Selective emotion regulation in creative art therapy: Psychophysiological engagement during painting reduces anxiety

Art therapy, which employs creative activities such as painting to aid in emotion regulation, is gaining increased attention for its potential therapeutic value. However, empirical research on its affective regulatory mechanisms is limited and often hampered by methodological issues, making it difficult to isolate the effects of the cognitive and behavioral components involved in art-making. This study aims to clarify the role of creative expression in the emotional benefits of aesthetic production. We conducted a pre-registered, randomized controlled study with 99 participants to assess the behavioral and physiological effects of abstract painting on emotion regulation. Abstract painting was chosen for its feasibility of implementation in a laboratory setting, its capacity for creative expression, and its avoidance of technical skill requirements that could introduce confounding emotional associations. In a multi-day cross-over design, participants completed both an abstract painting task and a non-creative maze-completion control task matched in duration, environment, and motor engagement. Results showed that painting significantly and selectively reduced state anxiety compared to the control task. This reduction was mediated by higher cognitive engagement (i.e., reduced boredom) during painting. Additionally, painting elicited higher baseline-corrected heart rate than the control task, particularly among individuals who frequently engage in creative activities. Increased physiological engagement during painting further predicted greater anxiety reduction. These findings highlight the multi-modal determinants of emotional improvement during artistic production, providing empirical support for the therapeutic benefits of art therapy.