An evaluation of the impact of an arts intervention on the wellbeing of women who have experienced sexual violence

Grace, Pippa; Holt, Nicola; Halliwell, Emma

Abstract

Introduction
The study evaluated the impact of a four-session creative workshop on well-being and mood among women who had experienced sexual violence, run through Somerset and Avon Rape and Sexual Abuse Support (SARSAS; https://www.sarsas.org.uk/). We examined the impact of the workshop on trait measures of wellbeing. We also examined whether state mood after each workshop explained changes in wellbeing across the whole programme.
Methodology
Twelve women (average age = 41, range = 24-57) took part in the evaluation of the art workshops; five women completed the workshops in Autumn 2019 and seven in Spring 2020. Each set of workshops included the same themes, across four weeks: ‘Introduction to creativity’; Collage workshop; ‘Soul animals, clay workshop’; and ‘Calm spaces, a personal mixed media project’.
A pre-post design was used. The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS; Tennant et al., 2007) was collected at the beginning of the first workshop and after the final workshop. This assesses psychological wellbeing, such as feeling connected to others, experiencing positive emotions and being able to think clearly. A minimum ‘meaningful change’ in scores has been defined as an increase of three points, and a score of 40 or less has been associated with depression, and of 44 or less with possible depression. In addition, the Short Mood Scale (Wilhelm & Schoebi, 2007) was completed at the beginning and end of each workshop. This measured state hedonic tone (feeling content rather than depressed); tense arousal (feeling anxious rather than relaxed); and energetic arousal (feeling energetic rather than sluggish). At the end of the course participants completed a six-item evaluation scale (Wilson, Secker, Kent & Keay, 2017) and open-ended questions assessing their experience of the programme.
Findings
At baseline the average wellbeing score was 36.85 (range 18-63), indicative of ‘probable depression’. Multi-level modelling was used to assess change in wellbeing over time. This method allows for nested data, where, in this case, different measurement points over time were nested within individuals. There was a meaningful and significant increase in wellbeing (F(1,9.28) = 12.35, p= .006) on the WEMWBS, from week one to week four, increasing to 43.05 (SD = 9.92). After the course wellbeing scores were out of the range of probable depression, but still in the range of possible depression. It is worth noting that there was variation between individuals in wellbeing scores – with small (3) to large (18) points of increase – and for one participant there was a decrease (-3). Hence, not all participants appeared to benefit equally from the intervention. One factor that might impact upon the efficacy was attendance, as wellbeing change was significantly positively associated with the number of sessions attended (B = -7.625, t = -2.221, p = .047).
In addition, there was a significant improvement on all three dimensions of mood after taking part in the art workshops: a reduction in tension so that participants reported feeling more relaxed (t = 6.64, p < .001); increased energy and alertness (t = 6.24, p < .001); and increased contentment (t = 4.82, p < .001). Further, these changes in mood during the art workshops predicted longer-term changes on the WEMWBS, with statistically significant outcomes for all three dimensions: reduction in anxiety (B = .379, t = 3.02, p = .004); increased contentment (B = .282, t = 2.84, p = .006); and increased alertness (B = .360, t = 2.91, p = .005).
Participants reported that the art workshops had positively impacted on their art skills, confidence, motivation, positivity and relationships with others. Open ended feedback from women indicated additional benefits from participation. Specifically, they enjoying feeling connected to other women in the group, and felt that they had become less socially isolated as a result. Participants reported that they benefitted from the opportunity to bring the freedom of creativity into their lives. Finally, participants appreciated that there was no pressure to talk or share experiences, and felt that the creative process itself could be cathartic.
Discussion
The quantitative outcomes suggest that the four-week-long art intervention improved participants’ self-reported wellbeing, with a meaningful mean increase of 6 points. This wellbeing change was linked directly to the art workshops, since it was predicted by the extent to which participants reported feeling more calm, content and alert at the end of them. These findings are encouraging as they suggest that just four-weeks of art workshops can improve wellbeing. It is important to note that, although improved, at the end of the intervention, participants’ wellbeing scores were still indicative of possible depression. We would expect that a longer programme would lead to greater change.
The intervention was well received by participants. Yet, there was clearly variability in impact of this arts intervention on women, with some women experiencing more dramatic benefits than others. Attendance played a role in this. In addition, process factors during the workshops explained some variation – for example, the extent to which participants were able to relax in the workshops. This is important because looking at changes experienced across each session may help to identify, early on, which participants may need additional support to maximise the impact of the arts intervention.
Strengths and limitations of the study
The strengths of the study include the consideration of the mechanisms of change to well-being through the assessment of state-fluctuations in mood. The partnership between charity, arts practitioner and researchers also allowed an integration between the workshops and the evaluation with minimal intrusion or disruption to the sessions. The small sample size is a limitation. However, this is an ongoing project and more data is being collected which will boost confidence in the results. In addition, it would be optimal to have a control group or alternative intervention group so we could compare the improvements seen here with natural changes in well-being, or with a different therapeutic programme.
Conclusions and recommendations for further research
Our results indicate that arts interventions are an acceptable and effective intervention for women who are struggling with a history of sexual violence. However, more research is needed. Specifically, these findings need to be replicated with a larger sample, longer-term follow-up should be included to explore the stability of these changes, and longer programmes need to be evaluated to see if these can lift people out of the possible depression band of wellbeing scores. However, these findings are promising and support further development of this work.

References
Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., ... & Stewart-Brown, S. (2020). The Warwick-Edinburgh Mental Well-Being Scale. Health and Quality of Life Outcomes, 5, 63.
Wilhelm, P., & Schoebi, D. (2007). Assessing mood in daily life. European Journal of Psychological Assessment, 23(4), 258-267.
Wilson, C., Secker, J., Kent, L., & Keay, J. (2017). Promoting mental wellbeing and social inclusion through art: Six month follow-up results from Open Arts Essex. International Journal of Mental Health Promotion, 19(5), 268-277.

• Presentation Conference Type: Conference Paper (published)
• Conference Name: Culture, Health and Wellbeing Alliance International Conference
• Start Date: Jun 21, 2021
• End Date: Jun 23, 2021
• Acceptance Date: Feb 2, 2021
• Online Publication Date: Jun 8, 2021
• Publication Date: Jun 8, 2021
• Deposit Date: Mar 30, 2021
• Publicly Available Date: Mar 31, 2021
• Pages: 48-50
• Book Title: Culture, Health and Wellbeing International Conference 2021 CHW21 Research Proceedings
• Keywords: Art, wellbeing, sexual violence
• Public URL: https://uwe-repository.worktribe.com/output/7240851
• Publisher URL: https://www.ahsw.org.uk/wp-content/uploads/2021/07/CHW21-Conference-Research-Proceedings-June-2021-PDF.pdf