Managing depression through needlecraft creative activities: A qualitative study

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Introduction

This qualitative study explores women’s views about the personal meanings of creative arts activities and the subjective part they play in the self-management of depression. To place a boundary around the focus of enquiry, the participants in this study were all needlecraft practitioners. Needlecrafts comprise a wide variety of activities such as embroidery, tapestry, applique and quilting, and its products may be two-dimensional pictures or three-dimensional objects. It was anticipated that focusing on the common experience of working in fabrics and threads (to the exclusion of other art media) would facilitate the discovery of shared themes in the participants’ accounts.

Arts activities may be used to promote psychological well-being, whether these activities occur within a recreation, remediation or therapeutic context (Schalkwijk, 1994). While art therapists often regard the therapeutic relationship as central to facilitating clients’ exploration of emotional concerns about self, personal engagement in the process of art and craftwork may in itself promote well-being. Creative arts therapists often view the arts as facilitating self-expression, developing empathy and emotional awareness, promoting self-actualization and achieving a more integrated self (e.g., Case and Dalley 1992, Payne 1992, Payne 1993). Warren (1993, p. 4) argues “Each creative mark reaffirms the self. It says ‘I am here’, ‘I have something to express’.” Within the creative arts therapies, some research to examine these processes is underway although it is still limited in scope Gilroy and Lee 1995, Payne 1993.

The self-management of physical and psychological health have received recent attention by researchers (e.g., Berman & Iris, 1998). Studies of how people control and enhance mood have mainly focused on the use of relaxation and exercise strategies (e.g., Thayer, Newman, & McClain, 1994). There has also been some interest in relationships between leisure use and well-being, particularly among older people (e.g., Oakley and Pratt 1997, Sherrard 1998). However, people’s perceptions of the place of creative leisure activities in promoting their own well-being have been explored very little. Reynolds (1997) reported a qualitative study of needlework practitioners who were all coping with chronic illness or disability. They reflected on the role of needlecrafts in their lives. The women’s accounts frequently represented creative activity as a potent means of preserving or regaining a satisfactory sense of self. Their artwork helped them to define an “able” identity, regardless of their mobility limitations, pain or fatigue. This identity-enhancing function was particularly valued by those whose illness had enforced a dependent role within the family or early retirement from work. The findings demonstrated that individuals may have considerable ability to reflect in detail upon the meanings of creative activities and offer from a personal perspective, careful analysis of their therapeutic elements.

The present study sought to examine the role of needlecraft creative arts activities in the self-management of depression. Some respondents had received a medical diagnosis and treatment for depression but the majority had not. This may represent a fair sample from the community as depressive episodes are quite common yet often do not receive medical attention Gilbert 1992, Ormel and Sanderman 1989. Women are somewhat more vulnerable than men to episodes of depression (Nolen-Hoeksema, 1987). Depression and dysphoria often occur in response to stressful events that involve irreversible loss or failure. The psychological state of depression additionally reduces motivation, enthusiasm and self-belief, sabotaging attempts at active coping and problem-solving. Various conceptual perspectives have been developed to guide understanding of depression.

From a psychodynamic perspective, the depressives’ tendency to self-punish and turn anger inwards may be released through verbal or art-based means (Read Johnson, 1998). Where negative feelings are highly threatening and repressed, artwork may provide a safer, more oblique means of exploration than verbal therapy (Dekker, 1996). The artwork may also present a “container” for expressed emotions (Schaverien, 1989). Alternatively, the cognitive behavioral perspective regards depression as an outcome of both unconscious schemata (core beliefs) and more consciously available negative thoughts. The depressed person may have the subjective experience of facing overwhelming and uncontrollable demands, losses or failures Ormel and Sanderman 1989, Seligman 1975. Beck (1976) in addition suggests that the depression is fueled by negative intrusive appraisals about the self, ongoing experience and future possibilities. Additionally, depressed behaviors (such as passivity, inactivity and failure to self-reward) may exacerbate low mood and further diminish self-esteem. While cognitive behavioral therapy usually addresses these facets of depression through verbal interchange and behavioral “experiments,” creative arts experiences certainly can be helpful in challenging negative self-beliefs and reframing them into more positive interpretations of life experiences (Reynolds, 1999).

When offered formally, cognitive behavioral therapy of depression empowers the client do the following: (a) challenge spirals of negative thinking (e.g., through examining experiences that disprove negative appraisals of the self); (b) build self-esteem (to challenge depressives’ focus on self-blame and feelings of worthlessness); (c) foster an increased sense of control (to challenge helplessness about the present and future); (d) increase activity levels (to challenge lethargy and dysphoria); (e) schedule rewarding experiences (to challenge depressives’ tendencies to self-punish); and (f) enhance social support to increase buffers against stress and build self-esteem Beck 1976, Stern and Drummond 1991.

This study examines whether “lay” people within the community develop similar or different understandings to account for how and why creative arts activities help them to manage depression and promote well-being. This qualitative study, involving written narratives, will explore whether any of the therapeutic experiences mentioned above appear in respondents’ own accounts. The study also explores participants’ reflections about when and how they first discovered that creative activity alleviated low mood states. This will help to establish whether the meaningful management of psychological health through arts activities requires a life-long interest in the arts or whether artwork can become a potent vehicle for self-development even when engaged in for the first time in later years.

The findings may provide recreational, and remedial arts specialists (as well as art therapists) with further insights into the therapeutic facets of creative occupations. No claim is intended that needlecrafts are uniquely therapeutic. They provide a convenient focus for enquiry and further studies are needed to determine whether other arts-based recreational pursuits contain similar opportunities for managing depression and promoting well-being.

Section snippets

Design and procedure

This was a qualitative study of written narratives, supplemented in a few cases by interviews. Qualitative research seeks to explore the “insider’s” perspective, and so no formal evaluation of the respondents’ clinical state was attempted. The sample was recruited through requests for volunteers printed in national needlecrafts magazines available across the UK. Respondents were asked to reflect on whether and how needlecrafts helped them to manage depression. The age at which needlecrafts were

Discussion

There is limited research on people’s diverse coping strategies for managing depressed mood. This study opens a new avenue of enquiry, into the subjective meanings of creative arts activities. The findings suggest that the leisure activities with most personal meaning are not necessarily lifetime interests. The majority of the sample described discovering an occupation in later life that they now saw as vital to coping with stress. Many had been prompted by stressful events to try a new

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