This is a bonus episode of the Why I Knit podcast for anyone wanting to know or read more about the research into how knitting can benefit our mental well-being.
Fellow clinical psychologist and knitter, Dr Paula Redmond and I will be reading one research paper a month and discussing it in our journal club podcast. This month we are discussing Healing Stitches: a scoping review of the impact of needlcraft on mental health and well-being. The full-text of this article is available here: Healing Stitches
I refer to the interview with Betsan Corkhill which you can listen to here: Betsan Corkhill
If you’d like to learn more about how to use knitting for your self-care, check out our course Self-Care One Stitch at a Time.
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Transcript
(this transcript is AI generated, so please forgive any mistakes)
Mia: Hello and welcome to our first bonus episode, which is a journal club episode. So I’m joined by Paula Redmond, who is my business partner. And we have decided that we’re going to do a few bonus episodes, probably not super regularly, sprinkled in every now and then. Is that about right, Paula?
Paula: Yep. Sounds good. Yeah.
Mia: Where we are reading a research paper. because that’s something both of us want to do more of and in contribution to our kind of resources on using knitting for self care and also in our own work where we’re using knitting as part of our therapeutic work. So we have read a paper and our plan today is to spend a bit of time giving a brief summary because I’m sure there are other people listening who would like to do more reading than they actually have time to do. And give a brief summary of what the paper is, what the kind of main themes were, and then a little chat about what our thoughts were, what we thought it might have contributed to the research and to our own thinking about how knitting can benefit our mental health. So Paula, you were going to do a little summary of the study that we read.
Paula: Yes. So the study that we have read for this episode is called Healing Stitches: a scoping review on the impact of needlecraft on mental health and wellbeing. And it was published in a journal called Issues in Mental Health Nursing in July, 2024, so pretty recent, by Le Lagadec et al. I hope I am pronouncing that correctly. So the authors were all nursing academics based in Australia. And it’s an open access article, so you can have a read of it yourself and we’ll have the link in the show notes.
So basically what they did was a scoping review of 25 primary research studies into the impact on mental health and wellbeing of sewing, crochet, knitting, lace making, embroidery and quilting. So what that means is they conducted a literature search including primary research studies. So they excluded anything that wasn’t doing research itself. So any other kind of literature reviews or case reports or kind of conference presentations, they didn’t include. And papers that had a specific focus on needle craft. And they decided to exclude any studies that related to dementia. So they were looking at wellbeing more broadly. And they came up with 25 research studies. And sort of a bit of an international feel. they had seven that were from North America, 11 from Europe, three from Australia, one, and then the rest were kind of from multiple countries. And there was a mix of studies here with the majority of them being qualitative studies. So they were based on interviews and narratives and observations and kind of collecting um, people’s stories. And then a few that were more quantitative in nature. looking at numbers and kind of rating people, how they rated their experiences. Um, and out of that 25, there were 18 studies, which were observational, which meant that, um, they were asking questions of people’s every day experience their kind of sort of just what they were doing anyway in life. And then there were seven intervention studies. So where the researchers had introduced a craft activity, a workshop, a group and measured the impact. And just in terms of the breakdown of the different crafts, the biggest number were related to knitting. So eight studies were related to knitting, two crochet, four quilting, three sewing, two embroidery, one lace making, and five studies looked at more than one type of craft. And then what they did is, as a group, read through all these papers and did a thematic analysis. So they coded the results and drew out themes that they found were kind of common to studies. And they came up with four themes. Mia, do you want to tell us about what they were?
Mia: So the four themes were the first one was mental well-being. So that was where they talked about experiences like finding the crafts, calming and relaxing and being a diversion from stress, eliciting positive emotions and the kind of meditative flow kind of aspect of crafting. And some of the studies also related to things like smoking or drinking alcohol less, but I think that was based on a self-report measure rather than something they measured separately. And also that there were certain ones that were related to trauma. So they were also talking about surviving difficult life events like trauma and grief.
The second theme was about social connection. having a sense of community, either in person or online, developing friendships. And one of the quotes I particularly liked was about the idea of knitting being the WD-40 in a conversation. So as that kind of being a lubricant in making conversation and the idea of mutual learning and encouraging other people within their crafts.
The third theme was about sense of achievement and purpose and about knitting for other people. There was a big theme about gifting in relation to that.
And the fourth one was identity, family, culture and legacy. So that was covering many things about things to do with identity, like having a new identity outside of being a family member or an employee, having a voice and kind of creativity and self-expression. So those were the four themes, which I think are kind of familiar to a lot of the things we talk about in our work, suppose, Paula.
Paula: Yes. And I guess overall, they concluded that that needlecraft from these studies has a overwhelmingly positive impact on wellbeing. And they described how this is both related to the process of creating and the end product. And also they sort of emphasized the social aspects of needlecraft, that that in itself is something that can be really beneficial. And they sort of pointed out that there is scope and potential for needlecraft to be used as a mental health intervention and that it may be sort of really applicable to a wide range of different sort of populations and health professionals as well. They made that point.
Mia: Yeah. So we thought it might be helpful to think a little bit about the, I don’t know, limitations of that study and how, actually we can conclude from it because I guess it was very broad but also didn’t have very strict inclusion criteria and sometimes there wasn’t that much information on the studies that they looked at in terms of how many participants and how they collected the data.
Paula: Yeah, exactly. So I think I suppose the first thing to say would be that this was a scoping review. the idea of that is to kind of map out what research is out there and it’s usually used to try and identify research questions for future research. So it’s a good way of doing things when the research is limited, which it is in this field, but it does have its limitations because unlike what we would see in a systematic review, which is much more about analyzing the quality of the research and of the data and kind of synthesizing it. It’s difficult from this paper to kind of weigh up the merits of the findings because the studies were very different from each other, different methods of data collection, different population sizes, different sort of interventions and crafts. And the paper doesn’t really give a sense of the quality of the research. So when they’re making sort of statements about the benefits, As a reader, can’t really judge how reliable that is. So, you know, one of the examples they say is that one of the studies found that that needlecraft can lower blood pressure, relieve chronic pain, reduce smoking and alcohol use, which are big claims. And you think, wow, that’s, you know, amazing kind of public health intervention. But it’s really not clear how they assess that in particular, and I think it was from a survey study. So that’s kind of people just self reporting that those were the impacts. It’s difficult to judge how, you know, how much weight we can give to those claims compared to claims of other studies, it wasn’t really possible to make that kind of judgment.
Mia: I guess the most of the studies were there was a gender bias towards mainly female participants. think a lot of them were middle-aged or older, although there were some specific ones, I think, for teenage girls. But I think also many of them were existing, asking existing crafters. They were not introducing new people to a craft and seeing whether it was helpful for their mental health.
Paula: Yes, exactly. That’s important to taken to consideration when thinking of it as a kind of self-selected and therefore biased population.
Mia: Exactly. And I think what it was also not possible to… So some of the studies which were intervention studies, for example, when they introduced knitting as an intervention to women in prison or for people affected in Japan by an earthquake, it also wasn’t clear whether this was a new experience for them or whether they had been pre-existing knitters. So again, we’re not sure how much of a self-selection bias is at play here in those kind of studies.
Paula: I also had to thought about the kind of search terms that they use. So, you know, when you’re doing literature search, you’ve got to choose the words that you put into the search machine to see what comes out. And I guess that the terms that they use to pull out papers around mental health and wellbeing were not ones I necessarily would have used. So things like, if they used the word anxiety, for example, but they didn’t include the word depression or trauma. They used the word relaxation therapy, but they didn’t use mood, for example. So…
And when they were looking at the crafts, they particularly looked at knitting, crochet, sewing and quilting. So they didn’t look for other needle crafts like lace making or embroidery. Those came up sort of incidentally, but they didn’t look at cross stitch, for example, or kind of mending other, you know, so it’s difficult to say what else might be out there that could have been included if those search terms have been different.
Mia: Okay, so then we were going to have a little think about, was there anything else in terms of the limitations?
Paula: I think those were the main thoughts I had. Yeah.
Mia: So then I guess we were going to have a little think about whether there were any things that jumped out at you from reading the paper, things that you think made you think about something a bit different or things you particularly, I don’t know, wanted to think more about.
Paula: Yeah, I think for me, it was really interesting to hear about the first sort of theme. One of the first things that came up was about the therapeutic nature of needlecraft. And I guess as a psychologist, particularly interested in that. And it was particularly related to these intervention studies, and the different populations that had introduced this, which was really interesting. So for example, population of people with anorexia. There was people who’d been affected by HIV and AIDS loss, female prisoners, adolescents with what they called emotional disorders, and the earthquake survivors. So a really broad range of kind of populations, which was really interesting. And I think one of the points that they made which I think was nicely articulated, was the difference between people using needlecraft for the everyday stuff. those people who were regular knitters and who found it really helpful for their everyday life. And then those times when it was useful to respond to exceptional circumstances or life crises. And I thought that was really interesting and just reflecting on how I’ve used knitting in my life and the different choices that I’ve made, depending on whether it’s a kind of everyday time or whether it’s something where I’ve needed something different from it. And I guess how versatile it is as a craft to enable that.
Mia: Yeah. And I wondered, that made me wonder about, Yeah, and I’d be interested in your thoughts about the different kind of types of needlecraft that they included and how similar or different they all are. Because I know there’ll be others that you’ve done some of or tried and and I wonder whether because I think that is one of the things that is quite well, I’m interested in how similar that is for something else like quilting. My immediate reaction is maybe that’s not as adaptable to how you’re feeling on the given day. And a quilt, I guess, is a bigger project. You maybe don’t have more than one on the go at once because I think, I guess it takes a lot of cutting out and a lot of, you know, fine, intricate work and how adaptable that is, I suppose, to what, how you’re feeling on that given day. I don’t know if you had thoughts about the…
Paula: Yeah, it was interesting that they kind of, particularly the quilting seemed to be much more in the context of using quilting as a form of commemoration. So it’s particularly in relation to loss, but also in relation to kind of telling a story somehow, I guess.
Mia: maybe quilting, for example, lends itself more easily to than something like knitting. I mean, I don’t know if that’s strictly always true, but certainly it seems easier to imagine a quilt or maybe a piece of embroidery that would be commemorative in that way that knitting is maybe more tricky to use it for. That was something I noticed in terms of the themes that came out as well about the idea of this kind of finding a voice or having a narrative that I, that was something I felt was not particularly reflective of the other things I’ve read about how knitting can benefit our mental health.
Because exactly as you said, I’m not sure. I think some people do use storytelling in knitting. Like for example, more I think the designers I’ve interviewed in my podcast. I know we have both heard like Sylvia, what’s Cherry speak about using knitting as a way of connecting with kind of African heritage or about, you know, having more of a narrative there. But I think many knitters who don’t design, I’m not sure how, to what extent they would feel it was telling a story necessarily.
Paula: Yes. Yeah, exactly. And I guess, I mean, one of the things that came to my mind reading it was, maybe I need to try lace making, but that’s something I haven’t tried before. But that seems quite, well, definitely less portable, I think, quite complicated, but maybe worth a try. Yeah.
Mia: Yeah, for sure. Anything else that jumped out, I suppose?
Paula: I guess I was, yeah, just the paper really emphasised, I think, the sort of social aspects of needlecraft and really, as you said about how that might be able to sort of lubricate social contact and enable connection between people. And I suppose that’s something that is a kind of an interesting angle that maybe I haven’t thought about so much before that I guess for me, it’s much more being something that is a useful sort of hobby because I can do it by myself at home. Whereas it’s not something that for me has been so much about the social side of it. But I guess we know from a mental health perspective that social connection is a huge factor in our wellbeing. that’s, I mean, I know that’s been something I’ve really enjoyed about the groups, for example, that we have run, that it does enable connection and that can be really meaningful and helpful too.
Mia: Yeah. Yeah. And I think and I wonder whether that’s a product of their being, I think in the study itself, it does mention one of the limitations as being that there’s some many of the samples are using kind of an older population. then maybe there are more issues about kind of loneliness or the idea of feeling useful if you aren’t working, for example. maybe people in those groups might also have more time than you and I do to pursue our own.
Paula: Yeah. It does also make the comment, I think towards the end, that a recent survey of young people also highlighted loneliness as being a big factor. even though we’re in this hyper-connected world, many people still feel lonely. And maybe we can make more of connecting around a hobby that reduces the pressure for, I suppose, social, you know, in the social situation, can don’t necessarily have, you’ve got something to talk about something to facilitate conversation, you’re not necessarily having to make lots of eye contact, or, you know, share very personal things and find ways of bonding through helping each other and solving problems together or learning from each other can be a really nice way of making those connections.
Mia: Sure. Yeah. One of the thoughts I had when I was reading it was thinking about what next? Like, what does this study make you want to know more about? Or if you had an amazing research budget and, you know, people to help you do a study, like, what would you want to learn more about?
Paula: Yeah, I guess I would like to, I think, have an opportunity to, you know, create a randomized control trial where you’ve got really good kind of research structures to, you know, control for all these different variables around gender and age and previous experience of knitting to create a study looking at the impact of, for example, introducing knitting to people who’ve not knitted before, what is the impact on their mental health? It’d be really interesting to compare different types of craft craft. Yeah. So comparing, you know, knitting to crochet to embroidery, you know, what are the differences there? And, yeah, I think that would be really interesting to kind of get some really good quality research there where you can draw some conclusions, get a big enough sample. And I think it’s also useful to have a mix of kind of qualitative and quantitative data. you could measure blood pressure. You could measure cortisol levels. You could get people to, I guess you can. measure alcohol consumption, you know, through blood tests, you know, you could do all of these things. You could also have ways of, you know, capturing people’s experiences in more narrative kind of qualitative ways because those are really useful too. And I’d be interested in what the difference might be between you know, how knitting the projects are approached, you know, whether people are choosing their own work or having something that they are given to make, whether it’s an individual piece or a joint, you know, joint project, those kinds of variables would be really interesting to explore. What would you do? What would you to research?
Mia: Wouldn’t it be amazing if that could actually happen? Yeah, I mean, I think obviously, like, randomised control, I don’t know whether it’s just helpful for us to say into a little bit about what that is. So I guess it’s where participants are allocated at random to different groups that would be offered a different in this case, intervention that might be knitting, and then it might be knitting in a group or it might be knitting alone or it might be doing something which was a control. that is something that whether it’s either a treatment as usual or there is some different form of using your time that isn’t knitting. Yeah. I don’t know what that is, playing Tetris or if it’s just, I don’t know. It could be just knitting. Yeah, it could be going to a group where there isn’t a craft. Yes. Like a talking group without a particular agenda or therapy. Yeah. Yeah. So I guess that is that there isn’t very much in the literature at all, which is based on that type of method where knitting is offered as an intervention. Most of the studies are based on surveys of existing knitters. And it’s not nothing that there’s loads of those people report it as helpful, particularly when the potential intervention is something that is so cheap and easy to offer in a group and also like not you know, chances of it being harmful to anyone are very, very low. So in that sense, it’s, you know, as somebody I interviewed on my podcast said, it’s low hanging fruit. Like it really is almost so easy to offer. But I think I would love to see a kind of knitting used as an intervention, probably in a group.
And you didn’t mention what whether there was a particular type of participant you would think to recruit. Because I guess as psychologists, could think, you know, as clinical psychologists, we work mainly in the field of mental health. So you might think therefore of somebody with a specific experience or diagnosis. Yeah, so I guess it would be very interesting. So you could pick, you could pick one. So you could pick people who, you know, have low mood, experiences of low mood and do an intervention there or anxiety. And I guess because that generally tends to be my working life tends to be kind of broadly under the umbrella of anxiety and low mood in young people, I suppose that would be my temptation would be to start there really.
Paula: Yes. And I think as you’re talking, I’m thinking it would be great from my point of view to study an intervention with health professionals. Yeah
And you could imagine that that’s potentially quite a captive audience and you could compare one department or one shift to another. people who may be doing very similar jobs, but one gets a meeting for an hour just to chat, the other meets for an hour to knit together another meets for an hour to do some cross stitch. Yeah. And you know, you could, yeah, you know, be measuring before and after and also longitudinal effects. You know, I think that’s always really useful that what impact might this have in the longer term, six months.
Mia: And I think there was one study on compassion fatigue in oncology nurses that I think was included as part of included.
Paula: It was mentioned, but it was a conference presentation study rather than an actual research So I think, but I don’t think that was compared to another group. think that was just offering, it was offering knitting and then using measures to see its impact on compassion fatigue. Yes.
Mia: So there’s loads of ideas of where to go next. Yes. But I think interesting, I don’t think there were any mentions of negative. There was one actually maybe a mention about knitting, wasn’t there? About a negative. So some people feeling worried about being criticized. That was knitting specific. So must have come up in one of the knitting studies.
Paula: Yeah, one of the studies mentioned people being worried about their kind of they were producing not being good enough or being criticized by other people. And I think, again, I think that’s really interesting because it’s difficult to know from the paper whether any questions are actually asked about, you know, what problems has knitting caused you or have there been negative experiences and whether that was spontaneously reported or, you know, specifically asked about. Yeah.
And I think that’s always something to keep in mind. We’ve got to, you know, not have a positivity bias for this stuff as well. we only looking for the good things and not seeing the more tricky things?
Mia: And I think that’s the, I suppose, one of the tricky things about many of the studies interviewing people who have the ones who’ve stuck with the craft. Because there’ll be many others, as many, if not more, others who’ve tried it or are much more kind of, I don’t know, now and then knitters or have tried it and felt like actually, no, that was not for me. I’ve certainly got a friend who says, no, I’m never trying it because I think because I’m a perfectionist and I would hate it. And I think that, you know, of course, there’ll be those people. Yeah. But I guess more research would help us figure out who the right people are to offer it to as an intervention or the right time to offer it to the right people. Yeah. Yeah. And in the right way. It’s like what can make the most of.
Pauka: And I guess they will be those people who just not had the opportunity to try it. And I guess that’s the other thing about research of who actually volunteers to take part. You’re not likely to take part in something that is totally irrelevant to you or that you don’t care about. So the people who are going to answer surveys and spend time doing this are invested already. So for sure getting a that there’s definitely a kind of self selection bias there, as you mentioned, but I guess my overall sense was that there was a real kind of validity to their findings into the themes that came out because those are the things that I have experienced personally and also, you know, that people do talk about when they talk about knitting and it can support us in a variety of ways. So it did feel valid to me in terms of, and it also did feel like a really long list of all sorts of great benefits, like it was, you know, they’re articulating it all in a really nice way. it’s felt like important to, you know, share that there are all these benefits. And maybe it is something we need to take more seriously. I guess that’s, for me, an important thing. Like, is this something that, you know, historically, needle craft has been relegated to, like a very domestic female kind of task that people might be doing at home by themselves or maybe in groups with other women. And is it something that needs to be elevated? If it’s something that holds all of these really tangible benefits, do we need to elevate it more and be prouder of it? I wonder how the research evidence-based would look different if this was a more male-dominated you know, activity. What would that look like?
Mia: Highly likely to be true. Well, we know that is reflective in the research, isn’t it? That more female dominated things do get generally less research focus. know, female dominated health concerns. One, guess it just reminds me of Betson Corkhill when I interviewed her. And in a very early episode, we can link to that one in the show notes also of my of the podcast where she mentioned like going to conferences and not mentioning the K word and instead, you know, asking people if they’re interested in hearing about a bilateral psychosocial intervention for wellbeing, which of course they were. And then later, then she could reveal the truth. But that she was called like the mad knitting lady and I don’t, you know, I was at an event with other psychologists not that long ago where people are going, oh, you’re the knitting lady. Yeah. Yeah. I don’t find offensive obviously. Yeah. Very happy to identify as a knitting lady. But yeah, I think there is a slight, and I think that was what got in the way of me doing, using it earlier, think in my own practice, I think was that other people would think it was silly or there wasn’t enough research, you know, and there isn’t, you know, there needs to be more, but yeah, I think it’s worth putting on the agenda for sure. yes.
Okay. Well, it has been very interesting to have this conversation with you. Thank you for joining me. Paula. Yeah. And we plan to do some more little Journal Club episode sprinkled in. So, but it would be really great to hear what you think of this idea of us talking about paper, whether you found it interesting, whether there’s anything else that would be helpful for us to talk or think about. So, yeah, so we’d love to hear your feedback. If you want to email me, it’s Mia at therapeuticknitting.org. Yeah, so it’d be great to have your feedback. Thank you, Paula.
Paula: Thank you!
Mia: Thank you for listening to the Why I Knit podcast. If you enjoyed this conversation and would like to find out more about how you can get the maximum benefit for your self care from your knitting, then visit creativerestoration.org to find out more about our audio course, Self Care, One Stitch at a Time. If you’re enjoying the podcast, I would also really appreciate it if you would subscribe and leave a rating and a review as it helps us to spread the word about the therapeutic benefits of knitting.