Traumatology

© 2023 American Psychological Association 2024, Vol. 30, No. 3, 410–422

ISSN: 1085-9373 https://doi.org/10.1037/trm0000450

The Crane Project: Mixed-Methods Analysis of an Expressive Art Therapy

Intervention to Promote Collective Healing During the COVID-19 Pandemic
Sriya Bhattacharyya, Ellen Y. Park, Shelby Adler, Stephanie Saklad, and Olivia Davis
PRIME Center for Health Equity, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, United States

Across the globe, societies have experienced devastating losses during the COVID-19 pandemic. Due to
social distancing guidelines, funerals and other forms of commemoration were put on pause. In response
to the lack of ability to honor lives and the need for personal and collective healing, a team came together
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

and formed the Crane Project—an expressive art therapy intervention to help the community process grief
This document is copyrighted by the American Psychological Association or one of its allied publishers.

and foster resilience in the form of a public art exhibit. Specifically, through workshops, individuals were
encouraged to write six-word poems to describe their COVID-19 experience and create a paper crane for
display with their poem inside. In total, 457 individuals created 514 poems. Using a mixed-methods
study design, researchers analyzed participants’ six-word poems and changes in subjective units of distress
scores (SUDS) before and after the intervention. We found statistically significant decreases in mean SUDS
in the full sample and within each intervention group; however, no statistically significant between group
differences were found. Poems were also qualitatively coded into four main themes: (a) grief, loss, and chal-
lenges; (b) painful emotions; (c) gratitude, resilience, and hope; and (d) connection and community. Our
quantitative and qualitative findings highlight the importance of arts-based experiential projects in process-
ing the grief and loss experienced by individuals, as well as the critical importance of fostering hope, heal-
ing, and community in the face of tragedy.

Keywords: COVID-19, mental health, collective trauma, art therapy

Supplemental materials: https://doi.org/10.1037/trm0000450.supp

The Devastating Impact of the COVID-19 Pandemic distancing guidelines, visitations from loved ones were restricted in
hospitals, and funerals and other forms of commemoration were put
Across the globe, societies have experienced devastating losses on pause (Burrell & Selman, 2022; Wallace et al., 2020).
during the COVID-19 pandemic with over 434 million coronavirus Consequently, individuals lost the ability to care for and “say good-
cases and over 5.9 million deaths worldwide (WHO Coronavirus bye” to their family members and as a result the emotional toll on
Dashboard, 2022). These rates of infection and lives lost, in addition families, loved ones, and health-care workers notably increased
to changes in routine, closure of businesses and schools, and lock- (Wallace et al., 2020).
down measures have all played a role in disrupting the public’s over- In response to the inability to honor these lives and the need for
all mental health (Cusinato et al., 2020). Additionally, health-care emotional healing, it became clear that there was an urgent need
workers including nurses, physicians, and nonclinical staff have to develop and research an effective strategy to mitigate and treat
faced overwhelming levels of stress, anxiety, and depression in serv- the emotional trauma experienced by both frontline health-care
ing on the frontlines, working under extreme pressures, balancing workers and the community they serve during the COVID-19 pan-
work needs with personal needs, and witnessing countless complica- demic. As a result of this need, interventions to provide grief pro-
tions and deaths from the virus (Greenberg et al., 2020; Lai et al., cessing and psychological support for both frontline workers and
2020; Luo et al., 2020; Teo et al., 2021). Furthermore, due to social the community were implemented by public services and hospital
systems across the world. These interventions included, but were
not limited to, online mental health resources (Headspace and
This article was published Online First July 13, 2023. New York Governor Cuomo’s Office Team Up to Release ‘New
Sriya Bhattacharyya https://orcid.org/0000-0003-4749-8048 York State of Mind,’ Free Meditation and Mindfulness Content
We appreciate every project participant, facilitator, volunteer, the organi- Hub Curated for New Yorkers, 2020; Kang et al., 2020), emotional
zations and departments which contributed to making this project a success, support hotlines (Cheng et al., 2020), support groups (Chen et al.,
as well as our outside collaborators Legion Paper, Center for Arts in Medicine 2020), and in-hospital relaxation centers for health-care workers
at the University of Florida, and the National Asian American and Pacific (Bernstein et al., 2021). For individuals in New York, these interven-
Islander Mental Health Association. A special thank you to Drs. Jonathan tions were especially relevant, as New York City became the epicen-
Alpert and Dharma Cortez for their support of our vision and editing of
ter of the pandemic in the United States accounting for
this manuscript. We honor all of the lives lost during the pandemic; as best
stated in the six-word poem of a participant, “Fly free my friends, miss you.”
approximately 10.8% of all cases and 19.8% of all COVID-19 deaths
Correspondence concerning this article should be addressed to Sriya in the United States around the time of June 2020 (Center for Disease
Bhattacharyya, Columbia University Irving Medical Center, 701 West Control and Prevention, 2020).
168th Street, HHSC 316, New York, NY 10032, United States. Email: Although these interventions were implemented in the hopes of
[email protected] providing emotional support during a time of need, there have

410
 CRANE PROJECT 411

been few studies examining the impact of these interventions on In particular, individuals who have experienced trauma or loss have
individuals’ overall well-being. In response to this need for more frequently turned to poetry to articulate their grief. This is because
researched interventions and their overall short and long-term effects, individuals who have survived trauma cannot always find the words
a dedicated team of staff came together to form and study a new inter- to express their experiences (Carroll, 2005). By engaging in expres-
vention that incorporated the principles of collective trauma, art as a sive writing, individuals can make meaning of their traumatic experi-
tool for emotional healing, and public memorials in order to deepen ences with overall positive downstream effects on their health and
the reach on gravely impacted communities in New York City. well-being (Park & Blumberg, 2002; Smyth & Helm, 2003). One
type of poetry that has specifically been used by individuals to express
The Pandemic as Both a Personal and Collective Trauma an emotional experience is the poetic form known as six-word mem-
oirs. The idea of six-word memoirs came about when it was discov-
To implement an effective intervention to improve individuals’
ered that the shortest story ever written was in six words by
well-being during COVID-19, it was imperative to recognize that
Hemingway “For sale: Baby shoes, never worn.” This led to various
the current pandemic took on aspects of being both a personal
initiatives and projects to engage individuals in sharing their own story
trauma and a collective trauma for communities impacted. The
through six words. Examples include a published book documenting
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

term collective trauma is eloquently defined by sociologist Kai

This document is copyrighted by the American Psychological Association or one of its allied publishers.

the collective experiences of war in Iraq and Afghanistan using thou-

Erikson as a “blow to the basic tissues of social life that damages
sands of veterans’ individual six words stories (Six Word Memoirs,
the bonds attaching people together and impairs the prevailing
2005) along with a school curriculum that used six-word storytelling
sense of communality” (Erikson, 1976, p. 153). In addition to indi-
to engage students in critical, reflexive considerations of their cultural
viduals experiencing personal psychological distress, such as anxi-
identity and collective experience (Simmons & Chen, 2014). In these
ety, depression, and posttraumatic stress disorder, individuals
examples, the use of the six-word poem demonstrates how this form
experience a loss of connection to their community, feelings of
of poetry could allow for one to share their own story both powerfully
alienation, and difficulties maintaining strong relational ties
and simply while also making meaning of their experience. At the
(Erikson, 1976). Similarly, collective traumas have been shown to
same time, writing six-word poetry to describe a shared experience
devastate communal infrastructure and systems of support
could allow for the emergence of group connectedness and a collec-
(Hirschberger, 2018) such that a collective trauma not only leads
tive identity in the face of trauma or devastation.
to the direct insult or displacement of an individual, but also leads
Similarly, for individuals who cannot find the words to express
to the indirect upheaval of people as a whole (Duane et al., 2020;
their experiences, the act of physical creation is yet another avenue
Hirschberger, 2018). As a consequence, the combination of these
that can assist with processing and healing from grief. For instance,
effects dramatically alters the way that society functions for both pre-
by actively engaging in physical creation, one can reestablish order
sent and future generations to come (Duane et al., 2020). Therefore,
in the midst of chaos, while also enabling a process of recuperation
recovery from a collective trauma not only involves personal healing
and restoration (Storr, 1991). One example of physical creation is
processes, but collective processes of adjustment and adaptation and
origami making, the folding of paper into unique shapes and figures.
the mobilization of capacities for community resilience (Saul, 2014).
Origami making has been shown to improve the emotional well-
Throughout history, countless events, conflicts, and disasters have
being of individuals with mental illness (Edwards & Hegerty,
been classified as collective traumas due to their influence on entire
2018), help individuals such as hospitalized patients adapt to devas-
communities and the way these communities’ function. Such exam-
tating circumstances (Varghese et al., 2018), and increase patients’
ples have included the Holocaust, Hurricane Katrina, and the Civil
level of hope and connection to their community (Lundberg, 2014).
War in Sri Lanka, where whole societies were negatively impacted
Furthermore, in addition to personal healing and growth, the ben-
and suffered a sense of pervasive despair, a lack of motivation,
efits of physical creation have also been documented for their merits
and a loss of values (Duane et al., 2020; Saul, 2014). It can be argued
in community building, social transformation, and collective heal-
that the COVID-19 pandemic also falls into this category of a collec-
ing, such as in coping with stressful work environments (Bojner
tive trauma due to its devastation and impact on global communities
Horwitz et al., 2017) and in overcoming disasters (Orr, 2007). For
(Holman & Grisham, 2020). With this being the case, effective strat-
example, after health-care workers engaged in art-based workshops
egies to promote the process of personal and communal healing are
to improve workplace burnout, workers felt a greater sense of com-
especially needed in order to prevent the disastrous and long-term
munity, an enhancement in work-related relationships, and a chal-
effects of a collective trauma.
lenge to the hierarchy of roles among staff (Bojner Horwitz et al.,
Art as a Tool for Emotional Healing: The Benefits of 2017). Additionally, for health-care workers experiencing a trauma
in the workplace, art workshops that involved transforming images
Poetry Writing and Origami Crane Making
of stress into images of coping decreased workers’ overall levels
It has long been known that art such as painting, music, dance, and of distress (Huss & Sarid, 2014) Similarly, the physical creation of
narrative-based writing is a tool for personal healing and growth. art has been used as a means of collective healing in national or
Participation in these artistic mediums has been found to reduce stress, global disasters. For example, the creation and display of origami
decrease anxiety and depression, and assist with processing and paper cranes have become a global symbol for hope and for memo-
healing from grief (Carroll, 2005; Phillips & Becker, 2019; Planas rializing loss. In Japanese legend, the crane—a large migratory
Domingo et al., 2015). By actively engaging in these artistic avenues bird—is thought to live for 1,000 years and is held in the highest
which specifically demand concentration and selective attention, the regard by the public. It is believed that with the creation of each
individual can find relief and rest from their grief through quieting paper crane one’s suffering and pain can be set free (Beser, 2015).
of their inner dialogue and finding a contemplative space in which per- Hence, after the major catastrophes of the Hiroshima atomic bomb
ceptions can be reviewed and shifted (Rothschild, 2000). in Japan and the 11th September attacks in the United States, origami
 412 BHATTACHARYYA, PARK, ADLER, SAKLAD, AND DAVIS

cranes were folded and then displayed in public exhibits as a symbol The chosen art practices engaged therapeutic goals. Poetry writing
of resilience in the face of disaster (Beser, 2015). invited participants to explore their written emotions and their asso-
ciated emotional responses, and origami-making, a skill that requires
Public Exhibits as an Act of Remembrance focus, attention, patience, and concentration, invited participants to
engage in individual, creative expression, along with relaxation,
The use of public exhibitions as a symbol of hope and fortitude mastery, and self-soothing. Utilization of this nonverbal form of self-
such as the ones created after the Hiroshima atomic bomb and the expression invited participants to process emotions and experiences
11th September attacks, are not uncommon. For example, the without fear of judgment from those around them.
Vietnam Veterans Memorial was created in order to honor the The creation of a poem that one knows will be placed on public
lives lost during the Vietnam War. Similarly, the AIDS Memorial display also offers a sense of public commemoration, which in
Quilt was developed to acknowledge the devastation wreaked by turn offers a chance at public grieving, so that the experience and
the AIDS epidemic, to offer healing and hope to survivors, and to losses can be acknowledged. This is helpful in exploration and
provide an avenue for commemorating lives lost (National AIDS acceptance of the trauma and grief that continues to plague health-
Memorial, 2021). It is through these displays of remembrance that care workers and affected communities. Finally, utilization of ori-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

allow for affected individuals and their families to restructure their

This document is copyrighted by the American Psychological Association or one of its allied publishers.

gami allows participants to create their own structured space. For

view of life, make meaning out of all of the chaos, and find light those who felt engulfed by the pandemic, this offers an opportunity
among the darkness (Bennett, 2005). to have control of a metaphorical environment, through deliberate
It is not surprising then that public exhibits used in this manner actions. These exercises gave the participants the opportunity to pro-
also offer a connection with the community at large. As noted by cess their experiences in a succinct way, which promotes acceptance.
Riggs (2010) in her dissertation on art and well-being in the shadow Through quantitative and qualitative research methods, the project
of trauma, community acts of remembrance serve to create a space team aimed to accomplish three overarching goals: (a) evaluate
for public acknowledgment, for receiving affirmation that one’s expressive art, specifically poetry writing and origami making, as
pain and sorrow is authentic, and for offering the opportunity to a tool to reduce COVID-19-related distress; (b) explore the emotions
share with and receive support from one’s community. Public acts experienced by frontline health-care workers and the community in
of remembrance enable the transformation of individual suffering the face of the COVID-19 pandemic; and (c) gain insight into the
into a place of social interaction (Bennett, 2005), a much-needed impact of a COVID-19 public commemorative exhibit on individu-
space that has been greatly severed during the COVID-19 pandemic. als’ well-being.

Intervention Development Method

In recognizing the devastation of the COVID-19 pandemic in Procedure
New York City, a team of dedicated hospital staff from Montefiore
Medical Center (MMC) in the Bronx, consisting of psychologists, Study Setting
artists, and creative arts therapists, came together to brainstorm The study took place at MMC and the surrounding Bronx commu-
ways to provide emotional healing to the communities they serve. nity. MMC serves a diverse patient population, with the majority of
Through weekly group discussions and collaborative processes the population identifying as Black or Latinx, a population dispro-
between members, a support intervention was designed that incorpo- portionally impacted by the COVID-19 pandemic. MMC and its
rated the expertise and unique experiences of individual members. associated health-care facilities are the largest employer of the
Using evidenced-based principles of collective trauma, art as a Bronx. During the height of the pandemic, more than 9,000 patients
tool for emotional healing, and public memorials as an act of remem- were treated and over 2,000 patients and 20 staff members from the
brance, the Crane Project was formed. Implementation and analyses Montefiore Health System died.
were completed thereafter by a team of researchers from the Center
for Health Equity, dedicated to eradicating health-care disparities in
Recruitment
the Bronx by developing and rigorously evaluating clinical and pol-
icy interventions, leveraging community assets, and mobilizing sys- Health-care workers within the MMC and members of the sur-
tem transformation. rounding Bronx community were invited to participate in the
Crane Project. Participants were recruited through established
The Crane Project: An Expressive Art Therapy department listservs, flyers distributed around the hospital,
Intervention and Public Tribute COVID-19 staff emotional support centers, word of mouth, and a
dedicated project website and Instagram account.
The Crane Project involved a series of art therapy workshops
for health-care workers and the community in which individuals Intervention Experience
created both six-word poems to describe their emotions and paper
cranes embedded with these poems inside for display in a public Individuals were able to participate in the Crane Project by either
exhibit. The project design took into consideration social distanc- submitting an online poem independently through a dedicated por-
ing guidelines and allowed participants to engage in online work- tal, joining a poetry writing only workshop or joining a combined
shops and fold paper cranes in their own homes to safely adhere crane making and poetry writing workshop.
to social distancing guidelines. The project aimed to be simplistic Participants in the poetry writing only workshop had the option of
to ensure greater accessibility, especially for individuals who have partaking in a 30 min or 1-hr poetry writing workshop while partic-
not previously engaged in the utilization of the expressive arts. ipants in the combined workshop had the option of partaking in a 1
 CRANE PROJECT 413

or 2-hr combined crane making and poetry writing workshop. Both licensed practical nurses, attendings, physicians, physician associ-
types of workshops were facilitated by a trained professional and ates, physician liaisons, physical therapists, pharmacy specialists,
occurred either in-person, virtually, or through a hybrid model. research assistants, and surgical technologists. Additionally, 52 indi-
Data were analyzed by subgroup: independent online submission, viduals self-identified as a friend/family member of someone
poetry writing only workshop, and combined crane making and impacted by/lost to COVID-19, with most participants’ parents
poetry writing workshop. The multi-modality intervention design being the ones impacted by/lost to the virus, 22 individuals self-
enabled us to explore which modality, or combinations of modali- identified as patients at Montefiore,10 individuals self-identified as
ties, influenced distress reduction. high school students, and eight individuals self-identified as medical
Each six-word poem was written in an origami crane folded by students at Albert Einstein College of Medicine. Individuals could
participants themselves or a member of the Crane Project Team. select multiple options (i.e., a participant could both select a hospital
These cranes were then displayed in a public exhibit at a dedicated employee and someone impacted by COVID-19).
hospital site for both health-care workers, patients, and the surround-
ing community to visit. Measures
The study was deemed exempt by the IRB due to none to minimal
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Pre and Postsubjective Units of Distress

This document is copyrighted by the American Psychological Association or one of its allied publishers.

risk for participants. All participants consented to participate and

signed media releases for the content of their poems to be utilized. In order to understand the impact of the workshops on partici-
All submissions remained anonymous. pants’ emotional well-being, individuals were given two questions
to answer before and after the creation of a poem and/or paper
Public Exhibition crane: (a) summarize how you feel in one word and (b) from a
Crane Project workshops began during the month of October 2020 scale of 0–10 how distressed do you feel? 0 = no distress 10 =
and continued until May 13, 2021. The Crane Project exhibitions were extreme distress. The first question asked participants to qualitatively
installed throughout March and June of 2021. A mini exhibition was describe how they felt in one word pre- and postintervention: (a)
featured at the Children’s Hospital at Montefiore as a part of MMC’s Before writing your poem, summarize how you feel today in one
March Healing Garden, and the main exhibition was installed at word and (b) (After writing your poem) summarize how you feel
MMC in June of 2021. During both exhibitions, participants were after participating in the Crane Project in one word. The second
invited to pause, reflect, and honor the lives lost at MMC during question, the subjective units of distress scores (SUDS) developed
COVID-19. The exhibit slides, which included a sample of the partic- by Wolpe and Lazarus in 1966, has become a useful scale often uti-
ipants’ poems, were on display next to the paper cranes, which gave lized by researchers and therapists to measure how much fear or anx-
hospital employees and community members an opportunity to read iety participants are experiencing in any given moment (Milosevic
and understand the various emotions experienced by participants at & McCabe, 2015). Questions were administered immediately before
the time of submission. The exhibitions served three purposes: (a) and after poem creation (on a paper scale for in-person workshops
to provide an avenue for collective healing; (b) to honor the lives and as survey questions for online participation).
lost during the pandemic; and (c) to instill hope and resilience
among hospital employees and Bronx community members. Six-Word Poems
Participants were invited to create a six-word poem that reflected
Participants their experience during the COVID-19 pandemic. The poems were
A total of 457 individuals submitted 514 poems to the Crane included in the paper crane, and were also stored for analysis. In
Project by May 13, 2021. One hundred and forty-four poems were an effort to make the project more accessible, participants were
submitted independently online, 180 poems were submitted during encouraged to submit poems in their native languages if English
the poetry only workshops, and 190 were submitted during the com- was not their first language. After the workshop, these poems were
bined crane making and poetry writing workshops. All participants translated by a professional on the Crane Project team. The poem
provided written or digital consent for their submissions to be uti- analyst, a specific member of the Crane Project Team, then took
lized anonymously in the exhibition and research. Participants the time to read and analyze each submission multiple times, allow-
were asked to provide the following demographic information: (a) ing for more in-depth analysis and understanding.
name; (b) email; (c) relationship to Montefiore (e.g., employee,
friend/family of someone impacted by/lost to COVID-19, and Reflections on the Crane Project
patient) Participants were also given the option to self-select their
employee status; some participants indicated their specific role, Workshop participants, hospital workers, and the Bronx commu-
while other participants indicated their department. In total, 334 nity had the option to submit or contact the team with any comments
poem submissions were received from hospital employees, which regarding the workshops or public exhibit. All reflections were
included the departments of: Administration, Housekeeping, the recorded for reference and selections are shared below.
Office of Community and Population Health, Pediatrics,
Psychiatry, and Psychology. Of those who indicated their specific Data Analysis
role within these departments submissions were received from: Quantitative Analysis
Operations managers, clerks, food service managers, pediatric fel-
lows, clinical psychologists, psychology interns, clinical social Analyses for this study were conducted using Stata SE for
workers, substance use counselors, creative arts therapists, postdoc- Macintosh, version 16.1 (StataCorp., 2019). A paired t test first
toral fellows, music therapists, registered nurses, nurse practitioners, used to analyze mean differences between SUDS for the full sample
 414 BHATTACHARYYA, PARK, ADLER, SAKLAD, AND DAVIS

before and after participating in one of the three workshop groups. After the completion of initial and focused coding, the primary
Based on this result, three additional paired t tests were conducted. coder shared the existing codes and subcodes with two members
This was done in order to see if there was a statistically significant of the research team (a medical student with previous qualitative
difference in preworkshop and postworkshop mean SUDS based research experience and a counseling psychologist with over a dec-
on three independent types of workshops: (a) independent online ade of qualitative research experience). The three researchers each
poem submissions, (b) poetry only workshop submissions, and (c) individually formed higher-level codes with the existing codes,
joint poetry writing and crane making workshop. Finally, a one-way compared them, and then developed a final list utilizing consensus.
analysis of variance (ANOVA) was utilized to identify group differ- A method of constant comparison (Killian, 2008) was utilized by the
ences in preworkshop and postworkshop SUDS among the three researchers to capture commonalities in existing codes and themes.
independent groups. For the paired t tests and the ANOVA, the clas- When there were disagreements, the three researchers discussed pos-
sic level of statistical significance (p = .05) was used for determin- sible explanations, examined their own biases, reevaluated the data
ing significance. submitted by participants, and came to a resolution to form the
final codes and subcodes. For example, during the process of form-
Word Clouds ing higher-level codes, there were minor discrepancies between the
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

three researchers’ groupings. This process helped researchers engage

The one-word that participants expressed before and after the
in reflexivity (Table S1 in the online supplemental materials) and
intervention were displayed on word clouds, which are visual repre-
explore how their own emotional experiences of COVID-19 had
sentations of key text that can be helpful for identifying patterns or
an influence on the groupings. As a result, the researchers reevalu-
themes within a dataset. In word clouds, words are organized
ated the poems and critically observed how participants grouped
based on frequency (DePaolo & Wilkinson, 2014), meaning that
their emotions in order to better inform the formation of the codes
larger words had more prominence within all of the poem submis-
and came to an agreement for the final codes and subcodes.
sions. Additionally, researchers that have utilized word clouds to
After comparing codes and themes multiple times, the researchers
compare pre- and posttest responses have found them to be helpful
agreed upon the creation of two coding families (Glaser, 1978),
when looking at differences between the two responses (DePaolo
one based on emotion and experience, and the other based on
& Wilkinson, 2014). The preintervention and postintervention
style and structure. The emotion and experience coding family
word clouds are displayed in the “Results” section.
included four larger codes, each with multiple subcodes, in
Qualitative Analysis order to understand and conceptualize the multitude of emotions
experienced by participants of the project. The style and structure
In order to identify the various emotions expressed by participants coding family included one code and five subcodes to outline the
in their poems, the researchers utilized inductive thematic analysis multiple ways participants detailed their experiences, but are not
(Thomas, 2006) informed by a consensual qualitative research- reported in this paper due to irrelevance to the research questions.
modified (CQR-M) approach (Spangler et al., 2012). The CQR-M All emotion and experience themes are outlined in the “Results”
method is often utilized in qualitative research in which sample section.
sizes are large and responses are relatively brief and succinct, allow-
ing for a comprehensive understanding of the study population as
opposed to individual situations or cases (Spangler et al., 2012). Results
Similar to the CQR-M method, inductive thematic analysis uses a Paired t Tests and One-Way ANOVA
bottom-up approach that allows researchers to derive categories
and themes directly from the data rather than utilizing a predeter- All participants’ SUDS before and after the workshop were com-
mined codebook or structure (Spangler et al., 2012). During initial pared using a paired t test. On average, participants’ SUDS were
coding, the primary coder read through a subsample of the poems higher before the workshop (M = 4.42, SD = 2.53) than after
and created codes in NVivo 12, an analysis software often used in (M = 3.70, SD = 2.59). The mean difference in post–pre SUDS
qualitative research. After initial coding, there were a total of 41 scores (.725, 95% CI [.542, .907]) was statistically significant, t =
codes and 12 subcodes. Then, the primary coder read through 7.80, df = 464, p , .001.
each of the remaining poems and placed them into existing codes. All three workshop types (independent online poem submission,
If an already existing code did not accurately encapsulate the emo- poetry only workshop, and the crane making and poetry writing
tions expressed in the poems, a new code was also created utilizing workshop) were found to have statistically significant mean differ-
in vivo codes in order to stay as true to the participants’ original ences between pre- and postworkshop SUDS. On average, those
words and meanings. After the completion of focused coding, who participated independently online reported higher SUDS before
there were a total of 11 main codes, herein referred to as “themes” the workshop (M = 4.33, SD = 2.44) than after (M = 3.53, SD =
(Charmaz, 2014) and 45 subcodes. It is important to note that 2.48), with a significant mean difference of .798 (95% CI [0.500,
each poem was categorized into multiple codes and subcodes, as 1.10], t = 5.30, df = 118, p , .001). There was also a significant dif-
many participants expressed multiple concurrent emotions in their ference in the mean SUDS before (M = 4.84, SD = 2.53) and after
six-word poems. For example, the poem “Fearful. Anxious. (M = 4.13, SD = 2.54) for those who participated in the poetry
Emotional. Exhausted. Overworked. Overwhelmed.” was coded only workshop, in which researchers saw a statistically significant
under Theme A, Grief, Loss, and Challenges, specifically under mean difference by .711, 95% CI [.418, 1.00], t = 4.79, df = 179, p
the subcodes fatigue/exhaustion and fear/terror/trauma, and under , .001. Lastly, for those who participated in the combined crane
Theme B, Painful Emotions, specifically under the subcodes anxi- making and poetry writing workshop, a statistically significant dif-
ety/stress and feeling overwhelmed. ference in mean SUDS was seen before (M = 4.03, SD = 2.53)
 CRANE PROJECT 415

and after (M = 3.34, SD = 2.66). This mean difference was .687, in Figure 1
which 95% CI [.342, 1.03], t = 3.94, df = 165, p , .001. Thus, on The Preintervention Word Cloud
average, participants had statistically significant mean decreases in
SUDS across all three types of workshops.
In order to check if the variance between samples was greater than
the variance within samples, a one-way ANOVA was utilized.
However, there were no marked differences between groups as
there was no statistically significant difference at the p , .05 level
in SUDS between the three groups (independent online poem
submission, poetry only workshop, and the crane making and poetry
writing workshop): F(.917, 1,861.3) = 0.11, p = .892. Quantitative
analysis results are summarized in Table 1.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Word Clouds
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Participants were asked to describe their emotions in one word prior

to writing their six-word poems. Figure 1 displays the most frequently
submitted words preintervention. The three words with the most fre-
quency were tired (n = 62), hopeful (n = 40), and stressed (n = 24).
Participants were also asked to describe their emotions in one
word after writing their six-word poems. Figure 2 displays the
most frequently submitted words postintervention. The three
words with the most frequency were: relaxed (n = 36), hopeful
(n = 29), and grateful (n = 29).

Thematic Analysis of Six-Word Poems

Responses from participants were coded into the following
themes: (a) grief, loss, and challenges; (b) painful emotions; (c) grat- Theme A: Grief, Loss, and Challenges
itude, resilience, and hope; and (d) connection and community. This first theme represents the various losses and changes par-
Many poems were categorized into multiple themes and subcodes ticipants experienced during the COVID-19 pandemic. A total
as participants documented a variety of emotions in just six words. of 441 submissions expressed emotions related to grief, loss,
Additionally, many of the themes and subcodes were formed death, and challenges. While some participants experienced the
based on participants’ direct words as expressed in their poems. loss of a loved one, others experienced the loss of a job, the
All subcodes are listed in order of prominence, and each is defined loss of social connection, or the loss of control over their situa-
in a couple of sentences. All poems are listed exactly as they were tion. Many participants also felt isolated, fearful, trapped, and
submitted in terms of grammar, punctuation, and style. The coding exhausted by the weight of the pandemic. Specifically, some par-
tree is represented in Figure 3. ticipants mentioned feeling fear/terror/trauma (126), loss/death
(71), isolation/loneliness (64), unknown/confusion (60), fatigue/
exhaustion (48), remembrance/memory (23), confined/trapped (14),
Table 1 denial (14), desperation (11), silence (7), and challenges that they
Results From Paired t-Tests Comparing Means Pre- and Post- faced (6).
workshop Between Types of Workshop
SUD Measure N M SD 95% CI t df p value Fear/Terror/Trauma
Full sample An overwhelming number of participants expressed heightened
Pre 465 4.42 2.52 [4.19, 4.65] — — — fear, terror, and trauma during the pandemic. Some participants
Post 465 3.70 2.59 [3.46, 3.93] — — — were fearful for their safety and well-being, while others were fright-
Difference 465 0.725 2.00 [0.542, 0.907] 7.80 464 ,.001
Independent online poem submission ened by the chaos and uncertainty that surrounded the pandemic. A
Pre 119 4.33 2.44 [3.88, 4.77] — — — children’s hospital nurse who participated in the crane making and
Post 119 3.53 2.48 [3.08, 3.98] — — — poetry workshop wrote: “Terrifyingly unknown. Scary. Goodbye.
Difference 119 0.798 1.64 [0.500, 1.10] 5.30 118 ,.001 Dread. Death.”
Poetry only workshop
Pre 180 4.84 2.53 [4.47, 5.22] — — —
Post 180 4.13 2.54 [3.76, 4.51] — — — Loss/Death
Difference 180 0.711 2.00 [0.418, 1.00] 4.79 179 ,.001
Crane-making and poetry workshop Participants described the ways in which they felt hopeless while
Pre 166 4.03 2.53 [3.64, 4.42] — — — witnessing death in hospitals and in homes. A health educator in the
Post 166 3.34 2.66 [2.94, 3.75] — — — emergency room, who independently submitted a poem online,
Difference 166 .687 2.25 [0.342, 1.03] 3.94 165 ,.001
stated: “Breathing lives lost with shocking speed.”
 416 BHATTACHARYYA, PARK, ADLER, SAKLAD, AND DAVIS

Figure 2 Confinement/Trapped
The Postintervention Word Cloud
Some participants utilized their six-word poem to illustrate physical
confinement at home, which inevitably led to boredom and restless-
ness at times. Other participants acknowledged the importance of
staying home and socially isolated, but expressed longing for commu-
nity. A psychiatrist who participated in a poetry only workshop,
shared the following poem: “Slow. Stuck. Sad. Hope. Community.
Together.”

Denial
Many participants documented their disbelief and frustration
toward those who denied the reality of COVID-19. A physician liai-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

son who was a friend and colleague of someone impacted by/lost to

This document is copyrighted by the American Psychological Association or one of its allied publishers.

COVID, participated in the poetry only workshop. They stated:

“Willful ignorance. Denial. Defiance spreads COVID.”

Desperation/Wish
Many participants utilized their six-word poems to express a wish,
regret, or plea. Some participants wished for more time with their loved
ones, while other participants expressed despair and prayed for better
days. A patient service representative who was a friend/colleague of
someone impacted by/lost to COVID, wrote the following poem dur-
ing a poetry only workshop: “Healing thoughts I’m begging for you.”
Isolation/Loneliness
Silence
Many participants described the intense fear, anxiety, and uncer-
tainty surrounding lockdown and isolation. While some participants Some participants expressed their silence and speechlessness as a
were isolated at home, others were confined in hospital intensive care direct response to the terror and trauma that resulted from the pan-
units. A physician who lost a loved one to COVID-19 submitted an demic. A patient, who participated in a crane making and poetry writ-
independent online poem and shared: “Monitor’s Dulcet tones. ing workshop, wrote: “My silence speaks louder than words.”
Patient dying alone.”
Challenges
Unknown/Confusion Many submissions described the new challenges that were
Participants expressed confusion and stress regarding the volatile brought upon by the pandemic. Some participants struggled to adjust
nature of the pandemic. Many poem submissions emphasized the to “the new normal” and expressed feelings of loneliness and diffi-
uncertainty of the situation and expressed concurrent emotions of culty adapting to online learning formats. A social worker, who par-
fear, anxiety, and pain. A unit clerk who independently submitted ticipated in a poetry only workshop, described facing numerous
a six-word poem stated: “The only constant thing is change.” challenges during the pandemic, specifically stating: “Frustration.
Stressful. Overwhelmed. Lonely. Difficult. Emotional.”
Fatigue/Exhaustion
Theme B: Painful Emotions
Many participants experienced fatigue and exhaustion. While
This second theme documents the painful and traumatic emotions
some participants were tired of waiting for the pandemic to be
experienced by participants during the pandemic. A total of 252 sub-
over, other participants were fatigued and drained by the mental,
missions expressed these emotions. Specifically, participants felt anxi-
emotional, and physical toll of the pandemic. A registered nurse
who participated in a poetry only workshop, expressed their fatigue ety/worry/stress (87), sadness (75), feeling overwhelmed (26), anger
using six distinct words: “Fearful. Anxious. Emotional. Exhausted. (21), pain (18), helplessness/hopelessness (15), and depression (10).
Overworked. Overwhelmed.” Some participants described anger toward the government and toward
those who refused to wear masks, some experienced depression as they
lost a sense of self, and others felt overwhelmed as they struggled to ful-
Remembrance/Memory
fill multiple competing demands while adjusting to the “new normal.”
Participants grieved the loss of a loved one. Some participants uti-
lized their six-word poem to write a tribute for their loved ones,
Anxiety/Stress/Worry
while other participants recalled distinct memories that they shared An overwhelming majority of submissions expressed anxiety,
with their loved ones. A nurse practitioner who lost many patients stress, and worry. Some participants spoke about the way in which
to COVID-19 submitted their online poem as a tribute: “Dearest anxiety and stress physically manifested within their bodies, while
D.T. I miss your laughter.” others described the intense worry and stress they felt for their
 CRANE PROJECT 417

Figure 3
Coding Tree
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

loved ones. A nurse who submitted a poem independently shared: and resilient. An administrative staff, who was a friend/family mem-
“Unknown fear taking over. Anxiety. Whirlwind. Trauma.” ber of someone who was impacted by/lost to COVID-19, submitted
their six-word poem online: “Watery eyes never could stay dry.”
Sadness
Many participants expressed feelings of sadness and described the
Feeling Overwhelmed
way in which they grieved the loss of loved ones. Some participants Many participants described being overwhelmed with intense
expressed sorrow and brokenness as they attempted to stay hopeful fear, stress, and confusion as they juggled multiple demands
 418 BHATTACHARYYA, PARK, ADLER, SAKLAD, AND DAVIS

throughout the pandemic. A psychologist, who participated in a their family and loved ones, some were grateful for teamwork, and
poetry only workshop, stated: “Overwhelmed. Scared. Grieving. others were hopeful for change and awakening. An administrator
Resilient. Alone. Together.” and patient at Montefiore wrote during their poetry only workshop:
“Sad. Frustrated. Hopeful. Trust. Blessed. Thankful.”
Anger
Endurance/Resilience
Some participants expressed anger regarding the innocent lives
taken due to the pandemic. Others expressed anger at poor leader- Participants described the way in which they stayed resilient and
ship and the loss of opportunities, along with feelings of frustration, garnered strength throughout the pandemic. Some participants
fear, guilt, and pain. A clinical social worker, who participated in a gained energy and hope by talking to family and friends, some con-
poetry only workshop, wrote: “Fearful. Anxious. Angry. Lost. nected with nature and Mother Earth, and others discovered new and
Discouraged. Exhausted.” creative ways to endure. A counselor declared in their online poem
submission: “I (yo) SURVIVED (sobrevivi) LIKE (como) A (un)
Pain WRITTEN (poema) POEM (escrito).”
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Pain was a common theme that arose in the poems. While some Faith/Spirit
participants wrote about the pain caused by mental and emotional
exhaustion, others wrote about the physical pain that accompanied Some participants felt comforted, safe, and hopeful through faith
the COVID-19 virus and its symptoms. A hospital employee, who and prayer. A nurse who participated in the combined crane making
participated in the poetry only workshop, shared: “Death. Limbs. and poetry writing workshop, submitted: “My faith in GOD moves
Helplessness. Pain. Tears. Loss.” mountains.”

Helpless/Hopeless Optimism

Many participants expressed hopelessness and despair as the pan- Many poems expressed optimism and hope. A patient at
demic continued to take a toll on individuals, families, and commu- Montefiore submitted the following six-word poem after participat-
nities. A pediatric attending, who participated in the combined crane ing in a combined crane making and poetry workshop: “Someday
making and poetry writing workshop, shared the following six-word things will get better again.”
poem: “Overwhelmed. Heart-pounding. Devastated. Helpless. Void.
Continuation.” Reflection
Some participants utilized their time during quarantine to self-
Depression reflect and explore new interests. A patient, who participated in a
combined crane making and poetry workshop, wrote the following
The participants who talked about depression also documented
poem: “Reflection. Exploration. Grateful. Hopeful. Still home.”
feelings of anxiety, fatigue, and isolation. A hospital employee,
who participated in a poetry only workshop, wrote: “Depleted.
Mom. Social worker. Wife. Loss of self. Depressed.”
Calm
Despite the chaos and confusion, some participants sought and
Theme C: Gratitude, Resilience, and Hope found small moments of serenity and peace. An outpatient psycho-
therapist shared during their poetry only workshop: “Serenity. Sun.
This third theme details the ways in which participants expressed
Warmth on my mind. Faith.”
gratitude, resilience, and hope during the pandemic. A total of 329
submissions documented these emotions. Some participants were
Acceptance
grateful for the health of their family, some were grateful for survival
and the ability to breathe, and some felt optimistic and hopeful that 1 Some participants detailed their struggle and resistance with
day, things would get better again. Specifically, participants accepting the new and challenging situation brought upon by the
expressed thankfulness/gratefulness/hopefulness (143), staying pandemic. While some were faced to accept the loss of a loved
resilient (73), finding hope in faith/spirit (25), optimism (21), find- one, others struggled with accepting the changes brought into
ing opportunities for reflection (17), remaining calm in stressful sit- their day-to-day lives. A student of the Einstein Enrichment
uations (12), acceptance for the situation (11), the ability and Program, who participated in the combined crane making and poetry
importance of breathing and staying grounded (10), safety (9), and writing workshop, submitted: “Tragic. Heartbreak. Separation.
happiness (8). It is important to note that even as participants docu- Realization. Acceptance. Realization.”
mented feelings of gratitude, resilience, and hope, many expressed
concurrent feelings of sadness, frustration, and feeling over- Breathe
whelmed, as shown in the examples below.
Some participants specifically mentioned the ability to breathe,
Thankful/Grateful/Hopeful especially as COVID-19 took the lives and breaths of so many
away. A hospital manager, who was a friend/family of someone
An overwhelming number of participants expressed concurrent impacted by/lost to COVID, shared the following six-word poem
feelings of gratitude and hopefulness, alongside anger, frustration, during their poetry only workshop: “Overwhelmed. Sad.
and sadness. Many participants were grateful for the health of Confused. Grateful to breathe.”
 CRANE PROJECT 419

Safety and worked together for the community, despite feeling scared, wor-
ried, or anxious. A children’s hospital nurse submitted their six-
Many participants described the way in which they prioritized word poem after the combined crane making and poetry workshop:
their safety and the safety of those in their communities. A child “Tough times pass. Tough teams last.”
of a hospital employee submitted the following poem indepen-
dently: “Happy. Class. Outside. Inside. Safe. Together.”
Care/Empathy
Happiness It is without a doubt that many individuals and communities
Despite the difficult and challenging situation that was brought exemplified compassion, sacrifice, and care during the pandemic.
upon by the pandemic, some participants chose to document feel- Many submissions documented the compassion and empathy
ings and experiences of happiness through their six-word poem. A that was embodied by community members, and most notably,
psychiatrist, who participated in the combined crane making and by hospital staff and administration, during the height of the
poetry writing workshop, proclaimed: “Do whatever makes your pandemic in 2020. A physician independently submitted their
six-word poem and shared: “Caring for heroes working like
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

soul happy.”
This document is copyrighted by the American Psychological Association or one of its allied publishers.

angels.”
Theme D: Connection and Community
Reflections on the Crane Project
In this fourth theme, 153 submissions documented the importance
of connection and community, especially during a time of mass iso- Many participants also provided feedback to the Crane Project
lation. For example, some participants wrote about the ways in team after the workshops. A few of these comments are provided
which they worked on a health-care team to provide for patients at below.
Montefiore while others wrote about how they felt connected to
• “Feeling less alone in my grief.” (Employee who lost some-
their family and friends. A majority of the participants who
one to COVID)
expressed these emotions self-identified as employees (physicians,
• “I really appreciate the space for this and the chance to reflect
nurses, residents, administrative staff) of Montefiore highlighting
on the range of reactions to this pandemic” (Administrative
the unique burden on health-care workers and the incredible com-
employee)
mitment to their patients and communities. Specifically, participants
• “No one ever asks me about my experience—I’m always
expressed humanity/unity (47), family (34), love (28), teamwork
focused on my patients. It was nice to be asked how I am feel-
(23), and care/empathy (21).
ing.” (Former Montefiore resident)
• “Thank you for providing this workshop—I was moved by
Humanity/Unity
hearing fellow employees’ stories in how they have been
Despite the isolation and separation brought upon by impacted (personally and professionally) by COVID—this
social distancing guidelines, some participants felt connected was very eye-opening and in the end, I felt a sense of reassur-
and hopeful through the collective power of humanity. An ance that I am not alone; and that I have a team of colleagues
employee in the emergency department shared their six-word who are resilient and supportive of one another. Thank you.”
poem after the combined crane making and poetry workshop: (Music therapist)
“Challenging. Humility. Compassion. Teamwork. Strength. • “We haven’t been able to grieve yet. It is so nice to be con-
Kindness.” nected while we grieve what is happening around us.
Thank you.” (Attending physician)
Family The leadership team also received numerous unsolicited feedback
A large number of poems-related to family and home. Some par- regarding the public exhibit. One of these testimonials is provided
ticipants expressed confusion, stress, and difficulty with being with below.
family, while others expressed gratitude for their family. A nurse • “I think the whole project is incredibly healing and sad and
who participated in the combined crane making and poetry work- uplifting and full of sorrow all at the same time and everyone
shop wrote: “Thankful for the health of my family.” can identify their feelings in the 6-word poems. Participating
can help people identify their own state of mind, in a way they
Love may not have recognized without this. I know it did for me.”
Some participants expressed the ways in which they practiced (Administrative nurse manager)
self-love, while other participants expressed the many ways in
which their community members poured out their love during Discussion
such a difficult and challenging time. A medical student submitted
an online poem and wrote: “Declaration: Thank you for loving me.” To our best knowledge, the Crane Project is the first expressive art
therapy mixed-methods study that utilizes six-word poems to under-
Teamwork stand participants’ experiences during a collective traumatic event,
such as the COVID-19 pandemic. The following themes were iden-
Many physicians, nurses, psychologists, and hospital staff that tified: (a) grief, loss, and challenges, (b) painful emotions, (c) grat-
submitted a six-word poem described the way in which they united itude, resilience, and hope, and (d) connection and community.
 420 BHATTACHARYYA, PARK, ADLER, SAKLAD, AND DAVIS

Three main findings emerged from this project. First, we wit- community-based artwork, which are two experiences identified
nessed COVID-19 as a collective trauma (e.g., Duane et al., 2020; as important to hospital staff and community members.
Erikson, 1976; Hirschberger, 2018), and that many participants Mitigating traumatic impact in the midst of trauma can be difficult
experienced multiple concurrent emotions as expressed in their six- without removal of the stressor (Nagoski, 2019). However, research
word poems, including grief, anger, stress, gratitude, connection, indicates the necessity to address stress stored in the mind and body
and resilience. Second, our findings suggest that expressive and cre- to prevent long-term consequences. In the height of COVID-19, it
ative art may act as a helpful and powerful emotional tool for pro- was unclear if, when, and how the stressor of COVID would be
cessing feelings of grief, loss, and pain associated with COVID-19 removed, so it was necessary to find avenues to hold the grief and
(e.g., Wallace et al., 2020), and can provide an avenue for healing process the trauma. Though this study did not follow participants
with community. Specifically, we found that the mean difference longitudinally, we know from SUDs data that perceived distress
in SUDS decreased after participation in the Crane Project, despite decreased after participation in the Crane Project. We posit this is
the type of intervention that was chosen, indicating that participation likely because participation in the project, regardless of style of
in any one of the three intervention groups was important to address engagement, provided an avenue to engage in mindful awareness—
emotional experiences which arose during a period of collective to pause, notice, and name feelings, and to tribute in some
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

trauma. Third, our findings support that there is a critical need for
This document is copyrighted by the American Psychological Association or one of its allied publishers.

small way the mass tragedy happening in our world. Additionally,

public and creative commemoration that unites community members the impact of trauma can be mitigated by acknowledging its collec-
(e.g., Saul, 2014), especially in the aftermath of such an unprece- tive nature—COVID-19 isolated us in a way that is atypical in the
dented mass tragedy in isolation. In the participant reflections stated face of mass tragedy. Witnessing others’ poems, cranes, and the
above, many expressed gratitude for the opportunity to reflect with installation symbolically provided a way for all of us to “be together”
their colleagues and community and felt supported and validated in the experience of grief. When experienced alone, one can internal-
throughout the workshops. Overall, these findings offer a novel con- ize blame for normative reactions to trauma. Collectively, all of us
tribution to the literature, providing qualitative and quantitative data can liberate from the pain of this unprecedented tragedy together.
regarding the efficacy of six-word poems (e.g., Simmons & Chen, Our findings inform us that a diverse group of participants, includ-
2014; Six Word Memoirs, 2005) as a tool to reduce psychological ing high school students, hospital administrative staff, registered
distress. nurses, physicians, psychologists, medical students, patients, and
The Crane Project design had two major merits. First, the online volunteers of Montefiore submitted poems and expressed similar
format allowed participants to engage in workshops and fold paper concurrent feelings of grief, loss, hope, and resilience. Thus, we
cranes in their own homes, on their own time, ensuring they could are hopeful that our healing project can serve as an example of an
safely adhere to social distancing guidelines. The design team expressive and creative art therapy-based project to foster collective
regularly reflected that we had never lived through nor heard of a healing across a variety of settings, including in classrooms, in hos-
mass tragedy where people were unable to come together physically pitals, in workplaces and offices, in community-based centers, and
to grieve and commemorate. The individual-yet-collective, one- even in homes. As a leadership team, we felt that this project was
part-of-a-whole nature of the poems and origami provided a “safe” not only critical for the Bronx community, but that the process of
way to be together. The decrease in SUDS score regardless of inter- facilitating workshops and conversations, folding paper cranes, read-
vention modality suggested a diverse array of art therapy practices ing participants’ poems, and witnessing the launch of the exhibition,
can target traumatic distress, and the art therapy activities themselves was therapeutic, humbling, encouraging, and healing. We encourage
could be done independently or collectively with others and still anyone, and especially those in leadership positions, to acknowledge
have an impact. Second, we found that six-word poems were a sim- the mental health concerns and challenges brought upon by the pan-
ple, yet profound, tool to gather succinct qualitative data. Art and demic and to implement various creative and engaging arts-based
poetry writing is not comfortable for everyone, however, we experi- strategies to provide an avenue for community healing and for
enced the invitation to identify and express only six words to sum- remembrance. It is critical that community members have an outlet
marize your experience was less intimidating for participants than to process, to reflect, and to heal from COVID-19-related distress.
other, longer-form therapeutic art exercises. The limitation of
words helped pinpoint or boil down that which is most salient in Limitations
one’s experience. In the same way, therapy visits begin with,
“what would you like to discuss today?” six-word poems identify Although the recruitment of participants for the workshops
the gist of how one would describe their internal experiences, either focused on hospital workers, patients, and the community, there
in story form or labels. While this is a relatively novel form of qual- was a limited number of patients and community members that par-
itative data utilizing novel analytic applications, we hope others ticipated in the Crane Project. In addition, individuals from a limited
build off of and continue to utilize this technique. In the future, number of departments participated. Future healing projects could
the team hopes to utilize augmented reality, a technology in which expand their recruitment to a broader range of departments and to
one can use a device such as a cell phone, computer, or tablet, to patients and the community through efforts such as announcements
see the exhibit and interact with it virtually. This will allow for in public departmental forums such as Grand Rounds, direct flyer
any associate or community member from any location to participate handouts to patients and their families, and display of flyers in
in the Crane Project. Augmented reality will allow the Crane Project local community spaces such as churches, greater use of social
to continue in perpetuity as COVID-19 continues to impact the media, and partnership with local organizations and media sources.
United States and many parts of the world. Finally, the use of aug- Due to the limited number of participants from the community, we
mented reality technology encourages socialization and promotes did not have sufficient numbers to meaningful compare themes
a sense of community through the grassroots experience of virtual between healthcare workers and members of the community.
 CRANE PROJECT 421

Furthermore, a second significant limitation of this study included Bernstein, C. A., Bhattacharyya, S., Adler, S., & Alpert, J. E. (2021). Staff
individual time constraints. When workshops were available, one of emotional support at Montefiore Medical Center during the COVID-19
the most common limiting factors for hospital participation was lack pandemic. The Joint Commission Journal on Quality and Patient Safety,
of dedicated time for wellness in certain departments. As a result of 47(3), 185–189. https://doi.org/10.1016/j.jcjq.2020.11.009
workshops being 30 min to 2-hr, hospital departments were often Beser, A. (2015, August 28). How paper cranes became a symbol of
unable to commit the time or individuals to take the time to attend healing in Japan. National Geographic Society Newsroom. https://blog
these sessions, particularly during usual work hours. Future efforts .nationalgeographic.org/2015/08/28/how-paper-cranes-became-a-
could focus on working with higher-level leadership to encourage symbol-of-healing-in-japan/
Bojner Horwitz, E., Grape Viding, C., Rydwik, E., & Huss, E. (2017). Arts as
participation and guarantee the time and space needed for employee
an ecological method to enhance quality of work experience of healthcare
engagement.
staff: A phenomenological-hermeneutic study. International Journal of
Additionally, regarding the crane making workshops specifically,
Qualitative Studies on Health and Well-Being, 12(1), Article 1333898.
we found there to be significant individual differences in the comfort
https://doi.org/10.1080/17482631.2017.1333898
of practicing origami making, creating a challenge in facilitation— Burrell, A., & Selman, L. E. (2022). How do funeral practices impact
especially during virtual workshops when in-person assistance was
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

bereaved relatives’ mental health, grief and bereavement? A mixed meth-

This document is copyrighted by the American Psychological Association or one of its allied publishers.

not feasible. Allowing for adequate time to practice, acknowledgment ods review with implications for COVID-19. OMEGA-Journal of Death
of the difficulty of doing something new, encouragement of leaning and Dying, 85(2), 345–383. https://doi.org/10.1177/0030222820941296
into the discomfort, distributing crane making resources before and Carroll, R. (2005). Finding the words to say it: The healing power of poetry.
during the workshop, and encouraging collaboration with colleagues Evidence-Based Complementary and Alternative Medicine, 2(2), 161–
are helpful ways to overcome this challenge. In-person workshops 172. https://doi.org/10.1093/ecam/neh096
made it easier for facilitators and colleagues to recognize and assist Center for Disease Control and Prevention. (2020). COVID data tracker.
with individual differences in crane making, but when the pandemic https://covid.cdc.gov/covid-data-tracker/#datatracker-home
became more severe, we recognized that in-person workshops were Charmaz, K. (2014). Constructing grounded theory (2nd ed.). Sage.
overall less practical and safe than virtual workshops. Chen, Q., Liang, M., Li, Y., Guo, J., Fei, D., Wang, L., He, L., Sheng, C., Cai,
Finally, we observed two potential limitations in our analyses. Our Y., Li, X., Wang, J., & Zhang, Z. (2020). Mental health care for medical
project is the first-ever, large, online mixed-methods study utilizing staff in China during the COVID-19 outbreak. The Lancet Psychiatry,
six-word poems to understand participants’ emotions and experiences 7(4), e15–e16. https://doi.org/10.1016/S2215-0366(20)30078-X
Cheng, P., Xia, G., Pang, P., Wu, B., Jiang, W., Li, Y. T., Wang, M., Ling, Q.,
during the COVID-19 pandemic. Thus, given the novelty of the pro-
Chang, X., Wang, J., Dai, X., Lin, X., & Bi, X. (2020). COVID-19 epi-
ject and the lack of previous studies analyzing this specific form of
demic peer support and crisis intervention via social media. Community
brief, qualitative data, we decided to adapt and combine two methods
Mental Health Journal, 56(5), 786–792. https://doi.org/10.1007/s10597-
of analyses, inductive thematic analysis (Thomas, 2006), and CQR-M
020-00624-5
(Spangler et al., 2012). However, despite this initial concern regarding Cusinato, M., Iannattone, S., Spoto, A., Poli, M., Moretti, C., Gatta, M., &
analytic methods, we were able to produce quantitative results based Miscioscia, M. (2020). Stress, resilience, and well-being in Italian children
on SUDS that contextualized the qualitative results and the impact of and their parents during the COVID-19 pandemic. International Journal
this intervention. Secondly, given that participants’ SUDS were mea- of Environmental Research and Public Health, 17(22), Article 8297.
sured immediately after the intervention, there is potential room for https://doi.org/10.3390/ijerph17228297
response shift bias, in which postintervention scores are predicted to DePaolo, C. A., & Wilkinson, K. (2014). Get your head into the clouds:
decrease the second time a participant completes a survey or question- Using word clouds for analyzing qualitative assessment data.
naire (Howard, 1980). Thus, future research could implement a longi- TechTrends, 58(3), 38–44. https://doi.org/10.1007/s11528-014-0750-9
tudinal mixed-method study design to facilitate multiple workshops Duane, A. M., Stokes, K. L., DeAngelis, C. L., & Bocknek, E. L. (2020).
with the same population or assess participants’ SUDS and emotions Collective trauma and community support: Lessons from Detroit.
at predetermined intervals following the intervention in order to gain a Psychological Trauma: Theory, Research, Practice, and Policy, 12(5),
better understanding of distress over time. 452–454. https://doi.org/10.1037/tra0000791
Edwards, C., & Hegerty, S. (2018). Where it’s cool to be Kitty: An art therapy
group for young people with mental health issues using origami and mind-
Conclusion fulness. Social Work with Groups, 41(1–2), 151–164. https://doi.org/10
.1080/01609513.2016.1258625
The innovative research approach helped us understand the statis-
Erikson, K. T. (1976). Everything in its path. Simon and Schuster.
tically significant impact that engagement with an expressive arts
Glaser, B. G. (1978). Theoretical sensitivity: Advances in the methodology of
therapy modality can have on traumatic distress. A six-word poem grounded theory. Sociology Press.
submitted by a medical student highlights the goal of this project Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020).
best: We Remember We Survive We Grow. COVID-19 made a per- Managing mental health challenges faced by healthcare workers during
manent impact on our lives. It is our sincerest hope that these find- COVID-19 pandemic. BMJ, 368, Article m1211. https://doi.org/10
ings become a catalyst for developing similar expressive art .1136/bmj.m1211
therapy interventions to foster community healing for this traumatic Headspace and New York Governor Cuomo’s Office Team Up to Release
time and beyond. “New York State of Mind,” Free Meditation and Mindfulness Content
Hub Curated for New Yorkers. (2020, April 6). Business wire. https://
www.businesswire.com/news/home/20200406005487/en/Headspace-
References
and-New-York-Governor-Cuomo%E2%80%99s-Office-Team-Up-to-
Bennett, J. (2005). Empathic vision: Affect, trauma and contemporary art. Release-%E2%80%98New-York-State-of-Mind%E2%80%99-Free-
Stanford University Press. Meditation-and-Mindfulness-Content-Hub-Curated-for-New-Yorkers
 422 BHATTACHARYYA, PARK, ADLER, SAKLAD, AND DAVIS

Hirschberger, G. (2018). Collective trauma and the social construction of Planas Domingo, J., Escudé Matamoros, N., Farriols Danés, C., Villar Abelló,
meaning. Frontiers in Psychology, 9, Article 1441. https://doi.org/10 H., Mercadé Carranza, J., Ruiz Ripoll, A. I., Mojal Garcia, S., & Rossetti, A.
.3389/fpsyg.2018.01441 (2015). Effectiveness of music therapy in advanced cancer patients admitted
Holman, E. A., & Grisham, E. L. (2020). When time falls apart: The public to a palliative care unit: A non-randomized controlled, clinical trial. Music &
health implications of distorted time perception in the age of COVID-19. Medicine, 7(1), 23–31. https://doi.org/10.47513/mmd.v7i1.295
Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), Riggs, A. (2010). The creative space: Art and wellbeing in the shadow of
S63–S65. https://doi.org/10.1037/tra0000756 trauma, grief and loss [Thesis]. https://vuir.vu.edu.au/16014/1/Riggs_
Howard, G. S. (1980). Response-shift bias: A problem in evaluating interven- PhD_thesis.pdf
tions with pre/post self-reports. Evaluation Review, 4(1), 93–106. https:// Rothschild, B. (2000). The body remembers: The psychophysiology of
doi.org/10.1177/0193841X8000400105 trauma and trauma treatment. Norton Professional Books.
Huss, E., & Sarid, O. (2014). Visually transforming artwork and guided imag- Saul, J. (2014). Collective trauma collective healing: Promoting community
ery as a way to reduce work related stress: A quantitative pilot study. The Arts resilience in the aftermath of disaster. Routledge Taylor & Francis Group.
in Psychotherapy, 41(4), 409–412. https://doi.org/10.1016/j.aip.2014.07.004 https://books.google.com/books?id=Ve0dAAAAQBAJ&dq=collective
Kang, L., Ma, S., Chen, M., Yang, J., Wang, Y., Li, R., Yao, L., Bai, H., Cai, +trauma&lr=
Z., Xiang Yang, B., Hu, S., Zhang, K., Wang, G., Ma, C., & Liu, Z. (2020).
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Simmons, N., & Chen, Y.-W. (2014). Using six-word memoirs to increase
Impact on mental health and perceptions of psychological care among
This document is copyrighted by the American Psychological Association or one of its allied publishers.

cultural identity awareness. Communication Teacher, 28(1), 20–25.

medical and nursing staff in Wuhan during the 2019 novel coronavirus dis- https://doi.org/10.1080/17404622.2013.839050
ease outbreak: A cross-sectional study. Brain, Behavior, and Immunity, 87, Six Word Memoirs. (2005). Six word memoirs. https://www.sixwordmemoirs
11–17. https://doi.org/10.1016/j.bbi.2020.03.028
.com/
Killian, K. D. (2008). Helping till it hurts? A multimethod study of compas-
Smyth, J., & Helm, R. (2003). Focused expressive writing as self-help for
sion fatigue, burnout, and self-care in clinicians working with trauma sur-
stress and trauma. Journal of Clinical Psychology, 59(2), 227–235.
vivors. Traumatology, 14(2), 32–44. https://doi.org/10.1177/1534765
https://doi.org/10.1002/jclp.10144
608319083
Spangler, P. T., Liu, J., & Hill, C. E. (2012). Consensual qualitative research for
Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li,
simple qualitative data: An introduction to CQR-M. In C. E. Hill (Ed.),
R., Tan, H., Kang, L., Yao, L., Huang, M., Wang, H., Wang, G., Liu, Z., &
Consensual qualitative research: A practical resource for investigating social
Hu, S. (2020). Factors associated with mental health outcomes among health
science phenomena (pp. 269–283). American Psychological Association.
care workers exposed to coronavirus disease 2019. JAMA Network Open,
StataCorp. (2019). Stata statistical software: Release 16.
3(3), Article e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976
Storr, R. (1991). Dislocations. MoMA. https://www.moma.org/calendar/
Lundberg, J. (2014). The Origami Wish Tree: The impact of art therapy using
origami with cancer survivors [Unpublished master thesis]. Saint exhibitions/350
Mary-of-the-Woods College. Thomas, D. R. (2006). A general inductive approach for analyzing qualitative
Luo, M., Guo, L., Yu, M., Jiang, W., & Wang, H. (2020). The psychological evaluation data. American Journal of Evaluation, 27(2), 237–246. https://
and mental impact of coronavirus disease 2019 (COVID-19) on medical doi.org/10.1177/1098214005283748
staff and general public—A systematic review and meta-analysis. Teo, W., Soo, Y. E., Yip, C., Lizhen, O., & Chun-Tsu, L. (2021). The psy-
Psychiatry Research, 291, Article 113190. https://doi.org/10.1016/j chological impact of COVID-19 on ‘hidden’ frontline healthcare workers.
.psychres.2020.113190 International Journal of Social Psychiatry, 67(3), 284–289. https://
Milosevic, I., & McCabe, R. (2015). Phobias: The psychology of irrational doi.org/10.1177/0020764020950772
fear. ABC-CLIO. Varghese, J. S., Samson, R., & Sujatha, S. (2018). Origami and manifested
Nagoski, E. (2019). Burnout: The secret to unlocking the stress cycle. behaviour in hospitalized children. International Journal of Advances in
Random House Publishing Group. Nursing Management, 6(2), 115–119. https://doi.org/10.5958/2454-
National AIDS Memorial. (2021). AIDS memorial quilt virtual exhibition. 2652.2018.00027.6
https://www.aidsmemorial.org/quilt Wallace, C. L., Wladkowski, S. P., Gibson, A., & White, P. (2020). Grief dur-
Orr, P. P. (2007). Art therapy with children after a disaster: A content analy- ing the COVID-19 pandemic: Considerations for palliative care providers.
sis. The Arts in Psychotherapy, 34(4), 350–361. https://doi.org/10.1016/j Journal of Pain and Symptom Management, 60(1), e70–e76. https://
.aip.2007.07.002 doi.org/10.1016/j.jpainsymman.2020.04.012
Park, C. L., & Blumberg, C. J. (2002). Disclosing trauma through writing: WHO Coronavirus (COVID-19) Dashboard. (2022, February 27). World
Testing the meaning-making hypothesis. Cognitive Therapy and Health Organization. https://covid19.who.int/
Research, 26(5), 597–616. https://doi.org/10.1023/A:1020353109229
Phillips, C. S., & Becker, H. (2019). Systematic review: Expressive arts inter- Received March 16, 2022
ventions to address psychosocial stress in healthcare workers. Journal of Revision received February 9, 2023
Advanced Nursing, 75(11), 2285–2298. https://doi.org/10.1111/jan.14043 Accepted March 12, 2023 ▪