Patients with cancer who participate in creative arts therapy experience reductions in anxiety, depression, and pain and improvement in quality of life, according to a recent meta-analysis; but for some patients only pain reduction is long-lasting, according to a study published in JAMA.1
The study investigators pooled data from 27 randomized clinical trials involving 1,576 patients with cancer who participated in programs offering visual arts, dance, drama, music, writing, or combinations of art modalities.
Patients were either undergoing treatment, in long-term follow-up, or receiving palliative care. They were compared with controls who did not receive creative arts therapy, were on a waiting list for an art therapy program, or underwent usual care. Studies that examined only mind-body techniques such as yoga and meditation were excluded, as were those that compared creative arts therapy with active treatments such as pharmacotherapy or counseling.
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Overall, participation in art therapy resulted in reductions in the level of anxiety, although studies varied in their effects—some studies showed improvement from therapy while others showed that control groups did better. During follow-up, anxiety returned to its pretreatment level.
The trials that studied the effect of art therapy on depression were more consistent in demonstrating improvement, but as with anxiety, the benefits did not persist during follow-up. Similarly, quality of life was improved in the immediate post-treatment period but declined during follow-up. Creative arts therapy had no beneficial effect on fatigue.
Somewhat surprisingly, the greatest benefit of creative arts therapy was on pain, which was significantly reduced both immediately after the programs and during follow-up. Pain reduction was greater in art therapy programs for in-patients and for out-patient groups who had the same cancer than for out-patient groups with a variety of cancers, again for unknown reasons.
The benefits from creative arts therapy found in this study were similar in magnitude to those found in other studies for mindfulness-based therapy, acupuncture and massage therapy, yoga, and exercise, according to the study authors.
An unexpected finding of the meta-analysis was that greater reductions in anxiety occurred when creative arts therapy was administered by someone other than a certified art therapist. The study authors could not explain this outcome, but speculate that it may result from the choice of interventions used by art therapists compared with those used by other therapists, or that art therapists may inadvertently contribute to tension surrounding the use of complementary and alternative treatments.
Creative arts therapy may be more effective when combined with mindfulness-based stress reduction. Together, these interventions may actually alter cerebral blood flow in participants, according to a study conducted at Jefferson-Myrna Brind Center of Integrative Medicine in Philadelphia, PA.2 Researchers randomly assigned 18 patients with breast cancer to 8 weeks of mindfulness-based art therapy or an educational program, then evaluated symptoms with a questionnaire and measured cerebral blood flow with functional MRI.
Participants in the mindfulness-based art therapy program showed increased blood flow to the left insula, which plays a role in perception of emotions; the amygdala, which is involved in stress perception; the hippocampus, which regulates the response to stress; and the caudate nucleus, a part of the brain’s reward system. These changes in cerebral blood flow were correlated with improvement of anxiety symptoms.
Follow-up data were not collected, so the investigators cannot say whether these changes persisted beyond the 8-week study period.
References
1. Puetz TW, Morley CA, Herring MP. Effects of creative arts therapies on psychological symptoms and quality of life in patients with cancer. JAMA Intern Med. 2013;173:960-9.
2. Monti DA, Kash KM, Kunkel EJ, et al. Changes in cerebral blood flow and anxiety associated with an 8-week mindfulness programme in women with breast cancer. Stress Health. 2012;28:397-407.
