Overview 

Definition of art therapy

Art therapy is a form of psychotherapy. Psychotherapy is a broad term that describes tackling mental health issues by talking with a mental health care professional such as a psychologist or psychiatrist. In art therapy, the professional is referred to as an art Therapist or an art psychotherapist. ¹ These people are professionally trained to deliver therapy that uses art as a mode of expression and a way to communicate complex thoughts and feelings. The therapy can involve talking to your art therapist about your thoughts and feelings.¹ The aims of art therapy are broad and depend on the needs of the patient they can include:¹

• Reducing distress
• Gaining personal insights 
• Promoting self-worth 
• Improving emotional and mental health
• Improving social skills 

Art therapy is well-regulated in the UK. Art therapists must be registered with the Health and Care Professions Council.¹

Definition of cognitive-behavioral therapy (CBT)

Cognitive-behavioural threapy (CBT) is another form of psychotherapy. It is a talking therapy that aims to change the way you behave and think to tackle your problems. It is commonly used to treat depression or Anxiety but can be used for other conditions. It is based on the concept that negative feelings can trap you in a cycle of negativity. It is designed to help change your actions as it is based on the fact that thoughts and feelings are interconnected with physical actions. CBT is designed to help with current problems rather than ones from your past. It aims to digest people's overwhelming problems into smaller parts to find practical solutions.²

A brief overview of the significance of combining art therapy and CBT

CBT can be very effective in treating anxiety and depression. It does however receive some negative comments for being too verbal for patients. This is why art therapy is considered a good combination with CBT. Combining art therapy with CBT is designed to allow patients to slow down when they are feeling pressured and overwhelmed. It provides a way of expressing feelings in the moments when words fail to communicate them alone^.3 

Understanding art therapy

Explanation of art therapy as a form of psychotherapy

As described art therapies are mental health treatments which use interactive art activities for treatment.¹

Overview of the creative process in art therapy

Patients don't need any skills or experience in art to benefit from it, and it can be used for patients of any age. Art therapy uses creative materials to make visual art that expresses your thoughts and feelings. Common materials and methods used include:⁴

• Paint
• Crayons 
• Pencils 
• Collaging 
• Chalk
• Photography
• Videography 

Art therapists will help provide ideas, prompts and themes. Therapists will never judge the art. Instead, they help people explore how making the art felt and what the piece means to them. Not every material or design choice will have a meaning, but therapists will help explore the aspects that do. For example, they may ask about a certain colour choice.⁴

Exploration of how art expression can serve as a therapeutic tool

There are several ways the expression of thoughts and feelings via visual art helps people, it can:⁴

• Allow the self-expression of thoughts and feelings that couldn't be articulated by words. 
• Allow people to recognise personal growth and strength by examining their inner self. 
• Explore difficult personal situations someone has experienced 
• Encourage someone to look at a problem in a new, more positive way 
• Make people more comfortable and relaxed in therapy 

Who can they treat?

The National Institute for Health Care and Excellence  (NICE) states that art therapy should be a considered form of treatment for those with⁴

• Schizophrenia 
• Psychosis 
• Schizoaffective disorder 

Research does, however, suggest that art therapy can help several other mental health disorders. In general, it can be beneficial for anyone having a difficult time putting their thoughts and feelings into words, which can be an aspect of several mental health issues:¹

• Art therapy can also be helpful for people processing trauma 
• It can also be used to help people who have faced difficult personal or cultural issues. 
• It can help people whose lives have been affected by a disability or illness. 
• Note this doesn't mean it can help cure a physical illness. Instead, it allows people to work through its impact on their lives.⁵

Understanding cognitive-behavioral therapy (CBT)

CBT is a structured, goal-oriented talking therapy. CBT  is a form of psychotherapy based on the fact how we think can affect how we feel and act. CBT aims to stop negative thought cycles by making your problems more manageable.⁶

Overview of key principles of CBT, including identifying and challenging negative thought patterns

CBT aims to make problems more manageable by breaking them down problems into smaller parts. CBT does this using 5 key areas to dissect them:⁶

• Thoughts
• Emotions 
• Situations 
• Actions 
• Physical feelings 

CBT is based on the concept that these 5 areas are connected, and so they all affect each other.6 Therefore, CBT combines 2 types of therapies to examine:⁷

• What you think = Cognitive therapy 
• The things you do = Behaviour threapy 

CBT works on the basis that it is:⁶ 

• Very structured: specific problems and goals are set out for conversations by the patient and therapist. 
• Focused on current problems: CBT doesn't aim to dive into your past problems. Instead, it is highly focused on your current thoughts and actions. 
• Pragmatic: CBT aims to find practical solutions. 
• Collaborative: You will work closely with your therapist to come up with these solutions, your therapist will not solely dictate. 

Who can it treat?

CBT can be used to manage a range of mental health concerns including:⁷

• Depression 
• Anxiety 
• Emotional issues relating to stress or grief 
• Anger problems 
• Bipolar 
• Phobias 
• Post-traumatic stress syndrome 
• Drug or alcohol problems 

It can also be used to help non-psychological conditions such as:²

• Insomnia 
• Chronic pain 

Integration of art therapy and CBT

Insights from art therapy and CBT can be usefully integrated into a treatment plan to promote self-awareness and positive thoughts and actions.³

How can art be integrated into CBT sessions?

It should be noted that art therapy is not a form of CBT.  Instead, CBT can be used as part of an approach to art therapy.³ Here is an example of how they can be combined:⁸

• Visual Art Activity (art therapy) to express thoughts and feelings
• Art reflection: The creative process and outcomes can be discussed to identify related emotions and feelings 
• CBT Can then be introduced to identify and challenge negative thoughts and actions 
• Integration of outcomes of art therapy and CBT combined for future treatment plans that promote positivity to break negative cycles. 

The rationale for combining art therapy and CBT

There are several rationales behind combining art therapy and CBT: 

• Art therapy can help you to slow down if you are feeling overwhelmed by CBT³
• Art therapy can help when words fail to feel adequate.³
• It can improve a patient's recognition and acceptance of a treatment.⁹

Exploration of how art expression enhances traditional CBT techniques

Art therapy enhances and supports traditional CBT. Art marking aids the exploration of unhelpful and negative thoughts. It offers an additional path from talking to uncovering personal growth, self-awareness and emotional regulation.⁸

Challenges and considerations

CBT and art therapy will not always serve as perfect therapies. Several barriers may occur depending on the needs of the patient and therapy may have some bumps in the road. 

 Potential challenges in art therapy¹⁰

• People with low self-esteem may feel as if they are not good enough at art to succeed in art therapy. 
• Time-limited sessions may cause frustration if art pieces can't be completed and may reduce the effectiveness of an art piece in conveying emotions.   
• Introverts may find it difficult to open up to their art therapist right away.

Potential challenges in CBT¹¹

• Lack of patient cooperation: People can be advised on how to lift their mood and change their actions. However, if people do not follow through with solutions, problems will not go away.
• CBT can be too structured for people with very complex mental health disorders 
• Confronting problems may cause initial periods of increased anxiety 
• Too specific: Some people argue that only focusing on current problems can leave past issues and underlying causes of mental health issues overlooked 

Summary

Art therapy and CBT are 2 different approaches to tackling mental health issues. They can be used to tackle anxiety, depression, stress,  trauma, psychosis and several other conditions. CBT and art therapy can be used on their own or in combination with one another^.4,7 Whilst art therapy focuses on conveying complex thoughts and feelings through visual art,¹ CBT is based on talking.² CBT is designed to tackle overwhelming problems by breaking them into smaller parts and coming up with solutions to beat negative mental and action cycles.² Art therapy can be seen as an approach to CBT. Art therapy can be used to enhance the benefits of CBT  by adding another way to communicate feelings and promote personal growth.⁸