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. 2018 Dec 17;13(12):e0208716.
doi: 10.1371/journal.pone.0208716. eCollection 2018.

The effectiveness of art therapy for anxiety in adults: A systematic review of randomised and non-randomised controlled trials

Annemarie Abbing  1   2 , Anne Ponstein  1   3 , Susan van Hooren  3   4   5 , Leo de Sonneville  2 , Hanna Swaab  2 , Erik Baars  1
Affiliations

The effectiveness of art therapy for anxiety in adults: A systematic review of randomised and non-randomised controlled trials

Annemarie Abbing et al. PLoS One. .

Abstract

Background: Anxiety disorders are one of the most diagnosed mental health disorders. Common treatment consists of cognitive behavioral therapy and pharmacotherapy. In clinical practice, also art therapy is additionally provided to patients with anxiety (disorders), among others because treatment as usual is not sufficiently effective for a large group of patients. There is no clarity on the effectiveness of art therapy (AT) on the reduction of anxiety symptoms in adults and there is no overview of the intervention characteristics and working mechanisms.

Methods: A systematic review of (non-)randomised controlled trials on AT for anxiety in adults to evaluate the effects on anxiety symptom severity and to explore intervention characteristics, benefitting populations and working mechanisms. Thirteen databases and two journals were searched for the period 1997 -October 2017. The study was registered at PROSPERO (CRD42017080733) and performed according to the Cochrane recommendations. PRISMA Guidelines were used for reporting.

Results: Only three publications out of 776 hits from the search fulfilled the inclusion criteria: three RCTs with 162 patients in total. All studies have a high risk of bias. Study populations were: students with PTSD symptoms, students with exam anxiety and prisoners with prelease anxiety. Visual art techniques varied: trauma-related mandala design, collage making, free painting, clay work, still life drawing and house-tree-person drawing. There is some evidence of effectiveness of AT for pre-exam anxiety in undergraduate students. AT is possibly effective in reducing pre-release anxiety in prisoners. The AT characteristics varied and narrative synthesis led to hypothesized working mechanisms of AT: induce relaxation; gain access to unconscious traumatic memories, thereby creating possibilities to investigate cognitions; and improve emotion regulation.

Conclusions: Effectiveness of AT on anxiety has hardly been studied, so no strong conclusions can be drawn. This emphasizes the need for high quality trials studying the effectiveness of AT on anxiety.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram.
See this image and copyright information in PMC

References

    1. Hassink-Franke LT, B., van Heest F., Hekman J,. van Marwijk H., & van Avendonk M. Dutch primary care standard anxiety [NHG-Standaard Angst (tweede herziening)]. 2012.
    1. Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology. 2011;21(9):655–79. 10.1016/j.euroneuro.2011.07.018 - DOI - PubMed
    1. de Graaf R, ten Have M, van Gool C, van Dorsselaer S. Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Social Psychiatry and Psychiatric Epidemiology. 2011;47(2):203–13. 10.1007/s00127-010-0334-8 - DOI - PubMed
    1. Kessler RC, Dupont RL, Berglund P, Wittchen H-U. Impairment in Pure and Comorbid Generalized Anxiety Disorder and Major Depression at 12 Months in Two National Surveys. American Journal of Psychiatry. 1999;156(12):1915–23. 10.1176/ajp.156.12.1915 - DOI - PubMed
    1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry. 2005;62(6):617 10.1001/archpsyc.62.6.617 - DOI - PMC - PubMed

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