Adolescent perspectives on mental health and an arts-based philosophical inquiry intervention

Adolescent perspectives on mental health and an arts-based philosophical inquiry intervention | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adolescent perspectives on mental health and an arts-based philosophical inquiry intervention Victoria Benny, Dale Stout, Megan Bernier, Ariane Marchand, Zachary Dylan Fry, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9368328/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Concerns for the mental health of adolescents are rising, yet many youth face barriers in accessing support and have difficulties expressing their psychological distress. School-based approaches that promote well-being may address these challenges. Specifically, integrating philosophical inquiry into artistic creation may offer adolescents reflective and expressive avenues for navigating mental health. However, research examining mental health interventions that combine philosophy and the arts remains limited. Objectives This qualitative study explored the perspectives of adolescents on ( 1 ) mental health and ( 2 ) their participation in an intervention incorporating artistic creation and philosophical inquiry related to mental health. Methods Seventeen high school students (M age = 16.5 years; 76% girls) from a visual arts program in Quebec, Canada, participated in the intervention. Semi-structured interviews were conducted and interpreted using coding reliability thematic analysis. Results Two overarching themes were identified: Mental Health and Thinking Together . The first theme highlighted that participants conceptualized mental health as a fluctuating experience encompassing both well-being and distress. It also revealed increased empathy and awareness of others’ emotions. The second theme captured how the intervention influenced reflection and creativity: for some adolescents, it enriched their views, whereas for others, it primarily reaffirmed existing ideas. The intervention also appeared to facilitate introspective processes. Conclusion Arts-based philosophical inquiry interventions on mental health may help adolescents in their understanding and expression of psychological experiences. They may also support well-being by eliciting protective factors, such as emotional awareness of oneself and others. Future research should evaluate these interventions using complementary study designs. mental health intervention arts-based intervention philosophical inquiry introspection creative process adolescence Figures Figure 1 Figure 2 Figure 3 Introduction Mental Health in Youth Adolescence is a formative developmental period characterized by rapid cognitive, emotional, and social changes. While this stage of life allows for exploration and growth, it is also associated with increased vulnerability to psychological distress and the emergence of mental health difficulties (1). In recent years, mental health concerns among adolescents have risen globally, with accumulating evidence suggesting that youth distress was further intensified during and after the COVID-19 pandemic (2, 3). This trend is particularly concerning given that mental disorders already constitute one of the main sources of illness during adolescence (1). In fact, approximately 75% of lifetime mental health disorders are found to emerge before the age of 24, positioning adolescence as a critical window for prevention, early identification, and intervention (4). Despite this, few studies have examined how youth themselves conceptualize mental health (5), and many adolescents experiencing emotional distress do not seek professional support (6). Barriers to seeking help remain well-documented and include stigmatization, embarrassment, limited access to health care providers, and difficulties articulating psychological distress or discussing mental health concerns (7). These challenges underscore the importance of developing supportive, accessible interventions that centre the voices of youth, particularly within school contexts, where adolescents with diverse profiles and needs spend much of their daily lives (8). Beyond clinical trials conducted in medical settings, research has increasingly emphasized the value of prevention programs that promote psychological well-being through protective factors, such as emotional awareness, self-efficacy, resilience, and interpersonal skills (9-11). More specifically, interventions that encourage reflection about personal experience may be especially relevant during adolescence, as youth continue to develop advanced capacities for abstract reasoning, navigate rich emotional experiences, and explore their identity (12, 13). Embracing discussions on mental health with adolescents may also help them develop an elaborate comprehension of the concept while simultaneously reducing stigma, uncertainty, and confusion around it (14, 15). In this context, school-based interventions aimed at fostering introspection and shared reflection may serve as a meaningful complement to didactic psychoeducational programs on mental health. Philosophical Inquiry Philosophical inquiry (PI) has gained increasing attention as an educational practice that can support reflection, emotional insight, and meaning making around complex topics, including youth mental health (10, 16). PI is often described as a practice of thinking together (17). Rather than focusing on transmitting knowledge, it invites participants into open-ended dialogue, where ideas are explored through listening, justification, questioning, and clarification (18). The aim is not to reach consensus, but to help young people learn how to think for themselves with others, tolerate uncertainty, and make sense of inquiry (19). PI offers a space where subjective experiences can be thoughtfully reflected upon without being reduced to labels or right answers. In classroom settings, it typically unfolds as structured discussions prompted by a topic or philosophical question. Educators adopt the role of facilitators, supporting a climate that values openness, mutual respect, and non-judgmental exchange (20). This format encourages students to articulate their ideas, listen attentively to peers, and revisit their thinking in response to others’ contributions. As Leng (21) suggests, these dialogues can promote social inclusion and engagement by providing an environment in which all voices are acknowledged. PI may be particularly relevant when mental health itself becomes the subject of inquiry. Discussing mental health through PI allows participants to explore emotions, psychological difficulties, and well-being in a way that does not require personal disclosure or position their experiences as pathological (10, 16, 22). Instead, young people are invited to reflect on broader questions – such as what it means to feel well, to struggle, or to cope – drawing on their own interpretations and understandings of mental health. As such, PI may be well-suited for adolescents who find it challenging to verbalize internal states and who prefer, for instance, to engage with emotional material through structured or analytical forms of thinking (19). Indeed, this approach may provide an opportunity for youth to thoughtfully consider a variety of psychological topics. PI is also related to a range of cognitive, social, and emotional benefits in adolescents. Studies suggest that PI is associated with gains in critical thinking and reasoning (23), as well as with positive developmental outcomes, including self-esteem, autonomy, and emotional understanding (16, 24). PI has additionally been linked to improved communication, moral judgment, and civic engagement (25). Although these outcomes are not specific to mental health per se, they reflect protective factors for psychological well-being. Artistic Creation Alongside PI, arts-based interventions represent another viable school-based approach that could support the mental health needs of students (9, 11). Artistic creation encompasses the use of diverse media, the creative process itself, and the resulting artwork. According to the American Art Therapy Association (26), such practices can foster emotional awareness, self-expression, and behavioural regulation, while also shaping how individuals perceive their reality. Participation in the arts has been associated with reductions in emotional and behavioural difficulties, improved coping capacities, and an enhanced sense of belonging and relational connection (27-29). By offering adolescents opportunities for personal storytelling, sharing their work, and commenting on their peers’ creations, arts-based practices may contribute to the development of resilience, self-esteem and self-efficacy (29-31). Mobilizing these protective factors through the artistic process is important, especially during adolescence – a developmental period largely characterized by identity exploration and heightened self-consciousness (32, 33). More central to the present study is the notion that artistic creation can function as an alternative means of communication when verbal expression feels inaccessible, overwhelming, or insufficient (34). Through colour, form, metaphor, and composition, youth may externalize emotions and explore them symbolically in ways that feel less threatening than direct verbal disclosure (28, 35). Such creative space can reduce fears of exposure while still supporting reflection and self-understanding (34). Adolescents have described arts-based activities as facilitating freer self-expression and a clearer understanding of the connections between their thoughts and emotions, echoing the reflective processes observed in PI (36). Such externalization of inner states through the arts may, over time, ease verbal expression by enhancing emotional clarity and confidence (34, 35). Accordingly, artistic creation may help adolescents conceptualize and make sense of their mental health experiences while serving as a tool for communication with peers. PI and Artistic Creation as a Combined Intervention Although PI and arts-based approaches have each been examined in relation to youth development and well-being, little is comparatively known about interventions that combine both practices. PI can help structure and deepen reflection through shared inquiry, the questioning of assumptions, and the co-construction of meaning, while artistic creation can enable the externalization of internal experiences through symbolic or visual forms (37-40). Conceptually, bringing PI into the creative process may support complementary pathways toward introspection and meaning making (39). Indeed, early work on PI suggests that it can foster creative thinking, including the generation of novel ideas and the exploration of alternative possibilities (19). More recent theoretical research proposes that philosophical education may act as a catalyst for creative thinking by cultivating openness, mental flexibility, and exposure to different options (41, 42). Abel (43) further hypothesizes that integrating PI before, during, and after artistic production could enrich the creative process by helping youth articulate the intuitive or implicit meanings embedded in their artwork : through reflective questioning, PI may support adolescents in considering why they created certain images, what their symbols signify, and how their artistic choices relate to personal experiences. In turn, engaging in artistic pursuits may offer concrete material for philosophical reflection, grounding dialogue in lived experience over abstract debate. Integrating PI and artistic creation may constitute an adequate approach for addressing topics such as mental health, which encompasses both conceptual dimensions (e.g., how mental health is defined) and experiential dimensions (e.g., how distress is felt and expressed). Given that adolescents may hold simplified or stereotypical understandings of mental health, shaped in part by media representations and limited emotional vocabulary (14, 15), an intervention integrating artistic creation and PI could support the exploration of more nuanced conceptualizations. It may also draw on similar protective factors for mental health as those observed in the individual approaches. Despite these theoretical promises, empirical research on how adolescents experience combined PI and arts-based interventions remains scarce, particularly regarding mental health. Qualitative approaches may be especially valuable in this domain, as they enable in-depth exploration of lived experiences and interpretive processes. Objectives The present qualitative study explored adolescents’ experiences of an arts-based intervention integrating PI around mental health topics. Specifically, it aimed to document the perspectives of youth on mental health and on their participation in artistic creation and PI workshops. The guiding research questions were: “How do adolescents conceptualize mental health?” and “How do adolescents perceive a mental health intervention combining PI and artistic creation?” Methods This study used a qualitative design to capture adolescents’ perspectives and followed the Consolidated criteria for reporting qualitative research (COREQ), a 32-item checklist to ensure comprehensive reporting of key methodological aspects (44). This project was part of a larger initiative aimed at destigmatizing mental health issues and raising public awareness in the media. Participants and Intervention Using a convenience sampling strategy, high school students were recruited from a specialized visual arts program in the province of Quebec, Canada. Of the 33 adolescents enrolled in this school program, 17 chose to participate (M age = 16.5 years; 76% female). Informed consent was obtained from both students and their legal guardians prior to participation. Students received a $20 bookstore gift card for their participation. Following recruitment, the intervention was implemented in three phases during the fall of 2023. The first phase consisted of two 75-minute brainstorming sessions in which participants identified mental health topics that were meaningful to them. Under the supervision of faculty members in psychology (CMH, DS) and education (OM), facilitators (VB, MB) conducted PI on mental health to support brainstorming. Sample discussion questions included: “Can someone have both good and poor mental health at the same time?”, “Do you think taking care of yourself is an innate or learned behaviour?”, and “Do people who are depressed stay that way for their whole life?” During these sessions, students worked in small groups on concept maps (i.e., flowcharts used to visually represent ideas and their connections). The primary topics that emerged from these discussions (e.g., stress, anxiety, bullying, and bipolar disorder) served as guiding focal points for the workshops. The second phase of the intervention took place one month later and consisted of seven workshops (six 75-minute sessions and one full-day session) during which participants engaged in visual artistic creation and PI (Table 1). Table 1. Overview of workshop topics and artistic techniques. Session Workshop topics Visual arts: Materials and techniques 1 What do you feel? Abstract self-portraits (mask) using paintbrushes 2 What do you feel? (continued) Abstract self-portraits (mask) continued using Posca markers 3 Stress and anxiety Pictograms (combination, cutting and gluing) 4 Bullying, sadness, and depression Tachisme technique (stamping), Chinese ink, paper folding 5 Bipolar disorder and ADHD Tachisme technique (stamping) continued, Chinese ink, paper folding 6 (full day) Revisiting all themes (primarily stress and anxiety) Revisiting previous artistic techniques 7 Revisiting all themes (primarily stress and anxiety) Pictograms continued (half pictogram, half painting) Each 75-minute workshop comprised a 15-minute introduction to the artistic technique and a stimulus related to the mental health topic (as described below). This was followed by 40 minutes of artistic creation, 10 minutes of sharing centred on participants’ artwork, and 10 minutes for clean-up. The full-day workshop followed a similar structure, repeated twice, with extended time allocated to each component. The artistic creation was facilitated by a graphic design professor (VY), a professional graphic designer, and the classroom art teacher, while VB and MB continued to lead PI. Following each workshop, the research team met to debrief and plan subsequent sessions, tailoring the content to the evolving interests and progress of the students. As such, workshop topics and artistic techniques remained flexible. Examples of the resulting artwork are presented in Figures 1-3. PI was implemented in a non-traditional format and adapted to be integrated within the artistic creation process. Each session began with the presentation of a stimulus designed to spark reflection, including testimonies (e.g., living with ADHD), inspirational quotes (e.g., “The mask does not hide, it reveals”) and visual artworks (e.g., logo design using pictograms). Students were then invited to generate questions inspired by the stimulus (e.g., “Can stress be a good thing?”, “When and why does good stress become harmful?”). They subsequently engaged in individual or small-group reflection throughout the creative process. During this time, facilitators circulated among participants to prompt reflection with questions (e.g., “What does this area of your drawing represent?”, “What were you trying to convey through this image?”). Next, students were invited to share their artwork and revisit earlier questions; the classroom was rearranged in a circle (if time permitted). The facilitators supported the exchange by asking for clarification and justification (e.g., What meaning does this image hold for you?”, “In what way does stress emerge through your artwork?”). Adolescents were encouraged to compare perspectives and identify similarities and differences, while facilitators occasionally paused to synthesize key ideas. The final phase of the intervention involved data collection through individual recorded interviews, conducted two weeks after the completion of the workshops. This interval allowed adolescents some time to reflect on the most salient aspects of artistic creation and PI. Each participant took part in a 15-minute semi-structured interview conducted by one of the facilitators (VB or MB) online through Microsoft Teams; interviews were held in an empty classroom, where a computer was set up for the participant. The semi-structured format provided a guiding framework while also enabling open-ended questions on mental health and further exploration of adolescents’ perceptions of the workshops. The interview guide can be found in the Appendix. Moreover, facilitators took field notes during the intervention to document their perceptions and observations (e.g., non-verbal expressions) of participants, supporting and contextualizing the interview data. Reflexivity The study was led by the first author (VB), a graduate student in psychology, who received training in qualitative methods through advanced coursework and mentorship from qualitative researchers. Prior to this project, VB contributed to several quantitative studies across health-related domains. She was supported by two undergraduate psychology research assistants: MB, who assisted with interviews, and AM, who contributed to coding. Neither the interviewers nor the coders had prior relationships with the participants before the study; however, by the time of the interviews, VB (interviewer and coder) and MB (interviewer) were known to participants through their role in facilitating the intervention. Participants knew that VB and MB were psychology students present in the classroom to assist with mental health discussions. The research team was primarily supervised by CMH, a child psychologist whose expertise lies in mental health, arts-based and PI research. Data Analysis Grounded in a positivist framework, the study employed coding reliability thematic analysis to capture the perspectives of youth on mental health and their participation in the intervention. Such thematic analysis prioritizes reliable and accurate coding to minimize researcher bias through structured codebooks, independent coding by multiple researchers, intercoder agreement, and consensus (45). Qualitative data were managed using MAXQDA 24 software, and the analysis followed an iterative process of organizing, reading, coding, and interpreting data, as outlined below (46). Interview recordings were transcribed verbatim and organized within the software. Through iterative readings and note-taking, the first author (VB) developed a comprehensive understanding of the dataset, identifying both manifest and latent meanings in the interviews. VB then conducted lean coding (47), beginning with a small set of initial codes derived from the data (i.e., inductive), which were expanded into subcodes as needed (approximately 25-30 total). Related codes and subcodes were synthesized into newly defined subthemes and overarching themes using MAXQDA’s Creative Coding tool, resulting in the development of a coding tree (Table 2). A research assistant (AM) independently coded the data. Collaborative review sessions with the principal investigator (CMH) were held to resolve divergences in coding and reach consensus on codes and themes. Aligning with the final stages of thematic data analysis (46), the research team subsequently engaged in higher-order interpretation to move beyond descriptive themes and articulate broader meaning structures (48), thereby informing the discussion. Table 2. Coding tree Themes (T) and their definitions Subthemes (S) and their definitions Codes T1 - Mental Health : as viewed and discussed by teenagers. S1 - Duality : the contrast between the positive and the negative aspects of mental health. A combination of both sides The negative side The positive side S2 - Awareness of Others : the workshops on mental health elicited empathy and understanding for one another. Demonstrating empathy Realizing that we share similar struggles More attentive Feeling like you can open up T2 - Thinking Together : engaging in group discussions to promote reflections and understanding. S1 - Influence of Others : sharing of ideas may impact one's creativity and personal reflections. PI to foster creativity (or not) PI to integrate new perspectives (or not) PI to reduce stigma PI to find solutions S2 - Introspection : the observation of one's own thoughts and feelings. Space to explore thoughts and emotions Thinking to enrich creation (or not) PI to clarify thoughts Resonating through personal experience PI + arts versus traditional art class Results Thematic analysis of the interviews identified two overarching themes. The first was Mental Health , also comprised of the subthemes Duality and Awareness of Others . The second overarching theme, Thinking Together , included the subthemes Influence of Others and Introspection . Each theme is elaborated below and supported with illustrative quotes that were translated from French to English. Mental Health The first overarching theme reflected how adolescents conceptualized and defined mental health. Participants described it as a fluctuating state involving thoughts, emotions, and overall balance – encompassing both well-being and distress. Their understanding of mental health was shaped not only by their own experiences but also by empathy and shared experiences with others. This theme was represented through two subthemes. Duality Adolescents in the study depicted mental health as a topic marked by duality, referring to both its positive and negative dimensions, which could coexist and fluctuate over time. This dual perspective emerged consistently across participants' reflections and artistic expressions. One student precisely captured this dichotomy: “It’s how you feel in your head. It can be positive, it can be negative, but it’s what’s going on in your head” (Interview ID-14). Another participant articulated this duality through a more polarized lens, demonstrating the absence of emotional neutrality in his personal experience: “It’s the two extremes. At least in my case, there’s no in-between. I won’t feel just okay; it’s either going well, or it’s going badly. There’s no middle ground” (Interview ID-13). Another student emphasized the more positive aspects of mental health: “[Mental health] would be a state of mind. Feeling good about yourself, not lacking energy. That would be in a positive situation” (Interview ID-11). Conversely, mental health was sometimes represented in negative terms, particularly through visual metaphors. For example, one participant talked about her artistic creation as “a puzzle that breaks apart” (Interview ID-04), explaining that feeling unwell can resemble a breakdown, with parts of the self fragmenting. Some participants also reflected on how their understanding of mental health evolved during the intervention. A student described shifting from a rigid, negative interpretation of anxiety to a more balanced view: Before, I was really set on the idea that I had only one way of thinking, especially when it came to my anxiety. I was like, “Oh, it’s horrible,” and all that. And after we had the discussions, I told myself maybe it’s not all horrible. I’m able to see a bit more of the positive, even if [anxiety] was something negative (Interview ID-10). These narratives underscore the complex and often ambivalent ways in which adolescents perceive and experience mental health. Awareness of Others Another subtheme that emerged in participants’ discourses around mental health was the awareness of others. This was conveyed both explicitly (manifest content) and implicitly (latent meaning) through expressions of empathy and sensitivity towards peers. One participant reflected on how learning about peers' different perspectives fostered greater understanding and compassion: “Knowing how other people felt about [mental health] teaches you that not everyone experiences it the same way. It helps you better understand and to be more compassionate toward people who go through [hardships] more regularly than you do” (Interview ID-04). For other participants, this awareness was rooted in shared experiences, particularly related to stress and anxiety. A student recalled that hearing about common struggles facilitated connection and fostered a sense of not being alone: “He was really open about his anxiety and all that. I think that kind of opened a door for us. Like, for me – I know I do certain things, and that there are other people like me out there” (Interview ID-16). Participants also reported increased attentiveness to the emotional states of others following the intervention. One participant described a transition away from superficial judgments to more reflective interpretations of others’ behaviours: You see them, and you're like, “oh that person is mean,” but you don’t know them well enough to understand why they act that way. Maybe they’re just putting up a wall because they don’t want to get hurt. And it’s really interesting to see that now my view of others has changed (Interview ID-10). Similarly, another student noted becoming more aware that others have their own inner lives: “Before, I wasn’t paying attention that others could also have mental health problems […]. And now, I know that everyone has their own thoughts, their own things” (Interview ID-07). Not all participants attributed these shifts to the workshops. One participant commented that regular conversations about mental health at home had also shaped his broad-mindedness and understanding. Several adolescents described a stronger inclination to disclose to others (whether friends, classmates, or parents) following the intervention. For many, artistic creation served as a communicative tool to express internal states. As one student explained: My creative process was really based on my own experience because I really wanted to show something clear, something that others could easily understand. I tried to think, if I had to describe to someone how I feel when I have anxiety, how would I show that in an image? (Interview ID-10). This intention was recognized by classmates, who reported that viewing the artwork of others offered insight into their peers’ feelings. A participant noted: “I saw the drawings that the others had made, so I think that maybe that speaks a little more to their own experience” (Interview ID-03). In summary, the discourse of participants on mental health suggested that they believed their participation in the workshops facilitated a deeper awareness of others’ emotional realities – often grounded in empathy, shared experience, and alternative ways of communicating, such as art. Thinking Together A second overarching theme that emerged from the interview data was related to the idea of thinking together, or the role of group discussions in fostering reflection and mutual understanding. This theme encompassed two subthemes: the first being the influence of others, as many participants described how the exchange of ideas shaped their creative thinking and personal reflections; and the second being introspection, defined as the observation of one’s own thoughts and feelings. Influence of Others For several students, PI served as a catalyst for creativity. One participant noted: “What we hear from others brings out [ideas] we wouldn’t have thought of automatically. Sometimes you think later: ‘Ah, I should’ve done that.’ Through communicating with others, we think more about things we wouldn’t have immediately considered” (Interview ID-17). Similarly, another student observed: “There were ideas that came from other people, and we could discuss what we thought, and then I would kind of bring it all together, and then I could… I could create” (Interview ID-02). These quotes illustrate how interpersonal exchanges were integrated into the artistic process, enabling participants to access ideas and insights that may not have surfaced in isolation. However, not all teenagers shared this perspective. Some felt that creating around the topics of mental health remained highly personal and thus could not be influenced by external input. A student explained: “Since mental health is really individual, you see what you see. […] You can see new points of view, but your first point of view when you create something, that is your point of view” (Interview ID-13). For this participant, group exchanges had little to no bearing on one’s creative process. Some participants maintained that PI served as a way of integrating new perspectives: “[Discussions] kind of led me in other directions and gave me ideas. There were things we talked about that wouldn’t have crossed my mind” (Interview ID-06), and “Especially talking about it with a big group, there are lots of different opinions and multiple perspectives. I think it was good because we got everyone’s opinion, and they’re not necessarily the same” (Interview ID-15). These participants viewed PI as a valuable mechanism for expanding their thinking and incorporating novel standpoints. Nonetheless, other students expressed skepticism about the significance of such exchanges, particularly when peer contributions were perceived as redundant or superficial. For example, one participant remarked: I felt like we were still speaking in very general terms. Like we were talking about mental health, but it was stuff I already knew. […] Like everyone’s on the same page because I think we’re all at the same level in terms of understanding what mental health is (Interview ID-04). Another participant also cited prior knowledge (stemming from personal interest and living with a psychological disorder) and limited peer engagement as factors that reduced the effect of the intervention, noting that “a lot of people weren’t taking it seriously” (Interview ID-12). These accounts highlight the various ways in which PI may or may not have exerted influence on creative inspiration. Introspection A recurring narrative in participants’ interviews was the offering of space, both physical and psychological, that enabled the exploration of their inner experience. As one student articulated, “I felt like it left a lot of room for your thoughts, for how you feel. [The workshops] really gave space to think about the definition, or rather the interpretation, of what your drawing means” (Interview ID-09). This shift from a surface-level approach to deeper personal reflection allowed participants to view the intervention as an opportunity for meaning making rather than simply completing a task: [PI] mostly helped me get a clearer visual of what I wanted to do and create. If I hadn’t had the discussions, I probably would’ve been a bit more lost […] We helped each other a lot in trying to figure out what it meant, instead of trying to do it alone” (Interview ID-08). As such, PI served as a key catalyst for introspection, helping participants acknowledge, articulate, and clarify their thoughts and emotions. Some adolescents even described a change in their emotional expression: “Nowadays, I’m more likely to express my emotions verbally rather than just keeping them inside” (Interview ID-08). Enhanced emotional awareness was similarly attributed to this reflective dialogue: “I kind of know a bit more what I’m feeling, you know?” (Interview ID-02). PI thus appeared to support emotional processing and insight through shared reflection. Participants also reported using artistic creation as a means to externalize internal moods, particularly emotional experiences such as anxiety. One described her creative process as follows: “When I feel anxious myself, I represent what might be going on in my head at that moment, how I see life” (Interview ID-05). Another expressed a similar effort to translate a mental state into visual form: “I was really trying to put on paper what I feel… Just all the mixed emotions together and to try to represent them with different brushstrokes” (Interview ID-07). Lastly, a clear distinction emerged between the intervention (i.e., integrating PI into the arts) and traditional art classes. Several participants noted that the workshops encouraged deeper emotional exploration and reflection in contrast to the more directive and outcome-focused format of regular classes. A participant emphasized: “Usually in art class, we have a project, we have a topic, we do it, but we don’t look inside ourselves – at our emotions, how we feel – and express that. We just do it” (Interview ID-14). Another student echoed this sentiment: “In regular classes, we’re just given something to do, we do it, and that’s it… there’s nothing deeper to it” (Interview ID-02). These quotes suggest that the workshops facilitated reflectiveness while also cultivating a more intentional and personally meaningful artistic process. Ultimately, thinking together during artistic creation appeared to foster a collaborative climate in which peer influence and introspection played central roles. Discussion This study explored adolescents’ perceptions of mental health and of an arts-based PI intervention. The two themes that emerged from the accounts of participants highlighted how the intervention supported their understanding of mental health and influenced empathy, creativity and introspection. Adolescents’ Evolving Conceptualizations of Mental Health Mental Health as a Duality Participants initially described mental health in polarizing terms (e.g., “going well” versus “going badly”), acknowledging the coexistence of positive and negative emotional experiences. This pattern mirrors findings by Johansson, Brunnberg (49) and Teng, Crabb (5), who similarly reported that adolescents often frame their mental health according to whether they feel well or are in distress. Such dichotomous framing may reflect the defence mechanism of splitting, or black-and-white thinking, whereby individuals struggle to integrate both positive and negative qualities of an experience into a cohesive and realistic whole – a tendency that is relatively common and transient as part of adolescent development (50, 51). Over time, however, many participants in the present study articulated mental health in more elaborated terms, particularly as an outcome of increased reflection on their own emotional experiences through the workshops. Indeed, engaging in a combined arts and PI intervention gradually resulted in participants viewing mental health as a constantly fluctuating process, as opposed to a static and binary state. This progression closely parallels the findings of Chisholm, Patterson (15) regarding the “dual perception” of mental health (p. 628). In their study, adolescents relied at first on stereotypical or extreme representations of mental illness but gradually developed a more nuanced perspective through personal or vicarious experiences, enabling them to move beyond rigid distinctions of “normality” and “craziness” (p. 632). The present findings similarly suggest that adolescents can integrate opposing emotional states within a flexible framework. This understanding of mental health is further supported by the dual-factor model, which conceptualizes mental health as the coexistence of well-being and psychological symptoms (52, 53). From this perspective, the presence of psychological distress does not exclude positive functioning, nor does well-being imply the absence of distress – a distinction that resonated with participants’ evolving interpretations of their own and others’ mental health experiences. Empirical work by Grych, Taylor (54) using this model identified adolescent profiles such as “symptomatic but content,” characterized by well-being alongside psychological distress (p.2). These profiles closely reflect participants’ narratives, reinforcing how the mental health of adolescents is dynamic and multifaceted. Mental Health and Awareness of Others Adolescents’ accounts of becoming increasingly attentive to others’ emotional states indicate a shift toward more context-sensitive social understanding. Building on Chisholm, Patterson (15), who found that young people move from stereotypical representations of mental illness toward more nuanced, experience-based interpretations, participants in the present study similarly appeared to reconcile their initial judgments with a growing recognition of others’ internal experiences. This process seemed to foster greater empathy and compassion, particularly as adolescents came to view behaviours as reflecting underlying emotional struggles instead of fixed and unchanging personality traits. This evolving awareness is consistent with developmental research indicating that empathic concern strengthens during adolescence; with advances in perspective-taking and Theory of Mind, youths are more likely to interpret others’ behaviour in light of situational and emotional contexts (55-57). Put differently, adolescence represents a key developmental period during which empathy becomes increasingly sophisticated, enabling more accurate and context-dependent interpretations of the emotions of others (58, 59). Nevertheless, some participants explicitly linked their heightened attentiveness to exchanges that occurred during the intervention, such as discovering that classmates shared similar experiences of stress or anxiety. Although effects of normative developmental maturation cannot be ruled out, the short timeframe between the initial brainstorming and the final interviews, coupled with participants’ explicit attributions of change to the workshops, suggested that the intervention contributed to some growth in empathy. Thus, participation in the workshops may have supported a shift away from attributing behaviour to stable personal dispositions and toward context-sensitive interpretations that account for stress, anxiety, or prior experiences. Importantly, this evolution did not invalidate adolescents’ initial perceptions – it expanded them through reflection and dialogue. Moreover, the increased willingness to disclose to others and the deeper attunement to the emotions of peers may be partly explained by the use of artistic creation as a mode of expression. Consistent with prior research, artistic pursuits appear to offer adolescents a nonthreatening means of externalizing internal states, facilitating emotional recognition and communication when words are insufficient (28, 34, 35). By sharing and interpreting one another’s artwork, participants were also exposed to the lived experiences of their peers – an exchange shown to foster empathy, relational connection, and shared understanding among youth (30, 31). Collectively, the present findings lend further support to prior evidence demonstrating that arts-based interventions can enhance interpersonal awareness and emotional attunement, thereby promoting empathy and a sense of belonging as key components of adolescent mental health and well-being (29, 36). Thinking Together Influence of Others PI appeared to support the reflection and creative exploration of participants; however, the extent of its influence varied across individuals. Many described how exposure to the perspectives of others prompted new ideas of their own that informed and enriched their creativity. This pattern highlights the role of social interaction as a catalyst for individual thinking, a process central to sociocultural theories of learning. In particular, Vygotsky (60)’s sociocultural theory emphasized that meaning is first constructed through social exchange before being internalized at the individual level. From this perspective, shared dialogue within PI can be understood as a mechanism through which new creative insights are jointly explored and selectively taken up – namely, when participants perceive the contributions of others as bearing influence on their own experiences. At the same time, some participants emphasized the primacy of their own personal viewpoint, portraying peer contributions as limited or only marginally relevant to their thinking. For these participants, PI on mental health remained mainly grounded in personal experiences and reflected pre-existing views rather than serving as a source of transformation. In other words, the engagement that participants had with PI seemed to be shaped by the extent to which they valued the ideas of others. This variability aligns with prior work affirming that dialogue-based learning environments do not produce uniform levels of engagement, even when opportunities for discussion are deliberately structured (61). Within PI, dialogue is intended to open space for shared exploration while preserving individual autonomy (21, 62). Accordingly, thinking together did not necessarily lead adolescents to think alike. Rather, PI appeared to support either the enrichment of perspectives through peer input, or the consolidation of internally derived insights, possibly shaped by the students’ initial epistemological stance. Introspection The final subtheme, introspection, revealed how the integration of PI within artistic creation supported adolescents in the processing of their own thoughts, emotions, and experiences with mental health. Most participants described the workshops as offering space to reflect internally, moving beyond surface-level task completion toward a more intentional exploration of meaning. Importantly, introspection in this context did not seem to emerge in isolation. While PI unfolded in a group setting, it appeared to help adolescents turn inward and engage in self-reflection (e.g., articulating what their artwork represented to them and why certain topics or symbols felt personally salient). Some of the participants’ accounts imply a movement between externalization and re-internalization: emotional states (e.g., anxiety and stress) were first expressed visually through form and symbolism, then examined through dialogue, and ultimately reintegrated as more coherent personal insights. This sequence is consistent with theoretical perspectives proposing that structured dialogue and artistic creation can render implicit experiences more accessible to conscious awareness (21, 28, 34, 61). As such, the intervention served as a stimulus for self-observation and introspection – capacities central to emotional understanding and self-regulation during adolescence (63, 64). In addition, the contrast drawn by participants between the intervention and regular art classes illustrates the distinctive role of PI in fostering introspection. Whereas the standard art curriculum was often described as outcome-driven and externally guided, the workshops in this study explicitly invited adolescents to observe their emotions and intentions. Arts-based interventions that integrate guided inquiry have been shown to promote deeper reflective engagement than approaches centred primarily on technical instruction (37, 39, 43, 65). PI, in particular, has been identified as a practice that can support youth introspection and well-being (10). In light of these studies – together with participants’ own comparisons between regular art classes and the present intervention – introspection appears not to have been a mere by-product of artistic activity, but an intentional outcome of PI. Through open-ended questions and shared exploration, PI thus emerged as an important mechanism for cultivating introspection within artistic creation. Strengths and Limitations This study includes a number of strengths. The intervention integrates artistic creation and PI, two accessible and complementary approaches that draw on verbal and non-verbal modes of expression. This combination supports a more holistic engagement with mental health, encompassing emotional, cognitive, and interpersonal dimensions, and facilitates the exploration of complex themes in ways that are meaningful to adolescents. In addition, the use of qualitative methods enabled an in-depth examination of the subjective experiences of participants. By centring youth voices, the study captured nuanced perspectives – including both positive and less favourable responses – thereby providing a comprehensive understanding of how the intervention was experienced. A notable limitation of this study is the potential for social desirability bias in participants’ responses during post-workshop interviews. Despite being informed prior to these interviews that there were no right or wrong answers and that their honest perspectives were valued, adolescents may have responded in ways they thought were expected. The same research assistants conducted both the PI workshops and the interviews. While this continuity potentially increased participants’ comfort and openness in sharing their views, it may also have amplified an inclination to please the researchers through their responses. A second limitation relates to the absence of participant validation procedures. Transcripts were not returned to students for comments or impressions, and they did not provide feedback on the study results, as recommended by COREQ (44). This may hinder the extent to which the findings accurately reflect the intended meanings of the participants, as interpretations may be influenced by the researchers’ perspectives. Third, because participants had chosen to take visual art classes as part of their curriculum, they may have been more receptive to the intervention than students enrolled in other electives. This self-selection introduces a risk of selection bias, as the interests and engagement of these art students may not represent the broader adolescent population. Lastly, the intervention was relatively brief, and its influence on students’ reflections about mental health may partly reflect a novelty effect, given that it differed from standard school practices. If PI and artistic creation were integrated into the regular curriculum, their impact might differ or even diminish over time. Given these limitations, the findings should be interpreted with caution. Conclusion This qualitative study explored the perspectives of adolescents on mental health and their experiences with a mental health intervention incorporating artistic creation and PI. Specifically, many adolescents approached mental health as a dynamic psychological state encompassing both well-being and distress, moving beyond polarized or deficit-based conceptualizations. The workshops also offered opportunities to engage with the lived experiences of others, thereby fostering empathy and creativity. For some participants, however, the workshops simply echoed pre-existing views, pointing to limitations in their influence. Overall, the intervention integrated artistic creation and PI such that they reinforced one another and, in turn, supported introspection, creativity, and emotional awareness (of oneself and others). These findings underscore the potential of school-based interventions that integrate arts and PI to mitigate barriers adolescents face in accessing mental health resources and expressing psychological distress. Such interventions provide opportunities for youth to explore mental health in accessible and personally meaningful ways by facilitating discussion through PI and expression through the arts. They may also support adolescents’ psychological well-being by eliciting protective factors (e.g., recognition and understanding of their internal states). Nonetheless, further research using complementary methodologies is needed to evaluate and quantify the impact of similar interventions and to examine their underlying mechanisms. Declarations Funding statement: Funding for this project was provided by the Fonds de recherche du Québec – Santé through a research grant to CMH and by Fonds de recherche du Québec – Société et Culture through a scholarship to VB. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Ethics statement: Approval to conduct the research leading to this manuscript was obtained from the Comité Institutionnel d’Éthique de la Recherche avec des Êtres Humains (CIEREH), the institutional human research ethics committee of the Université du Québec à Montréal (File Number 2023-5172). All research involving human participants was conducted ethically and in accordance with CIEREH guidelines and regulations, which adhere to the 2022 Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2). Permission to use the collected data (including interview transcripts and artwork) for research dissemination was obtained from both adolescent participants and their legal guardians through informed consent prior to participation. Interview verbatims and artwork included in this manuscript do not contain any identifying information other than gender. Participant identities were kept confidential. Competing interests policy: The authors have no competing interests as defined by Discover, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Data availability statement: The codes and themes derived from the data that support the findings are presented in Table 2. Additional details on the codes and themes, as well as the interview transcripts, are available from the corresponding authors (VB and CMH) upon request. Acknowledgements: We sincerely thank the students who took part in this study for their generosity, openness, and willingness to share their perspectives on mental health and the intervention. We are also grateful to Isabelle Morin, art teacher, for welcoming the intervention into her classroom with enthusiasm and flexibility, and to Malte Martin, artist and professional graphic designer, for his valuable insights and expertise in co-leading the artistic workshops. Author contributions statement: VB co-designed and co-led the philosophical inquiry, conducted interviews, led data analysis, and played a central role in drafting and revising the manuscript. VB is a corresponding author of this research. DS contributed to the development of the interview guide and provided expert perspectives on psychology and philosophy during manuscript revisions. MB co-led the philosophical inquiry and conducted interviews. AM contributed to data coding. ZDF provided critical feedback and commentary during manuscript revisions. VY co-designed and co-led the artistic workshops, contributing her expertise in visual arts. OM contributed expertise in education and philosophy for children and co-designed the philosophical inquiry workshops. CMH , the principal investigator and project supervisor, provided clinical supervision during data collection, oversaw all stages of the research, co-designed the intervention, contributed to the writing and revision of the manuscript, and funded the project. CMH is a corresponding author of this research. References World Health Organization. Mental health of adolescents. World Health Organization, 2025 September 1, 2025. Report No. Jones EAK, Mitra AK, Bhuiyan AR. Impact of covid-19 on mental health in adolescents: A systematic review. Int J Environ Res Public Health. 2021;18(5). Epub 20210303. doi: 10.3390/ijerph18052470. PubMed PMID: 33802278; PubMed Central PMCID: PMC7967607. Sojli E, Tham WW, Bryant R, McAleer M. COVID-19 restrictions and age-specific mental health-U.S. probability-based panel evidence. Transl Psychiatry. 2021;11(1):418. Epub 20210804. doi: 10.1038/s41398-021-01537-x. PubMed PMID: 34349100; PubMed Central PMCID: PMC8336527. 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Carlson MR. How inquiry based learning supports creative problem solving skills in elementary art education. Spark Repository: Bethel University; 2023. Additional Declarations No competing interests reported. Supplementary Files Appendix.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 29 Apr, 2026 Editor assigned by journal 10 Apr, 2026 Submission checks completed at journal 10 Apr, 2026 First submitted to journal 09 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Outaouais","correspondingAuthor":false,"prefix":"","firstName":"Valérie","middleName":"","lastName":"Yobé","suffix":""},{"id":634997432,"identity":"ec8c7da4-5060-43f2-9617-40b92bc23844","order_by":6,"name":"Olivier Michaud","email":"","orcid":"","institution":"Université du Québec à Rimouski","correspondingAuthor":false,"prefix":"","firstName":"Olivier","middleName":"","lastName":"Michaud","suffix":""},{"id":634997433,"identity":"cca15ada-8e0f-4ce7-85ef-2262569bd326","order_by":7,"name":"Catherine Malboeuf-Hurtubise","email":"","orcid":"","institution":"Université Laval","correspondingAuthor":false,"prefix":"","firstName":"Catherine","middleName":"","lastName":"Malboeuf-Hurtubise","suffix":""}],"badges":[],"createdAt":"2026-04-09 12:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9368328/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9368328/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108959499,"identity":"d783b629-d5c8-4292-a7a5-a3f018667812","added_by":"auto","created_at":"2026-05-11 08:30:10","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":114596,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eAnxiety represented through pictograms.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure1.Anxietyrepresentedthroughpictograms.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9368328/v1/b7e5b0e8fb3dd00fc2fc5101.jpeg"},{"id":108959439,"identity":"aace8ffe-c647-4a0a-a6cb-70966eb6469e","added_by":"auto","created_at":"2026-05-11 08:29:54","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":623458,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eStress illustrated as a face mask.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure2.Stressillustratedasafacemask.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9368328/v1/a7b5a0afdefaf691d5ed06bb.jpeg"},{"id":108959498,"identity":"19619546-25ef-4572-8c05-1e399bd41d12","added_by":"auto","created_at":"2026-05-11 08:30:10","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":169417,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eBipolarity expressed using a stamping technique.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure3.Bipolarityexpressedusingastampingtechnique.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9368328/v1/6455a28027176c245aef7f2b.jpeg"},{"id":108978179,"identity":"fe517061-8c73-4d82-b1e1-f1fbef67c39e","added_by":"auto","created_at":"2026-05-11 11:34:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1223479,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9368328/v1/d5d00975-8a2d-4ba5-99f2-1fe496660bac.pdf"},{"id":108959521,"identity":"8655c6e3-7623-4067-b1de-c4a52c4c83fe","added_by":"auto","created_at":"2026-05-11 08:30:16","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":42899,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-9368328/v1/6ec3712ebe0995fbea2615e1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adolescent perspectives on mental health and an arts-based philosophical inquiry intervention","fulltext":[{"header":"Introduction","content":"\u003ch2\u003eMental Health in Youth\u003c/h2\u003e\n\u003cp\u003eAdolescence is a formative developmental period characterized by rapid cognitive, emotional, and social changes. While this stage of life allows for exploration and growth, it is also associated with increased vulnerability to psychological distress and the emergence of mental health difficulties (1). In recent years, mental health concerns among adolescents have risen globally, with accumulating evidence suggesting that youth distress was further intensified during and after the COVID-19 pandemic (2, 3). This trend is particularly concerning given that mental disorders already constitute one of the main sources of illness during adolescence (1). In fact, approximately 75% of lifetime mental health disorders are found to emerge before the age of 24, positioning adolescence as a critical window for prevention, early identification, and intervention (4). Despite this, few studies have examined how youth themselves conceptualize mental health (5), and many adolescents experiencing emotional distress do not seek professional support (6). Barriers to seeking help remain well-documented and include stigmatization, embarrassment, limited access to health care providers, and difficulties articulating psychological distress or discussing mental health concerns (7). These challenges underscore the importance of developing supportive, accessible interventions that centre the voices of youth, particularly within school contexts, where adolescents with diverse profiles and needs spend much of their daily lives (8).\u003c/p\u003e\n\u003cp\u003eBeyond clinical trials conducted in medical settings, research has increasingly emphasized the value of prevention programs that promote psychological well-being through protective factors, such as emotional awareness, self-efficacy, resilience, and interpersonal skills (9-11). More specifically, interventions that encourage reflection about personal experience may be especially relevant during adolescence, as youth continue to develop advanced capacities for abstract reasoning, navigate rich emotional experiences, and explore their identity (12, 13). Embracing discussions on mental health with adolescents may also help them develop an elaborate comprehension of the concept while simultaneously reducing stigma, uncertainty, and confusion around it (14, 15). In this context, school-based interventions aimed at fostering introspection and shared reflection may serve as a meaningful complement to didactic psychoeducational programs on mental health.\u003c/p\u003e\n\u003ch2\u003ePhilosophical Inquiry\u003c/h2\u003e\n\u003cp\u003ePhilosophical inquiry (PI) has gained increasing attention as an educational practice that can support reflection, emotional insight, and meaning making around complex topics, including youth mental health (10, 16). PI is often described as a practice of thinking together (17). Rather than focusing on transmitting knowledge, it invites participants into open-ended dialogue, where ideas are explored through listening, justification, questioning, and clarification (18). The aim is not to reach consensus, but to help young people learn how to think for themselves with others, tolerate uncertainty, and make sense of inquiry (19). PI offers a space where subjective experiences can be thoughtfully reflected upon without being reduced to labels or right answers. In classroom settings, it typically unfolds as structured discussions prompted by a topic or philosophical question. Educators adopt the role of facilitators, supporting a climate that values openness, mutual respect, and non-judgmental exchange (20). This format encourages students to articulate their ideas, listen attentively to peers, and revisit their thinking in response to others\u0026rsquo; contributions. As Leng (21) suggests, these dialogues can promote social inclusion and engagement by providing an environment in which all voices are acknowledged.\u003c/p\u003e\n\u003cp\u003ePI may be particularly relevant when mental health itself becomes the subject of inquiry. Discussing mental health through PI allows participants to explore emotions, psychological difficulties, and well-being in a way that does not require personal disclosure or position their experiences as pathological (10, 16, 22). Instead, young people are invited to reflect on broader questions \u0026ndash; such as what it means to feel well, to struggle, or to cope \u0026ndash; drawing on their own interpretations and understandings of mental health. As such, PI may be well-suited for adolescents who find it challenging to verbalize internal states and who prefer, for instance, to engage with emotional material through structured or analytical forms of thinking (19). Indeed, this approach may provide an opportunity for youth to thoughtfully consider a variety of psychological topics.\u003c/p\u003e\n\u003cp\u003ePI is also related to a range of cognitive, social, and emotional benefits in adolescents. Studies suggest that PI is associated with gains in critical thinking and reasoning (23), as well as with positive developmental outcomes, including self-esteem, autonomy, and emotional understanding (16, 24). PI has additionally been linked to improved communication, moral judgment, and civic engagement (25). Although these outcomes are not specific to mental health per se, they reflect protective factors for psychological well-being.\u003c/p\u003e\n\u003ch2\u003eArtistic Creation\u003c/h2\u003e\n\u003cp\u003eAlongside PI, arts-based interventions represent another viable school-based approach that could support the mental health needs of students (9, 11). Artistic creation encompasses the use of diverse media, the creative process itself, and the resulting artwork. According to the American Art Therapy Association (26), such practices can foster emotional awareness, self-expression, and behavioural regulation, while also shaping how individuals perceive their reality. Participation in the arts has been associated with reductions in emotional and behavioural difficulties, improved coping capacities, and an enhanced sense of belonging and relational connection (27-29). By offering adolescents opportunities for personal storytelling, sharing their work, and commenting on their peers\u0026rsquo; creations, arts-based practices may contribute to the development of resilience, self-esteem and self-efficacy (29-31). Mobilizing these protective factors through the artistic process is important, especially during adolescence \u0026ndash; a developmental period largely characterized by identity exploration and heightened self-consciousness (32, 33).\u003c/p\u003e\n\u003cp\u003eMore central to the present study is the notion that artistic creation can function as an alternative means of communication when verbal expression feels inaccessible, overwhelming, or insufficient (34). Through colour, form, metaphor, and composition, youth may externalize emotions and explore them symbolically in ways that feel less threatening than direct verbal disclosure (28, 35). Such creative space can reduce fears of exposure while still supporting reflection and self-understanding (34). Adolescents have described arts-based activities as facilitating freer self-expression and a clearer understanding of the connections between their thoughts and emotions, echoing the reflective processes observed in PI (36). Such externalization of inner states through the arts may, over time, ease verbal expression by enhancing emotional clarity and confidence (34, 35). Accordingly, artistic creation may help adolescents conceptualize and make sense of their mental health experiences while serving as a tool for communication with peers.\u003c/p\u003e\n\u003ch2\u003ePI and Artistic Creation as a Combined Intervention\u003c/h2\u003e\n\u003cp\u003eAlthough PI and arts-based approaches have each been examined in relation to youth development and well-being, little is comparatively known about interventions that combine both practices. PI can help structure and deepen reflection through shared inquiry, the questioning of assumptions, and the co-construction of meaning, while artistic creation can enable the externalization of internal experiences through symbolic or visual forms (37-40). Conceptually, bringing PI into the creative process may support complementary pathways toward introspection and meaning making (39). Indeed, early work on PI suggests that it can foster creative thinking, including the generation of novel ideas and the exploration of alternative possibilities (19). More recent theoretical research proposes that philosophical education may act as a catalyst for creative thinking by cultivating openness, mental flexibility, and exposure to different options (41, 42). Abel (43) further hypothesizes that integrating PI before, during, and after artistic production could enrich the creative process by helping youth articulate the intuitive or implicit meanings embedded in their artwork : through reflective questioning, PI may support adolescents in considering why they created certain images, what their symbols signify, and how their artistic choices relate to personal experiences. In turn, engaging in artistic pursuits may offer concrete material for philosophical reflection, grounding dialogue in lived experience over abstract debate.\u003c/p\u003e\n\u003cp\u003eIntegrating PI and artistic creation may constitute an adequate approach for addressing topics such as mental health, which encompasses both conceptual dimensions (e.g., how mental health is defined) and experiential dimensions (e.g., how distress is felt and expressed). Given that adolescents may hold simplified or stereotypical understandings of mental health, shaped in part by media representations and limited emotional vocabulary (14, 15), an intervention integrating artistic creation and PI could support the exploration of more nuanced conceptualizations. It may also draw on similar protective factors for mental health as those observed in the individual approaches. Despite these theoretical promises, empirical research on how adolescents experience combined PI and arts-based interventions remains scarce, particularly regarding mental health. Qualitative approaches may be especially valuable in this domain, as they enable in-depth exploration of lived experiences and interpretive processes.\u003c/p\u003e\n\u003ch2\u003eObjectives\u003c/h2\u003e\n\u003cp\u003eThe present qualitative study explored adolescents\u0026rsquo; experiences of an arts-based intervention integrating PI around mental health topics. Specifically, it aimed to document the perspectives of youth on mental health and on their participation in artistic creation and PI workshops. The guiding research questions were: \u0026ldquo;How do adolescents conceptualize mental health?\u0026rdquo; and \u0026ldquo;How do adolescents perceive a mental health intervention combining PI and artistic creation?\u0026rdquo;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study used a qualitative design to capture adolescents\u0026rsquo; perspectives and followed the Consolidated criteria for reporting qualitative research (COREQ), a 32-item checklist to ensure comprehensive reporting of key methodological aspects (44). This project was part of a larger initiative aimed at destigmatizing mental health issues and raising public awareness in the media.\u003c/p\u003e\n\u003ch2\u003eParticipants and Intervention\u003c/h2\u003e\n\u003cp\u003eUsing a convenience sampling strategy, high school students were recruited from a specialized visual arts program in the province of Quebec, Canada. Of the 33 adolescents enrolled in this school program, 17 chose to participate (M\u003csub\u003eage\u003c/sub\u003e = 16.5 years; 76% female). Informed consent was obtained from both students and their legal guardians prior to participation. Students received a $20 bookstore gift card for their participation. Following recruitment, the intervention was implemented in three phases during the fall of 2023.\u003c/p\u003e\n\u003cp\u003eThe first phase consisted of two 75-minute brainstorming sessions in which participants identified mental health topics that were meaningful to them. Under the supervision of faculty members in psychology (CMH, DS) and education (OM), facilitators (VB, MB) conducted PI on mental health to support brainstorming. Sample discussion questions included: \u0026ldquo;Can someone have both good and poor mental health at the same time?\u0026rdquo;, \u0026ldquo;Do you think taking care of yourself is an innate or learned behaviour?\u0026rdquo;, and \u0026ldquo;Do people who are depressed stay that way for their whole life?\u0026rdquo; During these sessions, students worked in small groups on concept maps (i.e., flowcharts used to visually represent ideas and their connections). The primary topics that emerged from these discussions (e.g., stress, anxiety, bullying, and bipolar disorder) served as guiding focal points for the workshops.\u003c/p\u003e\n\u003cp\u003eThe second phase of the intervention took place one month later and consisted of seven workshops (six 75-minute sessions and one full-day session) during which participants engaged in visual artistic creation and PI (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Overview of workshop topics and artistic techniques.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.7e+2pt;border: none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSession\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWorkshop topics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVisual arts: Materials and techniques\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWhat do you feel?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAbstract self-portraits (mask) using paintbrushes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWhat do you feel? (continued)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAbstract self-portraits (mask) continued using Posca markers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eStress and anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePictograms (combination, cutting and gluing)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBullying, sadness, and depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTachisme technique (stamping), Chinese ink, paper folding\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBipolar disorder and ADHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTachisme technique (stamping) continued, Chinese ink, paper folding\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (full day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRevisiting all themes (primarily stress and anxiety)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRevisiting previous artistic techniques\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRevisiting all themes (primarily stress and anxiety)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePictograms continued (half pictogram, half painting)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eEach 75-minute workshop comprised a 15-minute introduction to the artistic technique and a stimulus related to the mental health topic (as described below). This was followed by 40 minutes of artistic creation, 10 minutes of sharing centred on participants\u0026rsquo; artwork, and 10 minutes for clean-up. The full-day workshop followed a similar structure, repeated twice, with extended time allocated to each component. The artistic creation was facilitated by a graphic design professor (VY), a professional graphic designer, and the classroom art teacher, while VB and MB continued to lead PI. Following each workshop, the research team met to debrief and plan subsequent sessions, tailoring the content to the evolving interests and progress of the students. As such, workshop topics and artistic techniques remained flexible. Examples of the resulting artwork are presented in Figures 1-3.\u003c/p\u003e\n\u003cp\u003ePI was implemented in a non-traditional format and adapted to be integrated within the artistic creation process. Each session began with the presentation of a stimulus designed to spark reflection, including testimonies (e.g., living with ADHD), inspirational quotes (e.g., \u0026ldquo;The mask does not hide, it reveals\u0026rdquo;) and visual artworks (e.g., logo design using pictograms). Students were then invited to generate questions inspired by the stimulus (e.g., \u0026ldquo;Can stress be a good thing?\u0026rdquo;, \u0026ldquo;When and why does good stress become harmful?\u0026rdquo;). They subsequently engaged in individual or small-group reflection throughout the creative process. During this time, facilitators circulated among participants to prompt reflection with questions (e.g., \u0026ldquo;What does this area of your drawing represent?\u0026rdquo;, \u0026ldquo;What were you trying to convey through this image?\u0026rdquo;). Next, students were invited to share their artwork and revisit earlier questions; the classroom was rearranged in a circle (if time permitted). The facilitators supported the exchange by asking for clarification and justification (e.g., What meaning does this image hold for you?\u0026rdquo;, \u0026ldquo;In what way does stress emerge through your artwork?\u0026rdquo;). Adolescents were encouraged to compare perspectives and identify similarities and differences, while facilitators occasionally paused to synthesize key ideas.\u003c/p\u003e\n\u003cp\u003eThe final phase of the intervention involved data collection through individual recorded interviews, conducted two weeks after the completion of the workshops. This interval allowed adolescents some time to reflect on the most salient aspects of artistic creation and PI. Each participant took part in a 15-minute semi-structured interview conducted by one of the facilitators (VB or MB) online through Microsoft Teams; interviews were held in an empty classroom, where a computer was set up for the participant. The semi-structured format provided a guiding framework while also enabling open-ended questions on mental health and further exploration of adolescents\u0026rsquo; perceptions of the workshops. The interview guide can be found in the Appendix. Moreover, facilitators took field notes during the intervention to document their perceptions and observations (e.g., non-verbal expressions) of participants, supporting and contextualizing the interview data.\u003c/p\u003e\n\u003ch2\u003eReflexivity\u003c/h2\u003e\n\u003cp\u003eThe study was led by the first author (VB), a graduate student in psychology, who received training in qualitative methods through advanced coursework and mentorship from qualitative researchers. Prior to this project, VB contributed to several quantitative studies across health-related domains. She was supported by two undergraduate psychology research assistants: MB, who assisted with interviews, and AM, who contributed to coding. Neither the interviewers nor the coders had prior relationships with the participants before the study; however, by the time of the interviews, VB (interviewer and coder) and MB (interviewer) were known to participants through their role in facilitating the intervention. Participants knew that VB and MB were psychology students present in the classroom to assist with mental health discussions. The research team was primarily supervised by CMH, a child psychologist whose expertise lies in mental health, arts-based and PI research.\u003c/p\u003e\n\u003ch2\u003eData Analysis\u003c/h2\u003e\n\u003cp\u003eGrounded in a positivist framework, the study employed coding reliability thematic analysis to capture the perspectives of youth on mental health and their participation in the intervention. Such thematic analysis prioritizes reliable and accurate coding to minimize researcher bias through structured codebooks, independent coding by multiple researchers, intercoder agreement, and consensus (45). Qualitative data were managed using MAXQDA 24 software, and the analysis followed an iterative process of organizing, reading, coding, and interpreting data, as outlined below (46).\u003c/p\u003e\n\u003cp\u003eInterview recordings were transcribed verbatim and organized within the software. Through iterative readings and note-taking, the first author (VB) developed a comprehensive understanding of the dataset, identifying both manifest and latent meanings in the interviews. VB then conducted lean coding (47), beginning with a small set of initial codes derived from the data (i.e., inductive), which were expanded into subcodes as needed (approximately 25-30 total). Related codes and subcodes were synthesized into newly defined subthemes and overarching themes using MAXQDA\u0026rsquo;s Creative Coding tool, resulting in the development of a coding tree (Table 2). A research assistant (AM) independently coded the data. Collaborative review sessions with the principal investigator (CMH) were held to resolve divergences in coding and reach consensus on codes and themes. Aligning with the final stages of thematic data analysis (46), the research team subsequently engaged in higher-order interpretation to move beyond descriptive themes and articulate broader meaning structures (48), thereby informing the discussion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Coding tree\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.4e+2pt;border: none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eThemes (T) and their definitions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSubthemes (S) and their definitions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCodes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eT1 - Mental Health\u003c/strong\u003e: as viewed and discussed by teenagers.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eS1 - Duality\u003c/strong\u003e: the contrast between the positive and the negative aspects of mental health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eA combination of both sides\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eThe negative side\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eThe positive side\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eS2 - Awareness of Others\u003c/strong\u003e: the workshops on mental health elicited empathy and understanding for one another.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDemonstrating empathy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRealizing that we share similar struggles\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMore attentive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFeeling like you can open up\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eT2 - Thinking Together\u003c/strong\u003e: engaging in group discussions to promote reflections and understanding.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eS1 - Influence of Others\u003c/strong\u003e: sharing of ideas may impact one\u0026apos;s creativity and personal reflections.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePI to foster creativity (or not)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePI to integrate new perspectives (or not)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePI to reduce stigma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePI to find solutions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eS2 - Introspection\u003c/strong\u003e: the observation of one\u0026apos;s own thoughts and feelings.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSpace to explore thoughts and emotions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eThinking to enrich creation (or not)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePI to clarify thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eResonating through personal experience\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePI + arts versus traditional art class\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Results","content":"\u003cp\u003eThematic analysis of the interviews identified two overarching themes. The first was\u003cem\u003e\u0026nbsp;Mental Health\u003c/em\u003e, also comprised of the subthemes \u003cem\u003eDuality\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;Awareness of Others\u003c/em\u003e. The second overarching theme, \u003cem\u003eThinking Together\u003c/em\u003e, included the subthemes \u003cem\u003eInfluence of Others\u003c/em\u003e and\u003cem\u003e\u0026nbsp;Introspection\u003c/em\u003e. Each theme is elaborated below and supported with illustrative quotes that were translated from French to English.\u003c/p\u003e\n\u003ch2\u003eMental Health\u003c/h2\u003e\n\u003cp\u003eThe first overarching theme reflected how adolescents conceptualized and defined mental health. Participants described it as a fluctuating state involving thoughts, emotions, and overall balance \u0026ndash; encompassing both well-being and distress. Their understanding of mental health was shaped not only by their own experiences but also by empathy and shared experiences with others. This theme was represented through two subthemes.\u003c/p\u003e\n\u003ch3\u003eDuality\u003c/h3\u003e\n\u003cp\u003eAdolescents in the study depicted mental health as a topic marked by duality, referring to both its positive and negative dimensions, which could coexist and fluctuate over time. This dual perspective emerged consistently across participants\u0026apos; reflections and artistic expressions. One student precisely captured this dichotomy: \u0026ldquo;It\u0026rsquo;s how you feel in your head. It can be positive, it can be negative, but it\u0026rsquo;s what\u0026rsquo;s going on in your head\u0026rdquo; (Interview ID-14). Another participant articulated this duality through a more polarized lens, demonstrating the absence of emotional neutrality in his personal experience: \u0026ldquo;It\u0026rsquo;s the two extremes. At least in my case, there\u0026rsquo;s no in-between. I won\u0026rsquo;t feel just okay; it\u0026rsquo;s either going well, or it\u0026rsquo;s going badly. There\u0026rsquo;s no middle ground\u0026rdquo; (Interview ID-13).\u003c/p\u003e\n\u003cp\u003eAnother student emphasized the more positive aspects of mental health: \u0026ldquo;[Mental health] would be a state of mind. Feeling good about yourself, not lacking energy. That would be in a positive situation\u0026rdquo; (Interview ID-11). Conversely, mental health was sometimes represented in negative terms, particularly through visual metaphors. For example, one participant talked about her artistic creation as \u0026ldquo;a puzzle that breaks apart\u0026rdquo; (Interview ID-04), explaining that feeling unwell can resemble a breakdown, with parts of the self fragmenting. Some participants also reflected on how their understanding of mental health evolved during the intervention. A student described shifting from a rigid, negative interpretation of anxiety to a more balanced view:\u003c/p\u003e\n\u003cp\u003eBefore, I was really set on the idea that I had only one way of thinking, especially when it came to my anxiety. I was like, \u0026ldquo;Oh, it\u0026rsquo;s horrible,\u0026rdquo; and all that. And after we had the discussions, I told myself maybe it\u0026rsquo;s not all horrible. I\u0026rsquo;m able to see a bit more of the positive, even if [anxiety] was something negative (Interview ID-10).\u003c/p\u003e\n\u003cp\u003eThese narratives underscore the complex and often ambivalent ways in which adolescents perceive and experience mental health.\u003c/p\u003e\n\u003ch3\u003eAwareness of Others\u003c/h3\u003e\n\u003cp\u003eAnother subtheme that emerged in participants\u0026rsquo; discourses around mental health was the\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eawareness of others. This was conveyed both explicitly (manifest content) and implicitly (latent meaning) through expressions of empathy and sensitivity towards peers. One participant reflected on how learning about peers\u0026apos; different perspectives fostered greater understanding and compassion: \u0026ldquo;Knowing how other people felt about [mental health] teaches you that not everyone experiences it the same way. It helps you better understand and to be more compassionate toward people who go through [hardships] more regularly than you do\u0026rdquo; (Interview ID-04). For other participants, this awareness was rooted in shared experiences, particularly related to stress and anxiety. A student recalled that hearing about common struggles facilitated connection and fostered a sense of not being alone: \u0026ldquo;He was really open about his anxiety and all that. I think that kind of opened a door for us. Like, for me \u0026ndash; I know I do certain things, and that there are other people like me out there\u0026rdquo; (Interview ID-16).\u003c/p\u003e\n\u003cp\u003eParticipants also reported increased attentiveness to the emotional states of others following the intervention. One participant described a transition away from superficial judgments to more reflective interpretations of others\u0026rsquo; behaviours:\u003c/p\u003e\n\u003cp\u003eYou see them, and you\u0026apos;re like, \u0026ldquo;oh that person is mean,\u0026rdquo; but you don\u0026rsquo;t know them well enough to understand why they act that way. Maybe they\u0026rsquo;re just putting up a wall because they don\u0026rsquo;t want to get hurt. And it\u0026rsquo;s really interesting to see that now my view of others has changed (Interview ID-10).\u003c/p\u003e\n\u003cp\u003eSimilarly, another student noted becoming more aware that others have their own inner lives: \u0026ldquo;Before, I wasn\u0026rsquo;t paying attention that others could also have mental health problems [\u0026hellip;]. And now, I know that everyone has their own thoughts, their own things\u0026rdquo; (Interview ID-07). Not all participants attributed these shifts to the workshops. One participant commented that regular conversations about mental health at home had also shaped his broad-mindedness and understanding.\u003c/p\u003e\n\u003cp\u003eSeveral adolescents described a stronger inclination to disclose to others (whether friends, classmates, or parents) following the intervention. For many, artistic creation served as a communicative tool to express internal states. As one student explained:\u003c/p\u003e\n\u003cp\u003eMy creative process was really based on my own experience because I really wanted to show something clear, something that others could easily understand. I tried to think, if I had to describe to someone how I feel when I have anxiety, how would I show that in an image? (Interview ID-10).\u003c/p\u003e\n\u003cp\u003eThis intention was recognized by classmates, who reported that viewing the artwork of others offered insight into their peers\u0026rsquo; feelings. A participant noted: \u0026ldquo;I saw the drawings that the others had made, so I think that maybe that speaks a little more to their own experience\u0026rdquo; (Interview ID-03). In summary, the discourse of participants on mental health suggested that they believed their participation in the workshops facilitated a deeper awareness of others\u0026rsquo; emotional realities \u0026ndash; often grounded in empathy, shared experience, and alternative ways of communicating, such as art.\u003c/p\u003e\n\u003ch2\u003eThinking Together\u003c/h2\u003e\n\u003cp\u003eA second overarching theme that emerged from the interview data was related to the idea of thinking together, or the role of group discussions in fostering reflection and mutual understanding. This theme encompassed two subthemes: the first being the influence of others, as many participants described how the exchange of ideas shaped their creative thinking and personal reflections; and the second being introspection, defined as the observation of one\u0026rsquo;s own thoughts and feelings.\u003c/p\u003e\n\u003ch3\u003eInfluence of Others\u003c/h3\u003e\n\u003cp\u003eFor several students, PI served as a catalyst for creativity. One participant noted: \u0026ldquo;What we hear from others brings out [ideas] we wouldn\u0026rsquo;t have thought of automatically. Sometimes you think later: \u0026lsquo;Ah, I should\u0026rsquo;ve done that.\u0026rsquo; Through communicating with others, we think more about things we wouldn\u0026rsquo;t have immediately considered\u0026rdquo; (Interview ID-17). Similarly, another student observed: \u0026ldquo;There were ideas that came from other people, and we could discuss what we thought, and then I would kind of bring it all together, and then I could\u0026hellip; I could create\u0026rdquo; (Interview ID-02). These quotes illustrate how interpersonal exchanges were integrated into the artistic process, enabling participants to access ideas and insights that may not have surfaced in isolation. However, not all teenagers shared this perspective. Some felt that creating around the topics of mental health remained highly personal and thus could not be influenced by external input. A student explained: \u0026ldquo;Since mental health is really individual, you see what you see. [\u0026hellip;] You can see new points of view, but your first point of view when you create something, that is your point of view\u0026rdquo; (Interview ID-13). For this participant, group exchanges had little to no bearing on one\u0026rsquo;s creative process.\u003c/p\u003e\n\u003cp\u003eSome participants maintained that PI served as a way of integrating new perspectives: \u0026ldquo;[Discussions] kind of led me in other directions and gave me ideas. There were things we talked about that wouldn\u0026rsquo;t have crossed my mind\u0026rdquo; (Interview ID-06), and \u0026ldquo;Especially talking about it with a big group, there are lots of different opinions and multiple perspectives. I think it was good because we got everyone\u0026rsquo;s opinion, and they\u0026rsquo;re not necessarily the same\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e(Interview ID-15). These participants viewed PI as a valuable mechanism for expanding their thinking and incorporating novel standpoints. Nonetheless, other students expressed skepticism about the significance of such exchanges, particularly when peer contributions were perceived as redundant or superficial. For example, one participant remarked:\u003c/p\u003e\n\u003cp\u003eI felt like we were still speaking in very general terms. Like we were talking about mental health, but it was stuff I already knew. [\u0026hellip;] Like everyone\u0026rsquo;s on the same page because I think we\u0026rsquo;re all at the same level in terms of understanding what mental health is (Interview ID-04).\u003c/p\u003e\n\u003cp\u003eAnother participant also cited prior knowledge (stemming from personal interest and living with a psychological disorder) and limited peer engagement as factors that reduced the effect of the intervention, noting that \u0026ldquo;a lot of people weren\u0026rsquo;t taking it seriously\u0026rdquo; (Interview ID-12). These accounts highlight the various ways in which PI may or may not have exerted influence on creative inspiration.\u003c/p\u003e\n\u003ch3\u003eIntrospection\u003c/h3\u003e\n\u003cp\u003eA recurring narrative in participants\u0026rsquo; interviews was the offering of space, both physical and psychological, that enabled the exploration of their inner experience. As one student articulated, \u0026ldquo;I felt like it left a lot of room for your thoughts, for how you feel. [The workshops] really gave space to think about the definition, or rather the interpretation, of what your drawing means\u0026rdquo; (Interview ID-09). This shift from a surface-level approach to deeper personal reflection allowed participants to view the intervention as an opportunity for meaning making rather than simply completing a task:\u003c/p\u003e\n\u003cp\u003e[PI] mostly helped me get a clearer visual of what I wanted to do and create. If I hadn\u0026rsquo;t had the discussions, I probably would\u0026rsquo;ve been a bit more lost [\u0026hellip;] We helped each other a lot in trying to figure out what it meant, instead of trying to do it alone\u0026rdquo; (Interview ID-08).\u003c/p\u003e\n\u003cp\u003eAs such, PI served as a key catalyst for introspection, helping participants acknowledge, articulate, and clarify their thoughts and emotions. Some adolescents even described a change in their emotional expression: \u0026ldquo;Nowadays, I\u0026rsquo;m more likely to express my emotions verbally rather than just keeping them inside\u0026rdquo; (Interview ID-08). Enhanced emotional awareness was similarly attributed to this reflective dialogue: \u0026ldquo;I kind of know a bit more what I\u0026rsquo;m feeling, you know?\u0026rdquo; (Interview ID-02). PI thus appeared to support emotional processing and insight through shared reflection.\u003c/p\u003e\n\u003cp\u003eParticipants also reported using artistic creation as a means to externalize internal moods, particularly emotional experiences such as anxiety. One described her creative process as follows: \u0026ldquo;When I feel anxious myself, I represent what might be going on in my head at that moment, how I see life\u0026rdquo; (Interview ID-05). Another expressed a similar effort to translate a mental state into visual form: \u0026ldquo;I was really trying to put on paper what I feel\u0026hellip; Just all the mixed emotions together and to try to represent them with different brushstrokes\u0026rdquo; (Interview ID-07).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLastly, a clear distinction emerged between the intervention (i.e., integrating PI into the arts) and traditional art classes. Several participants noted that the workshops encouraged deeper emotional exploration and reflection in contrast to the more directive and outcome-focused format of regular classes. A participant emphasized: \u0026ldquo;Usually in art class, we have a project, we have a topic, we do it, but we don\u0026rsquo;t look inside ourselves \u0026ndash; at our emotions, how we feel \u0026ndash; and express that. We just do it\u0026rdquo; (Interview ID-14). Another student echoed this sentiment: \u0026ldquo;In regular classes, we\u0026rsquo;re just given something to do, we do it, and that\u0026rsquo;s it\u0026hellip; there\u0026rsquo;s nothing deeper to it\u0026rdquo; (Interview ID-02). These quotes suggest that the workshops facilitated reflectiveness while also cultivating a more intentional and personally meaningful artistic process. Ultimately, thinking together during artistic creation appeared to foster a collaborative climate in which peer influence and introspection played central roles.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored adolescents\u0026rsquo; perceptions of mental health and of an arts-based PI intervention. The two themes that emerged from the accounts of participants highlighted how the intervention supported their understanding of mental health and influenced empathy, creativity and introspection.\u003c/p\u003e\n\u003ch2\u003eAdolescents\u0026rsquo; Evolving Conceptualizations of Mental Health\u003c/h2\u003e\n\u003ch3\u003eMental Health as a Duality\u003c/h3\u003e\n\u003cp\u003eParticipants initially described mental health in polarizing terms (e.g., \u0026ldquo;going well\u0026rdquo; versus \u0026ldquo;going badly\u0026rdquo;), acknowledging the coexistence of positive and negative emotional experiences. This pattern mirrors findings by Johansson, Brunnberg (49) and Teng, Crabb (5), who similarly reported that adolescents often frame their mental health according to whether they feel well or are in distress. Such dichotomous framing may reflect the defence mechanism of splitting, or black-and-white thinking, whereby individuals struggle to integrate both positive and negative qualities of an experience into a cohesive and realistic whole \u0026ndash; a tendency that is relatively common and transient as part of adolescent development (50, 51).\u003c/p\u003e\n\u003cp\u003eOver time, however, many participants in the present study articulated mental health in more elaborated terms, particularly as an outcome of increased reflection on their own emotional experiences through the workshops. Indeed, engaging in a combined arts and PI intervention gradually resulted in participants viewing mental health as a constantly fluctuating process, as opposed to a static and binary state. This progression closely parallels the findings of Chisholm, Patterson (15) regarding the \u0026ldquo;dual perception\u0026rdquo; of mental health (p. 628). In their study, adolescents relied at first on stereotypical or extreme representations of mental illness but gradually developed a more nuanced perspective through personal or vicarious experiences, enabling them to move beyond rigid distinctions of \u0026ldquo;normality\u0026rdquo; and \u0026ldquo;craziness\u0026rdquo; (p. 632). The present findings similarly suggest that adolescents can integrate opposing emotional states within a flexible framework.\u003c/p\u003e\n\u003cp\u003eThis understanding of mental health is further supported by the dual-factor model, which conceptualizes mental health as the coexistence of well-being and psychological symptoms (52, 53). From this perspective, the presence of psychological distress does not exclude positive functioning, nor does well-being imply the absence of distress \u0026ndash; a distinction that resonated with participants\u0026rsquo; evolving interpretations of their own and others\u0026rsquo; mental health experiences. Empirical work by Grych, Taylor (54) using this model identified adolescent profiles such as \u0026ldquo;symptomatic but content,\u0026rdquo; characterized by well-being alongside psychological distress (p.2). These profiles closely reflect participants\u0026rsquo; narratives, reinforcing how the mental health of adolescents is dynamic and multifaceted.\u003c/p\u003e\n\u003ch3\u003eMental Health and Awareness of Others\u003c/h3\u003e\n\u003cp\u003eAdolescents\u0026rsquo; accounts of becoming increasingly attentive to others\u0026rsquo; emotional states indicate a shift toward more context-sensitive social understanding. Building on Chisholm, Patterson (15), who found that young people move from stereotypical representations of mental illness toward more nuanced, experience-based interpretations, participants in the present study similarly appeared to reconcile their initial judgments with a growing recognition of others\u0026rsquo; internal experiences. This process seemed to foster greater empathy and compassion, particularly as adolescents came to view behaviours as reflecting underlying emotional struggles instead of fixed and unchanging personality traits. This evolving awareness is consistent with developmental research indicating that empathic concern strengthens during adolescence; with advances in perspective-taking and Theory of Mind, youths are more likely to interpret others\u0026rsquo; behaviour in light of situational and emotional contexts (55-57). Put differently, adolescence represents a key developmental period during which empathy becomes increasingly sophisticated, enabling more accurate and context-dependent interpretations of the emotions of others (58, 59). Nevertheless, some participants explicitly linked their heightened attentiveness to exchanges that occurred during the intervention, such as discovering that classmates shared similar experiences of stress or anxiety. Although effects of normative developmental maturation cannot be ruled out, the short timeframe between the initial brainstorming and the final interviews, coupled with participants\u0026rsquo; explicit attributions of change to the workshops, suggested that the intervention contributed to some growth in empathy. Thus, participation in the workshops may have supported a shift away from attributing behaviour to stable personal dispositions and toward context-sensitive interpretations that account for stress, anxiety, or prior experiences. Importantly, this evolution did not invalidate adolescents\u0026rsquo; initial perceptions \u0026ndash; it expanded them through reflection and dialogue.\u003c/p\u003e\n\u003cp\u003eMoreover, the increased willingness to disclose to others and the deeper attunement to the emotions of peers may be partly explained by the use of artistic creation as a mode of expression. Consistent with prior research, artistic pursuits appear to offer adolescents a nonthreatening means of externalizing internal states, facilitating emotional recognition and communication when words are insufficient (28, 34, 35). By sharing and interpreting one another\u0026rsquo;s artwork, participants were also exposed to the lived experiences of their peers \u0026ndash; an exchange shown to foster empathy, relational connection, and shared understanding among youth (30, 31). Collectively, the present findings lend further support to prior evidence demonstrating that arts-based interventions can enhance interpersonal awareness and emotional attunement, thereby promoting empathy and a sense of belonging as key components of adolescent mental health and well-being (29, 36).\u003c/p\u003e\n\u003ch2\u003eThinking Together\u003c/h2\u003e\n\u003ch3\u003eInfluence of Others\u003c/h3\u003e\n\u003cp\u003ePI appeared to support the reflection and creative exploration of participants; however, the extent of its influence varied across individuals. Many described how exposure to the perspectives of others prompted new ideas of their own that informed and enriched their creativity. This pattern highlights the role of social interaction as a catalyst for individual thinking, a process central to sociocultural theories of learning. In particular, Vygotsky (60)\u0026rsquo;s sociocultural theory emphasized that meaning is first constructed through social exchange before being internalized at the individual level. From this perspective, shared dialogue within PI can be understood as a mechanism through which new creative insights are jointly explored and selectively taken up \u0026ndash; namely, when participants perceive the contributions of others as bearing influence on their own experiences. At the same time, some participants emphasized the primacy of their own personal viewpoint, portraying peer contributions as limited or only marginally relevant to their thinking. For these participants, PI on mental health remained mainly grounded in personal experiences and reflected pre-existing views rather than serving as a source of transformation.\u003c/p\u003e\n\u003cp\u003eIn other words, the engagement that participants had with PI seemed to be shaped by the extent to which they valued the ideas of others. This variability aligns with prior work affirming that dialogue-based learning environments do not produce uniform levels of engagement, even when opportunities for discussion are deliberately structured (61). Within PI, dialogue is intended to open space for shared exploration while preserving individual autonomy (21, 62). Accordingly, thinking together did not necessarily lead adolescents to think alike. Rather, PI appeared to support either the enrichment of perspectives through peer input, or the consolidation of internally derived insights, possibly shaped by the students\u0026rsquo; initial epistemological stance.\u003c/p\u003e\n\u003ch3\u003eIntrospection\u003c/h3\u003e\n\u003cp\u003eThe final subtheme, introspection, revealed how the integration of PI within artistic creation supported adolescents in the processing of their own thoughts, emotions, and experiences with mental health. Most participants described the workshops as offering space to reflect internally, moving beyond surface-level task completion toward a more intentional exploration of meaning. Importantly, introspection in this context did not seem to emerge in isolation. While PI unfolded in a group setting, it appeared to help adolescents turn inward and engage in self-reflection (e.g., articulating what their artwork represented to them and why certain topics or symbols felt personally salient). Some of the participants\u0026rsquo; accounts imply a movement between externalization and re-internalization: emotional states (e.g., anxiety and stress) were first expressed visually through form and symbolism, then examined through dialogue, and ultimately reintegrated as more coherent personal insights. This sequence is consistent with theoretical perspectives proposing that structured dialogue and artistic creation can render implicit experiences more accessible to conscious awareness (21, 28, 34, 61). As such, the intervention served as a stimulus for self-observation and introspection \u0026ndash; capacities central to emotional understanding and self-regulation during adolescence (63, 64).\u003c/p\u003e\n\u003cp\u003eIn addition, the contrast drawn by participants between the intervention and regular art classes illustrates the distinctive role of PI in fostering introspection. Whereas the standard art curriculum was often described as outcome-driven and externally guided, the workshops in this study explicitly invited adolescents to observe their emotions and intentions. Arts-based interventions that integrate guided inquiry have been shown to promote deeper reflective engagement than approaches centred primarily on technical instruction (37, 39, 43, 65). PI, in particular, has been identified as a practice that can support youth introspection and well-being (10). In light of these studies \u0026ndash; together with participants\u0026rsquo; own comparisons between regular art classes and the present intervention \u0026ndash; introspection appears not to have been a mere by-product of artistic activity, but an intentional outcome of PI. Through open-ended questions and shared exploration, PI thus emerged as an important mechanism for cultivating introspection within artistic creation.\u003c/p\u003e\n\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\n\u003cp\u003eThis study includes a number of strengths. The intervention integrates artistic creation and PI, two accessible and complementary approaches that draw on verbal and non-verbal modes of expression. This combination supports a more holistic engagement with mental health, encompassing emotional, cognitive, and interpersonal dimensions, and facilitates the exploration of complex themes in ways that are meaningful to adolescents. In addition, the use of qualitative methods enabled an in-depth examination of the subjective experiences of participants. By centring youth voices, the study captured nuanced perspectives \u0026ndash; including both positive and less favourable responses \u0026ndash; thereby providing a comprehensive understanding of how the intervention was experienced.\u003c/p\u003e\n\u003cp\u003eA notable limitation of this study is the potential for social desirability bias in participants\u0026rsquo; responses during post-workshop interviews. Despite being informed prior to these interviews that there were no right or wrong answers and that their honest perspectives were valued, adolescents may have responded in ways they thought were expected. The same research assistants conducted both the PI workshops and the interviews. While this continuity potentially increased participants\u0026rsquo; comfort and openness in sharing their views, it may also have amplified an inclination to please the researchers through their responses. A second limitation relates to the absence of participant validation procedures. Transcripts were not returned to students for comments or impressions, and they did not provide feedback on the study results, as recommended by COREQ (44). This may hinder the extent to which the findings accurately reflect the intended meanings of the participants, as interpretations may be influenced by the researchers\u0026rsquo; perspectives.\u003c/p\u003e\n\u003cp\u003eThird, because participants had chosen to take visual art classes as part of their curriculum, they may have been more receptive to the intervention than students enrolled in other electives. This self-selection introduces a risk of selection bias, as the interests and engagement of these art students may not represent the broader adolescent population. Lastly, the intervention was relatively brief, and its influence on students\u0026rsquo; reflections about mental health may partly reflect a novelty effect, given that it differed from standard school practices. If PI and artistic creation were integrated into the regular curriculum, their impact might differ or even diminish over time. Given these limitations, the findings should be interpreted with caution.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis qualitative study explored the perspectives of adolescents on mental health and their experiences with a mental health intervention incorporating artistic creation and PI. Specifically, many adolescents approached mental health as a dynamic psychological state encompassing both well-being and distress, moving beyond polarized or deficit-based conceptualizations. The workshops also offered opportunities to engage with the lived experiences of others, thereby fostering empathy and creativity. For some participants, however, the workshops simply echoed pre-existing views, pointing to limitations in their influence. Overall, the intervention integrated artistic creation and PI such that they reinforced one another and, in turn, supported introspection, creativity, and emotional awareness (of oneself and others).\u003c/p\u003e \u003cp\u003eThese findings underscore the potential of school-based interventions that integrate arts and PI to mitigate barriers adolescents face in accessing mental health resources and expressing psychological distress. Such interventions provide opportunities for youth to explore mental health in accessible and personally meaningful ways by facilitating discussion through PI and expression through the arts. They may also support adolescents\u0026rsquo; psychological well-being by eliciting protective factors (e.g., recognition and understanding of their internal states). Nonetheless, further research using complementary methodologies is needed to evaluate and quantify the impact of similar interventions and to examine their underlying mechanisms.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding statement:\u003c/strong\u003e Funding for this project was provided by the Fonds de recherche du Qu\u0026eacute;bec \u0026ndash; Sant\u0026eacute; through a research grant to CMH and by Fonds de recherche du Qu\u0026eacute;bec \u0026ndash; Soci\u0026eacute;t\u0026eacute; et Culture through a scholarship to VB. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement:\u0026nbsp;\u003c/strong\u003eApproval to conduct the research leading to this manuscript was obtained from the Comit\u0026eacute; Institutionnel d\u0026rsquo;\u0026Eacute;thique de la Recherche avec des \u0026Ecirc;tres Humains (CIEREH), the institutional human research ethics committee of the Universit\u0026eacute; du Qu\u0026eacute;bec \u0026agrave; Montr\u0026eacute;al (File Number 2023-5172). All research involving human participants was conducted ethically and in accordance with CIEREH guidelines and regulations, which adhere to the 2022 Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2). Permission to use the collected data (including interview transcripts and artwork) for research dissemination was obtained from both adolescent participants and their legal guardians through informed consent prior to participation. Interview verbatims and artwork included in this manuscript do not contain any identifying information other than gender. Participant identities were kept confidential.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests policy:\u0026nbsp;\u003c/strong\u003eThe authors have no competing interests as defined by Discover, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u003c/strong\u003e The codes and themes derived from the data that support the findings are presented in Table 2. Additional details on the codes and themes, as well as the interview transcripts, are available from the corresponding authors (VB and CMH) upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe sincerely thank the students who took part in this study for their generosity, openness, and willingness to share their perspectives on mental health and the intervention. We are also grateful to Isabelle Morin, art teacher, for welcoming the intervention into her classroom with enthusiasm and flexibility, and to Malte Martin, artist and professional graphic designer, for his valuable insights and expertise in co-leading the artistic workshops.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions statement:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVB\u003c/strong\u003e co-designed and co-led the philosophical inquiry, conducted interviews, led data analysis, and played a central role in drafting and revising the manuscript. VB is a corresponding author of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDS\u003c/strong\u003e contributed to the development of the interview guide and provided expert perspectives on psychology and philosophy during manuscript revisions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMB\u003c/strong\u003e co-led the philosophical inquiry and conducted interviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAM\u003c/strong\u003e contributed to data coding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eZDF\u003c/strong\u003e provided critical feedback and commentary during manuscript revisions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVY\u003c/strong\u003e co-designed and co-led the artistic workshops, contributing her expertise in visual arts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOM\u003c/strong\u003e contributed expertise in education and philosophy for children and co-designed the philosophical inquiry workshops.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCMH\u003c/strong\u003e, the principal investigator and project supervisor, provided clinical supervision during data collection, oversaw all stages of the research, co-designed the intervention, contributed to the writing and revision of the manuscript, and funded the project. CMH is a corresponding author of this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Mental health of adolescents. World Health Organization, 2025 September 1, 2025. Report No.\u003c/li\u003e\n\u003cli\u003eJones EAK, Mitra AK, Bhuiyan AR. Impact of covid-19 on mental health in adolescents: A systematic review. Int J Environ Res Public Health. 2021;18(5). Epub 20210303. doi: 10.3390/ijerph18052470. PubMed PMID: 33802278; PubMed Central PMCID: PMC7967607.\u003c/li\u003e\n\u003cli\u003eSojli E, Tham WW, Bryant R, McAleer M. COVID-19 restrictions and age-specific mental health-U.S. probability-based panel evidence. Transl Psychiatry. 2021;11(1):418. Epub 20210804. doi: 10.1038/s41398-021-01537-x. PubMed PMID: 34349100; PubMed Central PMCID: PMC8336527.\u003c/li\u003e\n\u003cli\u003eKessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. 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Learn Cult Soc Interact. 2012;1(1):12-21. doi: 10.1016/j.lcsi.2012.03.001.\u003c/li\u003e\n\u003cli\u003eCam P. Philosophy for children, values education and the inquiring society. Educ Philos Theory. 2014;46(11):1203-11. doi: 10.1080/00131857.2013.771443.\u003c/li\u003e\n\u003cli\u003eFombouchet Y, Pineau S, Perchec C, Lucenet J, Lannegrand L. The development of emotion regulation in adolescence: What do we know and where to go next? Soc Dev. 2023;32(4):1227-42. doi: 10.1111/sode.12684.\u003c/li\u003e\n\u003cli\u003eGuyer AE, Silk JS, Nelson EE. The neurobiology of the emotional adolescent: From the inside out. Neurosci Biobehav Rev. 2016;70:74-85. Epub 20160806. doi: 10.1016/j.neubiorev.2016.07.037. PubMed PMID: 27506384; PubMed Central PMCID: PMC5074886.\u003c/li\u003e\n\u003cli\u003eCarlson MR. How inquiry based learning supports creative problem solving skills in elementary art education. Spark Repository: Bethel University; 2023.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"mental health intervention, arts-based intervention, philosophical inquiry, introspection, creative process, adolescence","lastPublishedDoi":"10.21203/rs.3.rs-9368328/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9368328/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eConcerns for the mental health of adolescents are rising, yet many youth face barriers in accessing support and have difficulties expressing their psychological distress. School-based approaches that promote well-being may address these challenges. Specifically, integrating philosophical inquiry into artistic creation may offer adolescents reflective and expressive avenues for navigating mental health. However, research examining mental health interventions that combine philosophy and the arts remains limited.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis qualitative study explored the perspectives of adolescents on (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) mental health and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) their participation in an intervention incorporating artistic creation and philosophical inquiry related to mental health.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eSeventeen high school students (M\u003csub\u003eage\u003c/sub\u003e = 16.5 years; 76% girls) from a visual arts program in Quebec, Canada, participated in the intervention. Semi-structured interviews were conducted and interpreted using coding reliability thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTwo overarching themes were identified: \u003cem\u003eMental Health\u003c/em\u003e and \u003cem\u003eThinking Together\u003c/em\u003e. The first theme highlighted that participants conceptualized mental health as a fluctuating experience encompassing both well-being and distress. It also revealed increased empathy and awareness of others\u0026rsquo; emotions. The second theme captured how the intervention influenced reflection and creativity: for some adolescents, it enriched their views, whereas for others, it primarily reaffirmed existing ideas. The intervention also appeared to facilitate introspective processes.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eArts-based philosophical inquiry interventions on mental health may help adolescents in their understanding and expression of psychological experiences. They may also support well-being by eliciting protective factors, such as emotional awareness of oneself and others. Future research should evaluate these interventions using complementary study designs.\u003c/p\u003e","manuscriptTitle":"Adolescent perspectives on mental health and an arts-based philosophical inquiry intervention","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 08:26:34","doi":"10.21203/rs.3.rs-9368328/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-29T23:51:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-10T13:21:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-10T13:21:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Psychology","date":"2026-04-09T11:50:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b29d0df8-089d-4df5-a2ad-e98a3c38b0e6","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewersInvited","content":"30","date":"2026-04-29T23:51:59+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T08:26:35+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 08:26:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9368328","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9368328","identity":"rs-9368328","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}