art and music therapy essay

The Role of Art and Music Therapies in Mental Health and Beyond

Prescribing art therapy , yoga, and music lessons is truly a breakthrough for mental health treatment . I want to be completely clear here, this is a breakthrough, but not a breakthrough therapy per se. It is a huge step forward, on the level of readjusting our mental health system, it is really a systems course correction at the root of it. Art therapy, music, etc., all are tested modalities for improving mental health conditions; almost all of them. For chronic, highly disordered and severely dysfunctional patients, this is not a miracle cure. These are, at best, supplementary, tandem, and co-functioning treatment methods to mitigate the severity and intensity of symptoms.

I am not knocking or trying to minimise the importance of this breakthrough. These are not only important modalities in and of themselves, but also support the creativity , independence, and freedom of patients to not only choose their own method of care but also nourish their capacity to carry on treatment more autonomously without being under direct supervision . 

Even more importantly, the system is broken, in total if not complete disarray, and needs to be revised urgently if we are to advance treatment at the speed it requires to meet the mental health crisis where it’s at. These new prescribed modalities will not only serve to add ‘person-centredness’ to the paradigm but also new flexibility within the limits of the system.

Even highly disordered patients are extremely creative during their darkest hour. Art therapy, music, and all of these modalities which draw upon creativity and promote purposeful free-flowing ideas are as self-soothing as they are productive in reducing the negative impact of active symptoms.

I can tell you that I have benefited from a music or art group on an inpatient unit in the hospital many times. Some of my fondest memories from experiencing first-episode psychosis in the hospital were singing and dancing to Stevie Nicks , at my request, when I could barely speak from word salad symptoms and was just a few moments away from being transferred to a higher level of inpatient care for unresolved psychosis. But I danced and laughed like the floor was on fire.

Art, music, yoga, all of these modalities are terribly inaccessible to most patients living off state benefits, who are consigned to a life shut-in and isolated in their homes. Aside from ‘getting out more’, these patients simply don’t have the resources to pay for and maintain a connection to art therapists and other more non-traditional treatment in the community. Unless you are connected to a special service or have the best insurance, these modalities simply aren’t an option for most service users and people with a severe mental health condition.

I truly applaud this shift in the systems paradigm that for so long was all about medication and traditional psychotherapy. We really need more of this in countries supposedly promoting better mental health treatment.

I also want to suggest that therapists who practice traditional talk therapy , straight CBT (cognitive behavioural therapy) can continue to add new self-soothing and proven techniques to their toolkit. I am always encouraging my student therapists to do artwork, let their children dance in therapy. Yes, you read this right, just dance, when the time is right and fits the course of treatment.

We need to get out of this traditional black and white thinking of what therapy is and is not . Therapy is what people need in the moment, to feel and behave in a manner that better suits their goals, chosen lifestyle, and needs. So with this said, why not let a child who is struggling to adjust to a new foster parent, dance in session when he can’t play at home. Sure, not for every session and for the duration of every patient contact, but sometimes, when it will benefit the patient, you just have to do it. 

Yes, this is truly a breakthrough in thinking among us practitioners and the higher-ups in our discipline who say what’s what in mental health treatment. It signals that we need to be dynamic, and shift our thinking as practitioners, peers, and anyone charged with providing therapeutic intervention . It is high time we see more of it, from government-sponsored care and any system which is charged with the care of people with a psychiatric disability, or who needs therapeutic intervention to find relief from whatever problem in their life is causing them distress.

Max E. Guttman, LCSW  is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.

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Art therapy: a complementary treatment for mental disorders.

• 1 College of Creative Design, Shenzhen Technology University, Shenzhen, China
• 2 The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
• 3 Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China

Art therapy, as a non-pharmacological medical complementary and alternative therapy, has been used as one of medical interventions with good clinical effects on mental disorders. However, systematically reviewed in detail in clinical situations is lacking. Here, we searched on PubMed for art therapy in an attempt to explore its theoretical basis, clinical applications, and future perspectives to summary its global pictures. Since drawings and paintings have been historically recognized as a useful part of therapeutic processes in art therapy, we focused on studies of art therapy which mainly includes painting and drawing as media. As a result, a total of 413 literature were identified. After carefully reading full articles, we found that art therapy has been gradually and successfully used for patients with mental disorders with positive outcomes, mainly reducing suffering from mental symptoms. These disorders mainly include depression disorders and anxiety, cognitive impairment and dementias, Alzheimer’s disease, schizophrenia, and autism. These findings suggest that art therapy can not only be served as an useful therapeutic method to assist patients to open up and share their feelings, views, and experiences, but also as an auxiliary treatment for diagnosing diseases to help medical specialists obtain complementary information different from conventional tests. We humbly believe that art therapy has great potential in clinical applications on mental disorders to be further explored.

Introduction

Mental disorders constitute a huge social and economic burden for health care systems worldwide ( Zschucke et al., 2013 ; Kenbubpha et al., 2018 ). In China, the lifetime prevalence of mental disorders was 24.20%, and 1-month prevalence of mental disorders was 14.27% ( Xu et al., 2017 ). The situation is more severely in other countries, especially for developing ones. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden. While pharmacological treatment is the first choice for mental disorders to alleviate the major symptoms, many antipsychotics contribute to poor quality of life and debilitating adverse effects. Therefore, clinicians have turned toward to complementary treatments, such as art therapy in addressing the health needs of patients more than half a century ago.

Art therapy, is defined by the British Association of Art Therapists as: “a form of psychotherapy that uses art media as its primary mode of expression and communication. Clients referred to art therapists are not required to have experience or skills in the arts. The art therapist’s primary concern is not to make an esthetic or diagnostic assessment of the client’s image. The overall goal of its practitioners is to enable clients to change and grow on a personal level through the use of artistic materials in a safe and convenient environment” ( British Association of Art Therapists, 2015 ), whereas as: “an integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psycho-therapeutic relationship” ( American Art Therapy Association, 2018 ) according to the American Art Association. It has gradually become a well-known form of spiritual support and complementary therapy ( Faller and Schmidt, 2004 ; Nainis et al., 2006 ). During the therapy, art therapists can utilize many different art materials as media (i.e., visual art, painting, drawing, music, dance, drama, and writing) ( Deshmukh et al., 2018 ; Chiang et al., 2019 ). Among them, drawings and paintings have been historically recognized as the most useful part of therapeutic processes within psychiatric and psychological specialties ( British Association of Art Therapists, 2015 ). Moreover, many other art forms gradually fall under the prevue of their own professions (e.g., music therapy, dance/movement therapy, and drama therapy) ( Deshmukh et al., 2018 ). Thus, we excluded these studies and only focused on studies of art therapy which mainly includes painting and drawing as media. Specifically, it focuses on capturing psychodynamic processes by means of “inner pictures,” which become visible by the creative process ( Steinbauer et al., 1999 ). These pictures reflect the psychopathology of different psychiatric disorders and even their corresponding therapeutic process based on specific rules and criterion ( Steinbauer and Taucher, 2001 ). It has been gradually recognized and used as an alternative treatment for therapeutic processes within psychiatric and psychological specialties, as well as medical and neurology-based scientific audiences ( Burton, 2009 ).

The development of art therapy comes partly from the artistic expression of the belief in unspoken things, and partly from the clinical work of art therapists in the medical setting with various groups of patients ( Malchiodi, 2013 ). It is defined as the application of artistic expressions and images to individuals who are physically ill, undergoing invasive medical procedures, such as surgery or chemotherapy for clinical usage ( Bar-Sela et al., 2007 ; Forzoni et al., 2010 ; Liebmann and Weston, 2015 ). The American Art Therapy Association describes its main functions as improving cognitive and sensorimotor functions, fostering self-esteem and self-awareness, cultivating emotional resilience, promoting insight, enhancing social skills, reducing and resolving conflicts and distress, and promoting societal and ecological changes ( American Art Therapy Association, 2018 ).

However, despite the above advantages, published systematically review on this topic is lacking. Therefore, this review aims to explore its clinical applications and future perspectives to summary its global pictures, so as to provide more clinical treatment options and research directions for therapists and researchers.

Publications of Art Therapy

The literatures about “art therapy” published from January 2006 to December 2020 were searched in the PubMed database. The following topics were used: Title/Abstract = “art therapy,” Indexes Timespan = 2006–2020.

A total of 652 records were found. Then, we manually screened out the literatures that contained the word “art” but was not relevant with the subject of this study, such as state of the art therapy, antiretroviral therapy (ART), and assisted reproductive technology (ART). Finally, 479 records about art therapy were identified. Since we aimed to focus on art therapy included painting and drawing as major media, we screened out literatures deeper, and identified 413 (84%) literatures involved in painting and drawing ( Figure 1 ).

Figure 1. Number of publications about art therapy.

As we can see, the number of literature about art therapy is increasing slowly in the last 15 years, reaching a peak in 2020. This indicates that more effort was made on this topic in recent years ( Figure 1 ).

Overview of Art Therapy

As defined by the British Association of Art Therapists, art therapy is a form of psychotherapy that uses art media as its primary mode of communication. Based on above literature, several highlights need to be summarized. (1) The main media of art therapy include painting, drawing, music, drama, dance, drama, and writing ( Chiang et al., 2019 ). (2) Main contents of painting and drawing include blind drawing, spiral drawing, drawing moods and self-portraits ( Legrand et al., 2017 ; Abbing et al., 2018 ; Papangelo et al., 2020 ). (3) Art therapy is mainly used for cancer, depression and anxiety, autism, dementia and cognitive impairment, as these patients are reluctant to express themselves in words ( Attard and Larkin, 2016 ; Deshmukh et al., 2018 ; Chiang et al., 2019 ). It plays an important role in facilitating engagement when direct verbal interaction becomes difficult, and provides a safe and indirect way to connect oneself with others ( Papangelo et al., 2020 ). Moreover, we found that art therapy has been gradually and successfully used for patients with mental disorders with positive outcomes, mainly reducing suffering from mental symptoms. These findings suggest that art therapy can not only be served as an useful therapeutic method to assist patients to open up and share their feelings, views, and experiences, but also as an auxiliary treatment for diagnosing diseases to help medical specialists obtain complementary information different from conventional tests.

Art Therapy for Mental Disorders

Based on the 413 searched literatures, we further limited them to mental disorders using the following key words, respectively: Depression OR anxiety OR Cognitive impairment OR dementia OR Alzheimer’s disease OR Autism OR Schizophrenia OR mental disorder. As a result, a total of 23 studies (5%) ( Table 1 ) were included and classified after reading the abstract and the full text carefully. These studies include 9 articles on depression and anxiety, 4 articles on cognitive impairment and dementia, 3 articles on Alzheimer’s disease, 3 articles on autism, and 4 articles on schizophrenia. In addition to the English literature, in fact, some Chinese literatures also described the application of art therapy in mental diseases, which were not listed but referred to in the following specific literatures.

Table 1. Studies of art therapy in mental diseases.

Depression Disorders and Anxiety

Depression and anxiety disorders are highly prevalent, affecting individuals, their families and the individual’s role in society ( Birgitta et al., 2018 ). Depression is a disabling and costly condition associated with a significant reduction in quality of life, medical comorbidities and mortality ( Demyttenaere et al., 2004 ; Whiteford et al., 2013 ; Cuijpers et al., 2014 ). Anxiety is associated with lower quality of life and negative effects on psychosocial functioning ( Cramer et al., 2005 ). Medication is the most commonly used effective way to relieve symptoms of depression and anxiety. However, nonadherence are crucial shortcomings in using antidepressant to treat depression and anxiety ( van Geffen et al., 2007 ; Nielsen et al., 2019 ).

In recent years, many studies have shown that art therapy plays a significant role in alleviating depression symptoms and anxiety. Gussak (2007) performed an observational survey about populations in prison of northern Florida and identified that art therapy significantly reduces depressive symptoms. Similarly, a randomized, controlled, and single-blind study about art therapy for depression with the elderly showed that painting as an adjuvant treatment for depression can reduce depressive and anxiety symptoms ( Ciasca et al., 2018 ). In addition, art therapy is also widely used among students, and several studies ( Runde, 2008 ; Zhenhai and Yunhua, 2011 ) have shown that art therapy also significantly reduces depressive symptoms in students. For example, Wang et al. (2011) conducted group painting therapy on 30 patients with depression for 3 months, and found that painting therapy could promote their social function recovery, improve their social adaptability and quality of life. Another randomized clinical trial also showed that it could decrease mean anxiety scores in the 3–12 year painting group ( Forouzandeh et al., 2020 ).

Studies have shown that distress, including anxiety and depression, is related to poorer health-related quality of life and satisfaction to medical services ( Hamer et al., 2009 ). Painting can be employed to express patients’ anxiety and fear, vent negative emotions by applying projection, thereby significantly improve the mood and reduce symptoms of depression and anxiety of cancer patients. A number of studies ( Bar-Sela et al., 2007 ; Thyme et al., 2009 ; Lin et al., 2012 ; Abdulah and Abdulla, 2018 ) showed that art therapy for cancer patients could enhance the vitality of patients and participation in social activities, significantly reduce depression, anxiety, and reduce stressful feelings. Importantly, even in the follow-up period, art therapy still has a lasting effect on cancer patients ( Thyme et al., 2009 ). Interestingly, art therapy based on famous painting appreciation could also significantly reduce anxiety and depression associated with cancer ( Lee et al., 2017 ). Among cancer patients treated in outpatient health care, art therapy also plays an important role in alleviating their physical symptoms and mental health ( Götze et al., 2009 ). Therefore, art therapy as an auxiliary treatment of cancer is of great value in improving quality of life.

Overall, art painting therapy permits patients to express themselves in a manner acceptable to the inside and outside culture, thereby diminishing depressed and anxiety symptoms.

Cognitive Impairment, and Dementia

Dementia, a progressive clinical syndrome, is characterized by widespread cognitive impairment in memory, thinking, behavior, emotion and performance, leading to worse daily living ( Deshmukh et al., 2018 ). According to the Alzheimer’s Disease International 2015, there is 46.8 million people suffered from dementia, and numbers almost doubling every 20 years, rising to 131.5 million by 2050. Although art therapy has been used as an alternative treatment for the dementia for long time, the positive effects of painting therapy on cognitive function remain largely unknown. One intervention assigned older adults patients with dementia to a group-based art therapy (including painting) observed significant improvements in the clock drawing test ( Pike, 2013 ), whereas two other randomized controlled trials ( Hattori et al., 2011 ; Rusted et al., 2016 ) on patients with dementia have failed to obtain significant cognitive improvement in the painting group. Moreover, a cochrane systematic review ( Deshmukh et al., 2018 ) included two clinical studies of art therapy for dementia revealed that there is no sufficient evidence about the efficacy of art therapy for dementia. This may be because patients with severely cognitive impairment, who was unable to accurately remember or assess their own behavior or mental state, might lose the ability to enjoy the benefits of art therapy.

In summary, we should intervene earlier in patients with mild cognitive impairment, an intermediate stage between normal aging and dementia, in order to prevent further transformation into dementia. To date, mild cognitive impairment is drawing much attention to the importance of painting intervening at this stage in order to alter the course of subsequent cognitive decline as soon as possible ( Petersen et al., 2014 ). Recently, a randomized controlled trial ( Yu et al., 2021 ) showed significant relationship between improvement immediate memory/working memory span and increased cortical thickness in right middle frontal gyrus in the painting art group. With the long-term cognitive stimulation and engagement from multiple sessions of painting therapy, it is likely that painting therapy could lead to enhanced cognitive functioning for these patients.

Alzheimer’s Disease

Alzheimer’s disease (AD) is a sub-type of dementia, which is usually associated with chronic pain. Previous studies suggested that art therapy could be used as a complementary treatment to relief pain for these patients since medication might induce severely side effects. In a multicenter randomized controlled trial, 28 mild AD patients showed significant pain reduction, reduced anxiety, improved quality of life, improved digit span, and inhibitory processes, as well as reduced depression symptoms after 12-week painting ( Pongan et al., 2017 ; Alvarenga et al., 2018 ). Further study also suggested that individual therapy rather than group therapy could be more optimal since neuroticism can decrease efficacy of painting intervention on pain in patients with mild AD. In addition to release chronic pain, art therapy has been reported to show positive effects on cognitive and psychological symptoms in patients with mild AD. For example, a controlled study revealed significant improvement in the apathy scale and quality of life after 12 weeks of painting treatment mainly including color abstract patterns with pastel crayons or water-based paint ( Hattori et al., 2011 ). Another study also revealed that AD patients showed improvement in facial expression, discourse content and mood after 3-weeks painting intervention ( Narme et al., 2012 ).

Schizophrenia

Schizophrenia is a complex functional psychotic mental illness that affects about 1% of the population at some point in their life ( Kolliakou et al., 2011 ). Not only do sufferers experience “positive” symptoms such as hallucinations, delusions, but also experience negative symptoms such as varying degrees of anhedonia and asociality, impaired working memory and attention, poverty of speech, and lack of motivation ( Andreasen and Olsen, 1982 ). Many patients with schizophrenia remain symptomatic despite pharmacotherapy, and even attempts to suicide with a rate of 10 to 50% ( De Sousa et al., 2020 ). For these patients, art therapy is highly recommended to process emotional, cognitive and psychotic experiences to release symptoms. Indeed, many forms of art therapy have been successfully used in schizophrenia, whether and how painting may interfere with psychopathology to release symptoms remains largely unknown.

A recent review including 20 studies overall was performed to summary findings, however, concluded that it is not clear whether art therapy leads to clinical improvement in schizophrenia with low ( Ruiz et al., 2017 ). Anyway, many randomized clinical trials reported positive outcomes. For example, Richardson et al. (2007) conducted painting therapy for six months in patients with chronic schizophrenia and found that art therapy had a positive effect on negative symptoms. Teglbjaerg (2011) examined experience of each patient using interviews and written evaluations before and after painting therapy and at a 1-year follow-up and found that group painting therapy in patients with schizophrenia could not only reduce psychotic symptoms, but also boost self-esteem and improve social function.

What’s more, the characteristics of the painting can also be used to judge the health condition in patients with schizophrenia. For example, Hongxia et al. (2013) explored the correlation between psychological health condition and characteristics of House-Tree-Person tests for patients with schizophrenia, and showed that the detail characteristic of the test results can be used to judge the patient’s anxiety, depression, and obsessive-compulsive symptoms.

Most importantly, several other studies showed that drug plus painting therapy significantly enhanced patient compliance and self-cognition than drug therapy alone in patients with schizophrenia ( Hongyan and JinJie, 2010 ; Min, 2010 ).

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental syndrome with no unified pathological or neurobiological etiology, which is characterized by difficulties in social interaction, communication problems, and a tendency to engage in repetitive behaviors ( Geschwind and Levitt, 2007 ).

Art therapy is a form of expression that opens the door to communication without verbal interaction. It provides therapists with the opportunity to interact one-on-one with individuals with autism, and make broad connections in a more comfortable and effective way ( Babaei et al., 2020 ). Emery (2004) did a case study about a 6-year-old boy diagnosed with autism and found that art therapy is of great value to the development, growth and communication skills of the boy. Recently, one study ( Jalambadani, 2020 ) using 40 children with ASD participating in painting therapy showed that painting therapy had a significant improvement in the social interactions, adaptive behaviors and emotions. Therefore, encouraging children with ASD to express their experience by using nonverbal expressions is crucial to their development. Evans and Dubowski (2001) believed that creating images on paper could help children express their internal images, thereby enhance their imagination and abstract thinking. Painting can also help autistic children express and vent negative emotions and thereby bring positive emotional experience and promote their self-consciousness ( Martin, 2009 ). According to two studies ( Wen and Zhaoming, 2009 ; Jianhua and Xiaolu, 2013 ) in China, Art therapy could also improve the language and communication skills, cognitive and behavioral performance of children with ASD.

Moreover, art therapy could be used to investigate the relationship between cognitive processes and imagination in children with ASD. One study ( Wen and Zhaoming, 2009 ; Jianhua and Xiaolu, 2013 ) suggested that children with ASD apply a unique cognitive strategy in imaginative drawing. Another study ( Low et al., 2009 ) examined the cognitive underpinnings of spontaneous imagination in children with ASD and showed that ASD group lacks imagination, generative ability, planning ability and good consistency in their drawings. In addition, several studies ( Leevers and Harris, 1998 ; Craig and Baron-Cohen, 1999 ; Craig et al., 2001 ) have been performed to investigate imagination and creativity of autism via drawing tasks, and showed impairments of autism in imagination and creativity via drawing tasks.

In a word, art therapy plays a significant role in children with ASD, not only as a method of treatment, but also in understanding and investigating patients’ problems.

Other Applications

In addition to the above mentioned diseases, art therapy has also been adopted in other applications. Dysarthia is a common sequela of cerebral palsy (CP), which directly affects children’s language intelligibility and psycho-social adjustment. Speech therapy does not always help CP children to speak more intelligibly. Interestingly, the art therapy can significantly improve the language intelligibility and their social skills for children with CP ( Wilk et al., 2010 ).

In brief, these studies suggest that art therapy is meaningful and accepted by both patients and therapists. Most often, art therapy could strengthen patient’s emotional expression, self-esteem, and self-awareness. However, our findings are based on relatively small samples and few good-quality qualitative studies, and require cautious interpretation.

The Application Prospects of Art Therapy

With the development of modern medical technology, life expectancy is also increasing. At the same time, it also brings some side effects and psychological problems during the treatment process, especially for patients with mental illness. Therefore, there is an increasing demand for finding appropriate complementary therapies to improve life quality of patients and psychological health. Art therapy is primarily offered as individual art therapy, in this review, we found that art therapy was most commonly used for depression and anxiety.

Based on the above findings, art therapy, as a non-verbal psychotherapy method, not only serves as an auxiliary tool for diagnosing diseases, which helps medical specialists obtain much information that is difficult to gain from conventional tests, judge the severity and progression of diseases, and understand patients’ psychological state from painting characteristics, but also is an useful therapeutic method, which helps patients open up and share their feelings, views, and experiences. Additionally, the implementation of art therapy is not limited by age, language, diseases or environment, and is easy to be accepted by patients.

Art therapy in hospitals and clinical settings could be very helpful to aid treatment and therapy, and to enhance communications between patients and on-site medical staffs in a non-verbal way. Moreover, art therapy could be more effective when combined with other forms of therapy such as music, dance and other sensory stimuli.

The medical mechanism underlying art therapy using painting as the medium for intervention remains largely unclear in the literature ( Salmon, 1993 ; Broadbent et al., 2004 ; Guillemin, 2004 ), and the evidence for effectiveness is insufficient ( Mirabella, 2015 ). Although a number of studies have shown that art therapy could improve the quality of life and mental health of patients, standard and rigorous clinical trials with large samples are still lacking. Moreover, the long-term effect is yet to be assessed due to the lack of follow-up assessment of art therapy.

In some cases, art therapy using painting as the medium may be difficult to be implemented in hospitals, due to medical and health regulations (may be partly due to potential of messes, lack of sink and cleaning space for proper disposal of paints, storage of paints, and toxins of allergens in the paint), insufficient space for the artwork to dry without getting in the way or getting damaged, and negative medical settings and family environments. Nevertheless, these difficulties can be overcome due to great benefits of the art therapy. We thus humbly believe that art therapy has great potential for mental disorders.

In the future, art therapy may be more thoroughly investigated in the following directions. First, more high-quality clinical trials should be carried out to gain more reliable and rigorous evidence. Second, the evaluation methods for the effectiveness of art therapy need to be as diverse as possible. It is necessary for the investigation to include not only subjective scale evaluations, but also objective means such as brain imaging and hematological examinations to be more convincing. Third, it will be helpful to specify the details of the art therapy and patients for objective comparisons, including types of diseases, painting methods, required qualifications of the therapist to perform the art therapy, and the theoretical basis and mechanism of the therapy. This practice should be continuously promoted in both hospitals and communities. Fourth, guidelines about art therapy should be gradually formed on the basis of accumulated evidence. Finally, mechanism of art therapy should be further investigated in a variety of ways, such as at the neurological, cellular, and molecular levels.

Author Contributions

JH designed the whole study, analyzed the data, and wrote the manuscript. JZ searched for selected the studies. LH participated in the interpretation of data. HY and JX offered good suggestions. All authors read and approved the final manuscript.

This study was financially supported by the National Key R&D Program of China (2019YFC1712200), International standards research on clinical research and service of Acupuncture-Moxibustion (2019YFC1712205), the National Natural Science Foundation of China (62006220), and Shenzhen Science and Technology Research Program (No. JCYJ20200109114816594).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords : painting, art therapy, mental disorders, clinical applications, medical interventions

Citation: Hu J, Zhang J, Hu L, Yu H and Xu J (2021) Art Therapy: A Complementary Treatment for Mental Disorders. Front. Psychol. 12:686005. doi: 10.3389/fpsyg.2021.686005

Received: 26 March 2021; Accepted: 28 July 2021; Published: 12 August 2021.

Reviewed by:

Copyright © 2021 Hu, Zhang, Hu, Yu and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Jinping Xu, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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What to Know About Music Therapy

Music can help improve your mood and overall mental health.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Verywell / Lara Antal

Effectiveness

Things to consider, how to get started.

Music therapy is a therapeutic approach that uses the naturally mood-lifting properties of music to help people improve their mental health and overall well-being.  It’s a goal-oriented intervention that may involve:

• Making music
• Writing songs
• Listening to music
• Discussing music  

This form of treatment may be helpful for people with depression and anxiety, and it may help improve the quality of life for people with physical health problems. Anyone can engage in music therapy; you don’t need a background in music to experience its beneficial effects.

Types of Music Therapy

Music therapy can be an active process, where clients play a role in creating music, or a passive one that involves listening or responding to music. Some therapists may use a combined approach that involves both active and passive interactions with music.

There are a variety of approaches established in music therapy, including:

• Analytical music therapy : Analytical music therapy encourages you to use an improvised, musical "dialogue" through singing or playing an instrument to express your unconscious thoughts, which you can reflect on and discuss with your therapist afterward.
• Benenzon music therapy : This format combines some concepts of psychoanalysis with the process of making music. Benenzon music therapy includes the search for your "musical sound identity," which describes the external sounds that most closely match your internal psychological state.
• Cognitive behavioral music therapy (CBMT) : This approach combines cognitive behavioral therapy (CBT) with music. In CBMT, music is used to reinforce some behaviors and modify others. This approach is structured, not improvisational, and may include listening to music, dancing, singing, or playing an instrument.
• Community music therapy : This format is focused on using music as a way to facilitate change on the community level. It’s done in a group setting and requires a high level of engagement from each member.
• Nordoff-Robbins music therapy : Also called creative music therapy, this method involves playing an instrument (often a cymbal or drum) while the therapist accompanies using another instrument. The improvisational process uses music as a way to help enable self-expression.
• The Bonny method of guided imagery and music (GIM) : This form of therapy uses classical music as a way to stimulate the imagination. In this method, you explain the feelings, sensations, memories, and imagery you experience while listening to the music.
• Vocal psychotherapy : In this format, you use various vocal exercises, natural sounds, and breathing techniques to connect with your emotions and impulses. This practice is meant to create a deeper sense of connection with yourself.

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Music Therapy vs. Sound Therapy

Music therapy and sound therapy (or sound healing ) are distinctive, and each approach has its own goals, protocols, tools, and settings: 

• Music therapy is a relatively new discipline, while sound therapy is based on ancient Tibetan cultural practices .
• Sound therapy uses tools to achieve specific sound frequencies, while music therapy focuses on addressing symptoms like stress and pain.  
• The training and certifications that exist for sound therapy are not as standardized as those for music therapists.
• Music therapists often work in hospitals, substance abuse treatment centers, or private practices, while sound therapists may offer their service as a component of complementary or alternative medicine.

When you begin working with a music therapist, you will start by identifying your goals. For example, if you’re experiencing depression, you may hope to use music to naturally improve your mood and increase your happiness . You may also want to try applying music therapy to other symptoms of depression like anxiety, insomnia, or trouble focusing.

During a music therapy session, you may listen to different genres of music , play a musical instrument, or even compose your own songs. You may be asked to sing or dance. Your therapist may encourage you to improvise, or they may have a set structure for you to follow.

You may be asked to tune in to your emotions as you perform these tasks or to allow your feelings to direct your actions. For example, if you are angry, you might play or sing loud, fast, and dissonant chords.

You may also use music to explore ways to change how you feel. If you express anger or stress, your music therapist might respond by having you listen to or create music with slow, soft, soothing tones.

Music therapy is often one-on-one, but you may also choose to participate in group sessions if they are available. Sessions with a music therapist take place wherever they practice, which might be a:

• Community health center
• Correctional facility
• Private office
• Physical therapy practice
• Rehabilitation facility

Wherever it happens to be, the room you work in together will be a calm environment with no outside distractions.

What Music Therapy Can Help With

Music therapy may be helpful for people experiencing:

• Alzheimer’s disease
• Anxiety or stress
• Cardiac conditions
• Chronic pain
• Difficulties with verbal and nonverbal communication
• Emotional dysregulation
• Feelings of low self-esteem
• Impulsivity
• Negative mood
• Post-traumatic stress disorder (PTSD)
• Problems related to childbirth
• Rehabilitation after an injury or medical procedure
• Respiration problems
• Substance use disorders
• Surgery-related issues
• Traumatic brain injury (TBI)
• Trouble with movement or coordination

Research also suggests that it can be helpful for people with:

• Obsessive-compulsive disorder (OCD)
• Schizophrenia
• Stroke and neurological disorders

Music therapy is also often used to help children and adolescents:

• Develop their identities
• Improve their communication skills
• Learn to regulate their emotions
• Recover from trauma
• Self-reflect

Benefits of Using Music as Therapy

Music therapy can be highly personalized, making it suitable for people of any age—even very young children can benefit. It’s also versatile and offers benefits for people with a variety of musical experience levels and with different mental or physical health challenges.

Engaging with music can:

• Activate regions of the brain that influence things like memory, emotions, movement, sensory relay, some involuntary functions, decision-making, and reward
• Fulfill social needs for older adults in group settings
• Lower heart rate and blood pressure
• Relax muscle tension
• Release endorphins
• Relieve stress and encourage feelings of calm
• Strengthen motor skills and improve communication for children and young adults who have developmental and/or learning disabilities

Research has also shown that music can have a powerful effect on people with dementia and other memory-related disorders.

Overall, music therapy can increase positive feelings, like:

• Confidence and empowerment
• Emotional intimacy

The uses and benefits of music therapy have been researched for decades. Key findings from clinical studies have shown that music therapy may be helpful for people with depression and anxiety, sleep disorders, and even cancer.

Depression 

Studies have shown that music therapy can be an effective component of depression treatment. According to the research cited, the use of music therapy was most beneficial to people with depression when it was combined with the usual treatments (such as antidepressants and psychotherapy). 

When used in combination with other forms of treatment, music therapy may also help reduce obsessive thoughts , depression, and anxiety in people with OCD.

In 2016, researchers conducted a feasibility study that explored how music therapy could be combined with CBT to treat depression . While additional research is needed, the initial results were promising.

Many people find that music, or even white noise, helps them fall asleep. Research has shown that music therapy may be helpful for people with sleep disorders or insomnia as a symptom of depression.

Compared to pharmaceuticals and other commonly prescribed treatments for sleep disorders, music is less invasive, more affordable, and something a person can do on their own to self-manage their condition.

Pain Management

Music has been explored as a potential strategy for acute and chronic pain management in all age groups. Research has shown that listening to music when healing from surgery or an injury, for example, may help both kids and adults cope with physical pain.

Music therapy may help reduce pain associated with:

• Chronic conditions : Music therapy can be part of a long-term plan for managing chronic pain, and it may help people recapture and focus on positive memories from a time before they had distressing long-term pain symptoms. 
• Labor and childbirth : Music therapy-assisted childbirth appears to be a positive, accessible, non-pharmacological option for pain management and anxiety reduction for laboring people.
• Surgery : When paired with standard post-operative hospital care, music therapy is an effective way to lower pain levels, anxiety, heart rate, and blood pressure in people recovering from surgery.

Coping with a cancer diagnosis and going through cancer treatment is as much an emotional experience as a physical one. People with cancer often need different sources of support to take care of their emotional and spiritual well-being.

Music therapy has been shown to help reduce anxiety in people with cancer who are starting radiation treatments. It may also help them cope with the side effects of chemotherapy, such as nausea.

Music therapy may also offer emotional benefits for people experiencing depression after receiving their cancer diagnosis, while they’re undergoing treatment, or even after remission.

On its own, music therapy may not constitute adequate treatment for medical conditions, including mental health disorders . However, when combined with medication, psychotherapy , and other interventions, it can be a valuable component of a treatment plan.

If you have difficulty hearing, wear a hearing aid, or have a hearing implant, you should talk with your audiologist before undergoing music therapy to ensure that it’s safe for you.

Similarly, music therapy that incorporates movement or dancing may not be a good fit if you’re experiencing pain, illness, injury, or a physical condition that makes it difficult to exercise.  

You'll also want to check your health insurance benefits prior to starting music therapy. Your sessions may be covered or reimbursable under your plan, but you may need a referral from your doctor.

If you’d like to explore music therapy, talk to your doctor or therapist. They can connect you with practitioners in your community. The American Music Therapy Association (AMTA) also maintains a database of board-certified, credentialed professionals that you can use to find a practicing music therapist in your area.

Depending on your goals, a typical music therapy session lasts between 30 and 50 minutes. Much like you would plan sessions with a psychotherapist, you may choose to have a set schedule for music therapy—say, once a week—or you may choose to work with a music therapist on a more casual "as-needed" basis.  

Before your first session, you may want to talk things over with your music therapist so you know what to expect and can check in with your primary care physician if needed.

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Werner J, Wosch T, Gold C. Effectiveness of group music therapy versus recreational group singing for depressive symptoms of elderly nursing home residents: Pragmatic trial . Aging Ment Health . 2017;21(2):147-155. doi:10.1080/13607863.2015.1093599

Dunbar RIM, Kaskatis K, MacDonald I, Barra V. Performance of music elevates pain threshold and positive affect: Implications for the evolutionary function of music . Evol Psychol . 2012;10(4):147470491201000420. doi:10.1177/147470491201000403

Pavlicevic M, O'neil N, Powell H, Jones O, Sampathianaki E. Making music, making friends: Long-term music therapy with young adults with severe learning disabilities . J Intellect Disabil . 2014;18(1):5-19. doi:10.1177/1744629513511354

Chang YS, Chu H, Yang CY, et al. The efficacy of music therapy for people with dementia: A meta-analysis of randomised controlled trials . J Clin Nurs . 2015;24(23-24):3425-40. doi:10.1111/jocn.12976

Aalbers S, Fusar-Poli L, Freeman RE, et al. Music therapy for depression . Cochrane Database Syst Rev . 2017;11:CD004517. doi:10.1002/14651858.CD004517.pub3

Trimmer C, Tyo R, Naeem F. Cognitive behavioural therapy-based music (CBT-music) group for symptoms of anxiety and depression . Can J Commun Ment Health . 2016;35(2):83-87. doi:10.7870/cjcmh-2016-029

Jespersen KV, Koenig J, Jennum P, Vuust P. Music for insomnia in adults . Cochrane Database Syst Rev . 2015;(8):CD010459. doi:10.1002/14651858.CD010459.pub2

Redding J, Plaugher S, Cole J, et al. "Where's the Music?" Using music therapy for pain management . Fed Pract . 2016;33(12):46-49.

Novotney A. Music as medicine . Monitor on Psychology . 2013;44(10):46.

McCaffrey T, Cheung PS, Barry M, Punch P, Dore L. The role and outcomes of music listening for women in childbirth: An integrative review . Midwifery . 2020;83:102627. doi:10.1016/j.midw.2020.102627

Liu Y, Petrini MA. Effects of music therapy on pain, anxiety, and vital signs in patients after thoracic surgery . Complement Ther Med . 2015;23(5):714-8.doi:10.1016/j.ctim.2015.08.002

Rossetti A, Chadha M, Torres BN, et al. The impact of music therapy on anxiety in cancer patients undergoing simulation for radiation therapy . Int J Radiat Oncol Biol Phys . 2017;99(1):103-110. doi:10.1016/j.ijrobp.2017.05.003

American Music Therapy Association (AMTA). Guidance for music listening programs .

What Is Art Therapy?

Understand arts efficacy and place in therapy..

Posted April 9, 2024 | Reviewed by Ray Parker

• What Is Therapy?
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• Art therapy is often coupled with psychotherapy as part of an integrative approach to therapy.
• Art can provide patients who struggle to verbalize trauma or emotions with alternative means of communication.
• Studies have found that art therapy can help with symptoms of anxiety and depression in some populations.

Art therapy is defined by the American Art Therapy Association as utilizing “active art-making, the creative process, and applied psychological theory—within a psychotherapeutic relationship—to enrich the lives of individuals, families, and communities.” Often practiced in tandem with psychotherapy , art therapy is nonpharmacological and can be used as a medical intervention for mental disorders. Art therapy is an integrative practice, as it encourages alternative methods of communication and expression. In doing so, art therapy is also capable of helping “ to improve cognitive and sensorimotor functions, foster self-esteem and self-awareness, cultivate emotional resilience , promote insight, enhance social skills, reduce and resolve conflicts and distress, and advance societal and ecological change.” There are many different ways of participating in art therapy, such as dance movement psychotherapy, music therapy, and drawing, painting, and craft therapy.

The History of Art Therapy

For most of human history, art has been an important method of communicating events, ideas, and stories. Closely connected to the expression of emotions, the term “art therapy” first emerged in 1942 when patients suffering from tuberculosis found freedom through drawing and painting. Art therapy practices soon moved into the mental health realm with the foundation of the British Association of Art Therapists in 1964. As art therapy gained traction around the world, it was implemented alongside child psychotherapy. The creation of art helped children express their feelings despite their “ underdeveloped or limited vocabulary .” It quickly became a treatment for patients with trauma , grief , anxiety , and a range of other mental health disorders.

The Efficacy of Art Therapy

In 2022, a report was produced by the Australian, New Zealand, and Asian Creative Arts Therapies Association called The Proven Efficacy of Creative Arts Therapies: What the Literature Tells Us . Created by Deanna Gray, the report is a compilation of over 40 peer-reviewed research articles that center around the use of creative arts as therapy. The library of research supporting the efficacy of art therapy has only continued to grow in the years since the report was published. One such study led by Khadeja Alwledat found that just four sessions of creative art therapy had a statistically significant positive impact on the levels of depression , anxiety, and stress of the participants, all of whom were within three months post-stroke diagnosis. This wide array of research behind art therapy is accompanied by the establishment of initiatives, such as the NeuroArts Blueprint, and outreach projects like the University of Michigan’s Prison Creative Arts Project.

The Blueprint is an interdisciplinary initiative that is working to “break new ground at the crossroads of science, the arts, and technology.” It is building a community of individuals and organizations who are invested in advancing the use of arts and aesthetic experiences as tools to improve health and well-being. In 2021, the Blueprint was released as an “authoritative, first-of-its-kind roadmap” to advance brain science research, policy, and funding and to catalyze and mobilize “the full power of art.”

Along with the Blueprint, some institutions have begun creating projects to acknowledge the efficacy of art therapy, as well as promote the use of art therapy across their campuses. The Prison Creative Arts Project at the University of Michigan is a program within the Residential College that provides academic training in “issues surrounding incarceration and practical skills in the arts.” This project sends a newsletter to over 1,800 recipients, informing them of upcoming programs and events. By reaching out to those impacted by the justice system and bringing them together with the University of Michigan community, the Prison Creative Arts Project promotes “artistic collaboration , mutual learning, and growth.”

How to Become an Art Therapist

In order to become an art therapist, one must complete a master’s degree in a related field, become board-certified through the Art Therapy Credentials Board , and complete “100 hours of supervised work along with 600 hours of a clinical internship.” Students looking to become art therapists must take graduate-level courses in topics such as the creative process, psychological development, psychodiagnostics, and art therapy assessment. Beyond this, they will also receive training in studio art methods such as drawing, painting, and sculpture. Students should choose a program that is approved by the Commission on the Accreditation of Allied Health Education Programs (CAAHEP) or the American Art Therapy Association (AATA). These well-renowned programs enable students to pursue national credentialing and licensure after graduation.

At its core, a degree in art therapy is a research-based discipline that “combines active art-making, the creative process, applied psychological theory, and the human experience within a psychotherapeutic relationship.” These hours of training provide art therapists with the ability to work with diverse populations and to support their clients through a wide range of challenges.

Searching for an Art Therapist

When looking for an art therapist as a patient, first make sure that the individual has completed either a CAAHEP-accredited or AATA-approved program. From there, choosing an art therapist is a matter of personal preference. Generally, the first time that you meet with an art therapist will be similar to any therapy intake session: they will ask you multiple questions about your background and experiences, and you will have the opportunity to ask them any questions, as well. You will want to choose someone with whom you feel comfortable and at ease. It is completely acceptable not to schedule another session with a therapist if there is something you do not like. Keep in mind that going to see an art therapist is meant to benefit you solely; thus, the choice is entirely yours.

Encouraging Art Therapy

For therapists, the question of whether it makes clinical sense to encourage a patient to look into art therapy depends on a variety of factors. If the patient struggles to verbalize trauma, art therapy may provide them with a better means of communication. As another example, if a patient is evasive and artistically inclined, allowing them to express themselves through art may help break down barriers, allowing them to become more cooperative.

While art therapy may exist outside of conventional clinical frameworks, therapists should recognize that it is an option from which many patients may benefit and an established method of therapy.

Samoon Ahmad, M.D. is a Clinical Professor of Psychiatry, NYU Grossman School of Medicine; Unit Chief, Inpatient Psychiatry, Bellevue Hospital Center; and Founder of Integrative Center for Wellness in New York City.

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Why Health Insurance Should Cover Art and Music Therapy?

The artistic compositions can influence more than we can imagine. The individuals subject to art therapies indicate their arousal in both physical and mental levels. Considering the mentioned, music and art therapy are not simply for pleasure, but they can also bring a remedy for patients who went through trauma or distress (Gilroy & Lee, 2019). Hence, the cost of art and music therapy should be covered by health insurance.

The named treatment is the technique that is implemented by doctors who pursue evidence-based medicine. The patients at schools, hospitals, nursing homes, and some private practices are prescribed to experience art and music therapy (Khan & Moss, 2017). Despite these facts, health insurance companies do not include this type of remedy in medical coverage. It is disappointing to realize that some patients might restrain from using the services because of their cost.

There are different types of therapies for distinctive disorders and patient preferences. Dance therapy, visual art therapy, drama therapy are some individual examples of the variety of options for people to consider (Khan & Moss, 2017). Given the freedom of choice, each person can find the treatment applicable and beneficial for them. Consequently, the necessity of other treatment options would be minimal. This factor is why insurance companies should also be interested in adding art and music therapy to medical coverage.

Health insurance companies often view mental health as less of a priority and do not take the problems and their treatment seriously. The evidence suggests that the named approach is faulty, as behavioral care is provided almost six times more frequently than physical assistance (Gilroy & Lee, 2019). In such a case, the art and music therapies are actual for the general population, who are the users of health insurance.

To conclude, the art and music should be covered by the insurance companies so the patient population can afford the treatment, which is beneficial for their well-being. The technique is widely used, and there are various types, which means that everyone can find the hobby that they like. Last but not least, insurance companies should pay more attention to the issues requiring behavioral care rather than medical and surgical care.

Gilroy, A., & Lee, C. (Eds.). (2019). Art and Music: Therapy and Research. Routledge.

Khan, W. U., & Moss, H. (2017). Increasing public health awareness of and capacity for arts-based therapy in medicine. JAMA Neurology , 74 (9), 1029–1030. Web.

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80 Music Therapy Essay Topic Ideas & Examples

🏆 best music therapy topic ideas & essay examples, 📌 good research topics about music therapy, 🔍 interesting topics to write about music therapy, ❓ music therapy research questions.

• Music Therapy as Experiential Activity For this reason, a technique was applied to the 10-year-old child with developmental delays to transform the lyrics of the favorite sad melody into a more positively inspiring and uplifting one.
• Music Therapy for Schizophrenic Patients’ Quality of Life Consequently, the purpose of the project will be to review the existing literature and prepare a document with recommendations regarding MT in the discussed population, including psychiatric nurses’ acceptable role in delivering such interventions. We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
• Art and Music Therapy Coverage by Health Insurance However, I do believe that creative sessions should be available for all patients, and I am going to prove to you that music and art are highly beneficial for human health.
• Music Therapy in Healthcare Therefore, the article suggests that music can be used for relaxation, as well as managing the health issues that may arise due to the lack of relaxation.
• Music Therapy for Children With Learning Disabilities This review includes the evidence supporting music therapy as an effective strategy for promoting auditory, communication, and socio-emotional progression in children with ASD.
• Music Therapy as a Related Service for Students With Disabilities From a neuroscientific perspective, how would music intervention improve classroom behaviors and academic outcomes of students with ADHD as a way to inform policy-makers of the importance of music therapy as a related service?
• Substance Use Disorder: Possibility of Using Music Therapy In their study, Bourdaghs and Silverman address the possibility of using music therapy as the tool for promoting the socialization of people with a substance use disorder.
• Music Therapy: The Impact on Older Adults There is therefore the need to focus more energy to aid more understating on the role of music therapy on older residents.”The recent qualitative review of literature in the area of music and music therapy […]
• Music Therapy: Alternative to Traditional Pain Medicine The sources underline that therapists should pay attention to the subjects of music and their impact on the health of clients.
• Music Therapy as a Social Work Intervention One of such interventions is music therapy which is aimed at helping people in a sensitive way accurately adjusting the possibilities this therapy may offer to the requirements of a particular client of a group […]
• The Role of Music Therapy as Alternative Treatment Music therapy is the use of music interventions to achieve individualized goals of healing the body, mind, and spirit. Thereafter, several developments occurred in the field of music therapy, and the ringleaders founded the American […]
• Music Therapy Effectiveness In addition to this, research has shown that stroke patients become more involved in therapy sessions once music is incorporated in the treatment program; this is the motivational aspect of music.
• Sound as an Element of Music Therapy This is one of the reasons why in the Abrams study the participants explained that they preferred the sound of rain, ocean waves and the soft strumming of a guitar as compared to the work […]
• Music Therapy Throughout the Soloist Globally, classical music in its sense has always been known to adjoin the listener to some transcendent understanding of the world order, the feeling of integrity with the Universe and enormous delight rising up from […]
• Music Therapy: Where Words Cease In spite of the fact that, as a rule, one indulges into art to find the shelter from the reality, the author of the book called The Soloist explores quite a different issue of the […]
• Active Music Therapy for Parkinson’s Disease
• Effectiveness of Music Therapy for Survivors of Abuse
• Music Therapy Effectiveness of Treatment of Alzheimer’s Disease
• The Link Between Ancestral Hormones and Music Therapy
• Analysis of the Effectiveness of Art and Music Therapy
• Music Therapy Usefulness for Cancer Patients
• Music Therapy Impact on Students With Emotional and Behavioral Disorders
• How Music Therapy Can Be Used to Reduce Pre-Operative Anxiety
• Healing Chronic Pain With Music Therapy
• Music Therapy Effect on the Wellness and Mood of Adolescents
• Comparing Cognitive Behavioral Therapy and Music Therapy
• Constructing Optimal Experience for the Hospitalized Newborn Through Neuro-Based Music Therapy
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• “Dementia and the Power of Music Therapy” by Steve Matthews Analysis
• Music Therapy for Children With Autism Spectrum Disorder
• Discussing Music Therapy Reducing Stress Health and Social Care
• Does Music Therapy Help Children With Special Needs?
• Music Therapy for Delinquency Involved Juveniles Through Tripartite Collaboration
• Heidelberg Neuro-Music Therapy Enhances Task-Negative Activity in Tinnitus Patients
• Music Therapy for Post Traumatic Stress Disorder
• How Does Music Therapy Promote Positive Mental Health?
• Music Therapy and Its Positive Effects on the Brain
• The Relationships Between Learning and Music Therapy
• Music Therapy for Sexually Abused Children
• Managing Sickle Cell Pain With Music Therapy
• Music Therapy: How Does Music Impact Our Emotions
• Dealing With Depression With the Help of Music Therapy
• Effectiveness of Music Therapy and Drug Therapy for Children With Autism
• Music Therapy and Its Effect on the Levels of Anxiety
• The Link Between Music Therapy and Personality Theory Psychology
• How Music Therapy Improves Depression Among Older Adults
• Music Therapy: The Best Way to Help Children With Mental Illness
• Interventions of Music Therapy for Stress Reduction
• The Real Science Behind the Theory of Music Therapy
• Music Therapy Should Not Be Considered a Therapy
• Neurologic Music Therapy Training for Mobility and Stability Rehabilitation
• Nursing Theory for Music Therapy Quality Improvement Program
• The Help of Music Therapy in Pain Management
• Relationship Between Hypertension and Music Therapy
• Yoga and Music Therapy as Effective Methods of Stress Management
• What Is Music Therapy Used For?
• What Are Some Examples of Music Therapy?
• What Kind of Music Is Used in Music Therapy?
• What Are the Side Effects of Music Therapy?
• What Mental Illnesses Does Music Therapy Help?
• Can Music Therapy Help With Anxiety?
• What Type of Music Therapy Helps Depression?
• Does Music Therapy Actually Work?
• Do Psychiatrists Use Music Therapy?
• Do Doctors Recommend Music Therapy?
• How Long Does Music Therapy Last?
• Why Is Music Therapy Not Used?
• What Is a Typical Music Therapy Session Like?
• What Are the Two Main Benefits of Music Therapy?
• How Can Music Therapy Be Done at Home?
• What Does Music Therapy Do to the Brain?
• Is Music Therapy Good for Stress?
• Can Music Therapy Help With Trauma?
• What Ages Benefit From Music Therapy?
• What Is the First Step of Music Therapy?
• Does Music Therapy Include Talking?
• What Instruments Are Used for Music Therapy?
• What Is the Difference Between Sound Therapy and Music Therapy?
• Can You Do Music Therapy Without a Degree?
• Why Is Music Therapy Better Than Medicine?
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IvyPanda. (2024, March 2). 80 Music Therapy Essay Topic Ideas & Examples. https://ivypanda.com/essays/topic/music-therapy-essay-topics/

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IvyPanda . 2024. "80 Music Therapy Essay Topic Ideas & Examples." March 2, 2024. https://ivypanda.com/essays/topic/music-therapy-essay-topics/.

1. IvyPanda . "80 Music Therapy Essay Topic Ideas & Examples." March 2, 2024. https://ivypanda.com/essays/topic/music-therapy-essay-topics/.

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IvyPanda . "80 Music Therapy Essay Topic Ideas & Examples." March 2, 2024. https://ivypanda.com/essays/topic/music-therapy-essay-topics/.

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Art Interventions for Children With Autism Spectrum Disorder: A Scoping Review

Allison bernier.

Allison Bernier is Entry-Level Occupational Therapy Doctoral Student, Department of Occupational Therapy, University of Texas Medical Branch, Galveston.

Karen Ratcliff

Karen Ratcliff, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Texas Medical Branch, Galveston.

Claudia Hilton

Claudia Hilton, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Texas Medical Branch, Galveston.

Patricia Fingerhut

Patricia Fingerhut, PhD, OTR/L, is Professor and Chair, Department of Occupational Therapy, University of Texas Medical Branch, Galveston.

Chi-Ying Li

Chi-Ying Li, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Texas Medical Branch, Galveston; ude.bmtu@ilihc

Associated Data

Importance: Autism spectrum disorder (ASD) is a neurological condition characterized by impairments in social interaction, communication, and behavior. Occupational therapy practitioners use creative arts interventions for children with ASD, but relevant evidence for these interventions is lacking.

Objective: To provide occupational therapists evidence of the benefit of creative arts interventions for children with ASD by evaluating treatment efficacy and connecting the evidence with the Occupational Therapy Practice Framework: Domain and Process (4th ed.; OTPF–4 ).

Data Sources: We searched peer-reviewed articles in six databases: CINAHL, Cochrane, PubMed, Ovid, PsycInfo, and Scopus. Eighteen articles published between 2000 and 2020 met Level 1b or 2b evidence criteria and were retrieved for full review; 15 were included in this scoping review.

Study Selection and Data Collection: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to extract data. Inclusion criteria were as follows: (1) Level 1b or 2b study; (2) quantitative data; (3) published in English; (4) population of children (ages <18 yr); (5) primary diagnosis of ASD; and (6) creative arts intervention in the forms of drawing, painting, or coloring; music; or theater.

Findings: Creative arts interventions benefited children with ASD in two OTPF–4 areas (process and social interaction) pertaining to the Performance Skills domain and one OTPF–4 area (body functions) pertaining to the Client Factors domain. We found similar effects for group and individual intervention sessions, and significant improvements required multiple sessions.

Conclusions and Relevance: Our findings provide evidence for the efficacy of creative arts interventions to enhance occupation-based outcomes for children with ASD.

What This Article Adds: Our findings support occupational therapy practitioners’ use of creative arts interventions to improve OTPF–4 -based client factors and process and social interaction skills for children with ASD.

The findings of this scoping review support occupational therapy practitioners’ use of creative arts interventions to enhance occupation-based outcomes for children with autism spectrum disorder (ASD).

Autism spectrum disorder (ASD) is a neurological condition characterized by impairments in social interaction, communication, and behavior and restricted and repetitive patterns and interests ( American Psychiatric Association, 2013 ). People with ASD often have fixed behaviors and sensory processing challenges, such as tactile defensiveness ( Kern et al., 2006 ). Occupational therapy interventions help clients improve their sensory processing, behavior, and interaction skills ( Case-Smith & Arbesman, 2008 ). Some common ASD interventions used by occupational therapists include sensory-based or behavioral interventions, social cognitive training, developmental skills interventions, interactive training, and parent-mediated approaches ( Case-Smith & Arbesman, 2008 ).

The definition of art can be broad and encompass numerous different activities. Perruzza and Kinsella (2010 ) considered creative arts occupations as any arts-based activities that elicit creativity in a person. These can include painting, drawing, creative writing, music, and textile arts and crafts. We applied Perruzza and Kinsella’s (2010) notion of creative arts occupations to define art in this study. We then considered whether the selected creative arts are commonly used by occupational therapists in practice and whether they have a potential positive impact on children with ASD. Creative arts activities have been shown to have positive effects on the performance skills of children with ASD ( Bharathi, Venugopal, & Vellingiri, 2019 ; Brancatisano et al., 2020 ; Corbett et al., 2011 ; Schweizer et al., 2019 ). For example, children with ASD often have trouble communicating and interacting with others. Drawing or painting allows them to express themselves and communicate in an indirect way with others ( Schweizer et al., 2019 ). Although there is abundant research on the topic of art activities in interventions for ASD, so far no research has systematically examined how occupational therapists use different art interventions in treating children with ASD. Even though relevant evidence is lacking, occupational therapists are equipped to integrate sensory processing and behavioral skills by using art in therapy.

Creative arts interventions have been shown to be effective in targeting behavioral, social, and developmental deficits in children with ASD ( Schweizer et al., 2019 ). Creative arts allow children with ASD to express themselves through different media and provide a safe space for them to communicate and develop their skills ( Bharathi, Venugopal, & Vellingiri, 2019 ; Schweizer et al., 2019 ). Occupational therapists are well suited to use creative arts interventions in therapy with children with ASD ( Case-Smith & Arbesman, 2008 ). Using different art materials can provide a wide range of sensory experiences (e.g., auditory, tactile; Bharathi, Jayaramayya, et al., 2019 ; Schweizer et al., 2019 ) and capture the status of depression and anxiety ( Li et al., 2011 ). This unique feature of art activities can benefit people with sensory processing and emotional regulation challenges, which are common among children with ASD ( Schweizer et al., 2019 ). For example, using picture creation and visual tangible aids can help children with ASD better integrate sensory and cognitive experiences and facilitate behavioral changes ( Schweizer et al., 2019 ). However, whether art activities can improve occupation-based outcomes remains unclear, prompting the need to connect evidence with the use of creative arts interventions and occupational therapy for children with ASD.

The Occupational Therapy Practice Framework: Domain and Process ( OTPF–4; American Occupational Therapy Association [AOTA], 2020 ) outlines the scope and domain of occupational therapy practice. This framework outlines specific aspects of the practice domain that interconnect to empower a person’s identity, well-being, and participation. Occupational therapists use the OTPF–4 as a foundation for selecting interventions that address specific aspects of the occupation-based domains to maximize clients’ overall health. The OTPF–4 domains are Occupations, Client Factors, Performance Skills, Performance Patterns, and Contexts ( AOTA, 2020 ). It is important for occupational therapists to identify effective OTPF–4 -based interventions that are tailored to clients’ needs.

The two aims of this scoping review were to (1) explore specific OTPF–4 domains that can be targeted through creative arts and (2) establish efficacy evidence of art interventions in the occupational therapy literature for children with ASD. One survey conducted in Sweden found that only 44% of occupational therapists used creative arts as interventions, and most of these interventions were designed for psychiatric health care ( Müllersdorf & Ivarsson, 2012 ). This implies that although research has indicated that creative arts are an effective intervention for children with ASD ( Bharathi, Venugopal, & Vellingiri, 2019 ; Brancatisano et al., 2020 ; Corbett et al., 2011 ; Schweizer et al., 2019 ), they are still not widely used for this population in occupational therapy practice. This review fills this gap in knowledge and sheds light on how to provide evidence-based creative arts interventions for children with ASD in occupational therapy. Our findings will allow occupational therapists to incorporate evidence-based art activities into their practice when working with children who have ASD to enhance effective occupation-based art interventions.

We followed Arksey and O’Malley (2005 ) and Levac et al.’s (2010) four steps to conduct this scoping review. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Moher et al., 2009 ) procedure to document the literature selection process ( Figure 1 ). We searched six databases—CINAHL, Cochrane, PubMed, Ovid, PsycInfo, and Scopus—using the following search terms: art, painting, art therapy, drawing, creative arts therapy, color, music, theater, therapy, intervention, autism spectrum disorders, ASD, and autism . These terms reflect Perruzza and Kinsella’s (2010 ) definition of creative arts occupations. To ensure the process was thorough, a librarian who specializes in systematic reviews assisted us with the search, which identified 1,997 articles. After duplicates were removed, 1,787 articles were screened. Titles and abstracts of these 1,787 articles were reviewed for eligibility. A total of 18 full-text articles were screened for eligibility. Fifteen articles met the inclusion criteria and were included in this study.

Flow diagram of the study selection process.

Note. Figure format from “Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement,” by D. Moher, A. Liberati, J. Tetzlaff, and D. G. Altman; PRISMA Group, 2009, PLoS Medicine, 6 (6), e1000097. https://doi.org/10.1371/journal.pmed.1000097

Inclusion and Exclusion Criteria

We included only peer-reviewed research published from January 2000 to April 2020. The inclusion criteria were as follows: (1) Level 1b or 2b study; (2) quantitative data; (3) published in English; (4) population of children (ages <18 yr), based on the definition used by the United Nations Children’s Fund (1995) ; (5) primary diagnosis of ASD; and (6) intervention in the form of general creative arts (including drawing, coloring, painting, or making things with clay), music, and theater. We selected creative arts, music, and theater because they are commonly used by occupational therapists in practice and met our definition of creative arts ( Perruzza & Kinsella, 2010 ). We also expected them to provide positive potential benefits that would address the predominant limitations commonly seen among children with ASD.

The five exclusion criteria were (1) population of nonchildren (ages ≥18 yr); (2) a primary diagnosis other than ASD; (3) combined interventions using art and other activities (i.e., interventions that included a modified diet along with art intervention were excluded); (4) interventions with multiple modalities that were expected to confound the effect of art interventions, including virtual reality, robots, auditory integration therapy, music-evoked rewards, or sound beam imitation; and (5) use of only qualitative outcome measures.

Occupational Therapy Practice Framework

We used the latest edition of the OTPF , the OTPF–4 ( AOTA, 2020 ). This edition is similar to the previous one; however, the OTPF–4 modified domains to outline additional areas in which occupational therapists have knowledge and skills and the process that describes client-centered and occupation-based interventions. The OTPF–4 is composed of five domains: (1) Occupations, (2) Contexts, (3) Performance Patterns, (4) Performance Skills, and (5) Client Factors. Each OTPF–4 domain contains detailed subcategories.

We used the OCEBM Levels of Evidence Working Group (2009 ) guidelines to determine the level of evidence for each screened article. We included only articles with a 1b or 2b level of evidence. Level 1b evidence is defined as “well-designed individual randomized controlled trial (RCT),” in other words, not a pilot or feasibility study with a small sample, and Level 2b evidence is defined as “individual prospective cohort study, low-quality RCT (e.g., <80% follow-up or low number of participants; pilot and feasibility RCT studies), ecological studies and two-group, nonrandomized studies” ( AOTA, 2022 ). To determine the risk of bias for each article, we used two assessment guidelines: (1) Higgins et al.’s (2019) chapter “Assessing Risk of Bias in a Randomized Trial” for low-quality RCT studies and (2) Study Quality Assessment Tools from the National Heart, Lung, and Blood Institute (2014 ) for pre–post studies that did not include a control group. In addition, we summarized the treatment intensity of each included study to provide transparency for the used art interventions. We also analyzed outcome measures of the included studies and linked the outcome measures with detailed and specific aspects of the OTPF–4 domain descriptions. We then analyzed and synthesized the OTPF–4 domains targeted through creative arts interventions.

Overview of Study Characteristics

A summary of the characteristics of each study is provided in Table A.1 in the Supplemental Appendix, available online with this article at https://research.aota.org/ajot . A total of 1,171 participants were represented by the included studies, with individual sample sizes varying from 9 to 364. Participants’ ages ranged from 3.5 yr to 16 yr. Four of 15 studies were conducted outside of the United States ( Chincholkar et al., 2019 ; Crawford et al., 2017 ; Koo & Thomas, 2019 ; Poquérusse et al., 2018 ). Three used general creative arts (painting, drawing, and clay use) activity interventions ( Chincholkar et al., 2019 ; Koo & Thomas, 2019 ; Richard et al., 2015 ), 8 used music interventions ( Bharathi, Jayaramayya, et al., 2019 ; Bieleninik et al., 2017 ; Crawford et al., 2017 ; Gattino et al., 2011 ; LaGasse, 2014 ; Poquérusse et al., 2018 ; Sharda et al., 2018 ; Simpson et al., 2013 ), and 4 used theater interventions ( Corbett et al., 2016 , 2017 , 2019 ; Ioannou et al., 2020 ). Individual treatment sessions ranged from 30 min to 4 hr. Intensity ranged from a single intervention session to three sessions a week over the course of 5 mo. The art interventions used, and the duration of each intervention, are outlined in Table A.2. We suggest that occupational therapists use Table A.2 as a guideline when designing and incorporating art interventions into their work with children with ASD to promote evidence-based practice.

Levels of Evidence

In accordance with established guidelines ( U.S. Preventive Services Task Force, 2018 ), we examined the level of evidence for each study and identified 7 articles as Level 1b ( Bieleninik et al., 2017 ; Corbett et al., 2017 , 2019 ; Crawford et al., 2017 ; Ioannou et al., 2020 ; Sharda et al., 2018 ; Simpson et al., 2013 ) and 8 as Level 2b ( Bharathi, Jayaramayya, et al., 2019 ; Chincholkar et al., 2019 ; Corbett et al., 2016 ; Gattino et al., 2011 ; Koo & Thomas, 2019 ; LaGasse, 2014 ; Poquérusse et al., 2018 ; Richard et al., 2015 ). Details of each study’s design are provided in Table A.1.

Risk of Bias

Nine RCT studies had a moderate risk of bias ( Bharathi, Jayaramayya, et al., 2019 ; Corbett et al., 2016 , 2017 , 2019 ; Ioannou et al., 2020 ; Koo & Thomas, 2019 ; LaGasse, 2014 ; Richard et al., 2015 ; Simpson et al., 2013 ). Five articles were determined to have a low risk of bias ( Bieleninik et al., 2017 ; Crawford et al., 2017 ; Gattino et al., 2011 ; Poquérusse et al., 2018 ; Sharda et al., 2018 ). One article was a one-group pre–post study ( Chincholkar et al., 2019 ), and we determined it to have a low risk of bias. Tables A.3 and A.4 provide detailed risk-of-bias information for each study.

Outcome Measures

Several outcome measures were used among the studies. Four studies used the Childhood Autism Rating Scale (CARS) or second version (CARS-2) ( Bharathi, Jayaramayya, et al., 2019 ; Chincholkar et al., 2019 ; Gattino et al., 2011 ; Koo & Thomas, 2019 ), and 4 studies used the Peer Interaction Paradigm ( Corbett et al., 2016 , 2017 , 2019 ; Ioannou et al., 2020 ). Two studies each used the Autism Diagnostic Observation Schedule ( Bieleninik et al., 2017 ; Crawford et al., 2017 ), the Social Responsiveness Scale (SRS; Corbett et al., 2016 ; LaGasse, 2014 ), the Developmental NEuroPSYchological Assessment (NEPSY; Corbett et al., 2016 , 2019 ), or the State–Trait Anxiety Inventory for Children ( Corbett et al., 2017 ; Ioannou et al., 2020 ). Chincholkar et al. (2019 ) also used the Vineland Social Maturity Scale to measure social maturity and social behavior. Other measures used were the Diagnostic Analysis of Nonverbal Accuracy 2, the Child Facial Expressions subscale (DANVA 2–CF; Richard et al., 2015 ), the Children’s Communication Checklist–2 (CCC–2; Sharda et al., 2018 ), the Beach Family Quality of Life Scale (FQoL; Sharda et al., 2018 ), the Vineland Adaptive Behavior Scales, Maladaptive Behavior subscale ( Sharda et al., 2018 ), the Autism Treatment Evaluation Checklist (ATEC; LaGasse, 2014 ), the TRIAD Special Skills Assessment ( Bharathi, Jayaramayya, et al., 2019 ), salivary α-amylase ( Poquérusse et al., 2018 ), observation of engagement and problem behaviors ( Simpson et al., 2013 ), the Adaptive Behavior Assessment System ( Corbett et al., 2016 ), the PSI-SF and short version of the Warwick–Edinburgh Mental Well-Being Scale ( Crawford et al., 2017 ), and the PPVT–2 ( Sharda et al., 2018 ; see Table A.1).

Fourteen of 16 outcome measures had good reliability ( r > .80) and construct validity ( Ahmad & Warriner, 2001 ; Corbett et al., 2016 , 2017 ; de Bildt et al., 2005 ; Doll, 1936 ; Hoffman et al., 2006 ; Lord et al., 2000 ; Magiati et al., 2011 ; Norbury et al., 2004 ; Nowicki & Duke, 2008 ; Poquérusse et al., 2018 ; Ruble et al., 2008 ; Schopler et al., 1980 ; Simpson et al., 2013 ). The two outcome measures with lower reliability ( r < .80) were the SRS and the DANVA 2–CF ( Corbett et al., 2016 ). The SRS specifically had lower reliability for females ( r < .80) but higher reliability for males ( r > .80; Corbett et al., 2016 ; Nowicki & Duke, 2008 ). The CARS, CCC–2, FQol, and ATEC had shorter administration times, only 5 to 15 min ( Hoffman et al., 2006 ; Magiati et al., 2011 ; Norbury et al., 2004 ; Schopler et al., 1980 ). The NEPSY took the longest to administer, 2 to 5 hr ( Ahmad & Warriner, 2001 ).

Summary of Creative Arts Interventions for Children With Autism Spectrum Disorder

We categorized the creative arts interventions into three categories: (1) general activities ( n = 3), (2) music ( n = 8), and (3) theater ( n = 4). In the sections that follow, we summarize the findings for each category.

General Activities

Three studies used general creative activities of drawing, painting, or coloring ( Chincholkar et al., 2019 ; Koo & Thomas, 2019 ; Richard et al., 2015 ). Two studies used 30-min sessions, with 1 study consisting of eight 30-min sessions ( Koo & Thomas, 2019 ) and the other consisting of 16 30-min sessions over 2 mo ( Chincholkar et al., 2019 ). In both studies, each session allowed the child to choose their art material (draw, paint, clay, or craft) to work through basic art concepts and motor skills ( Koo & Thomas, 2019 ; Chincholkar et al., 2019 ), which focuses on drama, risk taking, and problem-solving skills in children. The third study used an intervention that consisted of asking the child to use the facial features of a mouth, nose, eyes, and eyebrows to construct four different faces—happy, sad, angry, and fearful—in one 60-min session ( Richard et al., 2015 ).

Two of the 3 studies observed a positive effect in children with ASD. Koo and Thomas (2019 ) found a notable increase in social reply consistency and level of intellectual response relating to others as measured with the CARS. Chincholkar et al. (2019 ) found considerable improvements in visual response, verbal communications, and social communication. However, Richard et al. (2015 ) found no statistically significant difference in the ability to recognize emotions from before to after the intervention for the control and intervention groups. None of the articles examined whether positive improvements lasted after intervention.

Eight studies examined the effect of music interventions ( Bharathi, Jayaramayya, et al., 2019 ; Bieleninik et al., 2017 ; Crawford et al., 2017 ; Gattino et al., 2011 ; LaGasse, 2014 ; Poquérusse et al., 2018 ; Sharda et al., 2018 ; Simpson et al., 2013 ).

Three studies used structured individual music interventions to address specific learning skills ( Bieleninik et al., 2017 ; Crawford et al., 2017 ; Sharda et al., 2018 ). This type of intervention required one to three 30- to 45-min sessions per week for 2 to 5 mo. The sessions focused on singing or musical play to target attention, synchronizing (doing what the therapist is doing), mirroring (matching the therapist, in both music and body language), and grounding (organizing and steadying the music; Bieleninik et al., 2017 ); playing tuned or untuned percussion or wind instruments to target therapy session engagement and tolerance level to choose new or different musical instruments ( Crawford et al., 2017 ); or using musical instruments, singing, or rhythmic cues to target communication, taking turns, integrating senses, and musical interaction ( Sharda et al., 2018 ).

Three studies used less structured 1:1 interventions that required higher levels of improvisation ( Bharathi, Jayaramayya, et al., 2019 ; Gattino et al., 2011 ; Poquérusse et al., 2018 ). These types of interventions involved singing, dancing, and playing with the musical instruments while listening to songs ( Bharathi, Jayaramayya, et al., 2019 ); playing with the musical instruments and listening to music when a song was played on a CD player ( Gattino et al., 2011 ); or peer interaction and discussion about the emotions felt when listening to different musical pieces ( Poquérusse et al., 2018 ). One study allowed for the group to improvise a performance using the musical instruments ( Poquérusse et al., 2018 ).

One study was conducted in small groups ( LaGasse, 2014 ). These 50-min small-group sessions occurred twice a week for 5 wk. Sessions consisted of creating structured group musical experiences and encouraged participants to listen to and communicate with each other. The children were provided sensory experiences, such as sitting on therapy balls, jumping, running, stomping, or deep pressure, before and after the group music, and the sessions ended with cooperative play ( LaGasse, 2014 ). Simpson et al. (2013 ) used music as a way to deliver instructions in the intervention and found that children with ASD engaged more in a labeling task if the instructions were sung rather than spoken.

All 8 of these studies found at least one positive effect of using music in interventions with children with ASD. These improvements were seen specifically in verbal communication (e.g., speech and semantics), engagement, social awareness, social relations (e.g., increasing family interactions), less parental stress, less child stress, more joint attention, improved eye gaze, better understanding and perspective taking, more responding to others, and improved ability to maintain social interactions and interests. Among these 8 studies, 1 found that only nonverbal communication improved ( Gattino et al., 2011 ) and that maladaptive behaviors, such as inappropriate initiations and ASD– like mannerisms, were reduced. Two studies found no significant difference in the initiation of postintervention communication compared with the control group ( Bharathi, Jayaramayya, et al., 2019 ; LaGasse, 2014 ). One study found no difference in children’s responses to communication, social withdrawal, ATEC speech and communication scores, sociability, and health and physical behavior before and after the intervention ( LaGasse, 2014 ). Bharathi, Jayaramayya, et al. (2019 ) also found that the positive effect did not last in the posttest and follow-up periods. Simpson et al. (2013 ) found that singing had a notable effect on engagement but not on reducing challenging behaviors.

Four studies used theater interventions, specifically, the Social Emotional NeuroScience Endocrinology (SENSE) theater approach ( Corbett et al., 2016 , 2017 , 2019 ; Ioannou et al., 2020 ). This intervention is delivered through 10 4-hr group sessions and incorporates peer support using learning theory behavioral strategies. It involves theater games, role playing, improvisation, character development, rehearsals, and the production of a play ( Corbett et al., 2016 , 2017 , 2019 ; Ioannou et al., 2020 ). Three of the 4 studies also used video modeling, in which children were asked to watch 20 videos and practice target behaviors, including acting out songs and role plays for about 15 min a day ( Corbett et al., 2016 , 2017 ; Ioannou et al., 2020 ).

All 4 studies found positive effects of theater interventions in children with ASD. Specific improvements were seen in solicited group play, unsolicited group play, trait anxiety, social cognition, cortisol levels, social ability, communication symptoms, playing with toys with peers around, immediate memory of faces, delayed memory of faces, and Theory of Mind. A significant decrease in isolated play was also reported ( Ioannou et al., 2020 ). One study found that improvements in communication lasted for 2 mo after the intervention ( Corbett et al., 2016 ). Although 1 study found improvements in unsolicited group play ( Ioannou et al., 2020 ), another observed no difference ( Corbett et al., 2019 ). One study found no difference in unsolicited self-play ( Ioannou et al., 2020 ). Two studies found no change in state anxiety levels ( Corbett et al., 2017 ; Ioannou et al., 2020 ). State anxiety is defined as a temporary reaction to an event, whereas trait anxiety is defined as a more stable personality feature ( Saviola et al., 2020 ).

Connecting Effectiveness of Art Interventions With the OTPF–4

All studies targeted at least one aspect of the OTPF–4 domains (Table A.5). Fourteen of the 15 used interventions that targeted aspects of the Performance Skills domain. Twelve of those 14 studies targeted OTPF–4 social interaction skills ( Bharathi, Jayaramayya, et al., 2019 ; Bieleninik et al., 2017 ; Chincholkar et al., 2019 ; Corbett et al., 2016 , 2019 ; Crawford et al., 2017 ; Gattino et al., 2011 ; Ioannou et al., 2020 ; Koo & Thomas, 2019 ; LaGasse, 2014 ; Richard et al., 2015 ; Sharda et al., 2018 ). Two of the 14 focused on process skills, which are part of the Performance Skills domain ( LaGasse, 2014 ; Simpson et al., 2013 ). Seven studies targeted Client Factors, specifically, body functions. Among these 7, 3 targeted the body function of specific mental functions, such as higher level cognitive processes; attention; and emotional and global mental functions, such as temperament and personality ( Bieleninik et al., 2017 ; Corbett et al., 2019 ; Sharda et al., 2018 ). The remaining 4 studies targeted specific emotional functions, as part of mental functions of the body functions category ( Corbett et al., 2017 ; Crawford et al., 2017 ; Ioannou et al., 2020 ; Poquérusse et al., 2018 ).

The purpose of this scoping review was to identify specific OTPF–4 domains in which creative arts interventions can be effectively used by occupational therapists to help children with ASD. On the basis of evidence from 15 selected articles, we found that the evidence from 13 supports the efficacy of drawing and painting, music, and theater for children with ASD. Evidence supports the idea that creative arts activities specifically target the OTPF–4 Performance Skills and Client Factors domains. These creative arts interventions appear to have a similar impact on outcomes regardless of whether they are delivered to a group or an individual.

We found strong evidence to support the efficacy of creative arts interventions for children with ASD. Fourteen of the 15 studies used a control group for comparison. Although all creative arts interventions targeted different aspects of the child, no specific art form showed a greater effect than the others. The evidence suggests that art interventions allow children with ASD to express themselves through different media and gain a different perspective about themselves, others, and the world around them. The elements provided by art interventions appear to facilitate social learning in children with ASD. Our review supports the idea that creative art forms of the three included interventions (drawing and painting, music, and theater) influence the OTPF–4 Performance Skills and Client Factors domains for children with ASD. Our review also provides evidence of the benefit of using different creative art delivery formats and durations to enhance occupation-based skills for children with ASD.

One of the 15 articles found a nonsignificant result ( Richard et al., 2015 ). This intervention involved only one session and targeted performance skills. Richard et al.’s (2015 ) approach was to ask children to construct four different faces (happy, sad, angry, and fearful), using facial features of a mouth, nose, eyes, and eyebrows. The outcome measure was the DANVA 2–CF, which is used to assess facial expressions. The results indicated that both the control and intervention groups had a slight increase in scores, but neither within- nor between-groups differences were found in posttest scores. Richard et al.’s (2015) study also had a moderate risk of bias, implying that constructing facial expressions may not be an effective approach to use with children with ASD. This may be due to the fact that emotions do not have concrete features, so children with ASD cannot easily capture proper facial expressions.

We expect that children with ASD may require multiple sessions before the impact of an art intervention is observed. However, 1 article found that a single session of music intervention resulted in reduced stress levels ( Poquérusse et al., 2018 ). Perhaps the client factor of stress level is more responsive to a single creative art activity session than the performance skills addressed in Richard et al. (2015 )’s study.

General creative arts activities (e.g., painting or drawing) examined in this review were found to affect only targeted performance skills (social interaction skills). Our findings are consistent with those of previous research reporting that art activities, such as painting and drawing, can improve communication and social skills in children with ASD through effective self-expression ( Schweizer et al., 2019 ). Through general art activities, children with ASD are given unique sensory experiences to safely communicate and develop social skills with the therapist or other children ( Schweizer et al., 2019 ). Painting and drawing allow children with ASD to communicate through alternative channels and enhance self-expression ( Chincholkar et al., 2019 ).

Music interventions targeted OTPF–4 Client Factors and Performance Skills of social interaction and process skills. Music has been shown to improve arousal and attention ( Bharathi, Venugopal, & Vellingiri, 2019 ) and communication skills ( Brancatisano et al., 2020 ) in children with ASD. Our findings are consistent with those of previous studies and support the incorporation of music into occupational therapy interventions. Music activates specific parts of the brain, which can stimulate learning processes in children with ASD, resulting in positive behavioral changes ( Bharathi, Jayaramayya, et al., 2019 ). Music also allows children with ASD to express themselves nonverbally ( Bharathi, Venugopal, & Vellingiri, 2019 ), facilitating the active development of social skills.

Theater interventions were found to target social interaction skills (Performance Skills domain) as well as attention, emotion regulation, temperament, and personality (Client Factors domain). Our occupation-based review also supports previous research suggesting that theater interventions can enhance social skills and communication skills in children with ASD ( Corbett et al., 2011 ). Previous research also suggests that the repetition and rehearsal aspects of theater interventions enhance learning and lead to improvements in social skills and communication. Through theatrical features, such as modeled behavior, children with ASD can learn how to identify social cues and develop positively reinforced appropriate behaviors ( Corbett et al., 2011 ).

Implications for Future Research

Research with a higher level of evidence, such as multisite RCTs, is still needed to support the effectiveness of creative arts interventions for children with ASD. At present, no guideline exists to help occupational therapists design treatment plans that include creative arts components for children with ASD. We suggest that future research examine whether one form, or a combination of multiple creative art forms, is more effective. In addition, future research could determine whether certain creative arts activities are more useful in developing performance and participation in certain OTPF–4 domains and whether specific durations and intensity are most effective.

Limitations

We included only Level 1b or 2b evidence in this review; we excluded studies at other evidence levels. Although it is important to review higher level evidence, studies at other evidence levels may provide crucial information. For example, we noticed numerous case studies and feasibility studies that examined the efficacy of painting and drawing interventions, but we excluded them because of our inclusion and exclusion criteria. Also, all 4 of the theater interventions used the same theater intervention structure, SENSE theater. Although the intervention was supported by the evidence, our review did not include studies with other types of theater interventions. Therefore, our findings may have limited generalizability regarding the art modalities that can be recommended for this target population.

Implications for Occupational Therapy Practice

This review has several implications for occupational therapy practice. First, the findings support occupational therapists’ use of creative arts interventions to enhance performance skills and client factors among children with ASD. Painting and drawing, theater, and music interventions were found to be beneficial in several OTPF–4 domains. Occupational therapists can incorporate creative arts components into their interventions when working with children with ASD. Second, occupational therapists can design creative arts interventions for children with ASD that are based on the duration and intensity provided in Table A.2. We also suggest that more than one treatment session may be more effective when targeting performance skills. Finally, our review supports the concept that different OTPF–4 domains can be enhanced through the use of different forms of creative arts interventions for children with ASD. Occupational therapists can provide evidence-based creative arts interventions to meet the needs of this population.

This review provides evidence of the efficacy of creative arts interventions to enhance occupation-based outcomes for children with ASD. This scoping review indicates that painting, drawing, music, and theater can improve OTPF–4 client factors and performance skills in children (ages 3.5–16 yr) with ASD, specifically in process/social interaction skills and body functions. Our findings suggest that multiple sessions may produce more substantial improvements and should be used when targeting performance skills. We also found that group and individual intervention sessions had similar treatment effects for children with ASD. To support evidence-based practice, we recommend that occupational therapists design creative arts interventions for children with ASD based on the duration and intensity provided in this review. Our findings support occupational therapists’ incorporation of creative arts components in the treatment of children with ASD to enhance client factors, process, and social interaction skills.

Supplementary Material

Supplemental information, acknowledgments.

This study was funded in part by the National Institutes of Health, National Institute of Child Health and Human Development (K01HD101589; Chih-Ying Li, principal investigator). The authors declare no conflicts of interest in any regard with respect to publishing this article. We do not believe author biases in regard to social, ethnic, or cultural variables existed as this article was being prepared. This scoping review is registered in the Open Science Framework ( https://osf.io/akqjy ; because this is an open-ended registration, our review does not have a registration number but can be searched online).

* Indicates studies included in the scoping review.

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Art Therapy Essay Examples

The effectiveness of creative art therapies treating post traumatic stress disorder.

The authors in this article reviewed numerous records of studies that were done to test the effectiveness of creative art therapies treating PTSD (Post Traumatic Stress Disorder). They narrowed their review down to seven studies that used a controlled study structure and had conveyed evidence...

Effectiveness of Both Cbt and Art Therapy on Coping Mechanism

The Social work intern is currently interning at Sheltering Arms and Family Service. Sheltering Arms is a non-profit organization established in 1831. The population that is assisted is very diverse in all categories whether it’s ethnicity, race or all ages. The services it offers fall...

My Future Career as an Art Therapist

I’ve always wanted to combine my love of art and my compassion for people. I plan to do this by studying Social Work for my second master’s degree and eventually becoming an art therapist. My first master’s degree was in Fine Art; while making my...

Reflection on Visiting the Movement Theatre in Georgia

The Movement theatre is an ideal place to understand better modern Georgian culture and look at the theatre from the other side. Since the actors tell the story only through movements, there is no language barriers, and the theater tries its best to please everyone,...

To Investigate the Role of Art Therapy

In the developmental psychology, human relationship is the fundamental key of physical and psychological well-being, as human survives by depending on each other. According to the first and second principle of sociocultural level of analysis, human relationship is built because human being has the basic...

The Role of Art Therapy in Healing Anxiety and Depression

A recent scientific journal provided proof that the use of art therapy can improve psychological stability and help alleviate depression, anger, stress and anxiety levels. High levels of anxiety and depression can affect a patient not only psychologically but also physically. Through new studies, health...

The Effectiveness of Art Therapy and How It Results in Happiness

The article “Does Art Therapy Work? Identifying the Activate Ingredients of Art Therapy Efficacy” states that art, itself, can help clients cope with emotional pain. Art can effectively improve one’s mental state. Author Lynn Kapitan, editor of Art Therapy: Journal of the American Art Therapy...

The Effect of Art Therapy on Depressive Symptoms in the Elderly

A diagnosis of depression involves a loss of interest in usual activities or feelings of sadness accompanied by an array of possible symptoms that must be present for at least two weeks (American Psychiatric Association, 2017). The Centers for Disease Control and Prevention (CDC) (2017)...

Art Therapy in the Female Veteran Population

“Women have greater odds of adverse mental health among deployed veterans,” (Hoglund and Schwartz, 2014, Lehavot et al. , 2012, Maiocco & Smith, 2016). In today’s society, a lot more women are joining the military. According to the Department of Veterans Affairs, there were 1....

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