Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Dec 19, 2019; 9(8): 107-120
Published online Dec 19, 2019. doi: 10.5498/wjp.v9.i8.107
Do adjunctive art therapies reduce symptomatology in schizophrenia? A meta-analysis
Keith R Laws, William Conway
Keith R Laws, William Conway, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, United Kingdom
Author contributions: Laws KR designed the study, checked all searches and re-ran all analyses; Conway W conducted initial searches and analyses; Laws KR and Conway W wrote the paper.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Keith R Laws, BSc, PhD, Full Professor, School of Life and Medical Sciences, University of Hertfordshire, Hatfield Campus, Hatfield AL10 9AB, United Kingdom.
Telephone: +44-1707-281137
Received: June 3, 2019
Peer-review started: June 4, 2019
First decision: August 2, 2019
Revised: September 3, 2019
Accepted: October 14, 2019
Article in press: October 14, 2019
Published online: December 19, 2019

Art therapies are advocated by national bodies, such as the United Kingdom’s National Institute for Health and Care Excellence, to alleviate the negative symptoms associated with schizophrenia. The last decade has however, seen several new larger well-controlled trials published suggesting an update is timely.


To asses randomised controlled trials (RCT) of art therapies for reducing the symptoms of schizophrenia – particularly negative symptoms.


Searches of PubMed and Scopus were conducted until May 2019 for RCTs examining the impact of art therapies on psychosis (positive, negative and total) symptoms in people diagnosed with schizophrenia. Study quality was assessed using the Cochrane risk of bias tool. Random effects meta-analyses were used to derive overall effect sizes. Moderator analyses were conducted using both meta-regression and categorical comparisons.


We identified 133 articles, of which 9 RCTs involving 948 participants (475 assigned to art therapies and 473 controls) met our inclusion criteria. Using random effects models, we calculated pooled effect sizes (Hedges g) for end-of-trial symptomatic outcomes. Effect sizes both for total symptoms [g = -0.27, 95% confidence interval (CI) -0.60 to 0.05, k = 6] and for positive symptoms (g = -0.10, 95%CI -0.35 to 0.15, k = 6) were non-significant; however, we did find significant reduction of negative symptoms (g = -0.42, 95%CI -0.70 to -0.14, k = 9). Meta-regression revealed that negative symptom reduction was larger in trials with a greater proportion of women and in trials with younger patients. Crucially, the negative symptom reduction following art therapies was limited to lower quality trials and did not emerge in trials that used blind assessment of outcomes.


This review presents a comprehensive meta-analysis of art therapies in schizophrenia in terms of both studies included and participant numbers. We found that art therapies did not significantly reduce total or positive symptoms. A "small" therapeutic effect was found for negative symptoms, but we show that the effect is not present in blind trials and may be subject to publication bias.

Keywords: Schizophrenia, Symptoms, Art therapy, Meta-analysis, Bias

Core tip: This meta-analysis examines data from randomised controlled trials looking at whether art therapies reduce the symptoms of schizophrenia-particularly negative symptoms. Our study indicates that art therapies do not significantly reduce total symptoms or positive symptoms. While we found a "small" therapeutic effect on negative symptoms, the effect appears to reflect two forms of bias-first, no effect emerges when trials use blind outcome assessment; second, the trials also point to the possibility of publication bias.