Title of the module: Creative interventions to combat mental health problems

Organisation: Artemisszió Alapítvány

This module provides facilitators with both general and detailed instructions on using creative exercises to address mental health challenges, particularly among migrants and refugees. By integrating art, mindfulness techniques, and trauma-informed practices, you will learn to design workshops that support emotional expression, resilience, and community engagement.

Learning goals of the module:

After completing this module, the learner will be able to:

• Design workshops that use art therapy and mindfulness techniques to support emotional expression and community engagement among migrants and refugees.
• Identify and implement trauma-informed practices to create safe, supportive environments for workshop participants.

Recognize the mental health benefits of creative exercises and mindfulness, particularly for individuals from vulnerable communities.

Introduction to Art Therapy / Creative Exercises

This chapter will give the readers an overview of art therapy, its history, its relevance, its usage and its relation to mindfulness.

Art therapy has only gained recognition in the early 20th century, however, humans have been communicating through various forms of expression since before written history. Since the earliest known artifacts, such as cave paintings from around 40,000 years ago, humans have been using art not only as an emotional expression, but also due to its therapeutic benefits. Over time, as the fields of psychology and psychiatry evolved, so did the understanding of the therapeutic benefits of art.

Art therapy as a formal practice began with Adrian Hill, a British artist, who discovered its benefits while recovering from tuberculosis in the 1940s. Hill observed that drawing and painting helped him and other isolated patients alleviate emotional suffering. These creative exercises offered patients in sanatoriums a sense of freedom and emotional release, contributing to their healing. This discovery led to the broader adoption of art therapy in mental hospitals and institutions throughout Europe. In 1964, the United Kingdom established the British Association of Art Therapists, marking a significant step in the formalization of the field.

In the United States, Margaret Naumburg and Edith Kramer were notable figures in popularizing art therapy. Naumburg’s approach emphasized the psychological aspects, viewing art as a way to access unconscious thoughts and feelings, similar to the use of free association in psychotherapy. She believed that spontaneous artistic creation allowed patients to express their inner world. Edith Kramer, another key figure, focused on the therapeutic value of the artistic process itself. Kramer argued that the act of creating art, was inherently valuable for emotional processing and healing.

In the United States, the establishment of the American Art Therapy Association (AATA) in the 1960s further formalized the practice, which led to a growing acceptance of this method in mental health settings, schools, and hospitals. Research supporting the effectiveness of art therapy in addressing mental health issues began to accumulate, solidifying its place as a legitimate therapeutic approach.

Today, art therapy is recognized as an effective form of psychotherapy that helps individuals explore emotions, develop self-awareness, and improve overall well-being. It is used to address a wide range of mental health issues and is applicable in diverse settings.

When it comes to Art therapy, most people often assume it only involves visual arts, such as painting and drawing. However, there are other forms of creative expression that we can engage in and benefit from. Examples include: music therapy – playing, listening to, or engaging with music; writing therapy – getting things off our chest, which requires only a pen and paper; dance / movement therapy; psychodrama and drama therapy.

The connection between creative exercises and mental health using the example of migrants and refugees

As seen in the previous chapter Art therapy is beneficial for people due to emotional regulation and stress reduction. It enhances self-awareness, it improves mental health and well-being by enabling non-verbal emotional expression, and decreases feelings of shame and judgement as the focus is not on the final product, but on the creative process.

Other methods have similar benefits and even similar processes, which means they can be combined as complementary approaches. One such method is Mindfulness. Mindfulness involves being fully present and aware of one’s thoughts, feelings, body sensations, and environment without judgment. Although often associated with Buddhism, mindfulness has its roots in Hinduism, emerging between 2300 BC and 1500 BC in the Indus Valley. In Buddhism, mindfulness, or "sati", focuses on awareness and attention, which are central to Buddha's teachings as a path to enlightenment and liberation from suffering.

Mindfulness has evolved across various cultures and contexts over centuries. In the 20th century, it gained prominence in the Western world, particularly through the efforts of Jon Kabat-Zinn. In 1979, he developed the Mindfulness-Based Stress Reduction (MBSR) program at the University of Massachusetts Medical School, combining mindfulness meditation and yoga to help manage stress, pain, and illness.

As mindfulness became more popular, it was embraced by Western medical and psychological communities, leading to the development of numerous mindfulness-based interventions. These practices are now widely used to cultivate awareness, reduce stress, manage emotions, and enhance overall well-being.

The similarities between Art therapy and Mindfuless lie both in their effects and their methods. Both enable individuals to focus on the present moment; they both focus on the process, not an end goal; they both facilitate the mind-body connection through engaging the body and raising awareness about bodily sensations; they both offer opportunities for personal expression and reflection; and both can be practiced through non-verbal communication, without needing to articulate thoughts.

This is especially beneficial for several reasons. On the one hand, in Western culture, we place a higher emphasis on rational thinking and linear problem-solving, which affects how we approach our mental health. This often leads people to attempt to „think their way” out of their problems, which is why non-verbal and creative methods are so useful. On the other hand, creative methods might be even more beneficial to certain demographics. One such example is refugees and migrants. These populations often face a unique set of problems, leading to high stress and mental health challenges, such as: the loss of cultural and personal roots, trauma from war and violence, post-traumatic stress disorder (PTSD), and discrimination or isolation in their host countries.

Trauma is a pervasive issue, with 70-80% of refugees having experienced significant emotional scars from war or migration. Trauma can trap individuals in a constant state of alertness and fear, making it difficult for them to engage in rational thinking or feel safe. Art therapy offers a valuable way to address these challenges, helping refugees and migrants explore their emotions and regain a sense of control over their lives. As one psychologist mentioned, art therapy can expand narrow mindsets and help individuals find creative solutions to their struggles.

In addition to trauma, refugees and migrants frequently face culture shock, unmet expectations, and the loss of status they previously held in their home countries. Adults may find themselves in low-paying jobs despite having been highly educated or successful, and children may struggle to adjust academically and socially. These challenges create further psychological distress, contributing to feelings of inadequacy and loss of control. High expectations from family members in their home countries can also increase pressure, leading to financial strain and, in some cases, homelessness.

Migrants in some countries face additional systemic barriers such as lack of housing, language barriers, and a shortage of mental health services. The absence of strong migrant communities and societal pressures to assimilate make it difficult for newcomers to form supportive networks. Nationalistic and anti-immigrant rhetoric further exacerbates these difficulties, causing further social withdrawal, discrimination, and isolation.

To address these issues, a holistic approach to migrant integration is crucial. This includes not only providing for basic needs but also fostering emotional support and mental health care. Art therapy and creative exercises offer a non-verbal, accessible way for refugees to process trauma and adjust to new environments. These methods can be integrated with other forms of therapy and support, such as verbal counseling and mindfulness practices, to provide a more comprehensive healing experience.

Engaging in creative and/or movement-based activities can greatly alleviate this stress even when an activity is not explicitly therapeutic or a structured medical practice like Art therapy. In a survey conducted with migrants living in Hungary, we found that the majority of respondents engaged with a creative hobby, including activities like going to the gym, playing instruments, crafting, drawing, and painting. Whether done individually or in groups, creative activities allow individuals to express their emotions, vent frustration, and distract themselves from their problems. The majority (67 respondents) believe that creative outlets positively affect their mental health, with many describing creativity as a way to "give form and structure to feelings."

Popular creative activities include sketching, drawing, painting, theatre, drama, and singing. Many also express interest in dancing, writing, photography, and urban exploration. These activities not only help manage mental health but also foster community engagement, which is equally beneficial. While around half of respondents are not part of any community, those who are often participate in activities like sports, workshops, and community service. Being a part of a group provides social interaction, reduces stress, and offers a sense of inclusion, all of which contribute to improved mental and physical well-being.

Creativity, therefore, serves as a powerful tool for emotional expression and community connection, significantly aiding migrants and refugees in overcoming the psychological challenges they face.

Guidelines for Structuring a Workshop to Enhance Mindfulness While Engaging in a Creative Activity

Art therapy techniques or singular creative exercises can also be used outside of a specific Art therapy framework. This means that creative approaches can be a part of other types of therapeutic processes, and people can also get therapeutic benefits from expressing feelings through art outside of psychotherapy contexts. Shorter creative exercises can be the easiest to implement and include in other activities, such as in adult education, using non-formal education methods. An example of this could be using creative, art-based techniques as an ice-breaker or as part of a workshop.

However, we can build entire workshops around the use of creative methods to aid mental health challenges as well. In this case, there are several steps we need to take even before the workshop (in the planning stage), but also during it. Most importantly it’s essential to create a space that prioritizes safety, is trauma-informed, and focuses on the emotional well-being of participants. These workshops are not meant to address immediate needs like housing or employment, but instead to focus on emotional processing, cultural engagement, and therapeutic expression through creative tasks. If a participant is in dire need of housing, employment, medical or psychological care, then they might not be ready to attend a creative workshop just yet. In the planning stage you need to decide how you can gather information on participants that answers this question for you.

Let’s assume most people are in a somewhat stable environment and are ready to attend your creative workshop. In those cases, follow these principles:

• Create a Safe, Trauma-Informed Space: Safety is the foundation of any workshop, particularly for vulnerable groups such as migrants and refugees, many of whom may have experienced trauma. A trauma-informed approach requires giving participants control and providing clear information, which helps them feel secure. Start by outlining the logistics—explain the duration of the workshop, when breaks will occur, and where participants can find facilities like bathrooms and water. Offer options, allowing participants to decide for themselves when to take a break or step away. This sense of autonomy helps mitigate feelings of powerlessness, a common experience for those who have undergone trauma.
• Providing information about the structure of the session, like what activities will be included, can also reduce anxiety. Language barriers may arise, so it's crucial to have a translator available or clearly identify who participants can turn to with questions. Acknowledge that not everyone speaks the workshop's language fluently and encourage the use of simple, clear language.
• Use Creative Techniques to Aid Self-Expression: Creative activities allow participants to express emotions that may be difficult to articulate verbally, offering a therapeutic outlet for processing complex feelings. This can mean many things: working on one project together, working on similar projects in parallel (like painting mugs together), or allowing participants to work on different projects in parallel (like one might paint a mug, another might create a collage). These parallel activities can be deeply calming and allow participants to engage their senses and bodies without the pressure of verbal communication. Given that many individuals may have anxiety about their artistic skills, it's important to offer a variety of activities, such as collage making, pin-making, or other forms of craftwork. While drawing and painting may be options, they shouldn't be the sole focus, as many participants might feel uncomfortable or incapable of excelling in those areas. Offering choices like these ensures that everyone can participate without feeling intimidated by a lack of formal art training.
• Facilitate Positive Feedback and Empowerment: Workshops should be designed with empowerment in mind. Many migrants and refugees may struggle with low confidence, especially in an unfamiliar environment where they don’t speak the language or posses advanced creative skills. Constant positive feedback is essential to help build their confidence and reduce anxiety. Encourage participants to embrace the process rather than the result, emphasizing that their creative expression is valuable, regardless of the outcome. Furthermore, it's crucial to adopt a participatory process in which the knowledge and experiences of the participants are recognized and valued. Facilitators can invite participants to share their insights, or even take an active role in organizing a community event or leading aspects of the workshop. This not only helps build a sense of ownership and involvement but also encourages community building among the participants.
• Balance Emotional Expression and Practical Next Steps: While it's important for participants to express emotions, workshops should avoid becoming spaces solely for venting frustrations. Facilitators should guide the group toward discussions that acknowledge challenges but also focus on practical steps and constructive approaches to moving forward. This balance helps prevent the workshop from becoming overwhelming and ensures that participants leave feeling empowered rather than emotionally drained, or overwhelmed by emotions.

Be Flexible and Prepared: Facilitators must remain flexible, understanding that participants may not be used to workshops or structured activities. Some may arrive late, feel uncertain about how to engage, or experience discomfort during the session. It's important to be adaptable, offering adjustments to the schedule or activities if necessary, while also reassuring participants that their presence and participation – whatever form that takes – are valuable.

References

American Art Therapy Association. (n.d.). Art therapy. Retrieved from https://arttherapy.org/

Mindful. (n.d.). How to apply mindfulness in the creative process. Retrieved from https://www.mindful.org/apply-mindfulness-creative-process/

MindOwl. (n.d.). Mindfulness and art therapy. Retrieved from https://mindowl.org/mindfulness-and-art-therapy/

Neurolaunch. (n.d.). Mindfulness and art therapy activities. Retrieved from https://neurolaunch.com/mindfulness-art-therapy-activities/

PositivePsychology.com. (n.d.). Mindfulness workshop: Activities, exercises, and tips. Retrieved from https://positivepsychology.com/mindfulness-workshop/

Psychology Today. (n.d.). Art therapy. Retrieved from https://www.psychologytoday.com/us/therapy-types/art-therapy

Rubin, J. A. (2010). Introduction to art therapy: Sources and resources. Routledge.

Rubin, J. A. (n.d.). Introduction to art therapy: Sources and resources. Retrieved from https://archive.org/details/introductiontoar0000rubi

World Health Organization. (n.d.). Mental health and forced displacement. Retrieved from https://www.who.int/news-room/fact-sheets/detail/mental-health-and-forced-displacement

World Health Organization. (2023). Mental health and forced displacement: WHO fact sheet. Retrieved from https://www.who.int/publications/i/item/9789240081840

PLoS ONE. (2023). Mindfulness-based interventions for forced migrants: A systematic review. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0283889

Journal of Refugee Studies. (2024). Trauma and integration: The role of mindfulness in refugee mental health. Retrieved from https://academic.oup.com/jrs/article-abstract/37/2/336/7645481

Mindfulness for Integration Best Practices Handbook. (n.d.).