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OPINION ARTICLE
published: 19 June 2014
doi: 10.3389/fpsyg.2014.00613
Advancing the clinical science of creativity
Marie J. C. Forgeard*and Jeanette G. Elstein
Department of Psychology, Positive Psychology Center, University of Pennsylvania, Philadelphia, PA, USA
*Correspondence: mariefd@psych.upenn.edu
Edited by:
Anna Abraham, Kuwait University, Kuwait
Reviewed by:
Mahesh Menon, University of Toronto, Canada
Anna Abraham, Kuwait University, Kuwait
Keywords: creativity, psychopathology, clinical psychology, psychotherapy, flexibility
Can the therapeutic benefits of creativ-
ity explain its documented association
with psychopathology (Andreasen, 1987;
Ludwig, 1995)? Past research seems to
have devoted most of its attention to
another hypothesis in order to explain this
relationship: that features of some disor-
ders may be beneficial for creative cogni-
tion (especially in the arts)—for example,
the racing thoughts, energy, and open-
ness characteristic of hypomania in bipo-
lar disorder (Johnson et al., 2012), or
the rumination observed in depression
(Verhaeghen et al., 2005). Other expla-
nations, however, should not be ignored
or considered mutually exclusive. Creative
work may sometimes exacerbate psy-
chopathology. For example, Kaufman and
Baer (2002) suggested that poets may
be especially susceptible to mental illness
because poetry requires emotional expres-
sion and introspection, and unlike prose,
may not provide adequate opportunities
for making meaning out of one’s experi-
ence. Conversely, and leaving aside third
variable explanations (which also deserve
further research), we explore the hypoth-
esis that psychopathology may motivate
individuals to engage in creative activi-
ties as a way to alleviate their suffering
and enhance their well-being. To date, two
main empirical literatures have examined
this claim. First, reviews of art therapy
trials have found that such interventions
typically lead to small but statistically sig-
nificant improvements on a range of psy-
chological measures (Slayton et al., 2010;
Forgeard and Eichner, 2014; Maujean
et al., 2014). Second, studies examining
the benefits of “everyday creativity” sug-
gest that engaging in day-to-day creative
activities may both reflect and foster
psychological health (Richards, 2007). In
keeping with this, findings of a recent
experience-sampling study showed that
young adult participants were more likely
to be engaged in creative activities than
other activities when they reported feeling
happy and active (Silvia et al., 2014).
In spite of these efforts, important gaps
exist in our understanding of the thera-
peutic benefits of creativity. The first and
foremost of these gaps is the following:
to the best of our knowledge, little empiri-
cal evidence has demonstrated that creative
thinking per se is one of the specific active
ingredients accounting for the benefits of
creative activities. To date, past research
has investigated the role of other poten-
tial mechanisms including adaptive emo-
tion regulation, flow, meaning-making,
or growth from adversity in order to
explain the benefits of creative activi-
ties (Csikszentmihalyi, 1996; Drake and
Winner, 2012; Forgeard et al., 2014). Thus,
it remains unclear whether the benefits of
creative activities are due to creative think-
ing, or to other factors. We propose that
the time is ripe to collect such evidence
in order to provide a richer understand-
ingofthenatureofthetherapeuticbenefits
of creative thinking. We outline a research
agenda to advance the clinical science of
creativity from a cognitive-behavioral per-
spective.
CREATIVE THINKING AS A
TRANSDIAGNOSTIC PROCESS
Clinical scientists are developing a growing
interest in understanding transdiagnos-
tic processes (i.e., processes shared across
disorders) that can account for overlap
in symptoms and high rates of comor-
bidity between psychological disorders, as
well as recovery or resilience. These pro-
cesses (whether pathological or adaptive)
can help develop parsimonious theories
of disorder and health, as well as prag-
matic treatments (Mansell et al., 2009;
Forgeard et al., 2011). The research agenda
we present here is based on the following
hypothesis: Creative thinking constitutes
an important yet understudied transdiag-
nostic process that can be defined, oper-
ationalized, assessed, and (if found to be
adaptive) enhanced. Creativity refers to
the generation of ideas or products that
are both novel (i.e., original, unusual) and
useful (i.e., valuable, helpful) (Stein, 1953;
Runco and Jaeger, 2012). Creative think-
ing can be subjective (i.e., novel and
useful to the self) and/or in compari-
son to others (i.e., novel and useful to
all) (Kaufman and Beghetto, 2009). It is
also not reserved to prototypical creative
domains (e.g., the arts and the sciences),
but is present to varying degrees in almost
all areas of life—excelling at work, solving
thorny interpersonal problems, managing
painful emotions, or cooking dinner, are
all tasks that may benefit from effective
creative thinking. Related to this, creative
thinking takes place not only in “creative
therapies” (e.g., art therapy), but to some
degree also in all forms of psychotherapy.
How does creativity relate to other pro-
cesses already studied by clinical scientists?
Creative thinking is by definition closely
relatedtoprospection,definedasthe
mental representation of possible futures
(Seligman et al., 2013). Past research sug-
gests that maladaptive patterns in future-
oriented thinking play a key role in
psychopathology (Miloyan et al., 2013).
For example, both anxious and depressed
individuals tend to overestimate future
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Forgeard and Elstein Clinical science of creativity
negative outcomes, and depressed individ-
uals also tend to underestimate future pos-
itive outcomes (e.g., MacLeod and Byrne,
1996; Miranda and Mennin, 2007). How
might generating novel and useful ideas
influence the extent to which individ-
uals think about and prepare for the
future in a constructive manner? Creativity
may contribute to adaptive prospection by
enhancing another closely related process:
psychological flexibility, defined as the
ability to effectively adapt one’s cognitions,
emotions, and behaviors to the situation
at hand (Kashdan and Rottenberg, 2010).
Psychological flexibility does not necessar-
ily require creative thinking—individuals
may build a repertoire of options by
learning from others or from the envi-
ronment (as opposed to inventing them
anew). We propose, however, that creative
thinking probably enhances and strength-
ens psychological flexibility by allowing
individuals to generate new and effec-
tive cognitive, emotional, and behavioral
strategies on their own. Creative thinking
may therefore help counteract a number
of detrimental transdiagnostic processes
reflecting maladaptive prospection and
inflexibility, including repetitive negative
thinking, as well as interpretational and
expectancy biases (Harvey et al., 2004)by
helping individuals adopt adaptive inter-
pretations and coping styles (Fresco et al.,
2006).
EXAMINING CREATIVE THINKING AS
AN ACTIVE INGREDIENT
What comes next for clinical scientists
interested in examining whether and
how creative thinking promotes flex-
ibility and decreases psychopathology?
Treatment outcome researchers should
continue to build empirical support for
the efficacy of interventions thought to
rely on creative thinking (e.g., art ther-
apy) (Kaplan, 2000; Gilroy, 2006; Maujean
et al., 2014). Randomized controlled tri-
als (RCTs) remain the gold standard for
this purpose and are necessary to establish
that an intervention is empirically sup-
ported, among other criteria (Chambless
and Hollon, 1998). Of course, preliminary
investigations such as single case designs,
or uncontrolled trials, often provide useful
insights.
Aside from outcome research, rigor-
ous process research is needed in order
to test whether creative thinking itself
(as opposed, or in addition to, other
mechanisms) is one of the active ingre-
dients accounting for positive outcomes.
Process research uses appropriate research
designs and mediation analyses in order
to test causal mechanisms responsible for
the effects of an intervention (Kazdin,
2007). In addition to assessing the con-
tribution of creative thinking to out-
comes, researchers should also further
assess the mediating role of mechanisms
examined in prior scholarship (includ-
ing adaptive emotion regulation, flow,
meaning-making, or growth from adver-
sity, as mentioned above), as well as
additional mechanisms such as psycholog-
ical flexibility (Kashdan and Rottenberg,
2010), behavioral activation (Jacobson
et al., 2001), or self-efficacy (Bandura,
1997), among others.
Future research should examine the
extent to which creative thinking per se
contributes to these processes, and in turn,
to psychological adjustment. Such research
is needed to establish whether creative
thinking holds special benefits for well-
being compared to other thinking styles.
This assessment in no way diminishes
the value of previous findings, but rather
highlights the importance and value of
addressing this question in future research.
Similarly, little research has investigated
whether and how creative thinking abil-
ities contribute to the effects of other
forms of therapy. For example, cognitive
therapy for depression encourages indi-
viduals to generate alternative explana-
tions for automatic thoughts and to assess
cognitions for accuracy and usefulness
(Beck et al., 1979)—a process which could
recruit and/or develop creative thinking
abilities.
It is not just on the client’s end that cre-
ative thinking may enhance outcomes—
therapists too need to be creative thinkers.
Concerns have been raised about the
extent to which manualized treatments
can help clients whose symptoms are
more complex than those included in
RCTs (Westen et al., 2004). Yet, although
manuals are required to operational-
ize and demonstrate the efficacy of a
treatment, most researchers and clini-
cians tend to agree that good man-
uals leave space for “flexibility within
fidelity” in order to effectively tailor
treatment to clients’ specific concerns
and learning styles (Kendall and Beidas,
2007). Therapists’ creative thinking abil-
ities therefore probably enable them to
flexibly invent new ways to faithfully
implement treatments (Deacon, 2000).
Within the context of cognitive-behavioral
therapy, such creative thinking may be
manifested in astute behavioral experi-
ments to test negative cognitions, individ-
ualized exposures for anxiety disorders, or
compelling metaphors to foster motiva-
tion and change (Peterman et al., in press).
CONCLUSION
Researchers interested in advancing the
clinical science of creativity have exciting
tasks ahead of them: to continue building
empirical support for the value of creative
therapies using outcome research, and to
investigate the role of creative thinking as a
transdiagnostic process that may promote
adaptive future-thinking and psychologi-
cal flexibility using process research. These
endeavors will enrich our understanding
of the relationship between creativity, psy-
chopathology, and health by investigating
the circumstances under which creative
thinking is or is not beneficial, and by
identifying the metacognitive strategies
that help individuals tell the difference
(Kaufman and Beghetto, 2013). In partic-
ular, it is likely that original thinking may
only be beneficial in moderate amounts or
in certain situations, though more research
is needed to test this claim. Related to
this, researchers have called for investigat-
ing the boundary conditions under which
any positive psychological trait or pro-
cess may become detrimental, as seem-
ingly linear relationships may in fact be
nonmonotonic when examining their full
range of expression (Grant and Schwartz,
2011). The optimal “dose” of originality
and flexibility may therefore vary accord-
ing to the situation at hand. For example,
a person might benefit from considering a
wide array of options in order to repair a
romantic relationship after a fight. A sim-
ple “I am sorry” may not be as effective
as an apology expressed in a clever and
constructive way. Past a certain point how-
ever, the search for novel and flexible solu-
tions may lead to impulsivity or instability
(Kashdan and Rottenberg, 2010). In this
case, organizing a last-minute unusual and
extravagant date or writing an entire book
Frontiers in Psychology | Psychopathology June 2014 | Volume 5 | Article 613 |2
Forgeard and Elstein Clinical science of creativity
of poems to apologize could be perceived
as “too much of a good thing.”
In addition, future research should fur-
ther examine how various forms of cre-
ativity relate to well-being, given that past
research in this area has mainly explored
the effects of artistic creativity. For exam-
ple, past research suggests that artists suf-
fer from psychopathology at a greater rate
than scientists (Ludwig, 1995). These find-
ings could be influenced by self-selection
effects, and/or by the possibility that the
creative process has differential benefits
for artists vs. scientists. Related to this,
the extent to which creative thinking ben-
efits well-being may depend on whether
the creative work at hand focuses on
one’s personal situation or mental state
(a case perhaps more typical of the arts)
or on an external problem (a case per-
haps more typical of the sciences). Thus,
future research should further investigate
whether and how creative work affects
well-being in fields other than the arts.
In light of past research in this area,
as well as the promise of addressing exist-
ing remaining questions highlighted here,
we believe that the study of the thera-
peutic benefits of creativity will continue
to make important contributions to clini-
cal science by further investigating one of
the possible causal mechanisms account-
ing for the relationship between creativity,
psychopathology, recovery, and resilience.
ACKNOWLEDGMENT
We thank Ann Marie Roepke for her
comments on an earlier draft of this
manuscript.
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Conflict of Interest Statement: The authors declare
that the research was conducted in the absence
of any commercial or financial relationships
that could be construed as a potential conflict of
interest.
Received: 29 March 2014; accepted: 30 May 2014;
published online: 19 June 2014.
Citation: Forgeard MJC and Elstein JG (2014)
Advancing the clinical science of creativity. Front.
Psychol. 5:613. doi: 10.3389/fpsyg.2014.00613
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