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• Arts engagement has been clinically shown to improve mental health, including reducing depression for those living with type 1 and type 2 diabetes.
• Depression is two to three times more prevalent for those with diabetes. Elevated blood sugar can even mimic the symptoms of depression.
• Creative arts therapy combines psychotherapy with artmaking and can reduce depressive symptoms and even improve blood sugar. Find out what to expect in a guided practice.

Visual artist Anna Schuleit Haber’s installation, titled Bloom, filled the former Massachusetts Mental Health Center with nearly 28,000 potted flowers before the building’s demolition. A response to the absence of life and color in the institution, her art packed the empty corridors, stairwells, and offices. 

Not just a metaphor for the potential of mental health care, it was an act of healing for herself, past residents, and their relatives. She shares, “They are serious stories at the most basic level but filled with brilliant, individual anecdotes—mixing the general pain and isolation shared by so many with the specific, and deeply personal, workings of survival.”

Bloom is just one example of a body of work that resides at the juncture of arts and health, where the arts can help people process a past trauma or current challenge. Studies show that artmaking and arts engagement may reduce depressive symptoms, improve overall physical well-being, and even slow cognitive decline. An exhibition like Bloom then has the potential to aid the artist and those who visit. 

Yet you don’t need to be an acclaimed visual artist like Schuleit Haber or an arts advocate to realize the health benefits of making and experiencing art. How exactly does an ‘arts for health’ approach best support those living with chronic conditions like diabetes and depression? And can establishing an arts practice help maintain your health over time?

Arts, Mental Health, and Diabetes

Arts engagement has been clinically shown to have a real impact on improving mental health, including reducing depression for those living with type 1 and type 2 diabetes. It’s proven to boost physical health, too. Painting and listening to music improve blood sugar outcomes due to reduction of cortisol levels (thanks to better function of the hypothalamic-pituitary-adrenal axis activated during stress). 

A recent World Health Organization report studied the relationship between arts, health, and well-being, in particular the effects of literature, visual arts, performance, and digital art. It found that artmaking and engagement support emotional regulation and meaning-making for those living with chronic conditions. Participation in group arts activities such as dance even boost the ability to cope with lifestyle changes related to a diabetes diagnosis. 

The Diabetes-Depression Snowball

People familiar with the highs and lows that come with diabetes might not be surprised that depression is two to three times more common for those who live with diabetes than in those who don’t. “There’s a high risk of depressive symptoms—from feeling hopeless to having trouble concentrating. The constant stress of managing a condition and reacting to that stress isn’t good, but it’s natural to feel overwhelmed and depressed,” explains Dr. Mark Heyman, PhD, CDCES, author of the new book Diabetes Sucks and You Can Handle It, and CEO of the Center for Diabetes and Mental Health.  

When blood sugar is elevated, in fact, it mimics depression. They mirror and feed off each other producing what Heyman calls the snowball effect. Mayo Clinic maps the journey well: Diabetes can cause complications and health problems that may worsen symptoms of depression. Meanwhile, depressive symptoms can lead to poor lifestyle decisions, such as unhealthy eating, less exercise, smoking, and weight gain. The combination affects the ability to perform, communicate, and think clearly, essentially interfering with how blood sugar levels are managed.

 Heyman adds that if you’re feeling depressed and have no energy or motivation, it’s pretty hard to make good choices. When it becomes difficult to comply with medication, exercise, diet, and therapeutic recommendations, the risk of serious complications also bumps up. The silver lining? Diabetes and depressive symptoms can be improved together. Effectively managing one can have a positive effect on the other. 

The most widespread go-to for diabetes-related depression today is drug therapy; however, psychotherapy, or working through mental health challenges by talking with a psychiatrist, psychologist, or other mental health provider, is also recommended as an alternative or complement to medication. Heyman agrees. “By adding therapy to the mix,” he says, “individuals get 1.) support through having someone to talk to, 2.) problem solving skills to make decisions with less stress, and 3.) skill-building to better process or make sense of current situations.”

And if someone’s not ready for therapy? Then self-help, in-app coaching, and peer support are other strategies that can help them cope with mood management through increased social support, according to Dr. Harpreet Nagra, PhD, VP of behavior science and advanced technologies at One Drop.

Enter the Creative Arts 

Art, music, poetry, drama, dance/movement, and expressive arts therapies are all examples of creative arts therapies that combine psychotherapy with artmaking. Founded on the belief that self-expression through artistic creation has therapeutic value, they focus on the process rather than the product, and are tailored to those who are healing or seeking deeper understanding of themselves, including the experience of living with a chronic condition. They’re safe, easily repeatable, and proven effective. 

Heyman says he believes they perform a similar role to talk therapy: “When you’re knitting or drawing, the mind thinks freely—it allows you to make sense of things, like when you’re talking to a therapist. Spending time with friends, walking, all of those can be a continuum of treatment. It’s really about the art of immersion, not just the art.” 

Arts therapies use creative techniques to transform thoughts and experiences into tangible art forms. They also work in the reverse where psychological and emotional undertones are examined during the artmaking process or after the work is made. With the guidance of a certified art therapist, symbols and metaphors found in the work produced may be decoded, leading to a better understanding of feelings and behaviors. 

Elizabeth Tobias, MA, expressive arts therapist, recommends a useful tactic called “substitution theory” to work through a challenge, where an ‘art problem, art solution’ may be applied to a ‘life, problem, life solution:’ “When you’re trying to figure out how to make something, you go through problem-solving steps. And when you consider that process, you discover metaphorical comparisons to life that you can draw from.” 

Expressive arts therapy differs slightly from other creative arts therapies in that rather than focusing on one art form, it weaves together many (useful when you have multiple or hybrid interests, or aren’t sure which medium is right for you). Tobias explains the mix of arts-based therapeutic modalities creates a new approach distinct from its component parts: “People need the time and opportunity to find what combination works for them individually.” 

That said, she recommends having someone you can share the artmaking experience with, not just for accountability but as a witness. “You don’t necessarily need a therapist. A friend, confidante, even your hairstylist, can be a good sounding board.” Simply showing someone a moodboard can be a first step. 

According to Dr. Judith Greer Essex, PhD, founder of the Expressive Arts Institute in San Diego, people are indeed looking for qualified coaches for growth and healing outside of a therapeutic setting as much as seeking out a certified expressive arts therapist to do the work within one.

Get Started with a Guided Practice 

Artmaking can help recover memories that may reveal beliefs of the unconscious mind. Over time, creative arts therapies can help improve self-esteem, manage stress, improve symptoms of depression, and help cope with a physical illness or disability. Essex affirms, “Through expressive arts, we do see healing of the conditions related to the chronic condition.”

Tobias notes that expressive arts is a very gentle modality for being so effective: “We take time to get to know each other, identify goals, and leave our comfort zone and experiment. Creating requires sensitizing, tuning in to the senses, the imagination, and the body.”

What can you expect from a session? “Sometimes we have planned activities and sometimes the process is spontaneous and improvised.” Tobias adds, “Even if we start with something planned, the session might end up going in a totally unexpected direction.” 

There are, however, a few fundamental steps:

• Concept it: As with any form of therapy, your first session will involve talking to the therapist about why you want to find help and learning what the therapist has to offer and to build trust. Together, you’ll come up with a plan.
• Warm up: Yes, there’s a warm-up for mental as well as physical therapy. When a person has a busy, stressful day, it’s not always the best time to jump in and make art. Expect a check-in followed by an exercise to relax the mind and body. The same holds true for a group session.
• Let it flow: Get ready! Your therapist will set you up with a prompt in the form of a question. Then it’s time to create, move, play, and explore in response. Your process may be observed as you work without interference or judgment.
• Talk it out: It’s time to wind down and reflect. Once you’re finished, your therapist will ask you questions, along the lines of how you felt about the process, what was easy or difficult about creating your art, and what thoughts or memories came up while you were working.
• Feedback: This last step is often where the magic happens and many spontaneous realizations occur. You’ll receive insights from your therapist, and fellow makers if you’re in a group, to stir up a few ideas of your own. And don’t worry—assumptions are avoided when offering observations to ensure a safe space. 

Heyman offers a caveat, “Sometimes you’ll work so hard to try to find answers in therapy and part of the processing might be realizing that there is no answer.” Tobias agrees that not everything can be resolved, and the best part of therapy for her is learning to be comfortable with uncertainty: “There's a lot of worry, concern, and ‘overwhelm’ in acceptance. When a person has to deal with a chronic condition, it’s frightening. It’s a limbic space, like when you’re diagnosed but not cured. A lot of life is spent in the unknown.” And that realization, too, is a breakthrough.

This article has been clinically reviewed by Lisa Graham, RN, BDN, CDCES, Director of Clinical Operations at One Drop.