Art Therapy in Mental Health Treatment: A Narrative Review of Efficacy and Application in Developed Countries ()
1. Introduction
Art therapy has increasingly emerged as a valuable mental health intervention, recognized for its ability to support emotional regulation, self-expression, and psychological healing through creative processes (Bitonte & Santo, 2014). This form of expressive psychotherapy has been particularly beneficial in treating conditions such as depression, anxiety, borderline personality disorder (BPD), schizophrenia, and post-traumatic stress disorder (PTSD) (Slayton et al., 2010). Developed countries, including the USA, UK, Australia and Singapore, have integrated art therapy into their mental health care systems to address the rising prevalence of mental health disorders, which have become a growing public health concern.
Art therapy’s non-verbal, creative approach allows patients to explore emotions and experiences often difficult to express through conventional talk therapy (Shukla et al., 2022). An expanding body of research has then supported the efficacy of art therapy. A systematic review by Maujean et al. (2014), a significant contribution to the field, found that in nearly all the randomized controlled trials (RCTs) examined, art therapy interventions produced significant therapeutic outcomes, particularly among vulnerable populations such as war veterans, older adults, and prison inmates (Slayton et al., 2010). Similarly, a review of art therapy practices between 1994 and 2014 by Van Lith (2016) showed how various forms of art therapy have been integrated into mental health systems across developed nations, providing both short-term and long-term mental health benefits (). Despite these promising findings, there is still a need for more rigorous, large-scale research to better understand the full extent of art therapy’s impact, particularly in terms of its long-term effectiveness and the specific populations that benefit the most ().
The evidence suggests that art therapy can be a valuable intervention for individuals with mental health issues. A comprehensive review of studies carried out from 1994 to 2014 highlighted different art therapy methods employed in the clinical mental health field to aid individuals facing mental health issues such as depression, borderline personality disorder, schizophrenia, and post-traumatic stress disorder (; ). Randomized controlled studies have provided additional evidence supporting the effectiveness of art therapy (Uttley et al., 2015a). A review of eight such studies revealed that all but one reported positive effects of art therapy, suggesting its potential to benefit various groups, including older adults, war veterans, and prison inmates (Maujean et al., 2014). The prevalence of mental health issues in developed countries has been a growing concern in recent decades (Lith, 2016). As conventional therapeutic approaches have shown limitations, there is a rising interest in exploring complementary and integrative therapies to enhance treatment outcomes. Art therapy, as a treatment modality applied in mental health treatment, is a form of expressive therapy that utilizes the creative process of artmaking to improve and enhance the physical, mental, and emotional well-being of individuals (Slayton et al., 2010). It allows individuals to explore their emotions, gain self-awareness, and develop coping strategies through various art mediums such as painting, drawing, sculpture, and collage.
Purpose of the Narrative Literature Review
The narrative review aims to synthesize current research on the role, efficacy, and public perception of art therapy in developed countries. In recent years, art therapy has steadily gained prominence as an important and effective intervention for addressing a diverse array of mental health conditions, as evident by its growing adoption and integration within the healthcare systems of many developed nations. The therapeutic value of art-based modalities in treating mental health issues has been documented across a broad spectrum of populations, from older adults to war veterans to prison inmates (Slayton et al., 2010). Studies examining the efficacy of art therapy have consistently reported beneficial outcomes, including in RCTs that employed rigorous methodological approaches. While the existing body of research suggests the promise of art therapy, further investigation is warranted to more conclusively establish its efficacy and delineate the specific populations and conditions in which it offers the greatest therapeutic value (Abbing et al., 2018).
2. Search Methodology & Inclusion Criteria
This narrative review explores the current landscape of art therapy research, with an emphasis on its application to mental health in populations such as young adults, older adults, war veterans, and prison inmates. The review aims to highlight trends, identify research gaps, and provide a conceptual understanding of how art therapy impacts different groups. A broad search of the literature was conducted using key databases such as PubMed, Scopus, and Google Scholar. The search terms included “art therapy”, “mental health”, “young adults”, “older adults”, “war veterans”, and “prison inmates”. Sources included journal articles and review papers on the subject, drawing from both qualitative and quantitative studies, as well as theoretical papers. While no strict inclusion criteria were enforced, studies were selected based on their relevance to the populations of interest and the topic of art therapy in mental health. Rather than systematically identifying gaps, this narrative review takes a more exploratory approach on systematic themes highlighting areas where the literature is sparse or where further research could enhance the understanding of art therapy’s impact.
3. Efficacy of Art Therapy in Treating Mental Health
Conditions
The existing literature suggests that art therapy can be an effective intervention for a range of mental health conditions. A review of outcome studies found that art therapy can be beneficial in treating a variety of symptoms, age groups, and disorders, including major mental illnesses and the consequences of trauma (Slayton et al., 2010). Moreover, a systematic review of RCTs on art therapy reported that all but one of the studies found beneficial effects of art therapy on participants, including older adults, war veterans, and prison inmates.
4. Art Therapy as an Alternative Psychotherapy
Over the past few decades, art therapy has emerged as a promising alternative to traditional psychotherapy, particularly in the treatment of various mental health conditions (Lith, 2016; José et al., 2023). The existing body of research suggests that art therapy can have a positive impact on individuals dealing with a variety of mental health issues. Art therapy is founded on the premise that the creative process involved in artistic expression can foster healing and personal growth for individuals struggling with psychological challenges. Art therapy has been shown to facilitate emotional expression, self-discovery, and the development of resilience through creative outlets, as supported by a systematic review of art therapy approaches and practices, which identified beneficial effects of art therapy interventions for individuals with mental health. Given the potential benefits of art therapy, it is important to examine the existing evidence on the efficacy of this approach in treating specific mental health conditions.
While numerous studies have explored the efficacy of art therapy, a review of the current literature is necessary to synthesize the existing findings and identify areas for further research. Existing literature has examined the efficacy of art therapy in the treatment of various mental health conditions, including depression, borderline personality disorder, schizophrenia, and post-traumatic stress disorder (Lith, 2016). Art therapy has been found to be particularly beneficial for older adults, war veterans, and prison inmates, according to a systematic review of randomized controlled studies on art therapy (Slayton et al., 2010; Maujean et al., 2014; Lith, 2016). The existing literature on the efficacy of art therapy in treating mental health conditions provides promising evidence for its effectiveness. However, the current body of research is still limited, and more rigorous studies are needed to fully understand the potential of art therapy as a mental health intervention (José et al., 2023).
Numerous studies have demonstrated the utility of art therapy in addressing diverse mental health needs, such as alleviating symptoms associated with major mental illnesses, trauma and its consequences, and the impact of social problems. In a systematic review of randomized controlled studies on art therapy from 2008 to 2013, the majority of the examined studies, all but one, reported positive effects of art therapy interventions on participants, including older adults, war veterans, and prison inmates (Maujean et al., 2014). Similarly, a review by Reynolds et al. in 1999 found that art therapy was effective in treating a variety of symptoms and disorders, though the methodological rigor of the included studies varied. The existing research, while promising, also highlights the need for more robust and rigorous investigations to more conclusively establish the efficacy of art therapy. As the field of art therapy continues to evolve, the accumulation of empirical evidence supporting its therapeutic value will be crucial in shaping its integration and acceptance within the broader mental health landscape of developed countries.
4.1. Overview of Art Therapy’s Effectiveness on Mental Health
Art therapy is a form of psychotherapy that utilizes artistic expression as a means of communication and self-exploration. It is based on the premise that the creative process involved in artistic expression can promote emotional, cognitive, and physical well-being (Regev & Cohen-Yatziv, 2018). The effectiveness of art therapy has been the subject of extensive research, with numerous studies examining its application in the treatment of a wide range of mental health conditions, from depression to trauma (José et al., 2023; Slayton et al., 2010). Numerous studies had highlighted art therapy’s ability to help patients overcome symptoms and achieve meaningful progress in their recovery (Regev & Cohen-Yatziv, 2018; Slayton et al., 2010; Lith, 2016). Regev & Cohen-Yatziv (2018) noted the effectiveness of art therapy with adult clients, observing that this field had expanded significantly in the past two decades where art therapy interventions are being implemented with increasing frequency across diverse settings.
While the evidence base is still evolving, there is a growing body of research supporting the use of art therapy as an adjunct to traditional talk therapy (Slayton et al., 2010; Maujean et al., 2014; Regev & Cohen-Yatziv, 2018). For example, a review of randomized controlled studies between 2008-2013 found that art therapy may benefit a range of individuals, including older adults, war veterans, and prison inmates (Maujean et al., 2014). Another review highlighted the utility of art therapy in treating major mental illnesses and the consequences of trauma. (Slayton et al., 2010). Examining the findings from the literature, art therapy appears to be a promising intervention for addressing a variety of mental health conditions. This is supported by a systematic review of randomized controlled studies that found beneficial effects of art therapy in the majority of the studies, further underscoring its potential as a therapeutic modality (Abbing et al., 2018). The research indicates (Uttley et al., 2015b). that art therapy can be effective in treating a diverse range of mental health issues, including depression, borderline personality disorder, schizophrenia, and post-traumatic stress disorder. Additionally, a systematic review highlighted the utility of art therapy in treating major mental illnesses and the consequences of trauma (Slayton et al., 2010).
4.2. History and Development in Developed Countries
Art therapy, as a distinct therapeutic modality, has experienced significant growth and recognition in the latter half of the 20th century, particularly in developed countries. Developed countries are sovereign states with advanced economies, high standards of living, and well-established infrastructures. Examples include the United States, Germany, Japan, Canada, Australia, and Singapore. The establishment of professional associations, such as the American Art Therapy Association in 1969, has helped to formalize and legitimize the field, leading to its increased utilization in clinical practice. The founding of these professional organizations, coupled with the growing interest among arts students seeking alternative careers, has fostered the tremendous expansion of art therapy in recent decades.
The existing body of research suggests that art therapy can be an effective intervention in treating a variety of mental health conditions. While earlier studies were limited in their methodological rigor, more recent systematic reviews have provided stronger evidence for the therapeutic benefits of art therapy, particularly for adult populations (Regev & Cohen-Yatziv, 2018). One review of RCTs found that art therapy interventions yielded beneficial effects for a range of individuals, including older adults, war veterans, and prison inmates. The findings from these studies indicate that art therapy may offer significant value in addressing various mental health concerns, such as depression, anxiety, trauma, and behavioural issues, by providing a non-verbal and creative outlet for expression and emotional processing (Abbing et al., 2018). However, further research is needed to more conclusively establish its efficacy, establish the specific mechanisms by which art therapy achieves its therapeutic effects and identify the specific populations that stand to benefit the most from this modality approach. This review of the literature on the use and efficacy of art therapy in mental health treatment highlights the growth and evolution of this therapeutic modality in developed countries over the past several decades.
4.3. Cost-Effectiveness and Application
One systematic review noted that while no formal evaluation of the cost-effectiveness of art therapy has been conducted, the existing literature suggests it may provide more profound and long-lasting healing than more standard forms of treatment (Uttley et al., 2015b). The implications of these findings are significant, as they suggest that the broader integration of art therapy into mental health care systems, particularly in developed countries where access to mental health services may be limited, could improve patient outcomes and potentially reduce long-term healthcare costs. Despite the promising evidence, the authors acknowledge the need for further research to more conclusively establish the efficacy and cost-effectiveness of art therapy, as the evidence base, while growing, is still relatively limited (Slayton et al., 2010). Art therapy has shown promise in enhancing mental health outcomes and may contribute to long-term cost savings in healthcare. For example, a systematic review by Uttley et al. (2015a) evaluated the clinical and cost-effectiveness of group art therapy for individuals with non-psychotic mental health disorders. The study suggested that art therapy could lead to reductions in healthcare utilization, such as decreased reliance on medication and fewer hospitalizations, thereby potentially lowering overall healthcare costs.
4.4. Efficacy of Art Therapy in Mental Health
4.4.1. Effectiveness in Treating Specific Disorders
1) Depression and Anxiety
Art therapy has been shown to be effective in treating depression and anxiety, particularly in older adult populations, by promoting self-expression, reducing stress, and improving overall well-being. The available literature also suggests that art therapy can be effectively utilized in a variety of settings, including inpatient and outpatient mental health facilities, community-based programs, schools, and correctional institutions (Maujean et al., 2014; Uttley et al., 2015a; Slayton et al., 2010). The findings from this body of research indicate that art therapy is a promising intervention for a range of mental health conditions and can be implemented in diverse settings, providing individuals with a unique and potentially transformative therapeutic experience (Regev & Cohen-Yatziv, 2018).
2) Post-Traumatic Stress Disorder (PTSD)
Art therapy has been found to be an effective intervention for individuals experiencing trauma and post-traumatic stress disorder (Avrahami, 2006). Studies have demonstrated that art therapy can help reduce symptoms of PTSD, including intrusive thoughts, avoidance behaviours, and hyperarousal (Lith, 2016; Regev & Cohen-Yatziv, 2018). The creative process involved in art therapy can provide a safe and structured way for individuals to express and process their traumatic experiences, leading to improved emotional regulation and a reduction in PTSD-related symptoms (Lobban & Murphy, 2019).
4.4.2. Schizophrenia, Bipolar Disorder and Substance Abuse
Beyond the treatment of trauma, mood, and anxiety disorders, research has also explored the potential benefits of art therapy for individuals with other mental health conditions, such as schizophrenia, bipolar disorder, and substance abuse. Lobban & Murphy (2017) suggests that art therapy can be effectively utilized for individuals with more severe mental health conditions, such as schizophrenia and bipolar disorder. Regev & Cohen-Yatziv (2018) revealed that art therapy is a promising intervention for a range of mental health conditions and can be implemented in diverse settings, providing individuals with a unique and potentially transformative therapeutic experience. Other literature also suggests that art therapy may be an effective intervention for individuals struggling with substance abuse disorders (Aletraris et al., 2014).
4.4.3. Comparative Advantage in Treating Specific Disorders
Art therapy distinguishes itself by facilitating non-verbal expression, allowing individuals to convey complex emotions and experiences that may be difficult to articulate verbally. This approach is particularly beneficial for trauma survivors, as it enables them to process traumatic memories in a less re-traumatizing manner compared to traditional talk therapies (José et al., 2023). Additionally, art therapy enhances engagement, especially among children and adolescents, by incorporating creative activities that make therapy more accessible. It also aids in emotional regulation, providing a cathartic outlet for pent-up emotions. Furthermore, art therapy offers alternative communication methods for individuals with communication challenges, such as those on the autism spectrum, facilitating social skills development and emotional expression (Crawford et al, 2012).
4.5. Public Perception and Access to Art Therapy
Awareness and Acceptance in Developed Countries
Art therapy has been found to be an acceptable alternative form of psychological treatment for some individuals struggling with mental health conditions (Uttley et al., 2015a). Despite increasing recognition of its benefits, barriers continue to hinder wider adoption and utilization of art therapy in developed nations. While art therapy has gained recognition for its potential to address a range of mental health issues, its availability and accessibility in developed countries remain a concern (Lith, 2016). Despite the demonstrated efficacy of art therapy in improving mental health outcomes, access to these services varies considerably across developed nations. In many developed countries, the availability and accessibility of art therapy services are influenced by a range of factors, including funding, insurance coverage, geographic distribution of providers, and public awareness (Uttley et al., 2015a; Regev & Cohen-Yatziv, 2018).
4.6. Barriers to Access
While art therapy has demonstrated its effectiveness in addressing a range of mental health issues, the availability and accessibility of these services in developed countries remain a significant concern that requires a multifaceted approach to address, as highlighted below:
Cost and Insurance: The uneven distribution of art therapy providers in developed countries, with services often concentrated in urban areas, can also limit access for individuals living in rural or underserved communities (Regev & Cohen-Yatziv, 2018). These financial and geographic barriers are further compounded by the role of public awareness and stigma in shaping perceptions and utilization of art therapy in developed countries. In light of these challenges, researchers have explored various strategies to improve access to art therapy in developed countries (Slayton et al., 2010). To address these barriers, the literature suggests a multifaceted approach involving increased insurance coverage for art therapy services, dedicated funding for art therapy programs, and comprehensive public education campaigns to raise awareness and reduce the stigma associated with mental health treatment ().
Stigma and Misconceptions: Misconceptions about the nature and purpose of art therapy may also contribute to its limited use in developed countries. Despite the growing recognition of art therapy’s benefits, public perceptions and attitudes toward mental health treatment can still pose significant barriers to its wider adoption (Lith, 2026). Potential solutions and recommendations from the literature to increase access to art therapy in developed countries include advocating for improved insurance coverage, securing dedicated funding for art therapy programs, and implementing comprehensive public education campaigns to raise awareness and reduce the stigma associated with mental health treatment (Slayton et al., 2010).
4.7. Socio-Economic Barriers Affect Access in Developed Nations
Access to art therapy in developed countries is significantly influenced by socio-economic factors, including funding mechanisms and geographic disparities. In the United States, insurance coverage limitations present substantial barriers; many private insurance plans do not cover art therapy, and while the Affordable Care Act mandates mental health coverage, the inclusion of art therapy remains inconsistent, leading to out-of-pocket expenses for patients and restricting access, especially for low-income individuals (Regev & Cohen-Yatziv, 2018).
Conversely, the United Kingdom’s National Health Service (NHS) offers more structured support, employing art therapists and providing services without direct charges, thereby reducing financial barriers and enabling broader access across different socio-economic groups (Slayton et al., 2010). However, in both countries, geographic disparities persist, with urban areas typically having a higher concentration of art therapy services due to the greater availability of healthcare facilities and professionals, while rural regions often experience shortages of qualified art therapists, leading to reduced access regardless of the funding model. Addressing these socio-economic and geographic barriers is crucial to ensure equitable access to art therapy and mental health services across developed nations (Maujean et al., 2014).
5. Government Policies and Institutional Support for
Art Therapy
5.1. Governmental Support for Art Therapy
Asia: Art therapy has been gaining popularity in Singapore, with the government providing funding and support for education and research in the field. The National Arts Council of Singapore has recognized art therapy as a specialized field and has provided grants to support the training and development of art therapists (Kim, 2009). In Korea, the art therapy field has also experienced substantial growth and development over the past decade, with the establishment of a robust educational infrastructure to support the training and professional development of art therapists (Ahn et al., 2020).
United Kingdom: The National Health Service has incorporated art therapy as a recognized treatment modality, with art therapists employed within various healthcare settings to provide this specialized form of mental health care (Kim, 2009). Alongside the governmental support and recognition of art therapy as a legitimate and valuable mental health treatment, the field has also experienced significant institutional backing, particularly within the healthcare sector (Estevao et al., 2020). Numerous studies have been conducted to assess the efficacy and outcomes of art therapy in the treatment of various mental health conditions, with research demonstrating the substantial benefits of this therapeutic approach. The body of research on the efficacy of art therapy in mental health treatment has continued to grow, with studies examining its effectiveness across a range of clinical populations and settings (Uttley et al., 2015b).
United States: The accumulating evidence on the efficacy and effectiveness of art therapy as a treatment modality for mental health conditions has been instrumental in driving its increasing integration and recognition within various healthcare systems and mental health programs around the world (Crawford et al., 2012). Art therapy has become a well-established and recognized form of mental health treatment in many developed countries, with governments and healthcare institutions providing varying degrees of support and integration of this therapeutic approach (Lith, 2016). Beyond the governmental support and recognition of art therapy as a legitimate and valuable mental health treatment, the field has also experienced significant institutional backing, particularly within the healthcare sector.
5.2. Integration in Healthcare and Education
The existing body of research on the therapeutic benefits of art therapy has played a crucial role in driving its increasing recognition and integration within mental health care systems worldwide (Uttley et al., 2015a). Art therapy has been increasingly integrated into mental health treatment in developed countries, particularly in educational and care settings. For instance, the use of art therapy telehealth has been reported to promote emotional stabilization, a sense of connection, and self-worthiness, while fostering engagement, integration, and participation of family and community members (José et al., 2023).
The extensive and growing body of research on the clinical efficacy and cost-effectiveness of art therapy in the treatment of a wide range of mental health conditions has been instrumental in driving its increasing integration and recognition within various healthcare systems and mental health programs. As the field of art therapy has gained recognition and support from governments and healthcare institutions, the growing body of research on the efficacy of this therapeutic approach has also highlighted its substantial benefits in the treatment of various mental health conditions (Uttley et al., 2015b). Extensive research on the efficacy of art therapy in mental health treatment has been conducted, with studies consistently highlighting the significant and wide-ranging benefits of this approach. The growing recognition of art therapy as a legitimate and effective treatment approach for mental health conditions has led to increased institutional support and integration within healthcare systems in many developed countries (Lith, 2016).
6. Discussions, Challenges and Future Directions
Despite the growing recognition of art therapy’s benefits, several challenges remain. Access to art therapy services in many developed countries, including Singapore, is often limited by cost, geographic location, and the availability of trained professionals. In addition, public misconceptions and stigma surrounding art therapy can hinder its wider adoption. There is also a need for more rigorous research, particularly large-scale RCTs, to better understand the specific mechanisms by which art therapy improves mental health outcomes and to identify the populations that benefit most from these interventions (Uttley et al., 2015b). Future research should focus on expanding the evidence base for art therapy, with a particular emphasis on long-term outcomes, population-specific studies, and intersectional analyses that consider the cultural and socio-economic factors influencing access to art therapy. In Singapore, there is also potential for further integrating art therapy into mainstream mental health services, with additional government support and public education campaigns to raise awareness about the benefits of creative therapies. Future research must address these gaps through more rigorous, long-term studies and by exploring the therapy’s application in underrepresented populations. Additionally, interdisciplinary collaboration between mental health professionals and art therapists, along with public education, could enhance the broader integration of art therapy into mental health care, ensuring its benefits are more widely accessible in developed countries, including Singapore.
7. Conclusion
Art therapy has become a significant and promising intervention for addressing mental health conditions in developed countries, including Singapore. Its non-verbal, creative approach offers a valuable alternative to traditional therapies, particularly for individuals who may struggle to articulate their emotions through words. As mental health awareness continues to grow, so too does the recognition of art therapy’s potential to support psychological well-being across diverse populations. However, more research is needed to fully establish art therapy’s efficacy in managing mental health issues on larger scale studies to discover its long-term, and population-specific benefits to improve its collaboration with mainstream mental health services.