Flow and Meaningfulness as Mechanisms of Change in Self-Concept and Well-Being Following a Songwriting Intervention for People in the Early Phase of Neurorehabilitation

Abstract

Anecdotal evidence suggests that songwriting assists people with spinal cord injury (SCI) or acquired brain injury (ABI) to explore threats to self-concept, yet studies that explore the mechanisms of change have not been reported. In a pilot study, we explored the correlations between changes in self-concept and well-being, with mechanisms of flow and meaningfulness of songwriting. Five people with ABI (all male) and 5 SCI (4 males, 1 female) (mean age 38.90 years, SD = 13.21), with an average 3 months post-injury, participated in a 12-session songwriting program that targeted examination of self-concept. Measures of self-concept, depression, anxiety, emotion regulation, affect, satisfaction with life, and flourishing were collected pre-, mid-, and post-intervention, and compared with repeated measures of flow and meaningfulness of songwriting. Medium effects were found for changes in self-concept (d = 0.557) and depression (d = 0.682) and approached a medium effect for negative affect (d = 0.491). Improvements in self-concept over time were associated with decreases in depression (rp = −0.874, n = 9, p < 0.01), anxiety (rp = −0.866, n = 9, p < 0.01), and negative affect (rp = −0.694, n = 10, p < 0.05), and an increase in flourishing (rp = +0.866, n = 9, p < 0.01) and positive affect (rp = + 0.731, n = 10, p < 0.05). Strong experiences of flow were not positively correlated with positive changes to self-concept and well-being, whereas deriving high levels of meaning were associated with increased negative affect (rp = +0.68 p < 0.05), increased anxiety (rp = +0.74, p < 0.05), and reduced emotional suppression (rp = −0.58, p < 0.05). These findings show that the targeted songwriting intervention appears to be positively associated with enhanced well-being outcomes. However, the findings also suggest that people who find the songwriting process has strong meaning for them might be more likely to start accepting their emotions and as a result experience an increase in anxiety and depression, although full, mediated regression analyses with larger sample sizes are required to explore this further. Acknowledging their changed circumstances may nonetheless assist people with SCI and ABI to grieve their losses and facilitate the building of a healthy post-injured self-concept. We propose that there may be other mechanisms more critical in facilitating the positive changes in self-concept and well-being than flow and meaning, such as the role of story-telling and the impact of music in facilitating the consolidation of self-concept explorations in memory.

Beyond Ryff's scale: Comprehensive measures of eudaimonic well‐being in clinical populations. A systematic review

“…This is congruent with measures applied in populations dealing with mental health disorders. Five studies used Diener's FS (Baker, Rickard, Tamplin, & Roddy, ; Gimpel et al, ; Lyons, Heywood, & Rozbroj, ; Robertson, Davies, & Winefield, ; Strober, ), four studies (Langeland et al, ; Maré et al, ; Timmerman et al, ; Trompetter et al, ) used Keyes' MHC (Keyes, , , ), two investigations (Twemlow et al, ; Williams et al, ) used GCOS (Deci & Ryan, ), and one (Terrill et al, ) used the OHS (Peterson et al, ).…”

“…The FS was mainly used in Australia ( n = 3) and in the United States ( n = 1) in its original eight‐item version (see Table ). The populations assessed included adults infected with HIV/AIDS (Lyons et al, ), obese/overweight adults (Robertson et al, ), and patients with spinal cord injuries or acquired brain injuries (Baker et al, ). Strober () performed a longitudinal investigation in American patients with multiple sclerosis (MS).…”

“…Two studies involved patients with neurological disorders (Baker et al, ; Strober, ), and both used the FS (Diener et al, ). The first one (Baker et al, ) explored the effect of a 12‐session songwriting rehabilitation program in patients with spinal cord injuries or acquired brain injuries. After intervention, patients improved their levels of depression, anxiety, and well‐being.…”

“…The first two instruments were integrated in only a few studies, GCOS ( n = 5, Breitborde et al, ; Simoneau & Bergeron, ; Strauss & Ryan, ; Twemlow et al, ; Williams et al, ) and OHS ( n = 2, Samson & Antonelli, ; Terrill et al, ), respectively. The FS (Diener et al, ) was used in seven investigations: two of them involved patients with mental health problems (Barrington & Shakespeare‐Finch, ; de Manincor et al, ) and five individuals with medical conditions (Baker et al, ; Gimpel et al, ; Lyons et al, ; Robertson et al, ; Strober, ). MHC was the most extensively used instrument ( n = 14, Bohlmeijer et al, ; Borja & Callahan, ; Callahan et al, ; Fledderus, Bohlmeijer, & Pieterse, ; Fledderus et al, ; Fledderus, Bohlmeijer, Smit et al, ; Langeland et al, ; Maré et al, ; McGaffin et al, ; Salekin et al, ; Timmerman et al, ; Trompetter et al, ; Walker‐Williams et al, ; Walker & Lampropoulos, ).…”

“…The present review revealed that only four comprehensive measures of the 12 tools included were used: GCOS (Deci & Ryan, 1985), OHS , FS , and MHC Terrill et al, 2015), respectively. The FS was used in seven investigations: two of them involved patients with mental health problems (Barrington & Shakespeare-Finch, 2013;de Manincor et al, 2016) and five individuals with medical conditions (Baker et al, 2015;Gimpel et al, 2014;Lyons et al, 2016;Robertson et al, 2015;Strober, 2017). MHC was the most extensively used instrument (n = 14, Bohlmeijer et al, 2015;Callahan et al, 2013;Langeland et al, 2013;Maré et al, 2011;McGaffin et al, 2015;Salekin et al, 2012;Timmerman et al, 2015;Trompetter et al, 2015;Walker-Williams et al, 2012;Walker & Lampropoulos, 2014).…”