Background Creative arts have been present throughout humanity as a vehicle for emotional expression and social connection. Many experts advocate the use of creative art expressions for patients with serious illnesses. Unfortunately, there are a small number of controlled studies evaluating their effectiveness (1). This Fast Fact reviews the published evidence and the potential clinical application of creative arts in the care of patients with serious illness.

What is creative art? In medicine, the use of arts in treatment was once called ‘arts medicine’ (1). More recently, the term creative arts has been used to describe any expression not bound by language showcasing skill, imagination, reflection, and/or inspiration. Creative art therapy is the use of the creative and expressive process of art to improve and enhance the psychological and social well-being of individuals and is led by a trained therapist (2). Disciplines include but are not limited to painting, sculpture, music, dance, drama, and literature. Creative arts therapy can be used as therapeutic modalities over multiple sessions or a single session for all ages to improve patient- and/or family-quality of life (3). Trained professionals such as art therapists, music therapists, and drama therapists, provide tailored therapy plans according to each patient’s needs and interests. For example, a music therapist creates personalized songs for the patient and family based on their discussion at the bedside, including utilizing favorite songs with lyrics created from discussed values. Or an art therapist may utilize visual artistic skills for legacy planning.  Alternatively, creative art can be used as an ad hoc bedside tool to address the lived experience or symptomatology of a wide variety of serious illnesses.

What is the supporting evidence for the clinical benefits of creative arts?  

• A randomized trial and a meta-analysis have shown positive benefits of creative arts for coping with physical, existential, emotional, and spiritual conflicts associated with breast cancer (4,5).
• Among patients with chronic pain, creating art was described as a “transformative” way for patients to find meaning and resilience in a qualitative study (6). In this same qualitative study, both novices to creative arts and trained artists found emotional benefit (6).
• The process of creating artwork is a continuous challenge that involves physical, cognitive, and emotional activation (7); therefore, it can be beneficial not just for those with already present artistic skills, but non-artists too (6,8).
• Adjacent creative strategies (not technically considered creative art therapy) such as mandalas (also referred to as adult coloring books) have been associated with short-term anxiety reduction (9).
• Art and music therapy are commonly used in palliative care units and hospices for the benefit of both the patient and their family members (10-12).

Who are creative art therapists and where to find them? Creative arts therapists are trained at a master’s-level for entry-level practice with internships who undergo board certification and obtain licensing for their practice. Some may seek more advanced degrees such as PhDs and post-doctoral work. Most creative art therapists practice in organizations that have funding to support their salary, such as large academic centers, hospice organizations, or long-term care facilities, since their care is not usually covered by major insurances. Out-of-pocket costs generally range $100-$300/session based on therapists’ experience, group vs. individual, and the specific type of therapy. However, data have shown that even unofficial artistic endeavors, can be effective in reducing short term psychological distress (9).

When do I refer my patient to creative arts therapy? Who do I refer them to? As there are different forms of creative arts, a few factors to consider are: 

• Interests and familiarity of the patient and/or family with a specific creative outlet;
• Spiritual beliefs and cultural practices;
• Current medical condition, such as pain, discomfort, and functional ability to communicate needs;
• Cognitive ability to process sensory information;
• Trauma triggers.

Areas of future study: It is difficult to compare the degree of efficacy of formal creative arts therapies versus ad hoc sessions as the field is still in the early stages of developing standardized evaluation methods (13). Further research is needed to identify which populations of patients benefit most from creative art therapies and how to best utilize limited creative art resources.

Summary: Clinicians should inquire if patients with serious illness are engaging in creative arts to explore the emotions and reflections elicited from living with a serious illness. They may even encourage some patients to engage in creative arts expressions regardless of their past artistic experience. Some larger health care institutions and hospice agencies have licensed creative arts therapists available to engage interested patients in more structured, therapeutic ways.

References  

1. Rollins J, Sonke J, Cohen R, et al. State of the field report: Arts in healthcare. 2009. Washington, DC: Society for the Arts in Healthcare. https://www.americansforthearts.org/sites/default/files/pdf/get_involved/advocacy/research/2014/arts_in_healthcare.pdf.
2. Shafir T, Orkibi H, Baker FA, et al. Editorial: The State of the Art in Creative Arts Therapies. Front. Psychol. 2020: 11:68. doi: 10.3389/fpsyg.2020.00068.
3. Hartley, N. 2013. End of Life Care: A Guide for Therapists, Artists and Arts Therapists. London: Jessica Kingsley Publications.
4. Pengfei Cheng, Linlin Xu, Junxiang Zhang, et al. .Role of Arts Therapy in Patients with Breast and Gynecological Cancers: A Systematic Review and Meta-Analysis.Journal of Palliative Medicine.Mar 2021.443-452.
5. Puig A, Lee S, Goodwin L, et al. The efficacy of creative arts therapies to enhance emotional expression, spirituality, and psychological well-being of newly diagnosed Stage I and Stage II breast cancer patients: A preliminary study. The Arts in Psychotherapy 2006; 33:218-228. 10.1016/j.aip.2006.02.004.
6. Lynch M, Sloane G, Sinclair C, Bassett R. (2013) Resilience and art in chronic pain, Arts & Health, 5:1, 51-67, DOI: 10.1080/17533015.2012.693937.
7. Safrai MD. Art Therapy in Hospice: A Catalyst for Insight and Healing. Art Therapy. 2013; 30:3, 122-129, DOI: 10.1080/07421656.2013.819283.
8. O’Neill A, Moss H. A Community Art Therapy Group for Adults With Chronic Pain, Art Therapy 2015; 32:4:158-167, DOI: 10.1080/07421656.2015.1091642.
9. Jakobsson Støre S, Jakobsson N. The Effect of Mandala Coloring on State Anxiety: A Systematic Review and Meta-Analysis, Art Therapy 2022; 39:4:173-181, DOI: 10.1080/07421656.2021.2003144.
10. Collette N, Güell E, Fariñas O, et al. Art Therapy in a Palliative Care Unit: Symptom Relief and Perceived Helpfulness in Patients and Their Relatives. J Pain Symptom Manage. 2021;61(1):103-111. doi:10.1016/j.jpainsymman.2020.07.027.
11. Shukla A, Choudhari SG, Gaidhane AM, et al. Role of Art Therapy in the Promotion of Mental Health: A Critical Review. Cureus. 2022 Aug 15;14(8):e28026. doi: 10.7759/cureus.28026.PMID: 36134083; PMCID: PMC9472646.
12. Bercovitz A, Sengupta M, Jones A, et al. Complementary and alternative therapies in hospice: The national home and hospice care survey: United States, 2007. Natl Health Stat Report. 2011;(33):1-20.
13. Hass-Cohen N, Bokoch R, Goodman K, et al.  Art Therapy Drawing Protocols for Chronic Pain: Qualitative Findings From a Mixed-Method Pilot Study, Art Therapy 2022; 39:4:182-193, DOI: 10.1080/07421656.2022.2085491.

Authors’ Affiliations: Johns Hopkins University/Hospital, Baltimore, MD.
* Corresponding author. Zwang433@jh.edu
Conflicts of interest: none.
Version History: Originally edited by Sean Marks MD; first electronically published in October 2024.