Table 1.
Results of analysis of arts intervention studies.
| Studies | Interventions | Processes and mechanisms | Depression outcomes, measures and scales | Quality assess and design |
|---|---|---|---|---|
| *Ali et al., 2014 | “Group interactive art therapy” “drawing and painting using paper, pencils and crayons, making clay figures, drawing on an iPad, and taking photographs using a camera.” Group discussion about issues/emotional expression. n = 6 Session duration unknown; 2x week; 6 weeks |
Non-directive approach with free use of art materials. Enjoyment of arts processes; experience of safe space where fears and concerns regarding experiences of illness could be expressed. | HADS Median score of 8 (borderline abnormal anxiety and depression) to median score of 6 (normal range) post-intervention. |
COREQ 15/32 PEDro 3/11 MM, pilot study |
| + Canuto et al., 2008 | Group “encourages patients to express and understand emotions through artistic expression and creative processes.” Provides insight to emotions, thoughts, and feelings. n = 122 6 h; 2–3x week; duration unknown-ongoing during individual course of treatment. |
Enhanced self-awareness and empowerment, self-esteem, reduced stress. Outcomes: improvement in mental quality of life, better adhesion to therapeutic community treatment and progress in patients' self-rating of group therapy |
GDS (p < 0.001) |
PEDro 7/11 LA |
| *Ceramidas, 2012 | Group faith-based CBT intervention with art (abstract mixed-media paintings, clay to create animal forms/symbols of “life emerging,” individual collages depicting joys of life, religious symbols, and “free artwork,” found object collages created in pairs, and mask-making). “Encourage active, purposeful socialization and connectedness among residents.” n = 6 50 min; 1x week; 6 weeks |
Observed outcomes: acceptance of the cognitive/physical limitations of others, seeking to understand others through requesting facilitator assistance, caring for others/including others during sessions, altruism, a sense of belonging, trust, humor, and spirituality. | GDS Not significant; Effect size not reported |
PEDro4/11 PS, single group, pre and post-design |
| *Choi and Jeon, 2013 | Group art therapy with collage medium and reminiscence therapy Facilitate recall of memories through engagement in collage making. Process to aid in facilitation of interpersonal engagement and memory recall to improve cognition. Facilitation of open dialogue among group participants. n = 66. 1 h; 2 x week; 5 weeks |
Themes of support and empathy. Recall and sharing of memories- reflecting in group discussion on “the challenges posed by remembering,” “Internal integration” p. 329 | GDS (p < 0.001) |
PEDro7/11 QE |
| *Ciasca et al., 2018 | Art therapy group with individual focus. Relaxation/guided imagery before art making. Verbal group processing post art making. Techniques involved themes leading to reflection on adaptation to difficult life circumstances, such as losses, death, finitude, resentment, solitude, and feelings of impotence. n = 56 90 min; 1x week; 20 weeks; n = 11 |
Reduction of anxiety, increased self-esteem. Shifting from passively waiting for guidance and assistance to increased independent engagement in art process. Relaxation, shifting from worried and “negative” thought patterns, feelings and emotions concretized through art. | GDS (p < 0.007) BDI (p < 0.025) |
PEDro8/11 RCT |
| #de Guzman et al., 2011 | Individual interviews and traditional Filipino art-making (TFA) “puni-making” to “overcome pangs of depression” through the “provision of figurative psychological crutches” to foster a positive view of life and self. n = 3 Length of intervention not specified. |
Experience of support from researchers, feelings of accomplishment re ability to do something new and hopes to continue improving and learning new skills related to the art-making; engagement in new activities added to feelings of positive self-worth; engagement in traditional art-making offered opportunity to nurture self-esteem through exploring new skills and possibilities. | Emergent themes of depression and self-esteem: “Me, Myself, and Melancholy” and “Will Not Let My Worth Wither” |
COREQ 13/ 32 QS phenomenological |
| *Doric-Henry, 1997 | Individual pottery class/sessions based on Eastern Method throwing technique. Supporting and teaching participants ceramic process from start to finish, n = 40 (experimental group 20, control 20) 1 h; 1x week; 8 weeks |
Increased self-esteem through mastery of materials.; shifting from passively waiting for guidance and assistance to increasingly independence in art process | BDI (p < 0.05) |
COREQ 16/32 PEDro 5/11 QE |
| + Drăghici, 2012 | Group therapy; drawing tasks including draw a tree, house, silence, a rose bush, the ideal season, colors of life, draw feelings. Followed by verbal processing. Facilitating reminiscence, exploration of feelings, increasing self-insight/different aspects of self. Symbolization of strengths, weaknesses, and blockages. n = 30 (closed group 13, open group 17) unspecified session length; 8 sessions over one month. |
Increased awareness of needs to resolve old conflicts, restoration of confidence, communication abilities, and feelings of belonging to a group | HDRS Effect size not reported |
PEDro 3/11 PS, single group, pre and post- test design |
| + Goldblatt et al., 2010 | Group guided manipulation of modeling clay following protocol. No time limit for manipulating clay, but 12–40 min. followed by verbal processing. n = 22 One session (length unspecified) |
Self-expression, autonomy, playfulness, and self-soothing. Reduction of ruminating and recurring thoughts” through guided clay manipulation and verbal processing. |
BSI (p < 0.001) |
PEDro 5/11 PS, single group, pre and post- test design |
| *Hoffmann, 2013 | Individual intervention. Art therapy session directives: clock drawing test (CDT), Person Picking an Apple from a Tree (PPAT), a collage of likes and interests, non-directive modeling clay, family drawing, self-portrait, a wooden model airplane, and watercolor painting. n = 1 Session duration unknown; 1–2 x week; 6 weeks; 8 sessions total |
Focus on creativity activity to switch focus from Parkinson's Disease (PD) to the task at hand, lessening stress levels/preoccupation with PD. Visual communication of thoughts/feelings | “Slight decrease in depressive symptoms” Parkinson's Disease Questionnaire (PDDQ-8) scores No effect size reported |
PEDro1/11 SSR, single-subject research design with multiple baselines |
| #Hsu et al., 2017 | Group drawing and painting tasks to n = 141 50 min; 1x week; 6 months |
enable self-expression through different themes, Art therapy to reduce stress and incorporate fine motor skills/cognitive training | CSDD (P = 0.047) |
PEDro5/11 RCS |
| *Im and Lee, 2014 | Group session: mandala drawing, drawing taking turns, mud crafts, expression of body parts, collage, drawings of happy times in life. n = 94 (65 in art therapy, 29 in music therapy) 1 h; 1x week; 12 weeks |
Promotion of autonomy and validation of experiences of disease/ depression/ negative experiences. “reduces the resistance of revealing and it also helps to the formulation of positive self-ego by respecting patients' imagination and unique personality.” Expressions of anger and hostility through visual arts, self-contemplation, expression of emotion in “socially acceptable ways,” use of imagination | KGDS (p = 0.000; r = 0.32) |
PEDro5/11 PPT, one group |
| +Kang et al., 2010 | Group session. Landscape composition technique (drawing a house, tree, and people), a squiggle drawing game, mixed-media collage (newspaper, cloth remnants, wallpaper, found items, etc.), mandala drawings, finger painting, molding clay, and drawings reflecting on themes of the past, present, and future. n = 38 (20 in experimental group, 18 in control) 3 h (30 min art therapy); 2x week; 9 weeks |
Interventions developed to assess the mental state of the individuals who had difficulty expressing emotions, as a tool of expression, facilitated the individual's probing their own thoughts and feelings | Improved cognitive function, enhanced mental health, reduced depression KGDS (p < 0.001) |
PEDro6/11 QE |
| *Kim H.-K. et al., 2016 | Group and individual. 3 phases: traditional Korean art (1-10) Artmaking- structured art directives including pre-made clay figures that could be designed by participants, decorating bride and groom headpieces (11-25), creation of family photo frames, mandala drawings, and collaborative paintings (27-36) n = 28 (experimental group 14, control 14) 45 mins per session; frequency unknown; 36 sessions total |
Development of rapport among group members, facilitate life review/reminiscence, self-integration, conflict resolution. Reduction in levels of depression and improved ability for self-expression |
S-GDS (p = .036) | COREQ 4/32 PEDro 4/11 MM |
| *Kongkasuwan et al., 2016 | Group session. 5 stages: meditation with music, warm-up activity, main activity (art-making) and group singing activity, ending with group-healing circle. n = 113 (59 in control, 54 in intervention) 1.5–2 h; 2x week; 4 weeks |
“stimulate and benefit cognition, physical state, emotion, communication, social relations, and spiritual dimensions” improved concentration, emotion, self-confidence, and motivation; |
HADS (p = 0.361) |
PEDro8/11 RCT |
| *Lam, 2015 | Group art therapy with movement, play, and music. Warm up prior to art making. Structured art directives followed by group processing . n = 11 2 h; 1x week; 12 weeks |
Facilitation of meaningful group engagement, successful experiences in art processes, aiding in relaxation, increasing confidence and empowerment in ability to manage emotions. Increased socialization, increased aesthetic skills, increased-self-reflection, decreased depression, and anxiety, increased life satisfaction | GDS (p < 0.005) |
COREQ 15/ 32 PEDro5/11 MM |
| *Rawtaer et al., 2015 | Group session. Participants guided “through creative and narrative segments.” Specific interventions not stated. Multimodal approach of all included interventions emphasized. n = 101 30 min; 1x week; 10 weeks 30 min; biweekly; 42 weeks; 1-year total |
Mental stimulation and social/group engagement. | Reduce negative emotions and anxiety and improve self-esteem. SDS (p < 0.05) |
PEDro6/11 OS |
Key: Depression outcomes: We use the term ‘outcomes’ here for all studies, even though only some studies offer calculations of effects that adjust for outcomes compared to control group.
BDI, Beck Depression Inventory; BSI, Brief Symptom Inventory; CSDD, Cornell Scale for Depression in Dementia; GADI, Goldberg Anxiety and Depression Inventory; GDS, Geriatric Depression Scale; HADS, Hospital Anxiety and Depression Scale; HDRS, Hamilton Depression Rating Scale; KGDS, Short Form of the Korean Geriatric Depression Scale; S-GDS, Short Geriatric Depression Scale; SDS, Zung Self-Rating Depression Scale.
Intervention coding: * intervention delivered by trained or registered art therapist; # intervention delivered by other professional; and + unclear.
Design codes: COD, crossover design; CS, case study; CDA, collaborative discourse analysis; LA, longitudinal study; MM, mixed methods; OS, observational study; PE, pre-experimental (i.e. a single group studied without comparison to control group); PPGD, prospective, parallel-group design; PPT, pre and post-test; PS, pilot study; PT, pragmatic trial; QE, quasi experimental; QS, qualitative study, RCT, randomized control trial; RCS, retrospective cohort study; SSR, single subject research.