Is art therapy effective for treating anxiety and depression?

Art Therapy for Anxiety and Depression: Evidence-Based Recommendation

Yes, art therapy is supported by research and clinical guidelines as an effective complementary intervention for anxiety and depression, with the strongest evidence showing immediate reductions in state anxiety and improvements in quality of life, though the overall quality of evidence remains moderate and requires integration within comprehensive treatment plans. 1, 2

Guideline-Based Recommendations

Primary Recommendation from Major Guidelines

The National Comprehensive Cancer Network (NCCN) explicitly recommends creative therapies such as art and music for patients experiencing distress, depression, and anxiety. 1 This recommendation is based on systematic reviews of complementary and integrative therapies, positioning art therapy alongside other evidence-based interventions like meditation, yoga, and relaxation techniques. 1

The Society for Integrative Oncology and ASCO (2023) define art therapy as "a psychosocial intervention, facilitated by a professional art therapist, that utilizes art-making as a way for people to explore their subjective experiences and express their thoughts and emotions verbally and nonverbally." 1 The guidelines emphasize that art therapy is used to improve cognitive functioning, foster self-esteem, enhance coping skills, cultivate emotional resilience, and reduce conflicts and distress. 1

Context and Limitations

It is critical to note that ASCO guidelines (2018) list art therapy under "interventions with insufficient evidence to form a clinical recommendation" specifically for anxiety and stress reduction outcomes. 1 This apparent contradiction reflects the evolving evidence base—while art therapy is recommended as part of comprehensive distress management, the specific evidence for anxiety and depression as isolated outcomes was considered insufficient at that time. 1

Research Evidence Supporting Art Therapy

For Anxiety

The highest quality recent evidence comes from a 2019 randomized controlled trial of 59 adult women with diagnosed anxiety disorders (generalized anxiety disorder, social anxiety disorder, or panic disorder), which demonstrated large effect sizes for anxiety reduction and quality of life improvement. 2 This study showed:

• Significant reduction in anxiety symptoms compared to waiting list controls (large effect size) 2
• Increased subjective quality of life (large effect size) 2
• Improved emotion regulation strategies (medium effect size) 2
• Treatment effects maintained at 3-month follow-up 2
• Improved acceptance of emotions and goal-oriented action were associated with anxiety reduction 2

A 2018 systematic review of randomized and non-randomized controlled trials found only three RCTs (162 patients total) meeting inclusion criteria, all with high risk of bias. 3 The review found:

• Some evidence of effectiveness for pre-exam anxiety in undergraduate students 3
• Possible effectiveness for pre-release anxiety in prisoners 3
• Hypothesized working mechanisms: inducing relaxation, accessing unconscious traumatic memories to investigate cognitions, and improving emotion regulation 3

A 2025 pilot study in adolescents with eating disorders (n=19) demonstrated immediate reductions in state anxiety after art therapy sessions (p=0.002), with significant trait anxiety reductions emerging after 4-6 sessions. 4

For Depression

A 2019 systematic review of art therapy for depressive disorders identified 14 studies across multiple artistic techniques (manual work, music, poetry, photography, theater, art contemplation), with 12 of 14 studies showing positive effects. 5 The review concluded that art therapy is "a safe and reliable tool for treatment not only of depression but also of other mental disorders." 5

A 2019 pre-experimental study in an acute psychiatric inpatient setting (n=12) showed improvements in anxiety, stress, self-acceptance, purpose of life, and overall psychological well-being after a three-session art therapy program. 6 Qualitative analysis revealed the program's usefulness in participant recovery processes. 6

Clinical Implementation Algorithm

When to Recommend Art Therapy

Offer art therapy as a complementary intervention for:

1. Patients with mild to moderate anxiety or depression who prefer non-pharmacological approaches 1, 2
2. Patients experiencing distress related to medical illness (particularly cancer patients) 1
3. Patients with difficulties in emotional expression or emotion regulation 2, 3
4. Patients who have not responded adequately to first-line treatments alone 2

Essential Implementation Criteria

Art therapy should be:

• Facilitated by a professional art therapist (not simply art activities offered by volunteers or non-specialists) 1
• Structured as a systematic therapeutic process, not just recreational art-making 1
• Integrated within a comprehensive treatment plan that includes evidence-based psychotherapy (CBT) and/or pharmacotherapy for moderate to severe cases 7, 8
• Delivered in cycles of 4-6 sessions minimum for trait anxiety reduction 4

Specific Techniques with Evidence

Visual art techniques that have been studied include:

• Trauma-related mandala design 3
• Collage making 3
• Free painting and clay work 3
• Textile-based art therapy for body reconnection 4
• Drawing, painting, and modeling 5

Common Pitfalls and Caveats

Critical Limitations

The overall quality of evidence for art therapy remains low to moderate due to:

• Inability to mask participants to the intervention (inherent to the nature of art therapy) 1
• Inability to mask outcome assessors when using self-report measures 1
• Small sample sizes in most studies 4, 6, 3
• High risk of bias in available trials 3
• Limited long-term follow-up data 2

What Art Therapy Is NOT

Art therapy should not be confused with:

• Visual arts-based interventions offered by non-specialists for general therapeutic purposes 1
• Using visual arts to create healing environments in hospitals 1
• Recreational art activities without systematic therapeutic process 1

When Art Therapy Alone Is Insufficient

Art therapy should NOT be used as monotherapy for:

• Moderate to severe depression requiring pharmacotherapy (SSRIs as first-line) 7
• Severe anxiety disorders requiring immediate intervention 8
• Patients with suicidal ideation (require immediate psychiatric referral) 7

For these patients, art therapy serves as an adjunct to evidence-based treatments including SSRIs, CBT, and psychiatric consultation. 7, 8

Positioning Within Treatment Hierarchy

Art therapy ranks alongside other integrative therapies with established evidence:

• Mindfulness-based interventions (stronger evidence: SMD 0.34-0.74 for depression) 7
• Music therapy (large effect sizes for anxiety: SMD -1.51 to -1.87) 1
• Yoga and meditation (moderate evidence for both anxiety and depression) 1, 7
• Exercise (aerobic exercise SMD 0.25 for depression) 7

Art therapy appears most beneficial for immediate state anxiety reduction and may contribute to longer-term trait anxiety and depression improvements when delivered by trained professionals as part of comprehensive care. 4, 2