{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T01:56:43Z","timestamp":1784944603494,"version":"3.55.0"},"reference-count":76,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Mental health issues, such as depression and anxiety, are rising globally, and while conventional therapies like medications and psychotherapy remain common, they face limitations, including side effects and accessibility. This highlights the need for effective non-pharmacological interventions. Painting-based art interventions are a promising non-pharmacological approach for improving scale-assessed mental health outcomes, but quantitative evidence across age groups and outcome types remains limited. This meta-analysis synthesizes data from 45 randomized controlled trials to assess the impact of painting-based art interventions on mental health. The study explores potential moderating factors such as intervention duration, type of art, gender, and age group. A rigorous quality assessment of included studies was performed using Cochrane\u2019s risk of bias tool. The pooled effect size for painting-based interventions on mental health was significant, indicating a large positive impact. Subgroup analyses revealed that interventions of various durations, art forms, and gender compositions produced similar effects. Notably, older adults benefited the most from these interventions. Painting-based art interventions were associated with improved scale-assessed mental health outcomes. These findings should be interpreted as evidence for one visual art-making approach within broader art therapy practice, rather than as defining art therapy solely by painting-based methods.<\/jats:p>","DOI":"10.3390\/bs16050830","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T05:33:54Z","timestamp":1779687234000},"page":"830","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of Painting-Based Art Interventions on Mental Health Outcomes: A Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9005-6554","authenticated-orcid":false,"given":"Xu","family":"Song","sequence":"first","affiliation":[{"name":"Global Fine Arts Department, Kyonggi University, Suwon 16227, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihoon","family":"Jang","sequence":"additional","affiliation":[{"name":"Global Fine Arts Department, Kyonggi University, Suwon 16227, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Abbing, A., Baars, E. W., de Sonneville, L., Ponstein, A. S., and Swaab, H. (2019). The effectiveness of art therapy for anxiety in adult women: A randomized controlled trial. Frontiers in Psychology, 10.","DOI":"10.3389\/fpsyg.2019.01203"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.pedn.2025.06.029","article-title":"Mandala coloring reduces anxiety and pain in circumcised children: A randomized controlled trial","volume":"84","author":"Akay","year":"2025","journal-title":"Journal of Pediatric Nursing"},{"key":"ref_3","first-page":"1","article-title":"The impact of art-based interventions on emotional regulation in Chinese children with autism: A painting therapy approach","volume":"2025","author":"An","year":"2025","journal-title":"Journal of Autism and Developmental Disorders"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3947","DOI":"10.1021\/es903183r","article-title":"What is the best dose of nature and green exercise for improving mental health? A multi-study analysis","volume":"44","author":"Barton","year":"2010","journal-title":"Environmental Science and Technology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1080\/07421656.2007.10129589","article-title":"Effect of art production on negative mood: A randomized, controlled trial","volume":"24","author":"Bell","year":"2007","journal-title":"Art Therapy"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s11920-022-01402-8","article-title":"Efficacy of cognitive behavioral therapy for anxiety-related disorders: A meta-analysis of recent literature","volume":"25","author":"Bhattacharya","year":"2023","journal-title":"Current Psychiatry Reports"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1002\/jrsm.1678","article-title":"Avoiding common mistakes in meta-analysis: Understanding the distinct roles of Q, I-squared, tau-squared, and the prediction interval in reporting heterogeneity","volume":"15","author":"Borenstein","year":"2024","journal-title":"Research Synthesis Methods"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Cohen, J. (2013). Statistical power analysis for the behavioral sciences, Lawrence Erlbaum Associates.","DOI":"10.4324\/9780203771587"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1177\/070674371305800702","article-title":"A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments","volume":"58","author":"Cuijpers","year":"2013","journal-title":"The Canadian Journal of Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/S2215-0366(20)30036-5","article-title":"Treatment outcomes for depression: Challenges and opportunities","volume":"7","author":"Cuijpers","year":"2020","journal-title":"The Lancet Psychiatry"},{"key":"ref_11","first-page":"92","article-title":"Application of art therapy in the nursing care of psychiatric patients","volume":"21","author":"Dai","year":"2015","journal-title":"Qilu Nursing Journal"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref_13","first-page":"216","article-title":"An empirical study on the improvement of the mood of detainees by mandala painting group counseling","volume":"30","author":"Feng","year":"2020","journal-title":"Legal System and Society"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"101211","DOI":"10.1016\/j.ctcp.2020.101211","article-title":"The effect of interactive games compared to painting on preoperative anxiety in Iranian children: A randomized clinical trial","volume":"40","author":"Forouzandeh","year":"2020","journal-title":"Complementary Therapies in Clinical Practice"},{"key":"ref_15","first-page":"58","article-title":"Effects of group art therapy combined with dance intervention on self-efficacy and other aspects in patients with first-episode depression","volume":"28","author":"Fu","year":"2021","journal-title":"Chinese Rural Medicine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"101705","DOI":"10.1016\/j.aip.2020.101705","article-title":"The effectiveness of combining mindfulness and art-making on depression, anxiety and shame in sexual assault victims: A pilot study","volume":"71","author":"Goodarzi","year":"2020","journal-title":"The Arts in Psychotherapy"},{"key":"ref_17","first-page":"184","article-title":"Application of DIY painting therapy based on color psychology in the emotional management of long-term hospitalized psychiatric patients","volume":"20","author":"Gu","year":"2025","journal-title":"Psychologies"},{"key":"ref_18","first-page":"13","article-title":"The effect of comprehensive art intervention on the psychological rehabilitation of patients with schizophrenia","volume":"22","author":"Guo","year":"2007","journal-title":"Journal of Nursing"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.aip.2005.11.003","article-title":"Effects of art therapy with prison inmates: A follow-up study","volume":"33","author":"Gussak","year":"2006","journal-title":"The Arts in Psychotherapy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.aip.2008.10.002","article-title":"The effects of art therapy on male and female inmates: Advancing the research base","volume":"36","author":"Gussak","year":"2009","journal-title":"The Arts in Psychotherapy"},{"key":"ref_21","first-page":"e13491","article-title":"The effectiveness of mandala painting in reducing psychological symptoms, anxiety and depression in hospitalised adolescents with cancer: A randomised controlled trial","volume":"30","year":"2021","journal-title":"European Journal of Cancer Care"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., and Welch, V. A. (2019). Cochrane handbook for systematic reviews of interventions, The Cochrane Collaboration.","DOI":"10.1002\/9781119536604"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Statistics in Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref_25","first-page":"1719","article-title":"Effects of structural mandala painting therapy on anxiety and depression in elderly patients with chronic heart failure","volume":"27","author":"Hong","year":"2025","journal-title":"Zhejiang Clinical Medicine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1111\/jpm.70003","article-title":"The effects of visual art therapy on improving anxiety symptoms in adults: A systematic review and meta-analysis","volume":"32","author":"Huang","year":"2025","journal-title":"Journal of Psychiatric and Mental Health Nursing"},{"key":"ref_27","first-page":"110","article-title":"A study on the effects of art therapy on depressive symptoms in vocational college students","volume":"20","author":"Huang","year":"2020","journal-title":"Journal of Huainan Vocational and Technical College"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1080\/07421656.2018.1531276","article-title":"Impact of art-based life review on depression symptoms among older adults","volume":"35","author":"Ilali","year":"2018","journal-title":"Art Therapy"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e2428709","DOI":"10.1001\/jamanetworkopen.2024.28709","article-title":"Active visual art therapy and health outcomes: A systematic review and meta-analysis","volume":"7","author":"Joschko","year":"2024","journal-title":"JAMA Network Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1002\/jclp.23638","article-title":"Painting your way out: Imagery rehearsal based art therapy (IR-AT) for post-traumatic nightmares in borderline personality disorder","volume":"80","author":"Kehr","year":"2024","journal-title":"Journal of Clinical Psychology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1145\/3689649","article-title":"Developing an AI-based explainable expert support system for art therapy","volume":"14","author":"Kim","year":"2024","journal-title":"ACM Transactions on Interactive Intelligent Systems"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.aip.2012.11.002","article-title":"A randomized, controlled study of the effects of art therapy on older Korean-Americans\u2019 healthy aging","volume":"40","author":"Kim","year":"2013","journal-title":"The Arts in Psychotherapy"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1007\/s00431-025-06454-5","article-title":"Painting and mutual storytelling to alleviate anxiety and improve emotional well-being in children in PICU: A randomized controlled trial","volume":"184","author":"Kilicarslan","year":"2025","journal-title":"European Journal of Pediatrics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1002\/wps.20941","article-title":"The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: An umbrella review and meta-analytic evaluation of recent meta-analyses","volume":"21","author":"Leichsenring","year":"2022","journal-title":"World Psychiatry"},{"key":"ref_35","first-page":"84","article-title":"Effects of art therapy combined with risperidone on psychiatric symptoms and mild to moderate anxiety and depression in long-term hospitalized patients with schizophrenia","volume":"58","author":"Li","year":"2020","journal-title":"Chinese Modern Doctor"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1038\/s41746-023-00979-5","article-title":"Systematic review and meta-analysis of AI-based conversational agents for promoting mental health and well-being","volume":"6","author":"Li","year":"2023","journal-title":"Npj Digital Medicine"},{"key":"ref_37","first-page":"542","article-title":"Application of art therapy in maintaining the mental health of new recruits","volume":"31","author":"Li","year":"2017","journal-title":"South China Journal of National Defense Medicine"},{"key":"ref_38","unstructured":"Li, Y., Ma, A., and Liu, D. (2022). Exploring the effects of group art therapy on the social functioning and rehabilitation process of hospitalized schizophrenic patients. Psychological Monthly, 54\u201356."},{"key":"ref_39","first-page":"1285","article-title":"Effect of painting art training combined with drug therapy on schizophrenia in the community","volume":"25","author":"Li","year":"2017","journal-title":"Chinese Journal of Health Psychology"},{"key":"ref_40","first-page":"144","article-title":"A study on the efficacy of group emotional painting therapy for mixed anxiety and depression in adolescents","volume":"28","author":"Liu","year":"2024","journal-title":"Primary Care Medicine Forum"},{"key":"ref_41","first-page":"107","article-title":"Application of fill-in-the-blank painting combined with situational communication training in patients with bipolar disorder","volume":"27","author":"Liu","year":"2021","journal-title":"Qilu Nursing Journal"},{"key":"ref_42","first-page":"116","article-title":"Influence of mandala drawing therapy on post-stroke depression","volume":"4","author":"Liu","year":"2018","journal-title":"Integrated Traditional Chinese and Western Medicine Nursing (Chinese and English)"},{"key":"ref_43","first-page":"3064","article-title":"Intervention effect of group art therapy on anxiety and self-acceptance in children and adolescents with bone tumors","volume":"32","author":"Liu","year":"2023","journal-title":"Henan Medical Research"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1097\/SLA.0000000000004059","article-title":"Art heals: Randomized controlled study investigating the effect of a dedicated in-house art gallery on the recovery of patients after major oncologic surgery","volume":"274","author":"Lone","year":"2021","journal-title":"Annals of Surgery"},{"key":"ref_45","first-page":"496","article-title":"The effects of mandala painting therapy on the mental and physical health of family caregivers of cancer patients","volume":"33","author":"Lv","year":"2022","journal-title":"Journal of Aerospace Medicine"},{"key":"ref_46","first-page":"13","article-title":"An intervention study on interpersonal anxiety in eighth-grade students using art therapy","volume":"469","author":"Ma","year":"2021","journal-title":"Primary and Secondary School Mental Health Education"},{"key":"ref_47","first-page":"1344","article-title":"Application and effect of art therapy in the nursing care of adolescent patients with mental disorders","volume":"50","author":"Ma","year":"2025","journal-title":"Journal of Bengbu Medical University"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13034-021-00367-5","article-title":"Online art therapy in elementary schools during COVID-19: Results from a randomized cluster pilot and feasibility study and impact on mental health","volume":"15","author":"Mageau","year":"2021","journal-title":"Child and Adolescent Psychiatry and Mental Health"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1177\/0891988720901789","article-title":"Can visual art therapy be implemented with illiterate older adults with mild cognitive impairment? A pilot mixed-method randomized controlled trial","volume":"34","author":"Masika","year":"2021","journal-title":"Journal of Geriatric Psychiatry and Neurology"},{"key":"ref_50","first-page":"403","article-title":"Group art intervention for schizophrenic patients","volume":"37","author":"Meng","year":"2005","journal-title":"Acta Psychologica Sinica"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Montag, C., Haase, L., Seidel, D., Bayerl, M., Gallinat, J., Herrmann, U., and Dannecker, K. (2014). A pilot RCT of psychodynamic group art therapy for patients in acute psychotic episodes: Feasibility, impact on symptoms and mentalising capacity. PLoS ONE, 9, (11).","DOI":"10.1371\/journal.pone.0112348"},{"key":"ref_52","first-page":"558","article-title":"An experimental study on the improvement of depression in obese female college students by art therapy","volume":"32","author":"Niu","year":"2011","journal-title":"Chinese Journal of School Health"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s10728-025-00549-8","article-title":"Transforming public mental health: A review on global trends, challenges, and pathways to change","volume":"34","author":"Okesanya","year":"2025","journal-title":"Health Care Analysis"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/01.NME.0000658232.41065.aa","article-title":"Music and art therapy: Approaching patient care with a different stroke","volume":"18","author":"Perkins","year":"2020","journal-title":"Nursing Made Incredibly Easy"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"560","DOI":"10.5271\/sjweh.3839","article-title":"Effectiveness of occupational e-mental health interventions: A systematic review and meta-analysis of randomized controlled trials","volume":"45","author":"Phillips","year":"2019","journal-title":"Scandinavian Journal of Work, Environment & Health"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1037\/pas0000268","article-title":"Meta-analytic evidence for effects of mindfulness training on dimensions of self-reported dispositional mindfulness","volume":"28","author":"Quaglia","year":"2016","journal-title":"Psychological Assessment"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1038\/s44220-024-00368-1","article-title":"Group arts interventions for depression and anxiety among older adults: A systematic review and meta-analysis","volume":"3","author":"Quinn","year":"2025","journal-title":"Nature Mental Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/acem.13838","article-title":"Randomized controlled trial of adult therapeutic coloring for the management of significant anxiety in the emergency department","volume":"27","author":"Rajendran","year":"2020","journal-title":"Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"102203","DOI":"10.1016\/j.aip.2024.102203","article-title":"\u201cAttentive to their painting\u201d: A pilot study of the implications of a single session mindfulness-based art therapy intervention on early childhood assistants","volume":"91","year":"2024","journal-title":"The Arts in Psychotherapy"},{"key":"ref_61","first-page":"74","article-title":"Observation on the efficacy of sertraline combined with art therapy in treating adolescent depression","volume":"30","author":"Ran","year":"2021","journal-title":"China Pharmaceutical Industry"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1080\/07421656.2012.683748","article-title":"The influence of art making on anxiety: A pilot study","volume":"29","author":"Sandmire","year":"2012","journal-title":"Art Therapy"},{"key":"ref_63","first-page":"89","article-title":"The effects of group cognitive behavioral therapy combined with mandala painting intervention on coping styles and self-harm behaviors in adolescents with depression","volume":"21","author":"Shen","year":"2024","journal-title":"Chinese Journal of Medical Innovation"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.rasd.2011.09.001","article-title":"Effects of physical exercise on autism spectrum disorders: A meta-analysis","volume":"6","author":"Sowa","year":"2012","journal-title":"Research in Autism Spectrum Disorders"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"L4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_66","first-page":"97","article-title":"Application of art psychology in individualized psychological nursing for maintenance hemodialysis patients","volume":"19","author":"Sun","year":"2022","journal-title":"Chinese Journal of Medical Innovation"},{"key":"ref_67","first-page":"71","article-title":"Effects of mandala painting therapy on negative emotions in cancer patients","volume":"38","author":"Sun","year":"2021","journal-title":"PLA Nursing Journal"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"110236","DOI":"10.1016\/j.pnpbp.2020.110236","article-title":"Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: A global cross-sectional survey","volume":"109","author":"Varma","year":"2021","journal-title":"Progress in Neuro-Psychopharmacology and Biological Psychiatry"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1002\/jrsm.11","article-title":"Outlier and influence diagnostics for meta-analysis","volume":"1","author":"Viechtbauer","year":"2010","journal-title":"Research Synthesis Methods"},{"key":"ref_70","first-page":"1289","article-title":"The effects of group painting art intervention on negative symptoms, cognitive status and social function in adult patients with schizophrenia during the recovery period","volume":"46","author":"Xu","year":"2022","journal-title":"Guizhou Medical Journal"},{"key":"ref_71","first-page":"183","article-title":"Observation on the rehabilitation effect of mandala painting therapy on patients with depression","volume":"17","author":"Xu","year":"2022","journal-title":"Psychologies"},{"key":"ref_72","first-page":"1183","article-title":"Effects of group art therapy on psychiatric symptoms, cognitive function and sleep quality in patients with schizophrenia","volume":"43","author":"Yuan","year":"2023","journal-title":"Journal of Clinical and Pathological Diseases"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"100683","DOI":"10.1016\/j.clinsp.2025.100683","article-title":"The effect of the art therapy interventions to alleviate depression symptoms among children and adolescents: A systematic review and meta-analysis","volume":"80","author":"Zhang","year":"2025","journal-title":"Clinics"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1089\/jicm.2022.0780","article-title":"Does mandala art improve psychological well-being in patients? 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