Art therapy for mental health

Some individuals with mental health issues have trouble discussing or expressing their problems verbally. This is especially true with potentially severe mental health conditions such as schizophrenia. Since psychotherapy requires verbal interaction between therapist and patient, patients who cannot express themselves verbally may not be able to benefit from psychotherapeutic interventions. One means to overcome this barrier is through art therapy. Patients are provided with art supplies and encouraged to express themselves by drawing or painting.

Theoretical framework for art therapy

Art therapy has been used in various forms for over a half-century. Proponents of the psychotherapeutic approach claim that it helps patients in at least three ways.

• First, patients derive a therapeutic benefit from expressing themselves through art. In other words, performing the art itself could be part of the healing process. 
• Second, patients are able to express powerful emotions or experiences that may be too difficult or traumatic to put into words. Indeed, this may be the most important benefit to art therapy.
• Third, completed artwork discussed by the therapist helps to create a rapport or therapeutic alliance.
• A fourth benefit has been described for those participating in group art therapy. Patients are encouraged to compare and discuss their artwork with each other and with the group facilitator/therapist.

Art therapy does not require artistic talent

One common misconception about art therapy is that either the patient or the therapist or both must have some level of artistic ability in order to participate in art therapy. This is not true. The art therapist does not assess the artistic value of the patient's artwork, nor is the art used to formulate a diagnosis. The goals of art therapy are more modest. David Edwards states that the overall aim of art therapy is for its practitioners to “enable a client to effect change and growth on a personal level through the use of art materials in a safe and facilitating environment.”

Scientific support for art therapy

Art therapy is widely practiced in hospital settings and some clinical environments, and is even included in Great Britain's National Institute for Clinical Excellence Core Interventions in the Treatment and Management of Schizophrenia in Adults. Furthermore, a number of case reports seem to support the use of art therapy in mental health patients. Despite this, there are very few clinical trials specifically investigating the effectiveness of art therapy. 

The MATISSE study

The largest and perhaps the most definitive study published on the subject to date was the MATISSE study. In the MATISSE study, Crawford and co-authors randomly assigned patients with schizophrenia to one of three study arms:

• art therapy plus standard care
• attention control activity group plus standard care
• standard care alone

Outcomes included scores on the Global Assessment of Functioning scale and the Positive and Negative Syndrome Scale. Despite continuing art therapy treatment for up to two years, there were no significant differences between any of the three arms. The authors concluded that group art therapy did not improve “global functioning, mental health, or other health-related outcomes” in schizophrenia. 

While Crawford and colleagues showed that group art therapy did not have any observable effects on the entire population of over 400 participants, other researchers set out to determine if certain subsets of people with schizophrenia may benefit from the approach. Leurent and peers analyse the data collected from the MATISSE study looking for certain factors that would identify patients who could be helped by our therapy. 

Despite an exhaustive search, the group determined that the presence of negative symptoms, patient preference for treatment, gender, times since receiving a diagnosis of schizophrenia, adherence to medication, and engagement and acceptance of the treatment did not correlate with treatment effect. Even separating those who enjoy those who enjoy creative activities from those who do not did not seem to affect the outcome. Moreover, people who were more or less comfortable discussing their emotions or thoughts had similar responses to art therapy.

Taken together, this suggests that art therapy may not be beneficial for individuals with schizophrenia nor are there easily identifiable factors or traits that would identify individuals who could be helped by art therapy. Unfortunately for art therapists, the MATISSE study strikes a blow at the heart of their craft. On the other hand, some individuals may benefit from art therapy as evidenced by numerous case reports.

The problem is that it is currently impossible to determine who will benefit from art therapy and who will not. In essence, you do not know the effect of art therapy until you try. It is also important to note that the MATISSE study was performed on patients with schizophrenia, which is a serious mental health disease.

Successfully applied Art Therapy

Many art therapists have successfully applied this psychotherapeutic technique to mental health conditions such as:

• attention deficit hyperactivity disorder
• autism and Asperger's disorders
• substance dependency and abuse
• posttraumatic stress disorder 

Art therapy may be particularly helpful in providing treatment for young children who may lack the ability to verbalise their thoughts and feelings.

References

1. Crawford MJ, Killaspy H, Kalaitzaki E, et al. The MATISSE study: a randomised trial of group art therapy for people with schizophrenia. BMC Psychiatry. 2010;10:65. doi:10.1186/1471-244x-10-65
2. Gilroy A, Lee C. Art and music: therapy and research. Routledge; 1995.
3. Montag C, Haase L, Seidel D, et al. A pilot RCT of psychodynamic group art therapy for patients in acute psychotic episodes: feasibility, impact on symptoms and mentalising capacity. PLoS One. 2014;9(11):e112348. doi:10.1371/journal.pone.0112348
4. Ruddy R, Milnes D. Art therapy for schizophrenia or schizophrenia-like illnesses. Cochrane Database Syst Rev. 2005(4):CD003728. doi:10.1002/14651858.CD003728.pub2
5. Edwards D. Art therapy. Sage; 2014.
6. Bhugra D. Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. The British Psychological Society & The Royal College of Psychiatrists, United Kingdom. 2010;485.
7. American Art Therapy Association Research Committee. Art Therapy Outcome Bibliography. 2014; http://www.arttherapy.org/upload/outcomebibliographyresearchcmte.pdf.
8. Crawford MJ, Killaspy H, Barnes TR, et al. Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomised trial. BMJ. 2012;344:e846. doi:10.1136/bmj.e846
9. Leurent B, Killaspy H, Osborn DP, et al. Moderating factors for the effectiveness of group art therapy for schizophrenia: secondary analysis of data from the MATISSE randomised controlled trial. Soc Psychiatry Psychiatr Epidemiol. Nov 2014;49(11):1703-1710. doi:10.1007/s00127-014-0876-2
10. Waller D. Art therapy for children: how it leads to change. Clin Child Psychol Psychiatry. Apr 2006;11(2):271-282.