in dealing with daily challenges. Consequently, empowerment was demonstrated when participants regarded this workshop as “affection” and “harmony” after one year. Conjointly, the characteristic contents of AT managed communication and accelerated connections, facilitating social interaction skills. The bonding among participants and instructors was strengthened, which cultivated social connection as expansion providing support and power. Significantly, “connection” and “sense of belonging” were described as keywords from participants’ perspectives. In addition, the mindfulness concept and AT were applied with benefits to self-cognition in self-awareness enhancement and personal growth. With positive feedback, participants were evaluated with satisfaction about the unexpected efficacy in gaining self-understanding and self-care. During the interview, participants reflected on their experience and progress in self-empowerment. In detail, “raisin practice”, “story cube”, and “mindful seeing and hearing” were noted to be impressive and effective for providing energy from the questionnaire. Utilizing creative art materials emphasized self-exploration for participants in correlation with gaining insight and maintaining positivity.
Participants shared the workshop is great and helpful. The art and discussion bring the reflection on their experience and personality. Additionally, The mindfulness skill helped them find some peace in the preoccupation. (Participant C and Participant G)
3.2. Detracted Negativity
Aligned with the strategic adaptation theory, the findings synthesized the impact of detracting negatively from emotional well-being by alleviating negativities. First, to decrease and adapt to NA, the workshop helped participants in emotion regulation by reducing stress, utilizing mindfulness skills, normalizing universality and consolidating relief in difficulties. Consistent with the stage evolvement, boundaries were set such as time and confidentiality, giving clear instructions including explicit permission of speech time and order, and presenting confidence in leadership during the first stage to decrease nervous and strange feelings for participants. In the second stage, maintaining equality was important to prevent the feeling of being left out and ignored with the realization of the group and individual differences. During the workshop, some participants were noticed to be quiet all the time, and some of them were talkative. Specifically, some of the participants were self-involving and expressed more frequently. Therefore, instructors invited quiet participants to the sharing and discussion to balance the group with equality. The following stage began to break down the barrier between instructors and participants to remove estrangement. Instructors’ role has been weakened with each passing stage but also in mindful exercises and art interventions. Instructors were taking part in the exercise, activities and art pieces completed as a communal experience. Under profound interaction within and between group members, including instructors, participants initiated self-exploration following various aspects to discover the unknown and underlying cognition, reducing confusion and concern. For the last stage, the embodiment of instructors’ capacity to interact with the group as a whole was demonstrated due to the significance of maintaining the mindfulness concept. Spontaneously, the nonjudgmental and compassionate stance is indispensable to integrating into life-diminishing annoyance and worry.
Participants enjoyed the painting process and sharing, also indicated being relieved with the artwork turning negative into positive. Moreover, participants empathized with each other about their difficulties in the workplace and personal issues. Participants showed gratitude for this opportunity to acknowledge and experience the MBAT, which helped reduce stress. (All participants)
Alternatively, the advantages of the workshop contents were approved by participants’ feedback. Commonly, both mindful exercises and art interventions helped participants detract from negativity. As emotion regulation, the modified MBAT was deemed to be effective in emotion expression and reducing stress. Specifically, art interventions including painting and magazine collages helped lessen anxiety, further turning negative to positive while creating beauty. At the same time, participants described the workshop as “relaxing” and “peaceful”, indicating its efficacy in enriching mindfulness for relieving pressure. Moreover, the contents of the mindfulness concept and exercise as well as art interventions helped participants adapt to negativities. The psychoeducation of mindfulness was applied for cognition adjustment with the understanding of the cognitive system to weaken the negative impact. Simultaneously, the self-awareness of participants was developed when they were creating artwork. Through artwork sharing and discussion, participants formed consciousness with reflection on changes in self-recognition, which indirectly boosted adaptation.
“This workshop is a surprise with unexpected quality and effectiveness. I felt it helped reduce my stress a lot and encouraged me to engage in self-exploration, especially after my father had been diagnosed with cancer and I went to the hospital with him. It helped me with my emotion regulation and interpersonal connections” (Participant Z)
“The mindfulness skills are useful which I would do some exercise in daily life. And art intervention helped me recognize my negative thoughts” (Participant X)
3.3. Attendance
As presented above, the attendance of workshops was purely voluntary, and participants might be absent due to the work arrangement. Since school staff members do not have fixed break times, teachers, especially class teachers, need to mentor students in their free time and administrative staff members need to support teachers, students, and presidents. One participant dropped out after the first semester since the printing room became busy during lunchtime, and another participant missed out on several sessions since she hosted a tea ceremony club with time clashed in the second semester. Conversely, there was a new participant who attended this workshop at the beginning of the second semester via recruitment.
3.4. Long-Term Impact
The long-term impact was confirmed by the condition scaling of participants. The scale questions about participants’ well-being before, during, and one year after the workshop were collected for analysis (see Figure 2). Notably, 7 out of 8 participants were rated at least 2 points higher during the workshop than before. One participant even rated from 3 points to 8 points indicating the positive impact of the workshop. To conclude, the condition reflected by self-rating during the workshop was improved compared to the previous conditions. On the other hand, the long-term impact of scaling one year later was suggested to be correlated with the autonomous utilization of mindfulness practices after the workshop. Interestingly, the one-year later self-rating was found to be higher than the before-workshop status for all participants. In contrast, participants who had not practiced mindful exercise after the workshop rated the point lower than during the workshop. Whereas, participants’ ratings increased as they practiced mindfulness after the workshop. Overall, the peak rating point was centralized during and after the workshop, which implied the effectiveness of current modalities.
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Figure 2. Self-Rating of Well-being from 8 participants.
3.5. Improvement
On the other hand, there was feedback about some mindful exercises being hard to follow and being busy attending the workshop. Since most of the staff in the high school were not suffering from severe mental health issues with diagnoses, they would reflect being lack motivation for some difficult mindfulness exercises. The hardness of mindful experience could influence the engagement of participants who tried to find peace and comfortable preventing stress. Meanwhile, diverse choices probably confuse the intention and obstruct development because of the quick attempt and give up.
“The workshop is interesting and helpful, but it was hard to find time to join in each session.” (Participant C)
“It was good to learn some new things, and I was interested in psychology. However, some mindful exercises were hard, such as sitting meditation.” (Participant X)
In summary, the results exhibited the effectiveness of modified MBAT on promoting emotional well-being by contributing PA and decreasing NA based on the comprehensive analysis. Uniformly, positive response from participants and high attendance showed the applicability of the modified MBAT considering with its long-term impact.
4. Discussion
From the results, this study firstly innovates and assesses the modified MBAT, whose benefits and effectiveness are obvious for teachers promoting emotional well-being under COVID-19. Consistent with the goals and effects, significant improvements in emotional regulation had an impact on PA and NA. We found that aspects of the modified MBAT worked differently compared to the previous approach. There is a lack of studies on the mode of action of MBAT as well as its application in nonclinical settings. The innovation in the underlying mechanism of the current approach seemed to have a unique perspective as a breakthrough.
As introduced above, modified MBAT is supposed to differ from MBAT, which retained AT independently combining MBIs. AT interventions with activities that were applied as complementary roles magnified the effect in the present study. Astatically, AT did not have a systematic mechanism for practicality contrary to MBI. Hence, the underlying mechanism of the current modality would be generated by adding AT’s framework to MBIs’ mechanism. The model of mindfulness is broken down into simple constructs, and the core components embody the three axioms of 1) intention, 2) attention, and 3) attitude (IAA, Shapiro et al., 2006). Along with the process, they are interwoven aspects that occur simultaneously in a cycle, which cannot separate. Shapiro et al. in 2006 proposed a theory of reperceiving as a meta-mechanism of action including self-regulation, value clarification, cognitive, emotional, and behavioral flexibility, and exposure. The reperceiving involves standing back and witnessing a significant shift in perspective (Shapiro et al., 2006). Based on this model, AT was integrated to form consciousness in advance. Underlying, the process of the present workshop followed the mechanism of AT concluded perspectives from Margaret Naumburg and Edith Kramer as a symbolic form of self-expression through interpreting and analyzing the unconscious as well as facilitating the reconciliation of self-feeling and internal conflicts (Judith Aron Rubin, 2016). During the workshop, AT assisted in bringing unconsciousness to consciousness and then processed with MBIs intentionally focusing on the contents as a moment-to-moment process. When art interventions provide the opportunity to unearth omitted issues, they start to lead the self “in” with realization. Then, MBIs continue perspective shifting, strengthening the “observing self” as standing “out”.
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Figure 3. Model of modified MBAT, AT induced Unconscious to Conscious and the components of MBIs, Intention, Attention, and Attitude are interactive derived from Shapiro et al.’s study in 2006.
As illustrated (see Figure 3), the current workshop operated following this model to regulate emotions with effects on PA and NA. Parallel to the hypothesis raised by Guendelman et al. (2017), the core mechanism underlying MBIs and mindfulness is emotion regulation changes. The present study found that this 16-week workshop was effective, especially in reducing stress (NA). Consistently, there was evidence proposed by previous research of moderated effects on stress reduction via MBIs (Zhang et al., 2021). Specifically, a significant effect was found to be present in people at risk of living in stressful situations (Zhang et al., 2021). The current results exhibited observation, awareness, nonjudgment of inner experience, and description during the process, which is aligned with emotion regulation composition under the mechanism of MBIs proposed by Hölzel et al. (2011), providing a different approach to emotional reactions. In addition, Feng and Zhang 2020 suggested other perspectives on the mechanism of AT, validating our results in prolonging PA. Beauty and creation bring the positive, mindful creation process, and nonverbal format where the compositions assist people in maintaining PA. The art creation process of self-expression brought harmony and a sense of accomplishment, which could help individuals cope with negative emotions (Feng & Zhang, 2020). The goal of the painting process without judgment is to stimulate the experience of being at present (Feng & Zhang, 2020). Fundamentally, the nonverbal format is advantageous for observing and clarifying the inner experience of presenting psychological content and strengthening the emotional capacity (Feng & Zhang, 2020).
Subsequently, changing the perspective on oneself composition under this mechanism indicated the effects on self-cognition, even though the available evidence was weak (Hölzel et al., 2011; Zhang et al., 2021). In detail, mindfulness meditation separated the static self-cognition by enhancing awareness with increasing clarity, leading to an increasing sense of self (Hölzel et al., 2011). Static self-cognition is considered to be the cause of psychological distress, which could be facilitated by developing meta-awareness as subjective experience and executive monitoring during the process (Hölzel et al., 2011). The development of self-cognition fostered the autonomy, which is positively associated with adaptability in the classroom and learning environment (Wilson et al., 2022). Moreover, the composition of presenting the whole self in painting comprehensively uses body, mind, and spirit for individuals to experience and think. The effect on self-cognition was confirmed by the mechanism of feeling complete autonomy and integrity, presenting subjectivity and self-ego intuitively (Feng & Zhang, 2020). Meanwhile, self-esteem and self-awareness were found to be reinforced by AT-increased self-cognition (Hu et al., 2021). Collectively, self-cognition was enhanced under this mechanism with increasing PA as well as easier adaptation to NA.
Besides, the present study suggested the improvement of social interaction, whereas the mediator was unclear about the existence of the group process’s effect. Previous systematic reviews supported the effects of MBIs on prosocial behavior across interpersonal contexts with improvements in individuals’ well-being and positive connections with others for social and ecological sustainability (Zhang et al., 2021). Adherently, a study found that mindfulness helped increase social interaction in daily life (Lindsay et al., 2019). Meanwhile, social phobia and social anxiety disorder were associated with emotion regulation, which could be decreased in mediating fear extinction under the mechanism of MBIs (Hölzel et al., 2011), indirectly supporting the effects on social interaction. Compositions of symbolic expression and reconstruction as well as the “container” function of therapeutic relationships foster social skills. The presence of symbols and transitional spaces enhances the experience of freedom, ensuring security with fewer value constraints and defensive effects (Feng & Zhang, 2020). Also, the dual process of internal self and external interpersonal relationship was established in a secure, equal, and intimate environment (Feng & Zhang, 2020), which was vital for social interaction. Jointly, the mechanism of AT from various perspectives was consistent with the process and results of the present study.
Overall, the modified MBAT with an integrated mechanism from both MBIs and AT acts on the current workshop, which is applicable in the long term under a pandemic environment. The present mechanism was parallel to the prevention, mechanism, and rescue mechanisms in terms of specific operations proposed by Zhao et al. (2020). When this workshop assisted participants in relieving stress, tension and anxiety, and improving their self-cognition and self-growth, the construction moved from an intervention mechanism to a prevention mechanism that is conducive for long-term operation. Furthermore, from the perspective of the advantages of using modified MBAT, it was used to open the inward exploration mode for school teachers and staff under the environmental crisis, activate the internal resources of individuals, reconstruct the “problem”, fully empower them, and improve their happiness. Additionally, from the individual to the system, modified MBAT could provide a mutually respectful, equal, and safe environment to establish therapeutic relationships. Such a positive and communicative environment can better stimulate teachers’ inner strength, cope with external difficulties, and build a sustainable campus ecology.
5. Conclusion
The present case study is a qualitative study built on the process and feedback of the workshop with a small number of participants and time intervals. Notably, there were some limitations of this study that might have impacted the reliability and rigorousness, which need to be modified for future research. First, all the feedback and statements about the workshop were subjective and would easily be affected by the atmosphere, causing response bias. The present study utilized self-report via interviews and questionnaires due to the importance of self-experience with changes in perspectives during MBIs. Promisingly, self-report studies have become significant in demonstrating the changes in processes with internal and external aspects of self-presentation (Hölzel et al., 2011). However, self-reports could be biased by recall, estimation and other sources (Davidson & Kaszniak, 2015). As participants are colleagues with one of the instructors, the dual relationships might lead to compromise of the professional process with the intangible stress. Teachers and administrative staff from different departments are less familiar, and interpersonal relationships are respectful and polite. Although the feedback interview was one-to-one, the response bias probably appears in which participants valued the efforts the instructor as the interviewer put into the workshop. On the other hand, the nonmandatory character created a flexible and optional schedule that undermined the sense of organization and discipline. Participants who dropped out might have evoked the instability of the group, causing other influences on other participants’ behavior. Consistently, group cohesion might be weakened and associated with workshop quality. Furthermore, the duration of the workshop spanned two semesters with a winter holiday for one month. This time interval without any session probably increases disacquaintance with the mindfulness skills and distance among group relationships. New participants who took part in the second semester possibly led to some insecurity and discomfort for other participants disclosing private affairs. The group presumably needs more procedure and time to rebuild the rapport in relationship and empathy.
For future implications, researchers could focus on how derived MBAT could promote well-being and sustainability for teachers across a wide range with efficiency. The combination of mindfulness and art could be an alternative intervention to decrease the impact of environmental factors on high school teachers. To assess the effectiveness, long-term quantitative research could be conducted with pre- and post-evaluations. In addition, other creative art therapies, such as dance or music therapies, could be combined with mindfulness to cope with the environmental crisis, which could be discussed in the future. Interestingly, the participants were all female, which could be discussed and explored as the reason why this intervention combination is more attractive to the females.
To conclude, the current study is informative about the modified MBAT for high school staff’s emotional well-being promotion in China. Based on the process and feedback, the effectiveness of the innovation in intervention has been identified. From other aspects, the contents in detail could be substituted as long as the mindfulness is embodied for the group. The findings of this study implied that the four stages of warm-up, development, enhancement, and completion allow group cohesion. The mechanism and innovation of the modified MBAT was derived to improve emotional well-being by regulating self-cognition and social interactions. Presumably, the personal growth could be evolved along with the mindfulness skills being strengthened. However, the small case study could not provide significant validity and applicability. With these limitations above, the future implications could be more diverse and dynamic for large-scale studies.
Author Contributions
Conceptualization, Y.D., Z.J. and J.L.; methodology, Y.D.; validation, formal analysis, Y.D., Z.J. and J.L.; investigation, Y.D. and Z.J.; resources, Y.D. and J.L.; data curation, Z.J.; writing—original draft preparation, Y.D.; writing—review and editing, G.T. and Y.D.; supervision, G.T. All authors have read and agreed to the published version of the manuscript.
Institutional Review Board Statement
Ethical review and approval were waived for this study due to the unavailability of the Institutional Review Board (or Ethics Committee) at the affiliation of the second author who was responsible for data collection.
The audit (including president and school union) from the affiliation (The Branch School of the High School Affiliated to Remin University of China) of the second author who was responsible for data collection approved the research as Ethical review and approval granted.
Informed consent was obtained from the study participants.
The guidelines outlined in the Declaration of Helsinki were followed.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
The data presented in this study are available on request from the corresponding author.
Acknowledgments
We sincerely appreciate the valuable contribution of our teachers who joined in our workshop and RF high school providing this opportunity.
Appendix A
Rules and Structures of Specific Interventions |
Modified MBAT |
Introduced modified MBAT with a description of how the
intervention operates including case formulation of the
relation in thought, emotion, behavior, and bodily sensation |
Painting Activity ——stress reduction |
Provided papers, crayons, and glues, which participants chose three favorite colors representing small, medium, and large stress filling in the blank paper as thinking about the stress. Then, tear all three scrawl papers up and stick them together to recreate the beauty by gluing on another paper |
Painting ——family value |
Paper with 5 flowers outline was applied to participants to fill in with favorite colors and each flower would represent the value they bring to the family. Each participant exhibited their work with explanation |
Creating Artwork
——cops and robbers |
Participants joined in pair for this activity. One participant casually drew line on the paper with crayon and another one tried to catch it by drawing after until the paper full of lines as one piece for one participant. Then, switched roles and
repeated. Everyone would have one painting of messy lines as being robber, in which participants drew 5 shapes based on the existing lines then wrote a story with words of these 5 shapes |
Oh Card |
Oh card was utilized for participants to randomly select card and explaining 3 questions linked to the card. 3 questions are description of the card, what emotion this selected card
contained, and what self-experience linkage to the card |
Hearing Activity |
Participant joined in pair for this activity. The rule is that one person would talk for 1 minute, and the other one would only listen without interaction then retell the story,
afterwards switched the role repeating the procedure |
Emotional Card Game |
The rule of the emotional card game is to randomly choose 6 cards (3 pros and 3 cons) exchange the card with others via Rock Paper Scissors, and the winning person could choose one card they want from the losing person, finally shared what card they had and why they chose those cards |
Magazine Collage ——Shield-Making |
Dozens of old magazines and different sized of blank paper were provided, participants could cut 5 preferable pictures more from the magazines. Then, participants would cut the blank paper in different shapes as a shield and choose only 5 pictures from magazines sticking on the shield forming
favorite pattern. Afterwards, they shared why other pictures were left out as well as what pictures and shields represented |
Story Cube |
The story cube is a dice with 6 elements on each side.
Participant would play the story dice in sequence with each participant using the element on the cube to make up a story without other restrictions. The story would be completed in two rounds |
Mirroring Activity |
In the group, one participant was doing simple motions and other one need to imitate. After one motion, leading
participant would have eye contact with another participant pass on the leading position until everyone led the motion once |
Mandala |
Crayons and abrasive paper were provided. Participants would complete their mandala in any image and shape they like, which stood for this mindfulness journey |
Appendix B
Interview questions |
“How do you evaluate this mindfulness workshop?” |
“How did you feel during the workshop process?” |
“How did this workshop affect you afterwards?” |
Appendix C
The Survey of Teachers’ Mental Well-being and Psychological Skills Training Needs.
Question 1. Grade/Department (Single Choice)
Options |
Count |
Proportion |
Year 1 - 12 |
146 |
88.48% |
Administration |
19 |
11.52% |
Question 2. Are you responsible for class management (grade teacher, class teacher, and deputy class teacher) (Single Choice):
Options |
Count |
Proportion |
Yes |
77 |
46.67 |
No |
88 |
53.33% |
Question 3. How much do you think you know about mental well-being? (Single Choice)
Options |
Count |
Proportion |
Very well |
5 |
3.03% |
Relatively good |
42 |
25.45% |
Normal |
103 |
62.42% |
Not so well |
11 |
6.67% |
Very bad |
4 |
2.42% |
Question 4. How do you feel about your ability to consciously apply mental well-being knowledge and skills to solve problems in your work life? (Single Choice)
Options |
Count |
Proportion |
Very well |
7 |
4.24% |
Relatively good |
59 |
35.76% |
Normal |
89 |
53.94% |
Not so well |
5 |
3.03% |
Very bad |
5 |
3.03% |
Question 5. How much time do you prefer for mental well-being education-related training per semester? (Single Choice)
Options |
Count |
Proportion |
No time |
24 |
14.55% |
Within 2 hours |
52 |
31.52% |
2-8 hours |
57 |
34.55% |
8-16 hours |
18 |
10.91% |
Above 16 hours |
14 |
8.48% |
Question 6. Your preferred format if you want to attend mental well-being education training (Single Choice)
Options |
Count |
Proportion |
Offline lecture |
23 |
13.94% |
Offline workshop |
73 |
44.24% |
Online lecture |
46 |
27.88% |
Online training (once a month) |
23 |
13.94% |
Question 7. Of the following options, which mental well-being training are you most looking forward to participating in? (Multiple Choice)
Options |
Count |
Proportion |
Adolescent’s psychological development |
73 |
44.24% |
Identification and coping with psychological problems |
105 |
63.64% |
Psychology theory and practice on adolescents’ study |
54 |
32.73% |
Youth family problem identification and counselling |
84 |
50.91% |
Design of group counselling |
44 |
26.67% |
Youth career planning guide |
49 |
29.7% |
Self-exploration and stress reduction |
98 |
59.39% |
Others |
1 |
0.61% |