Visual and Performing Arts as Non-Pharmacological Interventions for Mental Health Support
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Abstract
Psychological distress and diminished mental well-being often coexist with social disconnection, disrupted routine, and limited participation, yet the independent contribution of visual- and performing-arts components remains uncertain. This study estimated factorial main effects in a three-center, assessor-blinded 2×2 randomized controlled trial. We allocated 280 adults aged 18–65 years with mild-to-moderate distress equally to 12 weeks of visual arts, performing arts, combined arts, or attention- and time-matched social-wellbeing programming. CORE-OM distress and WEMWBS well-being at week 12 were co-primary outcomes. An a priori Monte Carlo power analysis selected 70 participants per cell to provide approximately 81%–84% power for the factor-level joint co-primary success rule under minimally important standardized main effects of 0.30, baseline adjustment, repeated post-baseline measurement, anticipated attrition, clustered delivery, and multiplicity control. Intention-to-treat factorial multilevel models incorporated post-baseline time, center, delivery group, facilitator, and participant effects, with baseline entered once as a covariate, multiple imputation, and sensitivity analyses. Visual arts produced adjusted week-12 effects of −0.20 CORE-OM points and +3.3 WEMWBS points; performing arts produced effects of −0.24 and +3.8 points. Both factors met the prespecified success rule. Visual-by-performing interactions were exploratory and imprecise, showing no detected departure from additivity. Benefits attenuated but remained detectable at the remotely collected 12-month assessment. Exploratory process analyses were consistent with overlapping associations through emotion regulation, behavioural activation, creative self-efficacy, and social identification. Framework Analysis linked improvement to meaning-making, renewed activity, creative agency, and group belonging, while overload, self-consciousness, cultural mismatch, and access constraints limited engagement. Manualized visual and performing arts provided credible, supervised complements to usual mental-health support in the studied population.
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[1]. COVID-19 Mental Disorders Collaborators, “Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic,” The Lancet, vol. 398, no. 10312, pp. 1700–1712, 2021, doi: 10.1016/S0140-6736(21)02143-7.
[2]. L. Martin, R. Oepen, K. Bauer, A. Nottensteiner, K. Mergheim, H. Gruber, and S. C. Koch, “Creative arts interventions for stress management and prevention—A systematic review,” Behavioral Sciences, vol. 8, no. 2, art. 28, 2018, doi: 10.3390/bs8020028.
[3]. T. Van Lith, “Art therapy in mental health: A systematic review of approaches and practices,” The Arts in Psychotherapy, vol. 47, pp. 9–22, 2016, doi: 10.1016/j.aip.2015.09.003.
[4]. A. Abbing, E. W. Baars, L. de Sonneville, A. S. Ponstein, and H. Swaab, “The effectiveness of art therapy for anxiety in adult women: A randomized controlled trial,” Frontiers in Psychology, vol. 10, art. 1203, 2019, doi: 10.3389/fpsyg.2019.01203.
[5]. S. Aalbers et al., “Music therapy for depression,” Cochrane Database of Systematic Reviews, no. 11, art. CD004517, 2017, doi: 10.1002/14651858.CD004517.pub3.
[6]. V. Karkou, S. Aithal, A. Zubala, and B. Meekums, “Effectiveness of dance movement therapy in the treatment of adults with depression: A systematic review with meta-analyses,” Frontiers in Psychology, vol. 10, art. 936, 2019, doi: 10.3389/fpsyg.2019.00936.
[7]. S. C. Koch, R. F. F. Riege, K. Tisborn, J. Biondo, L. Martin, and A. Beelmann, “Effects of dance movement therapy and dance on health-related psychological outcomes: A meta-analysis update,” Frontiers in Psychology, vol. 10, art. 1806, 2019, doi: 10.3389/fpsyg.2019.01806.
[8]. D. Fancourt, C. Garnett, N. Spiro, R. West, and D. Müllensiefen, “How do artistic creative activities regulate our emotions? Validation of the Emotion Regulation Strategies for Artistic Creative Activities Scale (ERS-ACA),” PLOS ONE, vol. 14, no. 2, art. e0211362, 2019, doi: 10.1371/journal.pone.0211362.
[9]. R. C. Sumner, D. M. Crone, S. Hughes, and D. V. B. James, “Arts on prescription: Observed changes in anxiety, depression, and well-being across referral cycles,” Public Health, vol. 192, pp. 49–55, 2021, doi: 10.1016/j.puhe.2020.12.008.
[10]. N. Daykin et al., “What works for wellbeing? A systematic review of wellbeing outcomes for music and singing in adults,” Perspectives in Public Health, vol. 138, no. 1, pp. 39–46, 2018, doi: 10.1177/1757913917740391.
[11]. R. Joschko et al., “Active visual art therapy and health outcomes: A systematic review and meta-analysis,” JAMA Network Open, vol. 7, no. 9, art. e2428709, 2024, doi: 10.1001/jamanetworkopen.2024.28709.
[12]. M. S. Barnish and R. V. Nelson-Horne, “Group-based active artistic interventions for adults with primary anxiety and depression: A systematic review,” BMJ Open, vol. 13, no. 6, art. e069310, 2023, doi: 10.1136/bmjopen-2022-069310.
[13]. L. Jiang, F. Alizadeh, and W. Cui, “Effectiveness of drama-based intervention in improving mental health and well-being: A systematic review and meta-analysis during the COVID-19 pandemic and post-pandemic period,” Healthcare, vol. 11, no. 6, art. 839, 2023, doi: 10.3390/healthcare11060839.
[14]. F. A. Baker et al., “A systematic review of the efficacy of creative arts therapies in the treatment of adults with PTSD,” Psychological Trauma: Theory, Research, Practice, and Policy, vol. 10, no. 6, pp. 643–651, 2018, doi: 10.1037/tra0000353.
[15]. B. Han et al., “The effects of visual art therapy on adults with depressive symptoms: A systematic review and meta-analysis,” International Journal of Mental Health Nursing, vol. 33, no. 5, pp. 1183–1196, 2024, doi: 10.1111/inm.13331.
[16]. R. M. Lee, M. Draper, and S. Lee, “Social connectedness, dysfunctional interpersonal behaviors, and psychological distress: Testing a mediator model,” Journal of Counseling Psychology, vol. 48, no. 3, pp. 310–318, 2001, doi: 10.1037/0022-0167.48.3.310.
[17]. J. J. Gross, “Emotion regulation: Current status and future prospects,” Psychological Inquiry, vol. 26, no. 1, pp. 1–26, 2015, doi: 10.1080/1047840X.2014.940781.
[18]. D. A. Richards et al., “Cost and outcome of behavioral activation versus cognitive behavioral therapy for depression (COBRA): A randomized, controlled, non-inferiority trial,” The Lancet, vol. 388, no. 10047, pp. 871–880, 2016, doi: 10.1016/S0140-6736(16)31140-0.
[19]. N. K. Steffens et al., “Social identification-building interventions to improve health: A systematic review and meta-analysis,” Health Psychology Review, vol. 15, no. 1, pp. 85–112, 2021, doi: 10.1080/17437199.2019.1669481.
[20]. P. Tierney and S. M. Farmer, “Creative self-efficacy: Its potential antecedents and relationship to creative performance,” Academy of Management Journal, vol. 45, no. 6, pp. 1137–1148, 2002, doi: 10.2307/3069429.
[21]. K. Skivington et al., “A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance,” BMJ, vol. 374, art. n2061, 2021, doi: 10.1136/bmj.n2061.
[22]. K. F. Schulz, D. G. Altman, and D. Moher, “CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials,” BMJ, vol. 340, art. c332, 2010, doi: 10.1136/bmj.c332.
[23]. I. Boutron et al., “CONSORT statement for randomized trials of nonpharmacologic treatments: A 2017 update and a CONSORT extension for nonpharmacologic trial abstracts,” Annals of Internal Medicine, vol. 167, no. 1, pp. 40–47, 2017, doi: 10.7326/M17-0046.
[24]. A.-W. Chan et al., “SPIRIT 2013 statement: Defining standard protocol items for clinical trials,” Annals of Internal Medicine, vol. 158, no. 3, pp. 200–207, 2013, doi: 10.7326/0003-4819-158-3-201302050-00583.
[25]. T. C. Hoffmann et al., “Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide,” BMJ, vol. 348, art. g1687, 2014, doi: 10.1136/bmj.g1687.
[26]. C. Evans et al., “Towards a standardized brief outcome measure: Psychometric properties and utility of the CORE-OM,” British Journal of Psychiatry, vol. 180, no. 1, pp. 51–60, 2002, doi: 10.1192/bjp.180.1.51.
[27]. R. Tennant et al., “The Warwick–Edinburgh Mental Well-being Scale (WEMWBS): Development and UK validation,” Health and Quality of Life Outcomes, vol. 5, art. 63, 2007, doi: 10.1186/1477-7525-5-63.
[28]. K. Kroenke, R. L. Spitzer, and J. B. W. Williams, “The PHQ-9: Validity of a brief depression severity measure,” Journal of General Internal Medicine, vol. 16, no. 9, pp. 606–613, 2001, doi: 10.1046/j.1525-1497.2001.016009606.x.
[29]. R. L. Spitzer, K. Kroenke, J. B. W. Williams, and B. Löwe, “A brief measure for assessing generalized anxiety disorder: The GAD-7,” Archives of Internal Medicine, vol. 166, no. 10, pp. 1092–1097, 2006, doi: 10.1001/archinte.166.10.1092.
[30]. J. C. Mundt, I. M. Marks, M. K. Shear, and J. M. Greist, “The Work and Social Adjustment Scale: A simple measure of impairment in functioning,” British Journal of Psychiatry, vol. 180, no. 5, pp. 461–464, 2002, doi: 10.1192/bjp.180.5.461.
[31]. M. E. Hughes, L. J. Waite, L. C. Hawkley, and J. T. Cacioppo, “A short scale for measuring loneliness in large surveys: Results from two population-based studies,” Research on Aging, vol. 26, no. 6, pp. 655–672, 2004, doi: 10.1177/0164027504268574.
[32]. L. Yu et al., “Development of short forms from the PROMIS sleep disturbance and sleep-related impairment item banks,” Behavioral Sleep Medicine, vol. 10, no. 1, pp. 6–24, 2012, doi: 10.1080/15402002.2012.636266.
[33]. M. Herdman, C. Gudex, A. Lloyd, M. F. Janssen, P. Kind, D. Parkin, G. Bonsel, and X. Badia, “Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L),” Quality of Life Research, vol. 20, no. 10, pp. 1727–1736, 2011, doi: 10.1007/s11136-011-9903-x.
[34]. B. E. Bjureberg et al., “Development and validation of a brief version of the Difficulties in Emotion Regulation Scale: The DERS-16,” Journal of Psychopathology and Behavioral Assessment, vol. 38, no. 2, pp. 284–296, 2016, doi: 10.1007/s10862-015-9514-x.
[35]. R. C. Manos, J. W. Kanter, and J. D. Luo, “The Behavioral Activation for Depression Scale–Short Form: Development and validation,” Behavior Therapy, vol. 42, no. 4, pp. 726–739, 2011, doi: 10.1016/j.beth.2011.04.004.
[36]. T. Postmes, S. A. Haslam, and L. Jans, “A single-item measure of social identification: Reliability, validity, and utility,” PLOS ONE, vol. 8, no. 6, art. e64852, 2013, doi: 10.1371/journal.pone.0064852.
[37]. N. K. Gale, G. Heath, E. Cameron, S. Rashid, and S. Redwood, “Using the framework method for the analysis of qualitative data in multi-disciplinary health research,” BMC Medical Research Methodology, vol. 13, art. 117, 2013, doi: 10.1186/1471-2288-13-117.