A qualitative pilot study on how young adolescents perceive an arts-based existential intervention for grappling with the subject of death

Abstract

Objectives

This pilot study sought to explore the perceived value of Arts-Based Existential Interventions to support young adolescents regarding death. We were guided by the following research question: What are the perceptions that young adolescents have toward an arts-based existential intervention to navigate questions, feelings, and concerns pertaining to death?

Data Description

In conducting this study, we hoped to contribute to the existing clinical child psychology literature by qualitatively investigating how developmentally adapted, creative, and dialogical workshops benefitted–or not–a group of young adolescents (i.e., 10–12 year olds) exploring existential concerns related to death. Our findings indicated that although some participants expressed initial apprehension towards the workshops, most participants reported feeling positively impacted by receiving the opportunity to constructively explore, reflect on, and openly discuss the topic of death. With participants disclosing that they appreciated this opportunity, arts-based existential interventions could provide a meaningfully constructive method for supporting young adolescents in navigating the subject of death.

Introduction

Introduction: Discussing the topic of death is not easy for most, especially young adolescents. While adults may fear that talking about death with them leads to distress, research suggests they are naturally curious to explore it more [61]. Furthermore, adults report feeling uncomfortable and unqualified to lead these discussions (McGovern & Barry, 2000), thus leaving young adolescents without supportive spaces to openly explore this topic. One method that could potentially support them is through Arts-Based Existential Interventions.

Study Aims

This qualitative pilot study sought to explore the perceived value of Arts-Based Existential Interventions to support young adolescents regarding death. Methodology: A 10-week workshop was conducted with two sixth-grade classrooms (n = 21; Mage 11.5) using an interpretative qualitative design. Two of these ten workshops—focused on personal mortality and bereavement, respectively—formed the core of this study. Each workshop included an artistic creation activity, followed by philosophical inquiry. Data was collected through observation grids, as well as audio recordings of focus groups and semi-structured interviews. Themes were constructed through reflexive thematic analysis, as outlined by [10, 13]. No clinical changes were measured, and the findings reflect post-intervention perceptions from participants rather than being an assessment of psychological outcomes.

The Analysis

Despite expressing some initial negative emotional reactions, participants reported valuing the workshops as a tool for fostering emotional expression, conveying empathy, and positively refining their perspectives on death. Participants of this study reported finding the intervention to be helpful for exploring and expressing their thoughts and emotions about death.

Implications

Although this study is exploratory and its findings should be interpreted with caution, arts-based existential interventions show potential for helping young adolescents foster emotional resilience toward mortality. Building on these findings, future research should expand on this pilot study by exploring additional existential themes, such as suffering, empathy, meaning in life, and freedom.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1007/s44192-026-00531-3.

Introduction

"The benefit of the child engaging with [existential] therapy… is not in escaping or taking refuge from the world, but in confronting it [71]".

How we talk to young adolescents about life’s big existential questions can have putative lasting impacts on their understanding of, and approach towards, life itself. Starting from a young age, they strive to allocate meaning to their lives, and this requires questioning not only the meaning of existence, but also of death [25]. Indeed, young adolescents show a natural curiosity towards death and actively seek opportunities to learn more about it [61]. In many cases, however, they are the initiators of these conversations with adults–namely parents and teachers [79]. Some studies have found that adults often feel unprepared or uncomfortable addressing these topics with children [5] and may respond in ways that unintentionally dismiss or invalidate their questions or concerns [47, 52, 53, 84]. Some adults may also argue that engaging in these dialogues may pose psychological risks for young adolescents; however, there is a lack of evidence suggesting this could be the case. Research has instead found that choosing to withhold discussions on death can lead to negative outcomes, such as confusion, distress, frustration, and anger in young adolescents [29]. Young adolescents, consequently, may be at an increased risk of repressing emotions related to the topic, which can further manifest into psychiatric disorders if left unaddressed [42]. They are therefore in need of safe spaces that allow for the brave and open expression of questions and feelings regarding death.

It is relatively common for young adolescents to develop questions and concerns about death through life experiences. Indeed, 7% (5 million) of children of varying ages (e.g., 3–17 years of age) in the US are estimated to experience bereavement each year, either through the death of a parent or sibling [16]. The impact that these experiences have on them appear to depend on the closeness between the witnessing child and the recently deceased subject [50]. As an additional outcome, young adolescents may learn indirectly about death [74]. They can learn about death by what is communicated in the process–usually with parents–as well as by what is witnessed in media portrayals and depictions of death, such as in Disney films [19]. However, since parents often feel too uncomfortable to lead open dialogues with them [19], and media sources tend to involve inaccurate depictions of death (e.g., believing that death is reversible; [20]), young adolescents are at risk of being unsupported through their process of thinking and learning about it. This can in turn cause other potential side effects: (1) they develop inaccurate conceptualizations, and/or (2) the topic eventually becomes distressing and/or repressed [8]. Young adolescents are therefore in need of safe spaces that allow them to explore these concerns both verbally and non-verbally, in ways that are developmentally appropriate. However, minimal research has investigated their preferences on how to navigate these dialogues. The goal of this study, therefore, was to provide young adolescents an opportunity to explore their concerns related to death through a combined art and philosophy intervention.

Arts-based interventions

Although a substantial body of research has examined young adolescents’ experiences of interventions focused on bereavement (e.g., [37, 70]) or death education (e.g., [46, 69]), minimal research has conversely explored the potential benefits of interventions that support young adolescents in engaging in existential explorations of death. Exploring existential concerns (e.g., death) through creative outlets such as art-based interventions (ABIs) could partially present one effective method of supporting them with exploring their fears and understanding of mortality [3, 81]. ABIs typically adopt a humanistic approach and are often regarded as especially effective for young adolescents [30]. One reason for this may be due to their naturally authentic disposition–that is, a state of being true to oneself and one’s inner experiences [66, 67] Indeed, young adolescents may show inherently authentic traits because they are more attuned to their emotions and less influenced by societal or cultural expectations. This inherent authenticity may consequently facilitate deeper emotional expression and exploration, particularly when supported by creative and non-verbal modalities like art. Research has also found that authenticity is positively associated with creativity [81], suggesting that the authenticity of young adolescents could enhance their capacity for engaging with and process complex existential ideas through creative means. This inherent authenticity, along with their higher creativity, likely induces them to greater openness in exploring existential themes–including death–through an imaginative lens. As young adolescents grow older and become more susceptible to external influences, they are increasingly likely to suppress thoughts and questions about death. This tendency is reinforced by persistent societal taboos that discourage open discussions about death in modern culture [48]. The ideal time to explore these existential themes, therefore, could arguably be during the young adolescents’ elementary years when they are less susceptible to the expectations of others and are more motivated to explore their curiosity.

ABIs have been shown as a promising tool for supporting young adolescents in navigating issues pertinent to mental health, including those relating to existential concerns, such as death anxiety [41]. It could support them in better understanding their feelings about death in a way that is nonverbal. For example, in one study that used art therapy as a priming activity, it was shown to spark imagination, critical thinking, and improved coping towards experiences with grief [80]. ABIs thus show promise for tackling discussions on death in two ways: (1) they enable young adolescents to explore their thoughts and feelings without having to verbalize them, and (2) they become primed for verbal expression by exercising their imagination and critical thinking skills. However, a potential shortcoming of ABIs is that young adolescents may not receive opportunities for expressing and openly reflecting on their thoughts and feelings, as it is not the central goal of these interventions to focus on this aspect. An additional complementary method is required for building upon the value of ABIs by providing young adolescents opportunities to verbalize their reflections on death.

Existential interventions

Existential psychology, introduced by Yalom [83], presents a lens through which concerns about death can be verbalized. Death is outlined by Yalom as being one of the four (i.e., death, isolation, freedom, and meaninglessness) core “givens” of existence, which are existential concerns faced by everyone [83]. Although Yalom acknowledged the experiences that children–including young adolescents–have with existential concerns (including death), existential group psychotherapy was not developed for addressing their specific needs. As such, minimal research has studied if Yalom’s theories of death can–or should–be adapted for young adolescents within a clinical context. In contrast, and drawing on a framework specifically adapted for young adolescents, Lipman, Sharp, and colleagues (1980/2010) developed Philosophical Inquiry (PI) as a means of engaging young learners in the exploration of complex subjects. Although not originally designed to address existential concerns, PI was intended to cultivate their critical thinking skills through collaborative dialogue focused on social issues such as inequality and poverty [2]. Over time, such engagements have shown to foster the construction of a deeper sense of meaning in relation to their lives and the world around them [49]. Participation in PI has also been associated with a range of other positive developmental outcomes, including enhanced social skills, increased classroom participation, greater self-confidence, improved reasoning abilities, and heightened emotional intelligence [38]. These outcomes are largely facilitated through the process of collaborative dialogue, along with the expression of care between peers and teachers [73], underscoring the rich potential of PI to support young adolescents’ sociocognitive and emotional development on sensitive issues, such as death.

Given its broader effects seen in the classroom, PI thus represents a potentially promising proxy to existential therapy, specifically with young adolescents. PI takes questions investigated by philosophers of the past (e.g., “What is the meaning of life, knowing we will eventually die?”) and brings them to children and young adolescents for inquiry. Likewise in existential therapy practices–which strongly advocate for group intervention practices [83]–PI encourages its participants to explore their concerns by co-constructing the meaning of important issues as a group–that is, by asking questions, and finding answers together [49]. Research has shown that investigating these existential questions with young adolescents can be helpful for navigating psychological distress and existential anxiety [51]. Another study by Goering [35] combined PI with the reading of a novel about death, inviting children to engage in guided discussions about mortality and its meaning. Through these discussions, they reflected on the finitude of life, which was found to foster a deeper appreciation for their own lives and relationships. If done in a developmentally appropriate and dialogical way, discussions on death could therefore support meaningful existential reflection among children of varying ages, including young adolescents. This, in turn, can address the existential anxiety commonly associated with death [65]. A potential limitation of this approach, however, is that the direct initiation of discussions on death may feel abrupt or socially awkward for young adolescents, potentially leading to discomfort or disengagement. This suggests that PI may benefit from creative prompts (e.g., ABIs) for leading into meaningful conversations on death.

Arts-based existential interventions

This pilot study aimed to construct a new intervention, integrating ABIs with existential interventions (guided by the theoretical framework of PI), coined henceforth as Arts-based Existential Interventions. It aims to provide a complementary pathway towards the constructive exploration of existential concerns in young adolescents. Using Sharp’s [73] care approach–foregrounded in shared compassion throughout the workshops–it begins by prioritizing the cultivation of a trusting relationship between researchers and participants. This is primarily facilitated through an introductory session, during which the researchers introduce themselves and offer selective personal disclosures about their backgrounds. The aim in this process is to foster rapport between all parties involved in the workshop, and to ensure participants gain an impression of authenticity among the researchers.

Once an early foundation of care and trust has been built, the artistic component of the workshop commences, starting with an invitation for participants to introspectively explore their thoughts and emotions elicited by the designated workshop theme (e.g., anxiety or fear related to death or the future). Artistic creation is first integrated as an accessible and non-verbal medium aimed at externalizing feelings that are difficult to articulate. During this process, the facilitators remain attuned to the adolescent’s verbal and non-verbal emotional cues by regularly interacting with them during the artistic creation process. This is achieved by conducting regular checkpoints with each individual participant and asking about their thought processes around their creation. Participants are consistently praised and encouraged for their thoughtfulness towards their creation. After about 30 min when the art activity is completed, the facilitators prepare for a group discussion.

Once the researchers and participants have reconvened into a circle, a PI takes place. Participants are first praised for being so openly brave, thoughtful, and imaginative in developing their artistic creation. Participants are then asked if they would like to share their creation with the group. As some offer to share their creation, the animators ask more about the inspiration behind it. Following these exchanges, participant artwork is linked to the overarching theme of the workshop using prepared group discussions. It is in utilizing a semi-structured format that participants are asked thought-provoking questions (e.g., what happens when we die”?) and are given autonomy in navigating the discussion amongst themselves. When the question has been sufficiently explored and participants no longer have additional responses to offer, the facilitators segway into the next question. Given its semi-structured format, the facilitators may also pose unscripted follow-up questions when opportunities arise to enrich the quality of conversation. The duration of philosophical dialogue typically extends to 30 min. The session concludes with closing remarks from the facilitators, who once again affirm the participants' engagement, insight, and willingness to explore challenging ideas together.

A table outlining the theoretical pathway of Arts-Based Existential Interventions is provided below, in Table 1.

Table 1.

Theoretical pathway model to Arts-based existential interventions

Stage	Description
1.	Introductory session focused on building rapport and relational trust between researcher and participants
2.	Formation of emotional safety, increasing receptiveness to workshop content
3.	Introduction to, and initial unfolding of, workshop themes
4.	Engagement in artistic activity
5.	Activation of reflective and critical thought processes; facilitators remain attuned and responsive to the emotions elicited by participants
6.	Completion of art activity and preparation for group discussion
7.	Researchers and participants re-convene into a discussion circle
8.	Participants voluntarily share their artistic creation and reflections with their peers
9.	Group engages in reflective dialogue, guided by prepared philosophical questions that connect participants’ artwork to the broader workshop theme
10.	Collaboration broadens participants’ perspectives, supports emotional coping, and facilitates the reappraisal of the meaning of the workshop theme

In this framework, art serves as a non-verbal creative medium that encourages adolescents to externalize emotionally challenging subjects in a safe and accessible way. By first engaging their imagination and emotions through artistic expression, they become more emotionally grounded and open for further expansion on the explored idea(s). This could in turn foster improved preparedness for PI. It is also by collaborating with their peers on sensitive subjects that participants can engage in deeper meaning-making, developing greater autonomy in their thinking, stronger connections with others, and a richer understanding of the topics explored.

Although there is limited research on arts-based existential interventions, our own team found that combining art and philosophy into a singular intervention with children and young adolescents yielded greater improvements in mental health scores compared to an art-only group [52, 53]. In addition, other studies have investigated the potential of group philosophical dialogue and performance arts for promoting more effective pedagogical outcomes [54]. These findings provide early evidence for the value of integrating art and philosophy to support youth mental health when navigating emotionally complex topics. However, no research has investigated whether these interventions could also be positively impactful for exploring uniquely sensitive topics with young adolescents, such as death.

Study aims

Building on a research gap suggesting that young adolescents need safe and brave spaces to openly explore questions and concerns relating to death, this pilot study aimed to provide them with such a space. The research question guiding the study was: What are young adolescents’ and teachers’ perceptions of an arts-based existential intervention to navigate questions, feelings, and concerns pertaining to death? In doing so, we hoped to contribute to the existing clinical psychology literature by qualitatively investigating how young adolescents described their experiences around developmentally adapted, creative, and dialogical workshops for exploring the subject of death.

Methodology

An interpretive qualitative research design was employed to explore the experiences of an arts-based existential intervention intended to help 10–12 year-old adolescents navigate their thoughts, questions, and feelings related to death. A qualitative approach was considered most appropriate because the study sought to examine participants’ subjective experiences and meaning-making processes surrounding a complex and emotionally nuanced topic that cannot be captured through traditional quantitative methods. The study was guided by a social constructivist epistemological framework, which assumes that reality is not objective but is instead constructed through multiple lived experiences and social interactions. Consistent with this epistemological position, our findings were understood as being co-constructed through the interpretive engagement between participants and the research team. Data were analyzed using [10, 11] reflexive thematic analysis, which emphasizes the active role that the researchers serve in interpreting and constructing themes from participants’ accounts. To ensure sound theoretical practice, we sought to align our research procedures with Reflexive Thematic Analysis Research Guidelines (RTARG, [13, 14]).

Participants

Due to a pre-existing research partnership in place between the research team and the school, a convenience sampling method was used to recruit participants. 40 young adolescents from two sixth-grade classrooms (20 students each) in an elementary school in Quebec, Canada, were initially recruited for participation, with 19 choosing to opt out of the interview portion of the research. In sum, 21 white/Caucasian students (M_age 11.5; 60% girls), along with their visual arts and movement teacher, fully participated in the research study. The researchers and recruited participants did not know each other prior to this study. We had no instances of parents refusing consent on their behalf in this study.

According to Longbottom & Slaughter [50], young adolescents at this developmental stage are expected to approach a holistic understanding of death. There are aspects of death they are expected to grasp at this stage of their development; they include biological cessation, irreversibility (i.e., once a living thing dies, it cannot be brought back to life), universality (i.e., all living things must eventually die), causation (i.e., all deaths are necessitated by a cause), and personal mortality (i.e., being personally implicated in universality; [33, 50]. Although they are theorized to develop full maturity in their cognitive understanding of death as early as 9–10 years of age [60], it is possible some delay in their acquisition of this knowledge until 13 years of age at the latest [64]. Young adolescents also tends to express greater interest in discussing it [61, 74], and may convey more “abstract” emotional states, such as existential sadness, loneliness, or emptiness when reflecting on death [1].

Beyond enhancing participants’ understanding of death, the intervention aimed to create an environment that acknowledged and welcomed the thoughts and emotions elicited by discussions on death and bereavement. The interventions were designed to be emotionally validating, inviting participants to express feelings evoked during the activities. Both workshops provided participants with opportunities not only to explore ideas and questions about death, but also to engage in a collaborative process that fostered mutual support and validation.

Intervention

The intervention was collaboratively designed and developed by a licensed child psychologist (CMH), two master’s students in psychology (ZF and MG), and a researcher experienced in facilitating art-based workshops (AM). A multidisciplinary team of co-authors with expertise in education, philosophy, health sciences and clinical psychology reviewed the intervention and its findings to ensure a comprehensive approach was used.

This project was part of a broader 10-week workshop that explored various mental health themes (e.g., safe spaces, self-care, caring for nature, belonging, emotions) through multiple art mediums, including dance-movement, watercolor painting, clay-sculpting, and photovoice. The selection of specific art mediums (e.g., watercolor collaging, clay sculpting) was practically based on the specific expressed preferences of the participants in this study to ensure participants were afforded sufficient creative flexibility to express themselves as needed.

Sessions were held once a week for 60 min during school hours and were led by two facilitators and an observer. Semi-structured interviews with students and their teacher were conducted two weeks after the broader intervention concluded. The partnering school and school board permitted workshops on death under the condition that a maximum of two sessions would be dedicated to this topic to avoid overwhelming participants. As such, the preceding 7 workshops were designed to (1) explore other themes of and experiences related to mental health, and (2) emotionally prepare participants for the workshops on death. Participants occasionally discussed topics of death and grief with the researchers in previous workshops out of anticipation for it being more thoroughly addressed in weeks 8 and 9. For example, in week 7 (focused on emotions), participants described their fear of death as resulting in some negative emotional experiences, including anxiety.

This workshops of this study were intentionally scheduled during the eighth and ninth weeks of the intervention to allow facilitators and participants sufficient time during the first seven weeks to develop rapport. This timing was intended to ensure that participants felt more comfortable and trusting within the group context before engaging in the study procedures. Consequently, it is important to acknowledge that any perceived impacts reported by participants cannot be attributed solely to this study, but may also reflect the broader influence of the preceding weeks of the intervention.

All death-focused workshops were led by a master’s student (ZF) and facilitated by another master’s student (MG), along with a research assistant recording observational notes. Clinical supervision was provided by a licensed child psychologist (CMH). For further details on the full 10-week intervention plan, please refer to the supplemental materials section.

First intervention: personal mortality

The initial workshop addressed the theme of “personal mortality,” prompting participants to explore their own understanding of death. The session began with a brief introduction outlining the purpose of the activity and an emotional trigger warning to ensure a supportive environment.

Students then engaged in a creative arts activity, creating watercolor paintings to reflect their initial thoughts and emotions surrounding death. This approach allowed them to engage with the topic at their own pace. After 20–25 min, participants gathered for a PI on personal mortality. Example discussion questions included: (1) What is death? (2) What happens when we die? (3) If you could choose, would you want to live forever? Why or why not? The discussion was semi-structured, providing flexibility for spontaneous reflections and allowing students to explore existential meanings related to death.

Following the 20 min PI, students revisited their artwork and developed it further into a scrapbook. They were encouraged to add drawings, writings, or pasted elements inspired by the discussion. This activity promoted creative self-expression while reinforcing the themes discussed. Several participants chose to include quotes from the conversation in their scrapbooks, accompanied by additional drawings and colors.

Second intervention: bereavement

The second workshop shifted its focus into how participants navigated the death of others, or how they managed feelings of bereavement. The session began with a reflection on the universality of death and revisited key themes from the previous workshop to provide continuity and reinforce the purpose of these discussions. Like the first session, this discussion was semi-structured, allowing participants to shape the conversation according to their own perspectives.

The central question posed was: “Can death be beautiful?” Students were encouraged to explore this idea artistically. To do so, they created clay sculptures (using Play-Doh ™) representing what they envisioned as a beautiful death. Those who did not perceive death as beautiful were invited to sculpt something that symbolized their own perspective on the topic. This artistic component lasted approximately 25 min.

Following this, students reconvened for another PI discussion on death and bereavement. Example questions included: (1) Why do we grieve? (2) How can someone be kept in our hearts after they die? Like the first intervention, these discussions aimed to explore existential meanings while also considering the potential beauty of death. The semi-structured format ensured flexibility towards the validation of all emotions expressed during the conversation.

Distress protocol and participant safeguards

Prior to the workshops, a distress protocol was developed collaboratively between the research team (ZF, MG, CMH) and the visual arts and movement teacher to ensure appropriate procedures were in place should participants experience emotional discomfort when discussing death. As part of this preparation, the teacher briefed the researchers on the known students’ experiences with death and any contextual factors that might increase their vulnerability or sensitivity towards the workshops. According to the teacher’s knowledge, most students had experienced the death of a pet, several had experienced the death of a grandparent, and a small number had experienced the death of a parent. No student was identified as currently experiencing acute distress related to a recent or traumatic loss that would hinder their ability to take part in the intervention. Participation therefore remained open to all students in the class; however, the researchers remained attentive to the potential risks of emotionally triggering participants during the workshops.

Our distress protocol–as designed by the researchers and the classroom teacher–outlined preventative measures for monitoring and minimizing risks of participants experiencing distress throughout the workshops. For example, one safety measure involved informing participants one week in advance that the subject of death would be explored, to ensure they did not feel blindsided by it. During the workshops, the researchers also monitored their responses through observational note-taking and informal verbalized check-ins when circulating the classroom during the art activities. Participants were reminded that they could pause their participation at any time or move to a designated “safe space” in a nearby classroom if they needed. The classroom teacher and researchers conducted well-being check-ins with students before, during, and after the sessions, and the teacher monitored their students in the days and weeks following the workshops. Importantly, no participants required additional support, and no indications of sustained distress were reported in subsequent classroom interactions.

Dataset generation

An abductive approach (Earl Rinehart, 2021; Timmermans & Tavory, 2012) guided our analysis by generating the most plausible explanations for unexpected patterns in the data. We drew upon objective sources, such as photographs of artistic pieces and audio recordings, alongside interpretive ones like interviews and observation grids. This enabled us to enrich our interpretations of the data, weaving participants’ voices into a coherent qualitative narrative.

Interviews

Two weeks after the intervention concluded, semi-structured interviews were conducted by the researchers (ZDF & MG) in English with 21 students individually and privately, lasting between 15 and 45 min, depending on how much or little participants wanted to disclose with the interviewers. These interviews–which were conducted in the absence of their teachers to minimize social desirability bias–aimed to assess their overall impressions of the workshops and evolving perceptions of death and bereavement. Additionally, a semi-structured interview was conducted with the students’ visual arts and movement teacher via Microsoft Teams to gather insights into their observations of the students’ experiences and whether they perceived the workshops as beneficial in helping students conceptualize death and bereavement.

Further details on the interview guide can be found in Appendix A of the manuscript.

Group discussions

Throughout the intervention, PI-led group discussions were conducted. All discussions were audio-recorded, transcribed, and anonymized to protect participant identities. Although interruptions occurred during the discussions, participants were reminded by both the researchers and the visual arts and movement teacher to remain sensitive to the topic, which may have been difficult for some of their peers. In addition, to minimize the risk of any one participant dominating the conversation, the primary facilitator (ZF) directed questions to multiple members of the group rather than focusing on a single individual.

Observation grids

Observational data was also gathered by an observer (undergraduate research assistant) present at each session, who recorded participants’ non-verbal reactions, overall engagement, and group interactions throughout the activities on a structured observational grid. This method of data collection was primarily utilized to mitigate potential outcomes of social desirability bias during interviews, where participants may have over-exaggerated positive impacts of the intervention when in the presence of the researchers. Although the observational notes were not formally coded alongside the primary data (e.g., interviews and group discussions), they served as a supplementary source for enriching our interpretations of the codes.

An example of an observation grid can be found in Appendix B of the manuscript.

Artwork

Photographs were taken of participants’ artistic creations, including watercolor paintings, clay sculptures, and scrapbooks. Each piece of artwork was assigned a unique identification number to maintain participant confidentiality. The artifacts were not systematically analyzed or included as part of the formal coding process. Instead, they were collected to provide contextual illustrations of participants’ engagement with the workshop activities. Examples of these artworks are provided in Appendix C of the manuscript.

Analysis

All interviews and discussions were transcribed verbatim by research assistants and analyzed using reflexive thematic analysis as outlined by [10, 11]. The analysis followed an abductive approach (Earl Rinehart, 2021,Timmermans & Tavory, 2012), allowing themes to be constructed within the data while also remaining attentive to the study’s guiding research questions. Line-by-line coding was conducted to ensure detailed engagement with the dataset.

To ensure consistency with the reflexive thematic analysis framework, the analytic process followed the six phases described by Braun and Clarke. First, familiarization was achieved through repeated readings of all interview transcripts, discussion transcripts, and observational notes to develop an in-depth understanding of the dataset. Second, initial coding was conducted using open, abductive line-by-line coding in MAXQDA24 to generate preliminary codes reflecting patterned responses in participants’ accounts. Third, related codes were grouped together to develop initial candidate themes. Fourth, these candidate themes were reviewed and refined, with careful attention given to their internal coherence and their ability to meaningfully capture patterns across the dataset. At this stage, preliminary theme names were assigned while remaining open to further refinement in subsequent analytic stages. Fifth, an initial coding tree, along with provisional theme labels, was constructed. This coding framework was first reviewed by two undergraduate research assistants who underwent their own review of the data for reflexive purposes (e.g., to sense-check interpretations of the codes and/or explore potential assumptions/biases within the data, [17]). After their coding structures were compared and discussed, a coding tree and preliminary themes were shared with two supervising co-authors (AM and CMH) for further review. Feedback from these collaborators informed subsequent refinements to the thematic structure to ensure conceptual clarity and distinction between themes. Finally, in the sixth phase, the coding tree and overall thematic structure was finalized, resulting in the themes presented in this study.

Approximately 800 initial codes were constructed through individual interviews and two group discussions. All initial codes were reduced and synthesized into two overarching themes, along with three subthemes associated with the second overarching theme, through extensive collaborative review among members of the research team. Varied interpretations of the codes were discussed through ongoing correspondence—primarily via email for minor instances. An additional virtual meeting was also convened for a broader discussion of the analytical interpretations formed by the first author (ZF) with two supervising researchers (CMH & AM).

Although reflexive thematic analysis conceptually avoids data saturation [12], our analysis was considered sufficient when the frequency of a code corresponded to the analyzed sample (N = 21), meaning that each participant referenced that code at least once. Although no formal external audit of the analysis was conducted, the coding procedure was reviewed and discussed at each major stage of the analytical process, during which the research team provided constructive feedback and refinements to the evolving coding framework.

Note: Because participants occasionally spoke over one another during the group discussions, it was not possible to reliably determine which individual made particular statements. As a result, specific participant identifiers could not be assigned to individual quotes derived from group discussions. To provide some indication of the source of data, quotes are instead categorized by data source (group discussion or interview) and by role (“visual arts and movement teacher” or “student”). With respect to quotes made by students during individual interviews, identifiers are attached in parentheses for analytical transparency.

Reflexive statement

To maintain methodological transparency, a reflexive statement outlining the researchers’ positionality is critical. The broader research team is comprised of white (Caucasian) women and men residing in varied academic disciplines (e.g., clinical psychology, psychiatry, nursing, and education). The lead facilitator and first coauthor (ZF) is a self-identifying cisgender white male and PhD candidate in Clinical Psychology who led the workshops, interviews, analysis, and redaction of this research. The broader research team approaches qualitative inquiry from a social constructivist perspective, recognizing that knowledge and reality is constructed through social interaction. From this standpoint, the findings of this study were understood as co-created through the dialogues between researchers and participants. However, it is also important to acknowledge that the team’s shared backgrounds and interests in research discipline, alongside their homogeneity in racial identity, may have shaped both the generation and interpretation of the data in this study. For example, our role in adult–youth power dynamics may have indirectly influenced the responses of child participants during the post-intervention interviews. Furthermore, the educational background of the primary (ZDF) and supervising (CMH) co-authors may have foregrounded the analysis into clinical psychology contexts, whereas potential external variables influencing the outcomes of the research went unnoticed. Given these potential scenarios, we attempted to remain mindful of how our social positions (e.g., age, racial-ethnic identity, gender, educational status) and philosophical assumptions (i.e., social constructivism) potentially influenced decisions around coding. During this process, we engaged in reflexive exercises, such as memos and bracketing exercises, to capture the rooted nature in certain interpretations of the data. Following each stage of analysis, we also revisited our interpretations of the data through team discussions to ensure alternative explanations of the meaning of the data were considered.

Results/The analysis

Our thematic analysis constructed two overarching themes: apprehension towards the workshops, and appreciation of the workshops. Within these broader themes, sub-themes such as fostering empathy, encouraging emotional expression, and shifts in perspective on death were also constructed. These sub-themes are examined in detail in this section and are exemplified through quotes from participants and their visual arts and movement teacher.

A visual representation of the study’s themes and sub-themes are also found below in Table 2.

Table 2.

Overarching themes and sub-themes from data analysis

Overarching theme	Sub-themes	Summary of theme
1. Apprehension towards the workshops	–	Participants both conveyed and expressed feelings of anxiety when prompted by the intervention, which may have been fueled by anxiety towards the explored themes
2. Appreciation for the workshops	1. Encouraging emotional expression	Participants expressed an appreciation for being encouraged by the workshop to express their feelings elicited by the subject of death
	2. Fostering empathy	By engaging in creative reflection and collaborative group dialogues, students reported relating to their peers on a deeper level, including with those they are not normally on amicable terms with
	3. Shifts in perspectives on death	Through artistic creation and group philosophical inquiry, participants later reported during interviews that this process fostered a positive shift in attitude towards death, primarily stating how reminders of mortality provided positive consideration for both the meaning of, and appreciation for, life itself

Apprehension towards the workshops

As we anticipated may occur, a majority of participants (~ 80%) expressed initial apprehension towards the workshops, sometimes conveying or expressing anxiety. Indeed, the teacher expressed being unsurprised by this reaction, elaborating: “when we had the first part…they were all like, too closed up, and they would not participate. And even the body language was shock. They just cloaked” (interview, visual arts and movement teacher). Observational data also noted a similar reaction; participants attempted to avoid or flee the workshops by deflecting ideas and questions with humor or dismissing the importance of speaking vulnerably on sensitive topics. Other students in the first group discussion also verbalized their negative reaction to the intervention by questioning the purpose of the workshops: “can we like, do something happier this week?”. Perhaps explaining the reason for such apprehension towards the workshops was due to a fear of death. As one student stated during a group discussion, “that’s what keeps me up at night” (group discussion #1). Some participants consequently decided to physically exit the workshops to avoid discussing it: “I don’t know, I just started feeling sad, so I left [the group discussion]” (interview, student ID #22). In this way, beyond lacking a positive reaction to the workshop, some students reported feeling negatively impacted by the workshops in that they experienced greater anxiety and overall discomfort.

Despite this expressed apprehension, most of these same student participants and classroom teacher reported feeling comfortable discussing this topic during post-intervention interviews. One student explained what precipitated their discomfort:

During the activities, it was a little bit nerve wracking because you’re not used to talking about these subjects [death] just in your normal day life. So, like doing this was a little bit like nervous. I was a little nervous. And I could see it in my friends, too (interview, student ID #2).

This participant seemed to explain that their discomfort–though it was indeed evoked by the workshops–was more reflective of a cultural tendency to evade these discussions in the first place. Numerous participants described feeling burdened with death anxiety prior to our workshops: “but you know… when I thought about that, I was like, like I didn’t even know what it was called. So, you know, I was pacing around my room” (student ID #11); “I, to process it, I just like, think about it and like, also just try to calm myself down. I just like, understand, just start to find something to distract me” (interview, student ID #2). This could be partly explained by the teacher’s belief that their students had prior experiences with death: “I think some, they either had a grandparent or an animal [die]…I don’t think everyone has had to go through this, but I think they thought about it, yes” (interview, visual arts and movement teacher). Within these verbalizations, the workshops may have revealed to participants that discomforts around death are an unavoidable and normal aspect of life.

This expressed apprehension did not appear to be limited to the student participants. Elements of discomfort were also interpreted by the responses of the visual arts and movement teacher. During initial planning discussions for the workshops, the researchers observed what appeared to be signs of apprehension when openly addressing death-related concerns with students. In the post-workshop interview with this same teacher, their account also suggested a continued sense of uncertainty regarding their role in navigating these topics:

I think it’s hard because we don’t know. If they approach us [about death], then we’ll know. “Oh, their grandfather is in the hospital right now”, or whatever, but it’s not some...unless the parents e-mail us, or the kids let us know, we don’t always know, or we don’t always know their background. So, it’s hard. Like it could be very tricky to start talking about this and be blindsided by what someone is living. Say...they’re not ready to discuss it or they’re not equipped to discuss it–it’s not something that I was ever inclined to discuss with my students (interview, visual arts and movement teacher).

As the teacher suggested, there was a reported apprehension to discuss death openly with students with two concerns in mind: (1) they questioned whether the appropriateness of leading such dialogues is context-dependent, and (2) they expressed concern over worsening a situation that is already fragile.

Despite the negative reactions expressed by both the participants and the teacher, those who participated in post-intervention interviews attested to their support for the workshops. In the sections below, we will elaborate on the ways in which some apprehension appeared to manifest into appreciation.

Appreciation for the workshops

Although some participants verbalized their negative emotional reactions to the workshops, it was during the interviews that almost every student and the visual arts and movement teacher expressed some form of positive feedback. During a post-intervention interview with the teacher, they succinctly captured the impact of the workshops on their students:

They didn’t know how to initially approach it [death]. I think it [workshops] gave them the tools to say what they needed to, and it helped them connect with each other. Also, seeing their friends be vulnerable [was impactful] (interview, visual arts and movement teacher).

In the following sections, we will analyze this quote through the lens of three key and interpreted sub-themes. The visual arts and movement teacher’s observation that students “didn’t know how to initially approach” the topic reflects our interpretation of Apprehension, which was explored in the previous section. Aside from this central theme, however, we also interpreted the workshops appearing to provide students with tools for Emotional Expression, equipping them with tools to articulate their thoughts and feelings about death. Moreover, by expressing themselves openly, we also interpreted connections appearing to formulate between participants, thereby creating a foundation for Fostered Empathy. Lastly, by listening and connecting with each other during philosophical discussions, we interpreted participants leaning towards a Shift in Perspective on Death.

Encouraging emotional expression

Despite several participants initially expressing apprehension, a majority of participants also expressed appreciating the workshops for providing a space to openly share their emotions about death. As one participant verbalized, “for me it was definitely good because, you know, I got to share stuff. I just felt like talking about death helped people [in] like an emotional state” (interview, student ID #11). Some acknowledged that being reminded of death brought up painful memories: “people were more sad, kind of remembering what happened in their past” (interview, student ID #10). Another participant described a similar experience:

It made me feel sad because I never really... I’ve only felt it like three or four times, so I’m not really used to it, so it kind of just made me sad to think about my great-grand-parents that died (interview, student ID #28).

Participants nonetheless reported valuing the opportunity to openly express their emotions, as it provided a sense of relief: “I just think of [death], and like, let my emotions out instead of keeping it in. It’s not good to keep it in” (interview, student ID #13). Having these opportunities could have been meaningful because it reassured students that they were not alone in their experiences of loss and grief. The same participant elaborated by reflecting on a personal memory where being comforted by others left a significant, and clearly lasting impact: “when my papa [father] died, I heard about it, and I was supposed to go to a party. And everyone there was like comforting me… and they just really made me feel okay” (interview, student ID #13). For many participants, the chance to express these emotions appeared to present a rare opportunity, which may explain why they expressed valuing them. One participant highlighted the art component as an accessible and satisfying outlet: “for some people, art is their way of talking. Like when we do art, we draw what’s on our mind. And when we do that, we express it on paper” (interview, student ID #30). The visual arts and movement teacher, unaware that a student had expressed this sentiment, nonetheless echoed this theme:

“It gave them the space to… sometimes they won’t have the words to express themselves. And so, I feel like art was a good way [to explore these feelings] because it gave them… yeah, freedom. I don’t even have the words. More room to express themselves in only words you know” (interview, visual arts and movement teacher).

Fostering empathy

Beyond appearing to provide an outlet for personal expression, participants also shared how they believed the workshops fostered an improved sense of connection between them and their classmates (e.g., “because a lot of people had like…like some of their families that died, too, like their grandmas or grandpas. And it was like of like a connection”; interview, student ID #18), allowing them to witness and respond to each other’s emotions with empathy (i.e., the ability to understand, feel, and share another person’s emotional experience; [21]). Although we initially sought to understand students’ perspectives on the value of discussing death, an unexpected, yet recurrent code was constructed in our analysis: the belief from participants that these discussions actively promoted empathy between them. Among all constructed themes, fostering empathy was the most frequently coded item during interviews (i.e. 40), highlighting how a majority of participants valued witnessing each other’s shared vulnerability towards death. Students described observing this behaviour in their classmates during and after discussions: “when we would talk about death, it made people sad, and I just wanted to be more respectful so that people didn’t feel worse that some of their family died” (interview, student ID #28). In a separate interview, another participant drew a similar conclusion: “yeah, when we were gonna talk about death, it’s really emotional and a topic that you have to be respectful of because you don’t wanna hurt anyone’s feelings about it” (interview, student ID #4). Importantly, participants also described observing how their classmates perceived and treated them in moments of greater vulnerability: “Well, when we were talking about death, I felt like they respected me a bit more because I had something to say and I had an experience, so they listened to what I had to say” (interview, student ID #30). Although the concept of empathy can be developmentally challenging for adolescents to conceptualize, one participant demonstrated a clear understanding of its meaning within the context of navigating grief: “yeah, because my friend, her grandma died. And so, it was sad for the week that we were talking about death. So, like, I felt empathy for her” (interview, student ID #4).

Participant reports of experiencing increased empathy were particularly noteworthy, given the history of interpersonal conflict within the group. Some participants privately disclosed their experiences with bullying and strained relationships with classmates. Prior to the workshops on death, earlier sessions (weeks 1–7) had frequently been marked by instances of disrespect and lack of consideration among students (e.g., interrupting each other during group discussion, mocking targeted students, etc.). However, despite these prior communication barriers, participants–regardless of their past conflicts with each other–reported feeling heightened empathy towards not only their friends, but also those they had previously clashed with. When asked about what they believed prompted this shift in classroom dynamics, the teacher reflected:

I think they [the students] saw the others showing vulnerability. Vulnerabilities and they became more tolerant. Seeing others say struggles or especially when we talked about death, and some had lost someone close to them. I think at the beginning they didn’t know how to react to their friends. Having emotions and showing their emotions that they didn’t think they would (interview, visual arts and movement teacher).

In essence, exploring a vulnerable topic appeared to enable some participants to express their honest thoughts and emotions without concealment. It is similarly in witnessing the vulnerability of other classmates–especially among those who typically maintained a tough exterior mirage–that a more sensitive and delicate side of their peers appeared to be revealed, thus challenging their preexisting assumptions of them while also observing improved empathy in the process.

Shifts in perspectives on death

Aside from our workshops appearing to provide a safe space for openly exploring the emotions commonly elicited by death, about half of participants specifically reported finding the sessions thought-provoking, with both the art and discussion segments prompting personal reflection on the meaning of death. One participant mentioned that the busyness of everyday school life had previously prevented them from deeply reflecting on these topics. It wasn’t until they had time alone after the workshop that they could truly contemplate the impact of the intervention and the deeper meaning in what was discussed. During interviews, one participant alluded to the value of using art to further hone their perspective on death: “the art activity…it changed all our mindset. So, we could draw whatever we liked and what we thought about it [death] more” (interview, student ID #32). Other participants reported valuing the discussions for refining their perspectives: observational data showed that during these artistic segments, most participants engaged in conversations, sharing their interpretations and knowledge about death. Despite observational data noting apprehension during group discussions, they appeared to use this time to listen to each other’s viewpoints, as participant 32 again highlighted: “everybody had a different point of view. Some people were like, ‘oh, death is scary, that’s scary’. Other people were like, ‘it’s okay, we all have to die one day’” (interview, student ID #32). Some participants also described initially perceiving death as entirely negative, but the group discussion helped them reframe it as potentially relieving for those who are suffering:

I understood that some people…kill themselves so that they don’t have to live through the pain that they’re going through. So, if someone has cancer and it got really bad, then they would choose to die so they don’t have to live in pain anymore (interview, student ID #33).

Perhaps for this reason, there was an expressed belief from some students that aside from viewing death as a purely negative event or just as a form of relief, it could also be meaningful and potentially beautiful. A small selection of participants (i.e., 20%) attributed such beauty towards the imagery of an afterlife, where loved ones become reunited. Reflecting further on this observed sentiment among their students, the teacher added: “because it is the one thing that’s for sure gonna happen. You know that we’re all gonna die. I think it made them realize that it can be beautiful” (interview, visual arts and movement teacher).

Discussion

The purpose of this study was to better understand the perceptions that elementary school students and their visual arts and movement teacher had on an arts-based existential intervention for navigating their questions, feelings, and concerns pertaining to death. In this study, we sought to provide adolescents this rare opportunity to explore death in an open and constructive context. It was through our qualitative analysis that we interpreted participants initially expressing a negative emotional reaction to the arts-based existential intervention but later feeling an appreciation for the opportunity to openly reflect on and discuss themes related to death. In this discussion section, we further contextualize the significance of these findings by drawing upon relevant literature that may rationalize each of these constructed themes.

Navigating discomforts around death in the workshops

Participants in this study initially appeared to approach the workshops with hesitation, emotional discomfort, and avoidance. In some cases, a small portion of participants stepped away from the group discussion and went into the workshop’s reserved safe space, so to re-collect themselves and seemingly evade discomforts provoked by the intervention. This response–which was both observed in the student participants and the visual arts and movement teacher–would likely raise concern among those skeptical of embracing death-related discourses with young adolescents. Indeed, adult discomfort with mortality-related discussions in educational settings is well-documented; teachers and parents may believe that they are not emotionally ready for such conversations and that exposure may cause unnecessary distress [61]. From the perspective of some adults, it may be safer for the well-being of the young adolescents to avoid engaging in the subject altogether.

Despite these valid concerns, the expression of apprehension from both the student participants and the visual arts and movement teacher was–to some extent–expected; engaging in stigmatized topics is likely to introduce uncomfortable reactions from young adolescents, especially when they are led to believe it is abnormal to do so [5]. However, repressing such a vital aspect of our existence only serves to create taboos and worsen anxiety around it [4]. Referring to Pascal’s theory of inquietude, individuals may conceal their discomfort around an issue and subsequently engage in the constant endeavor of diverting themselves from that stressor, which may translate into an intense agitation (i.e., overt anxiety) when these attempts at repression have failed [26]. Research has also indicated that younger individuals are typically found to harbor greater covert death anxiety, and its overt expression becomes more dominant as they grow older, likely as reminders of human mortality becomes less avoidable [34]. In the case of our participants, death likely took on the initial form of covert anxiety, and our workshops may have confronted their discomforts in a way that led to an overt form of anxious expression, thus resulting in the negative emotional reaction towards the intervention.

Within the theoretical framework of existential psychology, death is frequently understood as a central source of the anxieties inherent to human existence. Anxiety, according to May [56], can be theorized as “the experience of Being affirming itself against Nonbeing” (pp. xvii), meaning that anxiety manifests when an individual recognizes the threat that death imposes on their desire to live freely and without restriction. To ensure oneself is protected against such psychological harm, anxiety takes on a covert form, with denial and avoidance being common defensive responses to this existential threat [8, 75]. Indeed, our tendency to evade thoughts of mortality can be reinforced, for example, by cultural and religious traditions, such as beliefs in an afterlife, which may provide one with a sense of symbolic immortality. Afterlife speculation was a broad and recurring topic during this study’s group discussions. Relatedly, a minority of participants (i.e., 20%) alluded to a continued presence of the predeceased individuals in their life that may continue to live on in some vague form. Our research interpreted the young adolescents in this study not only expressing mortality salience (i.e., an awareness of their own mortality; [15]), but also that, like adults, they appeared to employ various strategies to manage such reminders (e.g., belief in a continued presence from the dead). This was evident both in the ways participants appeared to avoid engaging in discussions about death and in the content of the conversations among those who did participate. For participants who reported feeling apprehensive about the workshops, these reactions may reflect conditioned behaviors—specifically, the tendency of adults to shield children–including young adolescents–from discussions on mortality [74]. While it remains entirely possible that our workshops had a limited capacity to foster positive outcomes, such expressed apprehension from participants may also be better understood as products of cultural conditioning around the taboo of death.

While concerns about young adolescents’ psychological well-being and safety should not be overlooked in this study, there is also reason to suggest that engaging with such uncomfortable topics can provide therapeutic value. Returning to May [56], he further argued that having optimal mental health requires not only accepting anxiety as an unavoidable part of life, but that we also learn how to live with and embrace aspects of it as a stepping stone towards personal growth and emotional intelligence. Similarly, Kierkegaard [45] argued that anxiety is the most important human experience to have because it is one of the few methods that fosters improved self-understanding and growth. Notably, like many philosophers, Kierkegaard viewed death as being a fundamental concern leading to anxiety. Freud (1917) also strongly advocated for investigating “unconscious” (i.e., covert) concerns. Noting that exploring the meaning of our anxiety forces a confrontation against a range of converging questions about our existence, it illuminates “a riddle whose solution would be bound to throw a flood of light of our whole mental existence” (pp. 393). More recent scholarship [72] has argued that experiencing this form of anxiety is what we may need more of, so that we can be better informed on how to make both mindful and careful choices in life.

With this in consideration, coupled with previous studies suggesting that, like adults, young people navigate existential anxiety [65], the anxiety reported by participants in this study could be partly reflective of an initially unresolved sense of meaning in death. This finding is particularly relevant for parents, teachers, and clinicians, as young adolescents are rarely provided with opportunities to openly explore existential questions [84]. When these questions remain unaddressed, their existential concerns may intensify into adulthood. In cases where death anxiety remains unresolved, it could increase the risk for the later development of psychopathologies, such as depression and anxiety disorders [40, 58, 59]. It is therefore essential that researchers continue exploring effective ways to support both adults (e.g., parents and teachers) and young adolescents with engaging with these existential themes. Rather than silencing or pathologizing such reflections, educators and clinicians should welcome their questions and feelings, creating space for meaning making in the face of death. Research on end-of-life discussions has found that both children and parents benefit from open, transparent dialogues on death, which appears to foster personal growth [43, 44]. Although this intervention may offer one approach for supporting young adolescents in exploring these concerns, further research is needed to determine how adults can be better equipped to support and guide them through these processes prior to an end-of-life context.

Arts-based existential interventions as a tool for coping with death

Participants also reported reacting positively to the intervention. Grounded in arts-based existential interventions, our workshops aimed to provide participants tools for reconciling some of the anxieties they expressed around death. Although minimal research has investigated art and philosophy as a combined intervention, McLeod and colleagues (2022) suggested it could potentially offer meaningful value for nurturing self-identity and embracing diversity. Moreover, Story [76] further argued in favor of its potential by elaborating on how its combination enables individual to live more meaningful lives, long after the creative process has finished. Building on this, other research has also shown that engaging in thematically rich philosophical discussions focused specifically on life and death can foster meaning-making in young adolescents by clarifying existential concerns (e.g., fear of meaninglessness or isolation), building resilience to inevitable realities, and ultimately, embracing impermanence [63]. Accordingly, these scholars recommended that death education—particularly when guided by “existential” inquiry—should be more widely integrated into pedagogical settings, so to strengthen their resilience in coping with the notion of impermanence. Our intervention–which appears to be the first of its kind for specifically supporting young adolescents’ existential concerns about death–could be one potential model for such an implementation into elementary school curricula.

In the following subsections, we elaborate on the overarching theme of participants’ reported appreciation for the intervention, focusing on three keyways they described benefitting from: encouragement of emotional expression, fostering empathy, and shifts in perspective on death.

A safe space for emotional expression

One potential theory underlying the positive reception participants had towards this intervention lied in the opportunity to emotionally express their thoughts and feelings on death. Indeed, participants utilized both philosophical discussion and artistic expression to process their emotions surrounding death. Research supports art creation as an outlet for articulating and processing difficult emotions–whether through verbal communication or artistic mediums [62]. These methods can in turn foster improved coping and distress management, which participants also described experiencing in the workshops during post-intervention interviews. May [55] particularly advocated for embracing artistic creation as a means of reconciling existential anxiety:

Creative people, as I see them, are distinguished by the fact that they can live with anxiety, even though a high price may be paid in terms of insecurity, sensitivity, and defenselessness … They do not run away from non-being, but by encountering and wrestling with it, force it to produce being. They knock on silence for an answering music; they pursue meaninglessness until they can force it to mean (pp. 62).

Although May does not exclusively focus on young adolescents in his analysis, it is nonetheless a highly applicable statement. Given that they are found to be inherently more authentic [66], and that authenticity is positively correlated with higher creativity levels [81], young adolescents are for this reason more likely to benefit from artistically exploring their concerns around sensitive issues, such as death. In this study, the courage of participants to creatively “wrestle” [55] with their thoughts and feelings on death may have enabled them to reconcile its commonly associated anxiety [8]. Our findings are thus largely consistent with May’s [55] contention that allocating spaces for creativity and reflection are critical processes required for helping individuals reconcile their concerns related to non-being. Arts-based existential interventions, in other words, appeared as one such approach suitable for facilitating this process.

Camus’ [18]intersecting analysis of philosophy and art in The Myth of Sisyphus may also provide further explanation on why artistic expression played a critical role in our intervention. Art was described by Camus as a rebellious response to the absurd, arguing that it enables individuals to invent structure on an otherwise chaotic and inherently meaningless universe. Among those who expressed a negative emotional reaction to the workshops, making an artistic creation and subsequently reflecting on it with others may have enabled them to transcend their anxiety and find meaning in death. Recent psychological research has also suggested that engaging with artistic exhibits on death can help improve life appreciation and reduce avoidance around the subject [22]. The impact of ABIs for reconciling death concerns are also found to be applicable to children–including young adolescents–in other previous research: studies by Testoni et al. [77] have found that employing various forms of artistic activities–such as photovoice–to be impactful for treating death anxiety. Art therefore serves not just as a passive outlet for emotional expression, but more importantly can be conceptualized as a tool for fostering meaningful engagement on existential issues, thereby prompting young adolescents to process mortality in a way that feels more accessible to them. Further supporting this finding, Beaumont [7] also advocated for ABIs focused on meaning-making in the context of death. Arguing that these creative methods offer individuals a unique space to explore existential questions, process grief, and confront mortality in a non-verbal manner, they could be better equipped to articulate complex emotions surrounding death, facilitating deeper insight into their personal life and fostering a sense of meaning and acceptance for any potential grief they become faced with.

Empathy as a bridge to improved interpersonal connections and coping towards death

As a result of encouraging emotional expression during the intervention, our analysis also interpreted how death discussions appeared to foster empathy between participants. Aligning with developmental research showing that perspective-taking and emotional sharing serve as precursors to empathetic behavior [27], Batson [6] also found that empathy emerges when individuals witness the vulnerability of others, prompting a genuine desire to communicate humility and emotional support. From a neuroscientific perspective, Decety & Jackson [23] suggested that witnessing distress in others can activate the mirror neuron system,thus, when witnessing vulnerability in others, the brain is compelled to elicit an emotional response that underlies empathic concern. In turn, the expression of concern likely enhances participants’ sense of feeling valued, and, importantly, of valuing others. Fernández et al. [28] suggested that well-being and social connection are fostered not only by expressing appreciation and value towards others, but also by feeling valued in return. This is particularly relevant for clinical contexts,for example, empathy art–that is, creative works aimed at increased reflection and validation of the lived experiences of individuals–can help young adolescents feel seen, heard, and better understood [68]. Our participants reported experiencing this process during the workshops: witnessing their peers share personal experiences of loss appeared to dissolve previous social tensions–if only temporarily–and developed instances of increased relatedness. In these moments of mutual recognition and care, participants reported feeling understood by others–a process that may be essential for building improved classroom dynamics between young adolescents.

Furthermore, as participants stepped away from the group discussion to seek a calming, safe space, others were observed checking in on them with concern and emotional support. We interpret that while discussions about death may have initially provoked negative emotional reactions and overall discomfort, there is nonetheless potential for fostered social cohesion and interpersonal relatedness–core tenets of human existence that are fundamental in satisfying our basic psychological needs [24]. Also consistent with existential-humanistic therapeutic practices, embracing one’s vulnerability in the face of death is viewed not only as an act of courage, but also as a catalyst for healing. Yalom [82] suggested that confrontations with death–our ultimate shared vulnerability–can provide improved clarity on how to live more urgently, authentically, and meaningfully. Rather than diminishing the presence of death, confrontations with death may have the power to reorient our values, priorities, and interpersonal relationships. For example, research consistently finds that individuals who undergo near-death experiences—such as surviving a serious illness or a life-threatening accident—subsequently report having reduced anxiety towards death, heightened self-esteem and mindfulness, and a tendency to interpret death as a transition rather than as a complete extinction [9]. Similarly, in the present study, participants described how witnessing their peers engage with death through art and philosophical dialogue fostered a sense of deeper relatedness through shared vulnerability, thus appearing to lead to a notable shift in their perspectives on death.

Reframing the meaning and value of death

Some participants also reported that openly exploring death through art and PI led to a meaningful transformation in their perceptions of it. Although existential questioning is likely to remain unresolved and persist throughout life [78], participants attested to the value of engaging in these questions, rather than avoiding them. For example, during the initial stages of the intervention, many participants perceived death solely as a negative event. By the time post-intervention interviews were conducted, however, some of these perspectives had evolved. Whereas some continued to acknowledge death’s potentially distressing aspects, they reported no longer perceiving it as purely negative. For some, it remained a symbol of the inherently cold indifference of the universe; for others, death came to represent a form of release from it.

One context in which participants reported refining their perspective on death related to medically assisted dying, which is a legal procedure in Canada where the study took place. During group discussions, a small number of participants referred to knowing of individuals—in one case, a family member (e.g., a grandparent)—who had chosen medically assisted death due to severe suffering associated with an incurable chronic or progressive illness. It was during these discussions that some participants described reframing their thoughts on medically assisted dying to represent a form of relief from suffering, rather than viewing it solely as a negative event. This reported reframing has clinical significance; in Canada, where this study was conducted, approximately 5% of all deaths in the country occur through medically assisted dying procedures–which is a 2% increase from two years prior [36]. This represents a significant proportion of deaths, many of which are likely to affect young adolescents–either directly or indirectly (e.g., through bereavement of grand-parents)–within schools across the country. While we caution against generalizing these findings across cultural contexts, the event of young adolescents reframing death as a form of relief from suffering could better equip them to cope with loss when they encounter it. As such, death could be viewed in a more nuanced way, where their reactions to death may involve less distress and more adaptive responses to certain experiences of grief.

Beyond perceiving death just as a form of relief, however, some participants also described viewing it as beautiful precisely because life is temporary–recognizing that only finitude can imbue existence with urgency and meaning. In other instances, participants expressed their views on how death enhances the beauty of the natural world. One participant, for example, created a sculpture of a fossil and later explained how studying the remains of once-living creatures allows us to appreciate the world’s history and inherent beauty. Others emphasized how there is also beauty in the process of grief by bringing people together through shared vulnerability.

Although it may seem counterintuitive that the common fear of death could give rise to perceptions of beauty, literature increasingly supports this viewpoint. Recent research with youth, for example, has suggested that contemplating one’s small place within the immensity of the cosmic calendar can enhance well-being by instilling a sense of urgency to live fully and not take time for granted [39]. Rather than solely eliciting anxiety or dread, such reflections can act as powerful catalysts for cultivating intention, presence, and a deeper appreciation for life. Also supporting this view, Frias et al. [32] found that engaging in death reflections are associated with long-term feelings of gratitude for one’s existence. Thus, if teachers or other adults express apprehension toward engaging in death-related dialogues with young adolescents, it could be countered that having such conversations, while often challenging, can also foster meaningful reflection and create opportunities for young adolescents to reframe death through a more nuanced—and potentially less exclusively negative—lens.

While discussing death was—and will likely remain—an anxiety-provoking topic for our participants and other young adolescents, our findings suggest that they could also view life’s meaning as not being diminished by its impermanence. More likely, it is temporality that appears to enrich life’s value, which could thus propel them to live more mindfully, authentically, and meaningfully in the present.

Ethical considerations

Approaching such sensitive workshops with ethical care is paramount when leading these interventions. While our findings suggest that the mental health of participants were positively supported by the workshops, it is essential to acknowledge the potentiality for some students to respond negatively to them. Indeed, individual differences and lived experiences of participants may have shaped their overall perception of, and reaction to, the workshops. We acknowledge that death is not something to be romanticized, as it inevitably consists of pain and suffering. For example, some students did not view death as beautiful, but rather, as an ugly occurrence due to a traumatic experience they previously had. In this way, ensuring that safeguards and ethical considerations are in place throughout such workshops remains critical.

To ensure that young adolescents are supported through these workshops with heightened sensitivity, it is of the upmost importance that such interventions are conducted in collaboration with school personnel (psychologists, counsellors, teachers and principals), who best understand their students. Furthermore, these interventions must always be approached with compassion and sensitivity to students’ emotional needs. Drawing from Sharp's [73] care-centered framework for philosophical inquiry, our approach emphasizes the importance of building trust between researchers and participants. With respect to the positive outcomes of this research, these results may also be partially explained by the role of rapport building during the workshops. Indeed, the researchers sought to build trust with participants, which likely played a significant role in determining their overall reception and openness towards the workshops. However, this favorable outcome could also present a potential limitation: the risk of social desirability bias, whereby participants may have felt inclined to highlight positive aspects of their experience, while also minimizing negative ones. This bias can be particularly salient when discussing sensitive topics shaped by prevailing social norms and representations, such as emotions, death, or environmental concerns. To mitigate this concern, we regularly sought throughout the broader 10-week intervention to create a psychologically safe environment in which they were encouraged to express themselves authentically. We casually interacted with participants outside of workshops and engaged in selective self-disclosure to reveal our personable side. While we acknowledge that social desirability cannot be entirely eliminated—particularly as our working relationship strengthened over the 10-week intervention—we consistently reminded participants of the importance of sharing all perspectives, including negative feedback.

This study received approval from the Bishop’s University Research Ethics Board (REB) on December 30^th, 2023, File #102,681.

Strengths and limitations

A key strength of this pilot study was in providing young adolescents the opportunity to explore existential questions–topics that they are naturally inclined to ponder but rarely given the opportunity to discuss. By integrating artistic creation with philosophical inquiry, we engaged both the verbal and non-verbal dimensions of their reflections on death through an extended intervention. We interpreted this dual approach as showing potential for fostering a holistic development of their emotional and intellectual engagement with mortality. With the exception of death education and bereavement interventions, which tend to target specific dimensions of death, this study is among the first to provide young adolescents with the opportunity to openly explore the topic of death as a form of mental health prevention. Given the largely positive responses to the intervention, this pilot study suggests potential value in providing them with opportunities to openly explore death in this context.

However, this study is not without limitations. First, the intervention was relatively short, consisting of two 60 min workshops over two weeks. While participants described how these sessions meaningfully refined their attitudes toward death, they likely would have required additional time to sustain meaningful effects from the intervention. This limitation, however, was imposed by school administrators, who requested that the workshops on death were limited to two sessions, so to minimize any potential distress among the students. Furthermore, given the pilot nature of this study and its aim of understanding the impact of an arts- and philosophy-based intervention on young adolescents’ perceptions of death, the findings should be regarded as preliminary evidence that may inform the design and evaluation of future, more extended interventions on death.

Second, while qualitative research does not aim to achieve generalizability to broader populations, these findings should be interpreted with caution, as they only aim to reflect the perceptions and lived experiences of an English-speaking group of elementary school students in the province of Quebec. Finally, sociodemographic information beyond ethnicity, age, and gender was not collected in this study.

Future research

With these strengths and limitations in mind, several directions for future research are proposed. First, to enhance the methodological rigor of future studies, researchers could incorporate a pre- and post-intervention death anxiety scale alongside qualitative interviews to better measure changes across time. Second, given the accessibility of these workshops, future research could examine the feasibility and practical guidelines for supporting teachers in implementing these workshops independently and within their own classrooms. This could include investigating the settings, conditions, and types of support that best enable teachers to facilitate such workshops effectively, thereby contributing to the development of a simplified toolkit that includes a death-themed artistic creation guide. Third, researchers could explore how young adolescents’ perceptions of death vary across cultures, particularly in regions where death may be approached with different attitudes and traditions (e.g., Asia). Fourth, the positive outcomes described by participants in this pilot study justifies further research investigating the feasibility of an expanded intervention on death that engages them on additional existential themes, such as meaning in life and identity. Fifth, although recent research from our team has demonstrated that art-and-philosophy-based groups are more effective than art-only groups in addressing related existential themes such as eco-anxiety [52, 53], future studies should continue to include these comparison groups to further substantiate the synergistic effects of arts-based existential approaches in the specific context of death-related workshops. Taken together, these proposals for future research underscore the importance of examining developmentally appropriate, reflective spaces that empower young adolescents to engage with life’s most profound questions.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abbreviations

ABIs

Arts-based interventions

PI

Philosophical inquiry

Appendix A: Interview Guide

Interview Guide: Students.

1. Introduction (script)

• Describe the research project

  • o
    As you know, we have been coming and hosting art activities and discussions with you over the last few weeks. We are meeting with you today to get a better sense of your impressions on these activities, whether you enjoyed them or not, if you have any suggestions to improve them, and how that overall experience was for you.

• Describe the process of their participation in the interview

• Clarifications:

  • o
    You don’t have to answer any questions you don’t feel comfortable answering
  • o
    You can take your time before answering
  • o
    You can ask for clarifications if you don’t understand the questions
  • o
    You can answer as you wish; there are only right answers to these questions

• I’m going to record this conversation so I can remember what we said. I will be transcribing everything we said and remove your name from the answers, and then delete the recording. Then, I will compare your answers with other students’ and see what is similar and what is different in your comments. No one will know who said what, which means your answers are confidential. Are you okay with participating in this discussion?

• I will start the recording and name myself, then you can name yourself. I will also verbally ask you to agree to this discussion on the recording. Are you ready?

[Start the recording].

Here is (name of the researcher), I am here with (name of the student). (Student name), do you agree to participate in this discussion?

2. Appreciation of the Activities

We have done many activities together over the last few weeks, can you name some of the things we did together? (Remind them of the activities)

• Can you start by telling me your overall experience with the activities we completed together in the past weeks?

• What did you find difficult about these activities? Why?

• What did you find easy about these activities? Why?

• What was/were your favourite activity(es)? Why?

• What activities did you enjoy the least? Why?

• In what situations do you think the activities could help you in school? How could they be helpful?

• Would you enjoy continuing art and philosophy activities like we did together in school? Why?

• Did you do art activities or group discussions like we had outside of school (e.g. at home, extracurriculars) before the activities?

• Now that we have completed the activities in school, do you think you’ll want to pursue artistic activities or philosophical discussions outside of school?

• What would you change about the activities we did?

• Were there any activities that you did not understand or where the instructions were not clear?

Well-Being

• Did you feel comfortable during the activities?

  • o
    [No] What could have made you feel more comfortable?
  • o
    [Yes] What made you feel comfortable?
• If you think back to before we started the arts and discussion activities and now, are there any differences in how you feel?

  • o
    The emotions you experience?
  • o
    With your teacher?
  • o
    With your parents?
  • o
    With your peers?

3. Death

As you know, we worked on two activities near the end of our time together that focused on the topic of death and grief. I will now be asking you some questions about these activities.

• How often did you think about death before we did these activities with you?

• Did you ever have a chance to talk about it with someone?

• If you think back on the weeks when we did talk about death, did you feel comfortable thinking about death? Can you tell me why or why not?

• (If uncomfortable), why do you think it is an uncomfortable topic of conversation for some people? Why is it for you?

• Is there a way that we can avoid these uncomfortable thoughts and feelings about death?

• Is there anything we can do to make ourselves feel more comfortable about it?

• Did you find these activities to change the way you think about death in any way? If so, can you tell me a bit more about that?

• Do you remember what your mood was during these activities? And once the activities were over? (i.e. after)

• Do you feel like our activities with art and discussions helped you think about and process death? Why or why not?

• Do you think that, moving forward, you will spend any more time thinking about death?

• Is there anything you are still wondering about/feeling unsure of about death?

• In your own words, can you tell me what grief means to you?

  • o
    (For interviewer’s reference) Grief: intense feelings of sadness or sorrow caused by someone’s death, usually someone that is close to us.

• Do you think there is a way that art and talking can help us process grief? Why or why not?

• Do you think there is a way that we can support others who are grieving? How so?

• Before we get to the conclusion, I have one last question for you: what do you think is the meaning of life? (Or rephrase: why do you think we were put on this earth to live?).

4. Conclusions

• Do you have anything else you would like to share with us before we end?

• Do you have any questions for us?

[Thank them for their participation]

Appendix B: Observation Grid

Appendix C: Examples of Participant Artwork

Author contributions

ZDF: leader of workshops, primary collector of data, analyzed qualitative findings, developed first working draft, along with final edits of manuscript AM: secondary supervisor to the research project; also provided edits on manuscript drafts MG: Assisted with animation of workshops; also reviewed and edited manuscript drafts TLG: Provided assistance with analyses along with manuscript edits DL: Reviewed and edited manuscript drafts JS: Reviewed and edited manuscript drafts NM: Reviewed and edited manuscript drafts MCG: Reviewed and edited manuscript drafts MAE: Reviewed and edited manuscript drafts CMH: Primary supervisor of the research project; central recipient of funding and provided clinical supervision to the workshops, reviewed each stage of analyses, and reviewed and edited each round of manuscript drafts.

Funding

Funding for this project was provided through a research grant by the Social Sciences and Humanities Research Council of Canada to CMH. Funding sources were not involved in the conduct of this research.

Data availability

The data that support the findings of this study are available on request from the corresponding authors, ZF and CMH. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

Declarations

Ethical approval and consent to participate

Approval to conduct this research was received from the Bishop’s University Ethics Board on December 30th, 2023 (Protocol #102681). All procedures performed in this study involving human participants were conducted in compliance with the ethical standards of the Research Ethics Board at Bishop’s University. For further details regarding the consent process, please contact the corresponding authors, ZDF and CMH. Informed consent in this study was obtained from all individual participants and their parents included in the study. Given that participants in this study were 11–12 years old, consent was first obtained by signature from a parent and/or legal guardian in a consent form approved by the Bishop’s University Research Ethics Board. Prior to the commencement of all workshops and post-intervention interviews with participants, verbal consent was provided by the child participants. Participants were continually reminded throughout the course of the study that they were free to withdraw at any time and were never obligated to disclose information they were uncomfortable sharing.

Consent for publication

Not applicable.

Competing Interests

The authors declare no competing interests.