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“That’s what keeps me up at night”: A qualitative pilot study on how arts-based existential interventions could benefit children grappling with death
[Author Details]
ZacharyFry
M.Sc. Ph.D.
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EmailEmail
Full Professor
AdriannaMendrek
Ph.D.
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Email
TerraLéger-Goodes
M.Sc. Ph.D.
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Email
Candidate3
Professor
DavidLefrançois
Ph.D.
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Email
Associate Professor
JonathanSmith
Ph.D.
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Email
Professor
NathalieMaltais
Ph.D.
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Email
psychologist Associate Professor
Marie-ClaudeGeoffroy
Ph.D.
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Email
Full Professor
Marc-AndréÉthier
Ph.D.
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Email
psychologist Associate Professor
CatherineMalboeuf-Hurtubise
Ph.D.
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Email
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Candidate in Experimental Psychology, School of PsychologyUniversity of Wollongong WollongongNSWAustralia
2Department of PsychologyBishop’s University SherbrookeQcCanada
3in Clinical Psychology, Department of PsychologyUniversité du Québec à Montréal MontrealQcCanada
4Department of EducationUniversité du Québec en Outaouais GatineauQcCanada
5Department of Preschool and Primary EducationUniversité de Sherbrooke SherbrookeQcCanada
6Department of Health SciencesUniversité du Québec à Rimouski RimouskiQcCanada
7Department of PsychiatryMcGill University MontrealQcCanada
8Department of DidacticsUniversité de Montréal MontrealQcCanada
Zachary Fry, M.Sc.
Ph.D. Candidate in Experimental Psychology, School of Psychology, University of Wollongong
Wollongong, NSW, Australia
zdf353@uowmail.edu.au
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Author Contribution
Author Contribution: leader of workshops, primary collector of data, analyzed qualitative findings, developed first working draft, along with final edits of manuscriptAuthor Contribution: secondary supervisor to the research project; also provided edits on manuscript draftsAuthor Contribution: Assisted with animation of workshops; also reviewed and edited manuscript draftsAuthor Contribution: Provided assistance with analyses along with manuscript editsAuthor Contribution: Reviewed and edited manuscript draftsAuthor Contribution: Reviewed and edited manuscript draftsAuthor Contribution: Reviewed and edited manuscript draftsAuthor Contribution: Reviewed and edited manuscript draftsAuthor Contribution: 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
Adrianna Mendrek, Ph.D.
Full Professor, Department of Psychology, Bishop’s University
Sherbrooke, Qc, Canada
Amendrek@ubishops.ca
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Author Contribution: secondary supervisor to the research project; also provided edits on manuscript drafts
Maxime Gilbert
M.Sc. Candidate in Psychology, Department of Psychology, Bishop’s University
Sherbrooke, Qc, Canada
Mgilbert20@ubishops.ca
Author Contribution: Assisted with animation of workshops; also reviewed and edited manuscript drafts
Terra Léger-Goodes, M.Sc.
Ph.D. Candidate in Clinical Psychology, Department of Psychology, Université du Québec à Montréal
Montreal, Qc, Canada
leger-goodes.terra@courrier.uqam.ca
Author Contribution: Provided assistance with analyses along with manuscript edits
David Lefrançois, Ph.D.
Professor, Department of Education, Université du Québec en Outaouais
Gatineau, Qc, Canada
david.lefrancois@uqo.ca
Author Contribution: Reviewed and edited manuscript drafts
Jonathan Smith, Ph.D.
Associate Professor, Department of Preschool and Primary Education, Université de Sherbrooke
Sherbrooke, Qc, Canada
Jonathan.Smith@USherbrooke.ca
Author Contribution: Reviewed and edited manuscript drafts
Nathalie Maltais, Ph.D.
Professor, Department of Health Sciences, Université du Québec à Rimouski
Rimouski, Qc, Canada
Nathalie_Maltais@uqar.ca
Author Contribution: Reviewed and edited manuscript drafts
Marie-Claude Geoffroy, Ph.D., psychologist
Associate Professor, Department of Psychiatry, McGill University
Montreal, Qc, Canada
marie-claude.geoffroy@mcgill.ca
Author Contribution: Reviewed and edited manuscript drafts
Marc-André Éthier, Ph.D.
Full Professor, Department of Didactics, Université de Montréal
Montreal, Qc, Canada
marc.andre.ethier@umontreal.ca
Author Contribution: Reviewed and edited manuscript drafts
Catherine Malboeuf-Hurtubise, Ph.D., psychologist
Associate Professor, Department of Psychology, Bishop’s University
Sherbrooke, Qc, Canada
catherine.malboeuf-hurtubise@ubishops.ca
Author Contribution: 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
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Abstract
Objectives:
This pilot study sought to explore the perceived value of Arts-Based Existential Interventions to support children regarding death. We were guided by the following research question: What are children’s perceptions of an arts-based existential intervention to navigate questions, feelings, and concerns pertaining to death?
Data Description:
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In conducting this study, we hoped to contribute to the existing clinical child psychology literature by qualitatively investigating how a developmentally adapted, creative, and dialogical workshops benefitted––or not––a group of children exploring existential concerns related to death. Our findings indicated that although some participants were initially apprehensive 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, our findings suggest that arts-based existential interventions could be a meaningfully constructive method for supporting children in navigating the subject of death.
Objective
Background
: Discussing the topic of death is not easy for most, especially children. While adults may fear that talking about death with children leads to distress, research suggests they are naturally curious to explore it more (Paul, 2019). Furthermore, adults report feeling uncomfortable and unqualified to lead these discussions (McGovern & Barry, 2000), thus leaving children without supportive spaces to openly explore this topic. One method that could better support children is through Arts-Based Existential Interventions. Study
Purpose
: This pilot study sought to explore the perceived value of Arts-Based Existential Interventions to support children regarding death.
Methods
: A 10-week workshop was conducted with two sixth-grade classrooms (n = 21; Mage 11.5) using a descriptive 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 audio recordings, observation grids, and semi-structured interviews.
Results
: Thematic analysis revealed that despite expressing some initial negative emotional reactions, participants later valued the workshops as a tool for fostering emotional expression, conveying empathy, and positively refining their perspectives on death. This pilot study reveals the intervention as a promising and meaningful space for children to explore and express their thoughts and emotions about death. Implications: Arts-Based Existential Interventions may help foster children’s 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.
Data description
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.
Limitations
Certain limitations must be acknowledged for this study. First, the workshops, which formed the core findings of this article, were relatively short in duration. Indeed, two total workshops were conducted on the theme of death, each being 60 minutes in total duration. Furthermore, although we used a qualitative approach in conducting this research, we caution readers against interpreting the findings of this research as being generalizable to a broader population.
Abbreviations
ABIs
Arts–Based Interventions
PI
Philosophical Inquiry
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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 to activate im
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 workshop theme’s meaning.
In this framework, art serves as a non-verbal creative medium that encourages children to externalize emotionally challenging subjects in a safe and accessible way. By first engaging their imagination and emotions through artistic expression, children become more emotionally grounded and open for further expansion on the explored idea(s). This in turn fosters an improved preparedness for PI, since participants are more emotionally grounded. By collaborating with their peers on sensitive subjects, 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. In our team’s related research, an intervention that combined arts and philosophy to explore themes of climate change and eco-anxiety with elementary school children was found to yield greater improvements in mental health scores compared to an art-only group (Malboeuf-Hurtubise et al., 2025). These findings provide early evidence for the value of integrating art and philosophy to support children’s mental health when navigating emotionally complex topics, such as death.
Study Aim
Building on a research gap suggesting that children need safe and brave spaces to openly explore questions and concerns relating to death, this pilot study aimed to provide children with such a space. The research questions guiding the study was: What are children’s 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 child psychology literature by qualitatively investigating how a developmentally adapted, creative, and dialogical workshops benefitted––or not––a group of children exploring existential concerns related to death.
Methods
Participants
For this study, children from two sixth-grade classrooms in an elementary school in Quebec, Canada, were recruited (n = 21; Mage 11.5; grade 6), along with their visual arts and movement teacher. Due to an ongoing research partnership in place between the research team and the school, a convenience sampling method was used to recruit participants. According to Longbottom & Slaughter (2018), children at this developmental stage are expected to approach a holistic understanding of death (i.e., universality, irreversibility, biological cessation, etc.), while simultaneously being curious to discuss it more. Participants were provided with opportunities to think, discuss, and learn about death through a combination of ABIs and PI activities. When participants had questions about death, they were encouraged to ask them within a framework that was open, welcoming, and supportive.
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 of the two 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
Development of Themes and Activities
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 fine arts, dance-movement, and photovoice. Sessions were held once a week for 60 minutes during school hours. 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, participants described their fear of death as resulting in some negative emotions, including anxiety.
All death-focused workshops were led by a master’s student (ZF) and facilitated by another master’s student (MG) using an arts-based existential intervention framework, 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 minutes, 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-minute 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 to the focus to 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 with 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 minutes.
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 of death, while also exploring the potential beauty within it. The semi-structured format ensured flexibility in validating all emotions expressed during the conversation.
Data Collection
A combined deductive and inductive approach was used to ensure data collection remained both objective (e.g., photographs of the artistic pieces, recordings) and interpretive (e.g., interviews, observation grids). This method allowed for a holistic representation of participants’ voices within our qualitative analysis.
Artwork
Photographs were taken of participants’ artistic creations, which included watercolor paintings, clay sculptures, and scrapbooks. Each artwork was assigned a unique identification number to maintain confidentiality of the participants. Each artifact was not systematically analyzed or included as part of the broader coding process, but rather, was collected for the purposes of providing illustrative examples on some of the creations participants made during the workshops. These selected examples illustrate how participants’ creations reflected and aligned with the themes identified in our qualitative analysis
Examples of artwork are provided in the supplementary materials section.
Interviews
Two weeks after the intervention concluded, semi-structured interviews were conducted with 21 students individually and privately, lasting between 15–45 minutes. 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 their 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 format can be made available upon request.
Group Discussions
Throughout the intervention, PI group-based discussions were conducted. All discussions were audio-recorded, transcribed, and anonymized to ensure participant confidentiality.
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. 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.
Analysis
All interviews and discussions were transcribed by research assistants and coded using a thematic analysis approach (Braun & Clarke, 2006). Open and inductive coding was applied using MAXQDA24 to identify preliminary themes and insights regarding participants’ responses to the intervention.
To ensure the validity and reliability of the initial codes, two researchers from the team (CMH & AM) reviewed and refined them. To further minimize researcher bias, the first author (ZF) collaborated with two additional research assistants who conducted independent open coding. Once all codes were synthesized, common themes were compiled into a single coding tree. Key thematic examples were structured into a table, supported by direct quotes from both participants and the classroom teacher.
Results
Thematic analysis revealed two overarching themes: negative reactions to the workshops, and appreciation of the workshops. Within these broader theme, sub-themes such as fostering empathy, encouraging emotional expression, and shifts in perspective on death emerged. These sub-themes are examined in detail in this section, which were derived by quotes from participants and their teacher. In this next section, we provide an account of the findings anchored by our data collection. A visual representation of the study’s themes and sub-themes are also found below in Table 3.
Table 3
Overarching themes and sub-themes from data analysis.
Overarching Theme
Sub-themes
Summary of theme
1. Negative reactions to 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 fosters both enhanced meaning of, and appreciation for, life itself.
Negative Reactions to the Workshops
As the team anticipated may occur, the workshops were met with some negative emotional reactions by participants, often conveying or outright expressing anxiety. Indeed, the teacher was also not surprised 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” (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 also verbalized their negative reaction to the intervention by questioning the purpose of the workshops with total apprehension: “can we like, do something happier this week?” (student). Others, conversely, decided to physically evade the workshops: “I don’t know, I just started feeling sad, so I left [the group discussion]” (student). 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 negative reaction, both the teacher and participants were comfortable discussing this topic during post-intervention interviews. In asking one student what precipitated their discomfort, one student explained: “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” (student). This participant seemed to explain that their discomfort––though it was indeed evoked by our workshop––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; “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” (student). This could be partly explained by the teacher’s belief that their students have 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” (teacher). Within these verbalizations, the workshops may have revealed discomforts around death are an unavoidable aspect of life, and in varying degrees, it may take hold during childhood.
This apprehension was not only reflected by our student participants, however. Indeed, this discomfort was also shown by the classroom teacher. In our initial discussions of planning these workshops, the researchers observed signs of apprehension towards openly addressing death concerns with students. After the workshops, in our interview with this same teacher, they still felt some degree 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 (teacher).
As revealed in this quote, there was an apprehension for this teacher 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 potentially fragile situation.
Despite the negative reactions expressed by both the participants and the teacher, those who participated in post-intervention interviews attested to their support for our workshops. In the sections below, we will elaborate on the ways in which some apprehension manifested into appreciation.
Appreciation for the Workshops
Although some participants expressed a negative emotional reaction to the workshops, it was during the interviews with some students and the teacher that the intervention received extensive 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] (teacher).
In the following sections, we will analyze this quote through the lens of three key sub-themes. The teacher’s observation that students “didn’t know how to initially approach” the topic reflects the presence of Negative Reactions, which was explored in the previous section. Aside from this central theme, however, the workshops importantly provided students with the necessary Encouragement of Emotional Expression, equipping them with tools to articulate their thoughts and feelings about death. Additionally, by expressing themselves openly, the connections formed between students during the workshops illustrated its potentiality for Fostering Empathy. Lastly, by listening and connecting with each other during philosophical discussions, this led participants to having a Shift in Perspective on Death.
Encouraging Emotional Expression
Aside from some participants expressing negative reactions, others expressed appreciation for the workshops as a space to openly share their emotions about death. As one participant plainly stated, “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” (student). Some acknowledged that being reminded of death brought up painful memories: “people were more sad, kind of remembering what happened in their past” (student). Another participant expressed 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” (student). participants nonetheless valued the opportunity to openly express their emotions, as it provided a sense of relief: “I just think of it, and like, let my emotions out instead of keeping it in. It’s not good to keep it in” (student). Having these opportunities was meaningful because it reassured students that they were not alone in their experiences of loss and grief. One participant reflected 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” (student). For many participants, the chance to express these emotions was rare, making the workshops particularly valuable to 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” (student). The classroom teacher, unaware that a student had expressed this sentiment, nonetheless echoed the same belief: “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” (teacher).
Fostering Empathy
Beyond providing an outlet for personal expression, the workshops also fostered a sense of connection between some participants, 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; Cuff et al., 2016). Although we initially sought to understand students’ perspectives on the value of discussing death, an unexpected yet dominant theme emerged in our analysis: the belief that these discussions actively promoted empathy between participants. Of all the coded themes, fostering empathy was the most frequently referenced, highlighting how participants saw value in witnessing each other’s shared vulnerability towards death. This pattern was observed by students 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” (student). 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” (student). Importantly, participants also appreciated 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” (student). Although the concept of empathy can be developmentally challenging for children to conceptualize, one participant demonstrated a clear understanding of its meaning within the context of navigating grief: “yeah, because my friend, h-h-her grandma died. And so, it was sad for the week that we were talking about death. So, like, I felt empathy for her” (student).
These findings of 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––displayed 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 (teacher).
In essence, exploring a deeply vulnerable topic allowed some participants to express their honest thoughts and emotions without concealment. Likewise, witnessing vulnerability in classmates––especially among those who typically maintained a tough exterior mirage––revealed a more sensitive and delicate side of their peers, thus challenging their preexisting assumptions of them while also fostering improved empathy in the process.
Shifts in Perspectives on Death
Aside from our workshops providing a safe space to openly explore the emotions that are commonly elicited by death, participants also 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 interventions’ impact and the deeper meaning in what was said. During interviews, one participant alluded to the value in 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” (student). Other participants found value in having discussions to refine 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 used this time to listen to each other’s viewpoints, as one participant 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’” (student). Some participants initially perceived death as entirely negative, but participating in these discussions resulting in them reframing it as potential relief 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 (student).
This shift in perspective led participants to view death not only as a negative event or just as a form of relief, but also as something meaningful and potentially beautiful: “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” (teacher).
Discussion
The purpose of this study was to better understand children’s perceptions of an arts-based existential intervention for navigating their questions, feelings, and concerns pertaining to death. Following a thematic analysis, results of this pilot study indicated that while participants initially had a negative emotional reaction in response to the arts-based existential intervention, they later expressed appreciation for the opportunity to openly reflect on and discuss themes related to death. In this discussion section, we contextualize the significance of these findings by drawing from relevant literature that may rationalize each of the themes that arose from the workshops.
Negative Reactions to the Workshop
Our findings revealed that children initially approached 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 allocated safe space, so to re-collect themselves and evade any discomforts provoked by the intervention. This reaction was––to some extent––expected; 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 (Duclos, 2013). Research has also indicated that younger individuals are typically found to harbour greater covert death anxiety, and its overt expression becomes more dominant as they grow older, likely as reminders of human mortality becomes less avoidable (Galt & Hayslip, 1998). 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 expression of anxiety, 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 (1977), can be theorized as “the experience of Being affirming itself against Nonbeing”, 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 (Becker, 1972; Solomon et al., 2015). Expanding on Becker’s (1973) argument that humans unconsciously structure their lives around a perpetual denial of death, Greenberg and colleagues (1986) developed Terror Management Theory (TMT) to explain the various psychological and cultural mechanisms that protect themselves against this threat. 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 recurring topic during this study’s group discussions. Our study revealed not only that children have mortality salience (i.e., an awareness of their own mortality; Burke et al., 2010), but also that, like adults, they employ various strategies to minimize existential threats. This was evident both in the ways participants avoided engaging in discussions about death and in the content of the conversations among those who did participate. For participants who reported negative experiences with the workshops, these reactions may reflect conditioned behaviors—specifically, the tendency of adults to shield children from discussions on mortality (Slaughter & Griffith, 2007). While it remains entirely possible that our workshops had a limited capacity to foster positive outcomes, such negative reactions from participants may also be better understood as products of cultural conditioning around the taboo of death.
While concerns about children’s psychological well-being and safety should not be overlooked in this study, there is also reason to suggest that engaging with such uncomfortable topics also holds therapeutic value. Returning to May (1977), he contended that having optimal mental health required that we learn not only how to accept anxiety as an unavoidable part of life, but that we also learn how to live with and embrace aspects of it, as it can often times foster personal growth and emotional intelligence. Similarly, Kierkegaard (1844) argued that anxiety is the most important human experience to have, precisely because it is one of the few methods that fosters improved self-understanding and growth.
Learning to know anxiety is an adventure which every man has to affront if he would not go to perdition either by not having known anxiety or by sinking under it. He therefore who has learned rightly to be anxious, has learned the most important thing.
Notably, Kierkegaard––like many philosophers––viewed death as being the most fundamental concern leading to anxiety. Freud (1917), who strongly advocated for investigating “unconscious” (i.e., covert) concerns, similarly argued that exploring the meaning of our anxiety force us to confront a range of converging questions about our existence, thus illuminating “a riddle whose solution would be bound to throw a flood of light of our whole mental existence”. More recent existential psychologists, such as Schneider (2023), argued that experiencing this form of anxiety is also 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, children navigate existential anxiety (Puskas et al., 2023), the anxiety revealed by participants in this study was likely reflective of an unresolved search for meaning in death. This finding is particularly relevant for parents, teachers, and clinicians, as children are rarely provided with opportunities to openly explore existential questions (Zanetti, 2020). When these questions remain unaddressed, children’s existential concerns may intensify, potentially heightening feelings of death anxiety and increasing the risk for the later development of psychopathologies, such as depression and anxiety disorders (Menzies et al., 2024). It is therefore essential that researchers continue exploring effective ways to support children in engaging with existential themes. Rather than silencing or pathologizing such reflections, educators and clinicians should welcome children’s questions and feelings, creating space for meaning making in the face of death.
Appreciation of the Workshops
Participants also responded positively to the intervention. Grounded in Arts-Based Existential Interventions, our workshops provided tools to help participants reconcile some of the anxieties they expressed around death. Prior research has shown that engaging in thematically rich philosophical discussions about life and death can foster meaning-making by clarifying existential concerns (e.g., fear of meaninglessness or isolation), building resilience to inevitable realities, and ultimately, embracing impermanence (Phan et al., 2025). Accordingly, these scholars recommended that death education—particularly when guided by “existential” inquiry—should be more widely integrated into pedagogical settings, so to strengthen children’s resilience in coping with the notion of impermanence. Our intervention offers one potential model for such an implementation into elementary school curricula.
In the following subsections, we elaborate on the overarching theme of participants’ appreciation for the intervention, focusing on three keyways they described benefitting from it: encouragement of emotional expression, fostering empathy, and shifts in perspective on death.
Encouragement of Emotional Expression
One potential theory underlying participants’ positive reception towards this intervention lied in their enhanced ability to emotionally express their thoughts and feelings on death. Indeed, participants utilized both philosophical discussion and artistic expression to thoroughly 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 (Pennebaker, 1997). These methods can in turn foster improved coping and distress management, which participants also described experiencing in the workshops during post-intervention interviews. May (1975) particularly advocated for embracing artistic creation as a means to reconcile 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.
Although May does not exclusively focus on children in his analysis, it is nonetheless a highly applicable statement. Given that children are found to be inherently more authentic (Rogers, 1951), and that authenticity is positively correlated with higher creativity levels (Xu et al., 2021), children for this reason are likely to benefit from artistically exploring their concerns around sensitive issues, such as death. In this study, the courage of participants to creatively “wrestle” (May, 1975) with their thoughts and feelings on death may have enabled them to reconcile its commonly associated anxiety (Becker, 1973). Our findings are thus largely consistent with May’s (1975) 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’ (1942) intersecting analysis of philosophy and art in The myth of Sisyphus provides 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 impose 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 (Das et al., 2024). The impact of ABIs for reconciling death concerns are also found to be applicable to children in other previous research: studies by Testoni et al. (2019) have found that employing various forms of artistic activities––such as Bibliodrama, youth literature, photovoice, and theater –– to be impactful for treating child death anxiety. Art therefore serves not just as a passive outlet for emotional expression, but more importantly can be conceptualized as a means to foster meaningful engagement on existential issues, thereby prompting children to process mortality in a way that feels more accessible to them. Further supporting this finding, Beaumont (2013) also advocated for the integration of ABIs into mental health treatments 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, children are theorized to 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 potential grief they are faced with.
Fostering Empathy
As a result of promoting emotional expression during the intervention, our analysis also revealed how death discussions appeared to foster empathy among participants. Aligning with developmental research showing that perspective-taking and emotional sharing serve as precursors to empathetic behavior (Eisenberg & Strayer, 1987), Batson (1991) 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 and Jackson (2004) 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. Fernandez et al. (2025) suggested that well-being and social connection are fostered not only by expressing appreciation and value toward 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––helps children feel seen, heard, and better understood (Rollins et al., 2020). Our participants experienced this process in action: witnessing peers share personal experiences of loss appeared to dissolve previous social tensions––if only temporarily––and fostered a sense of emotional closeness. In these moments of mutual recognition and care, participants were not only given space to express their feelings, but also to feel understood by others––a process that may be essential for building relatedness between school children.
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. This could suggest that while discussions about death may have initially provoked negative emotional reactions and overall discomfort, they can also foster social cohesion and interpersonal relatedness––core tenets of human existence that are fundamental in satisfying our basic psychological needs (Deci & Ryan, 2000). Also consistent with existential-humanistic therapeutic practices, embracing one’s vulnerability in the face of death is viewed not only an act of courage, but also a catalyst for healing. Yalom (2008) suggested that confrontations with death––our ultimate shared vulnerability––can provide us improved clarity on how to live more urgently, authentically, and meaningfully. Rather than diminishing the presence of death, confrontations with death have the power to reorient our values, priorities, and foster improved mental health. 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 (Bianco et al., 2019).
Shifts in Perspective on Death
Some participants also emphasized that openly and directly confronting death through art and PI led to a meaningful transformation in their thinking. Although existential questioning is likely to remain unresolved and persist throughout life (Tillich, 1952), participants recognized the value of engaging in these questions, rather than avoiding them. For example, in the initial stages of the intervention, many participants perceived death solely as a negative event. However, by the time post-intervention interviews were conducted, some perspectives had evolved. Whereas some continued to acknowledge death’s potentially distressing aspects, they no longer viewed 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. This shift in perception has clinical significance. In Quebec––a highly secularized region compared to other western regions––where this study was conducted, approximately 7% of all deaths occur through medical aid in dying (MAiD; Health Canada, 2022). This represents a significant proportion of deaths, many of which are likely to affect children––either directly or indirectly (e.g., through bereavement of grand-parents) ––within schools across the province. While we caution against generalizing these findings across cultural contexts, participants of this study viewed death as something that can be associated with relief. Indeed, they could be better equipped to cope with loss when they encounter it. By reframing death in a more nuanced way, children may experience less distress and subsequently develop more adaptive responses to certain experiences of grief.
Beyond viewing death just as a form of relief, some participants described it as beautiful precisely because life is temporary––recognizing that only finitude can imbue existence with urgency and meaning. In some instances, participants reflected 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 (Hornsey et al., 2025). Rather from 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. (2011) found that engaging in death reflections are associated with long-term feelings of gratitude for one’s existence.
While exploring the subject of death understandably was––and will likely continue remaining––an anxiety-inducing topic for participants, what emerged most clearly among our sample of participants is that life’s meaning, at minimum, is not diminished by its impermanence. More likely, it is temporality that enriches life’s value, which is thus what could compel us 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 participants’ mental health was 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 children 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 (2004) 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 favourable 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 children 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. Although children are often inclined to share their thoughts and feelings authentically (Rogers, 1951), this framing was intended to minimize any perceived pressure to provide expected responses.
This study received approval from the Bishop’s University Research Ethics Board (REB) on December 30th, 2023, File #102681.
Strengths and Limitations
A key strength of this pilot study was in its exploration of existential questions––topics that children 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 children’s reflections on death through an extended intervention. This dual approach fostered a holistic development of their emotional and intellectual engagement with mortality, demonstrating the potential of arts-based existential interventions to make complex existential themes accessible and meaningful.
However, this study is not without limitations. First, the intervention was relatively short, consisting of two 60-minute 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 children’s 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 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 rigour 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 practicality of teachers implementing them independently 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 children’s 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 children 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 (Malboeuf-Hurtubise et al., 2025), 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 children to engage with life’s most profound questions.
Declarations
Author Note
Correspondence regarding this article should be addressed to Zachary Fry (zfry16@ubishops.ca) and Dr. Catherine Malboeuf-Hurtubise (catherine.malboeuf-hurtubise@ubishops.ca)
Ethics Approval:
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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.
Consent to participate:
A
Informed consent to participate in this study was obtained from all individual children 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.
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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 to publish:
Informed consent for publication of confidential data was obtained from all individual participants included in the study.
Informed Consent:
A
All participants (and their parents/guardians) were informed about the purpose, procedures, and voluntary nature of the study within the consent form and also provided written consent prior to their participation. We also ensured to verbally remind the participants of what was going to unfold in each workshop, to ensure that participants never felt uncertain or anxious about their expectations regarding the outcomes of the research study.
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Funding
details: 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.
Clinical Trial Number
Not applicable
Competing Interests:
We have no known conflicting interests to disclose.
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Acknowledgement
We would like to thank Dr. Joel Montanez for his generous sharing of time and expertise in assisting with the development of this research. Furthermore, we would like to send our gratitude to the students and Catherine Jeanson-Daigle – the classroom’s art and dance teacher – for their trust, time, and participation in this work
“That’s what keeps me up at night”: A qualitative pilot study on how arts-based existential interventions could benefit children grappling with death
Introduction
The benefit of the child engaging with [existential] therapy… is not in escaping or taking refuge from the world, but in confronting it (Scalzo, 2010).
How we talk to children 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, children strive to allocate meaning to their lives, and this requires questioning the meaning of not only life, but also of death (Demers & Sinclair, 2015). Indeed, children show a natural curiosity about death and actively seek opportunities to learn more about it (Paul, 2019). In many cases, it is the child who initiates such conversations with adults––namely parents and teachers (Weber et al., 2021). However, studies find that some adults report feeling unprepared or uncomfortable addressing these topics (McGovern & Barry, 2000) and may respond in ways that unintentionally dismiss or invalidate the child’s questions or concerns (Koole & Tschacher, 2016; Malboeuf-Hurtubise et al., 2024; Zanetti, 2020). This reaction may thereby cause the child to repress emotions related to the topic. Children are thus left alone to explore this topic and need safe spaces that allow for the brave and open expression of questions and feelings regarding death.
What children know about death depends on their developmental stage and life experiences (Başyiğit & Arslan, 2024). Children are believed to become aware of death typically between the ages of four and six years-old, which is when they also seek to learn more about it (Paul, 2019; Slaughter & Griffith, 2007). Moreover, there are aspects of death that children grasp in various stages 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; Longbottom & Slaughter, 2018). Moreover, children are theorized to develop full maturity in their cognitive understanding of death as early as 9–10 years of age (Nagy, 1948), and by 13 years of age at the latest (Piaget, 1927). As for life events relating to death, children can experience these more blatantly by having a direct exposure, and the significance of it depends on the closeness between the witnessing child and the recently deceased (Longbottom & Slaughter, 2018). However, these experiences can also occur more subtly, which may result in the child indirectly learning about death (Slaughter & Griffith, 2007). These indirect learning experiences often occur via communication––usually with parents––as well as by what is witnessed in media portrayals and depictions of death, such as through Disney films (Cullen, 2017). However, since parents often feel too uncomfortable to lead open dialogues with their child(ren) (Cullen, 2017), and media sources tend to involve inaccurate depictions of death (i.e., ideas about death that contradict the aforementioned elements of death, e.g., believing that death is reversible; Cullen, 2017), children are at risk of being unsupported through their process of thinking and learning about it. This in turn can cause other potential side effects: (1) the child develops inaccurate conceptualizations, and/or (2) the topic eventually becomes distressing and/or repressed (Becker, 1972). As such, children require safe spaces that allow them to explore these concerns both verbally and non-verbally, in ways that are developmentally appropriate.
Art-based Interventions
Exploring existential concerns (e.g., death) through creative outlets such as art-based interventions (ABIs) could present an effective method of supporting children in navigating their fears and understanding of mortality (Alsharawneh, 2024; Xu et al., 2021). ABIs typically adopt a humanistic approach and are often regarded as especially effective for children (Schetman, 2009). One reason for this may be children's natural orientation toward authenticity––that is, a state of being true to oneself and one's inner experiences (Rogers, 1951). According to Rogers (1951), children are inherently authentic because they are more attuned to their emotions and less influenced by societal or cultural expectations. This natural authenticity may consequently facilitate deeper emotional expression and exploration, particularly when supported by creative and non-verbal modalities like art. Moreover, research has found that authenticity is positively associated with creativity (Xu et al., 2021), suggesting that children’s innate authenticity could enhance their capacity to engage 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 children 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 (Kwaśniewska-Paszta, 2022). The ideal time to explore these existential themes, therefore, could arguably be during the children’s 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 children in navigating issues pertinent to mental health, including those relating to existential concerns (Jones & Hughes, 2023). Indeed, they could further support children in expressing their feelings about death in a way that is nonverbal. In one study that used art therapy as a priming activity, it was shown to spark imagination and critical thinking prior to a discussion of death (McDonald & Holttum, 2020). ABIs thus show promise for tackling discussions on death in two ways: (1) they enable children to express their thoughts and feelings without having to verbalize them, and (2) they prime children for verbal expression by exercising their imagination and critical thinking skills.
Existential Interventions
Existential interventions, introduced by Yalom (1980), are one of the lenses through which concerns about death can be verbalized. Indeed, death is outlined as being one of the four (i.e., death, isolation, freedom, and meaninglessness) core “givens” of existence, which are existential concerns faced by everyone (Yalom, 1980). However, although Yalom acknowledged their experience around existential concerns (including death), existential therapy was never developed with children in consideration. As such, minimal research has studied whether Yalom’s (1980) theories of death can––or should––be adapted for children in a clinical context. In contrast, and drawing on a framework specifically adapted for children, Lipman & Sharp (1980) 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 children’s critical thinking skills through collaborative dialogue focused on social issues such as inequality and poverty (Alexander, 2004; Lipman et al., 1980). Over time, such engagements have shown to help children in constructing a deeper sense of meaning in relation to their lives and the world around them (Lipman et al., 1980). Importantly, participation in PI has 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 (Campbell, 2002). These outcomes are largely facilitated through the process of collaborative dialogue, along with the expression of care between peers and teachers (Sharp, 2004), underscoring the rich potential of PI to support children’s sociocognitive and emotional development on sensitive issues, such as death.
Given its broader effects seen in the classroom, PI could be a promising proxy to existential therapy. 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 for inquiry. Likewise in existential therapy practices––which strongly advocate for group intervention practices (Yalom, 1980)––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 (Lipman et al., 1980). Research has shown that investigating these existential questions with children can be helpful for navigating psychological distress and existential anxiety (Malboeuf-Hurtubise et al., 2024). Furthermore, a study by Goering (2014) 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, children reflected on the finitude of life, which was found to foster a deeper appreciation for their own lives and relationships. This suggests that keeping death present in children’s consciousness—when done in a developmentally appropriate and dialogical way—can support meaningful existential reflection. In this way, being able to philosophically engage in a discussion about sensitive subjects like death provides children with an opportunity to have their questions and feelings openly addressed. This, in turn, can address the existential anxiety commonly associated with death (Puskas et al., 2023).
Arts-Based Existential Interventions
Taken together, we propose that the combined integration of arts-based interventions and existential interventions (guided by the theoretical framework of PI)––coined henceforth as Arts-based Existential Interventions––offers a complementary pathway towards the constructive exploration of existential concerns in children. Using Sharp’s (2004) 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 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 relational openness and transparency between all 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 children’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 minutes when the art activity is completed, the facilitators prepare for a group discussion.
Once the researchers and participants have reconvened into a circle, a philosophical group discussion (PI) takes place. Participants are first praised for being so openly brave, thoughtful, and imaginative in developing their artistic creation. As such, participants are 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 their creation. Following these exchanges, participant artwork is linked to the overarching theme of the workshop using prepared group discussions. Utilizing a semi-structured format, participants are asked a thought-provoking question (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 points 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 deepen the conversation. The philosophical dialogue typically continues for approximately 30 minutes.
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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.
Declarations
Ethics Statement
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.
Consent to Publish
Informed consent for publication of confidential data was obtained from all individual participants included in the study.
Consent to Participate
Informed consent to participate in this study was obtained from all individual children 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.
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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.
References
Alexander R. (2004). Towards dialogic teaching. Dialogos.
Alsharawneh ZA. (2024). Working with existential inquiries in art therapy and expressive arts therapy. SMALTA, (2). http://dx.doi.org/10.15293/2312-1580.2402.04
Başyiğit Ö, Şimşek Arslan B. Death and grief literacy in the family. Psikiyatride Güncel Yaklaşımlar. 2024;16(4):644–57. https://doi.org/10.18863/pgy.1384342.
Batson CD. The altruism question: Toward a social-psychological answer. Erlbaum; 1991.
Becker E. The denial of death. Free; 1972.
Bianco S, Testoni I, Palmieri A, Solomon S, Hart J. The Psychological Correlates of Decreased Death Anxiety After a Near-Death Experience: The Role of Self-Esteem, Mindfulness, and Death Representations. J Humanistic Psychol. 2019;64(3):343–66. https://doi.org/10.1177/0022167819892107.
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa.
Burke BL, Martens A, Faucher EH. Two decades of terror management theory: A meta-analysis of mortality salience research. Personality Social Psychol Rev. 2010;14(2):155–95. https://doi.org/10.1177/1088868309352321.
Campbell JM. (2002). An evaluation of a pilot intervention involving teaching philosophy to upper primary school children in two primary schools, using the Philosophy for Children methodology [Unpublished MSc Educational Psychology thesis]. University of Dundee.
Camus A. (1942). The myth of Sisyphus. Vintage Books.
Cuff BMP, Brown SJ, Taylor L, Howat DJ. Empathy: A review of the concept. Emot Rev. 2016;8(2):144–53. https://doi.org/10.1177/1754073914558466.
Cullen C. ). Difficult conversations: Children, adolescents, and death. In: Stevenson RG, Cox GR, editors. Children, adolescents and death: Questions and answers. Routledge; 2017. pp. 235–46.
Das E, Fransen ML, Oliver MB. Beyond the denial of death: Death meditation increases a sense of connectedness and appreciation of life. Front Psychiatry 15. 2024. https://doi.org/10.3389/fpsyt.2024.1477479.
Decety J, Jackson PL. The functional architecture of human empathy. Behav Cogn Neurosci Rev. 2004;3(2):71–100. https://doi.org/10.1177/1534582304267187.
Deci EL, Ryan RM. The what and why of goal pursuits: Human needs and the self-determination of behavior. Psychol Inq. 2000;11(4):227–68.
https://doi.org/10.1207/S15327965PLI1104_01
Demers S, Sinclair F. (2015). Apprentissage et développement humain. In M.-A. Éthier, S. Demers & D. Lefrançois, editors, Les fondements de l’éducation: perspectives critiques (pp. 299–335). Éditions MultiMondes.
Duclos A. (2013). Inquietude in Pascal’s Pensées. Revue de métaphysique et de morale, No 78(2), 167–84. https://doi.org/10.3917/rmm.132.0167
Eisenberg N, Strayer J. Empathy and its development. Cambridge University Press; 1987.
Frias A, Watkins PC, Webber AC, Froh JJ. Death and gratitude: Death reflection enhances gratitude. J Posit Psychol. 2011;6(2):154–62. https://doi.org/10.1080/17439760.2011.558848.
Goering S. Using children’s literature as a spark for ethical discussion: Stories that deal with death. In: Mills C, editor. Ethics and children’s literature. Routledge; 2014. pp. 278–92.
Hornsey MJ, Tyson C, Ferris LJ, Crimston CR, Faulkner C, Barlow FK. The cosmic calendar: Being reminded of the vastness of time can improve wellbeing. J Posit Psychol. 2025;1–12. https://doi.org/10.1080/17439760.2025.2481039.
Jones K, Hughes B. Children’s experiences of death anxiety and responses to the Covid-19 pandemic. Illn Crisis Loss. 2023;31(3):558–75. https://doi.org/10.1177/10541373221100899.
Kwaśniewska-Paszta S. (2022). Death in children's literature against the background of selected child and childhood discourses. Soc Register (2), 109–32.
Koole SL, Tschacher W. Synchrony in psychotherapy: A review and an integrative framework for the therapeutic alliance. Front Psychol. 2016;7:862. https://doi.org/10.3389/fpsyg.2016.00862.
Lipman M, Sharp AM, Oscanyon F. Philosophy in the classroom. Temple University; 1980.
Longbottom S, Slaughter V. Sources of children’s knowledge about death and dying. Philosophical Trans Royal Soc B: Biol Sci. 2018;373(1754):20170267. http://dx.doi.org/10.1098/rstb.2017.0267.
Malboeuf-Hurtubise C, Lefrançois D, Éthier M-A, Smith J, Léger-Goodes T, Herba CM. (2024). Exploring children’s despair in the face of climate change. Communications Psychology, 2, 78. https://doi.org/10.1038/s44271-024-00130-4
Malboeuf-Hurtubise C, Léger-Goodes T, Dave H, Hoath L, Lefrançois D, Éthier M-A, Smith J, Fillion C, McLean E, Herba C. Climate change–based art and philosophy intervention and mental health in children. JAMA Netw Open. 2025;8(9). https://doi.org/10.1001/jamanetworkopen.2025.31298.
May R. The courage to create. W.W. Norton & Company; 1975.
May R. The Meaning of Anxiety. W.W. Norton & Company; 1977.
McDonald A, Holttum S. Primary school-based art-therapy: A mixed methods comparison study on children’s classroom learning. Int J Art Therapy. 2020;25(3):119–31.
McGovern M, Barry MM. Death education: knowledge, attitudes, and perspectives of Irish parents and teachers. Death Stud. 2000;24(4):325–33. https://doi.org/10.1080/074811800200487.
Menzies RE, McMullen K, Riotto GD, Iliescu S, Petrovic B, Remfrey M. From dread to disorder: A meta-analysis of the impact of death anxiety on mental illness symptoms. Clin Psychol Rev. 2024;113:102490. https://doi.org/10.1016/j.cpr.2024.102490.
Paul S. Is death taboo for children? Developing death ambivalence as a theoretical framework to understand children’s relationship with death, dying and bereavement. Child Soc. 2019;33(6):556–71. https://doi.org/10.1111/chso.12352.
Pennebaker JW. Writing about emotional experiences as a therapeutic process. Psychol Sci. 1997;8(3):162–6. https://doi.org/10.1111/j.1467-9280.1997.tb00403.x.
Rogers C. Client-centered therapy. Houghton Mifflin; 1951.
Rollins J, Rollins C, Boocks LA, Sitz T. Supporting children living with chronic medical conditions through empathetic art. J Child Fam stud. 2020;29:2218–33. https://doi.org/10.1007/s10826-020-01738-w.
Scalzo C. Therapy with children: An existential perspective. Routledge; 2010. https://doi.org/10.4324/9780429483929.
Schneider KJ. Life-enhancing anxiety: Key to a sane world. University Professors; 2023.
Sharp AM. The other dimension of caring thinking. Thinking: J Philos Child. 2004;1(1):15–21. https://doi.org/10.21913/jps.v1i1.989.
Slaughter V, Griffiths M. Death understanding and fear of death in young children. Clin Child Psychol Psychiatry. 2007;12(4):525–35. https://doi.org/10.1177/1359104507080980.
Testoni I, Piscitello M, Ronconi L, Zsák É, Iacona E, Zamperini A. Death education and the management of fear of death via photo-voice: An experience among undergraduate students. J Loss Trauma. 2019;24(5–6):387–99. https://doi.org/10.1080/15325024.2018.1507469.
Tillich P. The courage to be. Yale University Press; 1952.
Weber M, Alvariza A, Kreicbergs U, Sveen J. Family communication and psychological health in children and adolescents following a parent’s death from cancer. OMEGA - J Death Dying. 2021;83(3):630–48. https://doi.org/10.1177/0030222819859965.
Xu X, Xia M, Zhao J, Pang W. Be real, open, and creative: How openness to experience and to change mediate the authenticity-creativity association. Think Skills Creativity. 2021;41:100857. https://doi.org/10.1016/j.tsc.2021.100857.
Yalom ID. Existential psychotherapy. Basic Books; 1980.
Zanetti L. (2020). Why am I here? The challenges of exploring children’s existential questions in the community of inquiry. Child Philos, 16.
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Abstract
Background: Discussing the topic of death is not easy for most, especially children. While adults may fear that talking about death with children leads to distress, research suggests they are naturally curious to explore it more (Paul, 2019). Furthermore, adults report feeling uncomfortable and unqualified to lead these discussions (McGovern & Barry, 2000), thus leaving children without supportive spaces to openly explore this topic. One method that could better support children is through Arts-Based Existential Interventions. Study Purpose: This pilot study sought to explore the perceived value of Arts-Based Existential Interventions to support children regarding death. Methods: A 10-week workshop was conducted with two sixth-grade classrooms (n=21; Mage 11.5) using a descriptive 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 audio recordings, observation grids, and semi-structured interviews. Results: Thematic analysis revealed that despite expressing some initial negative emotional reactions, participants later valued the workshops as a tool for fostering emotional expression, conveying empathy, and positively refining their perspectives on death. This pilot study reveals the intervention as a promising and meaningful space for children to explore and express their thoughts and emotions about death. Implications: Arts-Based Existential Interventions may help foster children’s 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.
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