1. Creative Art: Connection to Health and Well-Being
“The most beautiful experience we can have is the mysterious. It is the fundamental emotion that stands at the cradle of true art and true science” (Einstein, 1931).
Throughout the ages, many cultures have used creativity and the arts to assist healing and to increase feelings of well-being. Stuckey and Nobel (2010) write, “throughout recorded history, people have used pictures, stories, dances, and chants as healing rituals” (para. Results). Over the years, there have been many philosophical discussions on the topics of creativity, healing, and wellness but only in the past two decades have health researchers and practitioners engaged in empirical studies on the effects of creative arts on health. Numerous studies show how various creative arts have beneficial and therapeutic effects on the physiological, psychological, emotional, and spiritual health of individuals across cultures and spanning the health spectrum (Daykin et al., 2021; Stuckey & Nobel, 2010; Tang et al., 2021; Tymoszuk et al., 2021). To understand the interrelatedness of these topics, we must first understand the concepts of health and creative arts individually. Later we will discuss and expand upon the correlation between creative art and health.
The World Health Organization [WHO] (2022) defines health as “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (Constitution, Para. 1). Further, WHO asserts that attaining the highest standard of health possible, is the right of every individual regardless of race, religion, political beliefs, or socioeconomic status. Social determinants and the cultural context underpin the concept of health, and health goals may not be the same for each individual and culture. Health goals for some individuals could include managing their chronic illnesses while still contributing to society in meaningful ways. The health goals for others could be to sustain health promotion and illness prevention (Fancourt & Finn, 2019). Either way, health is a dynamic process that can be self-managed regardless of specific health goals (Fancourt & Finn, 2019; WHO, 2022).
The concept of art may also be defined in various ways, though it has several common characteristics accepted across cultures. Elements of art embraced across cultures include that art is valued for itself and not only for its utility; art elicits expressive and emotional responses from both the producer and recipient; and art is creative and requires specialized skills to perform (Fancourt & Finn, 2019). Creative arts encompass a vast number of activities: some are activities that individuals can engage in alone (reading, writing, painting, drawing, and crafts), and others are activities that people can engage in with groups (viewing exhibitions and museums, going to the cinema or theatre, or listening to live music and dancing) (Tymoszuk et al., 2021). These creative art activities can potentially be beneficial to health in various ways. Each art activity can also bring forth multiple positive impacts (e.g., physical, psychological, and emotional benefits) and thereby may help decrease health issues and related healthcare costs (Fancourt & Finn, 2019; Tymoszuk et al., 2021).
Stuckey and Nobel (2010) state that due to globalization, we must embrace cultural diversity and different life philosophies and create strategies to share our lived experiences and their meaning. Many cultures already use the healing effects of creative arts to promote and sustain health. The relationship between art and health should continue to be studied and better understood through vigorous scientific investigation (Stuckey & Nobel, 2010). Participants who engage in creative art therapy describe it as enjoyable and uncomplicated and feel its psychosocial, physiological, emotional, and spiritual effects can enhance health and well-being (Stuckey & Nobel, 2010).
This study aims to explore the benefits of creative art therapy on health and well-being and to encourage the collaboration of the health and creative arts fields. We believe this is an area of health promotion that has great potential to sustain and improve global health and well-being and should continue to be thoroughly studied. In the following review, we will summarize the many benefits of creative arts on health and will specifically discuss and define the topics of creative art activities and health, receptive and participatory engagement: well-being and social connectedness, health and well-being in later stages of life, art therapy and children, creativity and well-being during COVID-19, and specific art therapies and their beneficial effects.
2. Creative Art Activities and Health
Engaging individuals in creative art activities is a form of health intervention that uses multiple components for health promotion. Fancourt and Finn (2019) list the elements for health promotion as “aesthetic engagement, involvement of the imagination, sensory activation, evocation of emotion, cognitive stimulation, social interaction, physical activity, engagement with themes of health, and interaction with healthcare settings” (p. 3).
Fancourt and Finn (2019) note that these creative arts components elicit various psychological, physiological, social, and behavioural responses. These responses include “enhanced self-efficacy, coping and emotional regulation, lower stress hormone response, enhanced immune function and higher cardiovascular reactivity, reduced loneliness and isolation, enhanced social support and improved social behaviours, increased exercise, adoption of healthier behaviours, and skills development” (p. 3). The multifaceted elements of creative art therapy, and the responses they elicit in individuals, produce outcomes that include health prevention, promotion, management, and treatment (Fancourt & Finn, 2019). Studies increasingly show that engaging in participatory and receptive art therapy increases feelings of well-being and facilitates the healing process (Stuckey & Nobel, 2010; Tymoszuk et al., 2021).
3. Receptive and Participatory Engagement: Well-Being and Social Connectedness
Tymoszuk et al. (2021) state that evidence of the beneficial effects of creative arts on health is growing. The authors used the HEartS Survey tool to balance the temporal variations in levels of arts engagement to decrease bias in the results of their research. Tymoszuk et al. (2021) also made a distinction between “receptive engagement, art that has been created and is now experienced by a listener, audience member, or gallery visitor; and participatory engagement, the creation of and participation in the arts” (para. 5). Making this differentiation, Tymoszuk et al. (2021) ascertained participatory arts (reading, writing, painting, drawing, crafts, etc.) are mostly solitary activities, whereas receptive arts (theatre, music concerts, films, dance, etc.) are mainly social activities.
Tymoszuk et al. (2021) concluded, and agreed with previous studies that increased and sustained engagement in the arts is associated with increased feelings of well-being and social connectedness and decreased feelings of social loneliness. The authors also noted that knowing which art activities were more social (receptive arts) could help in the design of arts-based interventions aimed at populations at risk for social isolation and loneliness. Engaging in creative arts, both participatory and receptive, facilitates better social well-being. But for individuals who feel intense emotional loneliness participating in more social art activities can be the better and more effective option.
In the systematic review by Daykin et al. (2021) the term participatory arts encompasses art forms that employ both participatory and receptive engagement. Daykin et al. (2021) agree that positive social experiences are crucial to health and well-being. Well-being is increasingly studied in populations as it is associated with good health and happiness in individuals. As studies in the field of arts and well-being expanded, Daykin et al. (2021) state that loneliness is increasingly seen and recognized as an obstacle to health. Loneliness is regarded as a negative experience and can lead to poor health and decreased feelings of happiness. Analysis of the studies in the review by Daykin et al. (2021) demonstrated that engagement in creative arts enhanced well-being, alleviated loneliness, and encouraged social relationships through “bonding and bridging” (para. Results).
Engaging in (participatory arts), as defined by Daykin et al. (2021), encourages connections to others, feelings of belonging, and shared identity in a community. These creative arts (music, dance, theatre, creative writing, museums, and heritage) also foster personal development and community and civic awareness (Daykin et al., 2021). Daykin et al. (2021) caution “that it is important to acknowledge negative experiences as well as the fact that the benefits of different social capital dimensions may not be shared by all participants equally” (para. Conclusions). In brief, engagement in participatory arts activities, both solitary and social activities, can increase feelings of well-being, decrease feelings of loneliness, and impact health positively. One consideration, though, is that these positive outcomes may not apply similarly to all individuals.
4. Health and Well-Being in Later Stages of Life
A growing amount of data reveals that engaging in creative arts can promote health and well-being in individuals. This data inspired Liu et al. (2022) to conduct a study on how participatory arts activities (both social and solitary) can potentially contribute to “meaningful and creative later stages of life” (para. 5). Liu et al. (2022) based their study on Cousins et al. (2020) taxonomy of arts interventions for people with dementia, including adults in later stages of life with or without health challenges. As life expectancies continue to increase in many countries, Liu et al. (2022) wanted to see if engaging in art therapy could facilitate “creative aging” to help in areas of vulnerability, loneliness, and lack of meaning in life. The authors concluded that participatory arts could advance social connectedness, promote personal and artistic growth, and increase feelings of psychosocial well-being in older adults (Liu et al., 2022).
As the global population of individuals in the later stages of life rises, we need to find efficient approaches to improve their health and quality of life and decrease the potential rise of global health costs. For instance, depression in older adults can increase the global health burden by up to 27%, negatively impacting physical, psychological, and emotional health (Dunphy et al., 2019). Dunphy et al. (2019) examined the influence of four creative arts therapies (art, dance, drama, and music) on depression in older adults and their potential effects on improving health and well-being. After analyzing 75 studies in their systematic review, Dunphy et al. (2019) concluded that older individuals with depression had significant and positive health outcomes when engaged in creative art interventions. Dunphy et al. (2019) found that the benefits across the four therapies included: “physical (e.g., increased muscle strength; neurochemical effects, such as endorphin release), intra-personal (e.g., enhanced self-concept, strengthened agency and mastery; processing and communication of emotions), cultural (e.g., creative expression, aesthetic pleasure), cognitive (e.g., stimulation of memory), and social (e.g., increased social skills and connection), that were all considered to contribute to reduced depression and symptoms” (para. 1). The potential to improve health and decrease health costs through the use of creative arts is worthy of further research.
5. Art Therapy and Children
An estimated 10% - 20% of children worldwide have psychosocial problems that could impede their everyday functioning and school performance (Bosgraf et al., 2020). Emotional disturbances (anxiety, depression, and withdrawal); behavioural disorders (hyperactivity and aggressive behaviour); and social dysfunctions (inability to initiate and maintain social interactions with others) can have a critical impact on the lives of children and create a strain on families and the healthcare system (Bosgraf et al., 2020).
To treat these psychosocial dysfunctions, accessible and easily tolerable interventions are needed to help children achieve a better quality of life (Bosgraf et al., 2020; Cohen-Yatziv & Regev, 2019). Art therapies show the potential to help children increase self-esteem and self-awareness, foster emotional resilience, improve social skills, and reduce distress (Bosgraf et al., 2020). Bosgraf et al. (2020) and Cohen-Yatziv and Regev (2019) concluded, in their respective research, that art therapies impacted positively in contrasting degrees across domains. Specifically, certain art activities were more effective with specific dysfunctions, but all art pursuits showed benefits in every area. The authors recommend continued research on the effectiveness of art therapy on children (Bosgraf et al., 2020; Cohen-Yatziv & Regev, 2019).
6. Creativity and Well-Being during COVID-19
With the advent of the Coronavirus 2019 (COVID-19), people worldwide had to cope with stressors specific to the new pandemic conditions. Mental health issues such as depression, anxiety, and post-traumatic stress disorder were prevalent and widespread (Tang et al., 2021). Tang et al. (2021) examined the possible alleviating effect of creativity on crises and the potential of increasing well-being by creative engagement. The Tang et al. (2021) study was one of few to test the relationship between creative engagement, stressors from the pandemic, and well-being cross-culturally, with data gathered from China, Germany, and the United States.
Tang et al. (2021) began by defining well-being. They concluded that well-being is a wide-ranging concept and has several elements that can help define it. In describing well-being individuals speak of life satisfaction, positive feelings, happiness, engagement, and meaning and purpose in life (Tang et al., 2021). The Tang et al. (2021) study focused on people’s positive experiences during the pandemic crisis and how they were able to foster these feelings. Earlier research studies showed the correlation between having positive feelings and enjoying good health and longevity. Tang et al. (2021) surmised that those who experience positive feelings most of the time enjoy better health and live longer. Though there were some differences across cultures, the Tang et al. (2021) study deduced that crises precipitated engagement in creative processes, fostered creative growth, and increased levels of well-being. Tang et al. concluded, “Our study suggests that for people, creativity is an effective way to deal with crisis and to achieve flourishing experiences, and this mediating effect is significant for three historically and culturally different countries” (Tang et al., 2021, para. Discussion).
Braus and Morton (2020) concur, stating that using art therapy during the stress and isolation of the COVID-19 pandemic can promote self-compassion, which has been shown through empirical studies to reduce anxiety and depression and improve quality of life, psychological well-being, and social connection. The authors agree that COVID-19 and the safety precautions (social distancing, home confinement, closure of schools, etc.) necessary to prevent its spread brought about feelings of loneliness, alienation, and isolation in many individuals (Braus & Morton, 2020). Braus and Morton (2020) write that isolation can negatively impact health and well-being, increasing mental health disorders such as depression, anxiety, and post-traumatic stress disorder symptoms. Creative art interventions are easily accessible (both as a face-to-face method and in an online milieu) and cost-effective, promote self-care and autonomy and provide a healthy and creative outlet for stress and emotional turmoil (Braus & Morton, 2020). We feel that further research into the impact of art therapy on mental health and well-being would be of worth to global health during the pandemic crisis.
7. Specific Art Therapies and Their Beneficial Effects
The studies detailed in previous sections demonstrate that engaging in creative art therapy produces many benefits to health and well-being. Specific art therapies seem to have a more positive impact on specific health outcomes. Analyzing the data, we delineated which art therapies are most effective for each desired positive change in health.
Dance and Movement
While all types of physical activity are known to have advantageous effects on health, most studies, to date, have concentrated on moderate-intensity aerobic exercise and its benefits on cardiovascular health (Marschin & Herbert, 2021). Recently, health researchers have included dance, yoga, and gentle, dance-like martial arts (like tai chi) in their studies (John Hopkins Medicine, 2022; Marschin & Herbert, 2021; Mayo Clinic, 2022; Stuckey & Nobel, 2010).
Newer studies indicate that dance and movement have valuable, though less intense, benefits to the cardiovascular system, and these exercises also provide considerable advantages for muscular strength, coordination, flexibility, balance, gait, and relaxation (John Hopkins Medicine, 2022; Marschin & Herbert, 2021; Mayo Clinic, 2022). John Hopkins Medicine (2022) states that dance and movement (like yoga) alleviate chronic pain, stress, sleep disturbances, and fatigue. Further, dance, yoga, and tai chi also boost physical and mental energy, improve quality of life, and decrease negative feelings (John Hopkins Medicine, 2022; Marschin & Herbert, 2021; Mayo Clinic, 2022).
For older individuals or those with chronic diseases such as cancer, dance and movement can have many health benefits for physical, psychological, and spiritual health (Bungay et al., 2020; Stuckey & Nobel, 2010). In the study by Bungay et al. (2020), dance therapy positively impacted older adults by encouraging physical activity and social interaction that they found meaningful and enjoyable. Studies of breast cancer survivors indicated that dance and movement therapy relieved stress and anxiety, increased self-esteem and self-awareness, and improved body function, body image, and quality of life (Stuckey & Nobel, 2010). We believe further research into the advantages of dance and movement therapy and other creative art therapy would be of value.
Music
The study on the effect of music on pain sensitivity by LiKamWa et al. (2022) found that music and singing can impact people’s central pain responses and may be effective as an addition to pain management programs. Martin-Saavedra et al. (2018) concurred that music is effective for pain management though they cautioned that further studies were needed to standardize successful music characteristics as a pain mitigation intervention. The Canadian Cancer Society (2022) also supports using art therapy in conjunction with conventional cancer treatments to reduce some of the debilitating effects of chemotherapy and help with pain and stress relief. The Canadian Cancer Society writes that music therapy assists in relaxation and can potentially reduce pain, stress, and anxiety and improve quality of life. Cancer patients use integrative medicines (such as music and other art therapy) in conjunction with traditional cancer treatments to add natural approaches to managing cancer-related symptoms (Yun et al., 2017).
Further, Daykin et al. (2018) write, “there is reliable evidence for positive effects of music and singing on well-being in adults” (para. Conclusions). Daykin et al. (2018) note that consistent participation in community music and singing activities can foster improved mood, well-being, and quality of life and reduce isolation, depression, and anxiety. Other studies have shown that music therapy increases positive emotions and immune system responses and may benefit health by reducing stress and balancing blood electrolyte and protein levels (Stuckey & Nobel, 2010). In brief, recent studies show that engaging in music therapy is effective and safe in increasing well-being and improving some health outcomes. More extensive research into music therapy would be beneficial to studying its other health advantages.
Visual Art Therapy
Visual art therapy encompasses many creative arts such as textiles, collage, pottery, painting, watercolours, acrylics, crocheting, crafts, and others (Stuckey & Nobel, 2010). Engaging in visual art therapy produces an increased feeling of well-being by helping individuals focus on positive life experiences instead of psychosocial, emotional, and physical problems (Liu et al., 2022; Stuckey & Nobel, 2010). Participating in visual arts allows people to express themselves illustratively through a particular art medium and thus enhances their self-worth and identity (Stuckey & Nobel, 2010). Other studies found similar results.
The study by Liu et al. (2022) found that participants in various creative art forms felt safe and supported by the artist and valued the chance to connect with others, learn something new, and relax. The participants stated that while engaging in the therapy, they forgot about their physical and psychological limitations and were able to immerse themselves in the art and “have a good time” (Liu et al., 2022). In the same sense, studies on cancer patients engaging in creative art therapy found that it eased their preoccupation with their cancer diagnosis and allowed them to feel challenged and have a sense of achievement in doing something new and different (Stuckey & Nobel, 2010).
Hsu et al. (2021), in their study on the effects of creative art intervention on rural healthcare workers, found that engaging in Zentangle art (the process of concentrating while painting) had a positive and healing effect on emotions. The Zentangle art-based intervention demonstrated that painting therapy improved physical, psychological, and spiritual well-being in rural healthcare workers by reducing stress and frustration in the workplace, strengthening self-worth and the ability to function effectively, and increasing commitment to work (Hsu et al., 2021).
Finally, Story et al. (2021), in their longitudinal study on engagement in art therapy and mortality risk, established that participation in any creative art that is an active art-based therapy decreased all-cause mortality risk in adults, especially in older adults. Story et al. (2021) described “active” arts as those where the participant is actively engaged, not just observing. These arts include “painting, sculpting, pottery, or ceramics, singing or playing an instrument, acting in theater or film, creative writing, and handwork crafts (weaving, crochet, knitting, jewelry, leatherwork, woodwork, metalwork)” (Story et al., 2021, Para. Measures). The authors noted that participation in active arts fostered a high level of focus and mastery and provided an opportunity for social interaction that helped reduce feelings of loneliness (Story et al., 2021). The evidence shows that engaging in creative visual art therapy promotes improved health, well-being, quality of life, and human survival. It would be advantageous to continue empirical studies on how creative arts can further benefit health promotion and prevention.
Creative Writing
As with the other art therapies, creative writing, narrative, and poetry can play a positive role in health and well-being and will not contradict the medical view on healing but rather complement it by holistically treating the whole person (Stuckey & Nobel, 2010). Wall et al. (2020) note that creative writing is one of several arts-based therapies, with an increasing empirical base of evidence, fostering positive health and well-being outcomes. Mazza (2017) concurs, stating that there has been significant progress, with a scholarly base, promoting poetry as one of the crucial creative art therapies.
Cooper (2010), in the study on the use of creative writing as a therapeutic activity for mental health, found that participants benefited from belonging and sharing in a group and reported an increase in self-knowledge. Patients wrote about painful memories that they could not verbally express, and most were able to facilitate healing by distancing themselves from their traumatic experiences in writing (Cooper, 2010). Similarly, Punzi (2021) described creative writing as an activity that involves “contemplation and self-reflection.” In interviewing the authors who guided psychiatric inpatients through creative writing classes, Punzi (2021) learned that creative writing included “curiosity and joy as well as reflections on difficult emotions and existential questions” (para. Encounters). The creative writing sessions became an opportunity for sharing emotions, encouraging meaning-making, and promoting a sense of belonging (Punzi, 2021). In writing about and sharing feelings and experiences, participants improved their feelings of well-being and aided themselves in recovery (Punzi, 2021).
Poetry, as noted above, is a crucial part of creative writing. Creative writing participants in the Punzi (2021) article appreciated that their poetry could express their feelings thoroughly yet in a concise format. Comparably, the study by Perry and Edwards (2019) on arts-based learning approaches adapted for mobile learning found that a method they originated called poetweet (a short form of poetry) could convey students’ emotions, ideas, and complex feelings. Poetweet engaged students, increased participation in online class activities, made learners feel part of a community and decreased psychological isolation (Perry & Edwards, 2019). In the same sense, engaging in poetweet can motivate any individual to write a short poem and thus encourage creativity, foster a sharing of emotions, and make participants feel a sense of belonging (Perry & Edwards, 2019). We believe creative writing is valuable art therapy for supporting good health and well-being and should be studied thoroughly to examine its other health benefits.
8. Findings and Discussion
This review communicates the potential worth of using creative art therapy in increasing overall well-being and health in individuals. Art therapy fosters the management and holistic treatment of physical, psychosocial, emotional, and spiritual health problems and facilitates health promotion and prevention (Fancourt & Finn, 2019). An increasing number of empirical studies show the numerous benefits of art therapy through a wide range of medical conditions emerging across an individual’s lifespan (Fancourt & Finn, 2019). Several themes came to light in this review that we will discuss below.
First, the growing body of evidence on the beneficial effects of creative art therapy on health comes from many and varied research studies. The report from Fancourt and Finn (2019) reveals that the findings on the effects of creative arts on health come from a broad spectrum of research designs. Fancourt and Finn (2019) state that the research “included a spectrum from uncontrolled pilot studies to randomized controlled trials, from small scale cross-sectional surveys to analyses of nationally representative longitudinal cohort studies, and from individual case studies to community-wide ethnographies” (para. Findings). The studies also examined a variety of creative arts whose projects were in settings such as hospitals, community centres, schools, and homes (Fancourt & Finn, 2019). The diversity of these studies and sites increases the validity of the findings. But further research is needed to confirm the results due to the quality of some of the studies. Each art activity needs a more thorough examination to understand each specific finding since some art therapies (music, dance, and visual arts) have been explored more extensively than others (Fancourt & Finn, 2019; Stuckey & Nobel, 2010).
Second, studies indicate that creative art activities positively affect physical, psychosocial, emotional, and spiritual health (Fancourt & Finn, 2019). Creative arts facilitate the management of a wide range of health problems, including complex conditions needing multi-factorial treatments (Fancourt & Finn, 2019). For instance, Yun et al. (2017) found that many prominent cancer centres in the United States furnish information about integrative therapies (dance, yoga, music, massage, etc.) on their websites and provide these therapies in their facilities in conjunction with traditional cancer treatments. Creative art therapies have also been used effectively in complex functional, psychological, emotional, and behavioural conditions in children (Bosgraf et al., 2020) and older adults (Liu et al., 2022).
Finally, creative art therapy may be pertinent and acceptable to diverse cultures and underserved populations and potentially reduce the economic burden on healthcare (Fancourt & Finn, 2019). Fancourt and Finn (2019) write that each creative art activity can provide many health benefits “(e.g., supporting physical activity and with components that support mental health), consequently, they may be more efficient for certain health conditions than the co-prescription of a physical activity intervention and a mental health intervention” (para. Findings), thereby possibly being more cost-efficient. Fancourt and Finn (2019) also note that creative art interventions can be customized (and therefore be relevant) to different cultural and socioeconomic groups. Stuckey and Nobel (2010) concur that many cultures already use creative arts for healing, health prevention, and health promotion and write that art therapy interventions can potentially reduce the health costs of populations with higher risks of health problems.
There is substantial and credible evidence that creative art therapies beneficially impact all facets of health (including being culturally relevant and cost-effective). Our aim is to encourage more research into creative art and health to understand these impacts more thoroughly and help decrease the possible inherent biases of weaker studies (Fancourt & Finn, 2019).
9. Conclusion
Empirical studies show the potential of art therapies to improve overall well-being and health and deserve further research. Our review has shown that creative art interventions can be adapted to be culturally relevant to individuals from differing backgrounds and effectively improve a broad spectrum of health issues spanning a person’s life. Participants of creative art therapy describe it as meaningful and enjoyable and say it eases their preoccupation with serious health issues. Art therapies allow individuals to express themselves creatively in various art mediums, promoting their autonomy in self-expression and allowing self-reflection. Creative art activities are holistic and complement traditional medical treatments. Finally, creative art activities can treat complex physiological, psychosocial, emotional, social, and behavioural problems providing multifactorial benefits to well-being and health and may prove to be cost-efficient to an already burdened healthcare system. We believe that health practitioners and researchers should continue to explore the benefits of using art therapies on well-being and health. Studies show that creative art activities have an advantageous effect on health prevention, health promotion, treatment, and management of individuals in various stages of life who may face diverse health challenges. Through this literature review, we hope to encourage the continued collaboration of the health and creative arts fields.
Funding
This project was funded by a SSHRC Insight grant.