Creative Arts Interventions for Stress Management and Prevention-A Systematic Review

Lily Martin, Renate Oepen, Katharina Bauer, Alina Nottensteiner, Katja Mergheim, Harald Gruber, Sabine C Koch, Lily Martin, Renate Oepen, Katharina Bauer, Alina Nottensteiner, Katja Mergheim, Harald Gruber, Sabine C Koch

Abstract

Stress is one of the world's largest health problems, leading to exhaustion, burnout, anxiety, a weak immune system, or even organ damage. In Germany, stress-induced work absenteeism costs about 20 billion Euros per year. Therefore, it is not surprising that the Central Federal Association of the public Health Insurance Funds in Germany ascribes particular importance to stress prevention and stress management as well as health enhancing measures. Building on current integrative and embodied stress theories, Creative Arts Therapies (CATs) or arts interventions are an innovative way to prevent stress and improve stress management. CATs encompass art, music, dance/movement, and drama therapy as their four major modalities. In order to obtain an overview of CATs and arts interventions' efficacy in the context of stress reduction and management, we conducted a systematic review with a search in the following data bases: Academic Search Complete, ERIC, Medline, Psyndex, PsycINFO and SocINDEX. Studies were included employing the PICOS principle and rated according to their evidence level. We included 37 studies, 73% of which were randomized controlled trials. 81.1% of the included studies reported a significant reduction of stress in the participants due to interventions of one of the four arts modalities.

Keywords: art; arts interventions; creative arts therapies (CATs); dance; drama; music; prevention; stress; systematic review.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow-Chart of the data base search on creative arts interventions for stress prevention.

References

    1. Korczak D., Kister C., Huber B. Differentialdiagnostik des Burnout-Syndroms. Schriftenreihe Health Technology Assessment (HTA) in der Bundesrepublik Deutschland; Köln, Germany: 2010. [(accessed on 1 December 2016)]. Available online: .
    1. Franke A., Franzkowiak P. Stress und Stressbewältigung. In: Bundeszentrale für gesundheitliche Aufklärung, editor. Leitbegriffe der Gesundheitsförderung: Glossar. Verlag für Gesundheitsförderung; Köln, Germany: 2011.
    1. GKV-Spitzenverband, editor. Leitfaden Prävention 2014. GKV-Spitzenverband; Berlin, Germany: 2014. Handlungsfelder und Kriterien des GKV-Spitzenverbandes zur Umsetzung der §§ 20 und 20a SGB V vom 21. Juni 2000 in der Fassung vom 10, Dezember 2014.
    1. Russ T.C., Stamatakis E., Hamer M., Starr J.M., Kivimaki M., Batty G.D. Association between psychological distress and mortality: Individual participant pooled analysis of 10 prospective cohort studies. BMJ. 2012;345:e4933. doi: 10.1136/bmj.e4933.
    1. Techniker-Krankenkasse Entspann Dich, Deutschland—TK-Stressstudie 2016. [(accessed on 1 December 2016)]; Available online: .
    1. Currie C., Roberts C., Morgan A., Smith R., Settertobulte W., Samdal O., Rasmussen V.B. Young People’s Health in Context. Health Behaviour in Schoolaged Children (HBSC) Study: International Report from the 2001/2002 Survey. Word Health Organization; Copenhagen, Denmark: 2004.
    1. Selye H. The Stress of Life. McGraw-Hill; New York, NY, USA: 1956.
    1. Folkman S., Lazarus R.S., Gruen R.J., DeLongis A. Appraisal, coping, health status, and psychological symptoms. J. Personal. Soc. Psychol. 1986;50:571–579. doi: 10.1037/0022-3514.50.3.571.
    1. Folkman S. Encyclopedia of Behavioral Medicine. Springer; New York, NY, USA: 2013. Stress: Appraisal and coping; pp. 1913–1915.
    1. Thoits P.A. Stress and health: Major findings and policy implications. J. Health Soc. Behav. 2010;51:41–53. doi: 10.1177/0022146510383499.
    1. Folkman S., Moskowitz J.T. Coping: Pitfalls and promise. Annu. Rev. Psychol. 2004;55:745–774. doi: 10.1146/annurev.psych.55.090902.141456.
    1. Lazarus R.S., Folkman S. Stress, Appraisal and Coping. Springer; New York, NY, USA: 1984.
    1. Bodenmann G., Gmelch S. Stressbewältigung. In: Margraf J., Schneider S., editors. Lehrbuch der Verhaltenstherapie. Springer; New York, NY, USA: 2009.
    1. Payne P., Crane-Godreau M.A. The preparatory set: A novel approach to understanding stress, trauma, and the bodymind therapies. Front. Hum. Neurosci. 2015;9 doi: 10.3389/fnhum.2015.00178.
    1. Koch S.C., Fuchs T. Embodied Arts Therapies. Arts Psychother. 2011;38:276–280. doi: 10.1016/j.aip.2011.08.007.
    1. Prinz J. Emotion, Psychosemantics, and Embodied Appraisals. R. Inst. Philos. Suppl. 2003;52:69–86. doi: 10.1017/S135824610000789X.
    1. Antonovsky A. In: Salutogenese. Zur Entmystifizierung der Gesundheit. Forum für Verhaltenstherapie und Psychosoziale Praxis. Franke A., editor. Volume 36 Dgvt; Tübingen, Germany: 1997.
    1. Koch S., Martin L. Verkörperte Ästhetik: Ein identitätsstiftender Wirkfaktor der Künstlerischen Therapien. In: Tüpker R., Gruber H., editors. Spezifisches und Unspezifisches in den Künstlerischen Therapien. Volume 6. HPB University Press; Berlin, Germany: 2017. pp. 81–106.
    1. Koch S.C. Arts and Health. Active factors and a theory framework of embodied aesthetics. Arts Psychother. 2017;54:88–98. doi: 10.1016/j.aip.2017.02.002.
    1. Oepen R., Gruber H. Ein kunsttherapeutischer Projekttag zur Gesundheitsförderung bei Klienten aus Burnout-Selbsthilfegruppen—Eine explorative Studie. Psychother. Psychosom. Med. Psychol. 2014;64:268–274. doi: 10.1055/s-0033-1358725.
    1. Bräuninger I. Dance movement therapy group intervention in stress treatment: A randomized controlled trial (RCT) Arts Psychother. 2012;39:443–450. doi: 10.1016/j.aip.2012.07.002.
    1. Karkou V., Sanderson P. Arts Therapies: A Research-Based Map of the Field. Elsevier Health Sciences; Oxford, UK: 2006.
    1. ECArTE—European Consortium for Arts Therapies Edcuation. [(accessed on 4 December 2017)]; Available online:
    1. Malchiodi C.A. Expressive Therapies. The Guildford Press; New York, NY, USA: 2005.
    1. Mc Niff S. Art-Based Research. In: Knowles J.G., Cole A.L., editors. Handbook of the Arts in Qualitative Research: Perspectives, Methodologies, Examples and Issues. Sage Publications Inc.; Thousand Oaks, CA, USA: 2008. pp. 29–40.
    1. Deutsche Musiktherapeutische Gesellschaft Kasseler Thesen zur Musiktherapie. [(accessed on 5 December 2017)];2010 Available online: .
    1. Kunzmann B., Aldridge D., Gruber H., Wichelhaus B. Künstlerische Therapien: Zusammenstellungen von Studien zu Künstlerischen Therapien in der Onkologie und Geriatrie: Hintergrund-Umsetzung-Perspektiven-Aufforderung. Musik Tanz Kunsttherapie. 2015;16:77–86. doi: 10.1026/0933-6885.16.2.77.
    1. Bergmann T., Sappok T., Diefenbacher A., Dames S., Heinrich M., Ziegler M., Dziobek I. Music-based Autism Diagnostics (MUSAD)—A newly developed diagnostic measure for adults with intellectual developmental disabilities suspected of autism. Res. Dev. Disabil. 2015;43:123–135. doi: 10.1016/j.ridd.2015.05.011.
    1. Von Spreti F. Kunsttherapie bei Psychischen Störungen. 1st ed. Elsevier Urban & Fischer; München, Germany: 2005.
    1. Archer S., Buxton S., Sheffield D. The effect of creative psychological interventions on psychological outcomes for adult cancer patients: A systematic review of randomised controlled trials. Psycho-Oncology. 2015;24:1–10. doi: 10.1002/pon.3607.
    1. EADMT. [(accessed on 1 November 2017)]; Available online:
    1. Hanna J.L. Dancing for Health: Conquering and Preventing Stress. Rowman Altamira; Lanham, MD, USA: 2006.
    1. Martin L., Koch S.C., Hirjak D., Fuchs T. Overcoming Disembodiment: The Effect of Movement Therapy on Negative Symptoms in Schizophrenia—A Multicenter Randomized Controlled Trial. Front. Psychol. 2016;7:483. doi: 10.3389/fpsyg.2016.00483.
    1. Koch S.C., Mergheim K., Raeke J., Riegner E., Machado C.B., Nolden J., Diermayr G., Moreau D., Hillecke T. The Embodied Self in Parkinson’s Disease: Feasibility of a Single Tango Intervention for Assessing Changes in Psychological Health Outcomes and Aesthetic Experience. Front. Neurosci. 2016;10:287. doi: 10.3389/fnins.2016.00287.
    1. Klees S. A Hero’s Journey in a German psychiatric hospital: A case study on the use of role method in individual drama therapy. Drama Ther. Rev. 2016;2:99–110. doi: 10.1386/dtr.2.1.99_1.
    1. Landy R. Role theory and the role method of drama therapy. Curr. Approaches Drama Ther. 2009;2:65–88.
    1. Acolin J. The Mind–Body Connection in Dance/Movement Therapy: Theory and Empirical Support. Am. J. Dance Ther. 2016;38:311–333. doi: 10.1007/s10465-016-9222-4.
    1. Gruber H., Rose J.P., Mannheim E., Weis J. Künstlerische Therapien in der Onkologie—Wissenschaftlicher Kenntnisstand und Ergebnisse einer Studie. Musikther. Umsch. 2011;32:206–218. doi: 10.13109/muum.2011.32.3.206.
    1. Al-Nawas B., Baulig C., Krummenauer F. Von der Übersichtsarbeit zur Meta-Analyse—Möglichkeiten und Risiken. From Review to Meta Analysis—Challenges and chances. Z. Zahnärztl. Impl. 2010;26:400–404.
    1. Agency for Healthcare Research and Quality (AHRQ) Methods Guide for Comparative Effectiveness Reviews. Volume 13. AHRQ Publication; Rockville, MD, USA: 2013. Grading the Strength of a Body of Evidence When Assessing Health Care Interventions for the Effective Health Care Program of the Agency for Healthcare Research and Quality: An Update; p. 14.
    1. Mayring P. Qualitative Inhaltsanalyse. In: Mey G., Mruck K., editors. Handbuch Qualitative Forschung in der Psychologie. VS Verlag für Sozialwissenschaften; Wiesbaden, Germany: 2010. pp. 601–613.
    1. Abbott K., Shanahan M.J., Neufeld R.W.J. Artistic tasks outperform nonartistic tasks for stress reduction. Art Ther. 2013;30:71–78. doi: 10.1080/07421656.2013.787214.
    1. Curl K. Assessing Stress Reduction as a Function of Artistic Creation and Cognitive Focus. Art Ther. 2008;25:164–169. doi: 10.1080/07421656.2008.10129550.
    1. Huss E., Sarid O. Visually transforming artwork and guided imagery as a way to reduce work related stress: A quantitative pilot study. Arts Psychother. 2014;41:409–412. doi: 10.1016/j.aip.2014.07.004.
    1. Kaimal G., Ray K., Muniz J. Reduction of Cortisol Levels and Participants’ Responses Following Art Making. Art Ther. 2016;33:74–80. doi: 10.1080/07421656.2016.1166832.
    1. Kimport E.R., Robbins S.J. Efficacy of Creative Clay Work for Reducing Negative Mood: A Randomized Controlled Trial. Art Ther. 2012;29:74–79. doi: 10.1080/07421656.2012.680048.
    1. Mercer A., Warson E., Zhao J. Visual journaling: An intervention to influence stress, anxiety and affect levels in medical students. Arts Psychother. 2010;37:143–148. doi: 10.1016/j.aip.2009.12.003.
    1. Pizarro J. The Efficacy of Art and Writing Therapy: Increasing Positive Mental Health Outcomes and Participant Retention after Exposure to Traumatic Experience. Art Ther. 2004;21:5–12. doi: 10.1080/07421656.2004.10129327.
    1. Sandmire D.A., Gorham S.R., Rankin N.E., Grimm D.R. The Influence of Art Making on Anxiety: A Pilot Study. Art Ther. 2012;29:68–73. doi: 10.1080/07421656.2012.683748.
    1. Schrade C., Tronsky L., Kaiser D.H. Physiological effects of mandala making in adults with intellectual disability. Arts Psychother. 2011;38:109–113. doi: 10.1016/j.aip.2011.01.002.
    1. Smolarski K., Leone K., Robbins S.J. Reducing Negative Mood through Drawing: Comparing Venting, Positive Expression, and Tracing. Art Ther. 2015;32:197–201. doi: 10.1080/07421656.2015.1092697.
    1. Walsh S.M., Martin S.C., Schmidt L.A. Testing the Efficacy of a Creative-Arts Intervention with Family Caregivers of Patients with Cancer. J. Nurs. Scholarsh. 2004;36:214–219. doi: 10.1111/j.1547-5069.2004.04040.x.
    1. Beck B.D., Hansen A.M., Gold C. Coping with Work-Related Stress through Guided Imagery and Music (GIM): Randomized Controlled Trial. J. Music Ther. 2015;52:323–352. doi: 10.1093/jmt/thv011.
    1. Brodsky W., Sloboda J.A. Clinical trial of a music generated vibrotactile therapeutic environment for musicians: Main effects and outcome differences between therapy subgroups. J. Music Ther. 1997;34:2–32. doi: 10.1093/jmt/34.1.2.
    1. Brooks D.M., Bradt J., Eyre L., Hunt A., Dileo C. Creative approaches for reducing burnout in medical personnel. Arts Psychother. 2010;37:255–263. doi: 10.1016/j.aip.2010.05.001.
    1. Byrnes S.R. The effect of audio, video, and paired audio-video stimuli on the experience of stress. J. Music Ther. 1996;33:248–260. doi: 10.1093/jmt/33.4.248.
    1. Chang M.-Y., Chen C.-H., Huang K.-F. Effects of music therapy on psychological health of women during pregnancy. J. Clin. Nurs. 2008;17:2580–2587. doi: 10.1111/j.1365-2702.2007.02064.x.
    1. DuRousseau D.R., Mindlin G., Insler J., Levin I.I. Operational Study to Evaluate music-based neurotraining at improving sleep quality, mood and daytime function in a first responder population. J. Neurother. 2011;15:389–398. doi: 10.1080/10874208.2011.623096.
    1. Goff L.C., Pratt R.R., Madrigal J.L. Music listening and A-lgA levels in patients undergoing a dental procedure. Int. J. Arts Med. 1998;5:22–26.
    1. Hatta T., Nakamura M. Can antistress music tapes reduce mental stress? Stress Med. 1991;7:181–184. doi: 10.1002/smi.2460070309.
    1. Ilie G., Rehana R. Effects of Individual Music Playing and music listening on acute-stress recovery. Can. J. Music Ther. 2013;19:23–46.
    1. Jacobsen S.L., McKinney C.H., Holck U. Effects of a dyadic music therapy intervention on parent-child interaction, parent stress, and parent-child relationship in families with emotionally neglected children: A randomized controlled trial. J. Music Ther. 2014;51:310–332. doi: 10.1093/jmt/thu028.
    1. Kim S.-A. Predictors of Acculturative Stress among International Music Therapy Students in the United States. Music Ther. Perspect. 2011;29:126–132. doi: 10.1093/mtp/29.2.126.
    1. Lesiuk T. The effect of preferred music listening on stress levels of air traffic controllers. Arts Psychother. 2008;35:1–10. doi: 10.1016/j.aip.2007.07.003.
    1. Maschi T., Bradley C. Recreational Drumming: A creative arts intervention strategy for social work teaching and practice. J. Baccalaureate Soc. Work. 2010;15:53–66.
    1. Mohammadi A.Z., Shahabi T., Panah F.M. An evaluation of the effect of group music therapy on stress, anxiety, and depression levels in nursing home residents. Can. J. Music Ther. 2011;17:55–68.
    1. Murphy E.M., Nichols J., Somkuti S.G., Sobel M., Braverman A., Barmat L.I. Randomized Trial of Harp Therapy During In Vitro Fertilization–Embryo Transfer. J. Evid. Based Complement. Altern. Med. 2013;19:93–98. doi: 10.1177/2156587213514054.
    1. Rider M.S., Floyd J.W., Kirkpatrick J. The Effect of Music, Imagery, and Relaxation on Adrenal Corticosteroids and the Re-entrainment of Circadian Rhythms. J. Music Ther. 1985;22:46–58. doi: 10.1093/jmt/22.1.46.
    1. Sharma M., Jagdev T. Use of Music therapy for enhancing self-esteem among Academically Stressed Adolescents. Pak. J. Psychol. Res. 2012;27:53–64.
    1. Smith J.C., Joyce C.A. Mozart versus New Age Music: Relaxation States, Stress, and ABC Relaxation Theory. J. Music Ther. 2004;41:215–224. doi: 10.1093/jmt/41.3.215.
    1. Smith M. The Effects of a Single Music Relaxation Session on State Anxiety Levels of Adulats in a Workplace Environment. Aust. J. Music Ther. 2008;19:45–66.
    1. Toyoshima K., Fukui H., Kuda K. Piano playing reduces stress more than other creative art activities. Int. J. Music Educ. 2011;29:257–263. doi: 10.1177/0255761411408505.
    1. Pinniger R., Brown R.F., Thorsteinsson E.B., McKinley P. Argentine tango dance compared to mindfulness meditation and a waiting-list control: A randomised trial for treating depression. Complement. Ther. Med. 2012;20:377–384. doi: 10.1016/j.ctim.2012.07.003.
    1. Pinninger R., Thorsteinsson E.B., Brown R.F., McKinley P. Intensive Tango Dance Program for People with Self-Referred Affective Symptoms. Music Med. 2013;5:15–22. doi: 10.1177/1943862112470143.
    1. Quiroga Murcia C., Bongard S., Kreutz G. Emotional and neurohumoral responses to dancing tango argentino: The effects of music and partner. Music Med. 2009;1:14–21. doi: 10.1177/1943862109335064.
    1. West J., Otte C., Geher K., Johnson J., Mohr D.C. Effects of Hatha yoga and African dance on perceived stress, affect, and salivary cortisol. Ann. Behav. Med. 2004;28:114–118. doi: 10.1207/s15324796abm2802_6.
    1. Wiedenhofer S., Koch S.C. Active factors in dance/movement therapy: Specifying health effects of non-goal-orientation in movement. Arts Psychother. 2016;52:10–23. doi: 10.1016/j.aip.2016.09.004.
    1. Körlin D., Nybäck H., Goldberg F.S. Creative arts groups in psychiatric care. Development and evaluation of a therapeutic alternative. Nord. J. Psychiatry. 2009;54:333–340. doi: 10.1080/080394800457165.
    1. Koch S.C., Kolter A., Kurz T. Indikationen und Kontraindikation in der Tanz- und Bewegungstherapie. Eine induktive Bestandsaufnahme. Musik Tanz Kunsttherapie. 2013;23:87–105. doi: 10.1026/0933-6885/a000094.
    1. Stegemann T., Schmidt H.-U. A pilot investigation on indication and contraindication of music therapy in child and adolescent psychiatry. Musikther. Umsch. 2010;31:87–101. doi: 10.13109/muum.2010.31.2.87.

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