Table 3.

Type of expressive art therapy activity, research details and outcomes/conclusions, in health and nursing care between 2010 and 2020 (in alphabetic order, by author name; n = 15 papers).

Authors	Type of expressive art therapy activity	Context	Research design	Sample	Intervention	Method(s) of data collection	Outcomes
Alders & Levine-Madori 2010 [68]	Group therapy: music, guided imagery, painting, movement, poetry, sculpture, photography, themed discussion.	A community center for immigrants	A pilot experiment	N = 24 adult immigrants (mean age 75 years)	10-week intervention. Participants had the choice of attending a 2-h weekly art therapy session or one of five other activities.	Demographic data, pre- and posttest with the Cognitive Failures Questionnaire and the Clock Drawing Test.	Participants who attended the art therapy sessions outperformed those who did not on both cognitive evaluation tests.
Blomdahl et al., 2018 [74]	Group therapy: narratives, exploration of art media, drawings, colorings, relaxation exercises.	Two clinics from general care and two clinics from specialist psychiatric outpatient care	Randomized controlled trial according to the CONSORT recommendations for nonpharmacological treatment	N = 79 adults (18–65 years). 43 Individuals with moderate to severe depression (usual treatment and art therapy). 36 in control group, treatment as usual.	10-week intervention. 1-hour weekly sessions. The art-making was based on the participants’ own preferences.	Sociodemographic data, Montgomery-Åsberg depression rating scale (MADRS-S).	The intervention group showed a significant decrease of depression levels and returned to work to a higher degree than the control. Self-esteem significantly improved in both groups. Suicide ideation was unaffected.
Buday 2013 [76]	Drawings and paintings.	Hospice	A case illustration	N = 1 female (78 years)	10-month intervention. 34 sessions with an art therapist.	Noty specified	Gaining self-empowerment through the engagement of making art and reflecting on the resulting product; and offering a non-threatening means to explore thoughts and feelings.
Ciasca et al., 2018 [75]	Group therapy: guided imagery, painting, drawing, clay modeling, weaving, and collage.	A psychiatric institute in a university hospital	Randomized controlled trial	N = 56 outpatients with depression, (70 years). 25 in intervention group, 31 in control group	20-week intervention. 90-minute weekly workshops.	Sociodemographic questionnaire and pre- and posttests with the Geriatric Depression Scale (GDS-15), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and cognitive measures (Mini Mental State Examination).	The art therapy intervention for elderly women with stable, pharmacologically treated depression led to improvement in depression (P = 0.007) and anxiety symptoms (P = 0.032).
Guay 2018 [78]	Group therapy: drawing, painting, modeling, sculpturing.	A communication program for brain injury survivors	A pre-experimental comparison group study	N = 19 adult (29–93 years) individuals with brain injury. 11 in art therapy group, 8 in communication skills group	10-week program, based on the participants’ own interests. 90-minute sessions compensatory communication strategies (15 min), engagement in art making (45–60 min), and group sharing about the meaning of the artwork using compensatory strategies for communication (15–30 min).	Pre- and postmeasures with a partial Assessment for Living with Aphasia and Art Therapy Perception (ATP) questionnaire.	Results from pre- and postmeasures did not show statistically significant between-group differences. However, the participants found art therapy to be a new way to express their thoughts and feelings, and appeared to reduce their levels of stress and anxiety. The group art therapy sessions created a new venue for socializing and establishing deeper, more meaningful friendships. Group art therapy seemed to build up the participants’ self-confidence.
Ilali et al., 2019 [79]	Group therapy: drawings as narratives.	A day center for elderly adults	A randomized controlled study	N = 54 older adults (age > 60). 27 in interventions group, 27 in control group	6-week intervention. 60-minute weekly group sessions.	Pre- and posttests with the Abbreviated Mental Test and the Short Geriatric Depression Scale.	Symptoms of depression appear to have decreased in the experimental group following the 6-week course of drawing based on life review. For the control group, a rising trend in depression scores was found.
Lee et al., 2017 [70]	Group therapy: famous painting appreciation, delivered in odd numbered sessions (i.e., sessions 1, 3, 5, and 7), and creative artwork generation, delivered in even numbered sessions (i.e., session 2, 4, 6, and 8).	An outpatient clinic at the Department of Radiation Oncology	A prospective, single-arm trial	N = 20 adult (32–79 years) cancer patients receiving radiotherapy	4-week intervention. Participants underwent eight 30-min art therapy sessions during radiotherapy, i.e., 2 sessions per week.	One-on-one interviews between trained therapists and patients, individual questionnaires before, during, and after radiotherapy: the Hospital Anxiety and Depression Scale (HADS), the Hamilton Depression Rating Scale (HDRS, The Edmonton Symptom Assessment Scale (ESAS.)	This form of art therapy led to improvement or maintenance of cancer-related distress compared to baseline among patients throughout their treatment and significant reductions in the prevalence of severe depression and anxiety. The ESAS scores showed no improvement.
Mahendran et al., 2018 [65]	Group therapy: Guided viewing and cognitive evaluation of art works at the respective sites was conducted as a group activity by trained staff and involved narration of thoughts and inner experiences. A second component involved visual art production.	Community	A randomized controlled trial	N = 46 (mean age 71). 22 in intervention group, 24 in control group	9-month intervention. Weekly art therapy or music listening.	The Rey auditory verbal learning test (RAVLT; memory test including list learning, delayed recall and recognition), Wechsler Adult Intelligence Scale-3rd edition (WAIS-III), Block design (visuospatial abilities), Digit Span Forward (attention and working memory), and Color Trails Test 2 (Executive function), Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), and a 100-point Visual Analog Scale (VAS; sleep quality).	Art therapy had more significant effects than music with improvements in memory, attention, visuo-spatial abilities and executive function at 3 months and which was sustained in the memory domain at 9 months.
Monti et al., 2013 [71]	Expressive art tasks (drawing a picture of their self, awareness of sensory stimuli, imaging self-care, art production to foster mindfulness, creating stressful and pleasant event pictures, and free expression) with mindfulness exercises.	One university’s cancer center	A randomized two-group controlled intervention study	N = 191 patients with breast cancer (mean age 56,9). 98 in intervention group, 93 in control group	8-week intervention. Either mindfulness-based art therapy (MBAT) intervention or a breast cancer educational support program.	The Symptoms Checklist-90-Revised, the Medical Outcomes Study Short-Form Health Survey at baseline; immediately post-intervention and at 6 months.	Results showed overall significant improvements in psychosocial stress and quality of life in both the MBAT and educational support groups immediately post-intervention; however, participants with high stress levels at baseline had significantly improved overall outcomes only in the MBAT group, both immediately post-intervention and at 6 months.
Moxley et al., 2011 [69]	Group therapy: quilting one’s story with a precut cotton square and an assortment of materials (e.g., pieces of colored fabric, felt, markers, beads, fringe, ribbon, etc.), then presenting it.	Leaving Homelessness Intervention Research Project	A cross-sectional study	N = 20 older African American homeless women	Two workshops	Two investigators’ observations and notes, a focus group interview.	Creating the quilt, e.g., pushing and pulling a needle through fabric, making decisions about design, ripping apart and starting over. Transforming a destructive experience into something constructive seemed to be a metaphor for the women’s progress in finding and maintaining housing and in their growing self-efficacy.
Pike 2013 [66]	Group therapy: collage, autobiographical timeline, coloring mandalas, installations.	A community center, a retirement center, an adult daycare, an assisted living facility, and a skilled nursing facility	A controlled intervention study with matching groups	N = 91 older adults. 54 (mean age 78 years) in intervention group, 37 (mean age 76 years) in control group	10-week intervention. Weekly group sessions.	Pre- and posttest with the Clock Drawing Test, the Cognitive Failures Questionnaire (CFQ).	A t-test and univariate linear regression, with a medium effect size (d = .064), indicated that the art therapy treatment was associated with significantly improved cognitive performance. Other findings suggest that session duration and art therapy approach significantly correlated with improved cognitive performance.
Safrai 2013 [77]	Painting and collage sessions.	Hospice care	A case illustration	N = 1 male, 71 years of age	2-month intervention. Twenty-two semiweekly sessions with an art therapist.	Discussion.	Painting with an art therapist allowed the patient to shift from a state of anxiety and existential dread to a more accepting, fluid awareness of the dying process. Additional benefits to the patient included improved quality of life, self-expression, and meaning making, as well as an increased ability to relate to the art therapist and to connect with family members and staff.
Stephenson 2013 [67]	Group therapy: drawing, painting, work in clay, printmaking, Chinese brush painting, collage.	A community art therapy program	A project description	N = 70 residents of a large cooperative housing complex (58–99 years)	Two weekly sessions.	Observations of diverse participant interactions in the nondirective therapy studio over the course of 6 years.	A community art therapy program can a) foster artistic identity, b) activate a sense of purpose and motivation through creative work, c) use art as a bridge to connect with others, and d) support movement toward the attainment of gerotranscendence.
Tucknott-Cohen & Ehresman 2016 [72]	Thick artist paper, outlined mandalas, pens, pencil crayons, and bingo magic markers.	Alzheimer care in a long-term care home	A case illustration	N = 1 female (>80 years) with advanced dementia, vocalizing with noises instead of words	17-week intervention. Individual 45-min therapy weekly.	After each session, the art therapist photographed the art and wrote summaries and annotations.	The treatment concerns that arose, altered view of reality, agitation, and retrogenesis provide insight on the use of art in dementia care for increasing the individual’s overall quality of life.
Woolhiser Stallings 2010 [73]	Collage and writing.	A care center for persons with dementia	A qualitative study	N = 3 females with dementia (70–80 years)	Two individual art therapy sessions per person.	A modified Magazine Photo Collage assessment.	A collage allows older adults with dementia an opportunity to convey information that they might not be fully capable of verbalizing.