Art Therapy Activities: Evidence, Mechanisms, and How to Run Them

Kaimal, Ray, and Muniz (2016) measured salivary cortisol in 39 adults before and after 45 minutes of unstructured art-making. Cortisol dropped in about 75 percent of participants, and prior art experience made no difference to the effect. Making the art lowered stress hormones whether or not the person could draw.

The second finding is the one that changes clinical instructions. Drake and Winner (2012) had participants induce a sad mood, then draw either to express the sadness or to distract themselves with unrelated content. Distraction beat expression for mood repair, and the same pattern has replicated across their program of research. This runs against the common instinct to hand a distressed client a pencil and say draw what you feel. When the goal is regulation, absorbing, neutral content works better than revisiting the wound.

For child work, the strongest single result is Gross and Hayne (1998). Children asked to draw while describing an emotional experience reported roughly twice as much verbal information as children who only talked, with no loss of accuracy.

On anxiety, Curry and Kasser (2005) compared coloring a structured mandala, coloring a plaid pattern, and free drawing after an anxiety induction. The structured conditions reduced anxiety; free drawing did not. Structure appears to be the active element for anxious clients, which matters before assigning open-ended drawing to an anxious client.

The review literature carries more caveats than the individual findings above. Schouten and colleagues (2015) found promising results for art therapy with traumatized adults across the small number of controlled trials that existed. Regev and Cohen-Yatziv (2018) reviewed the adult literature by population and found the clearest effects in specific groups, alongside persistent problems with small samples and weak designs. The defensible clinical claim: art-making is a well-supported adjunct with several specific, replicated effects, and a weakly supported standalone treatment. Used the first way, it earns its place.

At Walter Reed's National Intrepid Center of Excellence, service members with PTSD and traumatic brain injury decorated blank masks as part of integrative treatment. Clinicians there reported that the masks surfaced material months of verbal interviews had not reached, and the work produced durable engagement from a population with high dropout rates in talk therapy (Walker et al., 2016).

Affect labeling. Naming an emotion measurably dampens the brain's threat response; Lieberman and colleagues (2007) showed reduced amygdala activity when participants labeled affect rather than simply viewing emotional stimuli. Many clients cannot start at the label. A drawing gives the feeling a form first, and the label follows: clients name what they drew more easily than what they feel, and the naming is where the regulation happens.

Externalization. Once the anger is a red scribble on the page, it is an object in the room that client and therapist can examine together, at whatever distance the client needs. The child interview research suggests some unglamorous mechanics underneath this: drawing gives the hands something to do, removes the demand for eye contact, and keeps the child on the topic longer (Gross and Hayne, 1998). Adults get the same relief from the busy hands and the reduced eye contact.

Absorption. The Drake and Winner findings fit a broader pattern: attention has limited capacity, and a task absorbing enough to hold it displaces rumination. This is why structured coloring outperformed free drawing for anxiety, and why the practical instruction for regulation work is content that pulls attention in, whether or not it has anything to do with the problem.

Art therapy is a credentialed profession. Board-certified art therapists complete graduate training in both clinical work and studio practice, and treating complex trauma primarily through sustained artmaking belongs to them. Using an art-based activity inside a counseling session is ordinary clinical practice, the same way assigning journaling does not make anyone a bibliotherapist.

The distinction has one practical edge: if a client consistently accesses overwhelming material through image-making faster than sessions can contain, that is a referral question, and the referral is to an actual art therapist. For the activities below, ordinary pacing and containment skills are enough.

The Masks We Wear is the deepest of the set and the one with the NICoE evidence behind its format. The client decorates the outside of a mask with what other people see and the inside with what stays hidden. Give it a full session: five minutes to introduce, twenty to make, the rest to talk. Useful prompts: which side took longer, which side is more tiring to maintain, who has seen the inside. It fits guarded adolescents, trauma work, and clients who maintain an effortful public self. Most of the session's material comes from comparing the two surfaces.

The Personal Values Shield uses the coat-of-arms format for values work: quadrants for what matters most, what the client protects, where they come from, and where they are heading. It pairs naturally with ACT values clarification, and it converts an abstract conversation into something a client can point at. The family version, where each member builds a shield and presents it, reliably surfaces what members did not know about each other, which is the point.

The Therapeutic Postcard is the unsent letter at postcard size, and the small format does the clinical work: it forces the client to choose the few words that matter most. One side holds an image, the other a short message to someone who will never read it: a deceased parent, an ex, a younger self. Grief that cannot fill an essay will sometimes fit on a postcard. Ask what got left out and why.

Framing Your Strengths has the client fill a frame with evidence of their own capability. It lands with clients who recite their failures fluently and go silent at the opposite question, and it works well in a termination session, where the finished frame becomes a record of the work. Keep it evidence-based in the literal sense: each entry should be something that happened, not an affirmation.

My Identity Mosaic suits adolescents mid-construction: the self as a collage of roles, tastes, borrowed pieces, and experiments, none of which has to be the final answer. It externalizes the developmental task, and it gives a teen who answers in shrugs something concrete to be asked about.

The Blind Drawing Challenge is the outlier, an experiential communication exercise for couples and families. One person describes a simple image; the other draws it without looking at the original. The mismatched result demonstrates where specific language breaks down better than any lecture on communication, it takes ten minutes, and it produces laughter, which some couples sessions badly need. Debrief on what the describer assumed the drawer knew.

Across all six: cheap materials, pencils and markers and one page, introduced in one sentence, with the therapist doodling on scrap paper so nobody feels watched. Watch the process as much as the product: what gets drawn first, what gets erased repeatedly, which quadrant stays empty. When it is time to talk, ask about the art rather than the artist. Tell me about this part. What would the title be. The activity works through that third-person distance, so avoid collapsing it early by translating the image into a diagnosis while the client is still holding the marker.

When the goal is regulation, skip trauma imagery. The distraction findings cut against draw-your-trauma as a calming exercise; unstructured trauma drawing outside a protocol can flood rather than soothe. For a dysregulated client, structured and neutral content is the evidence-consistent choice, and the trauma narrative work waits for a treatment frame built to hold it.

Perfectionism and shame need handling up front. For some clients a blank page is an evaluation, and the activity triggers the exact self-attack it was meant to bypass. Say the stick-figure line out loud every time: this is not about making something good, and nobody grades it. If the client cannot put the evaluation down, put the art away; the exercise is not worth the spiral.

Use judgment with actively psychotic clients, where unstructured projective tasks can feed disorganization. And with adults generally: offer, never spring. A grown professional handed crayons without warning has a reasonable objection. One sentence of rationale, the option to decline, and most take the marker.

Last, the praise trap. Comment on content and process, never skill. You drew the storm bigger than the house lands as being seen. Nice drawing lands as being graded, and grading is the fastest way to make this the last art a client makes with you.

Kaimal, G., Ray, K., and Muniz, J. (2016). Reduction of cortisol levels and participants' responses following art making. Art Therapy, 33(2), 74-80.

Drake, J. E., and Winner, E. (2012). Confronting sadness through art-making: Distraction is more beneficial than venting. Psychology of Aesthetics, Creativity, and the Arts, 6(3), 251-266.

Gross, J., and Hayne, H. (1998). Drawing facilitates children's verbal reports of emotionally laden events. Journal of Experimental Psychology: Applied, 4(2), 163-179.

Curry, N. A., and Kasser, T. (2005). Can coloring mandalas reduce anxiety? Art Therapy, 22(2), 81-85.

Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., and Way, B. M. (2007). Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18(5), 421-428.

Schouten, K. A., de Niet, G. J., Knipscheer, J. W., Kleber, R. J., and Hutschemaekers, G. J. (2015). The effectiveness of art therapy in the treatment of traumatized adults: A systematic review on art therapy and trauma. Trauma, Violence, and Abuse, 16(2), 220-228.

Regev, D., and Cohen-Yatziv, L. (2018). Effectiveness of art therapy with adult clients in 2018: What progress has been made? Frontiers in Psychology, 9, 1531.

Walker, M. S., Kaimal, G., Koffman, R., and DeGraba, T. J. (2016). Art therapy for PTSD and TBI: A senior active duty military service member's therapeutic journey. The Arts in Psychotherapy, 49, 10-18.

Malchiodi, C. A. (Ed.). (2012). Handbook of Art Therapy (2nd ed.). Guilford Press.