From Therapeutic Factors to Mechanisms of Change in the Creative Arts Therapies: A Scoping Review

Martina De Witte*, Vicky Karkou, Hod Orkidi, Rebecca Zarate, Nisha Sajnani, Bani Malhotra, Rainbow Tin Hung Ho, Girija Kaimal, Felicity Anne Baker, Sabine C Koch

*Corresponding author for this work

Research output: Contribution to journalArticle (journal)peer-review

82 Citations (Scopus)
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Empirical studies in the creative arts therapies (CATs; i.e., art therapy, dance/movement therapy, drama therapy, music therapy, psychodrama, and poetry/ bibliotherapy) have grown rapidly in the last ten years, documenting their positive impact on a wide range of psychological and physiological outcomes (e.g., stress, trauma, depression, anxiety, and pain). However, it remains unclear how and why the CATs have positive effects, and which therapeutic factors account for these changes. Research that specifically focuses on the therapeutic factors and/or mechanisms of change in CATs is only beginning to emerge. To gain more insight into how and why the CATs influence outcomes, we conducted a scoping review (Nstudies = 67) to pinpoint therapeutic factors specific to each CATs discipline, joint factors of CATs, and more generic common factors across all psychotherapy approaches. This review therefore provides an overview of empirical CATs studies dealing with therapeutic factors and/or mechanisms of change, and a detailed analysis of these therapeutic factors which are grouped into domains. A framework of 19
domains of CATs therapeutic factors is proposed, of which the three domains are composed solely of factors unique to the CATs:
“embodiment,” “concretization,” and “symbolism and metaphors.” The terminology used in change process research is clarified, and the implications for future research, clinical practice, and CATs education are discussed.
Original languageEnglish
JournalFrontiers in Psychology
Early online date15 Jul 2021
Publication statusPublished - 15 Jul 2021


  • Creative arts therapies
  • Mechanisms of change
  • therapeutic factors
  • Change process research
  • Drama therapy (DT)
  • dance movement therapy (DMT)
  • Psychodrama
  • Music therapy (MT)
  • Art Therapy (AT)


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