The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial

Abstract

Objectives: Art therapy (AT) as a treatment option for anxiety is regularly employed in clinical practice, but scientific evidence for its effectiveness is lacking, since this intervention has hardly been studied. The aim was to study the effectiveness of AT on anxiety in adult women. The specific type of AT studied was anthroposophic AT. Methods: A RCT comparing AT versus a waiting list (WL) condition on anxiety symptom severity, quality of life, and emotion regulation. Factors influencing treatment outcome were additionally explored. Participants were women, aged 18-65 years, diagnosed with generalized anxiety disorder, social anxiety disorder or panic disorder, with moderate to severe anxiety symptoms. The trial was registered in the Dutch Trial Registration (NTR28143). Results: Fifty-nine women were included, of which 47 completed the trial. Both perprotocol and intention-to treat analyses demonstrated effectiveness of AT compared to WL, showing a reduction in anxiety, an increase in subjective quality of life (both with large effects) and an improvement in accessibility of emotion regulation strategies (medium effect). Treatment effects remained after 3 months follow-up. Improved acceptance of emotions and improved goal-oriented action are aspects of emotion regulation that are associated with the decrease in anxiety level. Conclusion: AT is effective in reducing anxiety symptoms, improving quality of life and aspects of emotion regulation. Future RCTs should use active controls (treatment as usual) and study cost-effectiveness.

Acceptance of Anxiety through Art Therapy: A Case Report Exploring How Anthroposophic Art Therapy Addresses Emotion Regulation and Executive Functioning

“…To date, one RCT on the effectiveness of AAT in women with anxiety disorders has been performed. e results are promising and show a significant reduction in level of experienced anxiety, compared to a waiting list condition [25]. From this study possible working mechanisms emerged: AAT may act through improvements in emotion regulation (strategies) and through improvement of executive functioning in daily behavior.…”

“…Unfortunately, it was not possible to create a complete description of the process. Although the therapist was requested to carefully document all stages in the process [25,28], some information was lacking from the therapist file. For instance, arguments that were used to select the specific assignments were not provided, the professional attitude per session was not documented and notes on Dewi's daily life experiences (between sessions) were not present in the case file.…”

Formal Elements of Art Products Indicate Aspects of Mental Health

“…The art form – the use of art materials in an art-making process resulting in an art product– is specific and unique for art therapy treatment and for art therapy observation and assessment. Art therapy approaches fundamentally assume that a clients’ mental health is expressed in the art form ( Hinz, 2009 , 2015 , 2020 ; Haeyen, 2018 ; Abbing et al, 2019 ).…”

Anxiety reduction through art therapy in women. Exploring stress regulation and executive functioning as underlying neurocognitive mechanisms

“…painting, drawing, sculpting, clay modelling) and is provided as standalone therapy or in multidisciplinary treatment programs for anxiety disorders. Outcomes of a RCT comparing three months AT with three months waiting list condition in women with anxiety disorders showed that anxiety symptoms can be reduced by AT and that there are indications that improved perceived emotion regulation plays a role in this reduction [12]. However, other aspects of self-regulation may also play a role in the reduction of anxiety symptom severity.…”

“…There is already some evidence for anxiety symptom reduction through AT and there are indications that improved perceived emotion regulation plays a role in this reduction [12]. To gain further understanding of other regulating processes that might play a role in the reduction of anxiety symptoms through AT, the question is addressed whether stress regulation and executive functioning improve as a result of AT and whether these mechanisms are related to the reduction of anxiety symptoms and may provide (further) mechanistic evidence and explanations of the AT treatment effect.…”