Art Therapy: A Complementary Treatment for Mental Disorders

Abstract

Art therapy, as a non-pharmacological medical complementary and alternative therapy, has been used as one of medical interventions with good clinical effects on mental disorders. However, systematically reviewed in detail in clinical situations is lacking. Here, we searched on PubMed for art therapy in an attempt to explore its theoretical basis, clinical applications, and future perspectives to summary its global pictures. Since drawings and paintings have been historically recognized as a useful part of therapeutic processes in art therapy, we focused on studies of art therapy which mainly includes painting and drawing as media. As a result, a total of 413 literature were identified. After carefully reading full articles, we found that art therapy has been gradually and successfully used for patients with mental disorders with positive outcomes, mainly reducing suffering from mental symptoms. These disorders mainly include depression disorders and anxiety, cognitive impairment and dementias, Alzheimer’s disease, schizophrenia, and autism. These findings suggest that art therapy can not only be served as an useful therapeutic method to assist patients to open up and share their feelings, views, and experiences, but also as an auxiliary treatment for diagnosing diseases to help medical specialists obtain complementary information different from conventional tests. We humbly believe that art therapy has great potential in clinical applications on mental disorders to be further explored.

Full text

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REVIEW
published: 12 August 2021
doi: 10.3389/fpsyg.2021.686005
Edited by:
Stephen Clift,
Canterbury Christ Church University,
United Kingdom
Reviewed by:
Rachel Brandoff,
Thomas Jefferson University,
United States
Juliet L. King,
George Washington University,
United States
*Correspondence:
Jinping Xu
jp.xu@siat.ac.cn
Specialty section:
This article was submitted to
Health Psychology,
a section of the journal
Frontiers in Psychology
Received: 26 March 2021
Accepted: 28 July 2021
Published: 12 August 2021
Citation:
Hu J, Zhang J, Hu L, Yu H and
Xu J (2021) Art Therapy:
A Complementary Treatment
for Mental Disorders.
Front. Psychol. 12:686005.
doi: 10.3389/fpsyg.2021.686005
Art Therapy: A Complementary
Treatment for Mental Disorders
Jingxuan Hu1, Jinhuan Zhang2,3 , Liyu Hu2, Haibo Yu2and Jinping Xu3*
1College of Creative Design, Shenzhen Technology University, Shenzhen, China, 2The Fourth Clinical Medical College
of Guangzhou University of Chinese Medicine, Shenzhen, China, 3Institute of Biomedical and Health Engineering, Shenzhen
Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
Art therapy, as a non-pharmacological medical complementary and alternative therapy,
has been used as one of medical interventions with good clinical effects on mental
disorders. However, systematically reviewed in detail in clinical situations is lacking.
Here, we searched on PubMed for art therapy in an attempt to explore its theoretical
basis, clinical applications, and future perspectives to summary its global pictures.
Since drawings and paintings have been historically recognized as a useful part of
therapeutic processes in art therapy, we focused on studies of art therapy which mainly
includes painting and drawing as media. As a result, a total of 413 literature were
identified. After carefully reading full articles, we found that art therapy has been gradually
and successfully used for patients with mental disorders with positive outcomes,
mainly reducing suffering from mental symptoms. These disorders mainly include
depression disorders and anxiety, cognitive impairment and dementias, Alzheimer’s
disease, schizophrenia, and autism. These findings suggest that art therapy can not
only be served as an useful therapeutic method to assist patients to open up and share
their feelings, views, and experiences, but also as an auxiliary treatment for diagnosing
diseases to help medical specialists obtain complementary information different from
conventional tests. We humbly believe that art therapy has great potential in clinical
applications on mental disorders to be further explored.
Keywords: painting, art therapy, mental disorders, clinical applications, medical interventions
INTRODUCTION
Mental disorders constitute a huge social and economic burden for health care systems worldwide
(Zschucke et al., 2013;Kenbubpha et al., 2018). In China, the lifetime prevalence of mental
disorders was 24.20%, and 1-month prevalence of mental disorders was 14.27% (Xu et al., 2017).
The situation is more severely in other countries, especially for developing ones. Given the large
numbers of people in need and the humanitarian imperative to reduce suffering, there is an
urgent need to implement scalable mental health interventions to address this burden. While
pharmacological treatment is the first choice for mental disorders to alleviate the major symptoms,
many antipsychotics contribute to poor quality of life and debilitating adverse effects. Therefore,
clinicians have turned toward to complementary treatments, such as art therapy in addressing the
health needs of patients more than half a century ago.
Art therapy, is defined by the British Association of Art Therapists as: “a form of psychotherapy
that uses art media as its primary mode of expression and communication. Clients referred to
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art therapists are not required to have experience or skills in the
arts. The art therapist’s primary concern is not to make an esthetic
or diagnostic assessment of the client’s image. The overall goal
of its practitioners is to enable clients to change and grow on a
personal level through the use of artistic materials in a safe and
convenient environment” (British Association of Art Therapists,
2015), whereas as: “an integrative mental health and human
services profession that enriches the lives of individuals, families,
and communities through active art-making, creative process,
applied psychological theory, and human experience within
a psycho-therapeutic relationship” (American Art Therapy
Association, 2018) according to the American Art Association.
It has gradually become a well-known form of spiritual support
and complementary therapy (Faller and Schmidt, 2004;Nainis
et al., 2006). During the therapy, art therapists can utilize many
different art materials as media (i.e., visual art, painting, drawing,
music, dance, drama, and writing) (Deshmukh et al., 2018;
Chiang et al., 2019). Among them, drawings and paintings have
been historically recognized as the most useful part of therapeutic
processes within psychiatric and psychological specialties (British
Association of Art Therapists, 2015). Moreover, many other art
forms gradually fall under the prevue of their own professions
(e.g., music therapy, dance/movement therapy, and drama
therapy) (Deshmukh et al., 2018). Thus, we excluded these
studies and only focused on studies of art therapy which
mainly includes painting and drawing as media. Specifically,
it focuses on capturing psychodynamic processes by means
of “inner pictures,” which become visible by the creative
process (Steinbauer et al., 1999). These pictures reflect the
psychopathology of different psychiatric disorders and even their
corresponding therapeutic process based on specific rules and
criterion (Steinbauer and Taucher, 2001). It has been gradually
recognized and used as an alternative treatment for therapeutic
processes within psychiatric and psychological specialties, as
well as medical and neurology-based scientific audiences
(Burton, 2009).
The development of art therapy comes partly from the
artistic expression of the belief in unspoken things, and
partly from the clinical work of art therapists in the medical
setting with various groups of patients (Malchiodi, 2013).
It is defined as the application of artistic expressions and
images to individuals who are physically ill, undergoing
invasive medical procedures, such as surgery or chemotherapy
for clinical usage (Bar-Sela et al., 2007;Forzoni et al.,
2010;Liebmann and Weston, 2015). The American Art
Therapy Association describes its main functions as improving
cognitive and sensorimotor functions, fostering self-esteem
and self-awareness, cultivating emotional resilience, promoting
insight, enhancing social skills, reducing and resolving conflicts
and distress, and promoting societal and ecological changes
(American Art Therapy Association, 2018).
However, despite the above advantages, published
systematically review on this topic is lacking. Therefore,
this review aims to explore its clinical applications and future
perspectives to summary its global pictures, so as to provide more
clinical treatment options and research directions for therapists
and researchers.
PUBLICATIONS OF ART THERAPY
The literatures about “art therapy” published from January 2006
to December 2020 were searched in the PubMed database. The
following topics were used: Title/Abstract = “art therapy,” Indexes
Timespan = 2006–2020.
A total of 652 records were found. Then, we manually screened
out the literatures that contained the word “art” but was not
relevant with the subject of this study, such as state of the art
therapy, antiretroviral therapy (ART), and assisted reproductive
technology (ART). Finally, 479 records about art therapy were
identified. Since we aimed to focus on art therapy included
painting and drawing as major media, we screened out literatures
deeper, and identified 413 (84%) literatures involved in painting
and drawing (Figure 1).
As we can see, the number of literature about art therapy is
increasing slowly in the last 15 years, reaching a peak in 2020.
This indicates that more effort was made on this topic in recent
years (Figure 1).
OVERVIEW OF ART THERAPY
As defined by the British Association of Art Therapists, art
therapy is a form of psychotherapy that uses art media as its
primary mode of communication. Based on above literature,
several highlights need to be summarized. (1) The main media
of art therapy include painting, drawing, music, drama, dance,
drama, and writing (Chiang et al., 2019). (2) Main contents
of painting and drawing include blind drawing, spiral drawing,
drawing moods and self-portraits (Legrand et al., 2017;Abbing
et al., 2018;Papangelo et al., 2020). (3) Art therapy is mainly
used for cancer, depression and anxiety, autism, dementia and
cognitive impairment, as these patients are reluctant to express
themselves in words (Attard and Larkin, 2016;Deshmukh et al.,
2018;Chiang et al., 2019). It plays an important role in facilitating
engagement when direct verbal interaction becomes difficult, and
provides a safe and indirect way to connect oneself with others
(Papangelo et al., 2020). Moreover, we found that art therapy
has been gradually and successfully used for patients with mental
disorders with positive outcomes, mainly reducing suffering from
mental symptoms. These findings suggest that art therapy can not
only be served as an useful therapeutic method to assist patients
to open up and share their feelings, views, and experiences, but
also as an auxiliary treatment for diagnosing diseases to help
medical specialists obtain complementary information different
from conventional tests.
ART THERAPY FOR MENTAL
DISORDERS
Based on the 413 searched literatures, we further limited them
to mental disorders using the following key words, respectively:
Depression OR anxiety OR Cognitive impairment OR dementia
OR Alzheimer’s disease OR Autism OR Schizophrenia OR mental
disorder. As a result, a total of 23 studies (5%) (Table 1) were
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FIGURE 1 | Number of publications about art therapy.
included and classified after reading the abstract and the full
text carefully. These studies include 9 articles on depression
and anxiety, 4 articles on cognitive impairment and dementia, 3
articles on Alzheimer’s disease, 3 articles on autism, and 4 articles
on schizophrenia. In addition to the English literature, in fact,
some Chinese literatures also described the application of art
therapy in mental diseases, which were not listed but referred to
in the following specific literatures.
Depression Disorders and Anxiety
Depression and anxiety disorders are highly prevalent,
affecting individuals, their families and the individual’s role in
society (Birgitta et al., 2018). Depression is a disabling and costly
condition associated with a significant reduction in quality of
life, medical comorbidities and mortality (Demyttenaere et al.,
2004;Whiteford et al., 2013;Cuijpers et al., 2014). Anxiety is
associated with lower quality of life and negative effects on
psychosocial functioning (Cramer et al., 2005). Medication is
the most commonly used effective way to relieve symptoms
of depression and anxiety. However, nonadherence are crucial
shortcomings in using antidepressant to treat depression and
anxiety (van Geffen et al., 2007;Nielsen et al., 2019).
In recent years, many studies have shown that art therapy
plays a significant role in alleviating depression symptoms and
anxiety. Gussak (2007) performed an observational survey about
populations in prison of northern Florida and identified that
art therapy significantly reduces depressive symptoms. Similarly,
a randomized, controlled, and single-blind study about art
therapy for depression with the elderly showed that painting
as an adjuvant treatment for depression can reduce depressive
and anxiety symptoms (Ciasca et al., 2018). In addition, art
therapy is also widely used among students, and several studies
(Runde, 2008;Zhenhai and Yunhua, 2011) have shown that
art therapy also significantly reduces depressive symptoms in
students. For example, Wang et al. (2011) conducted group
painting therapy on 30 patients with depression for 3 months,
and found that painting therapy could promote their social
function recovery, improve their social adaptability and quality of
life. Another randomized clinical trial also showed that it could
decrease mean anxiety scores in the 3–12 year painting group
(Forouzandeh et al., 2020).
Studies have shown that distress, including anxiety and
depression, is related to poorer health-related quality of life and
satisfaction to medical services (Hamer et al., 2009). Painting can
be employed to express patients’ anxiety and fear, vent negative
emotions by applying projection, thereby significantly improve
the mood and reduce symptoms of depression and anxiety of
cancer patients. A number of studies (Bar-Sela et al., 2007;Thyme
et al., 2009;Lin et al., 2012;Abdulah and Abdulla, 2018) showed
that art therapy for cancer patients could enhance the vitality of
patients and participation in social activities, significantly reduce
depression, anxiety, and reduce stressful feelings. Importantly,
even in the follow-up period, art therapy still has a lasting effect
on cancer patients (Thyme et al., 2009). Interestingly, art therapy
based on famous painting appreciation could also significantly
reduce anxiety and depression associated with cancer (Lee et al.,
2017). Among cancer patients treated in outpatient health care,
art therapy also plays an important role in alleviating their
physical symptoms and mental health (Götze et al., 2009).
Therefore, art therapy as an auxiliary treatment of cancer is of
great value in improving quality of life.
Overall, art painting therapy permits patients to express
themselves in a manner acceptable to the inside and outside
culture, thereby diminishing depressed and anxiety symptoms.
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TABLE 1 | Studies of art therapy in mental diseases.
Type of diseases/
author and year
Country Number
(painting)
Treatment Subjects Main results
Depression and anxiety
Bar-Sela et al., 2007 Israel 19/41 once-weekly, 4w/2w Cancer patients with
depression and anxiety
In the intervention group, the median Hospital Anxiety and Depression
Scale score for depression was 9 at the beginning and 7 after the fourth
appointment.
Gussak, 2007 Unite States
American
48 4-week period, two group
sessions per week
Depression The results reflected a significant decrease in depressive symptoms in
those inmates who participated in the program.
Geue et al., 2013 Germany 54 22 sessions Cancer patients with
psychological distress
Anxiety scores decreased in a pre–post comparison.
Crone et al., 2013 United Kingdom 202 10-week intervention Patients with anxiety,
depression, or stress
There was a significant improvement in well-being.
Montag et al., 2014 Germany 58 12 twice-weekly sessions Acute psychotic episodes with
depression
Patients in the ART group showed significant improvement in levels of
emotional awareness.
Armstrong and
Howatson, 2015
United Kingdom 6 mothers/
8 infants
12 consecutive weeks Postpartum depression The responses of the questionnaires were more positive after the
intervention, and 8 of the 10 mothers showed an improvement in
postpartum depression and in the relationship with their children.
Lefèvre et al., 2016 France 28 63 art therapy sessions,
1 h/session
Cancer patients with
depression and anxiety
There was a significant reduction in all of the symptoms: pain, anxiety,
evil, fatigue, sadness, and depression.
Ciasca et al., 2018 Brazil 31/25 20 weekly art therapy sessions
(90 min/session)
Depression Art therapy as an adjunctive treatment for MDD in the elderly can
improve depressive and anxiety symptoms.
Forouzandeh et al.,
2020
Iran 55 NA Anxiety Nurses should collaborate with medical teams to routinely use
non-pharmacological methods such as the painting and the interactive
games to alleviate preoperative anxiety in children.
Cognitive impairment, and dementia
Rusted et al., 2016 United Kingdom 45 1 h each week for 40
successive weeks
Dementia Art therapy is beneficial and appropriate interventions for older people
with dementia.
Pike, 2013 Unite States
American
91 10-week art therapy Cognitive impairment Art therapy treatment was associated with significantly improved
cognitive performance.
Heymann et al., 2018 Germany 32 analysis of tree drawings on a
digitizing tablet
Mild cognitive impairment (MCI) MCI group shows a higher recognition rate.
Yu et al., 2021 Singapore 22 weekly 45-min sessions were
carried out across 3 months.
MCI Significant gains in immediate memory and working memory span were
observed.
Alzheimer’s disease
Witkoski and Chaves,
2007
Brazil 11 31 months Alzheimer’s disease The selection of drawing or modeling showed significant association
with severity of cognitive deficit.
Mimica and Kaliniæ,
2011
Croatia 1 case report not available Alzheimer’s disease The art therapy was shown to be an excellent add-on
non-pharmacological intervention, beneficial for reducing stress-related
behaviors.
Hattori et al., 2011 Japan 39 once weekly for 12 weeks Alzheimer’s disease Significant improvement in the quality of life was observed in the art
therapy
Autism
Low et al., 2009 New Zealand 27 four 0.5 to 1 h sessions that
were approximately 1 week
apart
Autism There is an important relationship between generativity and imagination.
(Continued)
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TABLE 1 | Continued
Type of diseases/
author and year
Country Number
(painting)
Treatment Subjects Main results
Ten and Muller, 2018 Canada 22 1.5-h session Autism There are changes in the type of cognitive processes involved in
imagination and children with autism employ a unique cognitive strategy in
imaginative drawing.
Jalambadani, 2020 Iran 48 12 sessions Autism Autistic children showed more adaptive behaviors and emotions.
Schizophrenia
Richardson et al., 2009 United Kingdom 43 12 weekly sessions of one and
a half hours
Schizophrenia Art therapy produced a statistically significant positive effect on negative
symptoms.
Teglbjaerg, 2011 Denmark 5 2 h a week Schizophrenia The positive effect of art therapy is mainly due to a strengthening of the
Schizophrenia’ minimal sense of self.
Mannheim et al., 2013 Serbian 2 once a week, two months Schizophrenia The patient’s drawings show clinical improvement from the reduction of
depressive themes and an increase in the frequency of human figure
drawings and self-confidence.
Tong et al., 2020 China 104 90 min for a total of 30 times in
15 weeks
Schizophrenia Group art therapy can improve self-efficacy and social function, reducing
social and life function problems, and promote the recovery of individuals
diagnosed with schizophrenia.
Cognitive Impairment, and Dementia
Dementia, a progressive clinical syndrome, is characterized
by widespread cognitive impairment in memory, thinking,
behavior, emotion and performance, leading to worse daily
living (Deshmukh et al., 2018). According to the Alzheimer’s
Disease International 2015, there is 46.8 million people suffered
from dementia, and numbers almost doubling every 20 years,
rising to 131.5 million by 2050. Although art therapy has
been used as an alternative treatment for the dementia for
long time, the positive effects of painting therapy on cognitive
function remain largely unknown. One intervention assigned
older adults patients with dementia to a group-based art therapy
(including painting) observed significant improvements in the
clock drawing test (Pike, 2013), whereas two other randomized
controlled trials (Hattori et al., 2011;Rusted et al., 2016) on
patients with dementia have failed to obtain significant cognitive
improvement in the painting group. Moreover, a cochrane
systematic review (Deshmukh et al., 2018) included two clinical
studies of art therapy for dementia revealed that there is no
sufficient evidence about the efficacy of art therapy for dementia.
This may be because patients with severely cognitive impairment,
who was unable to accurately remember or assess their own
behavior or mental state, might lose the ability to enjoy the
benefits of art therapy.
In summary, we should intervene earlier in patients with mild
cognitive impairment, an intermediate stage between normal
aging and dementia, in order to prevent further transformation
into dementia. To date, mild cognitive impairment is drawing
much attention to the importance of painting intervening at
this stage in order to alter the course of subsequent cognitive
decline as soon as possible (Petersen et al., 2014). Recently, a
randomized controlled trial (Yu et al., 2021) showed significant
relationship between improvement immediate memory/working
memory span and increased cortical thickness in right middle
frontal gyrus in the painting art group. With the long-term
cognitive stimulation and engagement from multiple sessions of
painting therapy, it is likely that painting therapy could lead to
enhanced cognitive functioning for these patients.
Alzheimer’s Disease
Alzheimer’s disease (AD) is a sub-type of dementia, which is
usually associated with chronic pain. Previous studies suggested
that art therapy could be used as a complementary treatment
to relief pain for these patients since medication might induce
severely side effects. In a multicenter randomized controlled
trial, 28 mild AD patients showed significant pain reduction,
reduced anxiety, improved quality of life, improved digit span,
and inhibitory processes, as well as reduced depression symptoms
after 12-week painting (Pongan et al., 2017;Alvarenga et al.,
2018). Further study also suggested that individual therapy rather
than group therapy could be more optimal since neuroticism can
decrease efficacy of painting intervention on pain in patients with
mild AD. In addition to release chronic pain, art therapy has been
reported to show positive effects on cognitive and psychological
symptoms in patients with mild AD. For example, a controlled
study revealed significant improvement in the apathy scale and
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quality of life after 12 weeks of painting treatment mainly
including color abstract patterns with pastel crayons or water-
based paint (Hattori et al., 2011). Another study also revealed
that AD patients showed improvement in facial expression,
discourse content and mood after 3-weeks painting intervention
(Narme et al., 2012).
Schizophrenia
Schizophrenia is a complex functional psychotic mental illness
that affects about 1% of the population at some point in their
life (Kolliakou et al., 2011). Not only do sufferers experience
“positive” symptoms such as hallucinations, delusions, but
also experience negative symptoms such as varying degrees
of anhedonia and asociality, impaired working memory and
attention, poverty of speech, and lack of motivation (Andreasen
and Olsen, 1982). Many patients with schizophrenia remain
symptomatic despite pharmacotherapy, and even attempts to
suicide with a rate of 10 to 50% (De Sousa et al., 2020).
For these patients, art therapy is highly recommended to
process emotional, cognitive and psychotic experiences to release
symptoms. Indeed, many forms of art therapy have been
successfully used in schizophrenia, whether and how painting
may interfere with psychopathology to release symptoms remains
largely unknown.
A recent review including 20 studies overall was performed to
summary findings, however, concluded that it is not clear whether
art therapy leads to clinical improvement in schizophrenia with
low (Ruiz et al., 2017). Anyway, many randomized clinical
trials reported positive outcomes. For example, Richardson
et al. (2007) conducted painting therapy for six months in
patients with chronic schizophrenia and found that art therapy
had a positive effect on negative symptoms. Teglbjaerg (2011)
examined experience of each patient using interviews and written
evaluations before and after painting therapy and at a 1-year
follow-up and found that group painting therapy in patients with
schizophrenia could not only reduce psychotic symptoms, but
also boost self-esteem and improve social function.
What’s more, the characteristics of the painting can also be
used to judge the health condition in patients with schizophrenia.
For example, Hongxia et al. (2013) explored the correlation
between psychological health condition and characteristics of
House-Tree-Person tests for patients with schizophrenia, and
showed that the detail characteristic of the test results can be
used to judge the patient’s anxiety, depression, and obsessive-
compulsive symptoms.
Most importantly, several other studies showed that drug
plus painting therapy significantly enhanced patient compliance
and self-cognition than drug therapy alone in patients with
schizophrenia (Hongyan and JinJie, 2010;Min, 2010).
Autism
Autism spectrum disorder (ASD) is a heterogeneous
neurodevelopmental syndrome with no unified pathological or
neurobiological etiology, which is characterized by difficulties in
social interaction, communication problems, and a tendency to
engage in repetitive behaviors (Geschwind and Levitt, 2007).
Art therapy is a form of expression that opens the door to
communication without verbal interaction. It provides therapists
with the opportunity to interact one-on-one with individuals
with autism, and make broad connections in a more comfortable
and effective way (Babaei et al., 2020). Emery (2004) did a
case study about a 6-year-old boy diagnosed with autism and
found that art therapy is of great value to the development,
growth and communication skills of the boy. Recently, one study
(Jalambadani, 2020) using 40 children with ASD participating in
painting therapy showed that painting therapy had a significant
improvement in the social interactions, adaptive behaviors and
emotions. Therefore, encouraging children with ASD to express
their experience by using nonverbal expressions is crucial to their
development. Evans and Dubowski (2001) believed that creating
images on paper could help children express their internal
images, thereby enhance their imagination and abstract thinking.
Painting can also help autistic children express and vent negative
emotions and thereby bring positive emotional experience and
promote their self-consciousness (Martin, 2009). According to
two studies (Wen and Zhaoming, 2009;Jianhua and Xiaolu,
2013) in China, Art therapy could also improve the language and
communication skills, cognitive and behavioral performance of
children with ASD.
Moreover, art therapy could be used to investigate the
relationship between cognitive processes and imagination in
children with ASD. One study (Wen and Zhaoming, 2009;
Jianhua and Xiaolu, 2013) suggested that children with ASD
apply a unique cognitive strategy in imaginative drawing.
Another study (Low et al., 2009) examined the cognitive
underpinnings of spontaneous imagination in children with ASD
and showed that ASD group lacks imagination, generative ability,
planning ability and good consistency in their drawings. In
addition, several studies (Leevers and Harris, 1998;Craig and
Baron-Cohen, 1999;Craig et al., 2001) have been performed
to investigate imagination and creativity of autism via drawing
tasks, and showed impairments of autism in imagination and
creativity via drawing tasks.
In a word, art therapy plays a significant role in children
with ASD, not only as a method of treatment, but also in
understanding and investigating patients’ problems.
Other Applications
In addition to the above mentioned diseases, art therapy
has also been adopted in other applications. Dysarthia is a
common sequela of cerebral palsy (CP), which directly affects
children’s language intelligibility and psycho-social adjustment.
Speech therapy does not always help CP children to speak
more intelligibly. Interestingly, the art therapy can significantly
improve the language intelligibility and their social skills for
children with CP (Wilk et al., 2010).
In brief, these studies suggest that art therapy is meaningful
and accepted by both patients and therapists. Most often, art
therapy could strengthen patient’s emotional expression, self-
esteem, and self-awareness. However, our findings are based on
relatively small samples and few good-quality qualitative studies,
and require cautious interpretation.
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THE APPLICATION PROSPECTS OF ART
THERAPY
With the development of modern medical technology, life
expectancy is also increasing. At the same time, it also
brings some side effects and psychological problems during the
treatment process, especially for patients with mental illness.
Therefore, there is an increasing demand for finding appropriate
complementary therapies to improve life quality of patients
and psychological health. Art therapy is primarily offered as
individual art therapy, in this review, we found that art therapy
was most commonly used for depression and anxiety.
Based on the above findings, art therapy, as a non-verbal
psychotherapy method, not only serves as an auxiliary tool for
diagnosing diseases, which helps medical specialists obtain much
information that is difficult to gain from conventional tests,
judge the severity and progression of diseases, and understand
patients’ psychological state from painting characteristics, but
also is an useful therapeutic method, which helps patients
open up and share their feelings, views, and experiences.
Additionally, the implementation of art therapy is not limited
by age, language, diseases or environment, and is easy to be
accepted by patients.
Art therapy in hospitals and clinical settings could be
very helpful to aid treatment and therapy, and to enhance
communications between patients and on-site medical staffs in
a non-verbal way. Moreover, art therapy could be more effective
when combined with other forms of therapy such as music, dance
and other sensory stimuli.
The medical mechanism underlying art therapy using painting
as the medium for intervention remains largely unclear in the
literature (Salmon, 1993;Broadbent et al., 2004;Guillemin, 2004),
and the evidence for effectiveness is insufficient (Mirabella, 2015).
Although a number of studies have shown that art therapy could
improve the quality of life and mental health of patients, standard
and rigorous clinical trials with large samples are still lacking.
Moreover, the long-term effect is yet to be assessed due to the lack
of follow-up assessment of art therapy.
In some cases, art therapy using painting as the medium
may be difficult to be implemented in hospitals, due to medical
and health regulations (may be partly due to potential of
messes, lack of sink and cleaning space for proper disposal of
paints, storage of paints, and toxins of allergens in the paint),
insufficient space for the artwork to dry without getting in the
way or getting damaged, and negative medical settings and family
environments. Nevertheless, these difficulties can be overcome
due to great benefits of the art therapy. We thus humbly believe
that art therapy has great potential for mental disorders.
In the future, art therapy may be more thoroughly investigated
in the following directions. First, more high-quality clinical
trials should be carried out to gain more reliable and rigorous
evidence. Second, the evaluation methods for the effectiveness of
art therapy need to be as diverse as possible. It is necessary for
the investigation to include not only subjective scale evaluations,
but also objective means such as brain imaging and hematological
examinations to be more convincing. Third, it will be helpful to
specify the details of the art therapy and patients for objective
comparisons, including types of diseases, painting methods,
required qualifications of the therapist to perform the art therapy,
and the theoretical basis and mechanism of the therapy. This
practice should be continuously promoted in both hospitals and
communities. Fourth, guidelines about art therapy should be
gradually formed on the basis of accumulated evidence. Finally,
mechanism of art therapy should be further investigated in
a variety of ways, such as at the neurological, cellular, and
molecular levels.
AUTHOR CONTRIBUTIONS
JH designed the whole study, analyzed the data, and wrote the
manuscript. JZ searched for selected the studies. LH participated
in the interpretation of data. HY and JX offered good suggestions.
All authors read and approved the final manuscript.
FUNDING
This study was financially supported by the National Key R&D
Program of China (2019YFC1712200), International standards
research on clinical research and service of Acupuncture-
Moxibustion (2019YFC1712205), the National Natural Science
Foundation of China (62006220), and Shenzhen Science and
Technology Research Program (No. JCYJ20200109114816594).
REFERENCES
Abbing, A., Ponstein, A., van Hooren, S., de Sonneville, L., Swaab, H., and Baars, E.
(2018). The effectiveness of art therapy for anxiety in adults: a systematic review
of randomised and non-randomised controlled trials. PLoS One 13:e208716.
doi: 10.1371/journal.pone.0208716
Abdulah, D. M., and Abdulla, B. (2018). Effectiveness of group art
therapy on quality of life in paediatric patients with cancer: a
randomized controlled trial. Complement. Ther. Med. 41, 180–185.
doi: 10.1016/j.ctim.2018.09.020
Alvarenga, W. A., Leite, A., Oliveira, M. S., Nascimento, L. C., Silva-Rodrigues,
F. M., Nunes, M. D. R., et al. (2018). The effect of music on the spirituality
of patients: a systematic review. J. Holist. Nurs. 36, 192–204. doi: 10.1177/
0898010117710855
American Art Therapy Association (2018). Definition of Art. Available online at:
https://arttherapy.org/about-art-therapy/
Andreasen, N. C., and Olsen, S. (1982). Negative v positive
schizophrenia. Definition and validation. Arch. Gen.
Psychiatry 39, 789–794. doi: 10.1001/archpsyc.1982.042900700
25006
Armstrong, V. G., and Howatson, R. (2015). Parent-infant art
psychotherapy: a creative dyadic approach to early intervention.
Infant Ment. Health J. 36, 213–222. doi: 10.1002/imhj.
21504
Attard, A., and Larkin, M. (2016). Art therapy for people with psychosis: a narrative
review of the literature. Lancet Psychiatry 3, 1067–1078. doi: 10.1016/s2215-
0366(16)30146-8
Babaei, S., Fatahi, B. S., Fakhri, M., Shahsavari, S., Parviz, A., Karbasfrushan,
A., et al. (2020). Painting therapy versus anxiolytic premedication to reduce
preoperative anxiety levels in children undergoing tonsillectomy: a randomized
controlled trial. Indian J. Pediatr. 88, 190–191. doi: 10.1007/s12098-020-03
430-9
Frontiers in Psychology | www.frontiersin.org 7August 2021 | Volume 12 | Article 686005

fpsyg-12-686005 August 7, 2021 Time: 13:16 # 8
Hu et al. AT for Mental Disorders
Bar-Sela, G., Atid, L., Danos, S., Gabay, N., and Epelbaum, R. (2007).
Art therapy improved depression and influenced fatigue levels in cancer
patients on chemotherapy. Psychooncology 16, 980–984. doi: 10.1002/pon.
1175
Birgitta, G. A., Wagman, P., Hedin, K., and Håkansson, C. (2018). Treatment of
depression and/or anxiety–outcomes of a randomised controlled trial of the
tree theme method R
versus regular occupational therapy. BMC Psychol. 6:25.
doi: 10.1186/s40359-018- 0237-0
British Association of Art Therapists (2015). What is Art Therapy? Available online
at: https://www.baat.org/About-Art-Therapy
Broadbent, E., Petrie, K. J., Ellis, C. J., Ying, J., and Gamble, G. (2004). A picture of
health–myocardial infarction patients’ drawings of their hearts and subsequent
disability: a longitudinal study. J. Psychosom. Res. 57, 583–587.
Burton, A. (2009). Bringing arts-based therapies in from the scientific cold. Lancet
Neurol. 8, 784–785. doi: 10.1016/s1474-4422(09)70216- 9
Chiang, M., Reid-Varley, W. B., and Fan, X. (2019). Creative art therapy for mental
illness. Psychiatry Res. 275, 129–136. doi: 10.1016/j.psychres.2019.03.025
Ciasca, E. C., Ferreira, R. C., Santana, C.L. A., Forlenza, O. V., Dos Santos, G. D.,
Brum, P. S., et al. (2018). Art therapy as an adjuvant treatment for depression in
elderly women: a randomized controlled trial. Braz. J. Psychiatry 40, 256–263.
doi: 10.1590/1516-4446- 2017-2250
Craig, J., and Baron-Cohen, S. (1999). Creativity and imagination in autism and
Asperger syndrome. J. Autism Dev. Disord. 29, 319–326.
Craig, J., Baron-Cohen, S., and Scott, F. (2001). Drawing ability in autism: a
window into the imagination. Isr. J. Psychiatry Relat. Sci. 38, 242–253.
Cramer, V., Torgersen, S., and Kringlen, E. (2005). Quality of life and anxiety
disorders: a population study. J. Nerv. Ment. Dis. 193, 196–202. doi: 10.1097/
01.nmd.0000154836.22687.13
Crone, D. M., O’Connell, E. E., Tyson, P. J., Clark-Stone, F., Opher, S., and
James, D. V. (2013). ‘Art Lift’ intervention to improve mental well-being: an
observational study from U.K. general practice. Int. J. Ment. Health Nurs. 22,
279–286. doi: 10.1111/j.1447-0349.2012.00862.x
Cuijpers, P., Vogelzangs, N., Twisk, J., Kleiboer, A., Li, J., and Penninx, B. W.
(2014). Comprehensive meta-analysis of excess mortality in depression in the
general community versus patients with specific illnesses. Am. J. Psychiatry 171,
453–462. doi: 10.1176/appi.ajp.2013.13030325
De Sousa, A., Shah, B., and Shrivastava, A. (2020). Suicide and Schizophrenia: an
interplay of factors. Curr. Psychiatry Rep. 22:65.
Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine,
J. P., et al. (2004). Prevalence, severity, and unmet need for treatment of mental
disorders in the World Health Organization World Mental Health Surveys.
JAMA 291, 2581–2590. doi: 10.1001/jama.291.21.2581
Deshmukh, S. R., Holmes, J., and Cardno, A. (2018). Art therapy for people with
dementia. Cochrane Database Syst. Rev. 9:D11073.
Emery, M. J. (2004). Art therapy as an intervention for Autism. Art Ther. Assoc. 21,
143–147. doi: 10.1080/07421656.2004.10129500
Evans, K., and Dubowski, J. (2001). Art Therapy with Children on the
Autistic Spectrum: Beyond Words. London: Jessica Kingsley Publishers,
113.
Faller, H., and Schmidt, M. (2004). Prognostic value of depressive coping and
depression in survival of lung cancer patients. Psychooncology 13, 359–363.
doi: 10.1002/pon.783
Forouzandeh, N., Drees, F., Forouzandeh, M., and Darakhshandeh, S. (2020). The
effect of interactive games compared to painting on preoperative anxiety in
Iranian children: a randomized clinical trial. Complement. Ther. Clin. Pract.
40:101211. doi: 10.1016/j.ctcp.2020.101211
Forzoni, S., Perez, M., Martignetti, A., and Crispino, S. (2010). Art therapy with
cancer patients during chemotherapy sessions: an analysis of the patients’
perception of helpfulness. Palliat. Support. Care 8, 41–48. doi: 10.1017/
s1478951509990691
Geschwind, D. H., and Levitt, P. (2007). Autism spectrum disorders:
developmental disconnection syndromes. Curr. Opin. Neurobiol. 17, 103–111.
doi: 10.1016/j.conb.2007.01.009
Geue, K., Richter, R., Buttstädt, M., Brähler, E., and Singer, S. (2013). An art
therapy intervention for cancer patients in the ambulant aftercare–results from
a non-randomised controlled study. Eur. J. Cancer Care (Engl.) 22, 345–352.
doi: 10.1111/ecc.12037
Götze, H., Geue, K., Buttstädt, M., Singer, S., and Schwarz, R. (2009). [Art therapy
for cancer patients in outpatient care. Psychological distress and coping of the
participants]. Forsch. Komplementmed. 16, 28–33.
Guillemin, M. (2004). Understanding illness: using drawings as a research method.
Qual. Health Res. 14, 272–289. doi: 10.1177/1049732303260445
Gussak, D. (2007). The effectiveness of art therapy in reducing depression in prison
populations. Int J Offender Ther Comp Criminol 51, 444–460. doi: 10.1177/
0306624x06294137
Hamer, M., Chida, Y., and Molloy, G. J. (2009). Psychological distress and cancer
mortality. J. Psychosom. Res. 66, 255–258. doi: 10.1016/j.jpsychores.2008.11.002
Hattori, H., Hattori, C., Hokao, C., Mizushima, K., and Mase, T. (2011). Controlled
study on the cognitive and psychological effect of coloring and drawing in
mild Alzheimer’s disease patients. Geriatr. Gerontol. Int. 11, 431–437. doi:
10.1111/j.1447-0594.2011.00698.x
Heymann, P., Gienger, R., Hett, A., Müller, S., Laske, C., Robens, S., et al.
(2018). Early detection of Alzheimer’s disease based on the patient’s creative
drawing process: first results with a novel neuropsychological testing method.
J. Alzheimers Dis. 63, 675–687. doi: 10.3233/jad-170946
Hongxia, M., Shuying, C., Chuqiao, F., Haiying, Z., and Xuejiao, W. et al. (2013).
Relationship between psychological state and house-tree-person drawing
characteristics of rehabilitation patients with schizophrenia. Chin. Gen. Pract.
16, 2293–2295.
Hongyan, W., and JinJie, L. (2010). Rehabilitation effect of painting therapy on
chronic schizophrenia. Chin. J. Health Psychol. 18, 1419–1420.
Jalambadani, Z. (2020). Art therapy based on painting therapy on the improvement
of autistic children’s social interactions in Iran. Indian J. Psychiatry 62, 218–219.
doi: 10.4103/psychiatry.indianjpsychiatry_215_18
Jianhua, C., and Xiaolu, X. (2013). The experimental research on children with
autism by intervening with painting therapy. J. Tangshan Teach. Coll. 35,
127–130.
Kenbubpha, K., Higgins, I., Chan, S. W., and Wilson, A. (2018). Promoting
active ageing in older people with mental disorders living in the community:
an integrative review. Int. J. Nurs. Pract. 24:e12624. doi: 10.1111/ijn.
12624
Kolliakou, A., Joseph, C., Ismail, K., Atakan, Z., and Murray, R. M. (2011). Why do
patients with psychosis use cannabis and are they ready to change their use? Int.
J. Dev. Neurosci. 29, 335–346. doi: 10.1016/j.ijdevneu.2010.11.006
Lee, J., Choi, M. Y., Kim, Y. B., Sun, J., Park, E. J., Kim, J. H., et al. (2017). Art
therapy based on appreciation of famous paintings and its effect on distress
among cancer patients. Qual. Life Res. 26, 707–715. doi: 10.1007/s11136- 016-
1473-5
Leevers, H. J., and Harris, P. L. (1998). Drawing impossible entities: a measure of
the imagination in children with autism, children with learning disabilities, and
normal 4-year-olds. J. Child Psychol. Psychiatry 39, 399–410. doi: 10.1111/1469-
7610.00335
Lefèvre, C., Ledoux, M., and Filbet, M. (2016). Art therapy among palliative cancer
patients: aesthetic dimensions and impacts on symptoms. Palliat. Support. Care
14, 376–380. doi: 10.1017/s1478951515001017
Legrand, A. P., Rivals, I., Richard, A., Apartis, E., Roze, E., Vidailhet, M., et al.
(2017). New insight in spiral drawing analysis methods–application to action
tremor quantification. Clin. Neurophysiol. 128, 1823–1834. doi: 10.1016/j.
clinph.2017.07.002
Liebmann, M., and Weston, S. (2015). Art Therapy with Physical Conditions.
Philadelphia, PA: Jessica Kingsley Publishers.
Lin, M. H., Moh, S. L., Kuo, Y. C., Wu, P. Y., Lin, C. L., Tsai, M. H., et al. (2012). Art
therapy for terminal cancer patients in a hospice palliative care unit in Taiwan.
Palliat. Support. Care 10, 51–57. doi: 10.1017/s1478951511000587
Low, J., Goddard, E., and Melser, J. (2009). Generativity and imagination in
autism spectrum disorder: evidence from individual differences in children’s
impossible entity drawings. Br. J. Dev. Psychol. 27, 425–444. doi: 10.1348/
026151008x334728
Malchiodi, C. (2013). Art Therapy and Health Care. New York, NY: Guilford Press.
Mannheim, E. G., Helmes, A., and Weis, J. (2013). [Dance/movement
therapy in oncological rehabilitation]. Forsch. Komplementmed. 20,
33–41.
Martin, N. (2009). Art as an Early Intervention Tool for Children with Autism.
London: Jessica Kingsley.
Frontiers in Psychology | www.frontiersin.org 8August 2021 | Volume 12 | Article 686005

fpsyg-12-686005 August 7, 2021 Time: 13:16 # 9
Hu et al. AT for Mental Disorders
Mimica, N., and Kaliniæ, D. (2011). Art therapy may be benefitial for reducing
stress–related behaviours in people with dementia–case report. Psychiatr.
Danub. 23:125.
Min, J. (2010). Application of painting therapy in the rehabilitation period of
schizophrenia. Med. J. Chin. Peoples Health 22, 2012–2014.
Mirabella, G. (2015). Is art therapy a reliable tool for rehabilitating people suffering
from brain/mental diseases? J. Altern. Complement. Med. 21, 196–199. doi:
10.1089/acm.2014.0374
Montag, C., Haase, L., Seidel, D., Bayerl, M., Gallinat, J., Herrmann, U., et al. (2014).
A pilot RCT of psychodynamic group art therapy for patients in acute psychotic
episodes: feasibility, impact on symptoms and mentalising capacity. PLoS One
9:e112348. doi: 10.1371/journal.pone.0112348
Nainis, N., Paice, J. A., Ratner, J., Wirth, J. H., Lai, J., and Shott, S. (2006). Relieving
symptoms in cancer: innovative use of art therapy. J. Pain Symptom Manage.
31, 162–169. doi: 10.1016/j.jpainsymman.2005.07.006
Narme, P., Tonini, A., Khatir, F., Schiaratura, L., Clément, S., and Samson,
S. (2012). [Non pharmacological treatment for Alzheimer’s disease:
comparison between musical and non-musical interventions]. Geriatr.
Psychol. Neuropsychiatr. Vieil. 10, 215–224. doi: 10.1684/pnv.2012.0343
Nielsen, S., Hageman, I., Petersen, A., Daniel, S. I. F., Lau, M., Winding, C.,
et al. (2019). Do emotion regulation, attentional control, and attachment style
predict response to cognitive behavioral therapy for anxiety disorders?–An
investigation in clinical settings. Psychother. Res. 29, 999–1009. doi: 10.1080/
10503307.2018.1425933
Papangelo, P., Pinzino, M., Pelagatti, S., Fabbri-Destro, M., and Narzisi, A. (2020).
Human figure drawings in children with autism spectrum disorders: a possible
window on the inner or the outer world. Brain Sci. 10:398. doi: 10.3390/
brainsci10060398
Petersen, R. C., Caracciolo, B., Brayne, C., Gauthier, S., Jelic, V., and Fratiglioni, L.
(2014). Mild cognitive impairment: a concept in evolution. J. Intern. Med. 275,
214–228.
Pike, A. A. (2013). The effect of art therapy on cognitive performance among
ethnically diverse older adults. J. Am. Art Ther. Assoc. 30, 159–168. doi: 10.
1080/07421656.2014.847049
Pongan, E., Tillmann, B., Leveque, Y., Trombert, B., Getenet, J. C., Auguste, N.,
et al. (2017). Can musical or painting interventions improve chronic pain,
mood, quality of life, and cognition in patients with mild Alzheimer’s disease?
Evidence from a randomized controlled trial. J. Alzheimers Dis. 60, 663–677.
doi: 10.3233/jad-170410
Richardson, P., Jones, K., Evans, C., Stevens, P., and Rowe, A. (2007). Exploratory
RCT of art therapy as an adjunctive treatment in schizophrenia. J. Ment. Health
16, 483–491. doi: 10.1080/09638230701483111
Richardson, P., Jones, K., Evans, C., Stevens, P., and Rowe, A. (2009). Exploratory
RCT of art therapy as an adjunctive treatment in schizophrenia. J Ment. Health
16, 483–491.
Ruiz, M. I., Aceituno, D., and Rada, G. (2017). Art therapy for schizophrenia?
Medwave 17:e6845.
Runde, P. (2008). Clinical application of painting therapy in middle school students
with mood disorders. Chin. J. Health Psychol. 27, 749–750.
Rusted, J., Sheppard, L., and Waller, D. A. (2016). Multi-centre randomized control
group trial on the use of art therapy for older people with dementia. Group Anal.
39, 517–536. doi: 10.1177/0533316406071447
Salmon, P. L. (1993). Viewing the client’s world through drawings. J. Holist. Nurs.
11, 21–41. doi: 10.1177/089801019301100104
Steinbauer, M., and Taucher, J. (2001). [Paintings and their progress by
psychiatric inpatients within the concept of integrative art therapy]. Wien. Med.
Wochenschr. 151, 375–379.
Steinbauer, M., Taucher, J., and Zapotoczky, H. G. (1999). [Integrative painting
therapy. A therapeutic concept for psychiatric inpatients at the University clinic
in Graz]. Wien. Klin. Wochenschr. 111, 525–532.
Teglbjaerg, H. S. (2011). Art therapy may reduce psychopathology in schizophrenia
by strengthening the patients’ sense of self: a qualitative extended case report.
Psychopathology 44, 314–318. doi: 10.1159/000325025
Ten, E. K., and Muller, U. (2018). Drawing links between the autism cognitive
profile and imagination: executive function and processing bias in imaginative
drawings by children with and without autism. Autism 22, 149–160. doi:
10.1177/1362361316668293
Thyme, K. E., Sundin, E. C., Wiberg, B., Oster, I., Aström, S., and Lindh, J. (2009).
Individual brief art therapy can be helpful for women with breast cancer: a
randomized controlled clinical study. Palliat. Support. Care 7, 87–95. doi:
10.1017/s147895150900011x
Tong, J., Yu, W., Fan, X., Sun, X., Zhang, J., Zhang, J., et al. (2020). Impact
of group art therapy using traditional Chinese materials on self-efficacy and
social function for individuals diagnosed with schizophrenia. Front. Psychol.
11:571124. doi: 10.3389/fpsyg.2020.571124
van Geffen, E. C., van der Wal, S. W., van Hulten, R., de Groot,
M. C., Egberts, A. C., and Heerdink, E. R. (2007). Evaluation of
patients’ experiences with antidepressants reported by means of a
medicine reporting system. Eur. J. Clin. Pharmacol. 63, 1193–1199.
doi: 10.1007/s00228-007- 0375-4
Wang, Y., Jiepeng, L., Aihua, Z., Runjuan, M., and Lei, Z. (2011). Study on the
application value of painting therapy in the treatment of depression. Med. J.
Chin. Peoples Health 23, 1974–1976.
Wen, Z., and Zhaoming, G. (2009). A preliminary attempt of painting art therapy
for autistic children. Inner Mongol. J. Tradit. Chin. Med. 28, 24–25.
Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine,
H. E., et al. (2013). Global burden of disease attributable to mental and
substance use disorders: findings from the Global Burden of Disease Study 2010.
Lancet 382, 1575–1586. doi: 10.1016/s0140-6736(13)61611- 6
Wilk, M., Pachalska, M., Lipowska, M., Herman-Sucharska, I., Makarowski, R.,
Mirski, A., et al. (2010). Speech intelligibility in cerebral palsy children attending
an art therapy program. Med. Sci. Monit. 16, R222–R231.
Witkoski, S. A., and Chaves, M. (2007). Evaluation of artwork produced by
Alzheimer’s disease outpatients in a pilot art therapy program. Dement.
Neuropsychol. 1, 217–221. doi: 10.1590/s1980-57642008dn10200016
Xu, G., Chen, G., Zhou, Q., Li, N., and Zheng, X. (2017). Prevalence of mental
disorders among older Chinese people in Tianjin City. Can. J. Psychiatry 62,
778–786. doi: 10.1177/0706743717727241
Yu, J., Rawtaer, I., Goh, L. G., Kumar, A. P., Feng, L., Kua, E. H., et al. (2021).
The art of remediating age-related cognitive decline: art therapy enhances
cognition and increases cortical thickness in mild cognitive impairment. J. Int.
Neuropsychol. Soc. 27, 79–88. doi: 10.1017/s1355617720000697
Zhenhai, N., and Yunhua, C. (2011). An experimental study on the improvement
of depression in Obese female college students by painting therapy. Chin. J. Sch.
Health 32, 558–559.
Zschucke, E., Gaudlitz, K., and Strohle, A. (2013). Exercise and physical activity
in mental disorders: clinical and experimental evidence. J. Prev. Med. Public
Health 46 (Suppl. 1), S12–S21.
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