The Effect of Creative Arts Therapy on Psychological Distress in Health Care Professionals



      Work-related psychological distress is common among health care professionals. We determined whether 4 creative arts therapy (CAT) programs were acceptable, feasible, and improved psychological distress and job turnover intention in health care professionals with burnout symptoms.


      Health care professionals were enrolled during the coronavirus disease (COVID-19) pandemic from September 2020 until July 2021. Participants attended in-person weekly 90-minute group session for 12 consecutive weeks. Intervention and control subjects completed surveys before the beginning and after the end of their cohort. The study outcomes were session attendance (feasibility), program satisfaction (acceptability), and change in symptoms of anxiety, depression, burnout, posttraumatic stress disorder (PTSD), and job turnover intention.


      We randomized 165 participants into 4 CAT interventions and 1 common control group across 3 sequential cohorts. Thirty-five randomized participants dropped out before the start of the cohort, and 16 were replaced from a waiting list. Therefore, the cohort consisted of 146 participants. On average, participants were 35 years old, white (85%), and female (92%). Overall, 52% were nurses, 10% were doctors, and 16% were behavioral health specialists. Participants attended a median of 9.5 [8-11] sessions. Program satisfaction was high with a median Client Satisfaction Questionnaire (CSQ-8) score of 31 [17-32] out of a possible score of 32. Participants randomized to the intervention had improvements in anxiety (P < .0001) and depression scores (P = .0007), total posttraumatic stress disorder score (P =.0002), burnout scores (P = .001, .003, .008), and turnover intention (P = .001).


      A CAT program is feasible, acceptable, and may reduce psychological distress and turnover intention for health care professionals.


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        • Azoulay E
        • Cariou A
        • Bruneel F
        • et al.
        Symptoms of anxiety, depression, and peritraumatic dissociation in critical care clinicians managing patients with COVID-19. A cross-sectional study.
        Am J Respir Crit Care Med. 2020; 202: 1388-1398
        • Dzau VJ
        • Kirch DG
        • Nasca TJ.
        To care is human - collectively confronting the clinician-burnout crisis.
        N Engl J Med. 2018; 378: 312-314
        • Moss M
        • Good VS
        • Gozal D
        • Kleinpell R
        • Sessler CN.
        A critical care societies collaborative statement: burnout syndrome in critical care health-care professionals. A call for action.
        Am J Respir Crit Care Med. 2016; 194: 106-113
        • Shanafelt T
        • Ripp J
        • Trockel M.
        Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic.
        JAMA. 2020; 323: 2133-2134
        • Reed K
        • Cochran KL
        • Edelblute A
        • et al.
        Creative Arts Therapy as a Potential Intervention to Prevent Burnout and Build Resilience in Health Care Professionals.
        AACN Adv Crit Care. 2020; 31: 179-190
        • Cimiotti JP
        • Aiken LH
        • Sloane DM
        • Wu ES.
        Nurse staffing, burnout, and health care-associated infection.
        Am J Infect Control. 2012; 40: 486-490
        • Poghosyan L
        • Clarke SP
        • Finlayson M
        • Aiken LH.
        Nurse burnout and quality of care: cross-national investigation in six countries.
        Res Nurs Health. 2010; 33: 288-298
        • Demerouti E
        • Bakker AB
        • de Jonge J
        • Janssen PP
        • Schaufeli WB.
        Burnout and engagement at work as a function of demands and control.
        Scand J Work Environ Health. 2001; 27: 279-286
        • Ma Y
        • Faraz NA
        • Ahmed F
        • et al.
        Curbing nurses' burnout during COVID-19: The roles of servant leadership and psychological safety.
        J Nurs Manag. 2021; 29: 2383-2391
        • Camic PM.
        Playing in the mud: health psychology, the arts and creative approaches to health care.
        J Health Psychol. 2008; 13: 287-298
        • Uttley L
        • Scope A
        • Stevenson M
        • et al.
        Systematic review and economic modelling of the clinical effectiveness and cost-effectiveness of art therapy among people with non-psychotic mental health disorders.
        Health Technol Assess. 2015; 19 (v-vi): 1-120
        • Martin L
        • Oepen R
        • Bauer K
        • et al.
        Creative arts interventions for stress management and prevention-a systematic review.
        Behav Sci (Basel). 2018; 8: 28
        • Maslach C
        • Jackson SE.
        MBI: Maslach Burnout Inventory; Manual Research Edition.
        Consulting Psychologists Press, Palo Alto, CA1986
        • Mealer MBD
        • Cochran K
        • Hodapp R
        • et al.
        A mindfulness-based cognitive therapy (MBCT) intervention to improve resilience and mitigate symptoms of burnout syndrome in critical care nurses: Results of a randomized trial.
        Open J Nurs. 2021; 11 (653–637)
        • Matsubara C
        • Green J
        • Astorga LT
        • et al.
        Reliability tests and validation tests of the client satisfaction questionnaire (CSQ-8) as an index of satisfaction with childbirth-related care among Filipino women.
        BMC Pregnancy Childbirth. 2013; 13: 235
        • Attkisson CC
        • Zwick R.
        The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome.
        Eval Program Plann. 1982; 5: 233-237
        • Burrage Jr., J
        • Vance D
        Client perceptions of satisfaction with AIDS services: an instrument development.
        J Assoc Nurses AIDS Care. 2008; 19: 228-234
        • De Wilde EF
        • Hendriks VM.
        The Client Satisfaction Questionnaire: psychometric properties in a Dutch addict population.
        Eur Addict Res. 2005; 11: 157-162
        • Marchand KI
        • Oviedo-Joekes E
        • Guh D
        • Brissette S
        • Marsh DC
        • Schechter MT.
        Client satisfaction among participants in a randomized trial comparing oral methadone and injectable diacetylmorphine for long-term opioid-dependency.
        BMC Health Serv Res. 2011; 11: 174
        • Aylard PR
        • Gooding JH
        • McKenna PJ
        • Snaith RP.
        A validation study of three anxiety and depression self-assessment scales.
        J Psychosom Res. 1987; 31: 261-268
        • Bjelland I
        • Dahl AA
        • Haug TT
        • Neckelmann D.
        The validity of the Hospital Anxiety and Depression Scale. An updated literature review.
        J Psychosom Res. 2002; 52: 69-77
        • Chen H
        • Li G
        • Li M
        • Lyu L
        • Zhang T.
        A cross-sectional study on nurse turnover intention and influencing factors in Jiangsu Province, China.
        Int J Nurs Sci. 2018; 5: 396-402
        • Foa EB
        • McLean CP
        • Zang Y
        • et al.
        Psychometric properties of the Posttraumatic Diagnostic Scale for DSM-5 (PDS-5).
        Psychol Assess. 2016; 28: 1166-1171
        • Watson D
        • Clark LA
        • Tellegen A.
        Development and validation of brief measures of positive and negative affect: the PANAS scales.
        J Pers Soc Psychol. 1988; 54: 1063-1070
        • Mealer M
        • Burnham EL
        • Goode CJ
        • Rothbaum B
        • Moss M.
        The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses.
        Depress Anxiety. 2009; 26: 1118-1126
        • Dyrbye LN
        • Shanafelt TD
        • Gill PR
        • Satele DV
        • West CP.
        Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial.
        JAMA Intern Med. 2019; 179: 1406-1414
      1. Galvin G. Nearly 1 in 5 health care workers have quit their jobs during the pandemic. Available at: Accessed March 14, 2022.

        • Shanafelt T
        • Goh J
        • Sinsky C.
        The business case for investing in physician well-being.
        JAMA Intern Med. 2017; 177: 1826-1832
        • Han S
        • Shanafelt TD
        • Sinsky CA
        • et al.
        Estimating the attributable cost of physician burnout in the United States.
        Ann Intern Med. 2019; 170: 784-790
        • Richardson S
        • Hirsch JS
        • Narasimhan M
        • et al.
        Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.
        JAMA. 2020; 323: 2052-2059
        • Lai J
        • Ma S
        • Wang Y
        • et al.
        Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019.
        JAMA Netw Open. 2020; 3e203976
        • Wong TW
        • Yau JK
        • Chan CL
        • et al.
        The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope.
        Eur J Emerg Med. 2005; 12: 13-18
        • Brooks SK
        • Webster RK
        • Smith LE
        • et al.
        The psychological impact of quarantine and how to reduce it: rapid review of the evidence.
        Lancet. 2020; 395: 912-920
        • Herrmann C
        International experiences with the Hospital Anxiety and Depression Scale–a review of validation data and clinical results.
        J Psychosom Res. 1997; 42: 17-41
        • Zigmond AS
        • Snaith RP
        The hospital anxiety and depression scale.
        Acta Psychiatr Scand. 1983; 67: 361-370