By Denise Williams | News & Views

When she was having a bad day, young Chyela always felt better after strapping on her roller skates and whirling around the family garage, the soundtrack from “Xanadu” blaring in the background. The joy in the movement and the power of the music just did something for her emotionally. She didn’t have a name for it — and she certainly never expected to carve a career out of it — but she did know she wanted to do something creative with her life and, hopefully, improve the lives of others in the process.

Today, Chyela Rowe, PhD, RDT/BCT, is doing just that at CHI Memorial Hospital in Chattanooga, Tennessee, where she manages the Arts Therapies and Wellbeing Program. There aren’t any roller skates; but there is drawing, singing, lyric analysis, drama, and more. And the focus isn’t teenage angst, like Rowe described from her youth. Here, she and her team target the fear, grief, anxiety, depression, and hopelessness that adult patients — including those enrolled in cardiopulmonary rehabilitation — grapple with due to a medical diagnosis or event.

The Case for Cardiopulmonary Rehab Patients

When you think of creative arts therapy, who comes to mind? Psychiatric patients? Sick children? People battling cancer? But what about cardiac rehab (CR) and pulmonary rehab (PR) participants?

Although she concedes that not much research has been done to evaluate arts therapy specifically in the CR/PR setting, Dr. Rowe says there’s ample literature to support this approach in people recovering from stroke or other neurological trauma. She also cites newer findings that speak directly to the benefits of music therapy for people with high blood pressure¹ and the favorable impact of the arts on psychomotor and cognitive function in the rehabilitative setting.²

There’s good reason, Dr. Rowe adds, that patient assessments for CR/PR patients typically include scoring on the PHQ-9 (Patient Health Questionnaire-9) depression scale. Whatever problems landed them in rehab likely come with changes in physical health, new limitations, and daunting lifestyle changes — the prospect of which may put them in a bad space emotionally or psychologically. And professionals in the field know that outcomes can suffer when patients are weighed down by stress and depression.

The arts represent just another way that patients can acknowledge and address those feelings, which can impact them from a clinical standpoint. They don’t need to be a karaoke superstar or the next Picasso, either. In fact, Dr. Rowe notes, they don’t need to have “a creative bone” in their body — as countless patients have demurred.

“If you’ve ever danced or listened to music, been to a museum or drawn a sketch of something, you may have some tacit knowledge about how each one of those engagements can affect you in a different way,” she explains. “I like to think of them as ‘languages’ to communicate our inner world or our relationship to the outer world in different ways. It’s not scary or embarrassing; we’re just using the tools to open up.”

At CHI Memorial, Dr. Rowe and her colleagues work with the CR and PR patient community in a group format. “The way we have supported that program is either my music therapist or myself — and sometimes we have interns who are studying art therapy or expressive therapies — do a rotation of the stress management education, which is a standard part of the weeks-long education that patients get.”

Employee well-being is a big deal at the hospital, too, so CR/PR staff don’t miss out on the benefits of creative arts therapy. A multi-room office in the hospital has been converted into a wellness space equipped with musical instruments, an art room and supplies, and a kitchenette, among other features. Access is 24/7, and once workers badge in, they can tinker with the piano, guitar, or drum; help themselves to a hot tea; or simply decompress under the soft lighting.

Room to Grow

CHI Memorial’s program, built from the ground up under Dr. Rowe’s leadership, is fairly new — barely five years old — and also relatively uncommon in the CR/PR space. That’s because, she speculates, insiders simply don’t realize the ways in which their patients are good candidates for art therapy.  “There are a lot of people managing these programs who aren’t thinking of creative arts as helpful in this setting,” she suspects, “so they may not be creating those opportunities.”

The more budget-conscious programs also might shy away from the expense of bringing on paid facilitators, who undergo specialized training and credentialing for the specific disciplines in which they work. Dr. Rowe received a Master’s in intermodal expressive arts therapies, which she describes as a “jack-of-all-trades” of the creative arts, before going on to additional training in drama therapy, the medium in which she is now credentialed.

Even if they can’t afford the investment at the moment, she says that doesn’t mean rehab programs can’t offer patients anything in the way of art therapy. “There are options that will definitely make a difference and help support your patients and the environment without a whole lot of training and skill,” Dr. Rowe assures. “It’s just when you want to have someone there to ask the questions and engage people and hold space in that therapeutic way using the art tools…that’s where it’s really helpful to have someone who’s had the ethical training, who’s had the skills practice and supervision, who’s got an understanding of abnormal psychology and personality and cross-cultural issues — all those kinds of things that make that therapeutic encounter a little richer and a little safer in ways.”

“But,” she continues, “that’s not to say that the other stuff isn’t helpful; it’s just different.” And all it really takes, she suggests, is somebody who’s willing to champion those initiatives. Like her own program at CHI Memorial, one option is to arrange rotating art exhibits populated by local artists. It’s something to engage around and, she adds, it’s a win-win for everyone, including the community. Meanwhile, something as simple as adult coloring books could have an impact. “There’s a benefit in just being able to sort of zone out,” Dr. Rowe elaborates. “It might be that you need some distance from the emotional intensity of the world, and a coloring sheet is great for that.”

Whether programs attempt an arts therapy intervention on their own or hire a facilitator for a larger-scale effort, it’s important to understand why they’re going down that road. “It’s not, ‘hey, let’s do this because we like it,’” Dr. Rowe emphasizes. “It’s, ‘hey, let’s do this because it activates the parasympathetic nervous system and allows us to regulate our autonomic nervous system so that our breathing is better, our blood pressure is lower — all of those sort of things to help us be able to use our executive functioning skills a little better and be more successful at what we’re trying to do.’ And that’s the same for patients and for employees.”

If you missed Dr. Rowe's AACVPR Live Webinar, Creative Arts Therapy Approaches in Cardiac and Pulmonary Rehabilitation, the recording is available — at no cost to members — from the AACVPR Learning Center.

Related Reading

¹ Cao, M., Zhang, Z. Adjuvant music therapy for patients with hypertension: a meta-analysis and systematic review. BMC Complement Med Ther 23, 110 (2023). https://doi.org/10.1186/s12906-023-03929-6

² Brown, E., Gannotti, M. E., & Veneri, D. (2022). Including arts in rehabilitation enhances outcomes in the psychomotor, cognitive, and affective domains: A scoping review. Physical Therapy, 102(4), pzac003. Doi.org/10.1093/ptj/pzac003