Pre-Texts

Introduction

Depression and anxiety significantly impact global youth, at 45% of their disease burden. Specifically in low-resource settings such as Kenya and Latin America, mental illness is rising, along with poverty, high dropout rates from school, and increased suicide risk. Systemic obstacles to mental health include limited access to expert care, high treatment costs, and societal stigma. Moreover, Western-developed evidence-based treatments (EBTs) show limited adaptation or success in contexts of developing countries. Youth need new accessible, stigma-free, scalable, and culturally suitable interventions. Pre-Texts is an effective response. The arts-based pedagogy applies a holistic approach; making art from texts stimulates self-efficacy and mitigates suffering.

Scope

Arts-based interventions, with music, visual arts, dance, and drama, have shown significantly positive results in supporting mental health, particularly among youth. These interventions have been effective in enhancing self-confidence, self-esteem, resilience, and reducing externalizing behaviors in young people. 

The Pre-Texts protocol combines literacy with art-making, to address depression and anxiety in children and youth. Pre-Texts begins with a text in any genre - novels, physics, history – as raw material for art-making activities and for group reflections on the creative process. Though different from standard art therapy, Pre-Texts harnesses the therapeutic potential and cost-effectiveness of arts-based interventions to engage in academic learning through creative, non-competitive activities that stimulate autonomy and critical thinking.

Initially offered to young children, Pre-Texts has now been successfully implemented for a range of participants worldwide. A Randomized Controlled Trial (RCT) in Kenya evaluated its effectiveness for adolescents in an afterschool setting facilitated by trained lay providers, demonstrating a significant reduction in depression and anxiety symptoms among adolescents.

In a collaboration with the Ministry of Education, this project aims to scale up the work in Kenya through public schools over the next two years. The research team will test in parallel studies the therapeutic effectiveness of Pre-Texts in Asuncion, Paraguay, and in Bogotá, Colombia. 

Insights and Deliverables

The research will yield publishable papers on the therapeutic value of Pre-Texts in Kenya, Paraguay, and Colombia. Evidence to be analyzed will include surveys, biometrical measurements, and qualitative information through interviews, videos, and artistic productions. The current protocol for Pre-Texts is publicly available on the website and may be enhanced and developed in response to the new research. Most importantly, researchers plan to offer training for new facilitators, both teachers in public school classrooms and lay providers outside of class.

Project Team

The project is led by Doris Sommer (Professor of Harvard University and Founder of Cultural Agents, Inc.) and Tom Osborn (Founder and CEO of Shamiri Institute). 

The project team includes Jose Molinas, former Minister of Development, Paraguay and CEO of Instituto Desarrollo; Pier Luigi Sacco, Professor of Economic Policy, Pescara Italy and Senior Advisor OECD; Victoria Mena Rodriguez, Professor of Design, Tadeo Lozano University, Colombia; Jose Falconi, Professor of History of Art and Human Rights, University of Connecticut. 

Funding and Support

Support for this project is provided by the Motsepe Presidential Grant, Harvard University 2024; Ministry of Education, Paraguay; and the Secretariat of Education, Bogotá, Colombia.

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