Art Therapy For Anxiety

  • Isabel Rivera Doctor of Philosophy – PhD, University of Manchester, UK

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Introduction

Art therapy is a psychotherapy approach in which art is used to express difficult thoughts and feelings. This is done with the support of professional art therapists. While anxiety is a normal experience of life, many people experience anxiety disorders, where a sustained feeling of anxiety does not disappear and may worsen over time. Art therapy is a treatment that can be used to address the complexities arising from anxiety disorders.1

Anxiety disorders are one of the most common mental health issues diagnosed. Cognitive behavioural therapy (CBT) is a common treatment, sometimes in conjunction with taking pharmaceutical drugs like tricyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, or selective serotonin uptake inhibitors

However, treatment is not a ‘one size fits all’ approach. Art therapy is a complementary therapy option that is used to improve the effectiveness of anxiety treatments. Through art expression as a means to access memories and emotions, art therapy can help in developing self-awareness and emotion regulation to combat the overwhelming feelings of anxiety.1,2,3

Understanding your anxiety

What is anxiety?

Anxiety is an emotional response in anticipation of a perceived future threat. People experiencing anxiety usually express feelings of apprehension and worrying thoughts. Having occasional anxiety due to stress factors is a normal part of life. 

However, some people experience anxiety disorders, where prolonged feelings of anxiety and recurring intrusive concerns interfere with their quality of life and normal functioning. There is an exaggerated concern about a future threat that results in hypervigilance and emotional dysregulation. In these cases, anxiety may manifest physically with symptoms such as sweating, trembling, dizziness, or increased heart rate.4,5

Types of anxiety disorders

Mental health disorders categorised as anxiety disorders are:

Collectively, these are the most commonly diagnosed mental health disorders. It is the most prevalent class of mental health disorder in Europe and the US, occurring in 14% and 18.1% of adults, respectively.2,3

Symptoms of anxiety

Having anxiety results in the release of stress hormones like adrenaline and cortisol. This can lead to many different physical and mental symptoms, such as:

  • Increased or irregular heart rate
  • Lightheadedness or headaches
  • Chest pains
  • Loss of appetite
  • Sweating or feeling hot
  • Restlessness
  • Nervousness or tenseness
  • Difficulty sleeping
  • Difficulty concentrating
  • Inability to relax
  • Having obsessive, intrusive thoughts

Anxiety can also lead to behavioural issues like:

  • Compulsive behaviour
  • Avoidance 
  • Difficulty in relationships
  • Difficulty with self-care
  • Struggling with trying new things

Such symptoms and behaviour changes can affect day-to-day living and social functioning. Anxiety disorders are reported to be the sixth leading cause of disability, according to the Global Burden of Disease study.6

Causes of anxiety

Various stressors can cause anxiety, such as:

  • Work pressure, as well as unemployment or retirement
  • Relationship difficulties such as divorce or family issues
  • Financial problems 
  • Health issues 
  • Bereavement
  • Painful, traumatic experiences such as bullying, neglect, or abuse
  • Significant life changes like childbirth or marriage

What is art therapy?

Art therapy is a form of psychotherapy that focuses on creating visual art and talking to a licensed art therapist to address mental health issues like anxiety. While art forms like music, dance, and drama are also used as treatment, each has its own therapeutic approach. 

Art therapy commonly refers to using visual art as media. Art therapy draws on various psychotherapy perspectives such as:

Art therapy has been used as a treatment for various mental health issues such as:

Art therapy can be done on its own or as part of a mental health program, as well as in a group or individual setting. Individuals will create art and talk with their art therapist. They may also make art in silence if preferred. The therapist may quietly watch their client work or make art alongside them. Through the session, the therapist will guide the person to express their thoughts, feelings, and experiences that come up during the creative process.5

Understanding anxiety through art

The rationale behind art therapy for anxiety is that excessively talking about the thoughts, emotions, and experiences causing the anxiety and trauma can be detrimental. Excessive talking can arouse feelings of fear and lead to physical manifestations of anxiety. 

Since art therapy is primarily a non-verbal approach, this can help mentally and emotionally distance oneself from anxious thoughts and emotions. Therefore, the individual feels in control instead of overwhelmed with worry, allowing them to cope with and face the anxiety.5

Techniques used in art therapy

Many different art activities can be done for art therapy. Some activities that can be done during a session of art therapy are:

  • Painting
  • Drawing
  • Sculpting
  • Clay modelling
  • Collage making
  • Mandala creation1

Mindfulness techniques

Mindfulness is an important skill in several therapy approaches. It is about experiencing and acknowledging the present, teaching the person to slow down their thoughts and focus on the full experience of the moment through their senses. This lowers stress and increases relaxation.8

An example is a full body ‘scan’ and relaxation. With your eyes closed and in a comfortable position, start mentally scanning your body from head to toe, relaxing the muscles slowly as you go. Relax the forehead, eyebrows, cheeks, mouth, neck, shoulders, toes, etc. After this, draw how your body felt before and after the scan with some drawing materials (paper, crayons, markers, etc.). 

With the art therapist, the individual discusses how the artwork reflects their experience of mindfulness.8

Drawing

Drawing is used in art therapy to express thoughts, feelings, hopes, dreams, worries, and fears. The person is free to choose which art medium to use for their drawings. This develops their autonomy and decision-making skills which can be translated into their daily life. 

Sometimes, prompts are given on what to draw, providing a structure and starting point. Though, the person may be asked to draw whatever comes to mind. A discussion about the artwork usually takes place, allowing them to observe, analyse, and reflect on the symbols and thoughts that the artwork represents.8

For example, the therapist may ask you to imagine walking through a dark forest. On one half of the paper, draw what is behind you as you imagine how you feel, see, touch, and hear as you walk through the forest. On the other half, draw what is in front of you. This activity prompts an exploration into one’s perception of the past and the future.8

Collages

Collaging is another medium for art expression. This involves activities like selecting and pasting objects and photos into a montage (photo collage), assemblage (sculptural collage), and decoupage (paper collage). 

In art therapy, collaging has been used as:

  • A therapeutic tool that develops autonomy and decision-making skills
  • A projective assessment - a subjective personality test that is meant to reveal unconscious thoughts and desires
  • A way to improve communication skills through visual mediums
  • A way to cope with grief9

The therapeutic impact of art

Talking about anxiety and what is causing it can be difficult. During art therapy, creating visual art is used as a mode of expression for thoughts and feelings. This, in turn, can result in better communication by learning how to articulate these thoughts and feelings. 

Art therapy can develop skills that help you manage anxiety, such as: 

  • Emotion labelling
  • Developing mindfulness
  • Better communication
  • Increased trust
  • Self-awareness
  • Emotion regulation

Summary

Having overwhelming anxiety can make it difficult to express thoughts and emotions. Art therapy can be a useful approach for people who are experiencing anxiety. This lets them access, express, and reflect on their thoughts, emotions, and experiences in a safe and distanced manner through art, with the support and guidance of an art therapist. This can result in better management of anxiety and developed skills like improved communication, trust, self-esteem, and emotion regulation.

References

  1. Abbing A, Ponstein A, van Hooren S, de Sonneville L, Swaab H, Baars E. The effectiveness of art therapy for anxiety in adults: A systematic review of randomised and non-randomised controlled trials. Berger VW, editor. PLOS ONE. 2018 Dec 17;13(12):e0208716.
  2. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry [Internet]. 2005 Jun 1;62(6):617. Available from: https://pubmed.ncbi.nlm.nih.gov/15939839/
  3. Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology. 2011 Sep;21(9):655–79.
  4. National Institute of Mental Health. Anxiety Disorders [Internet]. National Institute of Mental Health. National Institute of Mental Health; 2023. Available from: https://www.nimh.nih.gov/health/topics/anxiety-disorders
  5. Abbing A, Baars EW, de Sonneville L, Ponstein AS, Swaab H. The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial. Frontiers in Psychology [Internet]. 2019 May 29;10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549595/
  6. Baxter AJ, Vos T, Scott KM, Ferrari AJ, Whiteford HA. The global burden of anxiety disorders in 2010. Psychological medicine [Internet]. 2014;44(11):2363–74. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24451993
  7. Hu J, Zhang J, Hu L, Yu H, Xu J. Art Therapy: A Complementary Treatment for Mental Disorders. Frontiers in Psychology [Internet]. 2021 Aug 12;12(34456801):686005. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397377/
  8. Buchalter S. Art Therapy Techniques and Applications [Internet]. Google Books. Jessica Kingsley Publishers; 2009 [cited 2024 Feb 1]. Available from: https://books.google.co.uk/books?id=a30cgI5RSvgC&dq=art+therapy+techniques+exercises&lr=&source=gbs_navlinks_s 
  9. ‌Stallings JW. Collage as an Expressive Medium in Art Therapy. The Wiley Handbook of Art Therapy. 2015 Nov 6;163–70.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Isabel Rivera

Doctor of Philosophy – PhD, University of Manchester, UK

Isabel Rivera, PhD, is an accomplished oncology researcher with a strong acumen for medical communications and creative marketing. With experience in scientific and medical writing, Isabel excels in simplifying intricate scientific concepts. She combines research practice, project management skills, teaching experience, and digital marketing expertise to drive impactful outcomes in roles requiring scientific rigor and effective communication.

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