art as therapy thesis

• NEWSLETTER SIGN UP

The Research Committee is dedicated to encouraging, supporting, and promoting a broad base of research that is grounded in diverse methodologies. By providing information to the public and the membership, the committee promotes standards of art therapy research, produces a registry of outcomes based research, and honors professional and student research activity.

Art therapy priority research areas, focusing research efforts in the following areas:.

• Outcome/efficacy research
• Art therapy and neuroscience
• Research on the processes and mechanisms in art therapy
• Art therapy assessment validity and reliability
• Cross-cultural/multicultural approaches to art therapy assessment and practice
• Establishment of a database of normative artwork across the lifespan

SEEKING TO ADDRESS THE FOLLOWING RESEARCH QUESTIONS:

• What interventions produce specific outcomes with particular populations or specific disorders?
• How does art therapy compare to other therapeutic disciplines that do not include art practice in terms of various outcomes?
• How reliable and valid is any art therapy assessment?
• What neurobiological processes are involved in art making during art therapy?
• To what extent do a person’s verbal associations to artwork created in art therapy enhance, support, or contradict?
• What are ways of making art therapy more effective for clients of different ethnic and racial backgrounds?

SUGGESTED POPULATIONS TO RESEARCH:

• Psychiatric major mental illness
• Medical/Cancer
• At-risk youth in schools

BIBLIOGRAPHIC SEARCH TOOL

AATA’s Art Therapy Bibliographic Search Tool allows you to find listings of art therapy publications and theses from FOUR research sources: the Art Therapy Outcomes Bibliography, the Art Therapy Assessment Bibliography, the Multicultural Committee Selected Bibliography and Resource List, and the National Art Therapy Thesis and Dissertation Abstract Compilation.

The Art Therapy Bibliographic Search Tool enables you to search bibliographic entries based on one or all of the following characteristics: author name, category/treatment group, keywords, title, reference type, and year of publication.

AATA Member Exclusive:   All AATA members have the benefit of viewing more details about each database entry, including abstracts, topics, and comments!

• < Previous

Home > Art Therapy Print Theses > 207

Art Therapy | Master's Theses in Print

A qualitative study with art therapists on the use of art as self-care in addressing vicarious trauma, author name.

Rachel A. Votaw , Notre Dame de Namur University

Graduation Date

Spring 2011

Document Type

Master's Thesis

Document Form

Degree name.

Master of Arts in Marriage and Family Therapy

Degree Granting Institution

Notre Dame de Namur University

Program Name

Art Therapy

Lisa Bjerknes, MD, MBA

First Reader

Laury Rappaport, PhD, ATR-BC

Second Reader

Richard Carolan, EdD, ATR-BC

This study sought to discover how art therapists use art for self-care to prevent vicarious trauma.

To expand upon current research, the researcher conducted a qualitative study through facilitating semi-structured interviews with ten art therapist participants and recording their experiences in using art as self-care to address vicarious trauma. Seven themes emerged, which included the therapists experiencing the following: extemalization, connecting with Art Therapists, engagement in spirituality, gaining access to insight and meaning, bringing the unconscious into conscious awareness, transformation, and finally, an improved mood. This study highlights the benefits art therapists experience through artmaking to prevent and manage vicarious trauma.

Since September 27, 2021

Advanced Search

• Notify me via email or RSS
• Collections
• Disciplines
• Expert Gallery

Author Corner

• Thesis Style Guides
• Art Therapy at Dominican University of California
• Dominican Scholar Feedback

Home | About | FAQ | My Account | Accessibility Statement

Privacy Copyright

• Reference Manager
• Simple TEXT file

People also looked at

Review article, art as therapy in virtual reality: a scoping review.

• 1 GET Lab, Department of Multimedia and Graphic Arts, Cyprus University of Technology, Limassol, Cyprus
• 2 Arts and Humanities Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates

This scoping review focuses on therapeutic interventions, which involve the creation of artworks in virtual reality. The purpose of this research is to survey possible directions that traditional practices of art therapy and therapeutic artmaking could take in the age of new media, with emphasis on fully immersive virtual reality. After the collection of papers from online databases, data from the included papers were extracted and analyzed using thematic analysis. The results reveal that virtual reality introduces novel opportunities for artistic expression, self-improvement, and motivation for psychotherapy and neurorehabilitation. Evidence that artmaking in virtual reality could be highly beneficial in therapeutic settings can be found in many aspects of virtual reality, such as its virtuality, ludicity, telepresence capacity, controlled environments, utility of user data, and popularity with digital natives. However, deficiencies in digital literacy, technical limitations of the current virtual reality devices, the lack of tactility in virtual environments, difficulties in the maintenance of the technology, interdisciplinary concerns, as well as aspects of inclusivity should be taken into consideration by therapy practitioners, researchers, and software developers alike. Finally, the reported results reveal implications for future practice.

1 Introduction

Given the rapid technological advancements, the steady decrease in prices of technological apparatus, and the continuous permeation of information technology in various disciplines, Adams et al. (2008) predict that, during the current millennium, digital art will be transcending its aesthetic role by adapting in multiple applications as a transdisciplinary medium. The present review touches upon the ubiquity of digital art and focuses on the fields of mental and physical healthcare. In this regard, of special interest is Virtual Reality (VR), a multipurpose communication medium ( Biocca and Levy, 2013 ) that intersects with the domains of both artistic expression ( Kim and Lee, 2021 ) and wellbeing ( Alqahtani et al., 2017 ; Montana et al., 2020 ). During the introductory part of this review, key concepts, which later contribute to a holistic understanding of the topic, are introduced. The present review approaches the integration of VR in practices relevant to art and therapy by presenting the state of the art, gaps in current knowledge, and potential future directions.

A VR system is characterized by its level of immersion, also referred to as sensory immersion, that has been described in the literature as the degree to which natural sensorimotor contingencies can be supported and engaged by the virtual simulation ( Kim and Biocca, 2018 ; Slater, 2018 ; Berkman and Akan, 2019 ). Immersion depends on the characteristics of the apparatus and optimizing immersion levels is supported by various VR studies, which conclude that high immersion is an antecedent of the sensation of “being present” in a Virtual Environment (VE) ( Slater et al., 2009 ; Slater and Sanchez-Vives, 2016 ).Eliciting presence is a crucial element of a VR experience as it indicates how natural sensorimotor contingencies ostensibly are and therefore how likely it is for the user to act in the VR environment as if in real life ( Slater and Sanchez-Vives, 2016 ), so that the experience becomes “organic, user-driven, and different for everyone” ( Bailenson, 2018 , p. 223) An example relevant to drawing/writing would be the visual stimuli of a pen matching the motor action of grasping it in the perceivably proper way ( Farmer et al., 2018 ) The naturalness in which the user’s body is perceived to be moving in order to form the action of grasping that pen, also contributes to the sensorimotor contingencies. Here, when the user embodies a virtual whole body or a body part, which they experience from a first-person perspective and onto which movements are mapped in real-time and in synchrony with the user’s real movements, this gives rise to the illusion of body ownership ( Maselli and Slater, 2013 ; Christofi et al., 2020 ). In VR storytelling, presence and embodiment together have been previously described as “narrative storyliving” ( Vallance and Towndrow, 2022 ).

Interestingly, the virtual bodies (or avatars) that act as surrogate bodies during VR embodiment are found to have capabilities which go beyond their technical capabilities. In cases when immersive VR applications allow for bodily customization, a psychosocial layer is added to VR embodiment, which may enhance the sense of body ownership by enabling role-play and the free expression of various behaviors and attitudes ( Bertrand et al., 2021 ). This influence on behaviors and attitudes which stems from the dispositional characteristics of the embodied avatar, is known as the “ Proteus Effect” ( Yee and Bailenson, 2007 ) and it has been shown to even lead to higher cognitive changes, such as, for example, embodying a child body causing adult VR users to overestimate the size of virtual objects ( Banakou et al., 2013 ), embodiment in a different race body leading to changes in implicit racial attitudes ( Maister et al., 2015 ; Banakou et al., 2020 ), or embodying a stereotypically empathic woman instigating empathy ( Hadjipanayi and Michael-Grigoriou, 2022 ). Embodying avatars in fully immersive VR can also lead to the acquirement of soft-skills, where for instance, embodying the avatar of Sigmund Freud was found to help VR users offer more sound counselling advice compared to embodying the avatar of a therapy client ( Osimo et al., 2015 ; Slater et al., 2019 ).

Contrary to fully immersive VR, non-immersive VR systems only offer a window on the virtual world, without this essentially being a disadvantage ( Alqahtani et al., 2017 ). A Window on World (WoW) type of VR is commonly projected through regular monitor screens. Non-immersive VR systems are less expensive and easier to use than immersive VR systems ( Bamodu and Ye, 2013 ). Desktop video games that include procedurally generated environments are classic examples of non-immersive VR ( Alqahtani et al., 2017 ). Semi-immersive VR systems are hybrid systems that aim to maintain the simplicity and low cost of non-immersive VR systems while emulating the advantages in sensorimotor contingencies that are successfully achieved by fully immersive VR systems ( Bamodu and Ye, 2013 ). This type of system occupies a portion of the physical environment and virtually transforms it to serve a specific purpose. For example, the therapeutic system for motor and cognitive rehabilitation that is introduced by Maggio et al. (2022) transforms an empty room into a virtual playground that can extend to the floor and the walls of the room to match the preferred design of specific rehabilitation exercises.

VR is a transdisciplinary medium that intertwines with subject areas relevant to both artistic creation and healthcare. However, artistic creation in VR is more commonly associated with aspects of creativity, entertainment, and culture rather than wellbeing ( Rubio-Tamayo et al., 2017 ; Pissini, 2020 ). This scoping review relies on gathering literature pieces for which all the relevant subject areas of “VR,” “art,” and “therapy” intersect. This is particularly challenging due to the broad terminology surrounding “art”, which is colloquially defined as any form of self-expression. For this reason, it is imperative that art-related aspects are further contextualized, while also keeping in mind that in this scoping review art is viewed through the lens of therapy and healing. in other words, the population included in this review is “VR users,” the concept is “the creation of visual artworks in immersive VR,” and the context is “therapy.” Notably, this review focuses on the visual aspect of artmaking, as it is favored by VR technology, and to-date there is a gap in the VR literature regarding non-visual therapeutic artmaking projects. In order to address the multi-dimensional role of art as a therapeutic practice, it is essential to first address the differences between 1) expressive arts therapy and art therapy and 2) therapeutic artmaking and art therapy.

Four distinct categories (disciplines) of expressive arts therapy are widely recognized among practitioners and are known as 1) art therapy, 2) music therapy, 3) dramatherapy, and 4) dance movement therapy ( Song et al., 2019 ). Disciplines of expressive arts therapy can sometimes be used adjunct to other affective, cognitive, or psychomotor approaches, forming tailored therapeutic interventions that meet the diverse needs of each cohort group ( Malchiodi, 2020 ). As an example, Mishina et al. (2017) introduced a set of playground activities into an expressive arts therapy intervention with troubled adolescents whose emotional states improved after the intervention. These playground activities included rhythmic movements and image creation, among other activities, that formed a multimodal expressive arts therapy approach. In the cognitive domain, art therapy elements are commonly combined with cognitive-behavioral therapy (CBT) to provide trauma-based treatment. In many cases, drawing or symbolically reenacting a traumatic memory under the guidance of a therapist helped clients come to terms with themselves regarding their feelings of anger, helplessness, and self-blame ( Pifalo, 2007 ; Sarid and Huss, 2010 ). Regarding the psychomotor domain, an improvement of psychomotor development in children with speech pathologies was observed after introducing a finger puppet theater approach (including the creation of puppets) in their correctional pedagogy training ( Arkhipova and Lazutkina, 2022 ). It is apparent that psychomotor therapy is well complemented by expressive arts therapy, as they share the element of active participation into activities that promote kinesthetic abilities, cognitive processes, and personal development ( Haeyen et al., 2021b ; Arkhipova and Lazutkina, 2022 ). In order to limit the scope of this review on the healing qualities of creating a visual artwork, this review focuses solely on art therapy. Art therapy includes practices such as drawing, coloring, painting, collaging, sculpting, and allows the use of any media and materials that can be utilized to create visual artworks of symbolic value ( Moon, 2011 ).

There are various definitions of art therapy as different schools of thought in psychology attribute different definitions and sometimes different psychotherapeutic goals to it. Three of the most notable approaches to art therapy are: humanistic, psychodynamic, and cognitive-behavioral. Humanistic art therapy is founded on the active participation of the client and the facilitation of the therapist in the exploration of the client’s artwork and its underlying narratives ( Farokhi, 2011 ). The psychodynamic approach in art therapy focuses on the unconscious of the human mind and borrows concepts from analytical and archetypal psychology which is associated with symbolic images ( Malchiodi, 2011 ). Cognitive-behavioral art therapy focuses on the attitude change of the client through visually externalizing problematic situations and identifying coping strategies ( Rosal, 2018 ). Overall, art therapy, as an expressive arts therapy discipline, most commonly refers to a triangular psychotherapeutic relationship between therapist, client, and artwork. Schaverien (2000) proposes that what is referred to as “art therapy” per se in the field of psychology, encompasses two other distinct forms of therapy, namely “art psychotherapy” and “analytical art psychotherapy.” The differences between these forms lie in the dynamic within the triangular psychotherapeutic relationship. Schaverien (2000) distinguishes “art therapy” as a process, in which the relationship between client and artwork is the main focus, whereas in “art psychotherapy” it is the relationship between client and therapist that is most emphasized, and in “analytical art psychotherapy” all three components of the relationship constellate equally.

Therapeutic artmaking, which can also be found in literature as “Art as Therapy,” contrary to art therapy, is a low-intensity intervention for which the involvement of a therapist is considered a non-prerequisite. The inherently beneficial properties of artmaking and the inclination of patients to turn artmaking into a coping mechanism against illness have been evident for centuries but scientific research on the healing aspects of art is fairly recent ( Farokhi, 2011 ). Immersive engagement with artmaking stimulates the senses, directs the artist’s mind to the present time, and employs multiple cognitive processes, such as problem-solving, differentiation, and decision-making ( Rosal, 2018 ). Also, contrary to art therapy, therapeutic artmaking can be characterized as a recreational experimentation with art materials, in which the overarching goal for the client is the creation of visually appealing artworks ( Angheluta and Lee, 2011 ; Worden, 2020 ).

Some argue that therapeutic artmaking is a form of art therapy in which the psychoanalytic value of creating art is attenuated in favor of focusing on the inherent healing qualities of creating art ( Czamanski-Cohen, et al., 2014 ). Others believe that art therapy and therapeutic artmaking should be considered as two completely different practices because of ethical considerations, as art therapy in contrast to therapeutic artmaking, requires the guidance and expertise of healthcare professionals ( Angheluta and Lee, 2011 ). Despite the differences between the two therapeutic approaches, therapeutic artmaking and art therapy share a similar therapeutic intent. As Worden (2020) elucidates, self-expression in art therapy opts for making an individual able to work through past traumas among other psychological issues, whereas therapeutic artmaking opts for evoking a feeling of catharsis, encouraging socialization, honing technical skills that cater to visual self-expression, and increasing self-esteem. All the above are positive outcomes that affect wellbeing. Admittedly, therapeutic artmaking and artistic expression as a psychotherapy, rehabilitation, or counseling intervention, are used complementary to each other to various degrees ( Farokhi, 2011 ; Malchiodi, 2020 ). Despite the main focus of the present scoping review being VR and therapeutic artmaking, the discipline of art therapy in this context cannot be omitted, because of the indicated interweaving between therapeutic artmaking and art therapy.

The topics of VR in therapeutic artmaking and art therapy remain vastly understudied, even though the groundwork that underscores potential uses of VR in different forms of psychotherapy has been laid during previous decades ( Riva, 2005 ). For instance, virtual reality exposure therapy (VRET), which refers to the systematic habituation of patients to stimuli reminiscent of traumatic memories through VR, is the most studied form of psychological VR intervention and is widely endorsed as a valid alternative to traditional psychotherapy ( Deng et al., 2019 ). The efficacy of VRET was evident since the infancy of VR ( Hodges et al., 1995 ), despite the low quality of graphics or level of human-computer interaction. Nowadays VRET is deemed as an equally effective treatment to in vivo interventions for a variety of disorders, such as specific phobias and anxiety disorders ( Carl et al., 2019 ; Mozgai et al., 2020 ) among others. With the exception of VRET, the number of studies addressing VR in psychotherapy is still limited ( Frewen et al., 2020 ) and considering the continuous changes in the technological landscape, definitive conclusions about the efficacy of art therapy interventions in VR cannot yet be drawn.

Furthermore, multiple commercial applications for wellbeing can be found across platforms and devices, but their efficacy is under scrutiny. Wagener et al. (2021) , after conducting a systematic application review, raised some critical points about the mismatch between the well-grounded theoretical background behind VR wellbeing applications and their subpar outcomes when it comes to practice. As they point out, most VR wellbeing applications unilaterally focus on specific wellbeing aspects and lack the flexibility of customization as well as opportunities for individual expression. Additionally, VR applications support users in identifying and reflecting upon their affective states, but they do so to a minimal degree. This reveals the need for further discourse on the potential and current limitations of practices about VR for wellbeing, which should derive insight from multiple disciplines for better understanding the intricacies of VR wellbeing. To this end, a scoping review is the most appropriate type of knowledge synthesis because it is most efficient in conveying the breadth of a variety of practices in a particular research area ( Brien et al., 2010 ) and can help clarifykey interdisciplinary concepts and definitions, as well as identify types of evidence and knowledge gaps in the literature.

Presently, and to the best of our knowledge, no literature reviews specifically focusing on the subject of immersive VR and art as a therapeutic practice exist. Pissini (2020) , who focuses on VR as a medium for artmaking, acknowledges the importance of studying VR practices in relation to the healthcare field, even though Pissini’s indicated work is deliberately directed towards other interesting aspects of immersive VR artmaking, such as embodied creativity. One literature review most relevant to the present paper titled “Technology use in art therapy practice: 2004 and 2011 comparison” by Orr (2012) , reviewed art therapy practice to every available technology at the time (between 2004 and 2011), and the author concluded that there was a gap between technological advancements and art therapy training, which further bred ethical limitations to the use of advanced technology in art therapy. Aspects of the ever-changing technology should be taken into account for the effective renewal of therapeutic practice, as old models of practice show signs of eventually becoming obsolete ( Salles et al., 2020 ). Especially after the COVID-19 pandemic and the mobility restrictions imposed on therapists and clients alike, therapists were forced to reevaluate their methods and find ways to best utilize technology to mitigate the negative effects of the pandemic on the normality of treatment procedures ( Feniger-Schaal et al., 2022 ). Long-distance VR interventions are deemed as suitable alternatives to face-to-face interventions in the case of treatments that require more “acting” instead of “talking,” such as psychomotor therapy, because of the experiential nature of using VR ( Haeyen et al., 2021b ). This scoping review revisits the technological gap indicated by Orr but purely focusing on VR, with the objective to assess the therapeutic utility of art-related practices in VR and provide guidelines for future research.

The question sought to be answered is twofold: 1) how has VR been integrated into practices relevant to art therapy and therapeutic artmaking? This review seeks to analyze how relevant studies define and juxtapose VR and artmaking in the context of therapy. Answering this first inquiry, while bearing in mind the overarching goals that each relevant study implies, can shed some light on the different forms in which advancing technology and artistic expression can manifest in a therapeutic setting; 2) how applicable are VR interventions for achieving therapeutic goals in relation to traditional art therapy and therapeutic artmaking practices? Through this inquiry, VR art-related interventions are being explored and contrasted to the well-established interventions that are traditionally used in art therapy and therapeutic artmaking. This inquiry is viewed from both the perspective of the client/user and the therapist/researcher to identify possible limitations and challenges.

2 Research methodology

2.1 eligibility criteria, 2.1.1 inclusion criteria.

The inclusion criteria were 1) academic manuscripts published between 2011 and the end of the data collection process, which ended in November 2022. VR and computer graphics have changed drastically during the last decade hence academic articles published before 2011 were omitted. The reason for this drastic change in the past decade is the sudden introduction of cost-effective VR head-mounted displays ( Harley, 2020 ). 2) Academic manuscripts on the topic of VR, wellbeing, art therapy and therapeutic artmaking. Out of the four disciplines of expressive arts therapy mentioned above, the present scoping review focuses only on the discipline of art therapy, as defined in the introduction. Concepts that are universal to all expressive arts disciplines are also considered to be relevant. Under the scope of the present review, both art therapy and artmaking are accepted as relevant interventions. The relevance of the interventions is appraised based on the inclusion of artistic expression that results in the creation of visual artworks via visuomotor integration. 3) Peer-reviewed academic manuscripts (research articles, quantitative and qualitative studies, opinion pieces, and essays).

2.1.2 Exclusion criteria

The exclusion criteria were 1) Manuscripts which focus solely on VR therapy techniques. One of the prime examples of VR therapy that is distinctively different from VR art therapy is VRET. 2) VR-related manuscripts that focus on the sensory aspect of art when the virtual experience allows only a passive participation of virtual reality users (i.e., watching or observing a VE). Being exposed to a VR simulation that is purposefully designed for inducing wellbeing outcomes is a method that is typically employed for psychological healing through aestheticism ( Moller et al., 2020 ) and spirituality ( Pendse et al., 2016 ). Therefore, the combination of animated images, ambient sounds, and other stimuli, which is used to provide a therapeutic experience without involving psychomotor activity, is more related to VR therapy than the practices of art therapy or artmaking. 3) VR-related manuscripts which refer to VR as its non-immersive counterpart (WoW) only, or demonstrate digital applications with the premise of exocentric navigation only. Non-immersive VR interventions are excluded due to technical qualities that result in differences in the overall experience compared to fully immersive VR systems ( Rubio-Tamayo et al., 2017 ; Slater, 2018 ). 4) VR-related manuscripts which include art therapy or therapeutic art-making practices but do not draw any associations between VR and art therapy or VR and therapeutic artmaking other than being parts of a holistic therapeutic approach.

2.2 Information sources

The searching process was carried out mainly through 4 databases, namely Scopus (138), Web Of Science (80 in the topic of “virtual reality and art therapy”), PubMed (67), ScienceDirect (263 in the subject areas of psychology, social sciences, computer science, neuroscience, and nursing and health professions). All 548 papers were sorted and then a second search from Google Scholar was carried out. From Google Scholar, 7 additional papers were found that were identified as potentially relevant. Within the first 6 search result pages of Google Scholar, only 4 potentially relevant papers were found, as most relevant articles had already been detected by previous search engines and had already been included for screening. Therefore, the total number of publications that potentially met the required criteria was finalized at 555. No additional articles were retrieved afterwards using incremental searching.

2.3 Search methods

The keywords used for the search engines to retrieve the 555 publications were “virtual reality art therapy.” In the stage of the publication retrieval and screening process, the usage of the keyword “art” required additional caution. From the first few searching sessions, it was apparent that the keyword “art” was inviting a multitude of irrelevant publications in the search results. The main reason for this outcome was that “art” in scientific literature is an excessively used term, with its most common usage found in the phrase “state of the art.” Therefore, the exclusion of the phrase “state of the art” from the search engines has significantly increased the quality and decreased the load of search results. For example, the search strategy for the Google Scholar search engine that was performed on 09 November 2022 included the search query: ((virtual reality AND art* AND therapy) -“state of the art”). Another issue caused by the keyword “art” is that the acronym “ART” is also found to be excessively used in areas of healthcare and science, technology, engineering, arts, mathematics education (STEAM). This issue has been resolved through the screening process, where the relevance of the retrieved publications has been appraised.

2.4 Selection of sources of evidence

All 555 papers were screened by title and abstract. The screening and selection of the manuscripts was carried out on Rayyan ( www.rayyan.ai ), a web tool designed to help researchers carry out knowledge synthesis projects ( Ouzzani et al., 2016 ). After all the sources were uploaded to the web tool, the 555 publications were manually categorized as duplicates (76), irrelevant (446), and relevant (33) according to the criteria and processes discussed. Some aspects of the inclusion and exclusion criteria were easier to pinpoint with precision once the authors were familiarized with the 33 selected papers. After a thorough examination of the theoretical background and if applicable the employed apparatus and methodology of the 33 papers, it became apparent that the relevance of 7 papers should be reconsidered. In 3 out of the 7 papers the human-computer interaction involved a 2D virtual interface instead of a VE, but their intervention was labelled as “virtual reality” regardless that VEs are integral components of immersive VR. In 2 out of 7 papers, the references to VR and the technology used during interventions were too vague and could be exclusively concerning a WoW approach or even be irrelevant to VR as defined in this review. In another paper, the study intervention involved solely mixed reality (MR) technology. The remaining 1 out of 7 papers describes a human-computer interaction model that generates artworks solely based on the user’s affective state, without any psychomotor activity being evidently required. With these 7 papers abiding to the exclusion criteria, the 26 remaining papers consisted of mixed methods (5), qualitative (17), and quantitative (4) research publications ( Figure 1 ); 15 of the 26 included publications consist of empirical studies ( Table 1 ). The rest of the papers consist of academic articles that have aims other than the production of novel empirical knowledge ( Table 2 ).

FIGURE 1 . Flow diagram of the article retrieval process according to the PRISMA statement methodology.

TABLE 1 . Empirical studies included for analysis.

TABLE 2 . Academic articles that synthesize empirical evidence and are included for analysis.

2.5 Data charting process

After familiarization with the texts and the transcription process, the extracted transcriptions were recorded in a table format based on the content of the papers and more specifically, the advantages and disadvantages of VR over traditional media in the context of therapeutic artmaking and art therapy. Whenever applicable, the primary results, main conclusion, as well as methodological approaches, including apparatus, study purpose, data collection and analysis were also collected. The tables were tested by the reviewer team for refinements and to ensure that all relevant data were gathered. Therefore, data pertaining to the different approaches towards art and VR technology were also included. An inductive thematic analysis was used for the collected data to define the most common recurring themes. The data charting process was manually carried out while two reviewers were permitted to simultaneously edit the transcribed data on the shared tables. The emergent themes became apparent after one of the reviewers used color coding on the transcribed data that helped in discerning patterns and aggregating the data into meaningful categories.

2.6 Data items

The generated codes regarding the methodological approach of studies revealed that there are two main treatment categories, namely psychological and neurorehabilitation treatments. The generated codes regarding advantages and disadvantages of VR over traditional media in the context of therapeutic artmaking and art therapy revealed 6 main themes for each. The occurred themes regarding advantages were recognized as:

A.i. “Expanding the current limitations of artistic ability and expression in clinical settings through VR”

A.ii. “Gaining novel insights of therapeutic value through VR.”

A.iii. “Overcoming the restraints of physical space”

A.iv. “Ludicity and motivation”

A.v. “Digital natives in the therapeutic setting”

A.vi. “Facilitating client data management”

The occurred themes regarding disadvantages were recognized as:

D.i. “Tactility”,

D.ii. “Digital literacy”

D.iii. “Inclusivity”

D.iv. “Interdisciplinary concerns”

D.v. “Technical limitations”

D.vi. “Affordability and maintenance.”

2.7 Synthesis of results

Thematic synthesis was used to formulate a descriptive analysis of the findings. In the results, reports on study logistics and the identified approaches regarding the use of art therapy and therapeutic artmaking in VR can be found. Also, advantages and disadvantages, limitations, and challenges of digitizing art therapy with the use of VR are presented in both narrative and table format ( Table 3 ). This scoping review was synthesized based on the PRISMA ScR checklist guidelines ( Tricco et al., 2018 ).

TABLE 3 . Summary of the advantages and disadvantages, challenges, and limitations in digitizing art therapy and therapeutic artmaking by using the VR medium.

An overview of the 26 publications indicates that the concept of using VR as an artmaking tool in therapy context has been nascent in the past decade (2011–2022 included) and it has recently grown in trend, with 73.07% ( n = 19) of the included papers being published between 2020 and 2022. A bibliometric analysis, which is conducted by Liu et al. (2021) and is spanning over a period of 75 years, confirms-through the co-occurrence of keywords used in the context of art therapy-that VR technology is becoming increasingly relevant with art therapy aided health and wellbeing research. Also, 57.69% ( n = 15) of the included papers involve experimental research with human participants, with the remaining 42.30% ( n = 11) consisting of opinion pieces, demos, and essays. All studies made use of a VR apparatus, most commonly mentioned being the Oculus, the HTC VIVE, and the Windows Mixed-Reality VR/MR headsets. Additionally, some of these studies included hardware complementary to VR, such as motion capture devices (MOCAP) for body tracking. Regarding the software, both custom and commercial VR drawing applications were used, with the most widely used one being the commercial application Google Tilt Brush. Participants fell under the category of either “patient” who suffers from psychological or physical conditions, “therapist,” “university student,” or “healthy subject,” and the research objectives suggest high heterogeneity among studies.

3.1 Approaches to art therapy and therapeutic artmaking

This subsection constitutes general observations drawn from the reviewed papers, which do not necessarily conform to the acceptable definitions of “art therapy” or “therapeutic artmaking” as presented in the introductory section. The presentation of these observations provides a brief overview of the therapeutic approaches and the state of the art. In the reviewed papers, the terms of art therapy and therapeutic artmaking, sometimes clearly distinguished and other times used interchangeably, are used to describe a wide variety of treatments. In general, all the reviewed treatments operate on the basis that creative endeavors can generate emotions and incentives for both mental and physical wellbeing. Art, and more specifically art materials and media, are viewed as intermediaries between the realms of ideas and reality, which are experienced through the individual’s senses. Specifically for VR, therapeutic activities such as painting, drawing, coloring, collaging, and sculpting, take a different form in the 3D environments, which could also vary (e.g., digital twins of an art therapy room or ostensibly infinite 3D canvases).

The authors identify two main categories, namely psychological and neurorehabilitation treatments, in which theoretical approaches to art diverge.

3.1.1 Psychological treatment approach

Most of the reviewed papers that are relevant to the field of psychology define their psychotherapeutic treatments in terms of art therapy, as a mental health profession and, more specifically, an expressive arts discipline. Art therapy is applied as a dynamic emotional therapy where art materials, the creative process, and the produced artwork serve as means of self-exploration and self-expression, in order to create personal change. In this context, the most widely mentioned theoretical influence is the psychodynamic perspective (Jungian psychology). This is often put in practice as depth psychology-based psychotherapy, in which the unconscious is brought to the surface thanks to the symbolic potential of artistic self-expression and, as a result, suppressed feelings are being revealed ( Song et al., 2019 ). During this process, creating art and the psychotherapeutic relationship are elements of higher psychotherapeutic value than the final product of artistic creation. In analytical art psychotherapy, the patient’s artwork is examined by the therapist to better understand the unconscious mind ( Schaverien, 2000 ; Cheng et al., 2021 ).

Principles from other schools of thought are also adapted to the theoretical framework of the reviewed papers. Through the lens of CBT, art facilitates the communication of the individual’s conceptual structures in a different way than verbal communication does, thus often providing alternative and illuminating perspectives to both the individual and the therapist. Within the triangular psychotherapeutic relationship, the artwork represents a subjective experience that is externalized by the client, in a way that the visualized mental relations of the client become more explorable and often reveal conflicting perspectives ( Hacmun et al., 2021 ). The “open studio approach” to art therapy is an approach that many of the reviewed papers find befitting of VR art therapy because of the ludic nature of current VR art-related applications. The creation of the “safe space” is a prominent practice in art therapy. Drawing the “self,” the “problem,” and “coping mechanisms,” such as a “sanctuary,” is found to significantly alleviate psychological trauma ( Frewen et al., 2020 ).

A strong implication that is pointed out is that artistic expression, even without being accompanied by verbal reflection or any psychotherapeutic intervention, could still be a source of psychological healing. Artmaking is viewed as an innate human characteristic and one of the most primitive forms of self-expression, which is continuously evolving as a result of technological advancement by encompassing new expressive capabilities ( Hacmun et al., 2018 ). Art is deployed as a source of solidarity, inspiration, and a sensation of security during times of crisis ( Gatto et al., 2020 ).

3.1.2 Neurorehabilitation treatment approach

Regarding rehabilitation treatments, it is revealed that VR drawing applications are often used by patients who suffer from post-stroke motor impairments or minor neurocognitive disorders. Under this framework, digital artmaking works as an effective treatment for rehabilitation because it values the enjoyability of the treatment, as it activates reward pathways of the brain, while supporting physical, cognitive, and emotional healing ( Kaimal et al., 2020a ). It also allows patients (e.g., stroke survivors) who encounter difficulties with speaking to express themselves non-verbally ( Alex et al., 2021 ; Zhang et al., 2021 ). The most recent findings in the field of VR artmaking suggest that different approaches to artmaking activate different brain regions ( Kaimal et al., 2022 ). Comparisons of prefrontal cortex activations between a visual tracing task of a drawing and creative self-expressive artmaking indicated significant differences. Distinctively, the implication is that creative self-expression, contrary to the tracing task, induces transient hypofrontality, a state of the brain that is associated with relaxation and the inhibition of self-reflective processes. This suggests that different artmaking approaches could be used for achieving specific treatment goals.

From the perspective of neuroaesthetics, the field which engages with the perceptual, cognitive, and emotional aspects involved during an aesthetic experience, the element of the artwork is an apt addition in the neurorehabilitation practice. A reason for this is that creation, or even mere observation, of artworks and the practice of rehabilitation are both tightly associated with sensorimotor activity, which is found to be cognitively concomitant to the emotive expressions of painted figures (e.g., the figures in “The Creation of Adam” by Michelangelo) ( Iosa et al., 2021 ). Artworks are found to neurobiologically induce motivation and affective arousal, which are fundamental aspects of neurorehabilitation, along with active participation and treatment intensity.

3.2 Advantages of VR over traditional media in therapeutic artmaking and art therapy

3.2.1 expanding the current limitations of artistic ability and expression in clinical settings through vr.

The authors of the reviewed papers appear to advocate for a potential revolutionization in the field of art therapy, because of the advent of VR. Especially in psychotherapy, VR’s increasing repertoire of tools for creative self-expression enables clients to better convey their conceptual structures to therapists and researchers by transforming and customizing the virtual environments where the therapeutic process takes place. The ability to tailor virtual environments according to the client’s psychological disorder and the psychotherapeutic approach of the therapist could more easily provide both clients and therapists or researchers a common ground of communication ( Hacmun et al., 2018 ).

The most notable contributions of artistic expression in VR psychotherapy are found to be the evocation of familiarity and safety in clients, as well as enhanced self-reflection and meditation. A common practice that is observed is the creation of a “safe space,” which is created by the client according to the client’s personal preference to serve as an emotional refuge. Safe spaces, which are usually in the form of houses or caves, have been used in psychotherapy practice long before VR but the ability to step into your artworks, which is exclusive to VR technology, expands the frontiers of this practice ( Frewen et al., 2020 ). VR safe spaces are most beneficial for people suffering with trauma and post-traumatic stress, as safe spaces allow them to gather and sort their thoughts and feelings out while being at one with themselves ( Brahnam, 2014 ). However, the creative ways the clients can express themselves through VR could go far beyond the concept of safe spaces and drastically vary, as clients continue to experiment with VR as a creative outlet.

In VR neurorehabilitation practices that involve artistic creation, as derived from the reviewed papers, artistic technique with emphasis on precision of movement seems to have an equally prominent, if not more prominent role, to that of artistic expression. Rehabilitation practices through VR technology are applicable because VR technology has evolved to allow a sufficiently high precision of movement, compared to the physical world. VR has the capacity of allowing patients who suffer from impaired mobility to make bold and expansive brush strokes in the virtual world by making simple gestures in the physical world ( Baron et al., 2021 ). This result can be achieved by accordingly adjusting the movement translation of the virtual avatar to the patient’s range of motion. In similar ways, the laws of physics in VR environments can be “adjusted” to the needs and comfort of the patients. In this sense, the VR medium offers a high level of independence to the user ( Alex et al., 2021 ).

3.2.2 Gaining novel insights of therapeutic value through VR

Throughout the reviewed papers, the concept of experiential discovery through VR is prevalent. From the client’s perspective, VR is a medium that is assumed to be effective in inducing emotional responses and stimulating cognition. Exposure in immersive VEs is found to decrease distracting thoughts (mind wandering) and increase properties required for eliciting attention, awareness, and self-reflectiveness. Some of these properties are presence and embodiment, which are important factors for changing implicit attitudes ( Hacmun et al., 2018 ; Gatto et al., 2020 ). From the therapist’s perspective as well as that of the researcher, VR enables the exploration of the client’s mind as an equivalent of exploring virtual worlds ( Marks et al., 2017 ). During the analysis, two of the most notable VR qualities that were indicated as salient contributors in gaining novel insights of therapeutic value in VR are enhanced perspective change and replay value (or playback).

The affordance of perspective change encompasses the user’s perspective but also the ability of virtual object manipulation. In this instance, “virtual objects” refers to the clients’ artistic creations, which play the role of externalized concepts. VR offers the ability of viewing objects from any angle, including from within the artwork, and the ability of scaling the size of objects ( Hacmun et al., 2018 ; Li and Shen, 2022 ). The viewing of such objects from different vantage points is a practice that is already employed in psychotherapy and VR can drastically enhance this practice. Through coming across these different perspectives, clients are given the opportunity to deconstruct and reconstruct their conceptual structures, such as the concept of the self ( Hacmun et al., 2018 ).

The ability to replay a recorded psychotherapy session and attempt to reassess the client’s behavior within the virtual environment allow the psychotherapist or researcher and the client to have a more accurate and clearer understanding of the client’s therapy progress ( Brahnam, 2014 ). In other words, the digital affordance of replaying each digital brushstroke during art therapy in VR can enhance reflection. Replay value is one of the many VR qualities that require ongoing study ( Carlton, 2014 ).

3.2.3 Overcoming the restraints of physical space

The reviewed papers often focus on the use of VR headsets that can be used in a patient’s daily life, even outside of the care services. The portability of VR allows the patients to engage in therapy in the comfort of their home, where no time or transportation restrictions apply ( Baron et al., 2021 ). However, even when it is mandatory for patients to either visit a clinical facility or remain hospitalized, VEs of immersive VR have the ability to transfer patients outside of the sterile physical environment of a clinical setting and “place” them somewhere more idyllic, thus providing inspiration and positive emotions. Furthermore, VEs are designed for the exploration of imaginal worlds and their design is in accordance with the central tenets of the creative processes in art therapy ( Gatto et al., 2020 ). This transportability through immersive VR allows the stimulation of the proprioceptive and vestibular senses without the need of a sizeable physical space and thus distinguishes immersive VR from other digital media. Equally important is the fact that VR artworks can be efficiently stored and retrieved for further editing without occupying physical space, unlike materials and artworks produced by traditional art therapy practices ( Baron et al., 2021 ).

3.2.4 Ludicity and motivation

The reviewed papers support the idea that ludic play and gamification models, which are compatible with VR technology, assist in establishing therapeutic interventions that drive the patient’s engagement while maintaining autonomy. Physical therapy requires time commitment while the therapeutic process is often arduous for the patient. Even so, the inherent qualities of VR applications motivate patients to keep exercising and instill in them the willingness to gain mastery over the new media ( Baron et al., 2021 ). As no hard-and-fast rules for artmaking exist, VR artmaking is often viewed as an activity for relaxation and recuperation with no substantial impact on the physical world and free from the fear of failure or committing mistakes ( Li and Shen 2022 ). A study that focused on the physiological measures of VR users during artmaking in a 3D virtual space, found a reduction in anxiety and negative affect ( Richesin et al., 2021 ). Also, the same study suggests that the aspect of having an end goal during a VR simulation, such as completing an artwork, plays an important role when aiming for specific wellbeing related outcomes. Another aspect worth mentioning is the element of inspiration. Guided imagery, as an art therapy practice, requires imagination, which patients sometimes lack. VR immersive environments may be able to provide the inspiration necessary for unimaginative patients to evoke concrete ideas and possibilities more easily while sparking the interest in further exploring these ideas ( Kaimal et al., 2020a ; Li and Shen, 2022 ).

3.2.5 Digital natives in the therapeutic setting

As technology has permeated every facet of current society, the group of digital natives is continuously increasing due to the succession of generations. Therapists and researchers from the reviewed papers suggest that most digital natives are accustomed to interacting with technology, including VR, and interaction with technology is intuitive and enjoyable to them. As digital natives grow up in a technologically abundant environment, their minds become wired towards best utilizing the technological resources at their disposal ( Marks et al., 2017 ). This is the main reason digital natives are often alienated by traditional media (i.e., art materials), which they often find too messy or even obsolete. In a psychotherapeutic setting, digital natives tend to feel more comfortable expressing themselves through means other than a conversation or a paper-and-pencil drawing. VR interventions are found to be great alternative options of therapy in cases of clients rejecting traditional therapeutic methods. Therefore, VR assists in building rapport between clients, especially younger ones, and their therapists, by enriching the psychotherapeutic relationship ( Shamri Zeevi, 2021 ; Li and Shen, 2022 ). The use of new media, such as VR, in art therapy paves the way for further cultural exploration of digital natives and their interaction with technology ( Carlton, 2014 ).

3.2.6 Facilitating client data management

The suitability and assistance of VR technology in data collection and data representation is occasionally mentioned in the reviewed papers. VR is widely portrayed as a technology that allows easier tracking of body movements, which on one hand is necessary for creating art and at the same time constitutes a crucial element of art therapy ( Ying-Chun and Chwen-Liang, 2018 ). Additionally, body movement is often viewed as a form of expression in and of itself. Especially for VR neurocognitive tests, the high ecological validity that is provided by VR, in comparison to their paper-and-pencil counterparts, makes the data collected through VR arguably more valid. This is because VR provides the possibility of safely reenacting activities of daily living in VR as if in real life ( Jin et al., 2020 ). Also, digital technologies can reach a large audience of patients and gather patient data that could lead to more informed decisions by both healthcare professionals and researchers. Data from multiple VR trials can be easily gathered and compiled, leading to reassessment and optimization of VR tests ( Jin et al., 2020 ; Salles et al., 2020 ).

3.3 Disadvantages of VR over traditional media in therapeutic artmaking and art therapy

3.3.1 tactility.

With the field of VR haptics still evolving, the reviewed papers point out that VR is insufficient in providing a similar level of sensory stimulation and tactility as traditional media in art therapy. VR technology replaces tangible art materials with virtual ones, which could be characterized as orderly and often unfamiliar, and this is especially true for clients who perceive traditional art therapy materials as more intuitive and easier to use ( Alex et al., 2021 ). The joy of “holding my completed artwork in my hands,” is a quality that seems to be exclusive to physical artworks ( Hacmun et al., 2018 ). The deprivation of sensory cues through the absence of sufficient tactility stimulation in digital media often brought up in the reviewed papers, is one of the main factors that prevent some art therapists from considering the adoption of not only VR but also other digital media in their psychotherapeutic treatments ( Haeyen et al., 2021a ).

3.3.2 Digital literacy

Most art therapy practitioners lack training in VR technology and their resources for employing VR are sparse. In addition, art therapy practitioners tend to consider traditional media in art therapy as more therapeutic than new media, even though there is no clear evidence of this belief ( Carlton, 2014 ). According to the reviewed papers that addressed these issues, the lack of systematic training in new media for art therapists discourages the use of VR technology in art therapy practice. Specifically, art therapists are hesitant about the use of VR technology, as they acknowledge the lack of technological expertise in the field and have no clear direction in how to incorporate digital materials in their psychotherapeutic treatments, which are often highly experiential and active by nature ( Brahnam, 2014 ; Haeyen et al., 2021a ). Consequently, the lack of technological expertise results in a lack of evaluation regarding the psychotherapeutic efficiency of the digital tools available and many practitioners arrive to the arbitrary conclusion that new media are inefficient compared to traditional media ( Salles et al., 2020 ). Some of the authors use the term “technophobia” to describe this phenomenon of repulsion towards new media. Technophobia is observed in practitioners and clients alike, as many of them admittedly perceive digital media and digital art as lesser than their traditional counterparts ( Jin et al., 2020 ). An important factor that caters to technophobia in clients is the uncertainty regarding confidentiality and privacy of the client’s data accumulated during VR sessions ( Marks et al., 2017 ). All things considered, and especially the obscurity of new media in art therapy graduate programs, there is also the issue that art therapy practitioners who are unfamiliar with new media may never come across the possibility of adopting VR in their psychotherapeutic practice. However, even when practitioners overcome any possible bias and consider the possibility of adopting VR, they are often intimidated by the steep learning curve and other limitations.

3.3.3 Inclusivity

From the analysis of the reviewed papers, it can be concluded that art therapy in VR is less inclusive than traditional art therapy. First and foremost, there is a digital divide among art therapy clients and those who are technology-savvy are more likely to find benefit in VR interventions ( Shamri Zeevi, 2021 ). Secondly, the use of VR by children who are below the age of twelve or thirteen is not recommended for safety reasons, according to policies of VR headset manufacturers ( Ying-Chun and Chwen-Liang, 2018 ). This age restriction specifically applies to VR gaming, so children younger than twelve could potentially make a healthy use of VR headsets when supervised by adults. Even so, this age restriction implies that VR usage requires the user to have a level of cognitive development that is higher than the one required for the usage of traditional art therapy media. Also, VR interventions are unsuited for people with major neurocognitive disorders, acute motor and vestibular issues, and those who are prone to headache and nausea, as the phenomenon of cybersickness seems to be a glaring problem. In addition, VR interventions are unsuited for people who suffer from hallucinations and those who struggle to distinguish between reality and fantasy ( Kaimal et al., 2020a ; Jin et al., 2020 ). The restrictions mentioned so far do not apply to traditional art therapy and even when clients seem to qualify for the use of VR, the opposite could be proven during therapy. For example, the client could be prone to distraction by the VR intervention. In this case, the client could easily diverge from the course of therapeutic practice, especially if the art therapy facilitator is negligent or unfamiliar with new media ( Carlton, 2014 ). It is difficult to predict a client’s response to a VR intervention before the beginning of the intervention as VR qualities are experienced differently by each user. Some users do not experience the illusion of presence–being in a different place than the physical one when using VR—but others experience this illusion too intensely. Regarding the latter case, patients may use VR interventions for unhealthy escapism instead of coping with real life problems ( Kaimal et al., 2020a ). This adds an extra layer of complexity in deciding whether VR interventions are benefactory to all clients. Issues with inclusivity can be encountered from the side of the art therapy practitioner too. This view stems from the observation that most applications of VR in psychotherapy are used in the context of CBT, while other approaches, such as the humanistic approach and their practitioners are obscured. Similarly, VR could be considered as impractical for some groups of art therapy practitioners who endorse art therapy practices other than the ones offered by most of the available VR applications ( Brahnam, 2014 ). It should be mentioned that practitioners often develop VR-applicable techniques based on various concepts and strategies (e.g., technical eclecticism, Ludic Engagement Designs for All) that could potentially cater to both the expertise of each practitioner and the unique needs of each client ( Brahnam and Brooks, 2014 ; Frewen et al., 2020 ).

3.3.4 Interdisciplinary concerns

Despite the attempts to digitize art therapy and therapeutic artmaking, more research is needed to ensure the satisfaction of therapists and clients alike regarding the efficacy of digital interventions. This seems to be true for both psychological and rehabilitation treatments in VR, according to the reviewed papers. Physical rehabilitation in its traditional form has long been proven as an effective method of regaining functionality, whereas more studies are needed to determine the extent to which VR rehabilitation is efficient ( Baron et al., 2021 ). Digital applications are notorious for widespread misinformation and, with applications in the healthcare industry being no exception, clinicians point out the significant risk of applications dictating therapy through digital means ( Salles et al., 2020 ). Clinicians stipulate that digital applications relevant to therapy should be flexible enough to be customized for each client instead of being adapted to the developers’ process of working. For example, art therapy is often misunderstood as the notion of simply making art for psychological healing or the notion that the completed artwork of the patient is a solid projection of the patient’s psychopathology. When these misconceptions are transferred to the digital realm, there is the danger of excluding the framework that makes art therapy therapeutic, such as aspects of the triangular psychotherapeutic relationship and the subtle expressions during the construction of an artwork ( Salles et al., 2020 ).

3.3.5 Technical limitations

Admittedly, the current state-of-the-art VR software for artmaking offers less sophisticated artistic capabilities for creative expression than traditional art therapy media. The range of tools and materials, which are available for drawing, painting, sculpting, and collage in VR, is comparatively more limited than the physical gamut of art tools and materials ( Kaimal et al., 2020a ).). Also, it can prove difficult for the client to convey some of the intentional or unintentional messages to the therapist or researcher due to the physical form of VR technology. By drawing examples from the reviewed papers, a common problem is that VR head-mounted displays hide the facial characteristics of the client and disallow eye-contact between the client and the physical environment, including the therapist ( Shamri Zeevi, 2021 ). In the case of physical rehabilitation, the rigidity, agelessness, and multi-perspective angles of 3D digital strokes often alienate patients, whose location tends to remain constant, due to them being inert ( Alex et al., 2021 ). A common issue for therapists and researchers is that they can only have a glimpse of the therapeutic process through a 2D projection of a computer screen, which makes monitoring the VR user ( Shamri Zeevi, 2021 ). Overall, the reviewed papers suggest that it is easier to evaluate social cues and initiate social interactions during traditional methods rather than VR interventions.

3.3.6 Affordability and maintenance

According to Carlton (2014) , there is a lack of affordability, renewability, and accessibility to new media compared to traditional media in art therapy. The issue of high cost in VR equipment and the development of specialized software applications, compared to traditional art therapy media and materials, is found in many of the reviewed papers. Specialized VR systems are usually available to psychotherapists only if provided by healthcare organizations that have their own IT departments where limitations, such as cost and maintenance, are most viably mitigated ( Brahnam, 2014 ).

4 Discussion

The findings indicate that the progress of VR technology is facilitating the use of VR in therapeutic practices relevant to the creation of artworks to a degree that allows a plethora of possibilities for innovation. In the field of psychotherapy, 3D digital brush strokes are employed to facilitate communication between client and therapist or researcher but also to act as building blocks for “safe spaces,” work as colorful mood regulators for reducing anxiety, and unravel empirical insight for self-improvement. The 3D digital strokes of Tilt Brush were only an instance of how therapeutic artmaking and art therapy manifest in VR. New forms of artistic expression are beginning to emerge through VR, such as generating graphics using biomarkers or simple gestures ( Song et al., 2019 ; Baldursson et al., 2022 ). Some of these art forms are made available thanks to the combination of VR with other technologies, such as the Brain-Computer Interfaces (BCI), where brain activity data can be easily collected and decoded to create control signals for virtual objects ( Coogan and He, 2018 ). One of the least expected findings was the emergence of digital drawing techniques in the field of neurorehabilitation. Rehabilitation strategies that involved the creation of traditional artworks were proposed by Skinner and Nagel (1996) , however the literature on the subject has been scarce for over 2 decades. Recent studies suggest that new media alleviate physical constraints from in-therapy motor-impaired patients to the point of allowing them to paint digital artworks and even “recreate” classical masterpieces in the form of a simulation ( Iosa et al., 2021 ; Zhang et al., 2021 ). For example, researchers used VR technology to simulate the illusion of painting classical art masterpieces, designed for the neuroaesthetic stimulation of patients with an affected upper limb, and found a “Michelangelo effect” arising ( Iosa et al., 2021 ). These imitations are neurologically comparable to performing the observed activity, akin to a virtual simulation, hence the term “embodied simulation” could be used ( Buk, 2009 ; Finisguerra et al., 2021 ). It is argued that the capabilities of computer simulations in inducing neuroplasticity are best utilized by the technology of VR, which provides patients with interactive, stimulatory and ecologically valid VEs ( Cheung et al., 2014 ). The sense of presence, which is induced within an immersive VR simulation, accounts for a bountiful allocation of cognitive resources that are relevant to motor control and is estimated to be one of the main factors that make VR technology especially suitable for rehabilitation ( Slobounov et al., 2015 ).

VR art therapy and therapeutic artmaking seem to be promising future interventions for wellbeing. Artmaking in immersive VR was found to lessen the participants’ insecurities about their skill in artmaking, allowing them to be more creative and focused on their therapeutic goals ( Kaimal et al., 2020a ). The malleability of VEs and their ability to adapt to the needs of clients as well as the illusion of presence are found to be some of the main contributors in facilitating healing. The symbolic, explorative, and controlled nature of VR art therapy allows personalized experiences that can be observed through different distances and points of view. These qualities allow individuals to create order from the fragmentary aspects of life and make sense of their emotions ( Malchiodi, 2002 ). VR could induce motivation and inspiration in clients, especially in those who are receptive towards new media, such as digital natives, whose life typically operates in both the physical and the digital world. Some digital natives choose to allocate their energy resources more in the digital world than the physical one and this phenomenon seems relevant to sociobiological factors and data ubiquity. Taking into consideration the above findings and the conclusions of the systematic review by Wagener et al. (2021) , it could be argued that the lack of applicability of holistic wellbeing approaches, customization, and self-expression in VR is prominent possibly because substantial steps to elevate the state of the art in the direction of art therapy and therapeutic artmaking have yet to be made.

The reviewed papers often indicate disadvantages of VR over traditional art media while implying that, nowadays, most of the highlighted issues are surmountable enough. Most of the explored issues, such as interdisciplinary concerns and the lack of digital literacy, are likely to move towards resolution the more they become adequately addressed. Other issues, such as the lack of cost-effective solutions for VR ownership and development, as well as tactility absence in VR during artmaking, can be more nuanced. The lack of tactility experienced through digital art therapy initially used to be one of the main sources of skepticism in art therapists regarding the adoption of digital art therapy practices. However, it has been observed that the lack of tactility could be an uncanny feeling for some but also a trivial matter for others, whose modalities combine inside the VR environment to create an illusion of tactility ( Hacmun et al., 2021 ). Currently, electrostimulation-based techniques are employed to tackle both the issue of tactility absence and cybersickness in VR ( Li et al., 2020 ; Vizcay et al., 2021 ).

All the reviewed papers are unanimous regarding the appropriateness of VR in art-based therapeutic practices, even though some researchers from the reviewed papers but also from the broader literature challenge the notion that fully immersive VR favors interventions for which the connection between client and therapist is deliberately distant ( Gatto et al., 2020 ; Hacmun et al., 2021 ). Xiong et al. (2022) argue that Augmented Reality (AR) could be a more suitable technology for art-based rehabilitation interventions than fully immersive VR because of the increased possibilities for social interaction in AR, among other reasons. As Alex et al. (2021) argue, sociability in VR applications, even though it exists, needs to be a more prominent feature. The accessibility increase of psychotherapeutic practices to collaborative VR spaces through telepresence could mitigate some of the interdisciplinary and technical problems which VR psychotherapy sustains, such as the limited accommodation of the triangular psychotherapeutic relationship to the VE. Importantly, the role of the therapist or the researcher, who is cut off from observing the implicit actions of the client/user during an artistic fully immersive VR intervention, is bound to be degraded due to the observer’s constrained ability to derive accurate conclusions. This implies that current VR technology favors the forms of art therapy in which the role of the therapist is peripheral to the psychotherapeutic relationship and this limitation is arguably detrimental to the overall usability of fully immersive VR as a therapeutic tool.

However, the authors by no means suggest that fully immersive VR is deleterious to the role of the therapist. Despite the drawbacks that fully immersive VR has in store regarding the therapist’s role, VR is also found to be especially useful for building trust between client and therapist, which is an important aspect of the psychotherapeutic relationship ( Frewen et al., 2020 ; Shamri Zeevi, 2021 ). The term “collaborative VR” refers to social VR platforms that allow user-generated content and synchronous communication in 3D virtual spaces via telepresence ( Saffo et al., 2021 ). Collaborative VR platforms where both client(s) and therapist(s) can simultaneously occupy the same virtual space through telepresence exist in a nascent stage (i. e., VRChat and the “Metaverse”), which are likely to become more of the norm in the years to come and prominent therapeutic spaces ( Rzeszewski and Evans, 2020 ; Hacmun et al., 2021 ). These platforms can employ eye tracking and real-time facial expression mapping techniques for avatars, which could be a solution to the problem of communicating emotional cues through VR ( Joachimczak et al., 2022 ). Nevertheless, a challenge that needs to be addressed regarding real-time facial expression mapping is that facial expressions of avatars need to mitigate their levels of perceived uncanniness and this challenge mostly concerns photorealistic avatars ( Kumarapeli et al., 2022 ). As fully immersive VR is progressively becoming more geared towards commercial use, the development of collaborative VR is more likely to gain momentum and subsequently elevate the role of the therapist and the possibilities offered regarding art-based therapy treatments.

5 Future directions

Despite the topic of VR in therapy being relatively new and the challenges being many, there is promising evidence regarding the therapeutic use of art-based VR interventions. The variables that constitute an effective digital application for art therapy are already evident ( Marks et al., 2017 ) but the transformation of theoretical knowledge into effective therapeutic practices, especially in the case of new media, needs further experimentation. As suggested by the reviewed papers, future research could pertain to the transfer and optimization of neurocognitive tests in VR with emphasis on drawing and visuospatial reasoning ( Jin et al., 2020 ). VR also poses an opportunity for studying the impact of artmaking on the Autonomic Nervous System (ANS) from a theoretical standpoint that derives from pieces of research focusing on artmaking and anxiety disorders ( Sandmire et al., 2012 ; Sandmire et al., 2016 ). It is already known that artmaking practices help in reducing stress and anxiety, but VR technology could elevate our understanding of artmaking even further, thanks to the facilitation of data management and the ecological validity offered by VR interventions ( Richesin et al., 2021 ).

Even though many novel approaches to therapy have been described in this review, the full potential of immersive VR technology in therapeutic treatments seems to remain underutilized ( Geraets et al., 2021 ) and art-based treatments are no exception. One of the most underutilized affordances of VR in art therapy and therapeutic artmaking is that of the embodied expression via virtual avatars. The concepts of embodied cognition, virtual avatars, and embodiment are commonly found in the literature of fully immersive VR ( Kyrlitsias and Michael-Grigoriou, 2022 ), but the role of the avatars in the reviewed papers was given little to no attention. Reviewed studies that deployed fully immersive VR were found to be limited to the obligatory motion capture of the hands, provided by the controllers or other motion-capture techniques, which tend to make the VR user feel like a body-less ghost with visible hands. Arguably, the embodiment of virtual avatars, and its subsequent sensations of body ownership and body agency, should be considered as crucial elements of art-based therapeutic treatments in VR because of the indispensable role of kinesthetic and sensorimotor activity, as well as spatial awareness, during art therapy interventions. As Malchiodi (2020) notes, the most compelling reason for using any expressive arts therapy intervention is probably the sensory nature of the arts themselves, which cultivate cognitive and emotional awareness but also the awareness of somatic sensations that contributes to body-kinesthetic intelligence. Given that the facilitation of the communication between mind and body is one of the tenets of art therapy, when the VR user has no visual affirmation of having and controlling a body, the possibility that the lack of the expected visuo-proprioceptive stimuli downplays the efficacy of art therapy becomes prevalent. On a psychosocial level, embodied expression via avatars in VR could organically integrate into art-based therapeutic practices and enhance therapeutic experiences because of the possible influence of VR embodiment and presence in changing implicit attitudes. Adopting methods such as, the “ Proteus Effect” could prove to be useful in the context of art therapy in numerous creative ways, for example using avatar-based emotional priming interventions (e.g., for attitude change) or aiming for avatar-assisted cultivation of psychomotor skills.

Continuing in the lines of embodied cognition, another area of interest for future research could be that of embodied simulation. The Michelangelo effect is a good example of the utilization of the mirror neuron system in motor-impaired individuals for neurorehabilitation. An inference from the study, in which the term “Michelangelo effect” hails ( Iosa et al., 2021 ), could be that artmaking, even if subconsciously practiced via embodied simulation, activates visual-motor mirror neurons to the degree of facilitating neurorehabilitation. More research is needed to assess the level of significance of the association between VR artmaking (combined with shared body states of virtual humans) and neurorehabilitation.

Finally, psychotherapy interventions should go beyond “building safe spaces” when it comes to externalizations of mental representations in VR. Creative work in VR could often lead to creating a bridge between the physical world and emotions ( Shamri Zeevi, 2021 ). Externalizations help in understanding where the person stands in relation to a problem, and what they might need in order to gain control over it, but it also provides understanding of the nature and the scale of the problem as it is already evident through enhanced perspective change and replay value ( Marks et al., 2017 ). Intrusive mental images of distinct shapes and forms could also become available for constructive interaction through externalization. The case study of Walker et al. (2016) corroborates that bringing tormenting intrusive images to “the light of day” through artmaking allowed a sufferer to deconstruct and ultimately vanquish these reoccurring images. However, the efficacy of externalizations for the treatment of intrusive images on a large population with diverse experiences and levels of severity is still in question, since the exact underlying mechanisms of this treatment are unclear. VR technology, through its ecological validity, controllability of environments, and creative applications, provides an adequate opportunity for experimentation on externalizations of mental representations and intrusive mental imagery, while making it possible to generalize results in a larger population. Rosal (2018) points out the necessity of clinical psychology research to focus on the study of intrusive mental images because they are related to many disorders for which our knowledge on their treatment is still insufficient.

6 Conclusion

The aim of this scoping review was to provide comprehensive information for therapy practitioners, application developers, and researchers, who could make use of the presented information to update current practices, and help elevate the state of the art in psychotherapy and rehabilitation. Knowledge regarding VR artmaking and art therapy in the area of wellbeing is already reported in various papers in a fragmented fashion and the scope of the present review was to congregate all the relevant information in a cohesive manner. The unique properties of VR and their significance to the area of art therapy and therapeutic artmaking were detailed and contrasted with traditional therapeutic practices. Further, this review provided the opportunity to focus on underexplored areas of VR practice in psychotherapy and rehabilitation, identify knowledge gaps in the literature and discuss potential future directions in the field of VR.

Author contributions

CH researched literature and conceived the review. CH wrote the first draft of the manuscript and substantially contributed to the creation of the final version. CH and DM-G were involved in data collection and CH was involved in data analysis and synthesis. DB substantially contributed to the revision of the manuscript and provided constructive feedback. DM-G substantially contributed to the critical evaluation of the manuscript and she also supervised the whole work from its conception to the final manuscript.

This work has been funded through the scholarship of academic excellence granted to CH for his doctoral studies and the research and other activities budget ED-DESPINA MICHAIL-300155-310200-3319 of the Cyprus University of Technology.

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.

R. Adams, S. Gibson, and S. M. Arisona (Editors) (2008). Transdisciplinary digital art: Sound, vision and the new screen ( Springer Science & Business Media ), 7.

Google Scholar

Alex, M., Wünsche, B. C., and Lottridge, D. (2021). Virtual reality art-making for stroke rehabilitation: Field study and technology probe. Int. J. Human-Computer Stud. 145, 102481. doi:10.1016/j.ijhcs.2020.102481

CrossRef Full Text | Google Scholar

Alqahtani, A. S., Daghestani, L. F., and Ibrahim, L. F. (2017). Environments and system types of virtual reality technology in stem: A survey. Int. J. Adv. Comput. Sci. Appl. (IJACSA) 8 (6). doi:10.14569/ijacsa.2017.080610

Angheluta, A. M., and Lee, B. K. (2011). Art therapy for chronic pain: Applications and future directions. Can. J. Couns. psychotherapy 45 (2).

Arkhipova, S., and Lazutkina, O. (2022). Psychomotor development of preschoolers with speech pathologies by means of art therapy techniques. Rev. Tempos Espaços em Educ. 15 (34), e17214. doi:10.20952/revtee.v15i34.17214

Bailenson, J. (2018). Experience on demand: What virtual reality is, how it works, and what it can do . WW Norton & Company .

Baldursson, B. R., Peterson, D., and Gamboa, M. (2022). “Nebula: Artistic somaesthetic appreciation with biosignals in virtual reality,” in Adjunct Proceedings of the 2022 Nordic Human-Computer Interaction Conference , 1–3.

Bamodu, O., and Ye, X. M. (2013). “Virtual reality and virtual reality system components,” in Advanced materials research (Paris, France: Trans Tech Publications Ltd, Atlantis Press ), 765, 1169–1172.

Banakou, D., Beacco, A., Neyret, S., Blasco-Oliver, M., Seinfeld, S., and Slater, M. (2020). Virtual body ownership and its consequences for implicit racial bias are dependent on social context. R. Soc. open Sci. 7 (12), 201848. doi:10.1098/rsos.201848

PubMed Abstract | CrossRef Full Text | Google Scholar

Banakou, D., Groten, R., and Slater, M. (2013). Illusory ownership of a virtual child body causes overestimation of object sizes and implicit attitude changes. Proc. Natl. Acad. Sci. 110 (31), 12846–12851. doi:10.1073/pnas.1306779110

Baron, L., Wang, Q., Segear, S., Cohn, B. A., Kim, K., and Barmaki, R. (2021). “Enjoyable physical therapy experience with interactive drawing games in immersive virtual reality,” in Symposium on Spatial User Interaction , 1–8.

Berkman, M. I., and Akan, E. (2019). “Presence and immersion in virtual reality,” in Encyclopedia of computer graphics and games . Editor N. Lee (Cham: Springer ). doi:10.1007/978-3-319-08234-9_162-1

Bertrand, S., Vassiliadi, M., Zikas, P., Geronikolakis, E., and Papagiannakis, G. (2021). From readership to usership: Communicating heritage digitally through presence, embodiment and aesthetic experience. Front. Commun. 6, 676446. doi:10.3389/fcomm.2021.676446

Biocca, F., and Levy, M. R. (2013). Communication in the age of virtual reality . Routledge, New York: Routledge .

Brahnam, S., and Brooks, A. L. (2014). “Two innovative healthcare technologies at the intersection of serious games, alternative realities, and play therapy,” in Innovation in medicine and healthcare 2014 (Springer, Cham: IOS Press ), 153–162.

Brahnam, S. (2014). “HCI prototyping and modeling of future psychotherapy technologies in second life,” in International Conference on Human-Computer Interaction (Cham: Springer ), 273–284.

Brien, S. E., Lorenzetti, D. L., Lewis, S., Kennedy, J., and Ghali, W. A. (2010). Overview of a formal scoping review on health system report cards. Implement. Sci. 5 (1), 2–12. doi:10.1186/1748-5908-5-2

Buk, A. (2009). The mirror neuron system and embodied simulation: Clinical implications for art therapists working with trauma survivors. Arts Psychotherapy 36 (2), 61–74. doi:10.1016/j.aip.2009.01.008

Carl, E., Stein, A. T., Levihn-Coon, A., Pogue, J. R., Rothbaum, B., Emmelkamp, P., et al. (2019). Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. J. anxiety Disord. 61, 27–36. doi:10.1016/j.janxdis.2018.08.003

Carlton, N. R. (2014). Digital culture and art therapy. Arts Psychotherapy 41 (1), 41–45. doi:10.1016/j.aip.2013.11.006

Cheng, C., Elamin, M. E., May, H., and Kennedy, M. (2021). Drawing on emotions: The evolving role of art therapy. Ir. J. Psychol. Med. , 1–3. doi:10.1017/ipm.2021.20

Cheung, K. L., Tunik, E., Adamovich, S. V., and Boyd, L. A. (2014). “Neuroplasticity and virtual reality,” in Virtual reality for physical and motor rehabilitation (New York, NY: Springer ), 5–24.

Christofi, M., Michael-Grigoriou, D., and Kyrlitsias, C. (2020). A virtual reality simulation of drug users’ everyday life: The effect of supported sensorimotor contingencies on empathy. Front. Psychol. 11, 1242. doi:10.3389/fpsyg.2020.01242

Coogan, C. G., and He, B. (2018). Brain-computer interface control in a virtual reality environment and applications for the internet of things. IEEE Access 6, 10840–10849. doi:10.1109/access.2018.2809453

Czamanski-Cohen, J., Sarid, O., Huss, E., Ifergane, A., Niego, L., and Cwikel, J. (2014). CB-ART—the use of a hybrid cognitive behavioral and art based protocol for treating pain and symptoms accompanying coping with chronic illness. Arts Psychotherapy 41 (4), 320–328. doi:10.1016/j.aip.2014.05.002

Deng, W., Hu, D., Xu, S., Liu, X., Zhao, J., Chen, Q., et al. (2019). The efficacy of virtual reality exposure therapy for ptsd symptoms: A systematic review and meta-analysis. J. Affect. Disord. 257, 698–709. doi:10.1016/j.jad.2019.07.086

Farmer, H., Ciaunica, A., and Hamilton, A. F. D. C. (2018). The functions of imitative behaviour in humans. Mind Lang. 33 (4), 378–396. doi:10.1111/mila.12189

Farokhi, M. (2011). Art therapy in humanistic psychiatry. Procedia-Social Behav. Sci. 30, 2088–2092. doi:10.1016/j.sbspro.2011.10.406

Feniger-Schaal, R., Orkibi, H., Keisari, S., Sajnani, N. L., and Butler, J. D. (2022). Shifting to tele-creative arts therapies during the COVID-19 pandemic: An international study on helpful and challenging factors. Arts psychotherapy 78, 101898. doi:10.1016/j.aip.2022.101898

Finisguerra, A., Ticini, L. F., Kirsch, L. P., Cross, E. S., Kotz, S. A., and Urgesi, C. (2021). Dissociating embodiment and emotional reactivity in motor responses to artworks. Cognition 212, 104663. doi:10.1016/j.cognition.2021.104663

Frewen, P., Mistry, D., Zhu, J., Kielt, T., Wekerle, C., Lanius, R. A., et al. (2020). Proof of concept of an eclectic, integrative therapeutic approach to mental health and well-being through virtual reality technology. Front. Psychol. 11, 858. doi:10.3389/fpsyg.2020.00858

Gatto, C., D’Errico, G., Nuccetelli, F., De Luca, V., Paladini, G. I., and De Paolis, L. T. (2020). “Xr-based mindfulness and art therapy: Facing the psychological impact of Covid-19 emergency,” in International Conference on Augmented Reality, Virtual Reality and Computer Graphics (Cham: Springer ), 147–155.

Geraets, C. N., Van der Stouwe, E. C., Pot-Kolder, R., and Veling, W. (2021). Advances in immersive virtual reality interventions for mental disorders: A new reality? Curr. Opin. Psychol. 41, 40–45. doi:10.1016/j.copsyc.2021.02.004

Hacmun, I., Regev, D., and Salomon, R. (2021). Artistic creation in virtual reality for art therapy: A qualitative study with expert art therapists. Arts Psychotherapy 72, 101745. doi:10.1016/j.aip.2020.101745

Hacmun, I., Regev, D., and Salomon, R. (2018). The principles of art therapy in virtual reality. Front. Psychol. 9, 2082. doi:10.3389/fpsyg.2018.02082

Hadjipanayi, C., and Michael-Grigoriou, D. (2022). Arousing a wide range of emotions within educational virtual reality simulation about major depressive disorder affects knowledge retention. Virtual Real. 26 (1), 343–359. doi:10.1007/s10055-021-00568-5

Haeyen, S., Jans, N., Glas, M., and Kolijn, J. (2021a). VR health experience: A virtual space for arts and psychomotor therapy. Front. Psychol. 12, 704613. doi:10.3389/fpsyg.2021.704613

Haeyen, S., Jans, N., and Heijman, J. (2021b). The use of VR tilt brush in art and psychomotor therapy: An innovative perspective. Arts Psychotherapy 76, 101855. doi:10.1016/j.aip.2021.101855

Harley, D. (2020). Palmer Luckey and the rise of contemporary virtual reality. Convergence 26 (5-6), 1144–1158. doi:10.1177/1354856519860237

Hodges, L. F., Kooper, R., Meyer, T. C., Rothbaum, B. O., Opdyke, D., Graaff, J. J. D., et al. (1995). Virtual environments for treating the fear of heights. IEEE Comput. 28 (7), 27–34. doi:10.1109/2.391038

Iosa, M., Aydin, M., Candelise, C., Coda, N., Morone, G., Antonucci, G., et al. (2021). The Michelangelo effect: Art improves the performance in a virtual reality task developed for upper limb neurorehabilitation. Front. Psychol. 11, 611956. doi:10.3389/fpsyg.2020.611956

Jin, R., Pilozzi, A., and Huang, X. (2020). Current cognition tests, potential virtual reality applications, and serious games in cognitive assessment and non-pharmacological therapy for neurocognitive disorders. J. Clin. Med. 9 (10), 3287. doi:10.3390/jcm9103287

Joachimczak, M., Liu, J., and Ando, H. (2022). “Creating 3D personal avatars with high quality facial expressions for telecommunication and telepresence,” in 2022 IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW) ( IEEE ), 856–857.

Kaimal, G., Carroll-Haskins, K., Berberian, M., Dougherty, A., Carlton, N., and Ramakrishnan, A. (2020a). Virtual reality in art therapy: A pilot qualitative study of the novel medium and implications for practice. Art. Ther. 37 (1), 16–24. doi:10.1080/07421656.2019.1659662

Kaimal, G., Carroll-Haskins, K., Ramakrishnan, A., Magsamen, S., Arslanbek, A., and Herres, J. (2020b). Outcomes of visual self-expression in virtual reality on psychosocial well-being with the inclusion of a fragrance stimulus: A pilot mixed-methods study. Front. Psychol. 11, 589461. doi:10.3389/fpsyg.2020.589461

Kaimal, G., Carroll-Haskins, K., Topoglu, Y., Ramakrishnan, A., Arslanbek, A., and Ayaz, H. (2022). Exploratory fNIRS assessment of differences in activation in virtual reality visual self-expression including with a fragrance stimulus. Art. Ther. 39 (3), 128–137. doi:10.1080/07421656.2021.1957341

Kim, G., and Biocca, F. (20182018). “Immersion in virtual reality can increase exercise motivation and physical performance,” in Virtual, Augmented and Mixed Reality: Applications in Health, Cultural Heritage, and Industry: 10th International Conference, VAMR 2018, Held as Part of HCI International 2018, Las Vegas (NV, USA: Springer International Publishing ), 10, 94–102. Proceedings, Part II.

Kim, Y., and Lee, H. (2021). Falling in love with virtual reality art: A new perspective on 3D immersive virtual reality for future sustaining art consumption. Int. J. Human–Computer Interact. 38, 371–382. doi:10.1080/10447318.2021.1944534

Kumarapeli, D., Jung, S., and Lindeman, R. W. (2022). “Emotional avatars: Effect of uncanniness in identifying emotions using avatar expressions,” in 2022 IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW) ( IEEE ), 650–651.

Kyrlitsias, C., and Michael-Grigoriou, D., (2022). Social Interaction With Agents and Avatars in Immersive Virtual Environments: A Survey. Front. Virtual Real. , 2, p.786665. doi:10.3389/frvir.2021.786665

Li, B., and Shen, M. (2022). The psychological recovery of patients in the context of virtual reality application by a complementary medicine scheme based on visual art. Evidence-based Complementary Altern. Med. 2022, 7358597. eCAM. doi:10.1155/2022/7358597

Li, G., McGill, M., Brewster, S., and Pollick, F. (2020). “A review of electrostimulation-based cybersickness mitigations,” in 2020 IEEE International Conference on Artificial Intelligence and Virtual Reality (AIVR) ( IEEE ), 151–157.

Liu, Z., Yang, Z., Xiao, C., Zhang, K., and Osmani, M. (2021). An investigation into art therapy aided health and well-being research: A 75-year bibliometric analysis. Int. J. Environ. Res. Public Health 19 (1), 232. doi:10.3390/ijerph19010232

Maggio, M. G., De Luca, R., Manuli, A., Buda, A., Foti Cuzzola, M., Leonardi, S., et al. (2020). Do patients with multiple sclerosis benefit from semi-immersive virtual reality? A randomized clinical trial on cognitive and motor outcomes. Appl. Neuropsychol. Adult 29, 59–65. doi:10.1080/23279095.2019.1708364

Maister, L., Slater, M., Sanchez-Vives, M. V., and Tsakiris, M. (2015). Changing bodies changes minds: Owning another body affects social cognition. Trends cognitive Sci. 19 (1), 6–12. doi:10.1016/j.tics.2014.11.001

C. A. Malchiodi (Editor) (2011). Handbook of art therapy (New York, NY: Guilford Press ).

Malchiodi, C. A. (2002). The soul's palette: Drawing on art's transformative powers . Boston: Shambhala Publications .

Malchiodi, C. A. (2020). Trauma and expressive arts therapy: Brain, body, and imagination in the healing process . New York, NY: Guilford Publications .

Marks, K., Marks, S., and Brown, A. (2017). Step into my (virtual) world: An exploration of virtual reality drawing applications for arts therapy. Aust. N. Z. J. Arts Ther. 12 (1), 99–111.

Maselli, A., and Slater, M. (2013). The building blocks of the full body ownership illusion. Front. Hum. Neurosci. 7, 83. doi:10.3389/fnhum.2013.00083

Mishina, A. V., Blinova, J. L., and Belomoyeva, O. G. (2017). Multimodal art therapy for overcoming negative emotional states among adolescents. Helix 8, 2307–2311.

Moller, H. J., Waterworth, J. A., and Chignell, M. (2020). “Returning to nature: VR mediated states of enhanced wellness,” in International Conference on Human-Computer Interaction (Cham: Springer ), 593–609.

Montana, J. I., Matamala-Gomez, M., Maisto, M., Mavrodiev, P. A., Cavalera, C. M., Diana, B., et al. (2020). The benefits of emotion regulation interventions in virtual reality for the improvement of wellbeing in adults and older adults: A systematic review. J. Clin. Med. 9 (2), 500. doi:10.3390/jcm9020500

Moon, C. H. (2011). Materials & media in art therapy: Critical understandings of diverse artistic vocabularies . New York, NY: Routledge .

Mozgai, S., Hartholt, A., Leeds, A., and Rizzo, A. S. (2020). “Iterative participatory design for VRET domain transfer: From combat exposure to military sexual trauma,” in Extended Abstracts of the 2020 CHI Conference on Human Factors in Computing Systems , 1–8.

Orr, P. (2012). Technology use in art therapy practice: 2004 and 2011 comparison. Arts Psychotherapy 39 (4), 234–238. doi:10.1016/j.aip.2012.03.010

Osimo, S. A., Pizarro, R., Spanlang, B., and Slater, M. (2015). Conversations between self and self as Sigmund Freud—a virtual body ownership paradigm for self counselling. Sci. Rep. 5 (1), 13899–13914. doi:10.1038/srep13899

Ouzzani, M., Hammady, H., Fedorowicz, Z., and Elmagarmid, A. (2016). Rayyan—A web and mobile app for systematic reviews. Syst. Rev. 5 (1), 210–10. doi:10.1186/s13643-016-0384-4

Pendse, A., Gravier, N., Deedwania, D., Gotsis, M., Patterson, M., and Summers, C. (2016). “Inner activity,” in ACM SIGGRAPH 2016 VR Village , New York NY, United States (New York, NY: Association for Computing Machinery ), 1–2.

Pifalo, T. (2007). Jogging the cogs: Trauma-focused art therapy and cognitive behavioral therapy with sexually abused children. Art. Ther. 24 (4), 170–175. doi:10.1080/07421656.2007.10129471

Pissini, J. (2020). Embodied by design: The presence of creativity, art-making, and self in virtual reality . PhD thesis. Columbus (Ohio): The Ohio State University .

Richesin, M. T., Baldwin, D. R., and Wicks, L. A. (2021). Art making and virtual reality: A comparison study of physiological and psychological outcomes. Arts Psychotherapy 75, 101823. doi:10.1016/j.aip.2021.101823

Riva, G. (2005). Virtual reality in psychotherapy: Review. Cyberpsychology Behav. 8 (3), 220–230. doi:10.1089/cpb.2005.8.220

Rosal, M. L. (2018). Cognitive-behavioral art therapy: From behaviorism to the third wave . New York, NY: Routledge .

Rubio-Tamayo, J. L., Gertrudix Barrio, M., and García García, F. (2017). Immersive environments and virtual reality: Systematic review and advances in communication, interaction and simulation. Multimodal Technol. Interact. 1 (4), 21. doi:10.3390/mti1040021

Rzeszewski, M., and Evans, L. (2020). Virtual place during quarantine–a curious case of VRChat. Rozw. Reg. i Polityka Reg. (51), 57–75. doi:10.14746/rrpr.2020.51.06

Saffo, D., Di Bartolomeo, S., Yildirim, C., and Dunne, C. (2021). “Remote and collaborative virtual reality experiments via social vr platforms,” in Proceedings of the 2021 CHI Conference on Human Factors in Computing Systems , 1–15.

Salles, J., Charras, M., and Schmitt, L. (2020). “Digital tools in psychiatry and art-therapy, which possible meeting points?,” in Annales medico-psychologiques ( Masson ), 178, 43–47. 21 STREET CAMILLE DESMOULINS, ISSY, 92789 MOULINEAUX CEDEX 9, FRANCE: MASSON EDITEUR.

Sandmire, D. A., Gorham, S. R., Rankin, N. E., and Grimm, D. R. (2012). The influence of art making on anxiety: A pilot study. Art. Ther. 29 (2), 68–73. doi:10.1080/07421656.2012.683748

Sandmire, D. A., Rankin, N. E., Gorham, S. R., Eggleston, D. T., French, C. A., Lodge, E. E., et al. (2016). Psychological and autonomic effects of art making in college-aged students. Anxiety, Stress, & Coping 29 (5), 561–569. doi:10.1080/10615806.2015.1076798

Sarid, O., and Huss, E. (2010). Trauma and acute stress disorder: A comparison between cognitive behavioral intervention and art therapy. arts psychotherapy 37 (1), 8–12. doi:10.1016/j.aip.2009.11.004

Schaverien, J., 2000. The triangular relationship and the aesthetic countertransference in analytical art psychotherapy. The changing shape of art therapy: New developments in theory and practice, pp.55–83.

Shamri Zeevi, L. (2021). Making art therapy virtual: Integrating virtual reality into art therapy with adolescents. Front. Psychol. 12, 584943. doi:10.3389/fpsyg.2021.584943

Skinner, M. K., and Nagel, P. J. (1996). Painting a mural and writing an article: Creative rehabilitation strategies. Rehabil. Nurs. 21 (2), 63–66. doi:10.1002/j.2048-7940.1996.tb01678.x

Slater, M. (2018). Immersion and the illusion of presence in virtual reality. Br. J. Psychol. 109 (3), 431–433. doi:10.1111/bjop.12305

Slater, M., Neyret, S., Johnston, T., Iruretagoyena, G., Crespo, M. Á. D. L. C., Alabèrnia-Segura, M., et al. (2019). An experimental study of a virtual reality counselling paradigm using embodied self-dialogue. Sci. Rep. 9 (1), 10903–10913. doi:10.1038/s41598-019-46877-3

Slater, M., Pérez Marcos, D., Ehrsson, H., and Sanchez-Vives, M. V. (2009). Inducing illusory ownership of a virtual body. Front. Neurosci. 3, 214–220. doi:10.3389/neuro.01.029.2009

Slater, M., and Sanchez-Vives, M. V. (2016). Enhancing our lives with immersive virtual reality. Front. Robotics AI 3, 74. doi:10.3389/frobt.2016.00074

Slobounov, S. M., Ray, W., Johnson, B., Slobounov, E., and Newell, K. M. (2015). Modulation of cortical activity in 2D versus 3D virtual reality environments: An EEG study. Int. J. Psychophysiol. 95 (3), 254–260. doi:10.1016/j.ijpsycho.2014.11.003

Song, M., Tadeo, T., Sandor, I., Ulas, S., and DiPaola, S. (2019). “BioFlockVR: Exploring visual entrainment through amorphous nature phenomena in bio-responsive multi-immersant VR interactives,” in Proceedings of the 2nd International Conference on Image and Graphics Processing , 150–154.

Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., et al. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann. Intern. Med. 169 (7), 467–473. doi:10.7326/m18-0850

Vallance, M., and Towndrow, P. A. (2022). Perspective: Narrative storyliving in virtual reality design. Front. Virtual Real 3, 779148. doi:10.3389/frvir.2022.779148

Vizcay, S., Kourtesis, P., Argelaguet, F., Pacchierotti, C., and Marchal, M., 2021. Electrotactile feedback for enhancing contact information in virtual reality. arXiv preprint arXiv:2102.00259 .

Wagener, N., Duong, T. D., Schöning, J., Rogers, Y., and Niess, J. (2021). “The role of mobile and virtual reality applications to support well-being: An expert view and systematic app review,” in IFIP Conference on Human-Computer Interaction (Cham: Springer ), 262–283.

Walker, M. S., Kaimal, G., Koffman, R., and DeGraba, T. J. (2016). Art therapy for ptsd and tbi: A senior active duty military service member’s therapeutic journey. Arts Psychotherapy 49, 10–18. doi:10.1016/j.aip.2016.05.015

Worden, M. (2020). 17 june the difference between art Therapy and therapeutic art-making. Art from the streets. Available at: https://artfromthestreets.org/blogs/news/art-therapy-near-me (Accessed: October 20, 2021).

Xiong, Z., Weng, X., and Wei, Y. (2022). SandplayAR: Evaluation of diagnosis game for people with generalized anxiety disorder. Arts Psychotherapy 80, 101934. doi:10.1016/j.aip.2022.101934

Yee, N., and Bailenson, J. (2007). The Proteus effect: The effect of transformed self-representation on behavior. Hum. Commun. Res. 33 (3), 271–290. doi:10.1111/j.1468-2958.2007.00299.x

Ying-Chun, L., and Chwen-Liang, C. (2018). “The application of virtual reality technology in art therapy: A case of tilt brush,” in 2018 1st IEEE International Conference on Knowledge Innovation and Invention (ICKII) ( IEEE ), 47–50.

Zhang, Y., Wang, H., and Shi, B. E. (2021). “Gaze-controlled robot-assisted painting in virtual reality for upper-limb rehabilitation,” in 2021 43rd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC) ( IEEE ), 4513–4517.

Keywords: virtual reality, art, psychotherapy, therapy, rehabilitation, wellbeing, new media

Citation: Hadjipanayi C, Banakou D and Michael-Grigoriou D (2023) Art as therapy in virtual reality: A scoping review. Front. Virtual Real. 4:1065863. doi: 10.3389/frvir.2023.1065863

Received: 10 October 2022; Accepted: 27 January 2023; Published: 09 February 2023.

Reviewed by:

Copyright © 2023 Hadjipanayi, Banakou and Michael-Grigoriou. 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: Despina Michael-Grigoriou, [email protected]

† ORCID:Christos Hadjipanayi, orcid.org/0000-0001-7444-5406 ; Domna Banakou, orcid.org/0000-0002-0974-6971 ; Despina Michael-Grigoriou, orcid.org/0000-0003-0824-7684

This article is part of the Research Topic

Machine Learning and Immersive Technologies for User-centered Digital Healthcare Innovation

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• HHS Author Manuscripts

Art Therapy and Cognitive Processing Therapy for Combat-Related PTSD: A Randomized Controlled Trial

Melissa campbell.

Art therapist at the University Neuro-psychiatric Institute, University of Utah, Salt Lake City

Kathleen P. Decker

Staff psychiatrist at the Hampton VA Medical Center, Hampton, VA, and faculty member in the Department of Psychiatry at Eastern Virginia Medical School, Norfolk

Community faculty

Sarah P. Deaver

Professor in the Graduate Art Therapy and Counseling Professions Program, Eastern Virginia Medical School

This randomized controlled trial was designed to determine if art therapy in conjunction with Cognitive Processing Therapy (CPT) was more effective for reducing symptoms of combat posttraumatic stress disorder (PTSD) than CPT alone. Veterans ( N = 11) were randomized to receive either individual CPT, or individual CPT in conjunction with individual art therapy. PTSD Checklist–Military Version and Beck Depression Inventory–II scores improved with treatment in both groups with no significant difference in improvement between the experimental and control groups. Art therapy in conjunction with CPT was found to improve trauma processing and veterans considered it to be an important part of their treatment as it provided healthy distancing, enhanced trauma recall, and increased access to emotions.

Introduction

Posttraumatic stress disorder (PTSD) affects hundreds of thousands of veterans in the United States. A meta-analysis estimated that 23% of veterans of recent wars in Iraq and Afghanistan suffer from PTSD ( Fulton et al., 2015 ), and 405,915 veterans of these operations were seen in Veterans Affairs facilities as of 2015 ( U.S. Department of Veterans Affairs, 2015 ) and diagnosed with primary, secondary, or provisional PTSD. In addition, an estimated 17% of Vietnam-era veterans ( Goldberg et al., 2016 ; Price, 2016 ), and an estimated 10% of Gulf War veterans ( Kang, Natelson, Mahan, Lee, & Murphy, 2003 ) have experienced lifetime PTSD.

The Diagnostic and Statistical Manual of Mental Disorders defines posttraumatic stress disorder (PTSD) according to the following diagnostic criteria: exposure to a traumatic event, reexperiencing traumatic material, hyperarousal, negative cognitions and mood, and avoidance of reminders ( American Psychiatric Association, 2013 ). One of the major evidence-based approaches to treating PTSD is Cognitive Processing Therapy (CPT; Forbes et al., 2012 ; Macdonald, Monson, Doron-Lamarca, Resick, & Palfai, 2011 ; Nishith, Nixon, & Resick, 2005 ; Ponniah & Hollon, 2009 ). However, research has suggested that as many as 30% of patients may be unresponsive to evidence-based treatments ( Wisco, Marx, & Keane, 2012 ), and some experience residual symptoms even after treatment ( Riggs & Sermanian, 2012 ). Evidence also suggests that impairment in verbal memory may be more severe in PTSD caused by combat compared with other sources of trauma ( Johnsen & Asbjørnsen, 2008 ). Therefore, it is critical for new treatment approaches to specifically address the needs of combat veterans.

Art therapy may assist with integration of sensory memories and declarative memory and has been shown to reduce symptoms of PTSD in a number of populations ( Harber, 2011 ; Henderson, Rosen & Mascaro, 2007 ; Lyshak-Stelzer, Singer, St. John, & Chemtob, 2007 ; Pifalo, 2007 , 2009 ; Tripp, 2007 ); however, there are no known randomized controlled trials on the effects of art therapy on combat-related PTSD. In a 2013 Delphi study ( Kaiser & Deaver, 2013 ), a panel of expert art therapy researchers identified randomized controlled trials as the highest priority for the art therapy field, and trauma as the most important psychological construct to address through research. Thus, our study supports these highest priorities of the profession.

Art Therapy and PTSD

Studies have suggested that some traumatic memories are stored nonverbally ( Gantt & Tinnin, 2009 ; Langer, 2011 ; Talwar, 2007 ) and may be retrieved through recollections of sensory, affective, visual, olfactory, auditory, and kinesthetic elements ( Langer, 2011 ). Although verbal therapies fail to address nonverbal aspects of trauma experiences, art therapy can access trauma recollections by engaging the senses. Art therapy has been hypothesized to bring order to traumatic experiences by creating links to nonverbal memories so that dissociated memories may be organized and processed in a meaningful way ( Gantt & Tinnin, 2009 ).

Art therapy provides a safe way to approach traumatic memories through the use of symbols, which may facilitate consolidation of experiences by converting an artistic form, representative of emotions and reactions to trauma, into linguistic communication ( Gantt & Tinnin, 2007 ; Morgan & Johnson, 1995 ). According to Talwar (2007) , art making is hypothesized to involve bilateral stimulation, engaging the integrating and planning functions of the prefrontal cortex to sequence narratives using left brain functions. This integration between the left and right hemispheres of the brain allows for complete processing and storage of traumatic experiences in long-term memory.

Art therapy provides externalization and emotional distance through materials and processes that use mediators, such as a paintbrush, between the patient and the image. The controlled distance encourages the patient to depict trauma experiences and to view the finished image at a physical distance ( Tinnin, Bills, & Gantt, 2002 ). According to Tinnin et al., these techniques can be useful when the patient does not consciously remember the sequence of events in visual trauma narratives, and they can help the patient feel safe enough to address unresolved trauma memories.

Types of Art Therapy for PTSD

The most widely used art therapy practice for PTSD is the creation of a visual trauma narrative ( Cross, 2015 ; Gantt & Tinnin, 2007 , 2009 ; Harber, 2011 ; Lyshak-Stelzer et al., 2007 ; Pifalo, 2009 ; Rankin & Taucher, 2003 ; Sarid & Huss, 2010 ; Spiegel, Malchiodi, Backos, & Collie, 2006 ; Talwar, 2007 ). The narrative can facilitate new insight, as well as help patients reconstruct their concept of self, others, and the world ( Rankin & Taucher, 2003 ; Spiegel et al., 2006 ) and is hypothesized to reduce emotional numbing and avoidance ( Spiegel et al., 2006 ; Tinnin et al., 2002 ). Naff (2014) also has stressed the importance of a visual trauma narrative, after the therapist creates a safe environment to contain the powerful emotional memories and emotions connected with the trauma. According to van der Kolk and Najavits (2013) , the first step in trauma therapy is to notice body sensations. In another study, narration of trauma in the first person was associated with greater increases in heart rate and skin conductance responses compared to narrating the trauma in the third person ( Wisco et al., 2015 ).

Results of Prior Studies of Art Therapy for PTSD

In a randomized controlled trial, Henderson et al. (2007) studied two groups of adults with PTSD symptoms; the experimental group depicted trauma-related feelings and emotions within a circle, and the control group drew assigned daily objects such as a cup. At a 1-month follow-up session, the researchers found that participants in the experimental group experienced greater reduction in PTSD symptoms—but not in depression or anxiety symptoms—than control group participants. Creating art also has been found to improve mood significantly more than simply viewing art ( Bell & Robbins, 2007 ). In a randomized controlled trial, Lyshak-Stelzer et al. (2007) found that adolescents with PTSD symptoms who made a narrative book of their life stories demonstrated significant PTSD symptom relief in comparison to control group participants. Furthermore, Gantt and Tinnin (2007) found that when using art therapy for trauma treatment, 89% of participants in their program either fully recovered or met criteria for improvement.

Although there are no prior studies of CPT in conjunction with art therapy ( Kaiser et al., 2005 ), Pifalo (2007) used art therapy in combination with cognitive behavioral therapy and found that art therapy allowed patients to communicate without relying strictly on words, and cognitive behavioral therapy provided clear goals for therapy. The combination of the two methods yielded significant subjective improvement in symptoms of children with PTSD from sexual abuse. An early observational study found that in specialized inpatient PTSD units, out of 15 standard components, art therapy produced the most benefit for combat veterans ( Johnson, Lubin, James, & Hale, 1997 ). In the only known study on art therapy with war veterans, art therapy was associated with reduced depression ( Kopytin & Lebedev, 2013 ).

Based on these prior studies, the goal of our research was to explore whether combining art therapy with Cognitive Processing Therapy would provide greater benefit in processing trauma and reducing symptoms in veterans with combat-related PTSD than CPT alone. A mixed methods design was used with an art therapy protocol devised by Campbell (2014) . This was a controlled trial in which participants were randomized by time to receive CPT alone or CPT along with eight sessions of individual art therapy. We hypothesized that participants who received CPT plus art therapy would experience a greater reduction in PTSD symptoms than participants who received only CPT, as measured by the PTSD Checklist–Military Version (PCL-M) and the Beck Depression Inventory–II (BDI-II). We also hypothesized that veterans in the experimental condition might prefer art therapy to CPT, as ascertained through reported satisfaction with treatment. Interviews were conducted to ascertain other benefits of art therapy that participants might have received that were not captured by PCL-M or BDI-II scores.

This was a controlled trial in which participants were randomized to a control group or an experimental group by time of entry into residential treatment. The study received Institutional Review Board approval from the Hampton VA Medical Center and Eastern Virginia Medical School.

Participants

Participants were veterans in treatment for combat-related PTSD in a residential program. All participants received group therapy for PTSD as well as the interventions described herein. Inclusion criteria included a score on the PCL-M higher than 50. There were no restrictions on age, gender, era of combat experience, or branch of service. Exclusion criteria included active substance use disorder, psychosis, and active suicidal or homicidal ideation. Five participants were randomized to receive both art therapy and CPT, all of whom completed treatment, and 10 participants were randomized to receive CPT alone, of whom six completed treatment. Thus, 11 participants completed treatment out of the original sample of 15. Three of five participants in the experimental group who completed treatment were White; the other two were African American. Five of six participants in the control condition who completed treatment were African American and one was White. All participants were male.

Veterans who consented to participate in the study were randomized to receive either eight sessions of individual CPT or eight sessions of individual art therapy in addition to eight sessions of individual CPT. Art therapy was delivered by the first author and CPT was delivered by several therapists, including the second author. The BDI-II and PCL-M scales were administered by the clinician delivering CPT or by the second author. The first author conducted semi-structured qualitative interviews with each participant to solicit feedback about the contribution of each therapy to treatment.

Cognitive Processing Therapy

CPT is a manualized, evidence-based treatment for PTSD ( Forbes et al., 2012 ; Macdonald et al., 2011 ). For this study, CPT consisted of the first eight sessions of the published manual. CPT includes written homework between sessions with worksheets that facilitate separating dysfunctional thoughts and beliefs from emotions generated by the traumatic event ( Resick, Monson & Chard, 2008 ). A written trauma narrative was also completed as homework. Discussion of the written trauma narrative with the CPT therapist and utilization of Socratic questioning to reframe negative thought processes and challenge distorted beliefs is central to CPT.

Art Therapy Protocol

The protocol for art therapy consisted of eight 75-minute sessions. The introductory session included the Art Therapy–Projective Imagery Assessment ( Deaver & Bernier, 2014 ) and an interview with semi-structured interview questions. Session 2 featured psychoeducational material about PTSD, goal setting, and safety, and also addressed and identified symptoms and triggers.

Session 3 focused on creation of a visual trauma narrative, based on work by previous investigators ( Gantt & Tinnin, 2007 ). Each veteran participant was directed to create six images. The first was an image of a time before the trauma when he felt peaceful and safe. The second was an image of the last moment he recalled immediately before the trauma occurred. The third was an image of what happened during the traumatic event. The fourth was an image of the moment immediately after the trauma. The fifth was an image of a time when he was safe from the physical threats of trauma. The last image was of a time when he tried to self-soothe. The participant was then asked to place the images on a wall and narrate the traumatic event from a third-person perspective to enhance healthy distancing from the event. This narrative was then repeated back to the participant by the art therapist. The visual trauma narrative was reviewed three times during the course of treatment.

Session 4 contained two elements: mask making and mind mapping. Mask making was utilized to assist participants in identifying and expressing emotions that were difficult to address verbally, and enable them to explore both their internal feelings and how they present themselves to the world. Mind mapping involved creating a web with the participant’s name in the middle inside of a small circle. From that center circle stemmed the core emotions he was experiencing as identified through the mask making, and any contributors to those emotions were included in order to further explore internal and external triggers. Session 5 began with narrating through the visual trauma narrative for a second time, and then addressed integration of “self before the trauma” with “self in the present.” This included making images about both of these parts of the self, then creating a written dialogue between the two images, using the nondominant hand for the former self, until a compromise could be reached about how these two parts of self can coexist ( Gantt & Tinnin, 2007 ).

In Session 6 participants used art to address grief and loss caused by combat trauma by making an image of something lost during the traumatic event. The image was then torn up and papermaking was used to transform the shredded image into handmade paper on which a new image or list was created to envision how to overcome the loss. Session 7 focused on reconstructing a new worldview and self-concept. The final session consisted of a post-intervention interview, a review of the trauma narrative and all other artwork, and creation of reflective art.

The PCL-M and BDI-II were administered at the start, midpoint, and end of treatment. The Beck Depression Inventory-II ( Beck & Steer, 1984 ) is a self-report measure of depression. The BDI-II has 21 items rated from 0 to 3, with higher scores indicating worse depression. Scores of 14 to19 indicate mild depression, scores of 20 to 28 indicate moderate depression, and scores above 29 suggest severe depression. The BDI-II demonstrates high internal consistency, with an alpha coefficient of .86 for psychiatric populations ( Beck, Steer, & Garbin, 1988 ).

The PTSD Checklist–Military Version ( Weathers, Litz, Herman, Huska & Keane, 1993 ) is a highly reliable—with Cronbach’s α of .94 ( Norris & Hamblen, 2004 )—and valid self-report scale with 17 items rated from 1 to 5 that measure the severity of PTSD symptoms. Items on the PCL-M correspond with the definition of PTSD according to criteria in the DSM-IV . A higher score corresponds to more severe PTSD symptoms ( Pietrzak, Tsai, Harpaz-Rotem, Whealin, & Southwick, 2012 ).

Data Analysis

Analysis of variance (ANOVA) with repeated measures was used to analyze results of quantitative rating scales for PTSD and depression symptoms. The dependent variables were the BDI-II and PCL-M scores. The independent variable was assignment to CPT plus art therapy or CPT alone. Statistical results were analyzed using SPSS. Subjective ratings of treatment satisfaction were measured post-treatment with a Likert scale of 1 to 5 (with 5 being the highest) rating the usefulness of art therapy or CPT. Interviews were analyzed using a basic content analysis approach.

PCL-M Scores

ANOVA with repeated measures was used to examine changes in PTSD symptoms. The mean PCL-M score in the experimental group decreased significantly, 73.0, SD = 8.5; 56.0, SD = 12.3.0, as did that of the control group, 62.8, SD = 10.9; 52.0, SD = 7.3. Improvement with treatment was significant for both groups, p < .001, μ 2 = 0.80, but there was no between-group effect, p = .54, μ 2 = 0.14.

BDI-II Scores

ANOVA with repeated measures was used to examine changes in depression symptoms. The mean BDI-II score improved in the experimental group, 37.0, SD = 11.7; 19.2, SD = 14.4, and the control group, 27.2, SD = 8.1; 17.6, SD = 9.7. The improvement with treatment was statistically significant for both groups with a large effect size, p < 0.001, μ 2 = 0.80. There was a nonsignificant trend to a greater improvement for the experimental compared to the control group, with a small effect size, p = 0.06, μ 2 = 0.3.

Ratings of Treatment Satisfaction

Control group participants’ average score for satisfaction with treatment was 4.8. Experimental group participants rated CPT at 3.2 and art therapy at 4.6 in terms of treatment satisfaction.

Interview Analysis

Content analysis of comments made by participants during pre-treatment and post-treatment interviews revealed the value of art therapy in helping participants work through avoidance and barriers to overcoming trauma. Another theme was that art therapy provided a positive form of expression, especially for painful emotions. One participant stated that art therapy “breaks through the ice and gets to heavier matters.” Two veterans had similar observations of the benefits of trauma exploration through art therapy: “It is easier for me to draw than write. It’s hard for me to put what I’m thinking into words,” and, “It helped me visualize trauma and emotions and connect it at the same time.”

Participants stated that art therapy assisted with understanding traumatic experiences: “I feel I learned a lot and was able to do a lot of soul searching.” A review of one participant’s artwork helped him “see differences in my perceptions before and after treatment.” One participant commented that art therapy helped with avoidance, and another stated, “I think I’ve made the greatest leaps forward here in my treatment with art therapy than with any of the other stuff.” Participants identified both the therapeutic relationship and the process as being helpful, and indicated that art therapy felt safe. Most veterans stated they would have liked to continue receiving art therapy.

Some trends between participants’ artwork before and after treatment were noted. Pre-treatment artwork manifested sketchy line quality, avoidance, regression in response to anxiety, lack of identity, and encapsulation in images about the reason for being in treatment. The collage of safety incorporated themes of nature, religious symbols, cool colors, arc shapes, and, for some, isolation—as shown in the image in Figure 1 . Participants were asked to depict six specific moments before, during, and after the traumatic event. The trauma narrative depicted in Figure 2 was created by a participant who added post-it notes with feelings labeled for each of the moments: the first reads “tranquility,” the second, “confusion,” the third “duty (anger),” the fourth “shock (disgust),” the fifth “content,” to which the participant later added “scared s…less,” and the last “numb.” Most participants’ trauma narratives manifested anxiety and deflection, and several did not include themselves in the images. Brown and black were common color choices. Most participants showed regression in their drawings of the trauma or the aftermath, as shown in the image in Figure 2 . Containment was suggested in the drawing of physical safety after the trauma, where most participants used square shapes or circles, as seen in Figures 3 and ​ and4. 4 . The image in Figure 3 is an example of a theme that was present in several participants’ artwork: containment using rectangular shapes or boxes to encapsulate sensitive material or provide compartmentalization for overwhelming emotions. It depicts a town in which the participant found physical safety after the trauma that includes rectangular buildings and two human outlines, with no other details. Another method of containment several participants used ( Figure 4 ) was to encircle traumatic events or emotions. This image depicts the participant controlling suicidal ideation by encircling the image of suicide by firearm with a red circle that is crossed through, and which he stated represents his goal “not to commit suicide.” Most participants had difficulty speaking in the third person while narrating the trauma narrative. Mask creation required 2 hours to complete instead of the planned hour. Participants created complex masks with multicolored exteriors and colored interiors with a simpler palette.

A Participant’s Collage Made to Depict the Concept of Safety

Example of a Trauma Narrative

Example of Containment Using Rectangular Shapes or Boxes to Encapsulate Sensitive Material or Provide Compartmentalization for Overwhelming Emotions

Another Method of Containment: Encircling Traumatic Events or Emotions

During the integration session, participants demonstrated a common theme of emptiness regarding the depiction of the self with PTSD, and none were able to complete a dialogue between the prior self and current self. There were no common themes in the session on grief and loss. Participants drew trauma-free worldviews that focused on childhood. All reported feeling stuck on trauma in their worldview. During the review of all artwork created during treatment, participants demonstrated an openness and honesty about what to leave behind.

PTSD and Depression Scores

Two of the highest priorities for the field of art therapy were recently identified as randomized controlled trials of art therapy and researching the use of art therapy for treatment of trauma ( Kaiser & Deaver, 2013 ). The current study addressed both these priorities. The hypothesis of our study was that art therapy provided with CPT would result in a greater reduction of PTSD symptoms in participants who received both treatments, compared with participants who received individual CPT alone. Both groups achieved clinically significant gains as defined by Weathers et al. (2013) . However, there was no statistically significant difference between the experimental and control groups. It is possible that the lack of significant difference between groups was due to the small sample size ( N = 11).

Another hypothesis was that participants receiving art therapy might experience greater reduction in depression symptoms than participants receiving only CPT. Both groups’ depression symptoms were reduced and both final mean scores were in the range of mild depression. Although not significantly different statistically, a trend toward greater reduction in depression symptoms for the experimental group compared to the control was noted.

Treatment Engagement and Satisfaction

An unexpected finding was that none of the participants in the experimental group dropped out of treatment, whereas 40% of those randomized to CPT alone left treatment prematurely. The dropout rate of the control group is consistent with a recent meta-analysis that showed a dropout rate for PTSD psychotherapies of 36% overall ( Goetter et al., 2015 ). Although this study had a small sample size, our results suggest that art therapy may enhance engagement, which would be an important improvement in the treatment of PTSD.

Participants were highly satisfied with art therapy. Interventions that addressed insight, safety, containment, nonverbal symbolic access to emotions, and visual trauma processing can be considered unique elements of art therapy that increased participant satisfaction. Some participants also expressed that they had not expected the art to be such a useful source of healing.

Art therapy helped access traumas and overwhelming emotions in a safe way as evidenced by veterans’ interviews. The need for containment was seen in participants’ artwork through the use of circles or boxes to encapsulate sensitive material or provide compartmentalization for overwhelming feelings. Not only did the artwork indicate this need, it helped facilitate the fulfillment of it.

Trauma Processing

All participants who received art therapy stated that they either recovered previously blocked memories or gained insights and realizations crucial to their healing processes through art therapy. This is consistent with prior hypotheses that sensory methods of accessing and processing traumatic memories facilitate integration of those memories, and that some portion of traumatic memory is stored nonverbally ( Gantt & Tinnin, 2009 ; Langer, 2011 ; Talwar, 2007 ). It has been hypothesized that trauma processing may be enhanced using sensory modalities to activate areas of the brain that have been affected and create pathways between declarative and nonverbal memories ( Gantt & Tinnin, 2009 ).

Improved trauma processing was one of the most significant contributions of the art therapy intervention. Through externalization of trauma and emotions, artwork acted as an external reflection of the internal self for each participant during treatment. Some participants stated that the most significant gains occurred while hearing their experiences recited back to them as they viewed the visual trauma narrative. Repetition of auditory, verbal, and visual processing also appeared to be important. Each review of the visual trauma narrative built on the last, filled more gaps in memory, and reduced anxiety. It also may have been that the sensory modalities involved in art therapy represented an alternate, nonverbal way of deconditioning the threat response.

This study was limited by the small number of participants and by the lack of long-term follow-up. Another limitation was that there were multiple CPT therapists but only one art therapist, so experimenter effects may have affected validity. Participants were a subpopulation of veterans with severe symptoms and no women were available to participate in this study, which limits the study’s generalizability, even to other veterans. There were many areas of positive growth post-treatment that were not measured. Finally, both the PCL-M and BDI-II are self-rating scales, so participants may have exaggerated or underreported their symptoms.

In this study, both depression and PTSD symptoms were reduced in veterans with combat-related PTSD. The results suggest that art therapy is a useful addition to treatment of PTSD using Cognitive Processing Therapy. Future studies should include larger numbers of participants, more art therapist researchers to eliminate experimenter bias, and perhaps also focus on the contribution of art therapy alone for treatment of PTSD. Finally, other measures are needed to elucidate the mechanism of art therapy’s contribution to trauma symptom reduction.

Portions of this study were completed as a master’s art therapy thesis by the first author at Eastern Virginia Medical School.

Color versions of one or more of the figures in this article can be found online at www.tandfonline.com/uart .

Contributor Information

Melissa Campbell, Art therapist at the University Neuro-psychiatric Institute, University of Utah, Salt Lake City.

Kathleen P. Decker, Staff psychiatrist at the Hampton VA Medical Center, Hampton, VA, and faculty member in the Department of Psychiatry at Eastern Virginia Medical School, Norfolk.

Kerry Kruk, Community faculty.

Sarah P. Deaver, Professor in the Graduate Art Therapy and Counseling Professions Program, Eastern Virginia Medical School.

• American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5. Washington, DC: Author; 2013. [ Google Scholar ]
• Beck AT, Steer RA. Internal consistencies of the original and revised Beck Depression Inventory. Journal of Clinical Psychology. 1984; 40 (6):1365–1367. doi: 10.1002/1097-4679(198411)40:6<1365::AID-JCLP2270400615>3.0.CO;2-D. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review. 1988; 8 (1):77–100. doi: 10.1016/0272-7358(88)90050-5. [ CrossRef ] [ Google Scholar ]
• Bell CE, Robbins SE. Effect of art production on negative mood: A randomized, controlled trial. Art Therapy: Journal of the American Art Therapy Association. 2007; 24 (2):71–75. doi: 10.1016/j.aip.2011.06.002. [ CrossRef ] [ Google Scholar ]
• Campbell M. Unpublished master’s thesis. Eastern Virginia Medical School; Norfolk, VA: 2014. Art therapy and cognitive processing therapy for combat PTSD: A randomized, controlled trial. [ Google Scholar ]
• Cross K. Unpublished master’s thesis. Eastern Virginia Medical School; Norfolk, VA: 2015. Interviews with trauma informed art therapists: A qualitative study. [ Google Scholar ]
• Deaver S, Bernier M. The Art Therapy–Projective Imagery Assessment. In: Handler L, Thomas A, editors. Drawings in assessment and psychotherapy: Research and application. New York, NY: Routledge; 2014. pp. 131–147. [ Google Scholar ]
• Forbes D, Lloyd D, Nixon RDV, Elliott P, Varker T, Perry D, … Creamer M. A multisite randomized controlled effectiveness trial of cognitive processing therapy for military-related posttraumatic stress disorder. Journal of Anxiety Disorders. 2012; 26 :442–452. doi: 10.1016/j.janxdis.2012.01.006. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Fulton JJ, Calhoun PS, Wagner HR, Schry AR, Hair LP, Feeling N, … Beckham JC. The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans: A meta-analysis. Journal of Anxiety Disorders. 2015; 31 :98–107. doi: 10.1016/j.janxdis.2015.02.003. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gantt L, Tinnin LW. Intensive trauma therapy of PTSD and dissociation: An outcome study. The Arts in Psychotherapy. 2007; 34 :69–80. doi: 10.1016/j.aip.2006.09.007. [ CrossRef ] [ Google Scholar ]
• Gantt L, Tinnin L. Support for a neurobiological view of trauma with implications for art therapy. The Arts in Psychotherapy. 2009; 36 :148–153. doi: 10.1016/j.aip.2008.12.005. [ CrossRef ] [ Google Scholar ]
• Goetter EM, Bui E, Ojserkis RA, Zakarian RJ, Brendel RW, Simon NM. A systematic review of dropout from psychotherapy for posttraumatic stress disorder among Iraq and Afghanistan combat veterans. Journal of Traumatic Stress. 2015; 28 :401–409. doi: 10.1002/jts.22038. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Goldberg J, Magruder KM, Forsberg CW, Friedman MJ, Litz BT, Vaccarino V, … Smith NL. Prevalence of post-traumatic stress disorder in aging Vietnam-era veterans: Veterans Administration Cooperative Study 569: Course and consequences of post-traumatic stress disorder in Vietnam-era veteran twins. American Journal of Geriatric Psychiatry. 2016; 24 (3):181–91. doi: 10.1016/j.jagp.2015.05.004. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Harber K. Creating a framework: Art therapy elicits the narrative. Art Therapy: Journal of the American Art Therapy Association. 2011; 28 (1):19–25. doi: 10.1080/07421656.2011.557766. [ CrossRef ] [ Google Scholar ]
• Henderson P, Rosen D, Mascaro N. Empirical study on the healing nature of mandalas. Psychology of Aesthetics, Creativity, and the Arts. 2007; 1 (3):148–154. doi: 10.1037/1931-3896.1.3.148. [ CrossRef ] [ Google Scholar ]
• Johnsen GE, Asbjørnsen AE. Consistent impaired verbal memory in PTSD: A meta-analysis. Journal of Affective Disorders. 2008; 111 :74–82. doi: 10.1016/j.jad.2008.02.007. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Johnson DR, Lubin H, James M, Hale K. Single session effects of treatment components within a specialized inpatient posttraumatic stress disorder program. Journal of Traumatic Stress. 1997; 10 (3):377–390. doi: 10.1023/A:1024833119339. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kaiser D, Deaver S. Establishing a research agenda for art therapy: A Delphi study. Art Therapy: Journal of the American Art Therapy Association. 2013; 30 (3):114–121. doi: 10.1080/07421656.2013.819281. [ CrossRef ] [ Google Scholar ]
• Kaiser D, Dunne M, Malchiodi C, Feen H, Howie P, Cutcher D, Ault R. Call for art therapy research on treatment of PTSD. Alexandria, VA: American Art Therapy Association; 2005. Retrieved from http://www.americanarttherapyassociation.org/upload/callforresearchptsd.pdf . [ Google Scholar ]
• Kang HK, Natelson BH, Mahan CM, Lee KY, Murphy FM. Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: A population-based survey of 30,000 veterans. American Journal of Epidemiology. 2003; 157 (2):141–148. doi: 10.1093/aje/kwf187. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kopytin A, Lebedev A. Humor, self-attitude, emotions, and cognitions in group art therapy with war veterans. Art Therapy: Journal of the American Art Therapy Association. 2013; 30 (1):20–29. doi: 10.1080/07421656.2013.757758. [ CrossRef ] [ Google Scholar ]
• Langer R. Combat trauma, memory and the World War II veteran. War, Literature, and the Arts: An International Journal of the Humanities. 2011; 23 (1):50–58. [ Google Scholar ]
• Lyshak-Stelzer F, Singer P, St John P, Chemtob CM. Art therapy for adolescents with posttraumatic stress disorder symptoms: A pilot study. Art Therapy: Journal of the American Art Therapy Association. 2007; 24 (4):163–169. doi: 10.1080/07421656.2007.10129474. [ CrossRef ] [ Google Scholar ]
• Macdonald A, Monson CM, Doron-Lamarca S, Resick PA, Palfai TP. Identifying patterns of symptom change during a randomized controlled trial of cognitive processing therapy for military-related posttraumatic stress disorder. Journal of Traumatic Stress. 2011; 24 (3):268–276. doi: 10.1002/jts.20642. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Morgan CA, Johnson DR. Use of a drawing task in the treatment of nightmares in combat-related post-traumatic stress disorder. Art Therapy: Journal of the American Art Therapy Association. 1995; 12 :244–247. [ Google Scholar ]
• Naff K. A framework for treating cumulative trauma with art therapy. Art Therapy: Journal of the American Art Therapy Association. 2014; 31 (2):79–86. doi: 10.1080/07421656.2014.903824. [ CrossRef ] [ Google Scholar ]
• Nishith P, Nixon RDV, Resick PA. Resolution of trauma-related guilt following treatment of PTSD in female rape victims: A result of cognitive processing therapy targeting comorbid depression? Journal of Affective Disorders. 2005; 86 :259–265. doi: 10.1016/j.jad.2005.02.013. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Norris FH, Hamblen JL. Standardized self-report measures of civilian trauma and PTSD. In: Wilson JP, Keane TM, Martin T, editors. Assessing psychological trauma and PTSD. New York: Guilford Press; 2004. pp. 63–102. [ Google Scholar ]
• Pietrzak RH, Tsai J, Harpaz-Rotem I, Whealin JM, Southwick SM. Support for a novel five-factor model of posttraumatic stress symptoms in three independent samples of Iraq/Afghanistan veterans: A confirmatory factor analytic study. Journal of Psychiatric Research. 2012; 46 (3):317–22. doi: 10.1016/j.jpsychires.2011.11.013. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pifalo T. Jogging the cogs: Trauma-focused art therapy and cognitive behavioral therapy with sexually abused children. Journal of the American Art Therapy Association. 2007; 24 (4):170–175. doi: 10.1080/07421656.2007.10129471. [ CrossRef ] [ Google Scholar ]
• Pifalo T. Mapping the maze: An art therapy intervention following disclosure of sexual abuse. Art Therapy: Journal of the American Art Therapy Association. 2009; 26 (1):12–18. doi: 10.1080/07421656.2009.10129313. [ CrossRef ] [ Google Scholar ]
• Ponniah K, Hollon SD. Empirically supported psychological treatments for adult acute stress disorder and post-traumatic stress disorder: A review. Depression and Anxiety. 2009; 26 :1086–1109. doi: 10.1002/da.20635. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Price JL. Findings from the National Vietnam Veterans’ Readjustment Study. 2016 Retrieved from National Center for PTSD website: http://www.ptsd.va.gov/professional/research-bio/research/vietnam-vets-study.asp .
• Rankin AB, Taucher LC. A task-oriented approach to art therapy in trauma treatment. Art Therapy: Journal of the American Art Therapy Association. 2003; 20 (3):138–147. doi: 10.1080/07421656.2003.10129570. [ CrossRef ] [ Google Scholar ]
• Resick PA, Monson CM, Chard KM. Cognitive Processing Therapy: Veteran/military version manual. Washington, DC: Department of Veterans Affairs; 2008. [ Google Scholar ]
• Riggs DS, Sermanian D. Prevention and care of combat-related PTSD: Directions for future explorations. Military Medicine. 2012; 177 (8):14–20. doi: 10.7205/MILMED-D-12-00140. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Sarid O, Huss E. Trauma and acute stress disorder: A comparison between cognitive behavioral intervention and art therapy. The Arts in Psychotherapy. 2010; 37 :8–12. doi: 10.1016/j.aip.2009.11.004. [ CrossRef ] [ Google Scholar ]
• Spiegel D, Malchiodi C, Backos A, Collie K. Art therapy for combat-related PTSD: Recommendations for research and practice. Art Therapy: Journal of the American Art Therapy Association. 2006; 23 (4):157–164. doi: 10.1080/07421656.2006.10129335. [ CrossRef ] [ Google Scholar ]
• Talwar S. Accessing traumatic memory through art making: An art therapy trauma protocol (ATTP) The Arts in Psychotherapy. 2007; 34 :22–25. doi: 10.1016/j.aip.2006.09.001. [ CrossRef ] [ Google Scholar ]
• Tinnin LW, Bills L, Gantt LM. Short-term treatment of simple and complex PTSD. In: Williams MB, Sommer JF Jr, editors. Simple and complex post-traumatic stress disorder: Strategies for comprehensive treatment in clinical practice. New York, NY: The Haworth Press; 2002. pp. 99–118. [ Google Scholar ]
• Tripp T. A short term therapy approach to processing trauma: Art therapy and bilateral stimulation. Journal of the American Art Therapy Association. 2007; 24 (4):176–183. doi: 10.1080/07421656.2007.10129476. [ CrossRef ] [ Google Scholar ]
• U.S. Department of Veterans Affairs. Report on VA Facility Specific Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans Diagnosed with Potential or Provisional PTSD. 2015 Retrieved from: http://www.publichealth.va.gov/docs/epidemiology/ptsd-report-fy2015-qtr2.pdf .
• van der Kolk BA, Najavits LM. Interview: What is PTSD really? Surprises, twists of history, and the politics of diagnosis and treatment. Journal of Clinical Psychology. 2013; 69 (5):516–22. doi: 10.1002/jclp.21992. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Weathers FW, Litz BT, Herman D, Huska J, Keane T. The PTSD Checklist: Reliability, validity and diagnostic utility. Paper presented at the Annual Meeting of the International Society of Traumatic Stress Studies; San Antonio, TX. 1993. Oct, [ Google Scholar ]
• Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD checklist for DSM-5 (PCL-5) 2013 Retrieved from National Center for PTSD website: http://www.ptsd.va.gov/professional/pages/assessments/ptsd-checklist.asp .
• Wisco BE, Marx BP, Keane TM. Screening, diagnosis, and treatment of post-traumatic stress disorder. Military Medicine. 2012; 177 (8):7–13. doi: 10.7205/MILMED-D-12-00111. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wisco BE, Marx BP, Sloan DM, Gorman KR, Kulish AL, Pineles SL. Self-distancing from trauma memories reduces physiological but not subjective emotional reactivity among veterans with posttraumatic stress disorder. Clinical Psychological Science. 2015; 3 (6):956–963. [ PMC free article ] [ PubMed ] [ Google Scholar ]

• Bibliography
• More Referencing guides Blog Automated transliteration Relevant bibliographies by topics
• Automated transliteration
• Relevant bibliographies by topics
• Referencing guides

What Is Art Therapy?

Understand arts efficacy and place in therapy..

Posted April 9, 2024 | Reviewed by Ray Parker

• What Is Therapy?
• Find a therapist near me
• 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.

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Teletherapy
• United States
• Brooklyn, NY
• Chicago, IL
• Houston, TX
• Los Angeles, CA
• New York, NY
• Portland, OR
• San Diego, CA
• San Francisco, CA
• Seattle, WA
• Washington, DC
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Therapy Center NEW
• Diagnosis Dictionary
• Types of Therapy

Understanding what emotional intelligence looks like and the steps needed to improve it could light a path to a more emotionally adept world.

• Coronavirus Disease 2019
• Affective Forecasting
• Neuroscience

• International
• Today’s Paper
• Premium Stories
• Express Shorts
• Health & Wellness
• Board Exam Results

Lost for words? Research shows art therapy brings benefits for mental health

Art therapy has supported improved mental health outcomes for people who have experienced trauma, people with eating disorders, schizophrenia and dementia, as well as children with autism..

Creating art for healing purposes dates back tens of thousands of years, to the practices of First Nations people around the world. Art therapy uses creative processes, primarily visual art such as painting, drawing or sculpture, with a view to improving physical health and emotional wellbeing.

When people face significant physical or mental ill-health, it can be challenging to put their experiences into words. Art therapists support people to explore and process overwhelming thoughts, feelings and experiences through a reflective art-making process. This is distinct from art classes, which often focus on technical aspects of the artwork, or the aesthetics of the final product.

Art therapy can be used to support treatment for a wide range of physical and mental health conditions . It has been linked to benefits including improved self-awareness, social connection and emotional regulation, while lowering levels of distress, anxiety and even pain scores.

In a study published this week in the Journal of Mental Health, we found art therapy was associated with positive outcomes for children and adolescents in a hospital-based mental health unit.

While a person’s engagement in talk therapies may sometimes be affected by the nature of their illness, verbal reflection is optional in art therapy.

Where possible, after finishing an artwork, a person can explore the meaning of their work with the art therapist, translating unspoken symbolic material into verbal reflection.

However, as the talking component is less central to the therapeutic process, art therapy is an accessible option for people who may not be able to find the words to describe their experiences.

Art therapy has supported improved mental health outcomes for people who have experienced trauma , people with eating disorders, schizophrenia and dementia, as well as children with autism.

Art therapy has also been linked to improved outcomes for people with a range of physical health conditions. These include lower levels of anxiety, depression and fatigue among people with cancer , enhanced psychological stability for patients with heart disease, and improved social connection among people who have experienced a traumatic brain injury.

Art therapy has been associated with improved mood and anxiety levels for patients in hospital, and lower pain, tiredness and depression among palliative care patients.

Mental ill-health, including among children and young people, presents a major challenge for our society. While most care takes place in the community, a small proportion of young people require care in hospital to ensure their safety.

In this environment, practices that place even greater restriction, such as seclusion or physical restraint, may be used briefly as a last resort to ensure immediate physical safety. However, these “restrictive practices” are associated with negative effects such as post-traumatic stress for patients and health professionals.

Worryingly, staff report a lack of alternatives to keep patients safe. However, the elimination of restrictive practices is a major aim of mental health services in Australia and internationally.

Our research looked at more than six years of data from a child and adolescent mental health hospital ward in Australia. We sought to determine whether there was a reduction in restrictive practices during the periods when art therapy was offered on the unit, compared to times when it was absent.

We found a clear association between the provision of art therapy and reduced frequency of seclusion, physical restraint and injection of sedatives on the unit.

We don’t know the precise reason for this. However, art therapy may have lessened levels of severe distress among patients, thereby reducing the risk they would harm themselves or others, and the likelihood of staff using restrictive practices to prevent this.

That said, hospital admission involves multiple therapeutic interventions including talk-based therapies and medications. Confirming the effect of a therapeutic intervention requires controlled clinical trials where people are randomly assigned one treatment or another.

Although ours was an observational study, randomised controlled trials support the benefits of art therapy in youth mental health services. For instance, a 2011 hospital-based study showed reduced symptoms of post-traumatic stress disorder among adolescents randomised to trauma-focussed art therapy compared to a “control” arts and crafts group.

In previous research we found art therapy was considered by adolescents in hospital-based mental health care to be the most helpful group therapy intervention compared to other talk-based therapy groups and creative activities.

In research not yet published, we’re speaking with young people to better understand their experiences of art therapy, and why it might reduce distress. One young person accessing art therapy in an acute mental health service shared: [Art therapy] is a way of sort of letting out your emotions in a way that doesn’t involve being judged […] It let me release a lot of stuff that was bottling up and stuff that I couldn’t explain through words.

The burgeoning research showing the benefits of art therapy for both physical and especially mental health highlights the value of creative and innovative approaches to treatment in health care. There are opportunities to expand art therapy services in a range of health-care settings. Doing so would enable greater access to art therapy for people with a variety of physical and mental health conditions.

• mental health

The Andhra Pradesh Board of Intermediate Education (BIEAP) will announce the results for the first and second year intermediate public exams (IPE) today at 11 am. Over 10 lakh students appeared for the exams, which were held from March 1 to April 20. The results can be checked on the official websites and students must collect their original mark sheet from their schools.

More Lifestyle

Buzzing Now

Apr 12: Latest News

• 01 The many perils of decorative lights wrapped on Mumbai’s trees
• 02 Gujarat: Nomination of candidates to begin today
• 03 MVA is a three-wheeler with mismatching spare parts: Amit Shah
• 04 Canadian brand offers Indian techie $10,000 in apology after mocking his surname
• 05 Won’t relinquish Gadchiroli guardianship: Devendra Fadnavis
• Elections 2024
• Political Pulse
• Entertainment
• Movie Review
• Newsletters
• Gold Rate Today
• Silver Rate Today
• Petrol Rate Today
• Diesel Rate Today
• Web Stories

ITP Group Thesis Show: Control + Art + Delight

Group thesis show this Friday!

Join us this Friday, April 12th at NYC Resistor for "Ctrl + Art + Delight," a group show of thesis projects from this year's graduating cohort. Projects include VR, textiles, sculptures, projections, and more.

Friday, April 12th  -  6-10pm

NYC Resistor:  87 3rd Ave, Brooklyn, NY 11217

not required to attend - feel free to show up at the door

Hope to see you there!

Related Events

• Hispanoamérica
• Work at ArchDaily
• Terms of Use
• Privacy Policy
• Cookie Policy

Dogchitecture: WE Architecture Designs a Center That Challenges Traditional Animal Shelters

• Written by Ella Comberg

Copenhagen firm WE Architecture has completed a proposal for a “Dog Center” in Moscow that challenges traditional notions of animal shelters. Nestled in the countryside, the one-story pavilion will rely on a series of courtyards divided by pergolas that disappear into the landscape. The firm notes that the courtyards, which provide enclosed outdoor space for the dogs , allow the center “to avoid the 'jail-like' fencing which is often associated with dog shelters."

WE, in collaboration with MASU Planning , hopes to create a “healthy and inspiring environment for sheltered dogs and for the different people who will visit and work at the Center.” The project accomplishes its atmospheric goals by complimenting steel pillars with wooden rafters. The rafters extend to create an exterior overhang which functions as “a sun screen in summer time and as an exterior cover/hallway on rainy days.” As visitors approach the building, the green roof , which sits atop the wooden rafters, is meant to serve as a “fifth facade” that can blend in easily with its wooded surroundings. Extensive outdoor seating space bleeds into greenery, inviting both human and animal recreation.

Design Team

Project year, photographs.

News via: WE Architecture

Project gallery

Materials and Tags

• Sustainability

世界上最受欢迎的建筑网站现已推出你的母语版本!

想浏览archdaily中国吗, you've started following your first account, did you know.

You'll now receive updates based on what you follow! Personalize your stream and start following your favorite authors, offices and users.

• Sustainability

‘A really amazing thing’: The 2024 Senior Thesis Exhibition has arrived

By Bates News — Published on April 12, 2024

A week ago, much of the artwork destined for the 2024 Senior Thesis Exhibition in the Bates College Museum of Art could be found in various studio spaces in the Olin Arts Center.

For the eight senior artists, moving their artwork from studio spaces into the museum for a professional exhibition is like having their name up in lights. A visitor approaching the double glass doors of the museum sees the names of all eight seniors displayed in big block letters on the gallery wall facing the doors.

“This moment validates what is possible. And that’s a really amazing thing.” Michel Droge

Whether an artist’s name is in lights on a Broadway marquee or on a Bates museum wall, the effect is the same, says Michel Droge, one of the Bates faculty members helping the seniors display their work in the popular annual exhibition.

“Seeing your name in big letters when you first walk in, or on a poster or postcard, really solidifies the idea that ‘I can do this. I can do this for a living.’ Sometimes people are like, ‘Oh, being an artist is too hard of a life,’ or whatever. This moment validates what is possible. And that’s a really amazing thing.”

This year’s Senior Thesis Exhibition, on display through May 25 , features seniors working in paint, mixed media, digital animation, and installation/performance. 

In moving just a few hundred feet from those studios into the museum’s galleries, the artwork, has traveled into a new dimension. It’s now in community — alive and almost begging for conversation.

“Since they moved their work into the museum, we’ve been talking about how everybody’s work is sort of bouncing off each other’s,” says Droge, a visiting assistant professor of art and visual culture. “They saw that when they were working in the studios, but you can really see the conversation happening now.”

Droge pointed to a piece of driftwood on a pedestal, which accents a presentation of oil paintings by George Peck ’24 of Philadelphia that recall a camping trip along the Down East coast. Nearby are oils by Amelia Hawkins ’24 of Sun Valley, Idaho, that capture the phenomenon of forest fires in Idaho. 

In some of Hawkins’ oils, “the way the [tree branches] are painted and drawn relates to the driftwood,” says Droge. “Then you look at the driftwood and then look at Emma’s work.” That’s Emma Upton ’24 of Amherst, N.H., who used drawn self-portraits to create mixed-media abstractions. “There’s all sorts of back and forth. And all of the work is transformative.”

Droge has supported this week’s installation of the show in the museum. The students’ advisors are Associate Professor of Art and Visual Culture Carolina Gonzalez Valencia (fall semester) and Senior Lecturer in Art and Visual Culture Elke Morris (winter semester).

— Jay Burns

Amelia Hawkins

The oil paintings of Amelia Hawkins ’24 of Sun Valley, Idaho, capture the phenomenon of forest fires in Idaho.

Fires have occurred for eons and can be part of a healthy forest ecosystem, but are now more frequent in the era of climate change. Hawkins recalls how in her childhood summer activities were canceled due to unhealthy air quality. 

“Once August rolls around, smoke from forest fires rolls in,” Hawkins says. “I remember asking my mom, ‘Where are all these ashes coming from?” 

Now such memories provide subject matter for her artwork. “I portray the various stages of forest fires. From the fiery inception to the tranquil regrowth, I’m captivated by the juxtaposition of chaos and serenity.”

The senior thesis by Yuri Kim ’24 of East Brunswick, N.J., drew from a daydream and parallels her research into the colonial origins of Easter that has roots both in Europe and Pennsylvania. It was made through digital animation and compositing.

“I found repeated violences in the colonization of pagan traditions, the colonization of children’s innocence, and the colonization of the land. I hope you consider these parallels in the viewing of this work,” Kim says.

In the work, Kim considers how  children interpret events in fascinating ways. “These interpretations are often rebutted, degraded, and dismissed by those around them. Sometimes, this is because the way children interpret things is not seen as particularly appropriate for the occasion.”

She explores “silliness, weirdness, discomfort, and inconsistencies” in her artwork.

“This work embraces these maligned apostles with its arms wide open. It sees the valuable things that lay inside children’s daydreams – eggs, waiting to be hatched,” Kim says.

Avery Mathias

Turning a common household object into art worth considering, Avery Mathias ’24 of Needham Heights, Mass., features the chicken egg in her recent oil paintings to illustrate how one can find “intrigue and beauty in the mundane.”

And as one who has fond childhood memories of making breakfast with her father on the weekends, Mathias wants to celebrate in her art how “a shared meal brings people together.”

Food and people’s relationships can inspire a range of emotions, Mathias points out. A single fried egg can evoke thoughts about health, life, routine, cooking, science, and sexuality, she says. Through the simplicity of her subject, Mathias endeavors to encourage viewers to bring their own associations.

As a biology major, she further wants to emulate the scientific perspective. So the eggs are painted larger than life to present the perspective of looking through a microscope. “To look at an object from a drastically different point of view made it infinitely more intriguing,” Mathias says.

Miguel Ángel Pacheco

Using mixed media that includes wood, cardboard, sticks, and a suitcase, Miguel Ángel Pacheco ’24 of Caracas, Venezuela, says he consciously and subconsciously changed, rearranged, and transgressed these materials to create a work that serves as a way to summarize his years at Bates.

“I stand in the missing place in between. In the place of forgetting an expression in my mother tongue, or thinking twice about how my accent sounds nowadays. Or the doorway of my grandma’s house in Los Teques, the positioning of the door, or the plant next to it. The crossroad between where I am, what I remember and what I’m trying not to forget,” Pacheco says.

The body of Pacheco’s work combines gestures and found materials in the act of “approaching memory as an active verb… like the skeleton of a house, without walls, see through.” 

“These are different scenes that I set for myself to remember or forget. Where actions occurred, materials and memories were boxed, carried and moved. They’re about movement, actions that I propose to myself, trying to understand the distance between here and there. The still remaining distance… deshilachandola,” Pacheco adds, using the Spanish word for “unraveled.”

George Peck

The oil paintings by George Peck ‘24 of Philadelphia are based on his memories of a camping trip last fall to the Cutler Coast Public Land along the Maine Down East coast.

He took no photographs during the trip. “I am just building this world from the way that I remember it,” he says, using themes of driftwood and fire as metaphors for how the vivid moments that we experience become memories that shift, change, and sometimes fade away.

“After you’ve lived a moment and have a memory in your head, it’s subject to change. It’s impermanent — kind of loose and vague.”

Peck began collecting natural objects to create sculptures last fall. Driftwood becomes a focus for its beauty and the myriad of metaphors within it, such as the growth rings in a tree, which mark time.

He says the driftwood and dead weathered trees symbolize how a moment in space and time “dies” when the moment has passed. But, like a tree, an experience doesn’t ever truly disappear, “but rather lives on as its own subject.” Both memory and driftwood, Peck says, change shape over time.

Olivia Rabin

Olivia Rabin ’24 of Montclair, N.J., wants to explore the emotions and sensations of the world around her and the experience of “being captivated by nature and the fantastical,” as illustrated in her mixed-media work using watercolor, wax, and graphite. 

She is interested in illustrative and abstract work “rooted in reality while distorting it or finding new meanings.” She recalls watching the documentary series Blue Planet , narrated by David Attenborough, as a child. This and other works by people who are inspired by nature provide material for her art. 

“While I am interested in many different things, I am always working to visualize them to help me understand how I connect them internally. In my work, I am trying to synthesize my own process into something tangible and observable. I am exploring the connections between my headspace, the act of expression, and the physical world,” Rabin says.

Joseph Vineyard

Joseph Vineyard ’24 of Danville, Vt., created a digitally drawn animation sequence that seeks to convey the overwhelming physical and emotional intensity of a panic attack.

While it’s not possible to convey the universal experience of a panic attack, Vineyard hopes to help those who have never experienced one get a sense of what it is like and to offer affirmation for those who have experienced one.

Vineyard explains it can make one feel as if “their bodies feel suffocated and out of control as if something else has taken over.”

“Art to me is a gateway into an alternate world, a place for the viewer to get lost in and find an experience that reflects or is unlike their own,” Vineyard says.

Emma Upton ’24 of Amherst, N.H. processed emotions from the Oct. 25 shootings in Lewiston through her mixed-media artwork to express “the sorrow, fear, and mourning” she witnessed in her community following the tragedy. It also is a personal expression of her experience during the lockdown.

“In the days that followed, I found myself in a state of numb disbelief within the surreal limbo of lockdown. In an attempt to process my emotions, I turned to art. I created a series of 50 continuous line self-portraits that seek to illustrate my internal state of sorrow and uncertainty. These portraits became the foundation of my work which involved abstracting the original self-portraits using a variety of techniques and mediums,” Upton says.

She found abstract forms within the interconnected lines of her self portraits to create a series of new abstract portraits that she then layered with pages from magazines that she later trimmed to reveal areas of light. Stained glass that is also used in the work, she says, creates a “transparent effect and enables the use of lighting that is a uniting element within this series,” while the use of mirrors incorporate the viewers into the artwork.

“The material is fundamentally connected to the initial experience during the lockdown, because it incorporates the same fractured mirrors that I looked into while creating the 50 original self-portraits,” Upton said. 

Related Content

Showing more content from "Art"

‘Witness, testimony, and evidence’: Bates students photograph COVID-19

May 7, 2020

Multimedia: Three days with art and artists, music and musicians in Olin Arts Center

February 13, 2020

Video: Katie Van Patten ’17 and the pursuit of directing

March 24, 2017

Recent News

Here are three recent news posts.

Picture Story: Celebrating students at Mount David Summit 2024

April 12, 2024

Bates alumni in the eclipse’s path are totally ready for their moment without the sun

April 5, 2024

What It Took: Love led Anthony Phillips ’10 to ask, ‘How can we make other people’s lives better?’

April 4, 2024

Subscribe to Bates News

You’ll receive weekly emails with the latest news from Bates.

New subscriber? Please enter your name and e-mail address to receive updates from Bates College. Select the Updates you'd like to receive. You'll receive an e-mail confirmation within an hour.

Current subscriber? If you would like to change your subscriptions, open one of your Bates Update e-mails (BatesNews, Sports Update or Events at Bates) and click on "Change Subscriptions."

Skip to Content

• Spring 2024 Master of Fine Arts Thesis Exhibition: Round 2

On view April 27–May 11 .

Artists in this round:

• Aunna Moriarty
• Cody Norton
• Natalie Thedford

Join us in celebrating the opening of this exhibition on Friday, April 26 from 4-6pm at the CU Art Museum! Light refreshments will be served and all are welcome to attend this free reception.

• Spring 2024 Master of Fine Arts Thesis Exhibition: Round 1
• Currently on view
• Artist-In-Residence Program
• Course-Developed Exhibitions
• Traveling Exhibitions

Subscribe to our newsletter! Follow us on social media! @cuArtMuseum   |  /cuArtMuseum   |  https://bit.ly/CUAMyoutube