Practitioner Review: Effectiveness and mechanisms of change in participatory arts‐based programmes for promoting youth mental health and well‐being – a systematic review

Abstract

BackgroundParticipatory arts‐based (PAB) programmes refer to a diverse range of community programmes involving active engagement in the creation process that appear helpful to several aspects of children's and young people's (CYP) mental health and well‐being. This mixed‐methods systematic review synthesises evidence relating to the effectiveness and mechanisms of change in PAB programmes for youth.MethodStudies were identified following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses approach. Eleven electronic databases were searched for studies of PAB programmes conducted with CYP (aged 4–25 years), which reported mental health and well‐being effectiveness outcomes and/or mechanisms of change. A mixed‐methods appraisal tool assessed study quality. A narrative synthesis was conducted of effectiveness and challenges in capturing this. Findings relating to reported mechanisms of change were integrated via a metasummary.ResultsTwenty‐two studies were included. Evidence of effectiveness from quantitative studies was limited by methodological issues. The metasummary identified mechanisms of change resonant with those proposed in talking therapies. Additionally, PAB programmes appear beneficial to CYP by fostering a therapeutic space characterised by subverting restrictive social rules, communitas that is not perceived as coercive, and inviting play and embodied understanding.ConclusionsThere is good evidence that there are therapeutic processes in PAB programmes. There is a need for more transdisciplinary work to increase understanding of context–mechanism–outcome pathways, including the role played by different art stimuli and practices. Going forward, transdisciplinary teams are needed to quantify short‐ and long‐term mental health and well‐being outcomes and to investigate optimal programme durations in relation to population and need. Such teams would also be best placed to work on resolving inter‐disciplinary methodological tensions.

“Finding light in the darkness”: exploring comedy as an intervention for eating disorder recovery

“…Many participants highlighted the absence of specific expectations for recovery as a useful counterpoint to traditional forms of peer support. In this respect, compared to traditional clinical/therapeutic approaches, participatory arts-based (PAB) activities can serve as “alternative therapeutic social space[s]” (Williams et al , 2023, 26). The arts-based approach to the course further served to diminish the stigma around EDs and recovery (see Pavarini et al , 2021, p. 4), making it easier for participants to also connect to people outside the course.…”

“…The C4C workshops are a type of participatory arts-based (PAB) activity, i.e. an activity that is structured around participatory involvement in creative processes to support mental well-being (Williams et al , 2023). As a PAB activity, C4C is developed and delivered by an artist/arts practitioner – i.e.…”

“…While a drama therapist has received clinical training that enables them to adopt a dual role of group facilitator and primary therapist (Wood, 2015), the role of facilitator in C4C is to train participants to perform stand-up comedy while sharing perspectives of their own lived experience with anorexia. So, while a PAB activity such as C4C can have “ therapeutic” outcomes for participants, it is not (framed as) “ therapy ” (Williams et al , 2023; Pavarini et al , 2021).…”

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“…This conception of working "with" connects to the ideologies of participatory community research in autism studies (see 1.4 below) and critiques of the deficitfocused medical model in preference to a conceptualization of 'difference' informed by the neurodiversity movement and a social model of disability. In contrast to social scientists who typically measure efficacy in terms of quantifiable improvements in well-being, symptoms or behavior, PAB researchers prioritize enhancements in agency (via artistic expression), community engagement (via creative collaboration) and esthetics (qualities of the art produced) in evaluative reports (Williams et al, 2023). Consequently, the standardized questionnaires commonly used in health science are not designed to capture the kinds of change valued by arts researchers.…”

“…Both the art and the artist are transformed through their interactions, as well as being the catalyst for change themselves. A recent systematic review (Williams et al, 2023) of participatory art-based studies which evaluated outcomes related to mental health and wellbeing in young people found clear similarities between arts-based processes and clinically therapeutic processes, such as those involved in Person-Centered approaches to Counseling (PCC; Rogers, 1957Rogers, , 1959. In both the therapeutic work appeared to rest on establishing relationships of trust between practitioners and participating youth as well as between the children and young people themselves.…”