At present, the predominant therapeutic modalities for addressing depression encompass pharmacotherapy, psychotherapy, electroconvulsive therapy (ECT), phototherapy, exercise therapy, social support interventions, and art therapy. Within this array of therapeutic choices, visual art therapy (VAT) has garnered attention as a burgeoning non-pharmacological treatment modality. It is posited to contribute to the amelioration of mood, reduction of depressive symptoms, and the facilitation of psychological recuperation (American Art Therapy Association, 2017; Bosmanet al., 2020).

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Visual art therapy rests on the belief that active engagement in creative expression and artistic experiences uniquely influences mental health. Engagement with visual art forms enables an individual to explore and communicate their emotions, experiences, and cognitive viewpoints with minimal reliance on linguistic expression (Joschko et al., 2022; Masika et al., 2020b). VAT encompasses diverse art forms, including but not limited to painting or drawing, sculpture, clay, and collage or papercutting (Avrahami, 2006).

 

Currently, there is no official comprehensive guideline covering all specific aspects of VAT. Individual therapists and institutions therefore employ different methods and techniques. The International Expressive Arts Therapy Association (IEATA), the Art Therapy Alliance, and the International Association for Creative Arts in Education and Therapy (IACAET) recommend and endorse the practice of VAT (IACAET; IEATA; The Art Therapy Alliance). These organisations provide professional support, training, certification, research development and industry guidelines to foster the implementation and advancement of VAT. Furthermore, they serve as platforms for practitioners to connect, exchange experiences and generate collaborations.

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The complete mechanism by which VAT alleviates depression remains only partially understood. However, it is likely to produce therapeutic benefits through five significant mechanisms.

 

First, emotion regulation and expression: VAT offers a nonverbal avenue for individuals to articulate their inner sentiments and emotions via artistic creations. This process enhances understanding and enables effective management of emotions, ultimately mitigating internal repression and distress (Stuckey & Nobel, 2010).

 

Second, creativity and self-exploration: VAT cultivates an environment that encourages individuals to harness their creative capacities, facilitating an exploration of inner emotions, ideas, and experiences through artistic mediums. This creative process helps individuals to re-establish their sense of self, bolstering both self-worth and self-confidence (Potashet al., 2013).

 

Third, disconnection and integration: Depression often engenders feelings of detachment and a severed connection with oneself and the surrounding environment. VAT allows individuals to translate intricate emotions and experiences into artistic representations, promoting a deeper understanding and integration of internal conflicts and contradictions (Haeyen et al., 2022).

 

Fourth, the flow experience: VAT establishes a focused and immersive environment, enabling individuals to enter a state of flow. Flow denotes an intense state of concentration and engagement that enables individuals to temporarily transcend their emotional pain and anxiety, thereby alleviating depressive symptoms (Isham &Jackson, 2022).

 

Lastly, social support and interaction: VAT is frequently administered in group or communal settings, affording individuals the opportunity to engage and interact with therapists and fellow participants. This social support and interaction can alleviate isolation, foster a sense of belonging, and provide emotional support and understanding (Gariépy et al., 2018).

 

Through an extensive review of existing literature, this meta-analysis substantiates the capacity of VAT to elicit a significant reduction in depressive symptoms among adults. In addition, it is worth noting that the effectiveness of VAT in alleviating depressive symptoms was potentially more pronounced among adults below 65 years of age, compared to adults above 65 years. Nonetheless, owing to the inherent limitations in this study and the paucity of high-quality evidence, the current milieu does not warrant the immediate implementation, translation, or endorsement of VAT within clinical practice.