Mindfulness and Engaged Creativity: A Best in Integrative Medicine

The words mindful and mindfulness are showing up everywhere these days, in exploring the value of mindful awareness practice in daily life with dishwashing and knitting, in advertising for beauty, health, learning and business products, and even as a more common form of everyday language. This recent popular interest in mindfulness has developed over 36 years following scientific interest and inquiry initiated by Jon Kabat-Zinn and the ongoing work of the Center for Mindfulness (CFM) at the University of Massachusetts with teacher training in the Mindfulness-Based Stress Reduction (MBSR) and other programs worldwide.

The resulting profusion of mindfulness as a concept or product has currently moved from trend to trendy. This commodification of mindfulness often belies the truth that mindfulness is a dimensional set of skills that develops over time and with practice. Learning mindfulness requires inquiry and unfolds more deeply in learning in relationship to others.

As a heart-centered human practice, mindfulness skills encourage our openness to experience as the process of our lived experience unfolds at each point in time. As it happens, openness to experience is key to our natural capacity for creativity and creative approaches deepen mindful inquiry, perhaps the more so with playful engagement with expressive tools. Specifically, engagement with making visual art has recently been shown to increase functional connectivity in the brain and is correlated with increased resilience or stress hardiness (Bolwerk et al., 2014).

With art therapy, creativity practice allows participants to shape a more generalized, integrative understanding of their subjective experience (on the art paper or in clay), thus transforming their inner experience into an observable object for reflection. Likewise in mindfulness practice, awareness of experiences is observed from a witnessing stance (Kabat-Zinn, 2009). With both approaches, personal reflection informs action towards living well. In this way, mindfulness and art therapy combined provides a powerful compass. It opens us to what’s happening now in life and acts as a bridge to what’s next. This growth is spurred on by the fact that mindfulness practice and creativity practice double up to support coherent learning in both our receptive and expressive domains.

By 2000, a number of mindfulness programs emerged from professionals engaged with the CFM to bring MBSR to clinical populations. Such programs included Mindfulness-Based Cognitive Therapy for Depression (Williams, 2000), Mindfulness-Based Eating Awareness Training (Kristeller & Hallett, 1999), and Mindfulness-Based Expressive Therapy for People with Severe and Persistent Mental Illness (Herring, 2014). In 2000, an art therapist and CFM Student developed the first piloted clinical program in Mindfulness-Based Art Therapy (Peterson, 2000) that resulted in research grants from the National Institutes of Health (NIH) (Monti et al. 2006; Monti et al., 2013). The extensive experience gained from leading the MBAT study groups informed the development of a new MBAT program, Walkabout: Looking In, Looking Out, which has been offered at Penn Medicine’s Abramson Cancer Center at Pennsylvania Hospital in Philadelphia since 2010 (Peterson, 2015).

Over the last two decades and independent of the CFM approach, art therapist clinicians familiar with contemplative traditions have explored the combination of these two non-verbal approaches. Individuals such as Paola Luzzatto and Bonnie Gabriel (Luzzatto and Gabriel, 2000) at Memorial Sloan Kettering, Michael Franklin at the Naropa Institute (2010) and Laury Rappaport (2009), founder of the Focusing and Expressive Arts Institute in California whose work has been informed by Buddhist teacher Thich Nhat Hanh, have been leaders in the examination of how these two components act in tandem.

In MBAT, creating images before and after mindfulness practices, such as guided sitting meditation or body scan meditation, supports clients’ abilities to expressively document their perceptual awareness or how they hold their experience. This is a novel way, though one of many, for exploring experience outside of the habits of speech. Making art before and after mindfulness practices is also a method of inquiry that yields information about any changes in state of mind or body. Drawing skills are not required for this, as images can be simply built from our earliest expressive language - that of line, shape and color. After this exercise, mindfulness practice continues by receiving the images without judgment. The ability to sit back and observe the expressed range of experiences in the pictures that emerge from these combined activities is very dynamic. It allows one to more objectively perceive the weight, shape, and color of experience and the narrative habits that may support feeling mentally or emotionally stuck. The quality of attention with mindfulness is kind and so with kindness this process informs activating intentions for responding more authentically to life’s challenges.

Evidenced-based outcomes point to the clinical value of the integration of mindfulness and art therapy’s creativity-encouraging practices. Two NIH-funded studies of Mindfulness-Based Art Therapy (MBAT) between 2001-2010 found that persons diagnosed with cancer showed significant clinical outcomes when using MBAT (Monti et al., 2006; Monti et al., 2013). The first MBAT program study included women with mixed cancer diagnoses and stages. Changes in pre to post program scores in the MBAT group showed a significant reduction in depression and anxiety, a better perception of bodily well-being, a significant reduction of the severity of overall distress and, importantly, improvements in their general health when compared with the control group of women who did not participate in the program and received their usual cancer care (Monti et al., 2006).

Clinical trial participants with breast cancer randomly assigned to receive the MBAT program, as compared to those assigned to a psychoeducational support program, demonstrated observable changes in their brains including enhanced cerebral blood flow. These changes were reported to be correlated with reductions in anxiety on self report measures (Monti et al., 2012). In this same clinical trial, women with breast cancer who presented with the greatest distress who received MBAT demonstrated significantly better outcomes as compared to women receiving the psycho-education program (Monti et al., 2013).

These clinical trial outcomes have encouraged the movement by art therapists to incorporate mindfulness in their work in such a way that mindfulness-based art therapy programs are emerging as clinical approaches within medical and mental health systems.

There is a life-enhancing synergy with the combination of mindfulness and creativity practices. Engaged creativity enhances mindfulness learning and mindfulness learning, in turn, enhances engaged creativity. This is integrative medicine at its best.

References

Bolwerk, A., Mack-Andrick, J., Lang, F.R., Dorfler, A., & Maihofner, C. (2014). How art changes your brain: Differential effects of visual  art   production and cognitive art production on functional brain connectivity. PloS ONE, 9(7). doi:10.1371/journal.pone.0101035

Kabat-Zinn, J. (2009). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York, NY: Delta Trade Paperbacks.

Herring, D., (2014). Mindfulness-based expressive therapy for people with severe and persistent mental illness. In L. Rappaport (Ed.), Mindfulness and the arts therapies: Theory and practice (pp. 168-180). London: Jessica Kingsley Publishers.

Kristeller, J.L. and Hallett, B. (1999). Effects of a meditation-based intervention in the treatment of binge eating. Journal of Health Psychology, 4(3), 357–363.

Luzzatto, P. & Gabriel, B. (2000). The creative journal: A model for short term group art therapy with post treatment cancer patients. Art Therapy: Journal of the American Art Therapy Association, 17(4), 265-269.

Monti, D. A., Peterson, C., Shakin-Kunkel, E., Hauck, W.W., Pequignot, E., Brainard, G.C., & Rhodes, L. (2006). A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psycho-Oncology, 15, 363–373.

Monti, D.A., Kash, K.M., Kunkel, E.J., Moss, A., Mathews, M., Brainard, G…  Newberg, A.B. (2013). Psychosocial benefits of a novel mindfulness intervention versus standard support in distressed women with breast cancer. Psycho-Oncology, 22, 2565–2575.

Monti, D.A., Kash, K.M., Kunkel, E.J.S., Brainard, G., Wintering, N., Moss, A.S… Newberg, A.B. (2012). Changes in cerebral blood flow and anxiety associated with an 8-week mindfulness programme in women with breast cancer. Stress and Health, 28(5), 397–407.

Peterson, C. (2000). A National Institutes of Health R-21 grant application with discussion: Mindfulness-based art therapy for cancer patients, MCP Hahnemann University, School of Health Professions, Department of Mental Health Sciences.

Peterson, C. (2014). Mindfulness-based art therapy: Applications for healing with cancer. In L. Rappaport (Ed.), Mindfulness and the Arts Therapies: Theory and Practice (pp. 64-80). London: Jessica Kingsley Publishers.

Peterson, C. (2015). Walkabout: Looking in, looking out: A mindfulness-based art therapy program. Art Therapy: Journal of the American Art Therapy Association, 32(2), 78-82.

Rappaport, L. (2009). Focusing oriented art therapy: Accessing the body’s wisdom and creative intelligence. London: Jessica Kingsley Publishers.

Williams, J. M., Teasdale, J. D., Segal, Z. V., & Soulsby, J. (2000). Mindfulness-based cognitive therapy reduces overgeneral autobiographical memory in formerly depressed patients. Journal of Abnormal Psychology, 109(1), 150–155.

About the Author

Caroline Peterson is a Board-Certified Art Therapist and Licensed Professional Counselor and the founder of Springboard Studio in the Mt. Airy neighborhood of Philadelphia. Her innovative work with Mindfulness-Based Art Therapy was the focus of two NIH funded research studies in oncology from 2002-2010. Since 2010, she has been a member of the Supportive Care Team at the Abramson Cancer Center at Pennsylvania Hospital/Penn Medicine where she developed a new MBAT program, Walkabout: Looking In, Looking Out. Caroline received advanced training to teach Mindfulness-Based Stress Reduction (MBSR) at The Center for Mindfulness at the University of Massachusetts Medical School; she received her graduate degree in the Creative Arts Therapy Program at Hahnemann/Drexel University in Philadelphia.