Doctors and nurses rarely learn in school how to tell a family that their loved one will not survive, but for healthcare professionals, the immense burden of tragedy, illness and death in a highly stressful environment is a daily and ongoing part of their job.

Long before the COVID-19 pandemic, studies documented widespread stress and burnout among healthcare professionals.

The impact of this crisis is far-reaching in the U.S. In 2022, Surgeon General Dr. Vivek Murthy expressed concern about the alarming levels of healthcare burnout amid the COVID-19 pandemic.

Studies estimate that by 2033, the United States will face a shortage of 1.1 million registered nurses, 3 million other caregivers, and over 140,000 physicians if current trends continue. A 2022 Mayo Clinic study found that only 58% of physicians would choose to be a doctor again if given the opportunity to reconsider their career choice, up from 72% the previous year.

For nearly two decades, our research group—a team of physicians, researchers, art therapists, and writers—has studied how work-related stress affects healthcare workers. In our experience, nearly every healthcare worker has a story about navigating times when the demands of the job are simply too much for them to handle.

To address this issue, our team founded the Colorado Resiliency Arts Lab, or CORAL, in 2019 with funding from the National Endowment for the Arts. Our goal is to use creative arts therapy as an intervention to improve the well-being of healthcare professionals and restore their sense of purpose in these demanding work environments.

As physicians who have worked in critical care and emergency medicine for many years, we believe that incorporating creativity into healthcare is critical. The health of the nation depends on the well-being of healthcare professionals. We believe that incorporating creativity and the arts as a means of building resilience in healthcare professionals could help change the culture of emotional isolation in which healthcare professionals live.

A challenge that was a long time coming

We as healthcare workers push ourselves to the limit to find new ways to improve human health. The irony is that this often comes at the expense of our own physical, emotional and mental health. We learn to hide our feelings and internalize any negative events we experience in healthcare. But this is not sustainable.

In the 2000s, up to 80% of critical care nurses reported burnout or other forms of psychological distress. This contributed to high turnover rates, with 67% of nurses planning to leave their positions within three years. This led to increased healthcare costs, compassion fatigue among staff, and reduced quality of patient care.

Then came the COVID-19 pandemic, which increased the stress on healthcare workers: 3 out of 5 doctors reported burnout during the peak of the omicron variant in 2022.

A combination of increased job demands, workload, job complexity, work pressure and intense working hours during the COVID-19 pandemic increased stress among healthcare professionals and led to emotional exhaustion.

Satisfaction with work-life balance fell from 46.1% in 2020 to 30.2% in 2021.

In the post-COVID-19 era, healthcare workers like us are at higher risk for anxiety, depression, and post-traumatic stress disorder. Burned-out healthcare workers are less likely to seek professional treatment and are therefore prone to increased substance use, depression, and suicidal thoughts.

Art as a way forward

In ancient Greece and Rome, people suffering from depression or anxiety were “prescribed” to participate in artistic activities. Similarly, tribal communities have used dance, music and art to promote physical and spiritual healing in individuals for centuries.

At CORAL, we have focused on teaching health care workers how to use arts work to effectively process trauma and develop coping mechanisms through expression and community. We invite our participants, including doctors, nurses, social workers, therapists and researchers, to explore their true vulnerabilities and share stories they wouldn’t normally tell, using pen and paper, paintbrushes, guitar, songwriting and movement.

From 2020 to 2023, we conducted six cohorts of our 12-week clinical trial of arts therapy interventions, involving at least half-time healthcare professionals. Participants were randomly assigned to one of four arts therapy groups: art, music, dance/movement, and writing, with 12 weekly sessions of 90 minutes each.

We measured participants’ anxiety, depression, burnout, PTSD levels, and job satisfaction using validated questionnaires and asked the same questions again after the intervention was completed. We also measured these scores in a control group that did not participate in the intervention.

The results were revealing. Study participants experienced less burnout and expressed less desire to quit their jobs. Burnout scores for anxiety, depression, PTSD, and emotional exhaustion decreased by 28%, 36%, 26%, and 12%, respectively, for participants who received the arts therapy. These improvements were maintained up to one year after completing the program.

Our findings add to the growing body of evidence that arts therapy can be an effective tool for treating burnout among healthcare workers worldwide.

We believe creative arts therapy is effective because it allows these health professionals to be imperfect—freedoms that can be healing in and of themselves. They can use these opportunities to speak the unspeakable through an art form that becomes a means to explore and overcome trauma.

This, in turn, can increase their tolerance for imperfection and help them feel grace and compassion for themselves and others. It expands their emotional vocabulary and thus builds their resilience.

Remembering what it means to be human

Although the roles of doctors, nurses and other healthcare professionals are often glorified with terms like “superheroes” and “guardian angels,” in reality they are also human beings who make mistakes and are exhausted.

The creative process invites them to remember what it means to be human and vulnerable. A health professional picking up a paintbrush for the first time since kindergarten can explore repressed feelings and buried memories—and even gain forgiveness for mistakes held onto for years.

One participant in the CORAL program wrote in his feedback: “When I have the space to bare myself and show all sides of my personality, I am creative and engaged. I think more deeply and clearly. I am more willing to take the risks necessary for breakthroughs. I am a better colleague, mentor, friend, partner, and scientist. When I feel safe and supported, I can be whole.”