Rebecca Bokoch
Noah Hass-Cohen
April Espinoza
Tyler O’Reilly
Elad Levi- California School of Professional Psychology, Alliant International University, Alhambra, CA, United States
Introduction: This article provided a scoping review of the current state of the field for integrated arts therapies and neuroscience research. The main arts therapies modalities included in this review were: of arts therapies (i.e., drawing, painting, sculpting, bibliotherapy, cinema therapy, dance movement therapies, drama therapies, music therapies, neuroaesthetics, phototherapies, and poetry). The main objectives of this integrated arts therapies and neuroscience scoping review were to: (1) include multiple modalities of arts therapies, (2) summarize, synthesize, compare, and contrast populations, settings, presenting problems, methods, modalities, measures, and outcomes, (3) discuss implications, and (4) suggest future directions.
Methods: The design for this scoping review was conducted according to PRISMA-ScR and the JBI Scoping Review Manual standardized recommendations. Eligibility criteria included: English language, peer-review, integration of arts therapies and neuroscience, and use of research methodologies such as case studies, quantitative, qualitative, mixed methods, systematic or scoping reviews, and meta-analyses. Articles were gathered from two online databases (EBSCOHost and PubMed) using keywords, and review of articles from reference lists. Publications that met criteria were reviewed and charted for the following information: author, year of publication, sample size and characteristics, research design, data analyses, modality (i.e., intervention, treatment), and outcomes. This scoping review included 84 publications that met inclusion criteria, after the research team discussed to consensus.
Results: Outcomes suggested improvements in brain activity and integration, cognitive, affective, sensory, and social functioning, memory reconsolidation, psychological symptoms, affect, and behavior.
Discussion: Interpretations were limited in that most publications lacked directionality in their approach, were exploratory, and dependent on researcher assumptions, expertise, and access to instruments and populations. Therefore, more research is needed on each modality that upholds stronger research methodology, and can develop focus across researchers. While this scoping review was able to summarize and synthesize the state of the field, it is still too early to be able to compare outcomes or make more solid conclusions about specific neuroscientific processes and benefits for each individual modality. This body of knowledge provided valuable implications for the field and made suggestions for future directions.
Introduction
Integrated arts therapies and neuroscience research has focused on establishing the efficacy of arts-based practices and continues to be an emergent area of interest (Hass-Cohen et al., 2022; Hass-Cohen and Clyde Findlay, 2015; Hass-Cohen and Clyde Findlay, 2019; King and Strang, 2024; Malik, 2022; Strang, 2024; Vaisvaser, 2024). Multiple theoretical chapters and articles have made the connection between arts therapies and neuroscience (Hass-Cohen and Carr, 2008; Hass-Cohen and Clyde Findlay, 2015; Hass-Cohen and Clyde Findlay, 2019; King and Strang, 2024). Reviews of arts therapies and neuroscience have been mostly brief and narrative (Malik, 2022; Oliva et al., 2023). Reviews have also highlighted a need for research that goes beyond theoretical claims and subjective reports (Malik, 2022). Thus, theoretical interpretations have been made without empirical backing, possibly due to a lack of access and understanding of biophysiological instruments in the general arts therapies field. A methodological review process that includes a team approach to analysis to reduce bias and provide a more in depth and valid map of the state of the field, is needed (Malik, 2022). Another constraint of the existing reviews of arts therapies and neuroscience is the research focus on one modality, e.g., art therapy (Malik, 2022) or music therapy (Tramontano et al., 2021), or by one specific population or clinical concern, e.g., Alzheimer’s or dementia (Popa et al., 2021). For almost two decades, there has been a call to further the understanding of neuroscience structures and functions associated with mechanisms of change in arts therapies (Hass-Cohen and Carr, 2008; Hass-Cohen and Clyde Findlay, 2015; Hass-Cohen and Clyde Findlay, 2019; King and Strang, 2024).
For purposes of this scoping review, the field of arts therapies are defined as art therapy and creative and expressive arts therapies (i.e., drawing, painting, sculpting, a variety of media), bibliotherapy, cinema therapy, dance therapy (and other movement therapies), drama therapy (including psychodrama, therapies incorporating performance art), music therapies, neuroaesthetics (including the experience of art, i.e., viewing art), phototherapy (including photography and video), and poetry (American Psychological Association, 2025). From a neuroscience perspective, each modality focuses on one biological system, for example, the visual and sensory system with art therapy, auditory system with music therapy, and motor system with dance therapy.
Arts therapies and neuroscience research has addressed some but not all neuropsychological psychological domains, such as: affect, behavior, cognition, cognitive function (i.e., memory, mindfulness), executive function, interpersonal/relational functioning and developmental neuroscience (i.e., attachment), mental health symptoms and functioning (i.e., anxiety, depression) (Czamanski-Cohen and Weihs, 2016; Malik, 2022; Strang, 2024). According to this research, related neuroscientific structures, neuropathways, and functions, have included: cortical and subcortical nervous system responses (i.e., responses to stress and trauma), endocrine systems, immune systems, movement and motor systems, sensations and perceptions (i.e., visual, tactile, auditory), and other relevant neuroscience information. For this scoping review the advantages of inclusion of multiple modalities for the current scoping review will provide an understanding of the integration of arts therapies and neuroscience and their benefits (Vaisvaser, 2024), as well as present gaps in addressing neuroscientific related functions and neuropsychological domains.
Methods
This article has provided a scoping review of the current state of the field for integrated arts therapies and neuroscience research. The overarching research question in this study was: “What integrated arts therapies and neuroscience research has been conducted to date?” Research sub-questions were organized according to the following main domains (research and clinical). They were: (1) which research methodologies and instrument were used, and what were the suggestions for future research to strengthen the body of research in this emerging field? (2) What clinical approaches and modalities, as well as populations, settings, and presenting problems have existing arts therapies and neuroscience research studies included, and what were the suggestions for clinical practice? (3) What is the comparative efficacy of different modalities for the various populations, settings, and presenting problems?
Theoretical and conceptual research was initially considered for inclusion in this scoping review; however, they were excluded as they would require an analysis of conceptual frameworks, principles, definitions, and foundations. Such an analysis merits its own scoping review, given the large number of theoretical publications on integrated arts therapies and neuroscience. Subsequently, this scoping review aimed to summarize the outcomes, results, and findings gathered from the more recent and prevalent clinical and empirical publications in this field. Because this review included a variety of research methodologies and aimed to organize the scope of a body of literature as well as identify the gaps in the literature to inform future clinical research, a scoping review was warranted (Munn et al., 2018). This scoping review also aims to create a foundation of knowledge on this integrated field to inform clinical applications, and depository of relevant publications to support further research.
The main objectives of this integrated arts therapies and neuroscience scoping review were to: (1) include main art therapy modalities (i.e., art therapy, dance, drama, movement, music, photo), (2) compare and contrast the efficacy of different art therapy modalities, (3) summarize, synthesize, compare, and contrast the relevant methodologies within the publications (i.e., meta-analyses, systematic or scoping reviews, quantitative, mixed methods, qualitative, case studies), as well as populations, settings, presenting problems, measures, and outcomes, (4) discuss implications, and (5) discuss suggestions for future directions.
Research design
The design for this scoping review was informed by PRISMA-ScR (Tricco et al., 2018) and the JBI Scoping Review Manual (Peters et al., 2021). Per the definition, the main inclusion criterion was the integration of arts therapies and neuroscience, meaning that clinical arts therapies approaches, as well as neuroscience theories or measures were linked in the publications. Additional inclusion criteria for articles in this scoping review were any case studies, primary research (quantitative, qualitative, mixed methods), systematic or scoping reviews, or meta-analyses articles. There was no limitation on years considered, as it was expected that the state of the field would benefit from a comprehensive review, as most research has been conducted in the past two to three decades. All articles were peer-reviewed publications, provided in English.
Procedures
Article searches were conducted in two steps. First, two online databases, EBSCOHost and PubMed, were searched using the following keywords and Boolean operators: “arts therapies,” or “expressive arts therapies,” or “art therapy,” and “neuroscience” or “neuropsychology.” There was no limitation on year of publication date, as this scoping review was exploratory, and it was expected that the range of time would not be too broad to be included as integrated arts therapies and neuroscience is a more recent, emergent field. Second, reference lists of articles were searched for additional sources. These article search steps were conducted from April 2024 to October 2024. The research team consisted of clinicians and researchers in the field of arts therapies and neuroscience, and graduate psychology student research assistants with clinical interest in arts therapies. Each article was reviewed via text analysis of titles, abstracts, and keywords by individual researchers, then two subsets of researchers among the team reviewed the article categorizations independently and discussed until consensus was collectively reached by the research team for inclusion.
Initially, 667 articles were found. Then, 269 articles were identified as potentially meeting inclusion criteria. After further team review, 84 articles met inclusion criteria. Exclusion criteria included theoretical articles, and a lack of integration between arts therapies and neuroscience. Research that only peripherally mentioned neuroscience as a theoretical basis or theme, or publications that did not apply neuroscience to the arts therapies, were excluded as they did not provide sufficient information or meet inclusion criteria of integration. Additionally, while neuropsychological conditions and biophysiological instruments are included in these publications, their use alone would not merit inclusion in this scoping review, as eligibility required the integration of arts therapies and neuroscience. Therefore, these inclusion and exclusion criteria prioritized clinical research studies. Publications that met criteria were charted for the following information first by individual researchers and then reviewed by the research team: author, year of publication, sample size and characteristics, research design, data analyses, modality (i.e., intervention, treatment), and outcomes related to the objectives of this scoping review. A discussion focusing on the knowledge generated by this depository, as well as research and clinical impressions concluded this process (Figure 1).
Figure 1. Venn diagram of the six overlapping principles/factors of Art Therapy Relational Neuroscience with partial descriptions. CREATE: (1) creative embodiment in action. (2) relational responding, (3) expressive communicating, (4) adaptive responding, (5) transformative integration, and (6) empathizing and compassion. Partial descriptions from Hass-Cohen and Clyde Findlay (2015).
The 84 publications included in this scoping review were organized by research design (Figure 1). There were five review articles, 28 quantitative empirical articles, nine mixed methods articles, four qualitative studies and 38 clinical case study reports (Table 1). Of the included publications study designs: 17 were experimental (20.24%), 11 were quasi-experimental (13.10%), 9 were pre-experimental (10.71%), and 45 were observational (53.57%).
Table 1. Article research methodologies.
Most publications were case studies (45.24%). A strength of the case studies was that some of them utilized biophysiological instruments (Belkofer and Konopka, 2008; Fachner et al., 2019; Kang et al., 2022; Pąchalska, 2022; Pąchalska et al., 2013; Pąchalska et al., 2021; Walker et al., 2016), as well as reporting on quantitative (Belkofer and Konopka, 2008; Kang et al., 2022; Kang and Thaut, 2019; Pąchalska et al., 2013) or mixed methods data (Fachner et al., 2019; Guseva, 2018; Pąchalska et al., 2021; Pąchalska and Góral-Półrola, 2020; Pąchalska, 2022; Walker et al., 2016; Warson and Warson, 2023). Other case studies mainly reported on qualitative findings, and shared descriptive case examples and clinical applications. Almost all case studies proposed theoretical conclusions.
Quantitative studies were the second most common type of publication (34.57%), with a range of designs including: pretest-posttest experimental control group design, pretest-posttest nonequivalent control group design, pretest-posttest single group design, and posttest only experimental control group design, posttest only nonequivalent control group design, within subjects pretest-posttest experimental control group design, and static comparison group design. About half of the quantitative studies were experimental, including random assignment to treatment versus control groups (n = 15; 53.57%) (Abbing et al., 2019; Bastepe-Gray et al., 2022; Bolwerk et al., 2014; Corbett et al., 2019; De Bartolo et al., 2020; Hass-Cohen et al., 2021; Herrera-Arcos et al., 2017; Iosa et al., 2021; Josef et al., 2019; Kaimal et al., 2020; Kang et al., 2021; Kruk et al., 2014; Pongan et al., 2017; Schindler et al., 2015; Verna et al., 2020), a quarter of the quantitative studies were quasi-experimental (n = 7; 25%) (Belkofer et al., 2014; Choi et al., 2009; Costa et al., 2020; Cucca et al., 2021; Hsieh et al., 2019; Kaimal et al., 2017; Walker et al., 2018), and about a fifth of the quantitative studies were pre-experimental (n = 6; 21.43%) (Ettinger et al., 2023; Fisher et al., 2020; Goldblatt et al., 2011; Haiblum-Itskovitch et al., 2018; Kleinmintz et al., 2014; Spring, 2004).
Mixed methods studies are the third most common (n = 9; 10.71%), with all but one study utilizing thematic analysis (n = 8; 88.89%), along with pretest-posttest single group design, pretest-posttest nonequivalent control group design, or pretest-posttest control group design. The least common types of publications were qualitative studies (n = 4; 4.94%) using thematic or latent content analysis, as well as review publications (n = 5; 5.95%), such as: scoping reviews, systematic reviews, or meta-analyses (Table 1).
Results
Review publications
Five review articles were included in this scoping review, including one meta-analysis, two systematic reviews, and two scoping reviews (Table 2). The number of articles included in these review publications ranged from 18 (Griffith and Bingman, 2020) to 46 articles (Malik, 2022; Tramontano et al., 2021). Three review articles focused on adults with neurological disorders or impairments and their caregivers, one focused on varied clinical populations, and one focused on the general adult non-clinical population. Interventions in these review articles included music therapy, drawing, and multiple methods of arts therapies (e.g., art, dance, drama, music). The results gathered from these reviews included neurophysiological and psychological outcomes, as well as implications for future research. Neurophysiological findings showed (1) activation of the prefrontal and cingulate cortices, functional connectivity, and (2) improvements in: cognitive function (e.g., information-processing, visual spatial attention, attention, episodic memory) and motor functions (i.e., walking), as well as cortisol regulation and pain outcomes (Griffith and Bingman, 2020; Malik, 2022; Oliva et al., 2023; Popa et al., 2021; Tramontano et al., 2021). Psychological findings included reduced anxiety, depression, fatigue, and aggression, as well as increased purpose in life, quality of life, self-confidence, socialization, and social status (Malik, 2022; Oliva et al., 2023; Popa et al., 2021; Tramontano et al., 2021). Implications for future research suggested seeking to build upon limitations in the field, such as reducing risk of bias, and conducting more quantitative studies (Table 2).
Table 2. Review research.
Quantitative research review
The 28 quantitative articles were reviewed for methodological and statistical strengths and weakness associated with random assignment to groups, inclusion of control or comparison groups, sample size, instruments, and statistical analyses. Arts therapies interventions were also reviewed for modality, frequency, and duration. A summary of results and recommendations followed (Table 3).
Table 3. Empirical articles summary table.
Research design
A strength was that a majority of the empirical studies included a control group or comparison group (n = 22; 78.57%), and almost half of the publications included random assignment to treatment vs. control groups (n = 15; 53.57%).
Sample characteristics
Sample sizes ranged from 10 to 209 participants, which is very broad. Participant samples included an almost equal number of females and males, more white participants than participants of other ethnicities, and diverse ages ranging from 6 to 88 years old. Presenting problems included neurological disorders (i.e., Alzheimer’s, Parkinson’s, dementia, stroke) (n = 12; 42.86%), neurodevelopmental disorders (i.e., autism, developmental disabilities) (n = 1; 3.57%), chronic illness (i.e., injury, chronic pain, cancer) (n = 2; 7.14%), psychological functioning (i.e., depression, anxiety, schizophrenia, emotion regulation) (n = 2; 7.14%), trauma, grief, and resilience (n = 1; 3.57%), parent–child relationships, substance abuse, and other general adult and community samples (n = 10; 35.71%). About half of the quantitative publications were neurological disorders, and about a third were general adult community samples. There were slightly more female participants than male participants across these studies (56% female), and more white participants than participants of other races and ethnicities, which is a typical limitation in most social science research.
Measures and instruments
A diversity of instruments, measures, and assessments were reported, including: (1) biophysiological instruments, (2) neuropsychological and psychological standardized scores from cognitive, perceptual, and performance-based tasks, and (3) standardized psychological assessments.
Biophysiological instruments included: electroencephalogram (EEG), FFT-EEG, qEEG (Belkofer et al., 2014; Corbett et al., 2019; Herrera-Arcos et al., 2017; Kang et al., 2021; Kruk et al., 2014), which measured neuronetwork activation in response to artmaking. Other examples of documenting the response to artmaking included: Event Related Potential (ERP) and Attention Quotient (ATQ). Other approaches included: functional magnetic resonance imaging (fMRI) (Bolwerk et al., 2014; Walker et al., 2018), functional near-infrared spectroscopy (fNIRS) (Kaimal et al., 2017; Kaimal et al., 2020), as well as bioelectrical measures of stress responses, heart rate, and heart rate variability (Abbing et al., 2019; Haiblum-Itskovitch et al., 2018).
There were a wide variety of neuropsychological and psychological standardized measures which included cognitive, perceptual, and performance-based tasks. Examples in alphabetical order included: Amsterdam Neuropsychological Tasks (ANT) (Abbing et al., 2019), Movement Disorder Society sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Navon Test (Cucca et al., 2021), NEPSY subtests (Corbett et al., 2019), Neuropsychiatric Inventory-Questionnaire (NPI-Q) (Choi et al., 2009), Montreal Cognitive Assessment (MoCA) (Costa et al., 2020; Cucca et al., 2021), Stroop test (Costa et al., 2020), Cognitive Assessment Screening Instrument (CASI) (Hsieh et al., 2019), etc. Physiological tracking of gaze (Cucca et al., 2021), gait (De Bartolo et al., 2020), balance (Fisher et al., 2020), and motion (Josef et al., 2019) was also used.
Examples of common standardized psychological assessments used included: Adverse Childhood Experiences Scale (ACES) (Hass-Cohen et al., 2022), Beck Depression Inventory-II (BDI-II) (Bastepe-Gray et al., 2022), Center for Epidemiologic Studies Depression Scale (CES-D) (Hsieh et al., 2019), Hospital Anxiety and Depression Scale (HADS) (Costa et al., 2020), State–Trait Anxiety Inventory (Kruk et al., 2014; Pongan et al., 2017), etc. (Table 3).
Statistical analyses
For small sample sizes, some analyses used non-parametric statistical tests to protect against violation of assumptions and low statistical power; thus, the statistical conclusion validity of some of the studies is questionable.
Outcomes
Results from biophysiological instruments and measures showed significant changes. Structurally, there were changes in activation in visual/spatial areas of the cortex, specifically for art therapy. Other structural and functional changes in activations in response to all arts therapies reviewed included: the right parietal and prefrontal cortex, gamma power in the right medial parietal lobe, alpha and theta waves, and suppression of beta band frequencies, suggesting reduced demand on cognitive functioning and increased parasympathetic functioning (i.e., relaxation) (Belkofer et al., 2014; Bolwerk et al., 2014; Corbett et al., 2019; Cucca et al., 2021; Fisher et al., 2020; Haiblum-Itskovitch et al., 2018; Herrera-Arcos et al., 2017; Hsieh et al., 2019; Kaimal et al., 2020; Kang et al., 2021; Kruk et al., 2014; Schindler et al., 2015). Spatial improvements in functional connectivity of the default mode network associated with creativity (i.e., posterior cingulate cortex/precuneus to frontal and parietal cortices) were noted for art therapy interventions, specifically, drawing (Bolwerk et al., 2014; Ettinger et al., 2023; Kaimal et al., 2020; Schindler et al., 2015). Executive functioning was found to improve in response to arts therapies (i.e., drawing, clay) based on functional connectivity within dorsal attention and executive control networks (Abbing et al., 2019; Cucca et al., 2021; Kaimal et al., 2017; Kaimal et al., 2020). Sensory function, as related to increased neuronal connectivity in the thalamic region was found (Walker et al., 2018). Motor movements and control, as well as balance, were also improved (De Bartolo et al., 2020; Ettinger et al., 2023; Fisher et al., 2020). In response to art therapy, nervous system activation associated with parasympathetic systems showed positive changes, such as through heart rate variability (HRV) measures (Haiblum-Itskovitch et al., 2018). A summary of quantitative biophysiological measures and instrument outcomes included improvements in theory of mind activation, cognition, motivation, global functioning, alertness and immune function, processing speed, and relaxation.
Results from standardized psychological measures suggested that arts therapies significantly improved anxiety symptoms, executive functioning, depression, quality of life, obsessive compulsive symptoms, helplessness, relationship quality, stress, self-esteem, pain, memory, dementia symptoms, independence, disability ratings, positive affect, creativity, and PTSD symptoms (Abbing et al., 2019; Bastepe-Gray et al., 2022; Choi et al., 2009; Ettinger et al., 2023; Goldblatt et al., 2011; Haiblum-Itskovitch et al., 2018; Hass-Cohen et al., 2021; Hsieh et al., 2019; Kaimal et al., 2017; Kang et al., 2021; Kleinmintz et al., 2014; Pongan et al., 2017; Spring, 2004; Verna et al., 2020; Walker et al., 2018).
Modalities
Modalities included arts psychotherapy (i.e., drawing, painting, clay, collage, sculpture, mask making, phototherapy), music-based interventions, dance movement therapy, mindfulness, performance arts, and neuroaesthetics. The frequencies ranged from single to 12 sessions, and the duration varied from 1-min exposures to interventions to 12-h long sessions that took place 1x to 2x per week (Table 3).
Mixed methods research
There were nine mixed methods studies reviewed (Table 4). Participants included Parkinson’s disease patients (n = 4; 44.44%), cancer patients (n = 2; 22.22%), adults impacted by trauma (n = 2; 22.22%), and community adult subjects (n = 2; 22.22%). Across studies there was a similar balance of males and females. Samples ranged in size from 7 to 50, which was small for the tests that were used. Due to small sample size and limited advanced statistical analyses (most used multiple dependent samples-tests or Wilcoxon signed ranks tests; thus, increasing likelihood of error), the validity and generalizability of these results should be interpreted with caution. Almost all studies utilized art-based interventions specifically drawing and clay work. One described a drama-based intervention. The amount of time dedicated to the intervention varied from single sessions lasting for about 45 min each, to weekly sessions lasting from 6 to 12 weeks for 1 to 2 h per session.
Table 4. Mixed methods research.
Results from the quantitative data in mixed methods studies included improvements in life satisfaction, positive affect (Elkis-Abuhoff et al., 2022; Kaimal et al., 2020), quality of life, psychological flexibility (Bar et al., 2021), processing difficult emotions (i.e., depression) and emotional awareness related to cancer (Czamanski-Cohen et al., 2019), decrease in somatic and emotional symptoms (Elkis-Abuhoff et al., 2008; Elkis-Abuhoff and Gaydos, 2018), such as OCD, phobias (Elkis-Abuhoff et al., 2013), and stress (Elkis-Abuhoff et al., 2013; Kaimal et al., 2020), trauma (Hass-Cohen et al., 2018; Kaimal et al., 2020), depression, and negative affect (Elkis-Abuhoff et al., 2013; Hass-Cohen et al., 2018; Kaimal et al., 2020; Munjuluri et al., 2020). Findings from qualitative data suggested positive emotional response to the art interventions (Elkis-Abuhoff et al., 2008), emotional expression of both negative and positive emotions (Elkis-Abuhoff et al., 2013; Elkis-Abuhoff et al., 2022; Kaimal et al., 2020; Munjuluri et al., 2020), meaning making (Hass-Cohen et al., 2018; Kaimal et al., 2020), perceived improvements to felt quality of life (Bar et al., 2021), and addressing aspects of the illness experience (Kaimal et al., 2020) (Table 4).
Qualitative research
There were four qualitative studies included in this scoping review. The methodologies of the qualitative studies included thematic analysis (n = 3; 75%) and latent content analysis of underlying meaning (n = 1; 25%). Data included transcripts of a group therapy session, individual interview transcripts, qualitative survey responses, drawings/artwork, and video recorded observations. Participants included: experienced art therapy clinicians, art therapy graduate students, adults with chronic pain, veterans with PTSD, and the general adult population. Sample sizes ranged from 5 to 122 participants that were majority female (80–100%), although the study with five veterans only included male participants (100%). All interventions involved single session art therapy individual or group experiences that incorporated drawings and mandalas after hypnotic induction, attachment bookmaking using cloth, three- and four-drawing protocols, and use of clay and pastels. Not all publications reported the length of the intervention, but of those reported, sessions lasted 2 h.
The main findings from these qualitative studies included emergent themes of (a) the neuroscientific aspects of attachment-based respect, care, and support (Hass-Cohen et al., 2015), (b) neurobiological processes associated with PTSD treatment specifically disconnection vs. connection, opening up as revealed by autobiographical retelling (Lobban, 2014), (c) Examination of neuroscience-based protocols for the amelioration of physical pain and stress which also reported on changes in cognitive/affective, social functioning, and self-identity (Hass-Cohen et al., 2022), and (d) the creation of an art therapy neuroscientific safety assessment tool based on the interpretation of pictural latent content (Gerge, 2017). In summary, the qualitative findings suggested the utility of arts therapies interventions for the amelioration of neuropsychological stress, threat and pain related syndromes and strengthened psychosocial capacities (Table 5).
Table 5. Qualitative studies.
Case studies
The case studies included in this review (n = 38) included quantitative, qualitative, and mixed methods designs. Objectives were to explore and describe potential impacts of the arts therapies. Sample sizes ranged from one to five participants, and included mostly women. With the exception of one community sample, all other samples represented clinical populations with a diversity of presenting problems. These are listed alphabetically and included: (a) biopsychological disorders such as bipolar disorder, eating disorders, panic disorders, schizophrenia, and substance abuse, (b) chronic conditions of illness such as pain and cancer, (c) medical disorders such as Alzheimer’s disease, aphasia, brain injury, cancer, cerebral palsy, dementia, quadriplegia, stroke, (d) neurodevelopmental disorders such as autism, (e) personality disorders, (f) psychological problems, such as aggression, anxiety, depression, and emotion regulation, (g) trauma and stress problems such as adult sexual assault survivors, maltreated children, and refugees, and (h) other presenting problems such as parenting concerns and perinatal anxiety. Interventions included art therapy (i.e., drawing, painting, portraits, collage, mandala, clay, sculpting, jewelry making, mask making), music therapy, dance and movement therapy. Duration of treatment ranged from single sessions to 2 years of sessions. Frequency ranged from 4x/week to biweekly sessions. Sessions lasted 15 min to 2 h; however, frequency and duration varied and not all publications reported these details.
From an integrated arts therapies and neuroscientific perspective, case studies suggested beneficial outcomes and highlighted clinical and theoretical implications. Biophysiological instruments demonstrated increased activity in alpha and beta waves, increased activation of socioemotional areas of the brain such as limbic areas of the brain, improved cognitive functioning, and recovery of chronic propognosia, as well as decreased activity in temporo-parietal areas and occipital-temporal neuropathways associated with negativity, and decreased stress markers and trauma symptoms (Belkofer and Konopka, 2008; Fachner et al., 2019; Kang et al., 2022; Holochwost et al., 2020; Pąchalska, 2022; Pąchalska et al., 2013; Pąchalska et al., 2021; Walker et al., 2016).
Other potential outcomes from these case studies were suggested or theorized. For example, that arts therapies may lead to other neuroscientific benefits, such as balanced autonomic nervous system function, utilization of the mirror neuron system and right orbitofrontal cortex (Homann, 2010; Kang et al., 2021; Pąchalska and Góral-Półrola, 2020). Findings also suggested that arts therapies promote improvements in memory reconsolidation, visual neglect status, line bisection test performance, hemispheric integration, executive functioning, and neurophysiological, neuropsychological, and psychiatric symptoms (Hass-Cohen and Clyde Findlay, 2019; Hass-Cohen et al., 2022; Homann, 2020; Kang and Thaut, 2019; Kang et al., 2022; McNamee, 2004; Pąchalska et al., 2013; Perryman et al., 2019; Warson and Warson, 2023). Cognitive findings suggested increased self-referential and associative thinking, awareness (cognitive, affective, sensory, bodily, attachment styles, coping skills), mindfulness and mind–body connection, implicit processing and somatic perceptions, cognitive functioning, and ability to address maladaptive beliefs (Carr, 2014; Elbrecht and Antcliff, 2014; Haeyen and Hinz, 2020; Hass-Cohen and Clyde Findlay, 2009; Hass-Cohen and Clyde Findlay, 2019; Homann, 2010; Homann, 2020; Pąchalska, 2022; Pąchalska et al., 2021; Pink and Mackley, 2014; Saltzman et al., 2013).
Information from quantitative psychological assessments and qualitative data also suggested improvements in affect and behavior. Affective improvements were also reported, such as: increased hope, optimism, decision-making, agency, joy, pleasure, triumph, emotional expression (i.e., anger, other negative emotions), emotion regulation, resiliency, grief-processing, desire to live and overcome depression, as well as decreased blame, trauma symptoms, pain symptoms, perinatal anxiety, stress, and trauma symptoms (Canty, 2009; Carr, 2014; Corrado et al., 2022; Gerge et al., 2019; Guseva, 2018; Haeyen and Hinz, 2020; Hass-Cohen and Clyde Findlay, 2009; Hass-Cohen et al., 2014; Holochwost et al., 2020; Homann, 2017; Homann, 2020; Klorer, 2005; Perryman et al., 2019; Riley, 2004; Walker et al., 2016; Vaisvaser, 2019). Behaviorally, case studies reported increased self-care, verbal and non-verbal communication, ability to breastfeed, positive and trusting relational interactions, overall functioning, creativity, motivation for sobriety, boundary setting, and body autonomy, as well as decreased aggression, and anxiety and avoidance behaviors (Carr, 2014; Corrado et al., 2022; Gerge et al., 2019; Guseva, 2018; Hass-Cohen et al., 2014; Homann, 2017; Homer, 2015; Mandić-Gajić, 2018; McNamee, 2005; Netzer and Brady, 2009; Saltzman et al., 2013; Stewart, 2004) (Table 6).
Table 6. Case study research.
Summary
The results are summarized according to modalities, methodologies, instruments, and measures, as well as population and context, across all articles included in this scoping review.
Modalities
Across all research methodologies, the main modalities included in the articles were: art therapy (n = 64), music therapy (n = 14), dance movement therapy (n = 10), neuroaesthetics (n = 4), drama therapy (n = 3), and phototherapy (n = 1). Art therapy was the most common modality, and several different types of interventions were reported, including clay, collage, coloring, digital art, drawing, painting, and sculpting. Many articles covered multiple modalities of arts therapies within one publication (n = 34).
Methodologies
The most common publications were case studies (almost half), and the second most common were quantitative studies (about a third). There were about a tenth of mixed methods studies, and few review and qualitative articles. This distribution of integrated arts therapies and neuroscience articles is broad but also imbalanced.
A methodological strength was the number of quantitative publications that included randomization of participants to control or comparison groups, and the use of high-tech instruments and standardized measures. Some methodological weaknesses included small sample sizes, more women than men participants, simple statistical analyses with lower power and higher likelihood of error, and a lack of consistently reporting details about the intervention (i.e., frequency and duration).
Certain modalities were only studied using certain methodologies. For example, neuroaesthetics and photo therapy were only included in quantitative research studies, and drama- and performance art-based therapies were included in review, quantitative, and mixed methods research. However, art therapy and music therapy were utilized in all methodologies.
Instruments and measures
Biophysiological instruments, neuropsychological and psychological standardized assessments, cognitive, perceptual, and performance-based tasks, qualitative interviews, and arts-based assessments were used across all reviewed studies. Standardized psychological measures were very common across studies that collected quantitative data. Interviews were very common across studies that included qualitative data. Of the biophysiological instruments, EEG was the most common, then fMRI.
Population and context
The context in which most studies took place varied, including individual therapy, hospitals, museums, group therapy, care facilities/nursing homes, rehabilitation programs, schools, research labs, and other generic settings. Medical populations were the most common, and included neurological problems (including Alzheimer’s, aphasia, dementia, neurological impairment, Parkinson’s, prosopagnosia, stroke, and TBI; n = 25), pain or injury (including chronic pain, multiple sclerosis, physical rehabilitation from injury, and pain management; n = 5), chronic illness (including cancer, chronic illness; n = 4). The second most common population studied were general community adult samples (n = 20), and trauma (including resilience, trauma, grief, stress, and Veteran populations; n = 19). A minority of the studies focused on psychological functioning (including anxiety, depression, emotion regulation; n = 5), neurodevelopmental problems (including autism and developmental disabilities; n = 5), schizophrenia (n = 2), substance use (n = 2), parent–child dynamics (n = 1), and art therapy providers (n = 1).
Discussion
The discussion of the findings was organized across the review, quantitative, mixed methods, qualitative, and case studies. The focus was on found communalities and unique aspects. The purpose was to map the state of the field and inform future directions.
Strengths and limitations of review articles
There were four review articles, with one meta-analysis from 2020. Most of the review articles focused on medical presenting problems, aside from the meta-analysis, which included publications focused on art therapy interventions with non-clinical adult samples. Findings were broad across diverse populations, problems, and functions, for example: cognitive and motor function. The main psychological findings were related to mood disorders, quality of life, and social outcomes. There was no consistent arts therapies and neuroscience theme, thread, or focus.
A strength of these review articles is that they were relatively current to the publication of this scoping review. A limitation was that empirically strong meta-analysis focused on art therapy interventions. This finding suggested that review articles on integrated arts therapies (with a diversity of modalities) and neuroscience are limited; thus, supporting the need for this scoping review, meta-analyses, and other review forms in the future. This paper provides an extensive review that maps out the current available research through charting and narrative summaries. The current scoping review of 84 articles, far surpasses the largest previous review of 46 articles (Malik, 2022; Tramontano et al., 2021); thus, ameliorating the gap that most reviews have been brief and limited (Oliva et al., 2023).
Contributions of quantitative research
Quantitative publications were the second most common publication, which underscores the growing importance of empirically supported integrated arts therapies and neuroscience research. A strength was that many of the articles were within the past 10 years. Of the quantitative publications, about half were focused on neurological disorders and about a third were about non-clinical community adult samples. Over half of the quantitative publications utilized art therapy, while other modalities included music, dance, neuroaesthetics, performance, and photo therapies. These results demonstrated that all the arts therapies modalities included in this review have some empirical support, and that the most empirically supported modality was art therapy. There were slightly more female and white participants in these studies, which is common in social science research. However, future researchers should make further efforts to fill in the gaps with more diverse samples with more varied clinical presenting problems.
A strength found by this current review of the quantitative studies was that over three fourths of the studies included a control or comparison group, and half of the studies included random assignment to groups. However, the statistical analyses chosen for these research designs were somewhat weak due to low power from small sample sizes, or less than ideal selection of statistical tests (i.e., using multiple dependent samples t-tests instead of one repeated measures ANOVA, or using dependent samples t-tests with a small sample instead of using Wilcoxon signed ranks test); thus, leading to increased risks of error and threats to validity and generalizability of the results. Results suggested improvements in cognitive function, sensory function, motor function, and executive function, as well as decreases in stress, anxiety, depression, pain, OCD symptoms, and increases in quality of life, relationship quality, memory, positivity, and creativity. There were no shared integrated arts therapies and neuroscience threads across all quantitative publications. Articles selected an arts therapies and neuroscience focus without a rationale tying it to previous research. This finding supported one of the gaps identified earlier, that integrated arts therapies and neuroscience research has addressed some but not all neuropsychological psychological domains (Czamanski-Cohen and Weihs, 2016; Malik, 2022; Strang, 2024). A mapping of arts therapies and neuroscience foci is needed to systematically provide focused direction for future research; thus, highlighting the importance of this publication in providing a step toward this goal.
Mixed methods research themes
Mixed methods research studies topics focused on Parkinson’s, cancer, trauma, and community non-clinical samples. All but one study were focused on adults, with an even distribution of medical, psychological, and non-clinical populations. Demographics were evenly balanced for male and female participants. These research studies predominantly included art-based interventions, aside from one focused on drama therapy. Interventions varied in frequency and duration. Mixed methods designs were predominantly pretest-posttest designs with thematic analyses of participant narrative self-reports. Most sample sizes were relatively small for the statistical tests that were used; therefore, limiting generalizability of the results. Results suggested improvements in positive affect, emotional awareness and processing, and decreases in phobias, OCD, and trauma, as well as negative affect and emotional and somatic symptoms. Findings supported these results with perceived and self-reported improvements in positive affect and emotional expression, as well as highlighting meaning making experiences. Relative to quantitative and case studies, only about a tenth of the total studies were mixed methods designs. The rationale for a mixed methods research did not seem to be grounded in the aims of arts therapies and neuroscience integration, nor for specific populations. Again, shared arts therapies and neuroscience themes or approaches were lacking, thus, constraining future research directions, and further contributing to the gaps (King and Strang, 2024).
Paucity of qualitative research
There were only a few qualitative studies. Participants included art therapy clinicians and graduate students, adults with chronic pain, veterans with PTSD, and community samples of adults. Most participants in these studies were female, and sample sizes ranged broadly from small to large. Qualitative studies focused on single session, art therapy interventions; however, duration was not well described. Findings suggested that qualitative studies used thematic analyses to describe neuroscientific aspects related to attachment, safety, and trauma processing. Qualitative outcomes related to cognitive, affective, and social functioning related to pain were described. These articles contributed to theoretical understandings of the connections between arts therapies and neuroscience (Hass-Cohen and Carr, 2008; Czamanski-Cohen and Weihs, 2016). However, when compared to other types of publications, additional qualitative publications are needed to support the development of constructs needed to inform quantitative research.
Prevalence of case study research
Case studies were the most common type of publication and included single participants and small samples of a diversity of clinical problems, which ranged from non-clinical community samples to severe mental health and medical disorders, including: biopsychological disorders, chronic illness, medical disorders, neurodevelopmental disorders, personality disorders, psychological problems, trauma, and social problems. A majority of the participants were adult women. Case studies focused on arts therapies, music therapy, and dance movement therapy with varied frequency and duration. Case studies included quantitative, qualitative, and mixed methods data. Including pre- and post-test findings was a strength of the case studies. Outcomes were limited in that not all studies reported the details on the intervention. Data was gathered from biophysiological instruments, psychological assessments, self-report surveys, interviews, and artwork. The use of biophysiological instruments was a strength of case studies and contributed to closing the gap between theory and empirical backing (Malik, 2022). Case study publications presented the neuropsychological impacts of arts therapies, as well as suggested neurological evidence for the integration of arts psychotherapies and neuroscience. Outcomes suggested improvements in brain activity and integration, cognitive functioning, memory reconsolidation, psychological symptoms, affect, and behavior. The current review of these case studies incorporating biopsychosocial instruments could be used for the development across arts therapies and neuroscience research (Strang, 2024).
Implications
Based on these findings, clinicians and researchers alike may be able to glean a better idea of the state of the field, as well as interpret implications for limitations and suggested future directions in these topic areas. For example, the most frequently researched modality of all the publications on integrated arts therapies and neuroscience, was art therapy. This suggests that its connections to neuroscience have been considered and studied the most, which may lead to it being more understood and accepted in the field; however, further research and documented clinical work needs to be conducted on other modalities to be able to decipher what is most beneficial for diverse clients and presenting concerns. Many studies were focused on medical issues, perhaps suggesting that most research in this integrated field relies upon medical art therapists who have access to populations with medical concerns, and the ability to collect neuroscience data using biophysiological measures. This also suggests that art therapy is more accepted and deemed as feasible in a hospital or neuroscience research setting than other areas of psychological research. The most frequently reported methodology incorporating arts therapies and neuroscience were case studies; thus, suggesting that to this point, it has been the most feasible way to integrate these topic areas. Further research with a range of modalities, especially those with more high-quality design and empirical strength, are needed.
Limitations
There were limitations specific to different methodologies. For example, the rationale for the quantitative studies seemed to be idiosyncratic to the researchers’ interests, and do not follow an overarching trend or articulated rationale for the integration of neuroscience and arts therapies. The purpose of the qualitative outcomes seemed to be more in support of building theory, with the exception of one publication, which was a follow-up to a quantitative study. It is not clear how the qualitative studies may contribute to other future evidence-based or quantitative empirical studies. A limitation of the case studies was that some theorized outcomes were often based on one or few participants.
More generally, a limitation in this field of study is that most arts therapists may not have access to biophysiological instruments, and therefore are hypothesizing about changes and processes in the brain based on prior research and theories without being able to measure them in research studies. This is an area of future transdisciplinary research that would benefit this integrated field (Malik, 2022). It is suggested that art therapy researchers collaborate with neurobiological researchers to be able to have support in accessing biophysiological instruments and interpreting data collected.
One of the main aims of arts therapies and neuroscience is to identify neural pathways responsible for mechanisms of change in arts therapies, to understand neural processes and support the effectiveness of arts therapies (Strang, 2024). However, the general scatter of methodologies and modalities included in these publications is what makes it difficult on how the evidence can clearly inform pathways in the field based on how systems interact in this integrated arts therapies and neuroscience field. This heterogeneity compromises the comparability of the results, thus, limiting the generalizability of findings and ability to differentiate effectiveness based on methodology and modality. It is suggested that more researchers used mixed methods to be able to speak to quantitative and qualitative effects of operationalized interventions, and to target specific modalities and presenting problems. This is still emergent and hopefully will be clarified as the field continues to develop and grow in its supportive evidence base.
Any publications on integrated arts therapies and neuroscience may have been missed, as more may have been published since this review was conducted in 2024. However, this review was able to include more publications than previous reviews, specifically 25 quantitative studies, which more than doubles what had been found only a few years earlier (Malik, 2022); thus, suggesting the rapid proliferation of publications in this integrated field. Overarching limitations across all publications included a lack in methodological strength of the research design, and statistical analyses. Most articles were theoretical, meaning they described how neuroscience may play a role in arts therapies. While these articles are helpful in understanding possible connections in this field and may inspire areas of future research, they are limited in that it is difficult to assess accuracy of these theories until further research is conducted. In addition, the collection of integrated arts therapies and neuroscience research lacks directionality in approach, as there are too many differences across publications and a lack of clear definitions, which makes it difficult to determine neural correlates to certain modalities and outcomes. Most research is exploratory and dependent on researcher assumptions, expertise, and accessibility to certain instruments and populations.
Future directions
Future directions for each methodology and general recommendations are considered. For purposes of meta-analysis, additional high quality, quantitative research on multiple forms of arts therapies and more diverse populations and specific presenting problems must be conducted to have more publications that are eligible to be included. For mixed methods research, the recommendation is to continue to engage in such methodologies, as there were less of these publications, and no Delphi studies were noted. Mixed methods studies have the potential to better explain quantitative data, fine-tune interventions, and could be useful for program design. It may behoove the field to consider engaging in such methodologies that include feedback from experts in the field.
For general recommendations, the use of multiple modalities in almost half of the publications allowed for understanding of overarching neuroscientific benefits of arts therapies as well as benefits that were unique to individual modalities. Further research may solidify understanding in the field about what specific neuroscientific processes and benefits are present for each individual modality. Standardization of methodologies, instruments and measures, and use and implementation of modalities with diverse populations, as well as focus across researchers will happen in time in order to support the further development of this integrated field and will support attempts to contribute to theories and research of arts therapies, effectively.
Conclusion
The main objectives of this scoping review were met in that there is now an existing map of the state of the field of integrated arts therapies and neuroscience research. This scoping review provides a comprehensive body of knowledge based on the review, quantitative, qualitative, and case study publications on integrated arts therapies and neuroscience. A review of theoretical publications further supporting the understanding of integration arts therapies and neuroscience from the current authors will be forthcoming. This scoping review is unique in that it included multiple modalities of arts therapies and diverse psychological topics. This review summarized and synthesized populations, settings, presenting problems, instruments, measures, and outcomes included in integrated arts therapies and neuroscience research. While this scoping review was able to summarize and synthesize the state of the field of integrated arts therapies and neuroscience, it is still too early to be able to compare and contrast results and findings or make more solid conclusions. Considering the variability of the reviewed publications, it is recommended that there is greater methodological alignment among future studies. For example, if there were more methodologically strong quantitative studies with large sample sizes and advanced statistical analyses, this would allow for more meta-analyses to be conducted to better inform the effect of arts therapies. This scoping review is of utmost importance as it provided implications for the field and made suggestions for future directions, which can be of value for both researchers and clinicians.
Data availability statement
The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding author.
Author contributions
RB: Conceptualization, Data curation, Investigation, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing. NH-C: Conceptualization, Formal analysis, Investigation, Writing – original draft, Writing – review & editing. AE: Data curation, Writing – original draft, Writing – review & editing, Formal analysis. TO'R: Data curation, Writing – original draft, Writing – review & editing, Formal analysis. EL: Data curation, Writing – original draft, Writing – review & editing, Formal analysis.
Funding
The author(s) declare that no financial support was received for the research and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The authors declare that no Gen AI was used in the creation of this manuscript.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2025.1569609/full#supplementary-material
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Keywords: scoping review, art therapy, arts therapies, neuroscience, modalities
Citation: Bokoch R, Hass-Cohen N, Espinoza A, O’Reilly T and Levi E (2025) A scoping review of integrated arts therapies and neuroscience research. Front. Psychol. 16:1569609. doi: 10.3389/fpsyg.2025.1569609
Edited by:
Luis Manuel Mota de Sousa, Universidade Atlântica, PortugalReviewed by:
Gianluca Cruciani, University of Rome Tor Vergata, ItalyGeyslane Pereira Melo de Albuquerque, Universidade de Pernambuco, Brazil
Ricardo Sousa Mestre, Atlântica University, Portugal
Isabel Bico, University of Evora, Portugal
Copyright © 2025 Bokoch, Hass-Cohen, Espinoza, O’Reilly and Levi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Rebecca Bokoch, cmJva29jaEBhbGxpYW50LmVkdQ==
†ORCID: Rebecca Bokoch, orcid.org/0000-0002-8624-2814