Boosting Resilience: Photovoice as a Tool for Promoting Well-Being, Social Cohesion, and Empowerment Among the Older Adult During the COVID-19 Pandemic.

This paper examines how older adults who participated in an online photovoice-based group intervention program reported their experience. In a qualitative-phenomenological study, in which 13 older-adult people participated, data were collected through semi-structured in-depth interviews and analyzed through content analysis. The findings point to three central themes: a) Challenges-technical difficulties, difficulties in finding a subject for photography, investing time in photography, and an emotional-intellectual effort to put their experience into photography; b) Growth: New knowledge and skills-acquiring new knowledge, acquiring skills, experiencing skills regardless of age, and empowerment; c) Meaning-reflexivity, the ability to project feelings onto images, connection to the outside world, mindfulness, ability to choose, creativity, and critical consciousness. The findings share the way in which the use of creative visual engagement with photography contributed to coping with various challenges and enabled various gains within the process among the older-adult participants.

Creating an empirically-based model of social arts as a public health resource: Training, typology, and impact.

Introduction: Mounting empirical evidence underscores the health benefits of the arts, as recently reported in a scoping review by the World Health Organization. The creative arts in particular are acknowledged to be a public health resource that can be beneficial for well-being and health. Within this broad context, and as a subfield of participatory arts, the term social arts (SA) specifically refers to an art made by socially engaged professionals (e.g., artists, creative arts therapists, social workers, etc.) with non-professionals who determine together the content and the final art product (in theater, visual arts, music, literature, etc.) with the aim to produce meaningful social changes. SA can enhance individual, community, and public health in times of sociopolitical instability and is an active field in Israel. However, SA is still an under-investigated field of study worldwide that is hard to characterize, typify, or evaluate. This paper presents a research protocol designed to examine a tripartite empirically-based model of SA that will cover a wide range of SA training programs, implementations, and impacts. The findings will help refine the definition of SA and inform practitioners, trainers, and researchers, as well as funding bodies and policymakers, on the content and impact of SA projects in Israel and beyond. Methods and analysis: This 3-stage mixed methods study will be based on the collection of primary qualitative and arts-based data and secondary, complementary, quantitative data. Triangulation and member checking procedures will be conducted to strengthen the trustworthiness of the findings obtained from different stakeholders. Discussion: Growing interest in the contribution of arts to individual and public health underscores the importance of creating an empirically grounded model for SA. The study was approved by the university ethics committee and is supported by the Israel Science Foundation. All participants will sign an informed consent form and will be guaranteed confidentiality and anonymity. Data collection will be conducted in the next 2 years (2022 to 2024). After data analysis, the findings will be disseminated via publications and conferences.

The Use of Online CB-ART Interventions in the Context of COVID-19: Enhancing Salutogenic Coping.

Community crises require the provision of short-term reflective intervention methods to help service users identify stressors, and access and intensify their adaptive coping. Here, we demonstrate the use of a single-session online cognitive behavioral- and art-based (CB-ART) intervention within the context of the COVID-19 pandemic. In this method, the individual draws three images: his/her COVID-19-related stress, his/her perceived resources, and an integration of stress and resources. This method provided a reflective space in which individuals could identify their experienced stressors, acknowledge their coping resources, and integrate these two elements within the context of the current pandemic. In this article, we use illustrative examples from a study implemented during the first national lockdown in Israel and present a tool that can be easily implemented by mental-health professionals in ongoing community crises. The aims of this intervention were to co-create knowledge with service users, access their self-defined needs and strengths, and enhance their coping by enabling them to view stress and coping as part of the salutogenic continuum.

Analysis of the Differential Relationship between the Perception of One's Life and Coping Resources among Three Generations of Bedouin Women.

Bedouin society has undergone rapid changes over the past decade. The younger generation of Bedouin women is better educated, which has enabled them to enter different professions, increased their incomes and elevated their social status. We examined the sense of coherence (SOC) and its components of meaningfulness, manageability and comprehensibility as well as the use of coping strategies among Bedouin women from three age groups. We also investigated the coping resources and strategies before determining the relationships between these variables in the three groups. One hundred ninety-six women participated in the study. Differences were found mostly between the oldest age group (61 years and older) and the two younger groups (21⁻40 and 41⁻60 years old). The oldest women reported less meaningfulness and used less positive reframing, planning, humor and acceptance. In terms of coping strategies, venting was used more by the youngest group whereas behavioral disengagement was used more by the oldest group. In the younger groups, SOC and its components were positively correlated with the use of coping strategies that are considered to be adaptive and with emotional support. However, the correlations between these factors were negative among the oldest group, which points to non-adaptive coping strategies used by these women. These results are discussed in light of the salutogenic, stress-appraisal and coping theories.

Using arts-based research to access sense of coherence in marginalised indigenous Bedouin youth.

The literature describes a mismatch between the core concepts of salutogenesis, or sense of coherence (SOC), meaning manageability and comprehensibility, as these concepts are manifested in research with Western populations, as compared to non-Western populations. The overall objective of this study is to explore this mismatch and to understand how the core concept of salutogenesis is manifested in youth ages 14-16 from the indigenous Bedouin ethnic minority culture of the Negev, Israel, in their own terms through arts-based qualitative methods. The research methods revolved 80 drawings and texts by youth who drew "a good day that went bad - and how [I] fixed it" as well as focus groups. All data, both verbal and visual, were analysed by dividing into themes and then socially contextualising the themes with a peer group. The findings reveal and concretize a mismatch in SOC between these youth and the predominant Western understandings of coping in terms of meanings, manageability and comprehensibility of coping methods. This study's theoretical recommendations are the need to take steps in the direction of closing the gap or mismatch between a universal versus culturally specific body of literature about culture and SOC. Its practical recommendations are to suggest such a methodology.

Shifts in Traditional Methods of Coping Among Elderly Bedouin Men.

Elderly Bedouin men in southern Israel are a unique traditional population living in remote unrecognized villages and experiencing rapid social transition, in addition to deep poverty and political tension. In this study, we aimed to explore stressful events, as self-defined by the participants, and the ways in which these men have coped with those stressful events. This study involved 12 men, aged 69⁻74, who participated in in-depth narrative interviews during which they were asked about transformative stressful events in their lives and how they had managed, understood, and utilized human capital, meaning-making, and other methods of coping. Analysis of the interviews revealed several themes: (a) the definition of stressful events within the cultural context, (b) the use of human capital to overcome those events, (c) the transformation of experience from hindsight into a didactic narrative that can be used to assign meaning to past events, which can then be passed on to the next generation, and (d) cultural transition as a catalyst for the creation of new understandings of events. This paper sheds new light on how elderly indigenous Bedouin men self-define stressful situations within a complex and unstable cultural context. This specific context, can help us to gain insight into how indigenous impoverished older men in similar contexts may self-define their stress and coping, based on the types of generalization accepted in qualitative research. The methodological contribution of this work lies in its use of narrative to culturally contextualize phenomenological meaning structures. Its theoretical contribution lies in its examination of the concept of stress within a specific cultural context.

Drawing on the Arts to Enhance Salutogenic Coping With Health-Related Stress and Loss.

The connection between art therapy and specific theories of positive psychology such as Antonovsky's theory of salutogenic sense of coherence (SOC) has been less articulated in the literature. This paper draws a methodological connection between art therapy and SOC, that is, meaning, manageability and comprehensibility, as the components of coping. This theoretical and methodological connection is then explored with a group of participants dealing with the health-stress of cancer. Method: We conducted a large-scale, qualitative study that included fifty transcribed hours of thematically analyzed arts processes and one hundred art works, used to explore salutogenic theory within a support group for recovering oncological patients. Results: The results point to the arts as including mechanisms that enhance meaning, manageability, and comprehensibility in an embodied and synergetic way. The art makes it possible both to separate and to 'fill' these three components, while on the other hand, integrating them into a cyclical element. We outline theoretical and methodological implications of understanding art therapy as a methodology to enact and concretize positive psychology theories, as well as presenting a protocol for using arts to enhance salutogenic coping in the context of health-related stress.

Humans' Relationship to Flowers as an Example of the Multiple Components of Embodied Aesthetics.

This paper phenomenologically and qualitatively explores the relationship between humans and flowers as a relationship that throws light on the synergetic dynamics of embodied aesthetics. Its methods include qualitative description and thematic analyses of preferred flower types, as well as concept maps of the general term 'flower' by 120 students in Israel. The results revealed the interactive perceptual-compositional elements, as well as embodied, relational, and socially embedded elements of the aesthetic pleasure associated with flowers. Implications of this case study are generalized to understand the multiple and interactive components of embodied aesthetic experiences as a deep source of pleasure through interactive stimulation by and connection to the natural world.

A cross-cultural perspective of medical clowning: comparison of its effectiveness in reducing pain and anxiety among hospitalized Bedouin and Jewish Israeli children.

PURPOSE: Medical clowning has proven effective for reducing pain, anxiety, and stress, however, its differential effects on children from different cultures have not yet been researched. This study evaluated the effects of medical-clowning intervention on anxiety and pain among Jewish and Bedouin children, and anxiety among their parents, in southern Israel. PATIENTS AND METHODS: The study was conducted in hospital pediatric departments and employed a pre-post design involving quantitative and qualitative methods. The study included 89 children whose ages ranged from 7.5 to 12 years (39 Jewish and 50 Bedouin) and 69 parents (19 Jewish and 50 Bedouin). Questionnaires assessing pain, anxiety, and demographics were used at the pre-intervention stage and pain, anxiety, and enjoyment of different aspects of the intervention were evaluated following the intervention. The intervention stage lasted for 8-10 minutes and included the use of word play, body language, and making faces, as well as the use of props brought by the clown. Semi-structured interviews were also conducted at the post-intervention stage. RESULTS: The intervention reduced pain and anxiety among both groups of children and reduced anxiety among both groups of parents. However, anxiety levels were reduced more significantly among Bedouin children. The nonverbal components of the clowns' humor were most central, but it was the verbal components that mediated the reduction in anxiety among the Bedouin children. CONCLUSION: This study underscored the effectiveness and importance of medical clowning in reducing pain and anxiety among children in different cultural contexts. Moreover, the issue of culturally appropriate humor was underscored and implications for intercultural clown training are discussed.

Arts as an ecological method to enhance quality of work experience of healthcare staff: a phenomenological-hermeneutic study.

This paper explores the impact of self-chosen arts-based recreational activities, as opposed to the traditional arts therapy activities, on the well-being of healthcare providers. Three qualitative case studies of programs in which arts-based activities were used to work with healthcare providers, lasting for 10 weeks each, are phenomenological-hermeneutically evaluated using interviews and focus groups. The findings show what we refer to as an "ecological" ripple of effects: (1) the arts-based activities helped to reduce individual stress and to enhance mood over time, (2) the activities helped to transform workplace relationships within wards, and (3) the arts humanized the overall work climate in the healthcare setting. These effects go beyond those of using the art production as a strategy for stress reduction and imply potential for a more encompassing role for the arts within healthcare.

Treating women with perinatal mood and anxiety disorders (PMADs) with a hybrid cognitive behavioural and art therapy treatment (CB-ART).

This paper presents an overview of a combined, evaluated protocol, cognitive behavioural and art therapy treatment (CB-ART), for the treatment of women with perinatal mood and anxiety disorders (PMADs). The protocol integrates cognitive behavioural interventions and art therapy. CB-ART focuses on changing distressing image, symptom or memory (ISM) that interferes with functioning. The method directs clients to identify compositional elements that characterize their stressful ISM and to alter the element in their imagination, in bodily sensations and on the page. Examples are provided to illustrate the therapeutic process.

Arts as a vehicle for community building and post-disaster development.

Use of the arts in international aid is common in an ad hoc form, but it has not been systematically theorised or evaluated. The arts have the potential to be a culturally contextualised and sustainable intervention for adults and children in the aftermath of war or disaster. On the micro level, the arts are a method to enable the retrieval and reprocessing of traumatic memories that are often encoded in images rather than in words. On a macro level, they can help to reconstruct a group narrative of a disaster as well as mobilise people back into control of their lives. This paper researches a long-term project using arts in Sri Lanka following the civil war and tsunami. A central finding is the need to understand arts within their cultural context, and their usefulness in strengthening the voices and problem-solving capacities of the victims of the disaster.

Computational Paradigm to Elucidate the Effects of Arts-Based Approaches and Interventions: Individual and Collective Emerging Behaviors in Artwork Construction.

Art therapy, as well as other arts-based therapies and interventions, is used to reduce pain, stress, depression, breathlessness and other symptoms in a wide variety of serious and chronic diseases, such as cancer, Alzheimer and schizophrenia. Arts-based approaches are also known to contribute to one's well-being and quality of life. However, much research is required, since the mechanisms by which these non-pharmacological treatments exert their therapeutic and psychosocial effects are not adequately understood. A typical clinical setting utilizing the arts consists of the creation work itself, such as the artwork, as well as the therapist and the patient, all of which constitute a rich and dynamic environment of occurrences. The underlying complex, simultaneous and interwoven processes of this setting are often considered intractable to human observers, and as a consequence are usually interpreted subjectively and described verbally, which affect their subsequent analyses and understanding. We introduce a computational research method for elucidating and analyzing emergent expressive and social behaviors, aiming to understand how arts-based approaches operate. Our methodology, which centers on the visual language of Statecharts and tools for its execution, enables rigorous qualitative and quantitative tracking, analysis and documentation of the underlying creation and interaction processes. Also, it enables one to carry out exploratory, hypotheses-generating and knowledge discovery investigations, which are empirical-based. Furthermore, we illustrate our method's use in a proof-of-principle study, applying it to a real-world artwork investigation with human participants. We explore individual and collective emergent behaviors impacted by diverse drawing tasks, yielding significant gender and age hypotheses, which may account for variation factors in response to art use. We also discuss how to gear our research method to systematic and mechanistic investigations, as we wish to provide a broad empirical evidence for the uptake of arts-based approaches, also aiming to ameliorate their use in clinical settings.

Women's stress in compulsory army service in Israel: A gendered perspective.

BACKGROUND: A growing number of women are serving in the military in a variety of roles, yet information on their experience of stressors not associated with either combat or sexual harassment is not commonly reported. OBJECTIVE: To present phenomenological data on stressors experienced in military service, together with the use of coping strategies as a way to focus on women's mental needs following deployment from service. METHODS: Twenty women who had recently completed their compulsory army service in Israel drew a picture expressing stressors they experienced in the army. They analyzed their own pictures on three levels: the content, context, and the composition as expressing stress and the resources they used in coping with stress. RESULTS: Six themes were raised: proximity to war situations, coping with accidents in training soldiers under their command, a conflict between political values and military orders, witnessing the injury of another female soldier, responsibility for accidental injury of a civilian, and distress over the army placement. CONCLUSIONS: Coping resources were relational, primarily family and friend support, rather than from the army framework. This reliance on relational sources of support was both a resource and a source of vulnerability and is viewed as distinct from men's style of coping.

Using art as a self-regulating tool in a war situation: a model for social workers.

War poses a challenge for social workers, adding exposure to direct risk of personal harm to the general stress of social work practice. Artworks are frequently used in health care settings with people in high distress. This study had three goals: (1) to characterize the stressors of social workers living in a war zone, (2) to teach social workers in crisis situations to identify stress and resilience factors in their artworks, and (3) to develop a general self-care model for arts intervention for professionals in these situations. Common stressors experienced by participants were anxiety and fear as a result of bombs, sirens, worry over loved ones, and overexposure to media. These were layered onto professional stressors, including constant work communication on cell phones during war and dilemmas related to work-family conflicts. Allowing social workers to name and identity the sources of their stress and then change their artwork to enhance resilience helped them to gain a sense of control over diffuse sources of anxiety. The authors propose this method as an effective intervention model with social workers in high-stress situations.

Embodied drawings as expressions of distress among impoverished single Bedouin mothers.

This paper demonstrates how marginalized, Bedouin, single mothers define pain through different depictions of their bodies and their embodied experience. Using visual data generated through an empowerment group with single Bedouin women living in the Negev, illustrative pictures were selected. The potential of drawing as an indirect, but deeply communicative symbolic vehicle with which to express the women's pain and struggle as marginalized and impoverished women is demonstrated through themes that emerged from a content analysis of the women's art and their verbal comments about what they had drawn. A central theme identified pain due to painful life circumstances, rather than due to inherent sickness or weakness. Other themes identified included the body as a site for cultural transition, power negations with men, intellectual development, and the struggles of motherhood. This shows how the visual depiction of pain on the page offers a socially critical, yet potentially mental health promoting medium that locates women's distress, not as the result of personal and physical weakness, but as the result of social oppression. The implications for the use of art with socially marginalized women are discussed.