Articles
Minnesota Futures Award Supports ‘Creative Camp’ Research for Adolescent Mental Health https://med.umn.edu/news/minnesota-futures-award-supports-creative-camp-research-adolescent-mental-health
Creativity and the Brain https://twin-cities.umn.edu/news-events/creativity-and-brain
Creativity Camp Lowers Symptoms of Depression for Youth https://scope.umn.edu/creativity-camp-lowers-symptoms-depression-youth
The World Inside You https://wam.umn.edu/calendar/theworldinsideyou/
Presentations & Publications
Gail Bernstein, MD
Symposium 33: New Advances in Arts-Based Interventions to Support Mental Health and Well-Being in Adolescents (Symposium Chair: Kathryn Cullen, MD)
Thursday, October 26, 2023 American Academy of Child and Adolescent Psychiatry
Abstract:
Objectives: To learn about Creativity Camp, a novel intervention for adolescents with depression that is designed to build on teenagers' strengths such as flexible thinking and creativity
Background:
Depression in adolescents is a serious public health problem. Current evidence-based treatments include cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs). These interventions are beneficial for about 50-60% of depressed teenagers (March et al., 2004). However, there is an urgent need for novel interventions to treat depression in teenagers who do not respond to CBT and/or SSRIs and for those who relapse after a good response to these standard treatments.
This study was designed to pilot a new intervention (Creativity Camp) that focuses on enhancing teenager’s strengths such as flexible thinking and resilience. The goal of the intervention was to alleviate the inflexible, narrow, negative outlook of depressed teenagers and inspire them to develop new ways of thinking by engaging in creative activities. Engaging in the arts offers a pathway for exploring and expanding new ways of thinking, developing insights, and sparking self discovery (?Zarobe & Bungay, 2017)
We hypothesized that participation in Creativity Camp would be associated with decreases in depression symptoms on the Children’s Depression Inventory 2 (CDI 2) (parent and child versions) and would be associated with increases on measures of well-being including the Flourishing Scale and Zest for Life Scale.
Methods:
Inclusion criteria required that all participants be 12-17 years of age and have a depression score on the CDI 2 > 12 (parent version). Exclusion criteria were MRI contraindications, psychotic disorder, current substance use disorder, neurodevelopmental disorder or medical or neurological condition that would interfere with participation in camp, and current active suicidal ideation with inability to engage in safety planning.
Three cohorts of 12-14 teenagers each received the 2-week Creativity Camp intervention. Camp activities included creative writing, dance, origami, modelling with clay, and visual arts. Data collected were quantitative (self-reports of anxiety, depression, and well-being; neuroimaging; cognitive tests) and qualitative (field notes, interviews with adolescents about their artistic creations). This presentation focuses on quantitative measures of depression, anxiety, and well-being.
Data were collected at 4 time points: 2 weeks before camp, pre-camp, post camp, and 2 weeks after camp. Participants were randomized to Group A (received an assessment 2 weeks prior to camp) or Group B (received an assessment 2 weeks after camp). This design allowed for a wait-list control comparison (i.e., comparison of Group A’s change in depression symptoms after being on a waitlist for 2 weeks versus Group B’s change in depression after 2 weeks of camp).
To address our hypothesis that depression scores would decrease (and scores on well-being measures would increase) from pre-camp to post-camp, paired t-tests for each of the pre-camp and post-camp measures: parent and child CDI 2, Flourishing Scale, Zest for Life, and Satisfaction with Life. To determine if camp-related changes would differ from natural variation, we conducted paired t-tests on all measures for change over time in Group A (the change between the 2-week waitlist period) versus change over time in Group B (change from pre- to post-camp).
Results:
Forty-three participants were enrolled and 39 completed the study. Mention demographics: ethnicity, gender identity, diagnoses. Based on parent CDI 2, depression scores significantly decreased for all participants from pre-camp to post-camp (p=0.006, Cohen’s d=0.75). Further, there was a significant decrease in depression severity in Group B during the 2-week camp intervention when compared to Group A during the waitlist control period (p=0.004, Cohen’s d=xx). ?Add persistence of change for 2 weeks. Based on child CDI 2, depression severity decreased for all participants from pre-camp to post-camp (p=0.003, Cohen’s d=.51). However, decrease in depression severity in Group B during Creativity Camp when compared to Group A during the waitlist control period was not significantly different (p=0.15, Cohen’s d=xx). Based on the Screen for Child Anxiety Related Disorders (SCARED), there were no significant changes in anxiety following the camp intervention. There were significant increases on the Flourishing Scale (p=0.04, Cohen’s d=xx) and Zest for Life (p=0.02, Cohen’s d=xx) when comparing all participants from pre-camp to post-camp.
Conclusions:
Creativity Camp is a novel intervention that shows promise in reducing depression symptoms and enhancing well-being in teenagers with depression. Parent-report of improvement in their children’s depression was stronger than child-reported changes. Perhaps the aspects of depression that are most sensitive to change in response to Creativity Camp are those which parents can observe (i.e., behavior rather than internal feelings). Upcoming analyses of neuroimaging and cognitive data may enlighten us about the mechanisms of change. Future directions will include delineating the key components of Creativity Camp that are integral to change (e.g., engaging in specific types of creative activities, trying new things, teenagers seeing themselves in a different light, making new social connections).
Bibliography:
March, J., Silva, S., Petrycki, S., Curry, J., Wells, K., Fairbank, J., Burns, B., Domino, M., McNulty, S., Vitiello, B., & Severe, J. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA: The Journal of the American Medical Association, 292(7), 807–820.
Zarobe, L., & Bungay, H. (2017). The role of arts activities in developing resilience and mental wellbeing in children and young people a rapid review of the literature. Perspectives in Public Health, 137(6), 337–347.
Yeritmary Rodriguez Delgado
Rodríguez-Delgado, Y., Edoigiawerie, O., DiMaggio-Potter, M. E., Padilla, L., Taniguchi, Y., Klimes-Dougan, B., Cullen, K. R., & Koutstaal, W. (October 2022; November 2022). Engaging in a 2-week Creativity Camp boosts positive emotional tone and authenticity during imagination in adolescents with depressive symptoms. Poster presented at the SACNAS National Diversity in STEM Conference, San Juan, Puerto Rico, Oct. 27-29, 2022. https://www.sacnas.org/conference Also presented, as a poster, at the 20th Annual Biomedical Research Conference for Minoritized Scientists, Anaheim, CA, Nov. 9-12, 2022.
Abstract:
This multiphase intervention study examines whether inviting adolescents with depressive symptoms to participate in a two-week creativity camp enhances their imagination and redirects their negative thoughts. The creativity camp consisted of mental agility, creative writing, and design exercises. To test this, we administered newly-developed fMRI-based imagination tasks before and after the camp, followed by post-scan written reflection tasks. The reflection tasks were evaluated using a psycholinguistic application known as the Linguistic Inquiry Word Count (LIWC-22). This application categorizes words into various semantic categories and four summary variables: analytical thinking, clout, authenticity, and emotional tone. We hypothesized participating in a variety of creative activities would promote a more hopeful and beneficial outlook. Preliminary LIWC analyses on the Phase 1 reflective written task (N = 14 adolescents, aged 12-17) revealed an increase in authenticity and positive emotional tone in the participants. In contrast, a standardized neuropsychological measure of verbal fluency showed little or no change. These findings suggest that engaging in a creativity camp may improve the participants' emotional outlets, candor, and hopefulness. In conclusion, engagement in broader creative behavioral repertoires during the two-week creativity camp may positively impact adolescents' flexible thinking despite depressive symptoms.
Shanze (Zay) Hayee
Hayee, S., Friedman, J., Costa, O., DiMaggio-Potter, M. E., Padilla, L., Bernstein, G. A., Koutstaal, W., Mueller, B., Fiecas, M., Asojo, A., Mejia Medina, A., Wu, P., Taniguchi, Y., Cullen, K. R., & Klimes-Dougan, B. (November 2022). Engaging in a Creativity Camp may enhance flourishing in adolescents with depression. Poster presented at the 1st Global Scientific Conference on Human Flourishing, Online.
Abstract:
Flourishing, or living optimally and fully to one’s potential, can be thwarted by the presence of mental health disorders such as depression. Depression frequently emerges during the adolescent period, with as many as one in five adolescents experiencing depression prior to adulthood. Adolescents with depression are also at a higher risk for suicide. Over the past three decades, rates of adolescent depression and suicide have been on the rise. This emphasizes a need for a broader array of effective treatment options which have traditionally included psychotherapy and antidepressant medications. Recently, research has suggested using creative forms of expression can increase cognitive flexibility and combat symptoms of depression in youth. This study evaluated flourishing within the context of a two-week “Creativity Camp” intervention in which adolescents with depression participated in creative activities geared toward self-discovery in a group setting. Our primary questions addressed in this report include: (1) How does depression symptom severity relate to indexes of flourishing in adolescents with depression symptoms? (2) Does flourishing significantly increase within the context of the Creativity Camp? During the summer of 2022, 43 adolescents were enrolled into three separate cohorts of Creativity Camp (12-14 participants completed each cohort). Pre- and post-intervention assessments were conducted, including measures of depressive symptoms reported by youth and parents - the Children’s Depression Inventory (CDI) - and three child-reported measures of thriving: Flourishing Scale, Zest for Life Scale, and Satisfaction with Life scale. Depressive symptoms were inversely correlated with all three of the flourishing measures. Compared to baseline, post-camp depression severity scores were significantly lower, while post-treatment Flourishing Scale scores were significantly higher. There were no significant changes in the Zest for Life or Satisfaction with Life scales after camp. Increased flourishing after the Creativity Camp intervention may partly be due to the opportunities provided by the camp to engage in meaningful self-discovery and connect with other campers in a safe and fun setting. Camp experiences may have boosted campers’ sense of meaning, purpose, and sense of connection. Creating artwork and beginning to view themselves as artists may have also positively impacted flourishing. Study limitations include a relatively small sample size and a lack of an active control intervention for comparison. Further research on these effects and the relationship of creative activities with enhancement of flourishing and consequent reduction in depressive symptoms is warranted.
Michaelle Evangeline DiMaggio-Potter
DiMaggio-Potter, M. E., Padilla, L., Taniguchi, Y., Koutstaal, W., Mejia Medina, A., Bernstein, G. A., Klimes-Dougan, B., & Cullen, K. R. (November 2022). Creatively examining “The World Inside You” as a strategy to improve mental health in adolescents. Poster presented at the 20th Annual Biomedical Research Conference for Minoritized Scientists in Anaheim, CA.
Abstract:
Mental health challenges such as depression and anxiety commonly emerge during adolescence. Adolescents with depression and anxiety often get stuck in negative thought patterns, including views of themselves. Engaging in artistic activities in a group setting may be a novel approach to inspire adolescents, help them discover their creative strengths, and support their well-being by finding new meaning in their lives. Thirty-nine adolescents ages 12-17 years whose parents reported elevated depression symptoms participated in a 2-week “Creativity Camp” where they engaged in visual art, poetry, dance, creative writing, clay, and outdoor exploration activities. Creative activities focused on the theme, “The World Inside You,” in which adolescents explored their own world and communicated meaningful aspects of themselves and their lives through art. Adolescents completed self-report questionnaires to assess their mental health before and after the intervention: the Children's Depression Inventory, Second Edition (CDI 2), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Flourishing Scale. We conducted paired t-tests to examine change over time for all measures. Qualitative data collection included interviews and field notes. Adolescents were invited to have their artwork included in a public art exhibition. CDI 2 scores significantly decreased from pre- to post-intervention (t(38) = 3.33, p = .002). Flourishing Scale scores significantly increased after the camp (t(38) = 2.13, p = .04). SCARED scores did not change significantly after the camp intervention (t(38) = .40, p = .69). Preliminary analysis of qualitative data suggested that adolescents highly enjoyed the camp, appreciated the opportunities to connect with peers and to engage in artwork, and felt valued as artists. At the end of the camp, 87% of the adolescents agreed to have their artwork shown in a local public art exhibition. This study provides preliminary evidence that engaging in creative activities in a group setting may positively impact mental health in adolescents. Key ingredients of the success of this intervention may include opportunities that fostered peer connection, allowed new self-perspectives, and made adolescents feel recognized and valued as artists. Comparisons to a wait-list control will also be presented.
Olivia Edoigiawerie
Edoigiawerie, O., Cullen, K. R., Koutstaal, W., & DiMaggio-Potter, M. E. (November 2022). The effects of engaging in creative activities on adolescent depression. Poster presented at the 20th Annual Biomedical Research Conference for Minoritized Scientists, Anaheim, CA.
Abstract:
Depression weakens creativity and flexibility and brings about negative, narrow, and persistent thought patterns. Current therapeutic options focus more on reducing the symptoms of depression rather than focusing on patients becoming more resilient or flexible to depressive symptoms. We hypothesized that creativity can inspire adolescents with depression to develop a more positive outlook and improve their self-esteem. The current study used various verbal, visual, and multimodal creative activities to determine whether creativity impacts adolescent depressive symptoms. The creative activities were given over an 8-day creativity camp to participants whose ages ranged from 12 to 17 years old. The participants received mood measures, fMRI-based Imagination Tasks, Post-Scan Reflection Tasks, and Cognitive Tasks before and after completing the creativity camp. This poster focuses on 2 measures of depression, the Child Depression Inventory (CDI) and the Parent-Child Depression Inventory (Parent CDI). The CDI is a self-report completed by the child, while the Parent CDI is completed by the parent. Both are used to assess cognitive, affective, and behavioral signs of depression in children and adolescents ages 7 through 17. The results showed a decrease in both Child and Parent CDI scores from before to after the camp. The results suggest that adolescents with depression engaging in creative activities can possibly lessen their depressive symptoms.
UMN Undergraduate Research Opportunties Program (UROP) Projects
Olivia Costa
Using Creativity To Improve Cognitive Flexibility In Adolescents With Depression
Josie Friedman
Effects of Creativity Camp on Community Connectedness, Depression, and Flourishing Among Adolescents with Depression
Eva Gomez
Effects of A Creativity Intervention on Adolescents with Depression and Co-occurring Anxiety
Noah Shore
Creativity Camp Enhanced the Social and Physical Activities of Adolescents with Depressive Symptoms
