A realist review of art therapy for clients with depression

• Art therapy has multidimensional therapeutic factors affecting clients with depression in several ways.
• All the exercises in the study can be linked to depression based on ICF core sets for depression.
• The environment seems to be unimportant in art therapy and can be carried out in varying circumstances.

Depression is a serious disease affecting an individual's entire life-situation, which can lead to great suffering and a reduced level of activity in everyday life. The aim of this study is to explore and describe how art therapy works for clients with depression. A systematic literature search of relevant databases was carried out to find articles concerning art therapy for depression, meeting criteria for reproducibility. This yielded 16 articles published in seven journals. The art therapy methods employed in each selected study were then examined and compared in order to understand the healing mechanism or mechanisms. These healing mechanisms are here termed “therapeutic factors”. The analysis resulted in eight therapeutic factors: self-exploration, self-expression, communication, understanding and explanation, integration, symbolic thinking, creativity, and sensory stimulation. No general conclusions could be drawn regarding circumstances, but the results indicate that art therapy can be performed successfully in a wide variety of clinical situations. The results are discussed in relation to International Classification of Functioning, Disability and Health (ICF) core sets for depression.