Understanding the Experience of Working Women in Managing Stress during Pandemic using Expressive Art Therapies

Understanding the Experience of Working Women in Managing Stress During Pandemic Using Expressive Art Therapies

Mohd Nazri Abdul Rahman, Amira Najiha Yahya, Kasturi Bai

Faculty of Education, University Malaya, Kuala Lumpur

DOI: https://dx.doi.org/10.47772/IJRISS.2024.8120086

Received: 28 November 2024; Accepted: 02 December 2024; Published: 03 January 2025

ABSTRACT

The COVID-19 pandemic has significantly exacerbated stress levels, particularly among working women in Malaysia, who faced increased domestic and professional responsibilities during the crisis. This study explores the effectiveness of Expressive Art Therapy in managing pandemic-induced stress among this demographic. Through qualitative research involving in-depth interviews with 30 participants, the study investigates how Expressive Art Therapy has been utilized to alleviate emotional and psychological strain. The findings reveal that engaging in activities such as painting, drawing, and dance allows these women to articulate emotions nonverbally, fostering a therapeutic release and promoting mental health resilience. This therapeutic approach has proven beneficial in enhancing emotional well-being, offering an innovative outlet for stress management, and improving overall life satisfaction among participants. The research underscores the potential of Expressive Art Therapy to serve as a valuable tool in occupational stress management strategies, particularly in times of crisis. However, the study acknowledges limitations, including the sample size and the specific focus on women who have opted for this therapy, potentially skewing broader applicability. Future research is recommended to explore Expressive Art Therapy’s efficacy in broader demographic settings and to examine its long-term psychological benefits. This study highlights the need for policy enhancements to integrate creative therapies into workplace mental health programs, thus supporting gender-specific mental health needs during unprecedented times.

Keywords: COVID-19, Expressive Art Therapy, Working Women, Stress Management, Mental Health, Malaysia

INTRODUCTION

Women form an integral part of the community and must live a stress-free life for their personal and social growth (Naganathan, Gupta, & Prasad, 2021). However, women in Malaysia have been experiencing symptoms of stress and burnout during the COVID-19 pandemic due to the dual burdens of household and workforce responsibilities (Naganathan, Gupta, & Prasad, 2021). The prevalence of mental stress has increased during the COVID-19 pandemic because of lockdown conditions, disruption of daily life routines, loss of livelihood opportunities, fear for life, and the universal threat of the virus (Beckstein et al., 2021). A survey by the National Health and Morbidity in Malaysia reported a significant increase in mental health issues among individuals due to economic insecurity, social isolation, and the loss of loved ones (Tan et al., 2023). Additionally, government statistics revealed a significant rise in levels of depression, anxiety, and stress over the last twenty years, leading to a surge in medical spending, which is expected to reach USD 6 trillion by 2030 (Mental Health First Aid International, 2024). The survey also revealed that more than half a million individuals in Malaysia showed symptoms of depression, contributing to increases in domestic violence, stress, and suicides in the country. Moreover, the Women’s Aid Organization and the government’s Talian Kasih hotline reported a significant rise in mental health issues among women, with 44% and 57% increases in calls, respectively (Clinical Research Centre Hospital Kuala Lumpur, 2024). A major contributing factor to the rise in mental health issues during the lockdown conditions of the COVID-19 pandemic was the increase in domestic violence cases (Boselli et al., 2020).

The psychological effects of the virus outbreak are so profound that they have adversely impacted individuals on both personal and social levels. These effects are especially evident among women, with many reported to be suffering from depression, anxiety, and stress. During the pandemic, women were confined to their homes without household help, which created challenges for working women in balancing professional and domestic responsibilities (Connor et al., 2020). According to local media reports in Malaysia, there has been an increase in calls to Women’s Aid Groups since the implementation of the Movement Control Order (MCO) during the COVID-19 pandemic. Most of these calls were related to domestic violence experienced by women during the lockdown period. Between March 18 and June 9, 78 suicides were recorded, and the Befrienders recorded a 34% increase in calls between March 18 and May 16, with one-third of those calls being related to suicidal thoughts (Kamel, 2020). The Health Ministry of Malaysia also reported an increase in calls, with 2,500 phone calls and more than 1,000 WhatsApp messages to its Psychological First Aid hotline between March 18 and April 12, 2020 (Idris et al., 2021). Additionally, women faced challenges such as intimate partner violence, lack of cooperation from family members, an overwhelming number of domestic tasks, and caregiving responsibilities for children or the elderly, all of which contributed to mental stress.

Stress due to COVID-19 is not only found among women balancing home and work responsibilities, but also among female students in Malaysia. A recent study found that most female students over the age of 25 experienced high levels of mental stress due to the pandemic (Prowse et al., 2021). A higher level of fear was observed in 70% of the females’ pursuing studies in various fields. The major causes of fear, stress, and anxiety among these students were financial constraints, remote teaching and learning practices, and uncertainty about future academic and career outcomes (Kassim et al., 2021). As stress levels rise, women exhibit symptoms such as memory loss, poor judgment, anxious or racing thoughts, constant worrying, concentration issues, depression, and constipation, among others. These symptoms degrade their individual and social well-being and diminish their ability to manage household and professional responsibilities. Therefore, it is essential to introduce mitigating measures such as Expressive Art Therapy to improve the challenging conditions women face and reduce mental stress levels. The introduction of Expressive Art Therapy could promote positive thinking among women at both conscious and subconscious levels, allowing them to feel more in control of their emotions and bringing depth and life to their feelings. Based on the above facts, it can be concluded that mental stress among Malaysian women could be effectively reduced through the use of Expressive Art Therapy.

The survey conducted by the National Health and Morbidity in Malaysia reported an increase in the reporting of mental health issues among individuals in the country (Mushaddik et al., 2022). The major drivers of stress identified include economic insecurity, social isolation, and the loss of loved ones. These factors have contributed to heightened symptoms of stress and depression. As a result, the stress levels reported in Malaysia are the highest the country has experienced in the past 20 years. Along with the increase in mental health issues, there has also been a rise in the healthcare burden, as more resources are needed to provide adequate care and treatment for those suffering from stress and mental health problems. Based on Power (2020) findings, it can be concluded that the COVID-19 pandemic has been particularly detrimental to women, as their stress levels have risen due to limited mobility and the lack of external help. Therefore, it is strongly recommended that expressive art therapy be introduced, as it can reduce negative thinking among women and promote positive thinking on both conscious and subconscious levels. Through expressive art therapy, women will have a better understanding of their emotions and be provided with various ways to release their innermost fears and pain. This approach not only helps in reducing stress levels but also boosts self-confidence and enhances their ability to complete tasks.

This study aims to explore how working women in Malaysia manage stress, particularly during the COVID-19 pandemic, through the use of expressive art therapy. The research seeks to understand how various forms of art, such as painting, drawing, music, dance, and drama, can help alleviate stress, enhance emotional well-being, and improve overall mental health. The study focuses on three key aspects: first, it investigates how working women perceive the role of expressive art therapy in stress management, including their expectations and the perceived benefits during and after therapy sessions. Second, the research examines the therapeutic elements of expressive art therapy, such as which art forms are most effective, the frequency and duration of sessions, and the long-term benefits of regular engagement. Finally, the study explores how women integrate expressive art therapy into their daily routines, considering factors like accessibility, scheduling, and support systems. The findings aim to contribute to occupational stress management and mental health practices, highlighting the potential of creative therapies to reduce stress and improve well-being. Ultimately, this research aims to inform future mental health strategies, particularly in the workplace, and advocate for the broader use of art-based therapies to manage stress in various contexts.

LITERATURE REVIEW

The global epidemic has caused severe emotional, physical, and financial difficulties, leading many individuals to seek methods to alleviate stress, sadness, and anxiety through various treatments. One of the most comprehensive studies on art therapy methods, forms, and therapist behaviour was published by Bosgraaf et al. (2020). According to Bosgraaf et al. (2020), art therapy has a long history of being used to treat mental health and psychosocial issues. Wu and Chung (2023) conducted a comprehensive scoping review of the literature and research on art therapy, tracing its roots back to the work of artists in mental hospitals in the 1940s. Their review highlighted a wide range of therapist styles, including non-directive, directive, and eclectic approaches. Wu and Chung (2023) emphasized that incorporating these three styles into various therapeutic approaches and expressions has been effective in easing psychosocial problems.

Brandão et al. (2019), in another publication discussed in more detail later, focus not on the causes of sadness but on how art therapy can assist individuals with depressive illnesses and the significant outcomes that result from this intervention. Their review included 14 papers selected from databases such as MEDLINE/PubMed, the American Psychological Association (APA), and the Web of Science. The included studies involved activities such as drawing, painting, modelling, music, and poetry. Their findings indicate that art therapy is both safe and effective in treating depression and other mental health concerns. Hilton (2021), in his literature review prior to his presentation, revealed several clinical studies demonstrating the positive effects of art therapy on a wide range of both objective and subjective medical outcomes. Favourable impacts were noted in conditions such as Type 1 diabetes mellitus and non-psychotic mental health disorders. Since 2020, the COVID-19 pandemic has dominated the global scientific research agenda, with studies addressing a spectrum of topics, from fundamental science and prevalence to vaccine development and even the application of art therapy.

The societal and mental health implications of the global COVID-19 pandemic have been profound, encompassing both pre-existing psychiatric problems and those arising directly from the pandemic (Carroll et al., 2020). Individuals who could benefit from art therapy during this time include COVID-19 patients, those grieving the loss of loved ones to the virus, healthcare workers, individuals experiencing prolonged social isolation, and those with pre-existing mental health issues (Keisari et al., 2023). The compounded stress and isolation experienced by these groups have heightened their vulnerability, making therapeutic interventions like art therapy particularly relevant. Numerous publications have highlighted the positive benefits of art therapy during the pandemic, focusing on alleviating the associated burden and sorrow. For instance, Li (2021) examined the role of art therapy in pandemics, specifically drawing lessons for COVID-19. According to Hilton (2021), this manuscript, authored by Potash and colleagues, brings together art therapists with prior experience in dealing with pandemics such as Ebola or SARS. These professionals have formed a collaborative online community aimed at disseminating information, guiding expression and inspiration, modulating media, building resilience, reducing stress, fostering relationships, and intensifying hope. Art therapy practice has been identified as essential in navigating the emotional and psychological challenges posed by the pandemic.

Art therapy’s impact during the COVID-19 pandemic has been multifaceted, addressing both direct and indirect mental health issues. The therapeutic practice has shown significant positive outcomes, offering relief to those struggling with heightened anxiety, stress, and grief. For example, a study by Luo et al. (2023) highlighted how a resident in a nursing home used drawing to articulate her emotional experiences during the pandemic. This case underscores the role of art therapy in providing a medium for self-expression and emotional processing, which is particularly valuable in the context of social isolation and limited physical interaction. Hunnewell (2019) described Expressive Arts Therapy as a multidisciplinary therapeutic technique that incorporates various approaches such as drama, dance, music, writing, and movement. This comprehensive approach is designed to treat patients suffering from stress, depression, anxiety, and social challenges. Expressive Arts Therapy leverages multiple creative modalities to promote deep healing and emotional growth, making it particularly effective for individuals experiencing high levels of stress. The increasing use of this therapy can be attributed to its ability to reduce anxiety and stress through creative processes, providing patients with diverse means of expression and emotional release.

The role of art therapy in managing stress and promoting mental health has been well-documented in various contexts. For instance, Kaye-Huntington and Peterson (2010) found that Expressive Arts Therapy significantly improved the emotional well-being of individuals suffering from chronic stress. Their research supports the broader literature highlighting the therapeutic benefits of creative expression in managing mental health issues. By engaging in activities like drawing, painting, music, and movement, individuals can explore and process their emotions in a supportive and non-judgmental environment. This process not only helps alleviate immediate stress but also builds resilience and coping skills for future challenges. Expressive Arts Therapy’s impact on stress management is multifaceted, involving various therapeutic techniques such as art therapy, dance therapy, music therapy, and writing therapy. These modalities provide patients with diverse means of expression and emotional release, fostering resilience and promoting overall mental health. By engaging in creative activities, individuals can explore and process their emotions in a supportive and non-judgmental environment.

The benefits of art therapy extend beyond individual mental health, impacting social and community well-being (Fancourt & Finn, 2019). For example, community-based art therapy programs have been shown to enhance social cohesion and support networks, which are critical in times of crisis (Hollings bee, 2019). Such programs provide a collective space for individuals to express their experiences, share their stories, and build connections with others facing similar challenges. This communal aspect of art therapy can be particularly beneficial during the pandemic, where social isolation and disrupted routines have eroded traditional support systems. Moreover, the integration of art therapy into broader mental health strategies can enhance the overall effectiveness of these programs. Combining art therapy with other therapeutic approaches, such as cognitive-behavioural therapy (CBT) or mindfulness practices, can provide a more comprehensive and holistic treatment plan (Monson, 2022). This integrative approach leverages the strengths of each modality, offering patients multiple pathways to recovery and well-being. For instance, art therapy can serve as a complementary tool in CBT by helping patients visualize and externalize their cognitive processes, making abstract concepts more tangible and accessible.

The practical application of art therapy during the COVID-19 pandemic has also highlighted the importance of accessibility and adaptability. Virtual art therapy sessions have emerged as a viable alternative to in-person sessions, ensuring continuity of care despite physical distancing measures. These online sessions allow therapists to reach a broader audience, including those who may not have access to traditional mental health services. Additionally, virtual platforms can facilitate group sessions, fostering a sense of community and shared experience even in isolation (Newland, & Bettencourt, 2020; Vaartio-Rajalin et al., 2021). The adaptability of art therapy to different settings and populations further underscores its value. For example, art therapy can be tailored to meet the needs of various age groups, from children to older adults, and can be adapted for individuals with different levels of artistic skill and comfort. This flexibility makes it an inclusive and versatile therapeutic tool, capable of addressing a wide range of mental health issues across diverse populations. The global pandemic has underscored the need for innovative and effective mental health interventions. Art therapy, with its emphasis on creative expression and emotional processing, offers a promising avenue for addressing the complex psychological impacts of the pandemic. By providing a non-verbal means of communication, art therapy can help individuals navigate the emotional turbulence of the pandemic, fostering resilience and promoting overall mental health.

Art therapy in the age of COVID-19 was explored by Braus and Morton (2020). According to Braus and Morton (2020), COVID-19 and its associated mental health difficulties have been described as being at war, causing unrelenting stress due to the restrictions and guidelines put in place to slow the spread of the virus. Art therapy may be utilized during times of solitude to assist individuals and can be beneficial throughout one’s entire life. On the topic of the 2019 coronavirus pandemic, Renzi et al. (2021) published an article detailing how a woman in a nursing home used drawings to describe her personal emotional experiences during the pandemic. Renzi et al. (2021) also examined the psychological impact of the COVID-19 pandemic on nurses, focusing on predictors of post-traumatic stress disorder (PTSD) and Generalized Anxiety Disorder (GAD). Their cross-sectional study, conducted between December 2020 and April 2021, included 359 nurses, predominantly female, unmarried, and working in central and northern Italy. The study revealed that 59.7% of participants exhibited clinical predictors of PTSD, with a significant number showing moderate to severe symptoms of GAD. The data indicated a strong association between GAD and nurses working on the front lines, particularly in intensive care units and emergency departments, during the pandemic’s second wave. Additionally, nurses employed in COVID-19 dedicated hospitals or institutions were more likely to develop PTSD. Renzi et al. (2021) concluded that PTSD and GAD among nurses are significant public health concerns that require post-pandemic attention. They stressed the need for healthcare organizations to implement specific support and rehabilitation programs to address the mental health challenges faced by healthcare professionals during the pandemic.

According to Hunnewell (2019), Expressive Art Therapy is a multidisciplinary therapeutic technique that incorporates various approaches, such as drama, dance, music, writing, and movement, to treat patients suffering from stress, depression, anxiety, and social challenges. Expressive Art Therapy is based on the use of diverse therapies, including art therapy, dance therapy, music therapy, and writing therapy, all of which play a major role in improving the condition of individuals through deep healing processes. The increasing use of this therapy is beneficial for individuals suffering from high levels of stress, as creative approaches help reduce anxiety and stress levels. Wong and Alias (2021) examined the rising rate of mental illness in Malaysia, which was exacerbated by the socio-economic downturn during the COVID-19 outbreak. Reports from the National Health and Morbidity Survey revealed that mental health issues are the second most common health problem in the country. The survey indicated that among every 10 individuals in Malaysia, 3 individuals aged 16 and above suffer from mental illness. It was also revealed that the Malaysian Ministry of Health received over 37,009 calls to its helplines seeking mental health guidance and counselling. This highlights the desperate need for psychological and emotional support during the COVID-19 lockdown.

Newland and Bettencourt (2020) examined numerous research papers that identify depression and anxiety as the primary mental health conditions affecting individuals. In addition, their study explored mindfulness-based art therapy as a treatment for symptoms related to anxiety and depression. The study also assessed the symptoms and quality of life outcomes by examining samples from both adolescent and adult populations. The findings indicated that mindfulness-based art therapy led to improvements in both psychological and physical symptoms compared to a control group, highlighting its potential as a promising intervention. However, the study also noted that its effectiveness is limited by the small number of studies available. Bosgraaf et al. (2020) conducted a systematic narrative review on art therapy for psychological problems in children and adolescents. This comprehensive review provided an overview of various art therapy interventions for children and adolescents facing psychological challenges.

The study identified three primary therapeutic approaches: non-directive, directive, and eclectic. These approaches, which combine a variety of expressions, were found to significantly impact psychosocial problems. Kim (2010) explored the use of expressive art therapy as a treatment for patients suffering from developmental disabilities, traumatic brain injury, post-traumatic stress, mental health disorders, and more. Expressive art therapy involves various art forms, including sound, music, painting, sculpting, drawing, improvisation, creative writing, and movement, to facilitate growth and healing among patients. It is a person-cantered approach, where skilled therapists analyze specific problems faced by the patient and use art as a medium for self-expression and emotional release rather than directly solving the problem. Safrai (2013) examined the use of expressive art therapy in groups, employing techniques such as guided imagery, painting, sculpture, themed discussions, photography, and music to increase active engagement and participation in regular activities. For example, coloring activities in expressive art therapy have been shown to reduce wandering tendencies among dementia patients. When conducted as group activities, these interventions help reduce anxiety and stress. Similarly, singing activities have been found to improve the health of mentally stressed individuals, enhance personal growth, and foster human connectivity.

Liddle, Parkinson, and Sibbritt (2012) found that when expressive art therapy activities, such as playing instruments, are conducted individually, they promote emotional well-being. When performed as group activities, these interventions contribute to personal growth, mental health, and social inclusion. Therapists providing expressive art therapy are typically highly qualified, often holding master’s degrees in counselling, and some have additional certifications from recognized universities. These therapists use various techniques such as the blob and wet paper technique, kinetic family drawing technique, and mask making to facilitate healing. For instance, drawing activities help develop cognitive abilities, reduce anxiety, and promote personal growth. Lane (2018) examined the significant difference between expressive art therapy and art therapy, noting that while both aim to improve mental health, their modalities differ. Expressive art therapy involves various creative art forms such as dance/movement therapy, music therapy, sketch therapy, and drawing therapy, while art therapy typically focuses on a single modality. In expressive art therapy, therapists may combine different art-based therapeutic approaches, such as drawing, music, and painting, to make patients feel more comfortable and help them heal by awakening their inner consciousness.

The combined effects of these therapies help reduce stress and improve emotional well-being. According to Wang, Tang, and Wei (2020), in December 2019, China was identified as the epicenter of the Novel Coronavirus, which caused severe pneumonia, characterized by symptoms such as fever, cough, and shortness of breath. The virus quickly spread worldwide, and China became a key player in the global fight against infectious diseases. The pandemic has had a substantial disruptive impact on society, challenging mental health service provision, especially among healthcare workers and individuals who contracted COVID-19 or lost loved ones. Social distancing measures exacerbated existing mental health conditions. As a result, various art therapies were found to be beneficial, especially during COVID-19, as they created virtual communities and offered a means of expression. Art therapy became a valuable tool for modulating stress and building resilient relationships, while also helping to disseminate important health information. Art therapy, in particular, is beneficial during times of isolation and can be a lifelong resource for individuals.

Lindsey, Robertson, and Lindsey (2018) examined how expressive therapy, including visual art therapy, helps adolescents manage academic and developmental tasks, ultimately reducing stress levels. It is considered an effective coping strategy that aids in understanding and managing stress. Expressive Arts Therapy also includes creativity-based interventions that facilitate self-discovery, healing, and personal change. Additionally, mindfulness-based interventions, such as the Mindfulness-Based Stress Reduction (MBSR) program, are incorporated to reduce hostility and improve stress management. Vaartio-Rajalin, Santamäki-Fischer, Jokisalo, and Fagerström (2020) examined the limitations of expressive art therapy, such as the lack of a discernible treatment process, which makes it difficult to analyze the implications of the different processes used together. Moreover, when expressive art therapy is applied, it is not always clear whether the healing of the patient occurs due to the implementation of the creative process itself or because of the constructive interactions with the therapists. While expressive art therapy has shown several benefits, such as reducing mental stress, promoting emotional well-being, and enhancing social inclusion, there is limited academic evidence to fully support its efficacy. Therefore, it is essential to conduct further studies in this area to analyze expressive art therapy more comprehensively and address the gap between previous and current literature.

THEORETICAL FOUNDATION

The theoretical foundation of this study is grounded in attachment theory, developed by John Bowlby and expanded by Mary Ainsworth, which offers a nuanced understanding of how early life experiences shape individuals’ stress responses and coping mechanisms (Bowlby, Ainsworth, & Bretherton, 1992). Attachment theory posits that the bonds formed between infants and their primary caregivers create internal working models, which influence emotional regulation and relationship dynamics throughout life (Nganyu, 2023). This perspective is particularly relevant in the context of the COVID-19 pandemic, where working women faced heightened stressors from balancing professional responsibilities with increased domestic duties. Attachment theory allows for a deeper examination of how attachment styles secure, anxious, dismissive, or fearful—affect stress perception and management strategies (Wang, 2023). For example, securely attached individuals tend to employ adaptive coping mechanisms, such as seeking social support, while those with insecure attachment styles may rely on maladaptive strategies, such as emotional withdrawal or hyper-activation (Bulosan, 2023).

The study’s conceptual framework applies attachment theory to explore how different attachment styles impact stress responses and coping strategies among working women during the pandemic. This framework illustrates that attachment style shapes individuals’ perceptions of stressors and their subsequent coping responses, ultimately affecting their overall mental health. Secure attachment fosters resilience, helping individuals view stressors as manageable and encouraging healthy coping strategies, such as problem-solving and self-care. In contrast, insecure attachment, particularly anxious or dismissive styles, may hinder stress management, leading individuals to adopt maladaptive responses that exacerbate stress and emotional turmoil. By integrating Expressive Arts Therapy into this framework, the study examines whether creative therapeutic interventions can mitigate the adverse effects of insecure attachment by providing an alternative outlet for emotional expression and enhancing self-awareness and emotional regulation.

The integration of Expressive Arts Therapy within the attachment-based framework addresses the psychological challenges faced by working women during the COVID-19 pandemic, offering a pathway for resilience and well-being. Expressive Arts Therapy, involving creative activities like drawing, music, and dance, aligns with attachment theory’s emphasis on emotional exploration and processing. For individuals with insecure attachment styles, this therapy provides a structured, supportive environment to express emotions nonverbally, fostering a sense of self-acceptance and control. By focusing on creative expression, the therapy can alleviate stress, reduce anxiety, and improve overall mental health. This framework not only enhances our understanding of the role of attachment styles in stress management but also highlights the therapeutic potential of creative arts in supporting mental health, making it a practical model for future interventions aimed at supporting working women during times of crisis.

The theoretical foundation of this study is rooted in attachment theory, developed by John Bowlby and expanded by Mary Ainsworth, which provides a nuanced understanding of how early life experiences shape individuals’ stress responses and coping mechanisms (Bowlby, Ainsworth, & Bretherton, 1992). Attachment theory posits that the bonds formed between infants and their primary caregivers create internal working models that influence emotional regulation and relationship dynamics throughout life. This perspective is particularly relevant for examining the experiences of working women during the COVID-19 pandemic, where increased domestic responsibilities and professional pressures exacerbated stress levels. For example, securely attached individuals tend to employ adaptive coping mechanisms, such as seeking social support, whereas those with insecure attachment styles may resort to maladaptive strategies, such as emotional withdrawal or hyper-activation (Wang, 2023).

To further enrich this theoretical foundation, resilience theory is integrated to provide a broader perspective on how individuals navigate and adapt to adversity. Resilience theory emphasizes the dynamic process by which individuals harness internal and external resources to overcome challenges, maintain well-being, and thrive despite significant stressors. Xiang et al. (2023) argue that resilience mechanisms are essential in buffering the psychological impact of crises, such as the COVID-19 pandemic. By linking attachment styles with resilience theory, the study explores how the quality of early attachment relationships influences the development of resilience in adulthood. For instance, securely attached individuals are more likely to possess robust resilience mechanisms, such as self-regulation and emotional stability, enabling them to engage effectively with interventions like expressive art therapy.

Expressive art therapy serves as a practical application of these theoretical constructs, offering a creative and non-verbal outlet for emotional expression and fostering resilience. Through activities such as painting, drawing, and music, participants can process complex emotions, reframe negative experiences, and develop adaptive coping strategies. Xiang et al. (2023) highlight that creative engagement enhances psychological flexibility, a key component of resilience, by encouraging individuals to explore multiple perspectives and solutions. This aligns with attachment theory’s emphasis on emotional exploration and regulation, demonstrating how art therapy can address the psychological challenges associated with insecure attachment styles while simultaneously building resilience.

The interplay between attachment styles and resilience mechanisms provides a comprehensive framework for understanding the impact of expressive art therapy on stress management. For example, individuals with insecure attachment styles may initially struggle with emotional regulation but can benefit from the structured support and creative freedom provided by art therapy. By fostering a sense of safety and self-expression, art therapy helps these individuals build resilience over time, enabling them to navigate stress more effectively. Conversely, securely attached individuals, who already exhibit adaptive coping strategies, may use expressive art therapy to further enhance their emotional well-being and resilience. This dual focus on attachment and resilience highlights the transformative potential of art therapy as both a therapeutic and preventive intervention, addressing immediate stressors while equipping individuals with long-term coping tools.

RESEARCH METHODOLOGY

The methodology of this study is grounded in a qualitative phenomenological design aimed at gaining a deep understanding of working women’s experiences with stress management through expressive arts therapy during the COVID-19 pandemic in Malaysia. Phenomenology, as a research approach, enables a rich exploration of the subjective experiences and emotions that these women encounter, especially in how they navigate work-related stress during unprecedented times. This qualitative design was chosen to capture the nuances of participants’ experiences and reflections, focusing on their personal narratives, which provides a comprehensive view of the prevalence and nature of mental health issues related to the pandemic. Data collection methods are carefully selected to align with the study’s goals, including semi-structured interviews, observations, document analysis, and therapy program implementation. The use of these multiple data sources ensures that the study captures a holistic view of expressive arts therapy’s effects on stress reduction, providing robust and validated insights.

Interviews are the primary data source, allowing participants to share personal stories, feelings, and perceptions in a confidential setting. The interviews incorporate both structured and semi-structured formats to gather demographic information and explore the participants’ stress management experiences. Highly structured interviews focus on collecting consistent demographic data, while semi-structured interviews allow flexibility to probe into specific aspects of expressive art therapy. This flexibility is essential in the phenomenological approach, as it allows participants to openly discuss their experiences with art-based interventions. Observations supplement the interviews by capturing non-verbal cues and interactions during expressive art sessions, which add depth to the understanding of participants’ emotional engagement with the therapy. Document analysis further enriches the data, incorporating personal and therapy-related documents such as diaries, life history journals, and artistic outputs. By examining these materials, the study can draw connections between participants’ lived experiences and the broader theoretical framework supporting expressive arts therapy for stress management.

The therapy program is a key component of the study, designed to provide structured expressive art sessions for the participants over three months. These sessions, lasting 60 to 90 minutes each, occur twice a week and cover various artistic mediums such as painting, music, dance, and creative writing. Each session is tailored to help participants explore their emotions, offering a therapeutic outlet for managing stress. For instance, painting sessions allow participants to visually express their emotional states, while music therapy involves rhythmic activities that resonate with their inner experiences. The therapy sessions begin with relaxation exercises to create a supportive environment, followed by a main expressive art activity, and conclude with reflective discussions. This structured approach not only enhances participants’ emotional well-being but also provides a consistent platform to observe and analyze the therapeutic benefits of expressive arts. By combining various art forms and reflective practices, the program offers diverse channels for emotional exploration, making it adaptable to each participant’s preferences and needs. The sessions’ effectiveness is measured through pre- and post-therapy assessments, which evaluate stress levels, emotional well-being, and mental health improvements.

Purposive sampling was employed to select participants who are working women experiencing stress during the COVID-19 pandemic. Inclusion criteria required participants to be employed in Malaysia, aged 21 to 60, and experiencing heightened stress levels due to pandemic-related challenges. This selection ensured that the sample represented individuals facing work-related stress exacerbated by the pandemic, particularly focusing on those likely to benefit from expressive arts therapy. Conversely, exclusion criteria omitted those who were not working, below 21 or above 60 years, and those without reported stress levels. This criterion focused on a demographic that would realistically face work-life balance challenges and pandemic-related stress, aligning with the study’s objective. Additionally, individuals outside of Malaysia or with severe psychiatric conditions were excluded, ensuring both cultural relevance and safety. By using this targeted sampling method, the study could gather insights from participants with shared, relevant experiences, thus strengthening the data’s applicability to the target population.

The data analysis employed Braun and Clarke (2012)’s thematic analysis approach, a structured and systematic method for identifying, analysing, and reporting patterns within qualitative data. This six-phase process began with familiarization with the data, during which all collected materials, including transcribed interviews, observational field notes, and document analysis outputs, were thoroughly reviewed to gain an in-depth understanding of participants’ experiences. Following this, initial codes were generated systematically across the dataset to highlight relevant segments. These codes were then collated into potential themes, representing significant patterns that emerged from the data, such as participants’ therapeutic journeys, emotional engagement with expressive arts, and perceived benefits of therapy in managing stress. The themes were subsequently reviewed and refined to ensure they accurately reflected the underlying data and provided a coherent narrative. In the final stages, themes were defined and named, encapsulating each theme’s essence and contribution to the study’s objectives. This thematic analysis, supported by careful adherence to Braun and Clarke (2012)’s guidelines, enabled a nuanced understanding of the role of expressive arts therapy in managing stress among working women during the COVID-19 pandemic, ensuring methodological rigor and depth in interpreting the qualitative data.

To ensure the robustness of the study, data saturation was considered a critical factor during data collection and analysis. Data saturation refers to the point at which no new information or themes emerge from the data, indicating that the collected information sufficiently addresses the research questions. This study reached data saturation after conducting 30 interviews, ensuring that the sample size was adequate to capture a comprehensive range of experiences and insights. The decision to stop recruitment at this point was based on the consistency of recurring patterns and themes identified during preliminary coding. The iterative process of data analysis, where emerging themes were reviewed against additional data, further strengthened the reliability of the findings. By incorporating this approach, the study minimized the risk of overlooking critical perspectives, providing a rich and nuanced understanding of working women’s experiences with expressive art therapy during the pandemic.

RESULTS

Research Objective 1 – To explore the type of stress experienced by working women during the COVID-19 pandemic.

The findings from the study reveal that working women in Malaysia experienced a wide range of stressors during the COVID-19 pandemic, captured through five core themes and associated subthemes. These themes – Navigating Mental and Emotional Turbulence, Struggling with Work-Life Integration, Financial Insecurity and Job Uncertainty, Loss and Grief, and Seeking Control in a Sea of Uncertainty – highlight the intricate ways the pandemic affected mental well-being, financial stability, personal relationships, and everyday routines. Each theme is supported by participants’ testimonies, showcasing the unique and often overlapping challenges these women faced. Their narratives shed light on the multidimensional impacts of the pandemic on personal and professional lives, offering a comprehensive understanding of the stress experiences among working women during this unprecedented time.

In the theme Navigating Mental and Emotional Turbulence, mental stress emerged as a predominant experience, with many respondents articulating anxiety, depression, and isolation as common companions. For example, R1 shared, “The blurred lines between work and home life led to extended work hours… contributing to significant mental exhaustion,” illustrating the erosion of boundaries that exacerbated their distress. Participants, such as R10, felt that social isolation compounded their stress, stating, “Despite being in the company of my family, I often felt incredibly alone,” which highlights the emotional loneliness that physical presence alone couldn’t counter. Respondents like R8 and R6 described the “relentless stream of distressing news” and “monotony of days” as catalysts for feelings of sadness and depression, revealing how the environment of prolonged lockdown and disconnection heightened negative emotions. This theme encapsulates the cumulative emotional and mental toll of constant pandemic-related fears, underscoring how the absence of social interaction and the blurring of personal and professional boundaries led to increased mental health struggles.

The theme Struggling with Work-Life Integration reflects participants’ challenges in balancing professional and personal responsibilities in a pandemic-induced remote work setting. This theme explores the dissolution of physical boundaries between home and work, resulting in overextension and fatigue, as described by R17, who noted the difficulty of “balancing personal and professional life within the same space.” Participants like R2 discussed how the shift to remote work extended their hours and eroded their productivity, with “virtual meetings becoming the norm” and an added pressure to maintain unrealistic productivity levels. The continuous need to manage household tasks alongside professional duties without relief further strained respondents. For example, R20 highlighted the pressure to fulfil “sales targets in a changing market environment” while managing her home, underscoring the burden of unrelenting expectations. Societal expectations also came into play, with participants expressing how traditional gender roles added to their workload, as R9 described: “Juggling the increased load of domestic responsibilities with career goals.” These narratives illustrate the heightened struggle of work-life integration in a disrupted environment and emphasize how gender roles influenced stress dynamics among working women.

The Financial Insecurity and Job Uncertainty theme captures the financial strain and fears of job stability that plagued many respondents, who were either directly impacted by job losses or anxious about potential economic instability. R3 spoke to this fear, saying, “Job uncertainties, potential salary cuts… contributed to significant financial stress,” revealing the added burden of economic insecurity on overall well-being. For others, such as R29, the sudden loss of employment “stripped away not just a source of income but also a sense of purpose,” illustrating the cascading impact of financial losses on mental health and self-identity. For single parents and those in caregiving roles, like R25, the pressure to manage family expenses while balancing work added to their daily worries. These testimonies emphasize the intersection of economic strain and emotional health, with respondents voicing concerns over meeting household needs and maintaining stability for their families. The financial burden thus went beyond income loss, permeating the broader aspects of self-worth, family support, and personal resilience during a global crisis.

In the Loss and Grief theme, participants shared their experiences of bereavement and the disruption of their normal routines, reflecting the heavy emotional toll of losing loved ones or aspects of daily life. R8, for instance, poignantly stated, “The loss of a loved one… compounded by restrictions that made traditional grieving processes impossible,” capturing the intense sorrow compounded by an inability to mourn communally. The loss of employment also led to a profound sense of grief for respondents like R7, who felt stripped of “stability and structure,” which had provided purpose and identity. R12 spoke about the collective mourning for pre-pandemic life, noting how the “altered routines” symbolized a world unrecognizable, further feeling her feelings of sadness and despair. This theme encapsulates the various layers of grief working women endured, not only due to personal losses but also due to the pandemic’s sweeping changes to everyday life, which amplified emotional suffering and disrupted long-standing coping mechanisms.

Lastly, the theme Seeking Control in a Sea of Uncertainty reflects respondents’ attempts to regain a sense of agency amidst the uncontrollable circumstances of the pandemic. With structured life routines disrupted, participants like R4 discussed the pervasive feeling of “losing control” over their lives, which contributed to a deep sense of vulnerability and anxiety. Many women, such as R22, described how they adopted new hobbies and routines to establish a semblance of normalcy, saying, “I began focusing on new routines as a way to cope with the disruption.” Others, like R26, found solace in creative outlets or physical activities to reclaim a sense of stability. R15 mentioned seeking “moments of peace” in personal activities, which acted as psychological anchors amidst the tumult. This theme illustrates the resilience of working women who, despite the pervasive uncertainties, proactively sought ways to regain control over aspects of their lives. By adopting creative, reflective, and adaptive practices, they aimed to mitigate the overwhelming stressors, highlighting a collective response to the shared crisis.

Table 1: Summary of Research Objective 1 Findings

These findings underscore the complexity of stress among working women during the pandemic, illustrating how each theme interlinks to form a broader narrative of resilience, struggle, and adaptation. As shown in the Table 1, the themes and subthemes offer insights into the unique ways in which these women navigated personal, professional, and societal pressures, providing valuable understanding into the need for comprehensive support systems in times of crisis. Through their stories, it becomes evident that the experiences of working women during the pandemic were shaped by multi-dimensional stressors, necessitating holistic approaches to address their diverse needs and challenges.

Research Objective 2 – To understand how expressive art therapy is used in managing stress among working women during the COVID-19 pandemic

Expressive Art Therapy (EAT) played a significant role in managing stress among working women during the COVID-19 pandemic, as evidenced by the responses of the 31 participants. Their diverse experiences revealed several prominent themes, including Emotional Expression and Self-Exploration, Physical and Mental Relief, Enhanced Self-Care and Mindfulness, Increased Positive Emotions, Strength and Psychological Stabilization, Creative Emotional Exploration, Discovery of Joy and Distraction, and Art as a Conduit for Emotional Alchemy. These themes and their sub themes highlight the therapeutic benefits of art-based activities in coping with the overwhelming stressors brought on by the pandemic. The participants’ reflections and dialogues provide deep insights into the emotional, mental, and physical impact of Expressive Art Therapy, showcasing its power in alleviating stress and promoting emotional healing during a time of global crisis.

The theme of Emotional Expression and Self-Exploration emerged as central to the participants’ experiences with Expressive Art Therapy. Art provided an essential outlet for processing and expressing emotions that were difficult to articulate through words. R1 described how the therapeutic use of art offered a chance to “find relief from mental clutter and anxiety”, stating, “The act of creating something, even as simple as a drawing, helped to divert my mind from the stressors. It brought a sense of calm and mindfulness.” This ability to externalize emotions, such as fear, sadness, and anxiety, was echoed by R6, who shared, “Each session of drawing or coloring provided me with a small voyage to tranquillity, shifting the balance from overwhelming negativity to peace and mindfulness.” The act of expressing emotions through art was particularly liberating for many participants, helping them engage in introspection and self-discovery. R7 further articulated how creating art enabled her to “express feelings through pictures that were difficult to articulate in words,” offering a visual dialogue with herself that provided emotional release. R3 also emphasized the role of art in facilitating “emotional discovery and introspection” through activities like dance and painting. These mediums allowed her to explore her emotions, “offering not just a distraction but a channel for healthy emotional expression.” For R5, drawing, colour-focused activities, and reflective writing provided an “invaluable outlet for my emotions”, helping her reconnect with a “deeper appreciation of the support systems in my life.” This emotional release was crucial in alleviating stress and managing the complex emotions that arose from the uncertainty of the pandemic.

Many participants spoke about the physical and mental relief provided by Expressive Art Therapy, with the tactile nature of the activities proving especially beneficial. R1 highlighted how “the tactile sensation of paint on canvas or the rhythmic movements of dance” contributed to reducing physical tension, “improving focus, and even enhancing sleep quality”. This is supported by R2, who found that “coloring and playing with clay became essential practices for mental health management. The focus required helped reduce tension, fostering a sense of calm.” This reduction of physical tension through creative activities like coloring, painting, and sculpting was a recurring theme in participants’ responses. R6 also noted the “mental clarity” that followed art-making, with the process allowing her mind to become “free from the incessant worries and anxieties that plagued it.” R9, who engaged in a range of artistic activities, similarly found that creating art “lightened my mind” and provided a sense of “accomplishment and control in an otherwise chaotic situation.” Many respondents noted that the act of focusing on art offered a form of mindfulness, a space for “present moment awareness” that temporarily alleviated stress and brought a sense of peace. R7 expressed that creating art offered her “a temporary escape from the heaviness of emotional stress,” allowing her to “step outside of myself” and gain perspective on her feelings.

Expressive Art Therapy facilitated enhanced self-care practices, with participants emphasizing the importance of incorporating mindfulness and structured self-care into their routines. R4 discussed how Expressive Art Therapy provided “a structured yet flexible approach to self-care,” helping her “explore my emotions, confront my stresses, and find moments of peace and clarity amidst the chaos.” This structured approach was particularly valuable as many respondents struggled with maintaining regular self-care habits due to the stressors of the pandemic. R6’s experience echoed the transformative power of art in cultivating self-love and mindfulness. She shared that “the act of creating art gradually became intertwined with self-care practices, illuminating the need to nurture myself.” This understanding of self-care through art was a crucial turning point for many participants, as it offered them a tool to prioritize their mental and emotional well-being. R5 also reflected on how art helped her reconnect with the fundamental aspects of life, acknowledging that “drawing and reflective writing became invaluable in my journey of self-care.” R3, who engaged in dance and painting, described how these activities encouraged “a mindful presence in the moment” and allowed her to reflect on her emotions, fostering a “deeper appreciation for the therapeutic value of the creative process.” This mindfulness aspect of Expressive Art Therapy helped many participants shift their focus from the overwhelming stress of daily life to a more balanced perspective. R10 discussed how writing poetry through Expressive Art Therapy allowed her to step outside her emotional turmoil, offering “a form of release and relief” that helped her “find solace, a quiet space of introspection and peace amidst the chaos of the pandemic.”

One of the most consistent findings was the significant increase in positive emotions that participants experienced through their engagement with Expressive Art Therapy. R3, who found relief through dance and painting, described how these activities offered “not just a distraction but a transformative experience”. She shared that dance, in particular, “provided a physical release, a way to express feelings without words,” which allowed her to “channel my energy into movement and rhythm.” Painting became another medium through which she “processed and navigated my emotions in a healthy way,” contributing to a renewed sense of positivity and joy amid the chaos of the pandemic. R8 found that Expressive Art Therapy offered moments of “joy and distraction” in the midst of grief and depression, stating, “Art became a way to momentarily divert my mind from sorrowful thoughts and anxiety.” The act of creating something through art allowed her to find “pockets of fun and lightness,” which were crucial for her emotional survival. Similarly, R9 reflected on how the act of creation through art provided her with “a sense of accomplishment” and helped “stabilize my psychological state.” This sense of achievement through art-making reinforced the participants’ resilience and ability to maintain a positive outlook. R5 also highlighted the therapeutic impact of art on her emotional state, explaining that the “drawing and reflective writing practices” not only helped her manage her emotions but also “reconnected me to my inner strength.” R12 echoed this sentiment, describing how painting allowed her to “bring colour to the darkness,” helping her step away from her grief and frustration, while R13 found solace in play clay, which offered a grounding and meditative escape from the chaos. These activities provided participants with tools to access and maintain positive emotions, which was crucial for emotional resilience during a period marked by uncertainty.

The theme of Strength and Psychological Stabilization was strongly supported by the participants’ reflections on how Expressive Art Therapy contributed to their emotional regulation and long-term psychological resilience. R9, for example, shared how art helped her “regulate my emotions and achieve a stabilized psychological state.” She described how the act of creation “made my mind lighter” and gave her a sense of “control in an otherwise chaotic situation.” Many respondents found that engaging in art activities empowered them to “confront their feelings head-on” and gave them tools to better cope with the ongoing stress of the pandemic. R11 described how songwriting became a method of “emotional alchemy,” turning raw emotions into songs that encapsulated her fears, hopes, and dreams. This act of transformation helped her find strength in expressing her emotions, while also providing a sense of purpose and direction. Similarly, R6 noted that creating art allowed her to rediscover her “inner strength” and resilience, reflecting on how she had “peeled back the layers of confusion and stress” to uncover a core of adaptability that she had not fully appreciated before. Art became a means for participants to not only stabilize their psychological states but also bolster their emotional endurance.

The theme of Creative Emotional Exploration underscored the unique role that Expressive Art Therapy played in allowing participants to express complex emotions that were difficult to articulate verbally. For R7, the ability to “express emotions through pictures” was invaluable, as it offered a visual dialogue with her inner self, providing a “sense of release and relief from the bottled-up emotions.” Similarly, R28 found that painting “offered a means to express emotions without words”, allowing her to explore and process her feelings in a way that verbal communication could not. This non-verbal engagement was especially beneficial for those experiencing overwhelming emotions that felt inexpressible through conventional means. R27 shared how the act of creating art allowed her to bypass verbal articulation and engage directly with her emotions. She described the process as a “creative outlet” that “allowed me to process my feelings in a more embodied way,” helping her deal with intensified symptoms of PTSD and anxiety. R25 also found relief through drawing, describing the process as a “constructive way to communicate emotions that were too complex or overwhelming” to articulate verbally. For many participants, this form of emotional release through art was transformative, providing not just a therapeutic escape but also a pathway to understanding and integrating their emotions in a deeper way.

The theme of Discovery of Joy and Distraction encapsulated the therapeutic benefits of engaging with art during the pandemic. R8 found that art offered a much-needed “distraction” from grief, allowing her to “focus on colours, textures, and forms,” which provided her with “pockets of fun and lightness.” This momentary break from sorrow and anxiety was a key aspect of emotional survival during the pandemic, helping participants manage their emotional states. Similarly, R24 spoke about how writing and journaling helped her step back, “reflect, and gain perspective,” offering moments of catharsis and emotional release. Art, in all its forms, became a critical tool for emotional resilience and distraction from the overwhelming pressures of the pandemic.

The final theme, Art as a Conduit for Emotional Alchemy, highlighted how art transformed difficult emotions into something meaningful and therapeutic. R11 described songwriting as an act of “emotional alchemy,” where chaotic feelings were transformed into music, offering relief from the emotional weight she had been carrying. This transformative process was echoed by R12, who described painting as “a way to express the inexpressible” and bring “colour to the darkness,” providing a temporary escape from grief and frustration. For many participants, engaging in art was not only a method of managing stress but also a way to transmute negative emotions into positive, creative outlets that fostered healing and understanding.

Table 2: Summary of Research Objective 2 Findings

Hence, as shown in Table 2, the findings underscore the diverse and profound ways in which Expressive Art Therapy helped working women manage the stress of the COVID-19 pandemic. Through various forms of creative expression, participants found relief, clarity, and emotional stability, reinforcing the therapeutic value of art in times of crisis. Whether through emotional expression, physical and mental relief, mindfulness, or the transformative power of art, participants’ experiences highlight the central role that creative practices can play in managing stress, fostering emotional resilience, and supporting overall well-being during unprecedented global challenges.

Research Objective 3 – To evaluate how expressive art therapy is practiced by working women in managing stress during COVID-19 pandemic.

Expressive Art Therapy (EAT) proved to be a crucial coping mechanism for many working women during the COVID-19 pandemic, helping them navigate the overwhelming stress and emotional challenges brought on by isolation, health concerns, and changes in work-life dynamics. From drawing and painting to writing and journaling, the various forms of expressive art provided these women with outlets for emotional expression, physical relief, and mental clarity. By analysing their responses across the five main themes of this research, we can explore the depth of how art served as both a therapeutic practice and a means of self-exploration during an exceptionally difficult period. The key themes identified in this study include Drawing and Coloring, Coloring Books and Play Clay, Dance and Movement, Creative Projects and Family Activities, and Writing, Journaling, and Singing. Each theme and its associated sub themes present a unique way that these women used creative expression to manage their emotions, connect with their inner selves, and restore their emotional well-being.

One of the most prevalent and accessible practices among the participants was drawing and coloring, activities that provided both meditative engagement and a space for mindfulness. R1 shared that drawing became her “go-to activity,” especially during moments of loneliness or overwhelming stress. She explained that these activities began as distractions but evolved into “meditative practices” that allowed her to process emotions in a creative, non-verbal way. She described how coloring and sketching “helped [her] process [her] emotions and feelings” by focusing on shapes and colours, providing an emotional reset after a long day filled with anxiety and stressful thoughts. The act of creating, without a specific goal in mind, allowed her to externalize her inner turmoil and gain a sense of calm, exemplifying the therapeutic power of art in managing mental stress. R4 echoed similar sentiments, explaining how drawing family members and loved ones served as a reminder of her support system during the pandemic. She practiced emotion-focused coloring, particularly focusing on the human body to identify areas of stress. This technique allowed her to visualize where she felt tension and, through the use of colour, acknowledge and process her emotions. By externalizing her feelings through these non-verbal expressions, she gained clarity on her emotional state, which helped reduce stress and improve her sense of control over her emotions. Similarly, R7 turned to drawing and painting as her sanctuary, where she could explore her emotions through “shapes, shades, and lines,” offering a break from her immediate reality and helping alleviate the weight of stress.

For many participants, the tactile engagement provided by play clay and coloring books offered an essential form of emotional expression and stress relief. R5 reflected on how the practice of drawing herself with family members and emotion-focused coloring became not just an emotional expression but a method of visualizing and understanding where stress physically manifested in her body. This sensory engagement was particularly helpful for individuals like R5, who needed a tangible method to process abstract emotions. She used the practice of color-coding different emotions to connect with her body’s responses, a technique that allowed her to externalize feelings and understand her emotional state better. Similarly, R13 found play clay to be an incredibly grounding practice. The act of kneading and shaping clay provided not just a distraction but also a form of emotional release. As R13 described, the tactile sensation of working with clay allowed her to channel her emotions into something physical and tangible, giving her a sense of control and agency during a time of uncertainty. The malleability of clay, which could be reshaped and molded, mirrored the process of adapting to a world in flux, offering both a physical and emotional outlet. The sensory focus required to mold the clay created a meditative experience, which helped alleviate the mental and emotional stress of the pandemic. R22 also noted that coloring, particularly with intricate designs, became a meditative exercise. She shared that coloring in these books not only calmed her mind but also provided a structured outlet for her anxiety. The repetitive nature of filling in the designs helped her focus on the present moment, promoting a form of mindfulness that reduced the overwhelming effects of her anxieties. For R22, this focus on coloring provided a break from the cycle of worry, offering moments of peace amidst the chaos of the pandemic.

For some participants, dance and movement emerged as powerful tools for emotional expression and stress relief. R4 described how dance helped her channel anxiety and stress into movement, offering a physical release of the emotions that were difficult to express verbally. Dance, she noted, was not just a form of exercise but a therapeutic medium that allowed her to feel liberated from the pressing worries of financial stress. By physically moving her body, she found that dance provided a cathartic release, helping her regain a sense of control and emotional stability. R24 also used dance as an outlet for emotional expression. For her, dancing was a form of liberation, allowing her to “release tension, embrace the present moment, and experience joy.” By focusing on the rhythm of the music and the movements of her body, she was able to detach from the stresses of the pandemic, finding moments of freedom and peace. This physical expression through dance not only alleviated emotional tension but also enhanced her physical health, contributing to a more balanced emotional state. For both R4 and R24, dance was not merely a form of exercise, but a form of emotional catharsis that allowed them to transform stress into empowerment.

For many participants, engaging in creative projects with family members became a therapeutic activity that allowed for emotional expression, reflection, and connection during the pandemic. R5 found solace in drawing herself alongside her family, an activity that reminded her of the love and support she had during a time of isolation. Similarly, R8 adopted a practice of drawing and creating art with family members, which became an important way to maintain emotional connections and express love when physical closeness was limited. These creative projects not only served as a way to express gratitude but also reinforced the bonds that sustained participants throughout the challenges of the pandemic. R7 further explained how art provided a form of escape, allowing her to step back and reflect on her emotions. She noted that drawing and painting helped her explore her emotional state, giving her the tools to understand and address her feelings more effectively. These creative practices became a form of emotional alchemy, helping her transform overwhelming emotions into something more manageable. The act of creating art with loved ones became a shared experience that allowed participants to bond and heal together, helping them navigate the isolation and emotional strain caused by the pandemic.

Writing, journaling, and singing emerged as essential practices for many women seeking a structured means of emotional articulation during the pandemic. R10 found poetry to be an invaluable outlet for her emotions. Writing poetry allowed her to explore the depths of her emotions in a structured, yet creative way. She shared that each poem became a snapshot of her emotional state, reflecting feelings of isolation, sadness, and loss, but also capturing moments of beauty and connection amidst the adversity. This practice of writing poetry gave her a way to transform difficult emotions into creative expressions, allowing her to process and understand her feelings more deeply. R11 used songwriting as a form of emotional exploration, finding that the act of composing lyrics allowed her to “delve into my feelings and experiences, exploring themes of loss, resilience, and the search for meaning in a world turned upside down.” Songwriting became a diary set to melody, a powerful tool for processing her emotional journey. Journaling, in particular, offered her a safe space to “unburden my soul without fear of judgment.” She noted that the act of journaling allowed her to navigate through her emotions and create a pathway toward acceptance and healing. Similarly, R12 shared how journaling and painting became essential tools for processing her emotions. She found that writing about her emotional experiences helped her gain clarity, while painting allowed her to externalize the inexpressible, visually representing her feelings of sadness, isolation, and hope.

Table 3: Summary of Research Objective 3 Findings

Based on Table 3, it was found that throughout the pandemic, expressive art therapy proved to be an essential practice for many working women, offering emotional relief, self-reflection, and creative release from the pervasive stress brought on by the global crisis. Whether through drawing, painting, journaling, dancing, or engaging in creative projects with loved ones, art provided a means of self-expression, emotional processing, and catharsis. For many, these practices became rituals that helped them navigate the uncertainty and isolation of the pandemic, offering moments of solace, mindfulness, and personal growth. By engaging in expressive art, these women not only managed their stress but also fostered resilience, creativity, and emotional well-being during an unprecedented time. Through art, they found strength, clarity, and connection both with themselves and with others making it an invaluable tool for healing and emotional survival

DISCUSSION

The COVID-19 pandemic has drastically reshaped the global landscape, causing widespread emotional, physical, and financial challenges, which have significantly affected individuals’ mental health worldwide. Among the most vulnerable populations are working women, who have faced increased stress due to the convergence of professional and domestic responsibilities. In Malaysia, this stress has been exacerbated by factors such as economic insecurity, isolation, and the overwhelming demands of balancing work and home life. Research has shown that stress during this period has led to a rise in mental health issues, such as anxiety, depression, and burnout, which further impacted the overall well-being of these women. Bosgraaf et al. (2020) emphasize the role of art therapy in addressing mental health concerns, noting its long-standing history of being used as a therapeutic tool for stress and psychological distress. Art therapy, which encompasses creative outlets such as painting, drawing, music, dance, and drama, offers a unique form of self-expression and emotional processing, which has been found to be effective in treating mental health conditions, particularly during times of crisis. Expressive art therapy, specifically, has gained recognition for its ability to help individuals manage stress and enhance emotional well-being by providing a non-verbal outlet for expression. According to Wu and Chung (2023), the therapeutic effects of art therapy are enhanced by its flexibility, allowing it to be adapted to various contexts and needs. The pandemic, with its numerous disruptions and stressors, has highlighted the need for innovative mental health interventions, and expressive art therapy provides a promising approach to alleviating the emotional burden faced by working women.

Throughout history, art therapy has proven to be a valuable intervention for individuals dealing with a wide range of mental health issues, from trauma to depression. During the COVID-19 pandemic, its relevance has increased as more individuals experience heightened stress, anxiety, and grief due to factors such as social isolation, loss of loved ones, and fear of the virus itself. Art therapy provides a therapeutic outlet by helping individuals express their emotions in a safe, non-judgmental environment. For working women in Malaysia, the pandemic has blurred the boundaries between their professional and personal lives, placing additional pressure on their emotional and psychological health. Studies such as those by Brandão et al. (2019) and Hilton (2021) have highlighted how creative forms of therapy, such as drawing, painting, and music, can significantly improve mood, reduce stress, and promote emotional healing. In addition to offering an emotional outlet, expressive art therapy also aids in cognitive processing by helping individuals confront and articulate their inner experiences. For women who may struggle to verbalize their feelings due to cultural, societal, or personal barriers, the ability to express themselves through art can provide a crucial means of emotional release and relief. Research by Li (2021) and Potash et al. (2021) further demonstrates how art therapy helps individuals develop resilience, mitigate stress, and enhance emotional well-being in times of crisis. In particular, studies have shown that art therapy provides essential psychological support to frontline workers, patients, and those suffering from prolonged isolation factors that were amplified by the pandemic. This suggests that expressive art therapy could play an important role in supporting working women who may be experiencing heightened stress and emotional turmoil during the ongoing global health crisis.

The implementation of expressive art therapy for working women in Malaysia can significantly improve their ability to cope with stress, manage mental health, and navigate the challenges imposed by the pandemic. In addition to addressing immediate emotional distress, the regular practice of art therapy can help build long-term coping strategies that foster resilience. Engaging in creative activities such as painting, dance, or music provides a structured yet flexible approach to self-care, helping individuals regain a sense of control over their emotions and circumstances. During a time of social isolation, the shared experience of art-making in therapy sessions also fosters a sense of connection, whether in-person or virtually, reducing feelings of loneliness and disconnection. For working women, incorporating art therapy into their daily routines may offer a much-needed reprieve from the demands of work and home responsibilities, allowing them to prioritize their mental health and emotional well-being. The accessibility of online platforms has further expanded the reach of art therapy, making it easier for individuals to participate in therapeutic sessions from home, which has been crucial during lockdowns and restricted mobility. Additionally, this research aims to explore the accessibility, integration, and long-term benefits of expressive art therapy, considering factors such as time constraints, financial barriers, and the role of support systems in facilitating participation. By emphasizing the importance of creative therapies, this study could influence mental health practices and workplace wellness initiatives, encouraging employers and policymakers to adopt alternative therapeutic strategies in promoting mental health among employees. The implications of this research extend beyond the pandemic context, as the ongoing mental health challenges faced by working women suggest that therapeutic art practices could be beneficial for stress management in a variety of occupational and personal settings.

Organizations aiming to address mental health challenges in the workplace can benefit significantly by integrating EAT into their wellness programs. To ensure successful implementation, organizations should consider partnering with certified art therapists or institutions specializing in expressive arts. By offering structured yet flexible therapy sessions during work hours or as part of employee assistance programs, employers can encourage participation and make mental health care more accessible to working women. Furthermore, organizations could explore hybrid models that combine in-person and virtual EAT sessions, ensuring inclusivity for employees with varied schedules or remote working conditions. Policymakers, on the other hand, should advocate for subsidies or grants to make art therapy services affordable for a broader demographic. Promoting the inclusion of EAT as a standard option in mental health coverage by insurance providers can further enhance accessibility.

Training programs should also be introduced for Human Resources (HR) and wellness staff to identify employees who might benefit most from these interventions. Workshops and webinars could be organized to create awareness about EAT and its benefits, encouraging a cultural shift toward prioritizing mental health in professional settings. Additionally, integrating feedback mechanisms to evaluate the impact of EAT programs can provide insights for ongoing improvements. For instance, conducting regular employee surveys or focus group discussions can help organizations adapt therapy sessions to better meet participants’ needs.

To sustain the benefits of EAT, organizations should aim for long-term integration of creative therapies within their workplace wellness frameworks. This could involve developing dedicated “wellness zones” where employees can engage in art-based activities during breaks or after work. Alternatively, digital platforms or mobile apps offering guided art therapy exercises can serve as supplemental tools for employees who prefer self-paced engagement. Organizations should also consider aligning these initiatives with global mental health awareness campaigns, using art exhibitions or creative showcases to celebrate employee participation and foster a supportive community. Promoting cross-sector collaboration between art therapists, mental health practitioners, and industry leaders can further elevate the impact of EAT. For instance, creating tailored programs addressing the unique stressors of specific industries such as healthcare or education can maximize its relevance and effectiveness. Lastly, organizations can position themselves as advocates for mental health by contributing to ongoing research on EAT’s long-term psychological and professional benefits, reinforcing their commitment to holistic employee well-being.

CONCLUSION

This study highlights the critical role of expressive art therapy in managing stress among working women during the COVID-19 pandemic. Through creative practices like painting, drawing, music, and dance, participants found significant emotional relief, improved mental well-being, and enhanced resilience. The findings underscore the potential of art therapy as a non-verbal outlet for emotional expression, particularly for women juggling professional and domestic responsibilities in high-stress environments. By fostering emotional connection and providing a structured yet flexible approach to self-care, expressive art therapy offers a practical and accessible solution for stress management. The integration of such therapies into workplace wellness programs can address the unique mental health needs of working women, contributing to better work-life balance and overall well-being. Moreover, the inclusion of virtual therapy sessions has expanded the reach of this approach, ensuring its accessibility even during periods of physical distancing.

While this study provides valuable insights, it is limited by its small sample size and the specific demographic focus on Malaysian working women. This may restrict the generalizability of the findings to broader populations or different cultural contexts. Future research should consider employing a mixed-methods approach to validate these qualitative findings with quantitative data. Additionally, exploring the long-term effects of expressive art therapy across diverse populations, including men, non-working individuals, and varying socio-economic groups, could provide a more comprehensive understanding of its impact. Investigating how specific art modalities address different stressors or mental health conditions would offer tailored therapeutic strategies. Finally, evaluating the cost-effectiveness and scalability of integrating expressive art therapy into workplace wellness programs can inform policies and promote its widespread adoption, ensuring that its therapeutic potential is fully realized in both pandemic and non-pandemic settings.

ACKNOWLEDGMENTS

I would like to express my heartfelt gratitude to my family for their unwavering support and encouragement throughout my journey. A special thanks to my supervisor for their guidance and valuable insights, which have greatly contributed to the success of this work. I am also deeply thankful to my friends and colleagues for their understanding, encouragement, and camaraderie, which kept me motivated and focused.

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