Can art therapy help with anxiety and depression?

The short answer is yes — and the evidence base, while still developing, is more substantial than the question's casual framing might suggest. But the more interesting answer requires distinguishing between what the clinical literature demonstrates and what depth psychology understands to be happening when image-making touches the soul.

On the empirical side, sandplay therapy — one of the most rigorously studied art-based modalities — shows consistent results across multiple populations. Roesler's (2019) overview of randomized controlled trials found significant reductions in anxiety across several studies, including a trial with generalized anxiety disorder patients that produced an effect size of 2.584. A 2022 meta-analysis by Wiersma and colleagues confirmed these findings across a broader sample, with studies showing meaningful decreases in depression, anxiety, and interpersonal distress. These are not trivial numbers. The effect sizes in some sandplay studies rival those of established cognitive-behavioral interventions, and the gains appear in populations ranging from earthquake survivors in Nepal to university students with ADHD tendencies.

The neuroscientific account of why this works runs through interoception — the body's capacity to receive, process, and integrate its own internal signals. Paulus and Stewart (2014) argue that the insular cortex, the central hub for interoceptive processing, is characteristically dysregulated in both anxiety and depression: hypoactive during cognitive control, hyperactive during cue reactivity. Art-making, particularly when it involves tactile engagement with materials, appears to recruit precisely the sensory-motor feedback loops that restore interoceptive regulation. Haeyen (2024) frames this through polyvagal theory: creative arts therapies activate the ventral vagal state, the physiological substrate of social engagement and felt safety, through bottom-up pathways that bypass the cognitive elaboration networks where anxiety and depression tend to entrench themselves. The body, in other words, finds its way back to regulation through the hands before the mind catches up.

This is where the depth-psychological reading becomes essential, because it names something the clinical literature tends to leave implicit. Hillman's argument in Re-Visioning Psychology — and it is a sharp one — is that depression is not primarily a disorder to be corrected but a via regia, a royal road into soul-making. He writes:

Through depression we enter depths and in depths find soul. Depression is essential to the tragic sense of life. It moistens the dry soul, and dries the wet. It brings refuge, limitation, focus, gravity, weight, and humble powerlessness. It reminds of death.

The alchemical language Hillman borrows here is precise: the movement from the nigredo (the black, symptomatic phase) through the albedo (the whitening, reflective phase) passes through blue — the color of mourning, melancholy, and the first emergence of self-reflective feeling. Art-making, on this reading, does not cure depression so much as it gives depression its proper medium. The image externalizes what was locked in the body as symptom; it makes the soul's speech visible. Bosnak (2007) puts it this way: what feels like immobilizing despair is actually hard labor — the vacating force of nothing emptying out space for something new to form.

This is why Hillman insists that art therapy "must take precedence over all other kinds" of therapy — not because it is more technically effective, but because it "activates imagination and allows it to materialize — that is, enter the world via the emotions of the patient." The image is not a symptom to be decoded; it is the soul's own speech, and the task is to hear it rather than translate it away.

The practical implication is that art therapy works on two registers simultaneously: the neurobiological (restoring interoceptive regulation, activating the ventral vagal system, reducing cortisol) and the imaginal (giving the soul's suffering a form it can inhabit and reflect upon). Neither register is sufficient alone. A purely somatic account misses what the image is saying; a purely symbolic account misses the body that is doing the suffering.

  • James Hillman — portrait of the founder of archetypal psychology, whose work on depression as soul-making remains the most searching account of why image-making matters
  • nigredo — the alchemical black phase, and its relationship to depression and the beginning of psychological transformation
  • active imagination — Jung's method of engaging the unconscious through image, and its relationship to the expressive arts
  • interoception — the body's sense of its own internal state, and its role in anxiety, depression, and recovery

Sources Cited

  • Hillman, James, 1989, A Blue Fire: The Essential James Hillman
  • Bosnak, Robert, 2007, Embodiment: Creative Imagination in Medicine, Art and Travel
  • Roesler, Christian, 2019, Sandplay Therapy: An Overview of Theory, Applications and Evidence Base
  • Wiersma, Jacquelyn K., 2022, A Meta-Analysis of Sandplay Therapy Treatment Outcomes
  • Paulus, Martin P. and Stewart, Jennifer L., 2014, Interoception and Drug Addiction
  • Haeyen, Suzanne, 2024, A Theoretical Exploration of Polyvagal Theory in Creative Arts and Psychomotor Therapies