Accepted Manuscript

Title: Emotion regulation strategies and effects in art-making:

a narrative synthesis

Authors: Harald Gruber, Renate Oepen

PII: S0197-4556(17)30005-9
DOI: https://doi.org/10.1016/j.aip.2017.12.006
Reference: AIP 1498

To appear in: The Arts in Psychotherapy

Received date: 14-1-2017

Revised date: 1-8-2017
Accepted date: 15-12-2017

Please cite this article as: Gruber, Harald., & Oepen, Renate., Emotion regulation
strategies and effects in art-making: a narrative synthesis.The Arts in Psychotherapy
https://doi.org/10.1016/j.aip.2017.12.006

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Emotion regulation strategies and effects in art-making: a narrative

synthesis

Title Page:
Title:
Emotion Regulation Strategies and Effects in art-making: A Narrative Synthesis
Author:

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Prof. Dr. Harald Gruber,
Alanus University of Arts and Social Sciences, Department of Arts Therapies and Therapy

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Science

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Villestrasse 3, 53347 Alfter/Bonn, Germany

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Phone: +49-(0)2222-9321-1800; Fax: +49-(0)2222-9321-1860
Email: harald.gruber@alanus.edu

Short biographical note: U

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Professor for Art Therapy at Alanus University of Arts and Social Sciences
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Dean of the Creative Arts Therapies & Therapy Sciences Department,
Co-Director of the Research Institute for Creative Arts Therapies RIArT
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Co-author and corresponding author:

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Dr. Renate Oepen,

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Alanus University of Arts and Social Sciences, Department of Arts Therapies and Therapy
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Villestrasse 3, 53347 Alfter/Bonn, Germany

Phone: +49-(0)2222-9321-1800; Fax: +49-(0)2222-9321-1860
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Email: renate.oepen@alanus.edu
Short biographical note:
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MA Art Therapy, Research Assistance, Occasional Teacher

Department of Arts Therapies and Therapy Science, Alanus University

Acknowledgements
This work was conducted at Alanus University of Arts and Social Sciences, Alfter. It was
supported by Alanus University.
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The author and co-author declare that there are no conflicts of interest in relation to the subject
of this study.

Highlights: 

 the mood-elevating effects of art-making were stronger when art was used to distract 
 art therapy interventions are most effective when they entail a structured task leading
to a specific end result or goal state 
 the importance of psychological models of emotion regulation for research in art
therapy 

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Abstract

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Questions concerning the regulation or dysregulation of emotions in mental distress

states are not only of fundamental concern in psychotherapy research but also a key issue in

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the art therapy field. Nevertheless, few studies have investigated the effectiveness of artistic
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activities in emotion regulation. This review aims to identify and analyze studies that
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investigate art-making to regulate emotions. Most studies to date have examined the effects of
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short-term mood repair, but some did investigate emotion regulation models in a

psychotherapy setting. They revealed that in positive mood enhancement resulted from art-
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making. A few comparative studies suggested that art-making was more effective than other
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therapies, with distraction strategy demonstrating special success in regulating emotion.

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Future research on emotion regulation in art therapy should also address psychological

models and take specific active factors of art into consideration.

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Keywords
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emotion regulation; art therapy; narrative synthesis; mood enhancement

Introduction

Scientific knowledge in the creative arts therapies (art, music, dance and drama

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therapy) is heterogeneous. Compared to psychotherapy, arts therapies as a field are less

systematically investigated. However, in recent years a growing number of systematic studies

on various arts therapies have been published, for example, on oncology (Boehm, Cramer,

Staroszynski, & Ostermann, 2014; Bradt, Dileo, Grocke & Magill, 2011; Gruber, Rose,

Manheim, & Weis, 2011), psychiatry (Crawford, H.J., Killapsy, H., Barnes, T.R., Barrett,

B., Byford, S., Clayton, K., & Waller, A., 2012; Montag, C., Haase, L., Seidel, D., Bayerl,

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M., Galliant, J., Herrmann, U., & Dannecker, K., 2014) and on child therapy (Geretsegger,

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Elefant, Mössler, & Gold, 2014). In a systematic meta-analysis, Boehm et al. (2014) were

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able to demonstrate a significant decrease in anxiety in individuals living with a diagnosis of

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cancer. Nevertheless, the extant corpus in this relatively young research discipline suggests a

need for studies that are better controlled by adhering to the requirements of evidence-based

medicine (EBM) standards. U

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Working with emotions is a core activity of both art therapy (Malchiodi, 2012) and
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psychotherapy (Greenberg, 2011). The connection between art and emotion regulation has

been described, studied and confirmed in art therapy literature (Dannecker & Herrmann,
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2017; Kramer, 1958; Naumburg, 1966; Rubin, 1984). Thus, Franklin (2010) pointed out that
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creating art helps to modulate emotions that arise concomitantly with attachment
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relationships. Working in an art psychotherapeutic setting with children acting out

troubled early childhood experiences, Armstrong (2013) applied attachment theory to

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discussing the development of an individual´s capacity for emotion regulation. Working

with borderline personality disorders, Springham, Findlay, Woods & Harris (2012)
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showed that art therapy is an essential factor in helping to develop greater mentalization

capabilities. Killick & Schaverien (1997) found that, for the psychotic individual, pictures

mediate in the actual space in-between psychotic client and therapist. This relationship

mediated by an object seems to create a less threatening environment for the client with a
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fragile personality than having to relate directly to another human being. Man & Ho (2014)

also asserted that art therapy – as one major, nonverbal psychotherapeutic approach –

has attracted growing attention got its efficiency in treating depression and anxiety.

Another study explored the relationship between prevention and art therapy for clients

suffering from burnout and found a significant increase in positive mood after just one art

therapy project day (Oepen & Gruber, 2012; 2014). Nonetheless, despite the growing number

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of studies on art therapy, little systematic, fundamental research has been carried out to date to

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investigate the connection between art-making interventions and emotion regulation.

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Psychotherapy has shed additional light on this problem. Finding by Berking &

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Wuppermann (2012), by Berking, Ebert, Cuijpers & Hofmann (2013) and Webb, Miles, &

Sheeran (2012) point out lead to the conclusion that new studies addressing emotion
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regulation in the fields of psychotherapy and neuro-psychotherapy need to be validated and
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integrated with the development of treatment concepts and art therapy research. Current
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models of emotion regulation in psychotherapy research assign high importance to the

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(dys)regulation of emotions in the presence of mental distress (Gross & Munoz, 1995).
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Research questions
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Given the significant questions involved in functional emotion regulation and the

hypothesized regulation of emotions through art, we scanned relevant databases for studies
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that investigated emotion regulation or emotion regulation effects stemming from artistic

activities to synthesize them in this study. By doing so, the present review seeks to answer
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the following questions:

- What are the identifying characteristics (e.g. research questions, sample population,

type of intervention, study design) of studies on art-making for emotion regulation?

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- What types of emotion regulation strategies did these studies examine?

- What kinds of effects of art-making on emotion regulation did these studies

describe?

- In the studies reviewed, what specific active therapeutic factors in art therapy (see

Koch, 2017) effected positive changes in emotions?

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- What do the present review’s findings imply for the future development of studies on

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art therapy and its effects on emotion regulation?

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Theoretical Background

Emotion regulation – definitions and models

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In recent years, the concept of emotion regulation has emerged as a topic in
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psychological and mental health research (Berking et al., 2012). It has been variously defined
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in the psychological literature (Eisenberg & Fabes, 1992; Thompson, 1994; Huang & Guo,

2001; Cole, Martin & Dennis, 2004; Meng, 2005 as cited in Hu, Zhang, Wang, Mistry, Ran,
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& Wang, 2014). There is general agreement, however, that “emotion regulation is the set
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of automatic and controlled processes involved in the initiation, maintenance, and

modification of the occurrence, intensity, and duration of feeling states” (Webb et al.,
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2012, p. 775). Strategies for regulating emotions focus on positive and negative emotions
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producing special behavioral and physiological states. Initiating, maintaining, inhibiting or

moderating emotional reactions may lead to emotion regulation in association with processes
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that influence experience and the expression of emotions (Gross & John, 2003; ibid.).

Emotion regulation refers to the downregulation of negative affects or the upregulation

of positive affects (Webb et al., 2012).

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Concurrently, we know from Schore (2003) that psychobiologically regulated

affect transactions that maximize positive affects und minimize negative affects cocreate

a safe attachment between mother and child. “The responsive relationship supports

healthy development by containing affective states and promoting the discrimination

…” needed to maintain proximity to attachment figures (Franklin, 2010, p. 161). In the

context of art therapy, Kramer (1971) informs us that considerations of sublimation and

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the use of art materials demonstrate how art regulates affects. Arnheim (1966) also saw

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expression and perception as intimately related.

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The psychological literature describes various models for classifying emotion

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regulation strategies. In this respect, the studies by Gross & Thompson (2007) are

fundamental in the field of psychology (Barnow, 2012). The model proposed by Gross et al.
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(2007) differentiates five emotion regulation processes in a temporal dimension of antecedent-
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focused and response-focused strategies (see Fig. 1). The antecedent-focused strategies
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include situation selection (choosing more positive characteristics and the avoidance of
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problematic situations), situation modification (e.g., actively shaping an interview situation),

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attentional deployment (e.g., reacting to positive, neutral or negative aspects) and cognitive
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change such as reappraisal, (e.g., observation from a neutral perspective). An example of a

response-focused strategy is response modulation, i.e., suppressing emotion or emphasizing

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(positive or negative) emotional reactions (Barnow, 2012; Webb et al., 2012).

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Figure 1. The process model of emotion regulation (adapted from Gross & Thomson, 2007, quoted in
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Webb et al., 2012).

Strategies of emotion regulation

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Based on the model proposed by Gross et al. (2007), Webb et al. (2012) in their meta-

analysis developed a taxonomy of emotion regulation processes associated with emotion

regulation strategies. The taxonomy also contained subtypes that eventually yielded different

outcomes within the same process (Webb et al., 2012). In the context of the strategy of

"attentional deployment" (“how individuals direct their attention within a given situation so as

to influence their emotions” [Gross & Thompson, 2007, p. 13]), "distraction" was revealed as

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an effective regulation strategy and "concentration" on the current feeling as an ineffective

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one. Distraction strategy focuses “on different aspects of the situation or moves attention

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away from the situation altogether” and “may also involve changing internal focus, such as

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when individuals invoke thoughts or memories that are inconsistent with the undesirable

emotional state” (Gross & Thompson, 2007, p. 13).

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The meta-analysis by Webb et al. (2012) revealed additional determining factors that
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modulate the level of emotion regulation. These included the kind of emotion to be regulated
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(sadness, anxiety, etc.), the type and timing of inducing emotion (type of medium, personality

based vs. neutral, before or after the intervention), the frequency of application (single,
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multiple times), the intended outcome (e.g. positive vs. neutral), the strategy used, the study
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design (object of the control group) and study parameters (e.g., gender, age of subjects)
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(Webb et al., 2012).

A major problem with this model is that the strategies developed by Gross &
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Thompson (2007) partially operate in a similar manner. Furthermore, no safe statements about

the importance of specific emotion regulation strategies for coping with mental distress can be
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assumed, since their findings are based on interventions with healthy students (Barnow,

2012). Webb et al. (2012) confined their meta-analysis to studies of healthy subjects because,

in their view, clinical subjects may resort to different emotion regulation processes. For

example, they held that rumination (i.e., “self-immersed, directed attention toward feelings
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and their consequences) as an emotion regulation strategy” is particularly problematic if

subjects are already in a “dysphoric mood” (Webb et al., 2012). More recent studies dealing

with the relationship between emotion regulation and mental health tend to show inconsistent

results (Hu et al., 2014).

A few studies have investigated how the type of artistic intervention technique

correlates with emotion regulation. Positive emotional experiences were generated especially

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if subjects of the art therapy intervention were instructed to focus on positive personal issues,

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such the positive feelings stimulated by common and decorative objects (Oepen & Gruber,

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2012; Wilkinson & Chilton, 2013), or to “create artwork about ‘you at your best’” (Chilton &

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Wilkinson, 2009, p. 36).

Since studies in this field have not paid much attention to the importance of
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effective emotion regulation for mental health and of art-making activities (Berking,
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2010), it seems reasonable to call for future studies that not only focus on demonstrating
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applied methods, intervention techniques (e.g. the kind of presentation or instruction)

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and the kind of emotion regulation strategies realized, but that also dwell on how they
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may relate to observed outcomes. We applied these preferences as criteria during our
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extensive database search for our sample of studies in this field.

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Method
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Database search

We employed the narrative synthesis methodology for our review. One of the
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features of this methodology is the reliance on multiple data sources. Another

characteristic is that the results are reported in a narrative, story-telling format

(Edwards & Kaimal, 2016).

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For our review, we did an extensive search of the Psyndex, PsycINFO, Medline

and PsycARTICLES data bases spanning the period 1933-2015 on “art therapy” and

“mood” as the search terms. As they imply, the first search cast a very wide net designed

to let us capture an overview of all the application areas and target groups (clinical and

non-clinical) (see Fig. 2).

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Figure 2. Information flow during all review phases.

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Inclusion/Exclusion criteria

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The initial search resulted in identifying 478 studies (Psycinfo 315, Medline 107,

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Psyndex 49, PsycArticles 7), of which 442 studies remained for further investigation after
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duplications had been eliminated. The studies were selected against the so-called "PICOS
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criteria" (patient, intervention, control, outcome, study design) (Al-Nawas, Baulig, &
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Krummenauer, 2010). For the “patient” criterion, following the review articles by Gross et al.

(2007) and Webb et al. (2012), we only included studies referencing healthy, mentally
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unburdened subjects on the grounds that emotion regulation based on different kinds of
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mental health conditions (internalizing or externalizing) is influenced by different types of

mechanisms (overregulation- or underregulation) (Barnow, 2012). Utilizing only studies of

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healthy subjects made it possible to concentrate on the emotion regulation process supported
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by art-making activities. Comparable studies in psychology generally tend to deal with

healthy adults, especially students.

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Under the “intervention” criterion, we only included studies that intervened with art

making to keep the focus on art therapy. Hence, we excluded studies that dealt with other

forms of artistic therapy, such as dance, music, poetry and drama therapy. Since research on

emotion regulation is relatively rare in the art therapy field, psychological studies that

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examined emotion regulation strategies and a specific connection to artistic activity were

included. Also included in the sample were studies in psychotherapy that did not investigate

emotion regulation strategies per se, but that did explore other emotion regulation

mechanisms, for instance, the application of art media techniques, specific active factors of

art as plausible emotion regulation strategies and that also addressed the how and the degree

of the emotional change. In this way, the present study incorporates the part of the

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psychological research realm that focuses on specific emotion regulation mechanisms in the

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context of art therapy.

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Studies that did not cover outcome-oriented investigations, such as studies dealing

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with how pictures express different emotions, were excluded, as were pure case studies.

As previously noted, art therapy research is still a nascent research field. Hence, in
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designing the study, we expanded our search to identify studies of all evidence types (I-IV).
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The study design did not include the use of a control group. An additional, important selection
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criterion was that the studies employed established, validated empirical methods, e.g., by
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using quantitative and/or qualitative data collection instruments.

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Ultimately, we identified a total of 10 studies for the period 1933–2015 (see Table 1).
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The studies were carried out in non-clinical areas with healthy, normal adult subjects and their

findings pertained to the regulation of one or multiple emotions through artistic activity.
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Results

Overview
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The following overview (Table 1) details the 10 identified studies. We deemed it

essential to describe the characteristics of the interventions and the outcomes since our

findings are intended to serve as a basis for further study.

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Table 1. Overview of the sample studies.

Characteristics of included studies and emotion regulation strategies

The 10 studies comprising our sample were completed in the United States during the

past decade. Each examined the regulation of short-term mood through art-making. Four

studies compared the effects of applying artistic versus non-artistic activities (De Petrillo &

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Winner, 2005; Drake, Coleman &Winner, 2011; Drake & Winner, 2012; Drake & Hodge,

2015; Kimport & Robbins, 2012). Two studies by Drake and colleagues (2011; 2015)

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compared writing with drawing activity, while Kimport et al. (2012) examined the effects of

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working with clay versus ball handling (throwing a stress softball). Three studies (Kimport &

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Robbins, 2012; Sandmire, Gorham, Rankin, & Grimm, 2012; Van der Vennett & Serice,
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2012) were conducted in university art therapy departments. They all clearly feature research
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into emotion regulation from a psychological research perspective.
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Target groups
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The study subjects were healthy adult university students and artists (Nageeb, 2013).
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Interestingly, a majority of the experimental subjects were women. Seven studies had more
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than 50 participants; one study had just ten subjects.

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Research focus, duration of interventions and instruction method

The sampled studies primarily investigated the effect of artistic activities on the
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process of emotion regulation. The majority of the studies used the approach of testing

mechanisms of short-term mood repair, with interventions lasting between 5 to 30 minutes.

To induce an initial negative mood in the subject, most of the interventions screened a film

with negative content. Alternatively, subjects were verbally prompted to recall negative
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personal life events. In both cases, the negative mood had to be described in writing (Kimport

& Robbins, 2012; Drake et al., 2011, 2012). In one study only, it was not necessary for the

researchers to induce a negative mood, given that the student subjects suffered from anxiety

because of impending final examinations the next week (Sandmire et al., 2012).

Design

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Nine of the studies investigated the degree of mood change by applying quantitative

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methods in a controlled pre-post design. One pilot study (Nageeb, 2013) relied exclusively on

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qualitative methods for the investigation. Three studies (Kimport & Robbins, 2012; Sandmire

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et al., 2012; Van der Vennett & Serice, 2012), centered on measuring anxiety, while two

studies (Drake et al., 2011; 2012) examined mood modification in the subjects. Eight studies
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were performed as randomized controlled trials (inter alia, Drake et al., 2011; 2012; Kimport
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et al., 2012; Van der Vennett et al., 2012).
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Efficacy of art-making activities in achieving emotion regulation

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Nine of the 10 studies we reviewed reported significant effective short-term mood

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repair through art-making. A longer-term emotion regulation through art-making could not be

definitively described (Nageeb, 2013). The most successful short-term mood repair was
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achieved by using artistic techniques instead of other activities such as writing, throwing a
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ball, or sitting (Drake et al., 2011; Kimport & Robbins, 2012; Drake & Hodge, 2015).
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Distraction and venting

With reference to the Gross model, it was suggested that the mood-elevating effects of

art-making were stronger when art was used as a distraction, i.e., by focusing on a neutral

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topic such as drawing a house rather than as a vehicle for venting negative feelings, or in

various strategic settings such as sitting quietly (Drake & Winner, 2012).

The same study, in examining positive and negative affects, found using art-making

for distraction induced positive emotions. This effect was significant as compared with a

second type of strategy (sitting quietly). A stronger effect on mood improvement was further

achieved by making associations with positive emotions (Dalebroux et al., 2008). Use of the

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venting strategy resulted in the most negative affects being recorded, with higher negative

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values than were measured for the control group using the sitting strategy. Gender also

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impacted use of the venting strategy: the impact was worse for men using the strategy than for

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women (Drake et al., 2012). The preferred distraction strategy was artistic activity; writing

activity was preferred for expressing feelings (Drake & Hodge, 2015).
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Directive approach in art therapy
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Regarding the methods used, the studies suggest that art therapy interventions are most
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effective in alleviating negative mood states when they entail a structured task leading to a
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specific outcome or goal state (Kimport & Robbins, 2012). The strength of the regulatory
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effect appears to depend on the specific type of pattern to be colored: coloring a mandala

reduced anxiety significantly more than did coloring a plaid pattern or blank sheet of paper
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(Van der Vennett et al., 2012; Babouchkina & Robbins, 2015). Thus, art-making activities
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seem to be superior to other methods for elevating short-term mood enhancement. The

distraction strategy had more impact than venting when using art-making activities. Some
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studies noted the influence exerted by the artistic method and form of instruction on the extent

of the mood enhancement.

Discussion

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We examined the “intervention” and “outcome” parameters of the ten studies that met

our criteria for this narrative synthesis, to develop starting points for further research

projects on the topic of emotion regulation in the field of art therapy.

As noted previously, the studies in our sample only examined healthy subjects, mostly

students and, in one study, artists. Most of the subjects were women. We found that emotion

regulation strategies as described and observed in psychological models and studies (e.g.,

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Gross & Thompson, 2007) had been examined in half of the ten selected studies (Dalebroux

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et al., 2008; De Petrillo & Winner, 2005; Drake et al., 2011; 2012; 2015). The authors

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primarily investigated two emotion regulation strategies based on findings from psychological

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research: the venting of negative feelings and distraction strategy, a form of attentional

deployment that focuses on positive or neutral emotions to distract from negative emotions
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(Gross & Thompson, 2007; Gross & John, 2003; Larsen, 2000; Parkinson & Totterdell, 1999;
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Thayer, et al, 1994 quoted in Drake et al., 2011).
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In addition, our review confirmed the results produced by Gross & Thompson (2007),
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who found that distraction strategy, a form of attentional deployment, is better suited for
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short-term mood repair than a strategy of concentrating on current emotion. Applying the
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distraction strategy through artistic activities while stressing positive emotions proved to be

particularly effective (Dalebroux et al., 2008). The positive effect of distraction strategy was
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also demonstrated in other studies that examined subjects suffering from illness or mental
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burdens (Dalebroux et al, 2008; Oepen & Gruber, 2012; 2014; Oepen, 2015).

Our review therefore points to the need for further research on distraction strategy with a
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focus both on positive and neutral emotions. Our findings confirm that it is possible to

observe efficient emotion regulation strategies (Webb et al., 2012) resulting from the use of

art-making. Participants who often used the reappraisal strategy showed more positive than

negative emotions (see Gross & John, 2003; Gross & Thompson, 2007; Hu et al., 2014).

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The type of artistic tasks and of art-making instructions appear to influence the degree

of mood enhancement. Thus, the results strongly suggest a need for investigating different

effects by a variety of artistic techniques on emotion regulation, including free-form painting,

collage making, drawing still life pictures, etc. Clearly, it will be important to carry out more

fundamental art therapy research. “Creative activity has also been used in psychotherapy and

counseling, not only because it serves as another language but also because of its inherent

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ability to help people of all ages explore emotions and beliefs, reduce stress, resolve problems

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and conflicts, and enhance their sense of well-being” (Malchiodi, 2003). The power of art

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therapy lies in its ability to evoke a practically-oriented experience with primarily nonverbal

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access embedded in artistic activities (Koch & Eberhard-Kaechele, 2014; Koch, Steinhage,

Haller, Kende, Ostermann, & Chyle, 2015).

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In line with the significant improvements in levels of emotional awareness observed
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by Montag et al. (2014) in the randomized controlled trial (RCT) of a psychodynamic group
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art therapy in acute psychotic episodes (Montag et al. 2014), more detailed research into
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which (art) intervention has the most potential for helping clients recommends itself as a topic
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of interest. Current attempts to identify the function of the arts from a health perspective
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(Koch, 2017), would benefit from investigating which active factors of the arts therapies are

of key importance (Tüpker & Gruber, 2017). As Crawford et al. (2012) point out in the
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MATISSE study, which found no difference between art therapy and standard care in
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the improvement achieved for schizophrenics, an approach combining different creative

arts therapies (for example, music therapy and body movement therapy) may be more
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effective.

Worth mentioning in this context also is the debate on whether a directive or non-

directive approach is to be preferred in art therapy. According to McNeilly (1983), the non-

directive approach in art therapy plays an additional, important role in art therapy

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interventions. He argues that resorting to direct suggestions in theme-centered art therapy may

possibly result in uncovering a powerful feeling too rapidly, creating a problem for the client ,

the group and/or the art therapist in containing or understanding it. This argument contrasts

with the results of other studies represented in this narrative synthesis that argue instead for

the advantages of a directive, theme-centered approach, especially when using distractive,

positively focused instruction (inter alia, Dalebroux, Goldstein, & Winner, 2008; Kimport &

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Robbins, 2012).

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In practice, falling between these two poles are a variety of group experiences which

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use art structures that can be interesting, revealing, and, moreover, enjoyable (Liebmann,

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1999 quoted in Edwards, 2004). In this regard, the experiences of clients in art therapy

treatment can lend additional perspectives on the effects of art-making. As Rankanen

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(2016) found in her study, 98% of the clients felt that art therapy had a positive impact
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on their psychological health, 82% recognized positive effects on their social
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relationships, and 67% noted positive physical health effects.

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More exploratory research is needed to discover in which specific context goal-

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oriented instruction (distraction or concentration strategy) is more effective than a non-

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directive instructional approach (free art-making) when it comes to regulating emotion

efficiently.
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Limitations

The following are possible limitations of the present review:

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1. The focus is only on healthy subjects.

We took this approach because we conducted our research based on current models of

emotion regulation used by psychologists (Gross et al., 2012), that favored the study of

healthy subjects first as a way of gaining initial, fundamental insights into emotion regulating
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processes before moving on to study subjects with varying illnesses. Our rationale for

emulating the psychologist’s approach was that it allowed us to make consistent, valid

comparisons.

2. The review concentrated on short-term mood changes.

Unquestionably, studying the change of emotions in an art therapy setting over longer periods

of time will be useful. It may be relevant here that the subjects in the studies we reviewed

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were mostly women and younger people (students). The study by Shella (2018), with a

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sample composed mostly of women, found significant improvements in pain, mood, and

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anxiety levels for all patients during their stay in a hospital regardless of gender, age, or

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diagnosis.

3. Inconsistent results between different art therapy settings

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According to Crawford et al., (2012) and Shella, (2018), further research is required to
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analyze emotion regulation adjusted for gender, age, sick and mentally burdened
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subjects, because these variables can be assumed to possibly correlate with the degree of
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emotion regulation (Webb et al., 2012; Drake & Winner, 2012).

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Conclusion
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Our findings underline the importance of referring to psychological models of emotion

regulation in conducting art therapy research. Investigating the specific active factors at work
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in art appears to be another promising avenue for future research. However, it should also be

pointed out that, while our findings are useful for describing and evaluating emotion
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regulation, they are nonetheless preliminary. Further research with larger research teams and

patient groups is called for. Also, priority should be given to conducting research into

regulation of emotions through art therapies potentially benefiting especially individuals

experiencing severe mental distress or undergoing palliative care.

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Figure 1. The process model of emotion regulation (adapted from Gross & Thomson, 2007 quoted in
Webb et al., 2012).
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Figure 2. Flow of information through the different phases of the review.
 
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Table 1. Overview of the sample studies.

U
Author Size (n) Aims/Hypothesis/ Interventions Measures/ Outcomes Study
Questions Tools Design

N
Babouchkina 67 Efficacy of mandala 1. Induction of negative mood, Profile of Mood Significantly greater mood Randomized
& Robbins painting for reducing 2. Coloring, four conditions: States improvement of the two
female controlled

A
(2015) negative mood states circle (mandala) groups
=51 A) Coloring a blank circle with instructions to
Drawing Task compared to the two
male= 16 express feelings

M
B) Coloring a blank circle with instructions to square conditions
age: 18-42 draw freely
C) Coloring a square with instructions to
ED express feelings
D) Coloring a square with instruction to draw
freely
Dalebroux et 57 Examination of two Induction of negative mood by a war film Affect grid No effect on arousal, effect Randomized
PT
al. (2008) f=53 mechanisms of short- on mood valence; most
Three conditions: controlled
m=22 term mood repair: effective when association
age: 18-22 arousal and valence 1. Venting: drawing a picture that expresses to positive emotions pre-post
the feelings in reaction to the movie
E

2. Positive emotions: drawing a picture that

depicts happiness
CC

3. Distraction control: finding and crossing out

symbols out of a sheet of symbols
De Petrillo 42 Does art-making Experiment 1: Affect Grid Art making increases the Randomized
& Winner f=12 improve mood, induction of negative mood by tragic images pleasure dimension of
A

drawing a picture based on the feelings or controlled

(2005) m=10 mood and does so via
age: 18-22 If so, copying shapes either catharsis or pre-post
is this effect best Experiment 2: redirection
explained by “catharsis” distraction by making a drawing or
or “redirection” completing a word puzzle

27 

 
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SC
Drake et al. 40 1. Comparison of short 1. Induction of negative mood by a film 1. Affect Grid 1. Short-term mood repair Randomized
(2011) term-mood repair effects better by drawing than by
of drawing vs. writing 2. writing or drawing condition about anything 2. Self-reported writing

U
f=23; m=17 one would like questionnaire: controlled
2. Determination whether decision whether 2. Drawing better strategy
age:

N
mood is more effectively distraction or for distraction than for pre-post
18-22 repaired when the venting is the venting
medium is used to vent

A
better strategy
negative feelings or to 3. Concerning both
distract oneself from activities:

M
negative feelings better mood repair by
distraction than by venting

Drake &
Winner
80
ED
1. Using art to
distract more
Study 1:
1. Induction of negative mood by a film
PANAS
(positive and
1. Distraction better
strategy than venting and
Randomized

(2012) f=60; m=20 beneficial for mood negative affect sitting

repair than to vent 2. Drawing condition (n=40): schedule) controlled
age: 2. Positive affect:
PT
venting by drawing something related to the pre-post
18-22 2. Using art to distract film significantly higher in
more beneficial for mood distraction condition (n=40): distraction than in venting
repair than sitting quietly drawing something unrelated to the film: a and higher than in sitting
E

or venting house condition

3. Negative affect:
CC

Study 2: least reduction in venting

1. Induction of negative mood by verbal condition
instructions/writing (personal experience)
Male participants (Study
A

2. Three conditions: using art for venting, for 1): more negative affect
distraction, control: quietly sitting after using art to vent than
to distract themselves

28 

 
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Drake & 80 One’s preference for 1. Indication of preference: drawing or writing Experience Negative affect Pilot study
Hodge regulating short-term Questionnaire significantly lower after
(2015) f=62; affect: drawing or 2. Sad mood induction by a film (preference for drawing than after writing

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writing drawing or (even when the preferred controlled
m=18 3. Half were assigned to their preferred
age: 18-22 activity, half to their non-preferred activity writing); activity indicated was

N
Investigation of emotion Mood Induction writing)
regulation strategy pre-post
Measure (rating
(distraction vs.

A
sadness of the Participants were more
expression) film); likely to use drawing to
PANAS (Positive distract and writing to

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and Negative express
Affect Schedule);
ED Strategy
Questionnaire
(venting or
distraction or
other-specify)
PT

Kimport & 102 1. More mood 1. Induction of negative mood by a film, POMS 1. More mood Randomized
Robbins enhancement by working writing about the negative feelings (Profile of Mood enhancement by
(2012) f=74; m=28 with clay than holding States) manipulating clay than
E

and manipulating soft 2. 4 groups: stress balls controlled

age: stress balls STAI
A) Structured instruction: pre-post
CC

18-63 (State-Trait 2. More effectiveness of

2. More mood making a pinch pot with clay Anxiety art therapy interventions at
enhancement by B) Free instruction: Inventory) alleviating negative mood
structured activities with manipulating the clay any way one wished states when entailing a
C) Structured instruction:
A

a result than doing structured task leading to a

aimless activities with moving the soft balls in the demonstrated way result
objects D) Free instruction:
handling the balls however anyone wanted
3. Most mood
enhancement by the
structured manipulation
of clay

29 

 
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SC
 
Nageeb 10 Role of emotion in the Creative process of visual artists from Qualitative, Results do not strongly Pilot study

U
creative process of visual conception to completion of a creative work phenomenological support either side of the
(2013) (information artists (positive or positive vs. negative mood
s about

N
negative emotion)
gender, age
not

A
available)

M
Sandmire et 57 Significant reduction of 5 groups with different art-making tasks: STAI Mean state anxiety score Not
al. anxiety one week before A) Coloring a pre-designed mandala (State-Trait between pre-activity and randomized
(2012) f=45; m=12 final exam by an art- B) Painting free form Anxiety post-activity decreased
making activity
ED C) Making a collage Inventory) significantly in the art- controlled
mean age: compared to a control D) Drawing a still life picture and coloring it making group, no
18,8 group that did not with sepia ink difference in the control pre-post
participate in art-making E) Control group: no activity group
PT
Van der 50 Significantly more 1. Induction of an anxious mood (personal SAI 1. Reduction of anxiety by Randomized
Vennett & reduction of anxiety by experience) by verbal instructions/writing (State Anxiety coloring a mandala to a
Serice f=41; coloring pre-drawn Inventory) greater degree than controlled
(2012) m=9 mandalas than coloring a 2. Three art-making groups: coloring free form pre-post
E

plaid design or coloring coloring a mandala Demographic

age: 21-59 free form coloring a plaid design questionnaire 2. Difference between
CC

coloring free form coloring the mandala and

plaid design but no
difference between
coloring the plaid design
A

and the free-form design

30