Even before the COVID-19 pandemic, many health care professionals admit they felt tired. Despite doing work they love, the days could be long or frustrating or very, very disheartening.
Two years of a global pandemic only intensified those feelings, adding layers of stress to their jobs and leading to burnout and turnover.
“It can be really hard to verbalize those feelings of frustration or grief or sadness,” says Marc Moss, MD, a professor of pulmonary sciences and critical care at the University of Colorado School of Medicine and director of the Colorado Resiliency Arts Lab (CORAL). “We deal with tragedy on a daily basis, and no one ever really taught us how to cope with it.”
For some health care providers, finding a voice for what they’re feeling can happen through the arts. Recently published research, which Moss helped to lead, demonstrates that health care professionals who participated in a 12-week creative arts therapy pilot study reported lowered rates of stress and anxiety from the beginning to the end of the program.
“One of the most important things we learned is that art becomes a medium to allow people to express fears, trauma, tragedy, events they’ve dealt with,” Moss explains.
Moss partnered with Katherine Reed, art therapist and Ponzio Creative Arts Therapy Program manager at Children’s Hospital Colorado, and Michael Henry, executive director of the Lighthouse Writers Workshop in Denver, to design and facilitate the clinical trials. "Between our four modalities – art, music, dance/movement, and writing – our therapist facilitators guided and encouraged the sharing and processing of these traumas,” Reed explains
Another vital lesson of the research "was how important it is to have a sense of community and a sense of safe space with people who understand," Moss says, and Reed adds, “The arts are natural community builders that help create a sense of vulnerability and authenticity.”
“It’s an occupational health issue”
The idea for the research grew from nearly two decades of studying issues of wellness and well-being among health care professionals, Moss says. As a pulmonary critical care physician, he not only feels the stresses associated with working in health care, but sees his colleagues navigate them as well.
“For a long time, nobody wanted to admit this was true,” Moss says. “Health care professionals have tough jobs, but they’ve tended to internalize it or think there’s something wrong with them if they were feeling symptoms of anxiety or depression. What we’re understanding now is that it’s an occupational health issue.”
The pandemic shed light on what health care professionals are feeling and experiencing, Moss adds, “and there started to be this understanding that stress leads to burnout and turnover, and that becomes a crisis for everyone if we don’t have enough people working in health care.”
As director of the CORAL – which is a partnership with the National Endowment for the Arts (NEA) that combines visual, musical, writing, and physical expression therapies and techniques to help providers identify, explore, and transform psychological difficulties – Moss has studied how creative art therapy (CAT) can benefit those experiencing stress, anxiety, depression, and other issues that may be associated with working in health care.
Before the pandemic, the NEA issued Requests for Applications (RFAs) for research proposals that could demonstrate the value of the arts in society. Among the NEA’s funding requirements was that researchers should partner with two arts groups, so Moss reached out to Reed and Henry.
Tapping into natural courage
“After Marc contacted me, we met with therapists at the Ponzio Creative Arts Therapy Program,” Henry explains. “They’re all trained art therapists, and I brought my experience leading workshops, so we started by creating a 12-week protocol, what we saw as the stages of this program, and how we can ensure it aligns with measurable science.”
Health care professionals from the CU Anschutz Medical Campus, as well other Denver-area facilities and organizations, were invited to participate and ranked their preference for the arts specialty areas the 12-week sessions would address: visual arts, writing, dance, and music.
Close to 150 participants attended weekly, 90-minute group sessions in-person for 12 consecutive weeks between September 2020 and July 2021. Each group was facilitated by a CAT-trained therapist and held at the Lighthouse Writers Workshop facility.
“The first four weeks revolved around creating a safe space,” Moss says. “People got to know each other, and one thing we learned in focus groups after the study was completed is that these traditional health care hierarchies, which I thought were going to be an issue, didn’t matter. I was concerned that if you had senior doctors in a group with junior nurses, those junior nurses might feel uncomfortable talking about certain things, but that wasn’t the case.”
Each session involved different exercises in creative arts, and the culmination of the program was creating a group project: a writing anthology, a song, a choreographed dance, or a visual arts portfolio.
“One thing reinforced through this process was that within these small groups, it’s a sacred space, and after a few weeks we could see that people understood that,” Henry says. “It’s a safe space for them to be vulnerable and for them to support other people presenting their vulnerabilities. I don’t think people go into this profession unless they have a certain amount of fearlessness – they’re unafraid to go into a room where death and pain are present – so I felt they were tapping into that natural courage that led them to their profession in the first place.”
Supporting health care professionals
Participants completed client satisfaction questionnaires at the beginning, mid-point, and end of each 12-week session, and results showed the program was feasible and acceptable to the attendees, and also demonstrated overall improvement in symptoms of anxiety, depression, burnout, and turnover intention scores.
With the results from this pilot study, Moss and his co-researchers are aiming for a larger grant proposal that will support a multi-center randomized trial focusing on CAT.
“I’d like to include an aspect of qualitative research where we can have focus groups with hospital administrators to ask, ‘What evidence would you need to make these interventions a part of someone’s work day?’” Moss says. “There are a lot of scary statistics about health care workers leaving the field, so how do we approach this as a matter of occupational health and safety? How can we support health care professionals?”