The art of managing stress – effectiveness of creative arts interventions for stress reduction and stress management: a systematic review

jat000025 10.3205/jat000025 urn:nbn:de:0183-jat0000255 Review Article The art of managing stress – effectiveness of creative arts interventions for stress reduction and stress management: a systematic review Arnaud Arnaud Christina C

School of Therapy Sciences, SRH University Heidelberg, Heidelberg, GermanySchool of Therapy Sciences, SRH University Heidelberg, Heidelberg, Germany

Chri.arnaud@gmail.com author Koch Koch Sabine C. SC

Department of Creative Arts Therapies and Therapy Sciences, Alanus University, Alfter, GermanyDepartment of Creative Arts Therapies and Therapy Sciences, Alanus University, Alfter, Germany

skoch@srh.de author German Medical Science GMS Publishing House

Düsseldorf

610 creative arts therapies (CATs) creative arts interventions stress prevention stress management systematic review Arts Therapies 20221114 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). 2629-3366 4 GMS Journal of Arts Therapies GMS J Art Ther 10 Background: Given the prevalence of stress-related disorders in contemporary societies and the associated burden on the health care systems, it is important to provide effective and feasible (preventive) interventions that can be delivered in various clinical and non-clinical contexts. The evidence base of creative arts therapies (CATs) in mental health research is developing rapidly. The current review provides an up-to-date overview of the effectiveness of creative arts interventions for stress prevention and stress management for individuals of all age groups across settings. Methods: The methodology of a systematic review was used to synthesize the available published evidence on the effectiveness of creative arts intervention for stress prevention and management. In order to provide an overview of the current evidence on the subject of CATs and stress prevention/management and to extract all relevant studies in the period of 2016 to 2020, the following major databases for scientific publications in healthcare were searched: PubMed, Medline, PsycInfo, ERIC, SocIndex and Psyndex. The present work is an update of an existing systematic review which summarizes the existing evidence up to August 2016.Results: Of the 2,036 studies reviewed, 52 studies were identified as meeting the inclusion criteria involving a total of 4,925 participants. 36 of the included studies (nearly 70%) were randomized controlled trials (RCT’s). 40 of the 52 included studies (over 75%) found a significant improvement on one of the stress- or anxiety-related outcomes. In particular, nearly 90% of the interventions led by a licensed creative arts therapist resulted in a significant reduction of stress whereas mere arts interventions (led by a health or arts professional but not a licensed creative arts therapist) reduced stress in 70% of the studies. Conclusion: The field of creative arts interventions can be described as rapidly growing. Moreover, creative arts interventions seem to have a positive effect on stress perception and stress management. They reduce the level of anxiety and enhance the subject's positive mood. Especially, when led by a licensed creative arts therapist. 1 BackgroundSlowly, under our feet, beneath our consciousness, is forming that new philosophy,and it is in times of new philosophies that art, itself in essence always a discovery, must flourish.John Galsworthy (1911)1.1 Stress and mental healthAlthough to varying degrees, stress is a natural part of life, it is acknowledged as one of the strongest predisposing factors for physical and mental health problems and a major source of disability and mortality in industrialized societies worldwide , . Stress figures prominent in r</PlainText></TextGroup>ecent conceptual models of the etiology and maintenance of psychopathological disorders including major depressive disorder, bipolar disorder, and posttraumatic stress disorder (PTSD) and a range of other mental health conditions <TextLink reference="2"></TextLink>, <TextLink reference="3"></TextLink>, <TextLink reference="4"></TextLink>, <TextLink reference="5"></TextLink>. Stress can also negatively affect physical health and is an important risk factor for cardiovascular, musculoskeletal and immunological disorders and physical disability <TextLink reference="6"></TextLink>, <TextLink reference="7"></TextLink>. Moreover, prenatal exposure to stressful conditions is associated with long-term adverse developmental health outcomes on multiple molecular, cognitive, emotional, and behavioral levels <TextLink reference="8"></TextLink>. </Pgraph><Pgraph>While stress or actually stress response is typically viewed from a biological perspective as a subjective physiological reaction to the presence of an external condition <TextLink reference="9"></TextLink>, simple physiological definitions of stress are limited in explaining the concept in its psychological and psychopathological dimensions <TextLink reference="10"></TextLink>. Rather, current research suggests that stress involves a complex, dynamic process which integrates aspects of mind and body; and that the stress response can be characterized as a negati<TextGroup><PlainText>ve e</PlainText></TextGroup>motional experience accompanied by biochemical, physiological, and behavioral changes that are releva<TextGroup><PlainText>nt to ad</PlainText></TextGroup>aptation <TextLink reference="11"></TextLink>, <TextLink reference="12"></TextLink>, <TextLink reference="13"></TextLink>. </Pgraph><Pgraph>A prototypic model that reflects this view is the recent embodied model of the <Mark2>Preparatory</Mark2> <Mark2>Set</Mark2>. This model describes stress as the preparation to act involving an organization of the five elements muscle tone, posture, breathing, autonomic functions, motivational/emotional state, attentional orientation, and expectations <TextLink reference="10"></TextLink>. </Pgraph><Pgraph>The perspective of an organism that organizes itself in order to adapt to environmental challenges <TextLink reference="10"></TextLink> also implies that individuals differ in their stress vulnerability (i.e., sensitivity or reactivity) and coping strategies (i.e., capacity for “stress management”) and thus in their individual risk for stress-related psychopathology, which has important implications for preventive measures. </Pgraph><SubHeadline>1.2 Stress prevention and stress management in the spectrum of interventions</SubHeadline><Pgraph>Stress-related disorders affecting mental health are highly prevalent and belong to the disorders with the highest burden to individuals and societies around the world <TextLink reference="14"></TextLink>. Reducing the high social and economic burden due to stress-related mental, emotional and behavioral health such as depression, anxiety and other disorders through effective prevention and promotion strategies is therefore a public health priority <TextLink reference="15"></TextLink>. Since stress is a relevant risk factor across a range of mental health disorder<TextGroup><PlainText>s it is r</PlainText></TextGroup>ecognized as an important target within the spectrum of primary prevention measures provided within the health care system <TextLink reference="16"></TextLink>. Preventive interventions in contrast to curative interventions foster the promotion of mental health and/or target the risk factors of a mental disorder, such as stress before the actual onset of the disorder (i.e., primary prevention, <TextLink reference="16"></TextLink>).</Pgraph><Pgraph>Interventions in the health care sector are typically classified into three categories, according to the specific needs assigned to a population or population segment on the basis of their respective risk levels. <Mark2>Universal interventions</Mark2> are delivered to an entire population (such as the general public, college students, pregnant women etc.) regardless of the individual risk of a person in this population. These are differentiated form targeted intervention approaches that focus on individuals or groups of individuals known to be at elevated risk (<Mark2>selective prevention</Mark2>) for stress (such as people living with HIV or women with breast cancer) or those who already show early signs of subthreshold symptoms but do not fulfill a formal diagnosis of a disorder (<Mark2>indicated prevention</Mark2>) <TextLink reference="17"></TextLink>, <TextLink reference="18"></TextLink>.</Pgraph><Pgraph>Given the prevalence of stress-related disorders in society and the associated immense burden on the health care systems <TextLink reference="19"></TextLink> it is important to provide effective and feasible prevention measures in a diverse conceptual spectrum that can be delivered in various clinical and non-clinical contexts <TextLink reference="16"></TextLink>. </Pgraph><SubHeadline>1.3 Description and evidence base of creative arts interventions</SubHeadline><Pgraph>Broadly, creative arts <Mark2>interventions</Mark2> support the clients to express themselves in a creative way and unite the artistic modalities of dance movement, drama, music, and arts. They include interventions conducted by creative arts therapists and by other therapists and health and arts professionals <TextLink reference="20"></TextLink>. Creative arts interventions have been recommended by the World Health Organization (WHO) for their positive impact on health and well-being <TextLink reference="21"></TextLink>. Latest trends in psychiatry towards a more holistic approach turned the attention to psychotherapeutic methods such as creative art therapy <TextLink reference="22"></TextLink>. More specifically, creative arts <Mark2>therapies</Mark2> (CATs) are defined as “the creative use of the artistic media (art, music, drama and dance/ movement) as vehicles for non-verbal and/or symbolic communication, within a holding environment, encouraged by a well-defined-client-therapist relations<TextGroup><PlainText>hip, in o</PlainText></TextGroup>rder to achieve personal and/or social therapeutic goals appropriate for the individual” <TextLink reference="23"></TextLink>. CATs often utilize psychoanalytic or psychodynamic principles, embedded in an evidence-based theoretical framework which differentiates them from pure artistic interventions. They are conducted by specialized and licensed therapists, who have a professional training in their specific modality of creative arts guided by ethical standards and can be used as a therapeutic and a diagnostic tool <TextLink reference="24"></TextLink>. See chapter 1.3.1 for a detailed description of the different art-based intervention modalities.</Pgraph><Pgraph>Recently the scientific interest in art-based therapies as an innovative intervention approach for <TextGroup><PlainText>mental health has</PlainText></TextGroup> been growing. The evidence base in this research area is currently developing rapidly as indicated by the availability of several systematic reviews during the past two years. For example, Baker and colleagues <TextLink reference="25"></TextLink> analyzed the evidence of the efficacy of creative arts therapies for the treatment of adults with PTSD; Dunphy and colleagues <TextLink reference="20"></TextLink> summarized the evidence of creative arts therapies for older people diagnosed with depression. Taken together the existing research indicates that these interventions are associated with significant patient-related improvements. </Pgraph><Pgraph>Simultaneously, the evidence base within the separate modalities (i.e., art, music, dance, drama) is constantly growing. In their systematic review, Regev and colleagues <TextLink reference="26"></TextLink> summarize the effectiveness of art therapy for adult patients in the mental health spectrum. They conclude that art therapy can be an effective form of treatment and a promising method to alleviate problems such as stress and work-related burnout. </Pgraph><Pgraph>De Witte and colleagues <TextLink reference="27"></TextLink> assessed in two systematic reviews each with multilevel meta-analyses the strength of the effects of music interventions on physiological and psychological stress-related outcomes. Overall the results of both reviews showed a significant reduction of physiological and stress-related outcomes. Umbrello et al. <TextLink reference="28"></TextLink> reviewed the effectiveness of music therapy for stress and anxiety reduction in the clinical context of intensive care units and found favorable effects for critically ill adult patients. </Pgraph><Pgraph>A recent meta-analysis of dance movement therapy (DMT) indicates (among other outcomes) that DMT can be effective in decreasing clinical symptoms of anxiety <TextLink reference="29"></TextLink>. Two further syntheses of evidence focus on clinical populations: In their systematic review Jimenez and colleagues <TextLink reference="30"></TextLink> summarize the evidence for the effects of DMT for older adults with a psychiatric condition (mainly dementia) with limited clinical effects (although DMT increased quality of life and expressiveness). Karkou and colleagues <TextLink reference="31"></TextLink>, in their systematic review and meta-analysis, found DMT to be an effective intervention for adults with depression. </Pgraph><Pgraph>Compared to these creative art therapy modalities the evidence base for drama therapy is not as mature. However, a recent integrative systematic review in drama therapy intervention research <TextLink reference="32"></TextLink> indicates that drama therapy research has produced promising results for various populations (i.e., adults and children with developmental disabilities and cognitive impairments). </Pgraph><Pgraph>While taken together the available research indicates positive effects of creative arts interventions, prevention studies are largely missing. Martin and colleagues <TextLink reference="33"></TextLink> up to now provided the only available systematic review that addresses the effectiveness of CATs for prevention in the context of psychological health. In their systematic review they summarize the results from the published studies in the field of stress prevention and stress management (i.e., individual capacity to manage emotional and behavioral stress response), which is also the central focus and the basis of the present review. </Pgraph><Pgraph>Their review involved 37 empirical studies from 1980–2016 including 2,136 healthy individuals or people at risk for stress-related disorders between evidence level Ib and III, defined according to the Agency for Healthcare Research and Quality (AHRQ). 20 studies concerned the music modality, eleven the art modality and six the dance movement modality. In the drama modality no study met the inclusion criteria. Over 70% of all included studies were randomized controlled trials (RCT’s), indicating a rather high quality of studies in the field. The authors report a significant stress reduction in 80% of all studies and found that interventions that were guided by a licensed creative therapist were even more effective (eleven of twelve studies, 92%). </Pgraph><Pgraph>Most of the studies (32 out of 37; 86%) were published after the year of 2000. This indicates the growing interest in this rapidly emerging field and highlights the importance for an update of the evidence base. </Pgraph><SubHeadline2>1.3.1 Description of the four modalities of creative arts interventions</SubHeadline2><Pgraph>In <Mark2>art interventions</Mark2> the clients use art media like painting (i.e. acrylic or oil paints, crayons, pastels, watercolours or aquarelle) or creating plastics and sculptures (i.e. clay, soapstone or wood) as a tool for symbolic and creative expression. The American Art Therapy Association (AATA) defines <Mark2>art therapy</Mark2> as “an integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship” <TextLink reference="34"></TextLink>. The overall aim is not the piece of artwork itself but to enable the client to find a nonverbal expression for previous conscious or unconscious experiences through a process of creation in a safe and facilitating environment <TextLink reference="35"></TextLink>. </Pgraph><Pgraph>Within <Mark2>music interventions</Mark2> the client is encouraged to create music actively (i.e. singing, playing an instrument) or to listen to music receptively. The American Music Therapy Association (AMTA) defines <Mark2>music therapy</Mark2> as “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program” <TextLink reference="36"></TextLink>. In active music therapy interventions improvisation is applied. During active performance, the client’s feelings can be mediated on a non-verbal level and made audible for the other person and oneself. Receptive music therapy focuses on actively listening to music and absorbing the vibrations. Therapeutic processes like upcoming feelings, bodily perceptions and pictorial ideas are initiated and can be verbalized <TextLink reference="37"></TextLink>.</Pgraph><Pgraph><Mark2>Dance interventions</Mark2> use practices of various dance styles (e.g., ballroom dance, folk dance, contemporary dance), to move and express in an aesthetic creative way <TextLink reference="29"></TextLink>.<Mark2> Dance movement therapy</Mark2> (DMT) is the psychotherapeutic use of movement, based on the assumption of the interconnection of body and mind, and the healing power of dance. Accordingly, DMT-interventions use bodily movements to explore and express emotions within groups or individuals <TextLink reference="31"></TextLink>. The American Dance Therapy Association (<TextGroup><PlainText>ADTA) defines it as “the psychotherapeutic use of m</PlainText></TextGroup>ovement to promote emotional, social, cognitive, and physical integration of the individual, for the purpose of improving health and well-being” <TextLink reference="38"></TextLink>. </Pgraph><Pgraph>In <Mark2>drama interventions</Mark2> participants imagine, enact, and reflect experiences within an improvisational, non-exhibitional, process-centered form of drama <TextLink reference="39"></TextLink>. <Mark2>Drama therapy</Mark2> can be defined as an active and experien<TextGroup><PlainText>tial p</PlainText></TextGroup>sychotherapy modality that involves the intentional and systematic use of drama/theater processes as primary means to achieve psychological growth and change within a psychotherapeutic relationship <TextLink reference="32"></TextLink>. </Pgraph><SubHeadline>1.4 How creative arts interventions might work</SubHeadline><Pgraph>Creative arts interventions are characterized by substantial heterogeneity but they share a set of meta-processes or “common factors” <TextLink reference="20"></TextLink>. According to Koch <TextLink reference="40"></TextLink>, general therapeutic factors known from psychotherapy research also apply to the arts therapies (e.g., therapeutic relationship, problem actualization, resource activation) <TextLink reference="41"></TextLink>. However, while conventional forms of psychotherapy often focus on cognitive processes and determinants of behavior, CATs are an innovative and embodied approach that can be understood as holistic <TextLink reference="33"></TextLink>. Moreover, Koch proposes a framework of specific factors as “mechanisms of action” that are specific to art-based therapies. The “Model of Embodied Aesthetics” identifies five factors of CATs: aesthetics, hedonism, nonverbal communication/metaphor, enactive transitional support and generativity <TextLink reference="40"></TextLink>. Lange and colleagues <TextLink reference="42"></TextLink> investigated the effect of “active creation” as an important part of creative arts interventions. Others emphasize the clinical usefulness of non-verbal, but body-centered approaches of creative arts interventions to explore the affective benefits of creative activities <TextLink reference="43"></TextLink>.</Pgraph><SubHeadline>1.5 Why is it important to do this review</SubHeadline><Pgraph>The present work is an update of the systematic review provided by Martin and colleagues <TextLink reference="33"></TextLink> which summarizes the existing evidence up until August 2016. The aim of the present article is to review the progress in the field of creative arts interventions with regard to stress reduction and stress management during the last four years. Given the rapid development of creative arts interventions across the different modalities, four years seems to be a sufficient period to review progress, both <TextGroup><PlainText>in terms of the</PlainText></TextGroup> quantity and quality of the published studies in the field. </Pgraph><Pgraph>We aim to provide up-to-date conclusions of the effectiveness of creative arts interventions for stress prevention and stress management for individuals of all age groups in all settings. Since the review addresses the context of prevention, both therapeutic and non-therapeutic creative arts interventions are considered. The study aims to contribute to the evidence base and a continued dialogue with health care practitioners and institutions about the potential of creative arts interventions for stress prevention and management. </Pgraph><SubHeadline>1.6 Objectives</SubHeadline><Pgraph>To assess the effects and summarize the scientific evidence of creative arts interventions for stress reduction across age groups and settings. </Pgraph></TextBlock> <TextBlock linked="yes" name="2 Methods"> <MainHeadline>2 Methods</MainHeadline><Pgraph>The methodology of a systematic review was used to synthesize the evidence on the effectiveness of creative arts interventions for stress management and prevention from published studies. To ensure a high scientific standard and reporting quality this systematic review was conducted according to the PRISMA Statement in its latest version <TextLink reference="44"></TextLink> and the current Cochrane manual for the preparation of medical guidelines <TextLink reference="45"></TextLink>.</Pgraph><SubHeadline>2.1 Criteria for selecting studies</SubHeadline><Pgraph>Eligibility criteria were defined by applying the PICOS acronym (population, intervention, comparison, outcome and study design) <TextLink reference="44"></TextLink>.</Pgraph><SubHeadline2>2.1.1 Population</SubHeadline2><Pgraph>Study participants eligible for this review were children, adolescents and adults. Because individuals of all ages and in all settings can potentially experience stress, no restrictions in these domains were applied. </Pgraph><Pgraph>Moreover, this review includes healthy participants as well as participants who may be at elevated risk to experience stress, for example people suffering from a serious illness such as HIV, cancer or pregnant women shortly before birth. Participants with a primarily stress associated medical condition such as patients with a PTSD were excluded as well as populations living in high risk circumstances for PTSD, such as veterans and refugees. </Pgraph><Pgraph>This approach follows the established classification used by the US American Institute of Medicine (IoM) <TextLink reference="17"></TextLink> to differentiate universal from targeted (selective and indicated) preventive measures for different populations according to their risk levels and intervention needs. </Pgraph><SubHeadline2>2.1.2 Interventions</SubHeadline2><Pgraph>Studies were included that specifically apply CATs and in addition also studies which provide mere arts intervention for stress prevention and management. A <Mark2>creative art therapy</Mark2> session as opposed to a mere intervention session (led by a health or art professional) is facilitated by a qualified creative arts therapist in art, music, dance or drama. The heterogeneity of the intervention approaches in the scientific literature reflects the variability of creative arts interventions in practice. That is why the interventions did not have to be standardized to fulfill the eligibility criteria. Furthermore, the included studies differ in duration length of treatment period. </Pgraph><SubHeadline2>2.1.3 Comparators</SubHeadline2><Pgraph>Studies with all types of control groups were included: </Pgraph><Pgraph><OrderedList><ListItem level="1" levelPosition="1" numString="1.">No treatment or standard care (treatment-as-usual, TAU) or waiting list</ListItem><ListItem level="1" levelPosition="2" numString="2.">Psychological therapies</ListItem><ListItem level="1" levelPosition="3" numString="3.">Pharmacological therapies</ListItem><ListItem level="1" levelPosition="4" numString="4.">Different types of creative arts interventions (i.e. dance vs music; coloring mandala vs. coloring triangles)</ListItem><ListItem level="1" levelPosition="5" numString="5.">No comparator: in this review, similar in the review of Karkou et al. <TextLink reference="31"></TextLink>, studies without control groups were also included. </ListItem></OrderedList></Pgraph><SubHeadline2>2.1.4 Outcomes</SubHeadline2><Pgraph>Primary outcomes:</Pgraph><Pgraph><OrderedList><ListItem level="1" levelPosition="1" numString="1.">Stress, measured by self-reports such as the Perceived Stress Scale (PSS <TextLink reference="46"></TextLink>) and psychophysiological parameters such as heart rate (HR) and heart rate variability (HRV); cortisol level with saliva sample (pre/post ELISA kit method); mental distress for example measured by the Kessler Psychological Distress scale (K10 scale <TextLink reference="47"></TextLink>)</ListItem><ListItem level="1" levelPosition="2" numString="2.">Anxiety, measured by a validated assessor-rating scales, such as the Hamilton Anxiety Scale (HAM-A; Hamilton 1959), or a self-rating scale, such as the Beck Anxiety Inventory (BAI; Beck 1988) or the State Scale of the Stait-Trait Anxiety Inventory (S-STAI <TextLink reference="48"></TextLink>)</ListItem></OrderedList></Pgraph><Pgraph>Secondary outcomes:</Pgraph><Pgraph><OrderedList><ListItem level="1" levelPosition="1" numString="1.">Mood and affect for example measured by the Positive and Negative Affect Scale (PANAS <TextLink reference="49"></TextLink>)</ListItem><ListItem level="1" levelPosition="2" numString="2.">Emotion Regulation for example measured by the Difficulties in Emotion Regulation Scale (DERS-SF <TextLink reference="50"></TextLink>)</ListItem></OrderedList></Pgraph><Pgraph>All time frames of outcome assessments were included. If a study reported more than one time point within the considered time frame, the latest time point was chosen as the primary endpoint. </Pgraph><SubHeadline2>2.1.5 Study designs</SubHeadline2><Pgraph>Included were published RCT’s (i.e., studies with a truly random allocation to at least two experimental conditions), controlled clinical trials (i.e., any studies including a control group with participants with comparable characteristics such as quasi-experimental studies as well as matching techniques), and uncontrolled studies (i.e., any other intervention study with a prospective design with available baseline values allowing for pre-post within-subject comparisons) in all languages. </Pgraph><SubHeadline>2.2 Search strategy</SubHeadline><SubHeadline2>2.2.1 Electronic database searches</SubHeadline2><Pgraph>The following relevant major databases for healthcare were included: PubMed, Medline, PsycInfo, ERIC, SocIndex and Psyndex. An additional hand search through scanning the references of the included studies was conducted. </Pgraph><SubHeadline2>2.2.2 Search string</SubHeadline2><Pgraph>We conceptualized the search string following the Cochrane Handbook for Systematic Reviews <TextLink reference="51"></TextLink> to be focused, economical and adequately sensitive. The individual search terms were linked with the Boolean operators AND or OR. An asterisk (*) was added <TextGroup><PlainText>at the end of a term</PlainText></TextGroup> for the inclusion of singular and plural <TextLink reference="52"></TextLink>. Table 1 <ImgLink imgNo="1" imgType="table"/> provides an overview of the databases and search terms.</Pgraph><SubHeadline2>2.2.3 Search time period</SubHeadline2><Pgraph>The present study chronologically continues a previous review <TextLink reference="33"></TextLink>, updates and extends it, for example, by including different databases. We searched for published studies between the publication dates of 2016 to April 30, 2020. The total search was performed and completed in April 2020.</Pgraph><SubHeadline>2.3 Data extraction and data management</SubHeadline><SubHeadline2>2.3.1 Study selection</SubHeadline2><Pgraph>To select the studies systematically and economically according to the eligibility criteria, we scanned the titles, then the abstracts and finally the full texts of the studies after removing the duplicates (see Figure 1 <ImgLink imgNo="1" imgType="figure"/>). </Pgraph><SubHeadline2>2.3.2 Level of evidence</SubHeadline2><Pgraph>The systematic review focused on different types of evidence. Evidence levels were defined according to the Agency for Healthcare Research and quality <TextLink reference="53"></TextLink>. We included studies of evidence levels Ia to III. </Pgraph><SubHeadline2>2.3.3 Data management and extraction</SubHeadline2><Pgraph>Searches were managed and saved using the reference manager “endnote”. The details of research design, author and year, levels of evidence, object of investigation, sample size, short description of the intervention, data collection, statistical analysis and central results were entered into an excel spreadsheet (see Attachment 1 <AttachmentLink attachmentNo="1"/>). The table in the previous review by Martin and colleagues was used as a template. For clinical outcome studies the mean scores and standard deviations were extracted alongside with the effect sizes and <Mark2>P</Mark2>-values for significance testing. Relationships between studies (i.e., whether one study referred to a secondary analysis of a sample that has already been included in the review) were explored and marked by text. </Pgraph><SubHeadline2>2.3.4 Dealing with missing full texts</SubHeadline2><Pgraph>Not all studies could be found in open-access journals. We contacted several authors via the online platform “ResearchGate” (<Hyperlink href="https://www.researchgate.net">https://www.researchgate.net</Hyperlink>). In the end, no full text was missing.</Pgraph></TextBlock> <TextBlock linked="yes" name="3 Results"> <MainHeadline>3 Results</MainHeadline><SubHeadline>3.1 Selection process</SubHeadline><Pgraph>As the PRISMA diagram illustrates (see Figure 1 <ImgLink imgNo="1" imgType="figure"/>) the database search identified 2,030 records and 6 additional records through other sources. After removing the duplicates 1,938 records left for the screening by title. 1,753 records were excluded, leaving 185 records for the screening at abstract level, of those were 112 excluded. From these, 73 records were examined by full text, excluding 22 to 52 eligible included studies which met the inclusion criteria and made up the final data set. One study <TextLink reference="54"></TextLink> met all the inclusion criteria and was added due of its publication year in 2017, even though it was already included in the previous review by Martin and colleagues <TextLink reference="33"></TextLink>.</Pgraph><SubHeadline>3.2 Study characteristics</SubHeadline><SubHeadline2>3.2.1 Sample size</SubHeadline2><Pgraph>The total number of participants included in the 52 studies was N=4,925. </Pgraph><Pgraph>Three studies conducted a second data analysis of existing studies with sample sizes already documented in this review. These participants were not counted twice. The study of Ho <TextLink reference="55"></TextLink> takes its sample from the previous study <TextLink reference="56"></TextLink> as does Vrinceanu <TextLink reference="57"></TextLink>, <TextLink reference="58"></TextLink>, whose analysis refer to the study sample of Esmail <TextLink reference="59"></TextLink>. </Pgraph><Pgraph>Classified according to arts discipline the total number of participants in art interventions was 1,267, in music interventions 3,144, in dance interventions 501 and drama interventions 13 (see Table 2 <ImgLink imgNo="2" imgType="table"/>). </Pgraph><Pgraph>Sample sizes across studies varied from six participants <TextLink reference="60"></TextLink> to 564 participants <TextLink reference="61"></TextLink>. </Pgraph><SubHeadline2>3.2.2 Setting</SubHeadline2><Pgraph>The 52 studies in the review were conducted over all continents in the world. 20 studies were conducted in North America, 16 of them in the United States (<TextLink reference="62"></TextLink>, <TextLink reference="63"></TextLink>, <TextLink reference="64"></TextLink>, <TextLink reference="65"></TextLink>, <TextLink reference="66"></TextLink>, <TextLink reference="67"></TextLink>, <TextLink reference="68"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="60"></TextLink>, <TextLink reference="70"></TextLink>, <TextLink reference="71"></TextLink>, <TextLink reference="72"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="74"></TextLink>, <TextLink reference="75"></TextLink>, <TextLink reference="76"></TextLink>) and four studies in Canada (<TextLink reference="77"></TextLink>, <TextLink reference="59"></TextLink>, <TextLink reference="57"></TextLink>, <TextLink reference="58"></TextLink>). </Pgraph><Pgraph>16 studies were conducted in Europe: Four studies took place in Spain (<TextLink reference="78"></TextLink>, <TextLink reference="79"></TextLink>, <TextLink reference="80"></TextLink>, <TextLink reference="81"></TextLink>), four studies in Turkey (<TextLink reference="82"></TextLink>, <TextLink reference="83"></TextLink>, <TextLink reference="84"></TextLink>, <TextLink reference="85"></TextLink>), four studies in Germany (<TextLink reference="86"></TextLink>, <TextLink reference="87"></TextLink>, <TextLink reference="88"></TextLink>, <TextLink reference="54"></TextLink>), two studies in Italy (<TextLink reference="89"></TextLink>, <TextLink reference="90"></TextLink>) and one study each in the Netherlands <TextLink reference="91"></TextLink>, the United Kingdom (<TextLink reference="61"></TextLink> and in Sweden <TextLink reference="92"></TextLink>. </Pgraph><Pgraph>Ten trials were conducted in Asia. Five studies in China (<TextLink reference="56"></TextLink>, <TextLink reference="55"></TextLink>, <TextLink reference="93"></TextLink>, <TextLink reference="94"></TextLink>, <TextLink reference="95"></TextLink>), two studies in Korea <TextLink reference="96"></TextLink>, <TextLink reference="97"></TextLink>, one study in India (<TextLink reference="98"></TextLink> and <TextLink reference="31"></TextLink>), one in Thailand <TextLink reference="99"></TextLink> and one in Taiwan <TextLink reference="100"></TextLink>. </Pgraph><Pgraph>Three studies were conducted in Oceania, two of them in New Zealand (<TextLink reference="101"></TextLink>, <TextLink reference="102"></TextLink> and one in Australia <TextLink reference="103"></TextLink>. One study was done in South America <TextLink reference="104"></TextLink>. </Pgraph><SubHeadline2>3.2.3 Study design</SubHeadline2><Pgraph>36 of the included studies were RCT’s, this represents 68% of the reviewed studies, seven studies were controlled trials without randomization, seven studies were quasi-experimental and two studies without control group. Table 3 <ImgLink imgNo="3" imgType="table"/> summarizes the various study designs by arts modality, year of publication and level of evidence.</Pgraph><SubHeadline2>3.2.4 Participants</SubHeadline2><SubHeadline3>Gender</SubHeadline3><Pgraph>There were 467 male, one diverse and 4,042 female participants, thus 82% of the total participants were female. 16 studies recruited only female participants: <TextLink reference="91"></TextLink>, <TextLink reference="98"></TextLink> and <TextLink reference="31"></TextLink>, <TextLink reference="61"></TextLink>, <TextLink reference="63"></TextLink>, <TextLink reference="85"></TextLink>, <TextLink reference="101"></TextLink>, <TextLink reference="65"></TextLink>, <TextLink reference="80"></TextLink>, <TextLink reference="66"></TextLink>, <TextLink reference="56"></TextLink>, <TextLink reference="55"></TextLink>, <TextLink reference="99"></TextLink>, <TextLink reference="93"></TextLink>, <TextLink reference="71"></TextLink>, <TextLink reference="83"></TextLink>, <TextLink reference="97"></TextLink>.</Pgraph><Pgraph>Several studies did not display the demographic data of their samples in detail and were omitted in the calculations. For 415 participants gender was not reported, for example in some parent-child-dyads where each <TextGroup><PlainText>dyad was</PlainText></TextGroup> counted as one participant, unless it was specified separately like in <TextLink reference="73"></TextLink> and <TextLink reference="98"></TextLink>, <TextLink reference="31"></TextLink>. A detailed description for the allocation of gender per modality can be found in Table 4 <ImgLink imgNo="4" imgType="table"/>.</Pgraph><SubHeadline3>Age</SubHeadline3><Pgraph>Age of participants was heterogeneous among the included studies. In particular, three studies <TextLink reference="97"></TextLink>, <TextLink reference="92"></TextLink>, <TextLink reference="76"></TextLink> focused on children, three studies recruited only adolescents (<TextLink reference="63"></TextLink>, <TextLink reference="103"></TextLink>, <TextLink reference="95"></TextLink>) and three studies included a geriatric population <TextLink reference="68"></TextLink>, <TextLink reference="59"></TextLink>, <TextLink reference="74"></TextLink> . Furthermore, three studies consisted of parent-child dyads <TextLink reference="90"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="75"></TextLink>. 47% of all included studies involved adults. 13 studies were omitted in the calculation of participants’ mean age: ten studies did not report the age of the participants and three studies were secondary analyses <TextLink reference="55"></TextLink>, <TextLink reference="57"></TextLink>, <TextLink reference="58"></TextLink>.</Pgraph><Pgraph>The mean age of all participants in the review was 34.23 years. The mean age of the modality <Mark2>Drama</Mark2> was relatively high (see Table 2 <ImgLink imgNo="2" imgType="table"/>) since it referred to only one study focusing on older adults.</Pgraph><SubHeadline3>Clinical and nonclinical population</SubHeadline3><Pgraph>The proportion of clinical and nonclinical populations was also heterogeneous among the included studies. 32 studies (60%) referred to a nonclinical healthy population, including three studies in the context of pregnancy (i.e. pre- or postpartum; <TextLink reference="61"></TextLink>, <TextLink reference="85"></TextLink>, <TextLink reference="80"></TextLink>). 15 studies (29%) included a clinical population (i.e. participants with a non-primarily stress associated medical condition, as discussed in the method section above). Included were patients with anxiety disorder <TextLink reference="91"></TextLink>, participants in treatment for cancer <TextLink reference="67"></TextLink>, <TextLink reference="90"></TextLink>, <TextLink reference="72"></TextLink>, <TextLink reference="75"></TextLink>, <TextLink reference="56"></TextLink>, <TextLink reference="55"></TextLink>, people living with HIV <TextLink reference="64"></TextLink>, clients with subjective cognitive decline <TextLink reference="68"></TextLink> and patients scheduled for a surgery or another clinical intervention <TextLink reference="105"></TextLink>, <TextLink reference="99"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="104"></TextLink>, <TextLink reference="84"></TextLink>, <TextLink reference="92"></TextLink>. </Pgraph><SubHeadline2>3.2.5 Interventions</SubHeadline2><Pgraph>As already illustrated (see Table 3 <ImgLink imgNo="3" imgType="table"/>) 17 studies investigated CATs (performed by a licensed creative arts therapist) and 35 studies investigated mere arts interventions (led by a health or art professional). The duration of the interventions varied from single sessions to weekly sessions over four months or daily sessions for one week. The total number of sessions ranged from one to 16 sessions. The duration of each session also varied from ten minutes to 2.5 hours. An exception to this was the study of Hides et al. <TextLink reference="103"></TextLink>, who investigated the effect of a music-based emotion regulation mobile app in distressed adolescents over 6 months without defining sessions. The specific arts-based intervention models were heterogeneous across the included studies. </Pgraph><SubHeadline3>Art therapy</SubHeadline3><Pgraph>Twelve of all 15 studies in the art modality sessions were conducted in a group setting. Three studies <TextLink reference="61"></TextLink>, <TextLink reference="101"></TextLink>, <TextLink reference="66"></TextLink> provided individual sessions. In five studies a trained art therapist offered the interventions <TextLink reference="91"></TextLink>, <TextLink reference="62"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="93"></TextLink>, <TextLink reference="72"></TextLink>. </Pgraph><Pgraph>In twelve studies, researchers adopted mere art interventions using artistic media such as drawing or coloring <TextLink reference="85"></TextLink>, <TextLink reference="77"></TextLink>, <TextLink reference="101"></TextLink>, <TextLink reference="67"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="93"></TextLink>, <TextLink reference="94"></TextLink>, <TextLink reference="60"></TextLink>, anthroposophic art therapy <TextLink reference="91"></TextLink>, expressive writing <TextLink reference="61"></TextLink>, textile art making <TextLink reference="65"></TextLink>, clay-based art <TextLink reference="62"></TextLink> and guided imagery <TextLink reference="66"></TextLink>. </Pgraph><Pgraph>Three interventions applied a combination of mindfulness and art called Mindfulness-based art therapy (MBAT) <TextLink reference="62"></TextLink>, <TextLink reference="63"></TextLink>, <TextLink reference="72"></TextLink>. </Pgraph><SubHeadline3>Music therapy</SubHeadline3><Pgraph>Seven out of the 25 studies of the music modality were explicitly labeled as group interventions. Five studies were guided by a licensed music therapist <TextLink reference="90"></TextLink>, <TextLink reference="95"></TextLink>, <TextLink reference="75"></TextLink>, <TextLink reference="92"></TextLink>, <TextLink reference="76"></TextLink>. In five studies, researchers adopted an active music therapy method. In the study of Litchke <TextLink reference="70"></TextLink> facilitators used drumming as the main intervention and Robb <TextLink reference="75"></TextLink> applied a parent delivered “Active Music Engagement” (AME, an interactive, music-based play intervention) accompanied by a music therapist. In Giodarno <TextLink reference="90"></TextLink> and Millet <TextLink reference="73"></TextLink> the music interventions were not described in detail. In the study of Uggla <TextLink reference="92"></TextLink> it was not clear whether the intervention was active or receptive. </Pgraph><Pgraph>20 studies (80%) were based on receptive techniques. Five studies took into consideration a combination of Reiki with music <TextLink reference="64"></TextLink>, music with mindfulness based stress reduction (MBSR) <TextLink reference="95"></TextLink>, music with progressive muscle relaxation (PMR) <TextLink reference="83"></TextLink>, depth relaxation music therapy (DRMT) with hypno-music therapy (HMT) <TextLink reference="88"></TextLink> and music with aromatherapy <TextLink reference="97"></TextLink>. </Pgraph><SubHeadline3>Dance therapy</SubHeadline3><Pgraph>All ten studies in the dance modality were conducted in a group setting. Seven studies were dance therapy sessions and guided by a trained dance therapist. Ho <TextLink reference="55"></TextLink>, Vrinceneau <TextLink reference="57"></TextLink>, <TextLink reference="58"></TextLink> were secondary analyses of the two previous studies of Ho <TextLink reference="56"></TextLink> and Esmail <TextLink reference="59"></TextLink>. </Pgraph><Pgraph>Four studies describe the applied interventions: Kuroda <TextLink reference="102"></TextLink> analyzed Japanese traditional Nihonbuyo and New Zealand’s Haka, Lopez <TextLink reference="81"></TextLink> applied “biodanza” sessions, Mama <TextLink reference="71"></TextLink> applied Latin dance and Wiedenhofer <TextLink reference="54"></TextLink> applied improvisational dance. In six studies the dance therapy intervention was not described in detail. </Pgraph><SubHeadline3>Drama therapy</SubHeadline3><Pgraph>In the drama modality, one study met the inclusion criteria <TextLink reference="74"></TextLink>. The study was conducted in a group setting, guided by a professional actor and consisted of drama exercises and self-exploration, and a final performance of sections of the play “An Accident” by Lydia Stryk. </Pgraph><SubHeadline3>Comparator interventions</SubHeadline3><Pgraph>39 studies had one control group (74%). Six studies included three treatment arms with two control groups, and one study had three control groups <TextLink reference="94"></TextLink>. </Pgraph><Pgraph>In particular, eleven studies compared creative arts interventions versus treatment as usual (TAU) or no treatment <TextLink reference="80"></TextLink>, <TextLink reference="90"></TextLink>, <TextLink reference="105"></TextLink>, <TextLink reference="99"></TextLink>, <TextLink reference="93"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="95"></TextLink>, <TextLink reference="104"></TextLink>, <TextLink reference="84"></TextLink>, <TextLink reference="89"></TextLink>, <TextLink reference="76"></TextLink>. Eight studies were waitlist controlled (<TextLink reference="91"></TextLink>, <TextLink reference="66"></TextLink>, <TextLink reference="103"></TextLink>, <TextLink reference="92"></TextLink>, <TextLink reference="98"></TextLink>, <TextLink reference="31"></TextLink>, <TextLink reference="56"></TextLink>, <TextLink reference="55"></TextLink>, <TextLink reference="81"></TextLink>). 22 studies were controlled by an active group control (<TextLink reference="62"></TextLink>, <TextLink reference="64"></TextLink>, <TextLink reference="85"></TextLink>, <TextLink reference="78"></TextLink>, <TextLink reference="79"></TextLink>, <TextLink reference="77"></TextLink>, <TextLink reference="101"></TextLink>, <TextLink reference="65"></TextLink>, <TextLink reference="68"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="86"></TextLink>, <TextLink reference="106"></TextLink>, <TextLink reference="102"></TextLink>, <TextLink reference="96"></TextLink>, <TextLink reference="71"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="74"></TextLink>, <TextLink reference="83"></TextLink>, <TextLink reference="88"></TextLink>, <TextLink reference="75"></TextLink>, <TextLink reference="97"></TextLink>, <TextLink reference="54"></TextLink>). </Pgraph><Pgraph>In detail, eleven studies used different types of creative arts interventions in the control group, such as Beerse <TextLink reference="62"></TextLink>, who employed a neutral clay-manipulation, Bremner <TextLink reference="64"></TextLink> music only, Eaton <TextLink reference="77"></TextLink> forced choice of coloring of a precolored image, Innes <TextLink reference="68"></TextLink> music listening, Kaimal <TextLink reference="69"></TextLink> coloring without interaction with an art therapist, Kim <TextLink reference="86"></TextLink> receptive music therapy with fixed tempo of 70 beats per minute, Kuroda <TextLink reference="102"></TextLink> New Zealand dance Haka, Lee <TextLink reference="94"></TextLink> coloring a rectangular grid with preset colors, Millet <TextLink reference="73"></TextLink> receptive music therapy, Son <TextLink reference="97"></TextLink> unspecified music therapy and Wiedenhofer <TextLink reference="54"></TextLink> goal directed movement. Three arm-controlled studies with an active and a waitlist group were Ayers <TextLink reference="61"></TextLink>, Esmail <TextLink reference="59"></TextLink>, Vrinceneau <TextLink reference="57"></TextLink>, <TextLink reference="58"></TextLink>. Six studies used no comparator interventions and were based on a single treatment arm (<TextLink reference="63"></TextLink>, <TextLink reference="67"></TextLink>, <TextLink reference="60"></TextLink>, <TextLink reference="70"></TextLink>, <TextLink reference="82"></TextLink>, <TextLink reference="72"></TextLink>).</Pgraph><SubHeadline2>3.2.6 Types of outcome measures</SubHeadline2><SubHeadline3>Primary outcomes</SubHeadline3><Pgraph><Mark1>Stress</Mark1></Pgraph><Pgraph>All studies assessed stress using different stress scales. Stress was measured through the Perceived Stress Scale, PSS <TextLink reference="63"></TextLink>, <TextLink reference="101"></TextLink>, <TextLink reference="66"></TextLink>, <TextLink reference="56"></TextLink>, <TextLink reference="68"></TextLink>, <TextLink reference="69"></TextLink>, <TextLink reference="70"></TextLink>, <TextLink reference="81"></TextLink>, <TextLink reference="83"></TextLink>, <TextLink reference="97"></TextLink>, subjective ratings (Visual Analog Scale, VAS) <TextLink reference="63"></TextLink>, the Parenting Stress Scale, PSI <TextLink reference="98"></TextLink>, <TextLink reference="31"></TextLink>, <TextLink reference="93"></TextLink>, the Depression Anxiety Stress Scale, DASS <TextLink reference="60"></TextLink>, the Events Scale-Revised, IES-R <TextLink reference="75"></TextLink>, the Child-Adult Medical Procedure Interaction Scale-Revised, CAMPIS-R <TextLink reference="76"></TextLink>, the Tension and Effort Stress Inventory, TESI <TextLink reference="102"></TextLink>, the Weekly Stress Inventory, WSI <TextLink reference="71"></TextLink>, the Kessler-10 Psychological Distress Scale <TextLink reference="103"></TextLink> and the Perceived Stress Questionnaire, PSQ30 <TextLink reference="54"></TextLink>. Six studies measured stress through psychophysiological parameters <TextLink reference="91"></TextLink>, <TextLink reference="79"></TextLink>, <TextLink reference="105"></TextLink>, <TextLink reference="106"></TextLink>, <TextLink reference="96"></TextLink>, <TextLink reference="89"></TextLink> and three through cortisol level from a saliva sample <TextLink reference="55"></TextLink>, <TextLink reference="57"></TextLink>, <TextLink reference="58"></TextLink>. </Pgraph><Pgraph>Three studies used combinations of outcome measures: Beerse <TextLink reference="62"></TextLink> considered PSS and Saliva sample and Kim <TextLink reference="86"></TextLink> measured with VAS combined with measures of two parameters of cardiovascular autonomous nervous system (ANS) reactivity: pulse rate (PR) and blood volume pulse amplitude (BVP-A). De la Torre-Luque <TextLink reference="78"></TextLink> used a combination of heartrate variability, HRV, the Positive Symptom Distress Index, PSDI and the Brief Symptom Inventory (BSI). Two Studies used a self-reported stress scale <TextLink reference="61"></TextLink>, <TextLink reference="67"></TextLink>. Robb observationally measured children and emotional distress through facial expressions in a behavioral coding form <TextLink reference="107"></TextLink>.<LineBreak></LineBreak><LineBreak></LineBreak></Pgraph><Pgraph><Mark1>Anxiety</Mark1></Pgraph><Pgraph>21 studies assessed anxiety. De la Torre-Luque <TextLink reference="79"></TextLink>, Eaton <TextLink reference="77"></TextLink>, Esmail <TextLink reference="59"></TextLink>, Garcia <TextLink reference="80"></TextLink>, Kongsawatvorakul <TextLink reference="99"></TextLink>, Lee <TextLink reference="100"></TextLink>, Millet <TextLink reference="73"></TextLink>, Osmanoglu <TextLink reference="82"></TextLink>, Öztürk <TextLink reference="84"></TextLink> and Son <TextLink reference="97"></TextLink> used the State Scale of State–Trait Anxiety Inventory, SSTAI. Flett <TextLink reference="101"></TextLink>, Litchke <TextLink reference="70"></TextLink> and Liu <TextLink reference="95"></TextLink> measured anxiety due the Hospital Anxiety and Depression Scale–Anxiety Subscale, HADS-A. Beerse <TextLink reference="62"></TextLink> used the GAD-7 self-report, Giordano <TextLink reference="90"></TextLink> and Millet <TextLink reference="73"></TextLink> a modified version of Yale Pre-operative Anxiety Scale, <TextGroup><PlainText>m-YPAS</PlainText></TextGroup>. Koelsch<TextLink reference="106"></TextLink> measured assessed anxiety with the Profile of Mood States, POMS. Lee <TextLink reference="93"></TextLink> used the Brief Symptoms Inventory, BSI and Meghani <TextLink reference="72"></TextLink> employed the Edmonton Symptom Assessment Scale-R, ESAS-R. </Pgraph><Pgraph>Ortega <TextLink reference="104"></TextLink> and Lee <TextLink reference="94"></TextLink> used a combination of physiological variables (blood pressure, pulse and heart rate) and State Scale of State-Trait Anxiety Inventory, SSTAI. Bremner <TextLink reference="64"></TextLink> used a mixed methods approach with a combination of physiological measures, the State Trait Anxiety Inventory and a self-report via qualitative, semi-structured interviews. </Pgraph><SubHeadline3>Secondary outcomes</SubHeadline3><Pgraph><Mark1>Mood and affect</Mark1></Pgraph><Pgraph>Ayers <TextLink reference="61"></TextLink> measured mood and affect using the UWIST Mood Adjective Checklist, UMACL and Eaton <TextLink reference="77"></TextLink>, Futterman <TextLink reference="65"></TextLink>, Kaimal <TextLink reference="69"></TextLink> employed the Positive and Negative Affect Scale, PANAS. Robb <TextLink reference="75"></TextLink> used the Profile of Mood States, POMS and Moore <TextLink reference="74"></TextLink> the Geriatric Depression Scale, GDS. Lee <TextLink reference="93"></TextLink> used a self-developed questionnaire to measure parental mood and related areas. </Pgraph><Pgraph><Mark1>Emotion regulation</Mark1></Pgraph><Pgraph>Hides <TextLink reference="103"></TextLink> measured emotion regulation by using the Difficulties in Emotion Regulation Scale, (DERS). </Pgraph><SubHeadline2>3.2.7 Effects of interventions</SubHeadline2><Pgraph>In order to deal with the heterogeneity of the results, effects are firstly roughly summarized and secondly reported in detail, broken down by artistic modality and the various different instruments below.</Pgraph><SubHeadline3>Primary outcomes</SubHeadline3><Pgraph>In total, stress and anxiety were significantly reduced (<Mark2>p</Mark2>≤.05) in 40 of the 52 included studies (76.5%) with 24 of the studies referring to differences between groups and 16 to pre/post differences within groups. 15 out of 17 studies in CATs (88%) and 25 out of 35 studies in arts interventions (70.6%) found a significant reduction in stress and anxiety. <LineBreak></LineBreak><LineBreak></LineBreak></Pgraph><Pgraph><Mark1>Art modality</Mark1></Pgraph><Pgraph>Five of 15 studies (33.3%) in the art modality reported a significant reduction in stress and anxiety compared to a control group. Eaton <TextLink reference="77"></TextLink> (free choice coloring vs forced choice coloring) found a marginally significant reduction in anxiety using a short form of the State Scale of the State–Trait Anxiety Inventory (S-STAI). Flett <TextLink reference="101"></TextLink> (coloring pictures vs solving riddles) reported a significant decrease in stress and anxiety measured with the Perceived Stress Scale (PSS) and the Anxiety Subscale of the Hospital and Depression Scale (HADS-AS-7). Glinzak <TextLink reference="67"></TextLink> found a significant decrease in stress via a self-report distress thermometer in the open studio condition and Sezen <TextLink reference="85"></TextLink> (group art therapy vs psychoeducation) a significant reduction in anxiety using the Beck Anxiety Inventory (BAI). </Pgraph><Pgraph>Abbing <TextLink reference="91"></TextLink>, Ayers <TextLink reference="61"></TextLink>, Björling <TextLink reference="63"></TextLink>, Giacobbi <TextLink reference="66"></TextLink> and Lee <TextLink reference="93"></TextLink> found no significant effects in their analysis. Beerse <TextLink reference="62"></TextLink>, Lindsey <TextLink reference="60"></TextLink> and Meghani <TextLink reference="72"></TextLink> reported no between group effect because of the single-arm study design. </Pgraph><Pgraph>Eight studies reported a significant reduction of stress and anxiety within group <TextLink reference="61"></TextLink>, <TextLink reference="62"></TextLink>, <TextLink reference="63"></TextLink>, <TextLink reference="77"></TextLink>, <TextLink reference="67"></TextLink>, <TextLink reference="60"></TextLink>, <TextLink reference="72"></TextLink>. </Pgraph><Pgraph><LineBreak></LineBreak><LineBreak></LineBreak></Pgraph><Pgraph><Mark1>Music modality</Mark1></Pgraph><Pgraph>14 of 26 studies (53.8%) in the music modality reported a significant reduction of stress and anxiety compared to a control group. Bremner <TextLink reference="64"></TextLink> (reiki combined with music vs music only) reported a significant reduction of stress and anxiety using a Visual Analog Scale (VAS) for stress, the State Trait Anxiety Inventory (STAI-Y) for anxiety and qualitative findings from of a semi-structured interview. Garcia <TextLink reference="80"></TextLink> (music stimulation vs no music stimulation during NST) found a significant reduction in anxiety measured with the State Trait Anxiety Inventory (S-STAI). Giordano <TextLink reference="90"></TextLink> (music therapy vs TAU) also reported a significant reduction in anxiety using a modified Yale Pre-operative Anxiety Scale (m-YPAS). Hides <TextLink reference="103"></TextLink> (using Music eScape App vs waitlist) reported a nonsignificant effect for stress in general but found a significant effect in stress reduction for women. Kahlouhl <TextLink reference="105"></TextLink> (listening to music during surgery vs TAU) found a significant effect for stress in the stability for blood pressure and calm recovery. Kim <TextLink reference="86"></TextLink> (entrained- tempo condition vs fixed tempo condition) found a significantly stronger increase in peripheral blood flow (<Mark2>p</Mark2><.01). Koelsch <TextLink reference="106"></TextLink> (musical stimulus vs control stimulus) reported a significant effect on stress on the recovery of cortisol level and found out that mood played a causal role in the responses to acute stress. Lee <TextLink reference="100"></TextLink> (listening to meditative music vs TAU during PET scanning) found a significant reduction of anxiety measured with the State Trait Anxiety Inventory (STAI-S-20). Liu <TextLink reference="95"></TextLink> (MBSR with music therapy vs TAU) reported a significant decrease in anxiety using the Hamilton Anxiety Rating Scale (HAM-A). Ortega <TextLink reference="104"></TextLink> (listening to music vs TAU) used a combination of the State Trait Anxiety Inventory (S-STAI) and physiological measurement (blood pressure) and found a significant reduction of anxiety. Öztürk <TextLink reference="84"></TextLink> (listening to music vs TAU) reported a significant reduction of anxiety measured with the State Trait Anxiety Inventory (S-STAI) and the Beck Anxiety Inventory (BAI). Robb <TextLink reference="75"></TextLink> (parent delivered music-based intervention vs reading audio-story books) found a significant reduction of stress for children via positive facial affect expressions in a behavioral coding form <TextLink reference="107"></TextLink> and Rossi <TextLink reference="89"></TextLink> (listening to music vs TAU) by physiological measurements (heartrate, oxygen saturation level). Yinger <TextLink reference="76"></TextLink> (listening to music vs TAU) reported a significant reduction in distress behaviors and coping by using the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R). </Pgraph><Pgraph>Ten Studies did not find a significant reduction in stress or anxiety <TextLink reference="78"></TextLink>, <TextLink reference="79"></TextLink>, <TextLink reference="68"></TextLink>, <TextLink reference="99"></TextLink>, <TextLink reference="96"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="82"></TextLink>, <TextLink reference="88"></TextLink>, <TextLink reference="97"></TextLink>, <TextLink reference="92"></TextLink>. The studies of Osmanoglu <TextLink reference="82"></TextLink> and Litchke <TextLink reference="70"></TextLink> used a single-arm study design without between-group effects. </Pgraph><Pgraph>Eight studies reported a significant reduction of stress and anxiety within-group <TextLink reference="78"></TextLink>, <TextLink reference="68"></TextLink>, <TextLink reference="96"></TextLink>, <TextLink reference="73"></TextLink>, <TextLink reference="82"></TextLink>, <TextLink reference="88"></TextLink>, <TextLink reference="97"></TextLink>, <TextLink reference="92"></TextLink>. Litchke <TextLink reference="70"></TextLink> reported no significance in overall stress reduction but pointed out a significant reduction on two subscales of the PSS: “handling unexpected events” and “controlling important life experiences”. </Pgraph><Pgraph><LineBreak></LineBreak><LineBreak></LineBreak></Pgraph><Pgraph><Mark1>Dance modality</Mark1></Pgraph><Pgraph>Five of ten studies in the dance modality reported a significant reduction of stress and anxiety compared to a control group. Aithal <TextLink reference="98"></TextLink> and Karkou <TextLink reference="31"></TextLink> (DMT vs waitlist) found a significant reduction of stress by using the Parenting Stress Index-Short Form (PSI-SF). Ho <TextLink reference="56"></TextLink> (DMT vs Aerobic training vs passive waitlist) reported a significant reduction of stress on the Perceived Stress Scale (PSS-10). Their secondary data analysis <TextLink reference="55"></TextLink> showed that the perceived stress at baseline, significantly moderated the intervention effect, which she called a “moderated mediation effect” <TextLink reference="56"></TextLink>. Lopez <TextLink reference="81"></TextLink> (Biodanza vs waitlist) and Wiedenhofer <TextLink reference="54"></TextLink> (non-goal-directed movement vs goal-directed movement) found a significant reduction in stress, measured with the Perceived Stress Scale (PSS). Mama <TextLink reference="71"></TextLink> (Latin dance vs internet-based education) reported a reduction in stress by using the Weekly Stress Inventory (WSI). In contrast to these results Kuroda <TextLink reference="102"></TextLink> reported a significant increase in stress in the Haka condition. Four studies did not find a significant reduction in stress and anxiety <TextLink reference="59"></TextLink>, <TextLink reference="55"></TextLink>, <TextLink reference="57"></TextLink>, <TextLink reference="58"></TextLink>. Three studies found a significant reduction in stress and anxiety within-group <TextLink reference="59"></TextLink>, <TextLink reference="57"></TextLink>, <TextLink reference="58"></TextLink>. </Pgraph><Pgraph><LineBreak></LineBreak><LineBreak></LineBreak></Pgraph><Pgraph><Mark1>Drama modality</Mark1></Pgraph><Pgraph>The study in the drama modality reported no significant reduction of anxiety compared to a control group <TextLink reference="74"></TextLink>. Moreover, Moore and colleagues found a significant increase in anxiety and a significant decrease in happiness relative to the control group but increases in self-esteem in the follow-up analysis of the within-group effects. </Pgraph><SubHeadline3>Secondary outcomes</SubHeadline3><Pgraph>In total, eight studies reported a significant difference in mood changes with four studies referring to differences between groups and four to pre/post differences within groups. Two of the eight studies employed creative arts therapies interventions <TextLink reference="69"></TextLink>, <TextLink reference="72"></TextLink> and five studies employed arts interventions <TextLink reference="79"></TextLink>, <TextLink reference="65"></TextLink>, <TextLink reference="68"></TextLink>, <TextLink reference="105"></TextLink>, <TextLink reference="106"></TextLink>, <TextLink reference="82"></TextLink>. </Pgraph><Pgraph>Additionally, there was one study <TextLink reference="103"></TextLink>, which analyzed the additional secondary outcome <Mark2>Emotion Regulation</Mark2>, and found a nonsignificant between-group difference on the DERS-SF Emotion Regulation Scale. </Pgraph><Pgraph><LineBreak></LineBreak><LineBreak></LineBreak></Pgraph><Pgraph><Mark1>Art modality</Mark1></Pgraph><Pgraph>Two studies in the art modality reported a significant change in mood compared to a control-group. Futterman <TextLink reference="65"></TextLink> (textile art making vs quit ego contemplation vs writing to negative mood) found a significant increase in positive mood and a significant decrease in negative mood using the Positive and Negative Affect Scale (PANAS). Kaimal <TextLink reference="69"></TextLink> (art therapy vs mere art intervention) reported a significant increase in positive affect, also measured with the Positive and Negative Affect Scale (PANAS). Ayers <TextLink reference="61"></TextLink> and Lee <TextLink reference="93"></TextLink> did not find a significant change in mood. Meghani <TextLink reference="72"></TextLink> found a significant within-group increases in different aspects of cancer patients’ spirituality (peace, faith, meaning). </Pgraph><Pgraph><LineBreak></LineBreak><LineBreak></LineBreak></Pgraph><Pgraph><Mark1>Music modality</Mark1></Pgraph><Pgraph>Two studies in the music modality reported a significant change in mood. Kahlouhl <TextLink reference="105"></TextLink> (listening to music vs TAU) found a significant increase satisfaction on the Evaluation du Vécu de l’Anesthésie Générale (EVAN-G scale) and Koelsch <TextLink reference="106"></TextLink> (musical vs control stimulus) found a significant increase in positive mood measured with Profile of Mood States (POMS). Innes <TextLink reference="68"></TextLink> (Kirtan Kriya meditation vs listening to music) did not find a significant change in mood. Significant within-group changes were reported in the studies of de la Torre-Luque <TextLink reference="79"></TextLink>, Innes <TextLink reference="68"></TextLink> and Osmanoglu <TextLink reference="82"></TextLink>. </Pgraph><Pgraph><Mark1>Dance modality</Mark1></Pgraph><Pgraph>No study in the dance modality reported a significant change in mood. </Pgraph><Pgraph><LineBreak></LineBreak><LineBreak></LineBreak></Pgraph><Pgraph><Mark1>Drama modality</Mark1></Pgraph><Pgraph>The study in the drama modality reported no significant change in mood compared to a control group <TextLink reference="74"></TextLink>. Moore and colleagues found a significant decrease in happiness compared to the control group (they also found increases in self-esteem in the within-group follow-up analysis). </Pgraph><SubHeadline>3.3 Summary of effects on stress reduction and management with creative arts interventions</SubHeadline><Pgraph>Attachment 1 <AttachmentLink attachmentNo="1"/> provides an overview of all included studies. The central information in each study was sorted by author and year of publication, level of evidence, object of investigation, sample size, study design, a description of the intervention, data collection, statistical analysis and central results. The results presented in Attachment 1 <AttachmentLink attachmentNo="1"/> are considered to continue the table in the systematic review of Martin and colleagues <TextLink reference="33"></TextLink>. Evidence levels are defined according to the Agency for Healthcare Research and Quality (AHRQ); creative arts therapies are demarcated from mere arts interventions by green text color: Creative arts therapies (guided by a licensed creative arts therapist) appear in green, mere arts interventions (led by an art or health professional) in black text. </Pgraph></TextBlock> <TextBlock linked="yes" name="4 Discussion"> <MainHeadline>4 Discussion</MainHeadline><SubHeadline>4.1 Summary of results</SubHeadline><Pgraph>In this systematic review, the effectiveness of creative arts interventions on stress reduction for participants across cultures and age-groups was investigated. 52 intervention studies published between 2016 and end of April 2020 with a total <Mark2>N</Mark2> of 4,925 participants were included. Over 80% of the participants were female. The number of studies varied between the four creative modalities. 50% of the included studies were studies on music interventions (<Mark2>N</Mark2>=26), 15 studies in the art modality, ten studies on dance interventions and one study in the drama modality. This indicates a need for more research in the modalities of art, dance and especially in drama, which are under-represented in the literature particularly with regards to their effectiveness for stress reduction.</Pgraph><Pgraph>The distribution of the study numbers by arts modality corresponds to the findings of Dunphy and colleagues <TextLink reference="20"></TextLink>, with higher numbers of studies on music interventions than in any of the other modalities in the context of depression. 36 studies, nearly 70% of the 52 included studies were RCT’s with high associated evidence levels (level I). This is in line with the previous review of Martin and colleagues <TextLink reference="33"></TextLink> on stress reduction, where 75% of the included studies were associated with evidence level I. Most of the RCT’s were found in the music modality (21 of 36 RCT’s), which reflects the high quality of evidence-based studies in music therapy <TextLink reference="22"></TextLink>. Over all modalities, however, only 17 studies (30% of all interventions) were led by a creative arts therapist, which appears to be a rather small proportion which may have influenced the corresponding effects sizes in the summarized studies. </Pgraph><Pgraph>Nevertheless, in the present review, over 75% of the included studies found a significant improvement on at least one of the stress or anxiety-related outcomes. These findings again confirm the results of Martin and colleagues <TextLink reference="33"></TextLink> where a significant reduction of stress in over 80% of the included studies was observed. In particular, nearly 90% of the interventions led by a creative arts therapist resulted in a significant reduction of stress which is also in line with the review of Martin and colleagues <TextLink reference="33"></TextLink>; mere arts interventions (guided by an art or health professional) reduced stress in only 70% of the cases. The following sections discuss some of the key findings for each modality.</Pgraph><SubHeadline2>4.1.1 Art modality</SubHeadline2><Pgraph>The quality of evidence of the included studies in the art modality was mixed, with ratings evenly distributed from the lowest to the highest level of evidence. In line with Dunphy and colleagues <TextLink reference="20"></TextLink>, studies with expressive writing were included and assigned to the art modality. In terms of how creative arts interventions can be specifically anchored in stress prevention, a trend seems to emerge in the art modality: three studies investigated the effects of art interventions in combination with mindfulness-based therapy <TextLink reference="62"></TextLink>, <TextLink reference="63"></TextLink>, <TextLink reference="72"></TextLink>, all with a significant decrease in one of the stress- or anxiety-related outcomes. The so-called Mindfulness-Based Art Therapy (MBAT) integrates art exercises with mindfulness skills training from the Mindfulness-Based Stress reduction (MBSR) by Jon Kabat-Zinn (<TextLink reference="108"></TextLink>, <TextLink reference="109"></TextLink>). This trend could be an interesting anchor point to establish a manualized program for MBAT similar to MBSR or MBCT (Mindfulness Based Cognitive Therapy) which are established in the clinical guidelines for prevention. Newland and Bettencourt <TextLink reference="110"></TextLink> analyzed in their systematic review and meta-analysis the effects of MBAT and found significant improvements in psychological and physical symptoms of anxiety, depression, and fatigue with an aggregated medium effect size. But only 14 studies met the inclusion criteria. More high-quality research would be of great importance here. </Pgraph><SubHeadline2>4.1.2 Music modality</SubHeadline2><Pgraph>16 of 25 studies demonstrated significant findings in the reduction of stress or anxiety and change in mood. Almost 85% of the included studies in the music modality were based on receptive techniques which occurred possibly due to mild inclusion criteria. In five studies a licensed music therapist led the session with three studies applying active music therapy interventions. Robb investigate in a parent delivered interactive (i.e., active) music-based play intervention accompanied by a music therapist; in the study of Giordano and colleagues <TextLink reference="90"></TextLink> and of Uggla and colleagues <TextLink reference="92"></TextLink> the experimental interventions were not described in detail. Two further studies included active music interventions, Litchke <TextLink reference="70"></TextLink> used drumming as the main medium and in Millet and colleagues <TextLink reference="73"></TextLink> the activity was not mentioned in detail. Koelsch and colleagues <TextLink reference="106"></TextLink> found out that mood plays a causal role in the modulation of responses to acute stress, which can generally be interpreted as a relevant finding for stress prevention. Because of missing transparency concerning the content of the interventions it is not possible to know if the studies involve the specific creative arts element of active creation <TextLink reference="42"></TextLink>. Moreover, this finding indicates a lack of consensus about what interventions in music therapy actually are. A major problem is the challenge that the term “music therapy” is not yet protected or standardized and that even “music listening” without any reference to music therapy methods is sometimes called “music therapy”. It is essential to more precisely define music therapeutical intervention approaches in future research. As Dunphy and colleagues <TextLink reference="20"></TextLink> mentioned, the application of manualized interventions or descriptions of clear intervention protocols may contribute to better practice in this respect. Correspondingly, in further systematic reviews in the field of creative arts interventions it may be feasible to define stricter inclusion criteria than in the present review and the review of Martin and colleagues <TextLink reference="4"></TextLink>. </Pgraph><SubHeadline2>4.1.3 Dance modality</SubHeadline2><Pgraph>Eight of ten studies with dance interventions demonstrated significant findings in the reduction of stress or anxiety. All interventions in the dance modality were group interventions. Six of seven studies were guided by a licensed dance movement therapist and found a significant reduction in one of the stress or anxiety-related outcomes. While in 60% of the studies the applied techniques were labeled as “dance movement therapy” and were not described in detail. Study interventions spanned a broad range of techniques including Japanese traditional Nihonbuyo, New Zealand’s Haka, Biodanza, Latin dance and directional or non-directional improvisational dance. </Pgraph><SubHeadline2>4.1.4 Drama modality</SubHeadline2><Pgraph>The inclusion of just one study implies that more research is needed to assess the evidence of drama interventions in the context of stress prevention and stress management. </Pgraph><SubHeadline>4.2 Methodological issues</SubHeadline><Pgraph>The summarized evidence in this review helps to clarify the benefit of creative arts interventions and can be considered an important step for a broader implementation in health care practice in the future. Unfortunately, across different health care sectors it is common that empirically proven intervention approaches are not sufficiently transferred to broad practical application (e.g. <TextLink reference="11"></TextLink>, <TextLink reference="111"></TextLink>). Therefore, the need for systematic knowledge on transferability and implementability and the question of effective methods to transfer scientific findings into health care practice is increasingly considered important in research and research funding <TextLink reference="112"></TextLink>. Particularly in the context of prevention, it can be observed that although many evidence-based programs are developed, only a few of them are transferred to routine practice after the development phase <TextLink reference="11"></TextLink>, <TextLink reference="113"></TextLink>. Particular to creative arts interventions, the great scope for creative approaches in practice, the diversity of procedures, methods and interventions can be considered an asset; however, this diversity and lack of standardized procedures limits their transfer to the health-care system. </Pgraph><Pgraph>This challenge also became apparent when conducting this systematic review. It was methodologically challenging to summarize the great variety among the various interventions, durations of interventions, the number of participants and statistical methods from the four modalities into superordinate categories, so that the summary of evidence appears to be rather small-scale.</Pgraph><Pgraph>Another relevant issue is the differentiation of CATs and mere creative arts interventions. As discussed in the introduction, it may not be as relevant to make this distinction in the field of prevention, as it would be in the field of therapy (i.e., interventions with actual patients). However, it is important for creative arts therapists to distinguish themselves from purely creative practitioners. The definitions of the various creative therapeutic professional associations for the individual disciplines confirm this by emphasizing the crucial role of quality standards of the therapist and the therapeutic work within the field of creative intervention. The results of the study confirm this notion by showing the great benefit in terms of effectiveness when sessions are conducted by licensed therapists. The present review provides evidence that quality standards in the qualification of creative arts therapists are essential and contribute to the effectiveness of interventions in the field.</Pgraph><SubHeadline>4.3 Limitations</SubHeadline><Pgraph>There are several limitations to the present review that need to be addressed. First and foremost, the review includes a very heterogeneous set of studies and applied interventions. Since the focus of the review was creative arts interventions and not a specific modality within that category, the resulting heterogeneity was – however – inevitable. Moreover, the aim of the present review was to provide an update of a previous evidence synthesis which was similar in its scope (<TextLink reference="33"></TextLink>, <TextLink reference="29"></TextLink>). The wide variety of types of interventions within the four modalities, even within one modality, however complicated the task of summarizing and interpreting the evidence <TextLink reference="114"></TextLink>, <TextLink reference="29"></TextLink>.</Pgraph><Pgraph>Another point is that the interventions are often not well described which makes replications difficult. Moreover, in some studies it was difficult to determine whether the experimental intervention could actually be considered a creative art-based intervention. The rational we applied in the present review was to examine that the central mechanism of action refers to one of the factors of the “Model of Embodied Aesthetics” proposed by Koch and colleagues <TextLink reference="40"></TextLink>. Future research, however, should be more specific about the concrete applied intervention models and techniques. </Pgraph><Pgraph>Also the interventions varied substantially in terms of group size and length of duration which makes them difficult to compare. As a consequence of the rather broad inclusion criteria applied in this review, a wide spectrum of intervention approaches has been assessed including studies with small samples, individual and group sessions etc.</Pgraph><Pgraph>Furthermore, the studies indicate a substantial gender imbalance. A large proportion of the study participants (over 80%) were female. This reflects the results of Martin and colleagues <TextLink reference="33"></TextLink>. However, from this review there is no indication for a differential effectiveness concerning gender or any other participant characteristics. This is in line with the sensitivity analyses of Koch and colleagues <TextLink reference="29"></TextLink> within their meta-analysis on the effects of CATs on health-related psychological outcomes. Future research should however systematically address the issue of differential effectiveness to determine what works for whom in creative art-based interventions. One way to approach this is the identification of participant characteristics that may be associated with differential effectiveness using moderator analyses <TextLink reference="115"></TextLink>. Moderators are variables that influence the direction or strength of the association between two variables <TextLink reference="116"></TextLink>. Moderator analyses can provide an indication of what treatment is effective for whom which is a critical next step with regards to creative arts intervention research, which to date has focused on establishing a “first-generation” evidence base for effectiveness. </Pgraph><SubHeadline>4.4 Implications for practice</SubHeadline><Pgraph>Given the findings that interventions led by certified creative arts therapists resulted in more significant improvements of stress-related outcomes than interventions led by other professionals, we recommend that interventions for stress reduction should be provided by certified creative arts therapists. For more transparency and for the replicability, future applied research should describe the examined interventions more precisely in form of clear intervention protocols and manuals.</Pgraph></TextBlock> <TextBlock linked="yes" name="5 Conclusion"> <MainHeadline>5 Conclusion</MainHeadline><Pgraph>The field of creative arts interventions can be described as highly emerging. The finding of 52 peer reviewed studies in the last four years confirms the growth of creative arts interventions as an innovative approach in psychotherapy and research on psychosocial preventive interventions. Moreover, interventions in creative arts seem to have a positive effect on stress prevention and stress management. They reduce the level of anxiety and enhance the subject’s mood. Especially, when led by a licensed creative arts therapist. </Pgraph><Pgraph>The flourishing of art (as quoted in the beginning), shown in the marked benefit of creative arts interventions speaks to continuation in the attempt of balancing the practice of creative arts therapies and evidence-based science. As the physician and physiologist Emil du Bois-Reymond highlighted:</Pgraph><Pgraph><LineBreak></LineBreak><LineBreak></LineBreak></Pgraph><Pgraph><Indentation><Mark2>But surely, </Mark2></Indentation></Pgraph><Pgraph><Indentation><Mark2>the human spirit shines brightest </Mark2></Indentation></Pgraph><Pgraph><Indentation><Mark2>where the brightness of art</Mark2></Indentation></Pgraph><Pgraph><Indentation><Mark2>is united </Mark2></Indentation></Pgraph><Pgraph><Indentation><Mark2>with the brightness of sciences.</Mark2></Indentation></Pgraph><Pgraph><Indentation><Mark2>Emil du Bois-Reymond (1890)</Mark2></Indentation></Pgraph></TextBlock> <TextBlock linked="yes" name="Notes"> <MainHeadline>Notes</MainHeadline><SubHeadline>Author contribution </SubHeadline><Pgraph>All authors have made a substantial, direct and intellectual contribution to the work, and approved it for publication. All authors contributed to manuscript revision and read and approved the submitted version. </Pgraph><SubHeadline>Acknowledgments</SubHeadline><Pgraph>The costs of this review were covered by the Research Institute for Creative ArtsTherapies (RIArT) at Alanus University for Arts and Social Sciences in Alfter/Bonn, Germany. We would like to thank Nicolas Arnaud and Peter-Michael Sack for the scientific support and all participants of the primary studies for completing the scales and driving research on embodied interventions further. </Pgraph><SubHeadline>Competing interests</SubHeadline><Pgraph>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. </Pgraph></TextBlock> <References linked="yes"> <Reference refNo="1"> <RefAuthor>Harkness KL</RefAuthor> <RefAuthor>Hayden EP</RefAuthor> <RefAuthor>Lopez-Duran NL</RefAuthor> <RefTitle>Stress sensitivity and stress sensitization in psychopathology: an introduction to the special section</RefTitle> <RefYear>2015</RefYear> <RefJournal>J Abnorm Psychol</RefJournal> <RefPage>1-3</RefPage> <RefTotal>Harkness KL, Hayden EP, Lopez-Duran NL. Stress sensitivity and stress sensitization in psychopathology: an introduction to the special section. J Abnorm Psychol. 2015 Feb;124(1):1-3. DOI: 10.1037/abn0000041</RefTotal> <RefLink>https://doi.org/10.1037/abn0000041</RefLink> </Reference> <Reference refNo="2"> <RefAuthor>Davis MT</RefAuthor> <RefAuthor>Holmes SE</RefAuthor> <RefAuthor>Pietrzak RH</RefAuthor> <RefAuthor>Esterlis I</RefAuthor> <RefTitle>Neurobiology of Chronic Stress-Related Psychiatric Disorders: Evidence from Molecular Imaging Studies</RefTitle> <RefYear>2017</RefYear> <RefJournal>Chronic Stress (Thousand Oaks)</RefJournal> <RefPage>2470547017710916</RefPage> <RefTotal>Davis MT, Holmes SE, Pietrzak RH, Esterlis I. Neurobiology of Chronic Stress-Related Psychiatric Disorders: Evidence from Molecular Imaging Studies. Chronic Stress (Thousand Oaks). 2017 Jan-Dec;1:2470547017710916. DOI: 10.1177/2470547017710916</RefTotal> <RefLink>https://doi.org/10.1177/2470547017710916</RefLink> </Reference> <Reference refNo="3"> <RefAuthor>Schmidt MV</RefAuthor> <RefAuthor>Sterlemann V</RefAuthor> <RefAuthor>Müller MB</RefAuthor> <RefTitle>Chronic stress and individual vulnerability</RefTitle> <RefYear>2008</RefYear> <RefJournal>Ann N Y Acad Sci</RefJournal> <RefPage>174-83</RefPage> <RefTotal>Schmidt MV, Sterlemann V, Müller MB. Chronic stress and individual vulnerability. Ann N Y Acad Sci. 2008 Dec;1148:174-83. DOI: 10.1196/annals.1410.017</RefTotal> <RefLink>https://doi.org/10.1196/annals.1410.017</RefLink> </Reference> <Reference refNo="4"> <RefAuthor>Slavich GM</RefAuthor> <RefTitle>Psychopathology and stress</RefTitle> <RefYear>2016</RefYear> <RefBookTitle>Encyclopedia of theory in psychology</RefBookTitle> <RefPage></RefPage> <RefTotal>Slavich GM. Psychopathology and stress. In: Miller HL, editor. Encyclopedia of theory in psychology. Thousand Oaks, CA: Sage Publications; 2016.</RefTotal> </Reference> <Reference refNo="5"> <RefAuthor>de Witte M</RefAuthor> <RefAuthor>Pinho ADS</RefAuthor> <RefAuthor>Stams GJ</RefAuthor> <RefAuthor>Moonen X</RefAuthor> <RefAuthor>Bos AER</RefAuthor> <RefAuthor>van Hooren S</RefAuthor> <RefTitle>Music therapy for stress reduction: a systematic review and meta-analysis</RefTitle> <RefYear>2022</RefYear> <RefJournal>Health Psychol Rev</RefJournal> <RefPage>134-59</RefPage> <RefTotal>de Witte M, Pinho ADS, Stams GJ, Moonen X, Bos AER, van Hooren S. Music therapy for stress reduction: a systematic review and meta-analysis. Health Psychol Rev. 2022 Mar;16(1):134-59. DOI: 10.1080/17437199.2020.1846580</RefTotal> <RefLink>https://doi.org/10.1080/17437199.2020.1846580</RefLink> </Reference> <Reference refNo="6"> <RefAuthor>Backé EM</RefAuthor> <RefAuthor>Seidler A</RefAuthor> <RefAuthor>Latza U</RefAuthor> <RefAuthor>Rossnagel K</RefAuthor> <RefAuthor>Schumann B</RefAuthor> <RefTitle>The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review</RefTitle> <RefYear>2012</RefYear> <RefJournal>Int Arch Occup Environ Health</RefJournal> <RefPage>67-79</RefPage> <RefTotal>Backé EM, Seidler A, Latza U, Rossnagel K, Schumann B. The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review. Int Arch Occup Environ Health. 2012 Jan;85(1):67-79. DOI: 10.1007/s00420-011-0643-6</RefTotal> <RefLink>https://doi.org/10.1007/s00420-011-0643-6</RefLink> </Reference> <Reference refNo="7"> <RefAuthor>Turner AI</RefAuthor> <RefAuthor>Smyth N</RefAuthor> <RefAuthor>Hall SJ</RefAuthor> <RefAuthor>Torres SJ</RefAuthor> <RefAuthor>Hussein M</RefAuthor> <RefAuthor>Jayasinghe SU</RefAuthor> <RefAuthor>Ball K</RefAuthor> <RefAuthor>Clow AJ</RefAuthor> <RefTitle>Psychological stress reactivity and future health and disease outcomes: A systematic review of prospective evidence</RefTitle> <RefYear>2020</RefYear> <RefJournal>Psychoneuroendocrinology</RefJournal> <RefPage>104599</RefPage> <RefTotal>Turner AI, Smyth N, Hall SJ, Torres SJ, Hussein M, Jayasinghe SU, Ball K, Clow AJ. Psychological stress reactivity and future health and disease outcomes: A systematic review of prospective evidence. Psychoneuroendocrinology. 2020 Apr;114:104599. DOI: 10.1016/j.psyneuen.2020.104599</RefTotal> <RefLink>https://doi.org/10.1016/j.psyneuen.2020.104599</RefLink> </Reference> <Reference refNo="8"> <RefAuthor>Chen A</RefAuthor> <RefTitle></RefTitle> <RefYear>2019</RefYear> <RefBookTitle>Stress Resilience: Molecular and Behavioral Aspects</RefBookTitle> <RefPage></RefPage> <RefTotal>Chen A. Stress Resilience: Molecular and Behavioral Aspects. London: Elsevier; 2019.</RefTotal> </Reference> <Reference refNo="9"> <RefAuthor>Everly Jr</RefAuthor> <RefAuthor>George S</RefAuthor> <RefAuthor>Lating</RefAuthor> <RefAuthor>Jeffrey M</RefAuthor> <RefTitle></RefTitle> <RefYear>2013</RefYear> <RefBookTitle>A Clinical Guide to the Treatment of the Human Stress Response</RefBookTitle> <RefPage></RefPage> <RefTotal>Everly Jr, George S, Lating, Jeffrey M. A Clinical Guide to the Treatment of the Human Stress Response. New York: Springer; 2013. DOI: 10.1007/978-1-4614-5538-7</RefTotal> <RefLink>https://doi.org/10.1007/978-1-4614-5538-7</RefLink> </Reference> <Reference refNo="10"> <RefAuthor>Payne P</RefAuthor> <RefAuthor>Crane-Godreau MA</RefAuthor> <RefTitle>The preparatory set: a novel approach to understanding stress, trauma, and the bodymind therapies</RefTitle> <RefYear>2015</RefYear> <RefJournal>Front Hum Neurosci</RefJournal> <RefPage>178</RefPage> <RefTotal>Payne P, Crane-Godreau MA. The preparatory set: a novel approach to understanding stress, trauma, and the bodymind therapies. Front Hum Neurosci. 2015;9:178. DOI: 10.3389/fnhum.2015.00178</RefTotal> <RefLink>https://doi.org/10.3389/fnhum.2015.00178</RefLink> </Reference> <Reference refNo="11"> <RefAuthor>Lazarus SR</RefAuthor> <RefAuthor>Folkman S</RefAuthor> <RefTitle></RefTitle> <RefYear>1984</RefYear> <RefBookTitle>Stress, Appraisel, and Coping</RefBookTitle> <RefPage></RefPage> <RefTotal>Lazarus SR, Folkman S. Stress, Appraisel, and Coping. New York: Springer; 1984.</RefTotal> </Reference> <Reference refNo="12"> <RefAuthor>Dougall AL</RefAuthor> <RefAuthor>Baum A</RefAuthor> <RefTitle>Stress, health, and illness</RefTitle> <RefYear>2012</RefYear> <RefBookTitle>Handbook of health psychology</RefBookTitle> <RefPage>53-78</RefPage> <RefTotal>Dougall AL, Baum A. Stress, health, and illness. In: Baum A, Revenson TA, Singer J, editors. Handbook of health psychology. New York: Psychology Press; 2012. p. 53-78.</RefTotal> </Reference> <Reference refNo="13"> <RefAuthor>Gunnar M</RefAuthor> <RefAuthor>Quevedo K</RefAuthor> <RefTitle>The neurobiology of stress and development</RefTitle> <RefYear>2007</RefYear> <RefJournal>Annu Rev Psychol</RefJournal> <RefPage>145-73</RefPage> <RefTotal>Gunnar M, Quevedo K. The neurobiology of stress and development. Annu Rev Psychol. 2007;58:145-73. DOI: 10.1146/annurev.psych.58.110405.085605</RefTotal> <RefLink>https://doi.org/10.1146/annurev.psych.58.110405.085605</RefLink> </Reference> <Reference refNo="14"> <RefAuthor>Vigo DV</RefAuthor> <RefAuthor>Kestel D</RefAuthor> <RefAuthor>Pendakur K</RefAuthor> <RefAuthor>Thornicroft G</RefAuthor> <RefAuthor>Atun R</RefAuthor> <RefTitle>Disease burden and government spending on mental, neurological, and substance use disorders, and self-harm: cross-sectional, ecological study of health system response in the Americas</RefTitle> <RefYear>2019</RefYear> <RefJournal>Lancet Public Health</RefJournal> <RefPage>e89-e96</RefPage> <RefTotal>Vigo DV, Kestel D, Pendakur K, Thornicroft G, Atun R. Disease burden and government spending on mental, neurological, and substance use disorders, and self-harm: cross-sectional, ecological study of health system response in the Americas. Lancet Public Health. 2019 Feb;4(2):e89-e96. DOI: 10.1016/S2468-2667(18)30203-2</RefTotal> <RefLink>https://doi.org/10.1016/S2468-2667(18)30203-2</RefLink> </Reference> <Reference refNo="15"> <RefAuthor>World Health Organization</RefAuthor> <RefAuthor>Regional Office for the Eastern Mediterranean</RefAuthor> <RefTitle></RefTitle> <RefYear>2017</RefYear> <RefBookTitle>Assessment of essential public health functions in countries of the Eastern Mediterranean Region: assessment tool</RefBookTitle> <RefPage></RefPage> <RefTotal>World Health Organization, Regional Office for the Eastern Mediterranean. Assessment of essential public health functions in countries of the Eastern Mediterranean Region: assessment tool. 2017 [accessed 2020 Jul 3]. Available from: https://apps.who. int/iris/handle/10665/254383</RefTotal> <RefLink>https://apps.who. int/iris/handle/10665/254383</RefLink> </Reference> <Reference refNo="16"> <RefAuthor>Klosterkötter J</RefAuthor> <RefAuthor>Maier W</RefAuthor> <RefTitle></RefTitle> <RefYear>2017</RefYear> <RefBookTitle>Handbuch Präventive Psychiatrie. Forschung – Lehre – Versorgung</RefBookTitle> <RefPage></RefPage> <RefTotal>Klosterkötter J, Maier W. Handbuch Präventive Psychiatrie. Forschung – Lehre – Versorgung. Stuttgart: Schattauer; 2017.</RefTotal> </Reference> <Reference refNo="17"> <RefAuthor>Mrazek PJ</RefAuthor> <RefAuthor>Haggerty RJ</RefAuthor> <RefTitle></RefTitle> <RefYear>1994</RefYear> <RefBookTitle>Reducing risks for mental disorders: Frontiers for preventive intervention research</RefBookTitle> <RefPage></RefPage> <RefTotal>Mrazek PJ, Haggerty RJ. Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington DC: National Academy Press; 1994.</RefTotal> </Reference> <Reference refNo="18"> <RefAuthor>National Academy of Sciences</RefAuthor> <RefTitle></RefTitle> <RefYear>2009</RefYear> <RefBookTitle>Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities</RefBookTitle> <RefPage></RefPage> <RefTotal>National Academy of Sciences. Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington: National Academies Press; 2009.</RefTotal> </Reference> <Reference refNo="19"> <RefAuthor>Wittchen HU</RefAuthor> <RefAuthor>Jacobi F</RefAuthor> <RefAuthor>Rehm J</RefAuthor> <RefAuthor>Gustavsson A</RefAuthor> <RefAuthor>Svensson M</RefAuthor> <RefAuthor>Jönsson B</RefAuthor> <RefAuthor>Olesen J</RefAuthor> <RefAuthor>Allgulander C</RefAuthor> <RefAuthor>Alonso J</RefAuthor> <RefAuthor>Faravelli C</RefAuthor> <RefAuthor>Fratiglioni L</RefAuthor> <RefAuthor>Jennum P</RefAuthor> <RefAuthor>Lieb R</RefAuthor> <RefAuthor>Maercker A</RefAuthor> <RefAuthor>van Os J</RefAuthor> <RefAuthor>Preisig M</RefAuthor> <RefAuthor>Salvador-Carulla L</RefAuthor> <RefAuthor>Simon R</RefAuthor> <RefAuthor>Steinhausen HC</RefAuthor> <RefTitle>The size and burden of mental disorders and other disorders of the brain in Europe 2010</RefTitle> <RefYear>2011</RefYear> <RefJournal>Eur Neuropsychopharmacol</RefJournal> <RefPage>655-79</RefPage> <RefTotal>Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker A, van Os J, Preisig M, Salvador-Carulla L, Simon R, Steinhausen HC. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011 Sep;21(9):655-79. DOI: 10.1016/j.euroneuro.2011.07.018</RefTotal> <RefLink>https://doi.org/10.1016/j.euroneuro.2011.07.018</RefLink> </Reference> <Reference refNo="20"> <RefAuthor>Dunphy K</RefAuthor> <RefAuthor>Baker FA</RefAuthor> <RefAuthor>Dumaresq E</RefAuthor> <RefAuthor>Carroll-Haskins K</RefAuthor> <RefAuthor>Eickholt J</RefAuthor> <RefAuthor>Ercole M</RefAuthor> <RefAuthor>Kaimal G</RefAuthor> <RefAuthor>Meyer K</RefAuthor> <RefAuthor>Sajnani N</RefAuthor> <RefAuthor>Shamir OY</RefAuthor> <RefAuthor>Wosch T</RefAuthor> <RefTitle>Creative Arts Interventions to Address Depression in Older Adults: A Systematic Review of Outcomes, Processes, and Mechanisms</RefTitle> <RefYear>2018</RefYear> <RefJournal>Front Psychol</RefJournal> <RefPage>2655</RefPage> <RefTotal>Dunphy K, Baker FA, Dumaresq E, Carroll-Haskins K, Eickholt J, Ercole M, Kaimal G, Meyer K, Sajnani N, Shamir OY, Wosch T. Creative Arts Interventions to Address Depression in Older Adults: A Systematic Review of Outcomes, Processes, and Mechanisms. Front Psychol. 2018;9:2655. DOI: 10.3389/fpsyg.2018.02655</RefTotal> <RefLink>https://doi.org/10.3389/fpsyg.2018.02655</RefLink> </Reference> <Reference refNo="21"> <RefAuthor>World Health Organization</RefAuthor> <RefTitle></RefTitle> <RefYear></RefYear> <RefBookTitle>Mental Health of Older Adults: Fact Sheet</RefBookTitle> <RefPage></RefPage> <RefTotal>World Health Organization. Mental Health of Older Adults: Fact Sheet. [accessed 2020 Jul 3]. Available from: http://www.who.int/mediacentre/factsheets/fs381/en/</RefTotal> <RefLink>http://www.who.int/mediacentre/factsheets/fs381/en/</RefLink> </Reference> <Reference refNo="22"> <RefAuthor>Chiang M</RefAuthor> <RefAuthor>Reid-Varley WB</RefAuthor> <RefAuthor>Fan X</RefAuthor> <RefTitle>Creative art therapy for mental illness</RefTitle> <RefYear>2019</RefYear> <RefJournal>Psychiatry Res</RefJournal> <RefPage>129-36</RefPage> <RefTotal>Chiang M, Reid-Varley WB, Fan X. Creative art therapy for mental illness. Psychiatry Res. 2019 05;275:129-36. DOI: 10.1016/j.psychres.2019.03.025</RefTotal> <RefLink>https://doi.org/10.1016/j.psychres.2019.03.025</RefLink> </Reference> <Reference refNo="23"> <RefAuthor>Karkou V</RefAuthor> <RefAuthor>Sanderson P</RefAuthor> <RefTitle></RefTitle> <RefYear>2006</RefYear> <RefBookTitle>Arts Therapies: A Research-Based Map of the Field</RefBookTitle> <RefPage></RefPage> <RefTotal>Karkou V, Sanderson P. Arts Therapies: A Research-Based Map of the Field. Oxford: Elsevier Health Sciences; 2006. DOI: 10.1016/B978-0-443-07256-7.50006-1</RefTotal> <RefLink>https://doi.org/10.1016/B978-0-443-07256-7.50006-1</RefLink> </Reference> <Reference refNo="24"> <RefAuthor>Dunphy K</RefAuthor> <RefAuthor>Mullane S</RefAuthor> <RefAuthor>Jacobsson M</RefAuthor> <RefTitle></RefTitle> <RefYear>2013</RefYear> <RefBookTitle>The effectiveness of expressive arts therapies: A review of the literature</RefBookTitle> <RefPage></RefPage> <RefTotal>Dunphy K, Mullane S, Jacobsson M. The effectiveness of expressive arts therapies: A review of the literature. Melbourne: PACFA; 2013.</RefTotal> </Reference> <Reference refNo="34"> <RefAuthor>American Art Therapy Association</RefAuthor> <RefTitle></RefTitle> <RefYear>2017</RefYear> <RefBookTitle>About Art Therapy</RefBookTitle> <RefPage></RefPage> <RefTotal>American Art Therapy Association. About Art Therapy. 2017 [accessed 2020 Jul 3]. Available from: https://www.arttherapy.org/upload/2017_DefinitionofProfession.pdf</RefTotal> <RefLink>https://www.arttherapy.org/upload/2017_DefinitionofProfession.pdf</RefLink> </Reference> <Reference refNo="35"> <RefAuthor>Case C</RefAuthor> <RefAuthor>Dalley T</RefAuthor> <RefTitle></RefTitle> <RefYear>2014</RefYear> <RefBookTitle>The handbook of art therapy</RefBookTitle> <RefPage></RefPage> <RefTotal>Case C, Dalley T. The handbook of art therapy. Third edition. East Sussex: Routledge; 2014. DOI: 10.4324/9781315779799</RefTotal> <RefLink>https://doi.org/10.4324/9781315779799</RefLink> </Reference> <Reference refNo="36"> <RefAuthor>American Music Therapy Association</RefAuthor> <RefTitle></RefTitle> <RefYear>2020</RefYear> <RefBookTitle>Definition and Quotes about Music Therapy</RefBookTitle> <RefPage></RefPage> <RefTotal>American Music Therapy Association. Definition and Quotes about Music Therapy. 2020 [accessed 2020 Jul 3]. Available from: https://www.musictherapy.org/about/quotes/</RefTotal> <RefLink>https://www.musictherapy.org/about/quotes/</RefLink> </Reference> <Reference refNo="37"> <RefAuthor>Deutsche Musiktherapeutische Gesellschaft</RefAuthor> <RefTitle></RefTitle> <RefYear>2010</RefYear> <RefBookTitle>Kasseler Thesen zur Musiktherapie</RefBookTitle> <RefPage></RefPage> <RefTotal>Deutsche Musiktherapeutische Gesellschaft. Kasseler Thesen zur Musiktherapie. 2010 [accessed 2020 Jul 3]. Available from: https://www.musiktherapie.de/musiktherapie/was-ist-musiktherapie/</RefTotal> <RefLink>https://www.musiktherapie.de/musiktherapie/was-ist-musiktherapie/</RefLink> </Reference> <Reference refNo="29"> <RefAuthor>Koch SC</RefAuthor> <RefAuthor>Riege RFF</RefAuthor> <RefAuthor>Tisborn K</RefAuthor> <RefAuthor>Biondo J</RefAuthor> <RefAuthor>Martin L</RefAuthor> <RefAuthor>Beelmann A</RefAuthor> <RefTitle>Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes. A Meta-Analysis Update</RefTitle> <RefYear>2019</RefYear> <RefJournal>Front Psychol</RefJournal> <RefPage>1806</RefPage> <RefTotal>Koch SC, Riege RFF, Tisborn K, Biondo J, Martin L, Beelmann A. Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes. A Meta-Analysis Update. Front Psychol. 2019;10:1806. DOI: 10.3389/fpsyg.2019.01806</RefTotal> <RefLink>https://doi.org/10.3389/fpsyg.2019.01806</RefLink> </Reference> <Reference refNo="31"> <RefAuthor>Karkou V</RefAuthor> <RefAuthor>Aithal S</RefAuthor> <RefAuthor>Zubala A</RefAuthor> <RefAuthor>Meekums B</RefAuthor> <RefTitle>Effectiveness of Dance Movement Therapy in the Treatment of Adults With Depression: A Systematic Review With Meta-Analyses</RefTitle> <RefYear>2019</RefYear> <RefJournal>Front Psychol</RefJournal> <RefPage>936</RefPage> <RefTotal>Karkou V, Aithal S, Zubala A, Meekums B. Effectiveness of Dance Movement Therapy in the Treatment of Adults With Depression: A Systematic Review With Meta-Analyses. Front Psychol. 2019;10:936. DOI: 10.3389/fpsyg.2019.00936</RefTotal> <RefLink>https://doi.org/10.3389/fpsyg.2019.00936</RefLink> </Reference> <Reference refNo="38"> <RefAuthor>American Dance Therapy Association (ADTA)</RefAuthor> <RefTitle></RefTitle> <RefYear>2020</RefYear> <RefBookTitle>What is Dance/Movement Therapy? Defining Dance/Movement Therapy</RefBookTitle> <RefPage></RefPage> <RefTotal>American Dance Therapy Association (ADTA). What is Dance/Movement Therapy? Defining Dance/Movement Therapy. 2020 [accessed 2020 Jul 3]. Available from: https://adta.memberclicks.net/index.php?option=com_content&view=article&id=70:what-is-dancemovement-therapy&catid=20:site-content</RefTotal> <RefLink>https://adta.memberclicks.net/index.php?option=com_content&view=article&id=70:what-is-dancemovement-therapy&catid=20:site-content</RefLink> </Reference> <Reference refNo="39"> <RefAuthor>Lobman C</RefAuthor> <RefAuthor>O'Neill B</RefAuthor> <RefTitle></RefTitle> <RefYear>2011</RefYear> <RefBookTitle>Play and Performance. Play and Culture Studies</RefBookTitle> <RefPage></RefPage> <RefTotal>Lobman C, O'Neill B. Play and Performance. Play and Culture Studies. Vol. 11. Lanham, MD: University Press of America; 2011.</RefTotal> </Reference> <Reference refNo="32"> <RefAuthor>Feniger-Schaal R</RefAuthor> <RefAuthor>Orkibi H</RefAuthor> <RefTitle>Integrative systematic review of drama therapy intervention research</RefTitle> <RefYear>2020</RefYear> <RefJournal>Psychology of Aesthetics, Creativity, and the Arts</RefJournal> <RefPage>68-80</RefPage> <RefTotal>Feniger-Schaal R, Orkibi H. Integrative systematic review of drama therapy intervention research. Psychology of Aesthetics, Creativity, and the Arts. 2020; 14(1):68-80. DOI: 10.1037/aca0000257</RefTotal> <RefLink>https://doi.org/10.1037/aca0000257</RefLink> </Reference> <Reference refNo="40"> <RefAuthor>Koch SC</RefAuthor> <RefTitle>Arts and health: Active factors and a theory framework of embodied aesthetics</RefTitle> <RefYear>2017</RefYear> <RefJournal>Arts Psychother</RefJournal> <RefPage>85-91</RefPage> <RefTotal>Koch SC. Arts and health: Active factors and a theory framework of embodied aesthetics. Arts Psychother. 2017; 54:85-91. DOI: 10.1016/j.aip.2017.02.002</RefTotal> <RefLink>https://doi.org/10.1016/j.aip.2017.02.002</RefLink> </Reference> <Reference refNo="25"> <RefAuthor>Baker FA</RefAuthor> <RefAuthor>Metcalf O</RefAuthor> <RefAuthor>Varker T</RefAuthor> <RefAuthor>O'Donnell M</RefAuthor> <RefTitle>A systematic review of the efficacy of creative arts therapies in the treatment of adults with PTSD</RefTitle> <RefYear>2018</RefYear> <RefJournal>Psychol Trauma</RefJournal> <RefPage>643-51</RefPage> <RefTotal>Baker FA, Metcalf O, Varker T, O'Donnell M. A systematic review of the efficacy of creative arts therapies in the treatment of adults with PTSD. Psychol Trauma. 2018 Nov;10(6):643-51. DOI: 10.1037/tra0000353</RefTotal> <RefLink>https://doi.org/10.1037/tra0000353</RefLink> </Reference> <Reference refNo="26"> <RefAuthor>Regev D</RefAuthor> <RefAuthor>Cohen-Yatziv L</RefAuthor> <RefTitle>Effectiveness of Art Therapy With Adult Clients in 2018 – What Progress Has Been Made?</RefTitle> <RefYear>2018</RefYear> <RefJournal>Front Psychol</RefJournal> <RefPage>1531</RefPage> <RefTotal>Regev D, Cohen-Yatziv L. Effectiveness of Art Therapy With Adult Clients in 2018 – What Progress Has Been Made? Front Psychol. 2018;9:1531. DOI: 10.3389/fpsyg.2018.01531</RefTotal> <RefLink>https://doi.org/10.3389/fpsyg.2018.01531</RefLink> </Reference> <Reference refNo="27"> <RefAuthor>de Witte M</RefAuthor> <RefAuthor>Spruit A</RefAuthor> <RefAuthor>van Hooren S</RefAuthor> <RefAuthor>Moonen X</RefAuthor> <RefAuthor>Stams GJ</RefAuthor> <RefTitle>Effects of music interventions on stress-related outcomes: a systematic review and two meta-analyses</RefTitle> <RefYear>2020</RefYear> <RefJournal>Health Psychol Rev</RefJournal> <RefPage>294-324</RefPage> <RefTotal>de Witte M, Spruit A, van Hooren S, Moonen X, Stams GJ. Effects of music interventions on stress-related outcomes: a systematic review and two meta-analyses. Health Psychol Rev. 2020 Jun;14(2):294-324. DOI: 10.1080/17437199.2019.1627897</RefTotal> <RefLink>https://doi.org/10.1080/17437199.2019.1627897</RefLink> </Reference> <Reference refNo="28"> <RefAuthor>Umbrello M</RefAuthor> <RefAuthor>Sorrenti T</RefAuthor> <RefAuthor>Mistraletti G</RefAuthor> <RefAuthor>Formenti P</RefAuthor> <RefAuthor>Chiumello D</RefAuthor> <RefAuthor>Terzoni S</RefAuthor> <RefTitle>Music therapy reduces stress and anxiety in critically ill patients: a systematic review of randomized clinical trials</RefTitle> <RefYear>2019</RefYear> <RefJournal>Minerva Anestesiol</RefJournal> <RefPage>886-98</RefPage> <RefTotal>Umbrello M, Sorrenti T, Mistraletti G, Formenti P, Chiumello D, Terzoni S. Music therapy reduces stress and anxiety in critically ill patients: a systematic review of randomized clinical trials. Minerva Anestesiol. 2019 Aug;85(8):886-98. DOI: 10.23736/S0375-9393.19.13526-2</RefTotal> <RefLink>https://doi.org/10.23736/S0375-9393.19.13526-2</RefLink> </Reference> <Reference refNo="30"> <RefAuthor>Jiménez J</RefAuthor> <RefAuthor>Bräuninger I</RefAuthor> <RefAuthor>Meekums B</RefAuthor> <RefTitle>Dance movement therapy with older people with a psychiatric condition: A systematic review</RefTitle> <RefYear>2019</RefYear> <RefJournal>Arts Psychother</RefJournal> <RefPage>118-27</RefPage> <RefTotal>Jiménez J, Bräuninger I, Meekums B. Dance movement therapy with older people with a psychiatric condition: A systematic review. Arts Psychother. 2019; 63: 118-27. DOI: 10.1016/j.aip.2018.11.008</RefTotal> <RefLink>https://doi.org/10.1016/j.aip.2018.11.008</RefLink> </Reference> <Reference refNo="33"> <RefAuthor>Martin L</RefAuthor> <RefAuthor>Oepen R</RefAuthor> <RefAuthor>Bauer K</RefAuthor> <RefAuthor>Nottensteiner A</RefAuthor> <RefAuthor>Mergheim K</RefAuthor> <RefAuthor>Gruber H</RefAuthor> <RefAuthor>Koch SC</RefAuthor> <RefTitle>Creative Arts Interventions for Stress Management and Prevention – A Systematic Review</RefTitle> <RefYear>2018</RefYear> <RefJournal>Behav Sci (Basel)</RefJournal> <RefPage>28</RefPage> <RefTotal>Martin L, Oepen R, Bauer K, Nottensteiner A, Mergheim K, Gruber H, Koch SC. Creative Arts Interventions for Stress Management and Prevention – A Systematic Review. Behav Sci (Basel). 2018 Feb 22;8(2):28. DOI: 10.3390/bs8020028</RefTotal> <RefLink>https://doi.org/10.3390/bs8020028</RefLink> </Reference> <Reference refNo="41"> <RefAuthor>Grawe K</RefAuthor> <RefAuthor>Donati R</RefAuthor> <RefAuthor>Bernauer F</RefAuthor> <RefTitle></RefTitle> <RefYear>1994</RefYear> <RefBookTitle>Psychotherapie im Wandel – von der Konfession zur Profession</RefBookTitle> <RefPage></RefPage> <RefTotal>Grawe K, Donati R,Bernauer F. Psychotherapie im Wandel – von der Konfession zur Profession. Göttingen: Hogrefe; 1994.</RefTotal> </Reference> <Reference refNo="42"> <RefAuthor>Lange G</RefAuthor> <RefAuthor>Leonhart R</RefAuthor> <RefAuthor>Gruber H</RefAuthor> <RefAuthor>Koch SC</RefAuthor> <RefTitle>The Effect of Active Creation on Psychological Health: A Feasibility Study on (Therapeutic) Mechanisms</RefTitle> <RefYear>2018</RefYear> <RefJournal>Behav Sci (Basel)</RefJournal> <RefPage>25</RefPage> <RefTotal>Lange G, Leonhart R, Gruber H, Koch SC. The Effect of Active Creation on Psychological Health: A Feasibility Study on (Therapeutic) Mechanisms. Behav Sci (Basel). 2018 Feb 12;8(2):25. DOI: 10.3390/bs8020025</RefTotal> <RefLink>https://doi.org/10.3390/bs8020025</RefLink> </Reference> <Reference refNo="43"> <RefAuthor>Fancourt D</RefAuthor> <RefAuthor>Garnett C</RefAuthor> <RefAuthor>Spiro N</RefAuthor> <RefAuthor>West R</RefAuthor> <RefAuthor>Müllensiefen D</RefAuthor> <RefTitle>How do artistic creative activities regulate our emotions? Validation of the Emotion Regulation Strategies for Artistic Creative Activities Scale (ERS-ACA)</RefTitle> <RefYear>2019</RefYear> <RefJournal>PLoS One</RefJournal> <RefPage>e0211362</RefPage> <RefTotal>Fancourt D, Garnett C, Spiro N, West R, Müllensiefen D. How do artistic creative activities regulate our emotions? Validation of the Emotion Regulation Strategies for Artistic Creative Activities Scale (ERS-ACA). PLoS One. 2019;14(2):e0211362. DOI: 10.1371/journal.pone.0211362</RefTotal> <RefLink>https://doi.org/10.1371/journal.pone.0211362</RefLink> </Reference> <Reference refNo="44"> <RefAuthor>Moher D</RefAuthor> <RefAuthor>Liberati A</RefAuthor> <RefAuthor>Tetzlaff J</RefAuthor> <RefAuthor>Altman DG</RefAuthor> <RefAuthor> PRISMA Group</RefAuthor> <RefTitle>Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement</RefTitle> <RefYear>2009</RefYear> <RefJournal>PLoS Med</RefJournal> <RefPage>e1000097</RefPage> <RefTotal>Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009 Jul;6(7):e1000097. DOI: 10.1371/journal.pmed.1000097</RefTotal> <RefLink>https://doi.org/10.1371/journal.pmed.1000097</RefLink> </Reference> <Reference refNo="45"> <RefAuthor>Cochrane Deutschland</RefAuthor> <RefAuthor> Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften – Institut für Medizinisches Wissensmanagemen</RefAuthor> <RefTitle></RefTitle> <RefYear>2017</RefYear> <RefBookTitle>Bewertung von systematischen Übersichtsarbeiten: ein Manual für die Leitlinienerstellung</RefBookTitle> <RefPage></RefPage> <RefTotal>Cochrane Deutschland; Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften – Institut für Medizinisches Wissensmanagemen. Bewertung von systematischen Übersichtsarbeiten: ein Manual für die Leitlinienerstellung. 1. Auflage. 2017. Available from: http://www.cochrane.de/de/review-bewertung-manual</RefTotal> <RefLink>http://www.cochrane.de/de/review-bewertung-manual</RefLink> </Reference> <Reference refNo="46"> <RefAuthor>Cohen S</RefAuthor> <RefAuthor>Kamarck T</RefAuthor> <RefAuthor>Mermelstein R</RefAuthor> <RefTitle>A global measure of perceived stress</RefTitle> <RefYear>1983</RefYear> <RefJournal>J Health Soc Behav</RefJournal> <RefPage>385-96</RefPage> <RefTotal>Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983 Dec;24(4):385-96.</RefTotal> </Reference> <Reference refNo="47"> <RefAuthor>Kessler RC</RefAuthor> <RefAuthor>Andrews G</RefAuthor> <RefAuthor>Colpe LJ</RefAuthor> <RefAuthor>Hiripi E</RefAuthor> <RefAuthor>Mroczek DK</RefAuthor> <RefAuthor>Normand SL</RefAuthor> <RefAuthor>Walters EE</RefAuthor> <RefAuthor>Zaslavsky AM</RefAuthor> <RefTitle>Short screening scales to monitor population prevalences and trends in non-specific psychological distress</RefTitle> <RefYear>2002</RefYear> <RefJournal>Psychol Med</RefJournal> <RefPage>959-76</RefPage> <RefTotal>Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Walters EE, Zaslavsky AM. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002 Aug;32(6):959-76. DOI: 10.1017/s0033291702006074</RefTotal> <RefLink>https://doi.org/10.1017/s0033291702006074</RefLink> </Reference> <Reference refNo="48"> <RefAuthor>Laux L</RefAuthor> <RefAuthor>Glanzmann P</RefAuthor> <RefAuthor>Schaffner P</RefAuthor> <RefAuthor>Spielberger CD</RefAuthor> <RefTitle></RefTitle> <RefYear>1981</RefYear> <RefBookTitle>State-Trait-Angstinventar (STAI)</RefBookTitle> <RefPage></RefPage> <RefTotal>Laux L, Glanzmann P, Schaffner P, Spielberger CD. State-Trait-Angstinventar (STAI). Weinheim: Beltz; 1981.</RefTotal> </Reference> <Reference refNo="49"> <RefAuthor>Watson D</RefAuthor> <RefAuthor>Clark LA</RefAuthor> <RefAuthor>Tellegen A</RefAuthor> <RefTitle>Development and validation of brief measures of positive and negative affect: the PANAS scales</RefTitle> <RefYear>1988</RefYear> <RefJournal>J Pers Soc Psychol</RefJournal> <RefPage>1063-70</RefPage> <RefTotal>Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988 Jun;54(6):1063-70. DOI: 10.1037//0022-3514.54.6.1063</RefTotal> <RefLink>https://doi.org/10.1037//0022-3514.54.6.1063</RefLink> </Reference> <Reference refNo="50"> <RefAuthor>Kaufman EA</RefAuthor> <RefAuthor>Xia M</RefAuthor> <RefAuthor>Fosco G</RefAuthor> <RefAuthor>Yaptangco M</RefAuthor> <RefAuthor>Skidmore CR</RefAuthor> <RefAuthor>Crowell SE</RefAuthor> <RefTitle>The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): Validation and replication in adolescent and adult samples</RefTitle> <RefYear>2016</RefYear> <RefJournal>J Psychopathol Behav Assess</RefJournal> <RefPage>443-55</RefPage> <RefTotal>Kaufman EA, Xia M, Fosco G, Yaptangco M, Skidmore CR, Crowell SE. The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): Validation and replication in adolescent and adult samples. J Psychopathol Behav Assess. 2016; 38(3):443-55. DOI: 10.1007/s10862-015-9529-3</RefTotal> <RefLink>https://doi.org/10.1007/s10862-015-9529-3</RefLink> </Reference> <Reference refNo="51"> <RefAuthor>Higgins JPT</RefAuthor> <RefAuthor>Thomas J</RefAuthor> <RefAuthor>Chandler J</RefAuthor> <RefAuthor>Cumpston M</RefAuthor> <RefAuthor>Li T</RefAuthor> <RefAuthor>Page MJ</RefAuthor> <RefAuthor>Welch VA</RefAuthor> <RefTitle></RefTitle> <RefYear></RefYear> <RefBookTitle>Cochrane Handbook for Systematic Reviews of Interventions, version 6.0 (updated July 2019)</RefBookTitle> <RefPage></RefPage> <RefTotal>Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane Handbook for Systematic Reviews of Interventions, version 6.0 (updated July 2019). Cochrane. [accessed 2020 Jul 3]. DOI: 10.1002/9781119536604</RefTotal> <RefLink>https://doi.org/10.1002/9781119536604</RefLink> </Reference> <Reference refNo="52"> <RefAuthor>Guba B</RefAuthor> <RefTitle>Systematische Literatursuche</RefTitle> <RefYear>2008</RefYear> <RefJournal>Wien Med Wochenschr</RefJournal> <RefPage>62-9</RefPage> <RefTotal>Guba B. Systematische Literatursuche [Systematic literature search]. Wien Med Wochenschr. 2008;158(1-2):62-9. DOI: 10.1007/s10354-007-0500-0</RefTotal> <RefLink>https://doi.org/10.1007/s10354-007-0500-0</RefLink> </Reference> <Reference refNo="53"> <RefAuthor>Annual Progress Report to Congress: National Strategy for Quality Improvement in Health Care</RefAuthor> <RefTitle></RefTitle> <RefYear>2013</RefYear> <RefBookTitle>Content last reviewed November 2016</RefBookTitle> <RefPage></RefPage> <RefTotal>Annual Progress Report to Congress: National Strategy for Quality Improvement in Health Care. Content last reviewed November 2016. Rockville, MD: Agency for Healthcare Research and Quality; 2013.</RefTotal> </Reference> <Reference refNo="54"> <RefAuthor>Wiedenhofer S</RefAuthor> <RefAuthor>Koch SC</RefAuthor> <RefTitle>Active factors in dance/movement therapy: Specifying health effects of non-goal-orientation in movement</RefTitle> <RefYear>2017</RefYear> <RefJournal>Arts Psychother</RefJournal> <RefPage>10-23</RefPage> <RefTotal>Wiedenhofer S, Koch SC. Active factors in dance/movement therapy: Specifying health effects of non-goal-orientation in movement. Arts Psychother. 2017; 52:10-23. DOI: 10.1016/j.aip.2016.09.004</RefTotal> <RefLink>https://doi.org/10.1016/j.aip.2016.09.004</RefLink> </Reference> <Reference refNo="55"> <RefAuthor>Ho RTH</RefAuthor> <RefAuthor>Fong TCT</RefAuthor> <RefAuthor>Yip PSF</RefAuthor> <RefTitle>Perceived stress moderates the effects of a randomized trial of dance movement therapy on diurnal cortisol slopes in breast cancer patients</RefTitle> <RefYear>2018</RefYear> <RefJournal>Psychoneuroendocrinology</RefJournal> <RefPage>119-26</RefPage> <RefTotal>Ho RTH, Fong TCT, Yip PSF. Perceived stress moderates the effects of a randomized trial of dance movement therapy on diurnal cortisol slopes in breast cancer patients. Psychoneuroendocrinology. 2018 Jan;87:119-26. DOI: 10.1016/j.psyneuen.2017.10.012</RefTotal> <RefLink>https://doi.org/10.1016/j.psyneuen.2017.10.012</RefLink> </Reference> <Reference refNo="56"> <RefAuthor>Ho RT</RefAuthor> <RefAuthor>Fong TC</RefAuthor> <RefAuthor>Cheung IK</RefAuthor> <RefAuthor>Yip PS</RefAuthor> <RefAuthor>Luk MY</RefAuthor> <RefTitle>Effects of a Short-Term Dance Movement Therapy Program on Symptoms and Stress in Patients With Breast Cancer Undergoing Radiotherapy: A Randomized, Controlled, Single-Blind Trial</RefTitle> <RefYear>2016</RefYear> <RefJournal>J Pain Symptom Manage</RefJournal> <RefPage>824-31</RefPage> <RefTotal>Ho RT, Fong TC, Cheung IK, Yip PS, Luk MY. Effects of a Short-Term Dance Movement Therapy Program on Symptoms and Stress in Patients With Breast Cancer Undergoing Radiotherapy: A Randomized, Controlled, Single-Blind Trial. J Pain Symptom Manage. 2016 May;51(5):824-31. DOI: 10.1016/j.jpainsymman.2015.12.332</RefTotal> <RefLink>https://doi.org/10.1016/j.jpainsymman.2015.12.332</RefLink> </Reference> <Reference refNo="57"> <RefAuthor>Vrinceanu T</RefAuthor> <RefAuthor>Esmail A</RefAuthor> <RefAuthor>Predovan D</RefAuthor> <RefAuthor>Pruessner J</RefAuthor> <RefAuthor>Bherer L</RefAuthor> <RefTitle>Dance-Movement therapy leads to a lower cortisol awaking response-a sign of stress reduction?</RefTitle> <RefYear>2017</RefYear> <RefJournal>Innov Aging</RefJournal> <RefPage>262</RefPage> <RefTotal>Vrinceanu T, Esmail A, Predovan D, Pruessner J, Bherer L. Dance-Movement therapy leads to a lower cortisol awaking response-a sign of stress reduction? Innov Aging. 2017; 1(1):262. DOI: 10.1093/geroni/igx004.959</RefTotal> <RefLink>https://doi.org/10.1093/geroni/igx004.959</RefLink> </Reference> <Reference refNo="58"> <RefAuthor>Vrinceanu T</RefAuthor> <RefAuthor>Esmail A</RefAuthor> <RefAuthor>Berryman N</RefAuthor> <RefAuthor>Predovan D</RefAuthor> <RefAuthor>Vu TTM</RefAuthor> <RefAuthor>Villalpando JM</RefAuthor> <RefAuthor>Pruessner JC</RefAuthor> <RefAuthor>Bherer L</RefAuthor> <RefTitle>Dance your stress away: comparing the effect of dance/movement training to aerobic exercise training on the cortisol awakening response in healthy older adults</RefTitle> <RefYear>2019</RefYear> <RefJournal>Stress</RefJournal> <RefPage>687-95</RefPage> <RefTotal>Vrinceanu T, Esmail A, Berryman N, Predovan D, Vu TTM, Villalpando JM, Pruessner JC, Bherer L. Dance your stress away: comparing the effect of dance/movement training to aerobic exercise training on the cortisol awakening response in healthy older adults. Stress. 2019 Nov;22(6):687-95. DOI: 10.1080/10253890.2019.1617690</RefTotal> <RefLink>https://doi.org/10.1080/10253890.2019.1617690</RefLink> </Reference> <Reference refNo="59"> <RefAuthor>Esmail A</RefAuthor> <RefAuthor>Vrinceanu T</RefAuthor> <RefAuthor>Lussier M</RefAuthor> <RefAuthor>Predovan D</RefAuthor> <RefAuthor>Berryman N</RefAuthor> <RefAuthor>Houle J</RefAuthor> <RefAuthor>Karelis A</RefAuthor> <RefAuthor>Grenier S</RefAuthor> <RefAuthor>Minh Vu TT</RefAuthor> <RefAuthor>Villalpando JM</RefAuthor> <RefAuthor>Bherer L</RefAuthor> <RefTitle>Effects of Dance/Movement Training vs. Aerobic Exercise Training on cognition, physical fitness and quality of life in older adults: A randomized controlled trial</RefTitle> <RefYear>2020</RefYear> <RefJournal>J Bodyw Mov Ther</RefJournal> <RefPage>212-20</RefPage> <RefTotal>Esmail A, Vrinceanu T, Lussier M, Predovan D, Berryman N, Houle J, Karelis A, Grenier S, Minh Vu TT, Villalpando JM, Bherer L. Effects of Dance/Movement Training vs. Aerobic Exercise Training on cognition, physical fitness and quality of life in older adults: A randomized controlled trial. J Bodyw Mov Ther. 2020 Jan;24(1):212-20. DOI: 10.1016/j.jbmt.2019.05.004</RefTotal> <RefLink>https://doi.org/10.1016/j.jbmt.2019.05.004</RefLink> </Reference> <Reference refNo="60"> <RefAuthor>Lindsey L</RefAuthor> <RefAuthor>Robertson P</RefAuthor> <RefAuthor>Lindsey B</RefAuthor> <RefTitle>Expressive arts and mindfulness: Aiding adolescents in understanding and managing their stress</RefTitle> <RefYear>2018</RefYear> <RefJournal>J Creat Ment Health</RefJournal> <RefPage>288-97</RefPage> <RefTotal>Lindsey L, Robertson P, Lindsey B. Expressive arts and mindfulness: Aiding adolescents in understanding and managing their stress. J Creat Ment Health. 2018; 13(3): 288-97. DOI: 10.1080/15401383.2018.1427167</RefTotal> <RefLink>https://doi.org/10.1080/15401383.2018.1427167</RefLink> </Reference> <Reference refNo="61"> <RefAuthor>Ayers S</RefAuthor> <RefAuthor>Crawley R</RefAuthor> <RefAuthor>Button S</RefAuthor> <RefAuthor>Thornton A</RefAuthor> <RefAuthor>Field AP</RefAuthor> <RefAuthor>Flood C</RefAuthor> <RefAuthor>Lee S</RefAuthor> <RefAuthor>Eagle A</RefAuthor> <RefAuthor>Bradley R</RefAuthor> <RefAuthor>Moore D</RefAuthor> <RefAuthor>Gyte G</RefAuthor> <RefAuthor>Smith H</RefAuthor> <RefTitle>Evaluation of expressive writing for postpartum health: a randomised controlled trial</RefTitle> <RefYear>2018</RefYear> <RefJournal>J Behav Med</RefJournal> <RefPage>614-26</RefPage> <RefTotal>Ayers S, Crawley R, Button S, Thornton A, Field AP, Flood C, Lee S, Eagle A, Bradley R, Moore D, Gyte G, Smith H. Evaluation of expressive writing for postpartum health: a randomised controlled trial. J Behav Med. 2018 Oct;41(5):614-26. DOI: 10.1007/s10865-018-9970-3</RefTotal> <RefLink>https://doi.org/10.1007/s10865-018-9970-3</RefLink> </Reference> <Reference refNo="62"> <RefAuthor>Beerse M E</RefAuthor> <RefAuthor>Van Lith T</RefAuthor> <RefAuthor>Stanwood G D</RefAuthor> <RefTitle>Is There a Biofeedback Response to Art Therapy? A Technology-Assisted Approach for Reducing Anxiety and Stress in College Students</RefTitle> <RefYear>2019</RefYear> <RefJournal>SAGE Open</RefJournal> <RefPage></RefPage> <RefTotal>Beerse M E, Van Lith T, Stanwood G D. Is There a Biofeedback Response to Art Therapy? A Technology-Assisted Approach for Reducing Anxiety and Stress in College Students. SAGE Open. 2019; 9(2). DOI: 10.1177/2158244019854646</RefTotal> <RefLink>https://doi.org/10.1177/2158244019854646</RefLink> </Reference> <Reference refNo="63"> <RefAuthor>Björling EA</RefAuthor> <RefAuthor>Stevens C</RefAuthor> <RefAuthor>Singh NB</RefAuthor> <RefTitle>Participatory Pilot of an Art-Based Mindfulness Intervention for Adolescent Girls with Headache</RefTitle> <RefYear>2019</RefYear> <RefJournal>Journal of the American Art Therapy Association</RefJournal> <RefPage>86-92</RefPage> <RefTotal>Björling EA, Stevens C, Singh NB. Participatory Pilot of an Art-Based Mindfulness Intervention for Adolescent Girls with Headache. Journal of the American Art Therapy Association. 2019; 36(2):86-92. DOI: 10.1080/07421656.2019.1609325</RefTotal> <RefLink>https://doi.org/10.1080/07421656.2019.1609325</RefLink> </Reference> <Reference refNo="64"> <RefAuthor>Bremner MN</RefAuthor> <RefAuthor>Blake BJ</RefAuthor> <RefAuthor>Wagner VD</RefAuthor> <RefAuthor>Pearcey SM</RefAuthor> <RefTitle>Effects of Reiki With Music Compared to Music Only Among People Living With HIV</RefTitle> <RefYear>2016</RefYear> <RefJournal>J Assoc Nurses AIDS Care</RefJournal> <RefPage>635-47</RefPage> <RefTotal>Bremner MN, Blake BJ, Wagner VD, Pearcey SM. Effects of Reiki With Music Compared to Music Only Among People Living With HIV. J Assoc Nurses AIDS Care. 2016 Sep-Oct;27(5):635-47. DOI: 10.1016/j.jana.2016.04.004</RefTotal> <RefLink>https://doi.org/10.1016/j.jana.2016.04.004</RefLink> </Reference> <Reference refNo="65"> <RefAuthor>Futterman Collier A D</RefAuthor> <RefAuthor>Wayment H A</RefAuthor> <RefAuthor>Birkett M</RefAuthor> <RefTitle>Impact of Making Textile Handcrafts on Mood Enhancement and Inflammatory Immune Changes</RefTitle> <RefYear>2016</RefYear> <RefJournal>J Am Art Ther Assoc</RefJournal> <RefPage>178-85</RefPage> <RefTotal>Futterman Collier A D, Wayment H A, Birkett M. Impact of Making Textile Handcrafts on Mood Enhancement and Inflammatory Immune Changes. J Am Art Ther Assoc. 2016;33(4):178-85. DOI: 10.1080/07421656.2016.1226647</RefTotal> <RefLink>https://doi.org/10.1080/07421656.2016.1226647</RefLink> </Reference> <Reference refNo="66"> <RefAuthor>Giacobbi P Jr</RefAuthor> <RefAuthor>Long D</RefAuthor> <RefAuthor>Nolan R</RefAuthor> <RefAuthor>Shawley S</RefAuthor> <RefAuthor>Johnson K</RefAuthor> <RefAuthor>Misra R</RefAuthor> <RefTitle>Guided imagery targeting exercise, food cravings, and stress: a multi-modal randomized feasibility trial</RefTitle> <RefYear>2018</RefYear> <RefJournal>J Behav Med</RefJournal> <RefPage>87-98</RefPage> <RefTotal>Giacobbi P Jr, Long D, Nolan R, Shawley S, Johnson K, Misra R. Guided imagery targeting exercise, food cravings, and stress: a multi-modal randomized feasibility trial. J Behav Med. 2018 Feb;41(1):87-98. DOI: 10.1007/s10865-017-9876-5</RefTotal> <RefLink>https://doi.org/10.1007/s10865-017-9876-5</RefLink> </Reference> <Reference refNo="67"> <RefAuthor>Glinzak L</RefAuthor> <RefTitle>Effects of Art Therapy on Distress Levels of Adults with Cancer: A Proxy Pretest Study</RefTitle> <RefYear>2016</RefYear> <RefJournal>J Am Art Ther Assoc</RefJournal> <RefPage>27-34</RefPage> <RefTotal>Glinzak L. Effects of Art Therapy on Distress Levels of Adults with Cancer: A Proxy Pretest Study. J Am Art Ther Assoc. 2016; 33(1): 27-34. DOI: 10.1080/07421656.2016.1127687</RefTotal> <RefLink>https://doi.org/10.1080/07421656.2016.1127687</RefLink> </Reference> <Reference refNo="68"> <RefAuthor>Innes KE</RefAuthor> <RefAuthor>Selfe TK</RefAuthor> <RefAuthor>Khalsa DS</RefAuthor> <RefAuthor>Kandati S</RefAuthor> <RefTitle>Effects of Meditation versus Music Listening on Perceived Stress, Mood, Sleep, and Quality of Life in Adults with Early Memory Loss: A Pilot Randomized Controlled Trial</RefTitle> <RefYear>2016</RefYear> <RefJournal>J Alzheimers Dis</RefJournal> <RefPage>1277-98</RefPage> <RefTotal>Innes KE, Selfe TK, Khalsa DS, Kandati S. Effects of Meditation versus Music Listening on Perceived Stress, Mood, Sleep, and Quality of Life in Adults with Early Memory Loss: A Pilot Randomized Controlled Trial. J Alzheimers Dis. 2016 Apr;52(4):1277-98. DOI: 10.3233/JAD-151106</RefTotal> <RefLink>https://doi.org/10.3233/JAD-151106</RefLink> </Reference> <Reference refNo="69"> <RefAuthor>Kaimal G</RefAuthor> <RefAuthor>Mensinger JL</RefAuthor> <RefAuthor>Drass JM</RefAuthor> <RefAuthor>Dieterich-Hartwell RM</RefAuthor> <RefTitle>Art therapist-facilitated open studio versus coloring: Differences in outcomes of affect, stress, creative agency, and self-efficacy</RefTitle> <RefYear>2017</RefYear> <RefJournal>Can Art Ther Assoc J</RefJournal> <RefPage>56-68</RefPage> <RefTotal>Kaimal G, Mensinger JL, Drass JM, Dieterich-Hartwell RM. Art therapist-facilitated open studio versus coloring: Differences in outcomes of affect, stress, creative agency, and self-efficacy. Can Art Ther Assoc J. 2017;30(2):56-68. DOI: 10.1080/08322473.2017.1375827</RefTotal> <RefLink>https://doi.org/10.1080/08322473.2017.1375827</RefLink> </Reference> <Reference refNo="70"> <RefAuthor>Litchke L G</RefAuthor> <RefAuthor>Dorman R</RefAuthor> <RefAuthor>Willemin T A</RefAuthor> <RefAuthor>Liu T</RefAuthor> <RefTitle>Mental Health Benefits of a Service-Learning Group Drumming between College Students and Children with Autism Spectrum Disorder</RefTitle> <RefYear>2019</RefYear> <RefJournal>Journal of Service-Learning in Higher Education</RefJournal> <RefPage>62-72</RefPage> <RefTotal>Litchke L G, Dorman R, Willemin T A, Liu T. Mental Health Benefits of a Service-Learning Group Drumming between College Students and Children with Autism Spectrum Disorder. Journal of Service-Learning in Higher Education. 2019;9(1):62-72. DOI: 10877/13048</RefTotal> <RefLink>https://doi.org/10877/13048</RefLink> </Reference> <Reference refNo="71"> <RefAuthor>Mama SK</RefAuthor> <RefAuthor>McNeill LH</RefAuthor> <RefAuthor>Soltero EG</RefAuthor> <RefAuthor>Orlando Edwards R</RefAuthor> <RefAuthor>Lee RE</RefAuthor> <RefTitle>Contribution of Psychosocial Factors to Physical Activity in Women of Color in the Saving Lives Staying Active (SALSA) Study</RefTitle> <RefYear>2017</RefYear> <RefJournal>J Aging Phys Act</RefJournal> <RefPage>351-9</RefPage> <RefTotal>Mama SK, McNeill LH, Soltero EG, Orlando Edwards R, Lee RE. Contribution of Psychosocial Factors to Physical Activity in Women of Color in the Saving Lives Staying Active (SALSA) Study. J Aging Phys Act. 2017 Jul;25(3):351-9. DOI: 10.1123/japa.2015-0239</RefTotal> <RefLink>https://doi.org/10.1123/japa.2015-0239</RefLink> </Reference> <Reference refNo="72"> <RefAuthor>Meghani SH</RefAuthor> <RefAuthor>Peterson C</RefAuthor> <RefAuthor>Kaiser DH</RefAuthor> <RefAuthor>Rhodes J</RefAuthor> <RefAuthor>Rao H</RefAuthor> <RefAuthor>Chittams J</RefAuthor> <RefAuthor>Chatterjee A</RefAuthor> <RefTitle>A Pilot Study of a Mindfulness-Based Art Therapy Intervention in Outpatients With Cancer</RefTitle> <RefYear>2018</RefYear> <RefJournal>Am J Hosp Palliat Care</RefJournal> <RefPage>1195-200</RefPage> <RefTotal>Meghani SH, Peterson C, Kaiser DH, Rhodes J, Rao H, Chittams J, Chatterjee A. A Pilot Study of a Mindfulness-Based Art Therapy Intervention in Outpatients With Cancer. Am J Hosp Palliat Care. 2018 Sep;35(9):1195-200. DOI: 10.1177/1049909118760304</RefTotal> <RefLink>https://doi.org/10.1177/1049909118760304</RefLink> </Reference> <Reference refNo="73"> <RefAuthor>Millett CR</RefAuthor> <RefAuthor>Gooding LF</RefAuthor> <RefTitle>Comparing Active and Passive Distraction-Based Music Therapy Interventions on Preoperative Anxiety in Pediatric Patients and Their Caregivers</RefTitle> <RefYear>2018</RefYear> <RefJournal>J Music Ther</RefJournal> <RefPage>460-78</RefPage> <RefTotal>Millett CR, Gooding LF. Comparing Active and Passive Distraction-Based Music Therapy Interventions on Preoperative Anxiety in Pediatric Patients and Their Caregivers. J Music Ther. 2018 Jan;54(4):460-78. DOI: 10.1093/jmt/thx014</RefTotal> <RefLink>https://doi.org/10.1093/jmt/thx014</RefLink> </Reference> <Reference refNo="74"> <RefAuthor>Moore RC</RefAuthor> <RefAuthor>Straus E</RefAuthor> <RefAuthor>Dev SI</RefAuthor> <RefAuthor>Parish SM</RefAuthor> <RefAuthor>Sueko S</RefAuthor> <RefAuthor>Eyler LT</RefAuthor> <RefTitle>Development and Pilot Randomized Control Trial of a Drama Program to Enhance Well-being Among Older Adults</RefTitle> <RefYear>2017</RefYear> <RefJournal>Arts Psychother</RefJournal> <RefPage>1-9</RefPage> <RefTotal>Moore RC, Straus E, Dev SI, Parish SM, Sueko S, Eyler LT. Development and Pilot Randomized Control Trial of a Drama Program to Enhance Well-being Among Older Adults. Arts Psychother. 2017 Feb;52:1-9. DOI: 10.1016/j.aip.2016.09.007</RefTotal> <RefLink>https://doi.org/10.1016/j.aip.2016.09.007</RefLink> </Reference> <Reference refNo="75"> <RefAuthor>Robb SL</RefAuthor> <RefAuthor>Haase JE</RefAuthor> <RefAuthor>Perkins SM</RefAuthor> <RefAuthor>Haut PR</RefAuthor> <RefAuthor>Henley AK</RefAuthor> <RefAuthor>Knafl KA</RefAuthor> <RefAuthor>Tong Y</RefAuthor> <RefTitle>Pilot Randomized Trial of Active Music Engagement Intervention Parent Delivery for Young Children With Cancer</RefTitle> <RefYear>2017</RefYear> <RefJournal>J Pediatr Psychol</RefJournal> <RefPage>208-19</RefPage> <RefTotal>Robb SL, Haase JE, Perkins SM, Haut PR, Henley AK, Knafl KA, Tong Y. Pilot Randomized Trial of Active Music Engagement Intervention Parent Delivery for Young Children With Cancer. J Pediatr Psychol. 2017 Mar;42(2):208-19. DOI: 10.1093/jpepsy/jsw050</RefTotal> <RefLink>https://doi.org/10.1093/jpepsy/jsw050</RefLink> </Reference> <Reference refNo="76"> <RefAuthor>Yinger OS</RefAuthor> <RefTitle>Music Therapy as Procedural Support for Young Children Undergoing Immunizations: A Randomized Controlled Study</RefTitle> <RefYear>2016</RefYear> <RefJournal>J Music Ther</RefJournal> <RefPage>336-63</RefPage> <RefTotal>Yinger OS. Music Therapy as Procedural Support for Young Children Undergoing Immunizations: A Randomized Controlled Study. J Music Ther. 2016;53(4):336-63. DOI: 10.1093/jmt/thw010</RefTotal> <RefLink>https://doi.org/10.1093/jmt/thw010</RefLink> </Reference> <Reference refNo="77"> <RefAuthor>Eaton J</RefAuthor> <RefAuthor>Tieber C</RefAuthor> <RefTitle>The Effects of Coloring on Anxiety, Mood, and Perseverance</RefTitle> <RefYear>2017</RefYear> <RefJournal>J Am Art Ther Assoc</RefJournal> <RefPage>42-6</RefPage> <RefTotal>Eaton J, Tieber C. The Effects of Coloring on Anxiety, Mood, and Perseverance. J Am Art Ther Assoc. 2017; 34(1):42-6. DOI: 10.1080/07421656.2016.1277113</RefTotal> <RefLink>https://doi.org/10.1080/07421656.2016.1277113</RefLink> </Reference> <Reference refNo="78"> <RefAuthor>de la Torre-Luque A</RefAuthor> <RefAuthor>Caparros-Gonzalez RA</RefAuthor> <RefAuthor>Bastard T</RefAuthor> <RefAuthor>Vico FJ</RefAuthor> <RefAuthor>Buela-Casal G</RefAuthor> <RefTitle>Acute stress recovery through listening to melomics relaxing music: A randomized controlled trial</RefTitle> <RefYear>2016</RefYear> <RefJournal>Nord J Music Ther</RefJournal> <RefPage>124-41</RefPage> <RefTotal>de la Torre-Luque A, Caparros-Gonzalez RA, Bastard T, Vico FJ, Buela-Casal G. Acute stress recovery through listening to melomics relaxing music: A randomized controlled trial. Nord J Music Ther. 2016;26(2):124-41. DOI: 10.1080/08098131.2015.1131186</RefTotal> <RefLink>https://doi.org/10.1080/08098131.2015.1131186</RefLink> </Reference> <Reference refNo="79"> <RefAuthor>de la Torre-Luque A</RefAuthor> <RefAuthor>Diaz-Piedra C</RefAuthor> <RefAuthor>Buela-Casal G</RefAuthor> <RefTitle>Effects of preferred relaxing music after acute stress exposure: A randomized controlled trial</RefTitle> <RefYear>2017</RefYear> <RefJournal>Psychol Music</RefJournal> <RefPage>795-813</RefPage> <RefTotal>de la Torre-Luque A, Diaz-Piedra C, Buela-Casal G. Effects of preferred relaxing music after acute stress exposure: A randomized controlled trial. Psychol Music. 2017;45(6):795-813. DOI: 10.1177/0305735617689953</RefTotal> <RefLink>https://doi.org/10.1177/0305735617689953</RefLink> </Reference> <Reference refNo="80"> <RefAuthor>García González J</RefAuthor> <RefAuthor>Ventura Miranda MI</RefAuthor> <RefAuthor>Requena Mullor M</RefAuthor> <RefAuthor>Parron Carreño T</RefAuthor> <RefAuthor>Alarcón Rodriguez R</RefAuthor> <RefTitle>Effects of prenatal music stimulation on state/trait anxiety in full-term pregnancy and its influence on childbirth: a randomized controlled trial</RefTitle> <RefYear>2018</RefYear> <RefJournal>J Matern Fetal Neonatal Med</RefJournal> <RefPage>1058-65</RefPage> <RefTotal>García González J, Ventura Miranda MI, Requena Mullor M, Parron Carreño T, Alarcón Rodriguez R. Effects of prenatal music stimulation on state/trait anxiety in full-term pregnancy and its influence on childbirth: a randomized controlled trial. J Matern Fetal Neonatal Med. 2018 Apr;31(8):1058-65. DOI: 10.1080/14767058.2017.1306511</RefTotal> <RefLink>https://doi.org/10.1080/14767058.2017.1306511</RefLink> </Reference> <Reference refNo="81"> <RefAuthor>López-Rodríguez MM</RefAuthor> <RefAuthor>Baldrich-Rodríguez I</RefAuthor> <RefAuthor>Ruiz-Muelle A</RefAuthor> <RefAuthor>Cortés-Rodríguez AE</RefAuthor> <RefAuthor>Lopezosa-Estepa T</RefAuthor> <RefAuthor>Roman P</RefAuthor> <RefTitle>Effects of Biodanza on Stress, Depression, and Sleep Quality in University Students</RefTitle> <RefYear>2017</RefYear> <RefJournal>J Altern Complement Med</RefJournal> <RefPage>558-65</RefPage> <RefTotal>López-Rodríguez MM, Baldrich-Rodríguez I, Ruiz-Muelle A, Cortés-Rodríguez AE, Lopezosa-Estepa T, Roman P. Effects of Biodanza on Stress, Depression, and Sleep Quality in University Students. J Altern Complement Med. 2017 Jul;23(7):558-65. DOI: 10.1089/acm.2016.0365</RefTotal> <RefLink>https://doi.org/10.1089/acm.2016.0365</RefLink> </Reference> <Reference refNo="82"> <RefAuthor>Osmanoglu D E</RefAuthor> <RefAuthor>Yilmaz</RefAuthor> <RefTitle>The Effect of Classical Music on Anxiety and Well-Being of University Students</RefTitle> <RefYear>2019</RefYear> <RefJournal>International Education Studies</RefJournal> <RefPage>18-25</RefPage> <RefTotal>Osmanoglu D E, Yilmaz. The Effect of Classical Music on Anxiety and Well-Being of University Students. International Education Studies. 2019;12(11):18-25. DOI: 10.5539/ies.v12n11p18</RefTotal> <RefLink>https://doi.org/10.5539/ies.v12n11p18</RefLink> </Reference> <Reference refNo="83"> <RefAuthor>Ozgundondu B</RefAuthor> <RefAuthor>Gok Metin Z</RefAuthor> <RefTitle>Effects of progressive muscle relaxation combined with music on stress, fatigue, and coping styles among intensive care nurses</RefTitle> <RefYear>2019</RefYear> <RefJournal>Intensive Crit Care Nurs</RefJournal> <RefPage>54-63</RefPage> <RefTotal>Ozgundondu B, Gok Metin Z. Effects of progressive muscle relaxation combined with music on stress, fatigue, and coping styles among intensive care nurses. Intensive Crit Care Nurs. 2019 Oct;54:54-63. DOI: 10.1016/j.iccn.2019.07.007</RefTotal> <RefLink>https://doi.org/10.1016/j.iccn.2019.07.007</RefLink> </Reference> <Reference refNo="84"> <RefAuthor>Öztürk E</RefAuthor> <RefAuthor>Hamidi N</RefAuthor> <RefAuthor>Yikilmaz TN</RefAuthor> <RefAuthor>Özcan C</RefAuthor> <RefAuthor>Başar H</RefAuthor> <RefTitle>Effect of Listening to Music on Patient Anxiety and Pain Perception during Urodynamic Study: Randomized Controlled Trial</RefTitle> <RefYear>2019</RefYear> <RefJournal>Low Urin Tract Symptoms</RefJournal> <RefPage>39-42</RefPage> <RefTotal>Öztürk E, Hamidi N, Yikilmaz TN, Özcan C, Başar H. Effect of Listening to Music on Patient Anxiety and Pain Perception during Urodynamic Study: Randomized Controlled Trial. Low Urin Tract Symptoms. 2019 Jan;11(1):39-42. DOI: 10.1111/luts.12191</RefTotal> <RefLink>https://doi.org/10.1111/luts.12191</RefLink> </Reference> <Reference refNo="85"> <RefAuthor>Sezen C</RefAuthor> <RefAuthor>Ünsalver BÖ</RefAuthor> <RefTitle>Group art therapy for the management of fear of childbirth Author links open overlay panel</RefTitle> <RefYear>2019</RefYear> <RefJournal>Arts Psychother</RefJournal> <RefPage>9-19</RefPage> <RefTotal>Sezen C, Ünsalver BÖ. Group art therapy for the management of fear of childbirth Author links open overlay panel. Arts Psychother. 2019;64:9-19. DOI: 10.1016/j.aip.2018.11.007</RefTotal> <RefLink>https://doi.org/10.1016/j.aip.2018.11.007</RefLink> </Reference> <Reference refNo="86"> <RefAuthor>Kim S</RefAuthor> <RefAuthor>Gäbel C</RefAuthor> <RefAuthor>Aguilar-Raab C</RefAuthor> <RefAuthor>Hillecke TK</RefAuthor> <RefAuthor>Warth M</RefAuthor> <RefTitle>Affective and autonomic response to dynamic rhythmic entrainment – Mechanisms of a specific music therapy factor</RefTitle> <RefYear>2018</RefYear> <RefJournal>Arts Psychother</RefJournal> <RefPage>48-54</RefPage> <RefTotal>Kim S, Gäbel C, Aguilar-Raab C, Hillecke TK, Warth M. Affective and autonomic response to dynamic rhythmic entrainment – Mechanisms of a specific music therapy factor. Arts Psychother. 2018;60:48-54. DOI: 10.1016/j.aip.2018.06.002</RefTotal> <RefLink>https://doi.org/10.1016/j.aip.2018.06.002</RefLink> </Reference> <Reference refNo="87"> <RefAuthor>Koelsch S</RefAuthor> <RefAuthor>Boehlig A</RefAuthor> <RefAuthor>Hohenadel M</RefAuthor> <RefAuthor>Nitsche I</RefAuthor> <RefAuthor>Bauer K</RefAuthor> <RefAuthor>Sack U</RefAuthor> <RefTitle>The impact of acute stress on hormones and cytokines, and how their recovery is affected by music-evoked positive mood</RefTitle> <RefYear>2016</RefYear> <RefJournal>Sci Rep</RefJournal> <RefPage>23008</RefPage> <RefTotal>Koelsch S, Boehlig A, Hohenadel M, Nitsche I, Bauer K, Sack U. The impact of acute stress on hormones and cytokines, and how their recovery is affected by music-evoked positive mood. Sci Rep. 2016 Mar;6:23008. DOI: 10.1038/srep23008</RefTotal> <RefLink>https://doi.org/10.1038/srep23008</RefLink> </Reference> <Reference refNo="88"> <RefAuthor>Pfeifer E</RefAuthor> <RefAuthor>Fiedler H</RefAuthor> <RefAuthor>Wittmann M</RefAuthor> <RefTitle>Enhanced relaxation in students after combined Depth Relaxation Music Therapy and silence in a natural setting</RefTitle> <RefYear>2019</RefYear> <RefJournal>Arts Psychother</RefJournal> <RefPage>68-79</RefPage> <RefTotal>Pfeifer E, Fiedler H, Wittmann M. Enhanced relaxation in students after combined Depth Relaxation Music Therapy and silence in a natural setting. Arts Psychother. 2019;63:68-76. DOI: 10.1016/j.aip.2019.02.006</RefTotal> <RefLink>https://doi.org/10.1016/j.aip.2019.02.006</RefLink> </Reference> <Reference refNo="89"> <RefAuthor>Rossi A</RefAuthor> <RefAuthor>Molinaro A</RefAuthor> <RefAuthor>Savi E</RefAuthor> <RefAuthor>Micheletti S</RefAuthor> <RefAuthor>Galli J</RefAuthor> <RefAuthor>Chirico G</RefAuthor> <RefAuthor>Fazzi E</RefAuthor> <RefTitle>Music reduces pain perception in healthy newborns: A comparison between different music tracks and recoded heartbeat</RefTitle> <RefYear>2018</RefYear> <RefJournal>Early Hum Dev</RefJournal> <RefPage>7-10</RefPage> <RefTotal>Rossi A, Molinaro A, Savi E, Micheletti S, Galli J, Chirico G, Fazzi E. Music reduces pain perception in healthy newborns: A comparison between different music tracks and recoded heartbeat. Early Hum Dev. 2018 Sep;124:7-10. DOI: 10.1016/j.earlhumdev.2018.07.006</RefTotal> <RefLink>https://doi.org/10.1016/j.earlhumdev.2018.07.006</RefLink> </Reference> <Reference refNo="90"> <RefAuthor>Giordano F</RefAuthor> <RefAuthor>Zanchi B</RefAuthor> <RefAuthor>De Leonardis F</RefAuthor> <RefAuthor>Rutigliano C</RefAuthor> <RefAuthor>Esposito F</RefAuthor> <RefAuthor>Brienza N</RefAuthor> <RefAuthor>Santoro N</RefAuthor> <RefTitle>The influence of music therapy on preoperative anxiety in pediatric oncology patients undergoing invasive procedures</RefTitle> <RefYear>2020</RefYear> <RefJournal>Arts Psychother</RefJournal> <RefPage></RefPage> <RefTotal>Giordano F, Zanchi B, De Leonardis F, Rutigliano C, Esposito F, Brienza N, Santoro N. The influence of music therapy on preoperative anxiety in pediatric oncology patients undergoing invasive procedures. Arts Psychother. 2020. DOI: 10.1016/j.aip.2020.101649</RefTotal> <RefLink>https://doi.org/10.1016/j.aip.2020.101649</RefLink> </Reference> <Reference refNo="91"> <RefAuthor>Abbing A</RefAuthor> <RefAuthor>de Sonneville L</RefAuthor> <RefAuthor>Baars E</RefAuthor> <RefAuthor>Bourne D</RefAuthor> <RefAuthor>Swaab H</RefAuthor> <RefTitle>Anxiety reduction through art therapy in women. Exploring stress regulation and executive functioning as underlying neurocognitive mechanisms</RefTitle> <RefYear>2019</RefYear> <RefJournal>PLoS One</RefJournal> <RefPage>e0225200</RefPage> <RefTotal>Abbing A, de Sonneville L, Baars E, Bourne D, Swaab H. Anxiety reduction through art therapy in women. Exploring stress regulation and executive functioning as underlying neurocognitive mechanisms. PLoS One. 2019;14(12):e0225200. DOI: 10.1371/journal.pone.0225200</RefTotal> <RefLink>https://doi.org/10.1371/journal.pone.0225200</RefLink> </Reference> <Reference refNo="92"> <RefAuthor>Uggla L</RefAuthor> <RefAuthor>Bonde LO</RefAuthor> <RefAuthor>Svahn BM</RefAuthor> <RefAuthor>Remberger M</RefAuthor> <RefAuthor>Wrangsjö B</RefAuthor> <RefAuthor>Gustafsson B</RefAuthor> <RefTitle>Music therapy can lower the heart rates of severely sick children</RefTitle> <RefYear>2016</RefYear> <RefJournal>Acta Paediatr</RefJournal> <RefPage>1225-30</RefPage> <RefTotal>Uggla L, Bonde LO, Svahn BM, Remberger M, Wrangsjö B, Gustafsson B. Music therapy can lower the heart rates of severely sick children. Acta Paediatr. 2016 Oct;105(10):1225-30. DOI: 10.1111/apa.13452</RefTotal> <RefLink>https://doi.org/10.1111/apa.13452</RefLink> </Reference> <Reference refNo="93"> <RefAuthor>Lee SL</RefAuthor> <RefAuthor>Peng MSC</RefAuthor> <RefTitle>The Effects of Group Art Therapy on Mothers of Children with Special Educational Needs</RefTitle> <RefYear>2017</RefYear> <RefJournal>J Am Art Ther Assoc</RefJournal> <RefPage>12-9</RefPage> <RefTotal>Lee SL, Peng MSC. The Effects of Group Art Therapy on Mothers of Children with Special Educational Needs. J Am Art Ther Assoc. 2017;34(1):12-9. DOI: 10.1080/07421656.2016.1273697</RefTotal> <RefLink>https://doi.org/10.1080/07421656.2016.1273697</RefLink> </Reference> <Reference refNo="94"> <RefAuthor>Lee SL</RefAuthor> <RefTitle>Why Color Mandalas? A Study of Anxiety-Reducing Mechanisms</RefTitle> <RefYear>2018</RefYear> <RefJournal>J Am Art Ther Assoc</RefJournal> <RefPage>35-41</RefPage> <RefTotal>Lee SL. Why Color Mandalas? A Study of Anxiety-Reducing Mechanisms. J Am Art Ther Assoc. 2018;35(1):35-41. DOI: 10.1080/07421656.2018.1459105</RefTotal> <RefLink>https://doi.org/10.1080/07421656.2018.1459105</RefLink> </Reference> <Reference refNo="95"> <RefAuthor>Liu H</RefAuthor> <RefAuthor>Gao X</RefAuthor> <RefAuthor>Hou Y</RefAuthor> <RefTitle>Effects of mindfulness-based stress reduction combined with music therapy on pain, anxiety, and sleep quality in patients with osteosarcoma</RefTitle> <RefYear>2019</RefYear> <RefJournal>Braz J Psychiatry</RefJournal> <RefPage>540-5</RefPage> <RefTotal>Liu H, Gao X, Hou Y. Effects of mindfulness-based stress reduction combined with music therapy on pain, anxiety, and sleep quality in patients with osteosarcoma. Braz J Psychiatry. 2019 Nov-Dec;41(6):540-5. DOI: 10.1590/1516-4446-2018-0346</RefTotal> <RefLink>https://doi.org/10.1590/1516-4446-2018-0346</RefLink> </Reference> <Reference refNo="96"> <RefAuthor>Lee KS</RefAuthor> <RefAuthor>Jeong HC</RefAuthor> <RefAuthor>Yim JE</RefAuthor> <RefAuthor>Jeon MY</RefAuthor> <RefTitle>Effects of Music Therapy on the Cardiovascular and Autonomic Nervous System in Stress-Induced University Students: A Randomized Controlled Trial</RefTitle> <RefYear>2016</RefYear> <RefJournal>J Altern Complement Med</RefJournal> <RefPage>59-65</RefPage> <RefTotal>Lee KS, Jeong HC, Yim JE, Jeon MY. Effects of Music Therapy on the Cardiovascular and Autonomic Nervous System in Stress-Induced University Students: A Randomized Controlled Trial. J Altern Complement Med. 2016 Jan;22(1):59-65. DOI: 10.1089/acm.2015.0079</RefTotal> <RefLink>https://doi.org/10.1089/acm.2015.0079</RefLink> </Reference> <Reference refNo="97"> <RefAuthor>Son HK</RefAuthor> <RefAuthor>So WY</RefAuthor> <RefAuthor>Kim M</RefAuthor> <RefTitle>Effects of Aromatherapy Combined with Music Therapy on Anxiety, Stress, and Fundamental Nursing Skills in Nursing Students: A Randomized Controlled Trial</RefTitle> <RefYear>2019</RefYear> <RefJournal>Int J Environ Res Public Health</RefJournal> <RefPage></RefPage> <RefTotal>Son HK, So WY, Kim M. Effects of Aromatherapy Combined with Music Therapy on Anxiety, Stress, and Fundamental Nursing Skills in Nursing Students: A Randomized Controlled Trial. Int J Environ Res Public Health. 2019 Oct;16(21). DOI: 10.3390/ijerph16214185</RefTotal> <RefLink>https://doi.org/10.3390/ijerph16214185</RefLink> </Reference> <Reference refNo="98"> <RefAuthor>Aithal S</RefAuthor> <RefAuthor>Karkou V</RefAuthor> <RefAuthor>Kuppusamy G</RefAuthor> <RefAuthor>Mariswamy P</RefAuthor> <RefTitle>Backing the backbones – A feasibility study on the effectiveness of dance movement psychotherapy on parenting stress in caregivers of children with Autism Spectrum Disorder</RefTitle> <RefYear>2019</RefYear> <RefJournal>Arts Psychother</RefJournal> <RefPage>69-76</RefPage> <RefTotal>Aithal S, Karkou V, Kuppusamy G, Mariswamy P. Backing the backbones – A feasibility study on the effectiveness of dance movement psychotherapy on parenting stress in caregivers of children with Autism Spectrum Disorder. Arts Psychother. 2019;64:69-76. DOI: 10.1016/j.aip.2019.04.003</RefTotal> <RefLink>https://doi.org/10.1016/j.aip.2019.04.003</RefLink> </Reference> <Reference refNo="99"> <RefAuthor>Kongsawatvorakul C</RefAuthor> <RefAuthor>Charakorn C</RefAuthor> <RefAuthor>Paiwattananupant K</RefAuthor> <RefAuthor>Lekskul N</RefAuthor> <RefAuthor>Rattanasiri S</RefAuthor> <RefAuthor>Lertkhachonsuk AA</RefAuthor> <RefTitle>Limited Impact of Music Therapy on Patient Anxiety with the Large Loop Excision of Transformation Zone Procedure – a Randomized Controlled Trial</RefTitle> <RefYear>2016</RefYear> <RefJournal>Asian Pac J Cancer Prev</RefJournal> <RefPage>2853-6</RefPage> <RefTotal>Kongsawatvorakul C, Charakorn C, Paiwattananupant K, Lekskul N, Rattanasiri S, Lertkhachonsuk AA. Limited Impact of Music Therapy on Patient Anxiety with the Large Loop Excision of Transformation Zone Procedure – a Randomized Controlled Trial. Asian Pac J Cancer Prev. 2016;17(6):2853-6.</RefTotal> </Reference> <Reference refNo="100"> <RefAuthor>Lee WL</RefAuthor> <RefAuthor>Sung HC</RefAuthor> <RefAuthor>Liu SH</RefAuthor> <RefAuthor>Chang SM</RefAuthor> <RefTitle>Meditative music listening to reduce state anxiety in patients during the uptake phase before positron emission tomography (PET) scans</RefTitle> <RefYear>2017</RefYear> <RefJournal>Br J Radiol</RefJournal> <RefPage>20160466</RefPage> <RefTotal>Lee WL, Sung HC, Liu SH, Chang SM. Meditative music listening to reduce state anxiety in patients during the uptake phase before positron emission tomography (PET) scans. Br J Radiol. 2017 Feb;90(1070):20160466. DOI: 10.1259/bjr.20160466</RefTotal> <RefLink>https://doi.org/10.1259/bjr.20160466</RefLink> </Reference> <Reference refNo="101"> <RefAuthor>Flett J</RefAuthor> <RefAuthor>Celia L</RefAuthor> <RefAuthor>Riordan B</RefAuthor> <RefAuthor>Thompson LM</RefAuthor> <RefAuthor>Tamlin SC</RefAuthor> <RefAuthor>Harlene H</RefAuthor> <RefTitle>Sharpen Your Pencils: Preliminary Evidence that Adult Coloring Reduces Depressive Symptoms and Anxiety</RefTitle> <RefYear>2017</RefYear> <RefJournal>Creat Res J</RefJournal> <RefPage>4</RefPage> <RefTotal>Flett J, Celia L, Riordan B, Thompson LM, Tamlin SC, Harlene H. Sharpen Your Pencils: Preliminary Evidence that Adult Coloring Reduces Depressive Symptoms and Anxiety. Creat Res J. 2017;29(4):4. DOI: 10.1080/10400419.2017.1376505</RefTotal> <RefLink>https://doi.org/10.1080/10400419.2017.1376505</RefLink> </Reference> <Reference refNo="102"> <RefAuthor>Kuroda Y</RefAuthor> <RefAuthor>Geisler G</RefAuthor> <RefAuthor>Morel PCH</RefAuthor> <RefAuthor>Hapeta J</RefAuthor> <RefTitle>Stress, Emotions, and Motivational States Among Traditional Dancers in New Zealand and Japan</RefTitle> <RefYear>2017</RefYear> <RefJournal>Psychol Rep</RefJournal> <RefPage>895-913</RefPage> <RefTotal>Kuroda Y, Geisler G, Morel PCH, Hapeta J. Stress, Emotions, and Motivational States Among Traditional Dancers in New Zealand and Japan. Psychol Rep. 2017 Oct;120(5):895-913. DOI: 10.1177/0033294117711130</RefTotal> <RefLink>https://doi.org/10.1177/0033294117711130</RefLink> </Reference> <Reference refNo="103"> <RefAuthor>Hides L</RefAuthor> <RefAuthor>Dingle G</RefAuthor> <RefAuthor>Quinn C</RefAuthor> <RefAuthor>Stoyanov SR</RefAuthor> <RefAuthor>Zelenko O</RefAuthor> <RefAuthor>Tjondronegoro D</RefAuthor> <RefAuthor>Johnson D</RefAuthor> <RefAuthor>Cockshaw W</RefAuthor> <RefAuthor>Kavanagh DJ</RefAuthor> <RefTitle>Efficacy and Outcomes of a Music-Based Emotion Regulation Mobile App in Distressed Young People: Randomized Controlled Trial</RefTitle> <RefYear>2019</RefYear> <RefJournal>JMIR Mhealth Uhealth</RefJournal> <RefPage>e11482</RefPage> <RefTotal>Hides L, Dingle G, Quinn C, Stoyanov SR, Zelenko O, Tjondronegoro D, Johnson D, Cockshaw W, Kavanagh DJ. Efficacy and Outcomes of a Music-Based Emotion Regulation Mobile App in Distressed Young People: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2019 Jan;7(1):e11482. DOI: 10.2196/11482</RefTotal> <RefLink>https://doi.org/10.2196/11482</RefLink> </Reference> <Reference refNo="104"> <RefAuthor>Ortega A</RefAuthor> <RefAuthor>Gauna F</RefAuthor> <RefAuthor>Munoz D</RefAuthor> <RefAuthor>Oberreuter G</RefAuthor> <RefAuthor>Breinbauer HA</RefAuthor> <RefAuthor>Carrasco L</RefAuthor> <RefTitle>Music Therapy for Pain and Anxiety Management in Nasal Bone Fracture Reduction: Randomized Controlled Clinical Trial</RefTitle> <RefYear>2019</RefYear> <RefJournal>Otolaryngol Head Neck Surg</RefJournal> <RefPage>613-9</RefPage> <RefTotal>Ortega A, Gauna F, Munoz D, Oberreuter G, Breinbauer HA, Carrasco L. Music Therapy for Pain and Anxiety Management in Nasal Bone Fracture Reduction: Randomized Controlled Clinical Trial. Otolaryngol Head Neck Surg. 2019 Oct;161(4):613-9. DOI: 10.1177/0194599819856604</RefTotal> <RefLink>https://doi.org/10.1177/0194599819856604</RefLink> </Reference> <Reference refNo="105"> <RefAuthor>Kahloul M</RefAuthor> <RefAuthor>Mhamdi S</RefAuthor> <RefAuthor>Nakhli MS</RefAuthor> <RefAuthor>Sfeyhi AN</RefAuthor> <RefAuthor>Azzaza M</RefAuthor> <RefAuthor>Chaouch A</RefAuthor> <RefAuthor>Naija W</RefAuthor> <RefTitle>Effects of music therapy under general anesthesia in patients undergoing abdominal surgery</RefTitle> <RefYear>2017</RefYear> <RefJournal>Libyan J Med</RefJournal> <RefPage>1260886</RefPage> <RefTotal>Kahloul M, Mhamdi S, Nakhli MS, Sfeyhi AN, Azzaza M, Chaouch A, Naija W. Effects of music therapy under general anesthesia in patients undergoing abdominal surgery. Libyan J Med. 2017 Dec;12(1):1260886. DOI: 10.1080/19932820.2017.1260886</RefTotal> <RefLink>https://doi.org/10.1080/19932820.2017.1260886</RefLink> </Reference> <Reference refNo="106"> <RefAuthor>Koelsch S</RefAuthor> <RefAuthor>Boehlig A</RefAuthor> <RefAuthor>Hohenadel M</RefAuthor> <RefAuthor>Nitsche I</RefAuthor> <RefAuthor>Bauer K</RefAuthor> <RefAuthor>Sack U</RefAuthor> <RefTitle>The impact of acute stress on hormones and cytokines, and how their recovery is affected by music-evoked positive mood</RefTitle> <RefYear>2016</RefYear> <RefJournal>Sci Rep</RefJournal> <RefPage>23008</RefPage> <RefTotal>Koelsch S, Boehlig A, Hohenadel M, Nitsche I, Bauer K, Sack U. The impact of acute stress on hormones and cytokines, and how their recovery is affected by music-evoked positive mood. Sci Rep. 2016 Mar;6:23008. DOI: 10.1038/srep23008</RefTotal> <RefLink>https://doi.org/10.1038/srep23008</RefLink> </Reference> <Reference refNo="107"> <RefAuthor>Robb SL</RefAuthor> <RefTitle>The effect of therapeutic music interventions on the behavior of hospitalized children in isolation: developing a contextual support model of music therapy</RefTitle> <RefYear>2000</RefYear> <RefJournal>J Music Ther</RefJournal> <RefPage>118-46</RefPage> <RefTotal>Robb SL. The effect of therapeutic music interventions on the behavior of hospitalized children in isolation: developing a contextual support model of music therapy. J Music Ther. 2000;37(2):118-46. DOI: 10.1093/jmt/37.2.118</RefTotal> <RefLink>https://doi.org/10.1093/jmt/37.2.118</RefLink> </Reference> <Reference refNo="108"> <RefAuthor>Peterson C</RefAuthor> <RefTitle>Mindfulness-Based Art therapy: Applications for Healing with Cancer</RefTitle> <RefYear>2013</RefYear> <RefBookTitle>Mindfulness and the Arts Therapies. Theory and Practice</RefBookTitle> <RefPage></RefPage> <RefTotal>Peterson C. Mindfulness-Based Art therapy: Applications for Healing with Cancer. In: Rappaport L, editor. Mindfulness and the Arts Therapies. Theory and Practice. London: Jessica Kingley; 2013.</RefTotal> </Reference> <Reference refNo="109"> <RefAuthor>Kabat-Zinn J</RefAuthor> <RefTitle></RefTitle> <RefYear>2011</RefYear> <RefBookTitle>Gesund durch Meditation. Das vollständige Grundlagenwerk zu MBSR</RefBookTitle> <RefPage></RefPage> <RefTotal>Kabat-Zinn J. Gesund durch Meditation. Das vollständige Grundlagenwerk zu MBSR. München: O.W. Barth; 2011.</RefTotal> </Reference> <Reference refNo="110"> <RefAuthor>Newland P</RefAuthor> <RefAuthor>Bettencourt BA</RefAuthor> <RefTitle>Effectiveness of mindfulness-based art therapy for symptoms of anxiety, depression, and fatigue: A systematic review and meta-analysis</RefTitle> <RefYear>2020</RefYear> <RefJournal>Complement Ther Clin Pract</RefJournal> <RefPage>101246</RefPage> <RefTotal>Newland P, Bettencourt BA. Effectiveness of mindfulness-based art therapy for symptoms of anxiety, depression, and fatigue: A systematic review and meta-analysis. Complement Ther Clin Pract. 2020 Nov;41:101246. DOI: 10.1016/j.ctcp.2020.101246</RefTotal> <RefLink>https://doi.org/10.1016/j.ctcp.2020.101246</RefLink> </Reference> <Reference refNo="117"> <RefAuthor>Mason WA</RefAuthor> <RefAuthor>Fleming CB</RefAuthor> <RefAuthor>Thompson RW</RefAuthor> <RefAuthor>Haggerty KP</RefAuthor> <RefAuthor>Snyder JJ</RefAuthor> <RefTitle>A framework for testing and promoting expanded dissemination of promising preventive interventions that are being implemented in community settings</RefTitle> <RefYear>2014</RefYear> <RefJournal>Prev Sci</RefJournal> <RefPage>674-83</RefPage> <RefTotal>Mason WA, Fleming CB, Thompson RW, Haggerty KP, Snyder JJ. A framework for testing and promoting expanded dissemination of promising preventive interventions that are being implemented in community settings. Prev Sci. 2014 Oct;15(5):674-83. DOI: 10.1007/s11121-013-0409-3</RefTotal> <RefLink>https://doi.org/10.1007/s11121-013-0409-3</RefLink> </Reference> <Reference refNo="111"> <RefAuthor>Glasgow RE</RefAuthor> <RefTitle>What does it mean to be pragmatic? Pragmatic methods, measures, and models to facilitate research translation</RefTitle> <RefYear>2013</RefYear> <RefJournal>Health Educ Behav</RefJournal> <RefPage>257-65</RefPage> <RefTotal>Glasgow RE. What does it mean to be pragmatic? Pragmatic methods, measures, and models to facilitate research translation. Health Educ Behav. 2013 Jun;40(3):257-65. DOI: 10.1177/1090198113486805</RefTotal> <RefLink>https://doi.org/10.1177/1090198113486805</RefLink> </Reference> <Reference refNo="112"> <RefAuthor>Walter U</RefAuthor> <RefAuthor>Nöcker G</RefAuthor> <RefAuthor>Plaumann M</RefAuthor> <RefAuthor>Linden S</RefAuthor> <RefAuthor>Pott E</RefAuthor> <RefAuthor>Koch U</RefAuthor> <RefAuthor>Pawils S</RefAuthor> <RefAuthor> unter Mitarbeit vonAltgeld T</RefAuthor> <RefAuthor>Dierks ML</RefAuthor> <RefAuthor>Frahsa A</RefAuthor> <RefAuthor>Jahn I</RefAuthor> <RefAuthor>Krauth C</RefAuthor> <RefAuthor>Pomp M</RefAuthor> <RefAuthor>Rehaag R</RefAuthor> <RefAuthor>Robra BP</RefAuthor> <RefAuthor>Süß W</RefAuthor> <RefAuthor>Töppich J</RefAuthor> <RefAuthor>Trojan A</RefAuthor> <RefAuthor>von Unger H</RefAuthor> <RefAuthor>Wildner M</RefAuthor> <RefAuthor>Wright M</RefAuthor> <RefTitle>Memorandum zur Präventionsforschung – Themenfelder und Methoden (Langfassung)</RefTitle> <RefYear>2012</RefYear> <RefJournal>Gesundheitswesen</RefJournal> <RefPage>e99-e113</RefPage> <RefTotal>Walter U, Nöcker G, Plaumann M, Linden S, Pott E, Koch U, Pawils S; unter Mitarbeit vonAltgeld T, Dierks ML, Frahsa A, Jahn I, Krauth C, Pomp M, Rehaag R, Robra BP, Süß W, Töppich J, Trojan A, von Unger H, Wildner M, Wright M. Memorandum zur Präventionsforschung – Themenfelder und Methoden (Langfassung) [Memorandum prevention research – research areas and methods]. Gesundheitswesen. 2012 Oct;74(10):e99-e113. DOI: 10.1055/s-0032-1327759</RefTotal> <RefLink>https://doi.org/10.1055/s-0032-1327759</RefLink> </Reference> <Reference refNo="113"> <RefAuthor>Tibbits MK</RefAuthor> <RefAuthor>Bumbarger BK</RefAuthor> <RefAuthor>Kyler SJ</RefAuthor> <RefAuthor>Perkins DF</RefAuthor> <RefTitle>Sustaining evidence-based interventions under real-world conditions: results from a large-scale diffusion project</RefTitle> <RefYear>2010</RefYear> <RefJournal>Prev Sci</RefJournal> <RefPage>252-62</RefPage> <RefTotal>Tibbits MK, Bumbarger BK, Kyler SJ, Perkins DF. Sustaining evidence-based interventions under real-world conditions: results from a large-scale diffusion project. Prev Sci. 2010 Sep;11(3):252-62. DOI: 10.1007/s11121-010-0170-9</RefTotal> <RefLink>https://doi.org/10.1007/s11121-010-0170-9</RefLink> </Reference> <Reference refNo="114"> <RefAuthor>Sharpe D</RefAuthor> <RefTitle>Of apples and oranges, file drawers and garbage: why validity issues in meta-analysis will not go away</RefTitle> <RefYear>1997</RefYear> <RefJournal>Clin Psychol Rev</RefJournal> <RefPage>881-901</RefPage> <RefTotal>Sharpe D. Of apples and oranges, file drawers and garbage: why validity issues in meta-analysis will not go away. Clin Psychol Rev. 1997;17:881-901. DOI: 10.1016/S0272-7358(97)00056-1</RefTotal> <RefLink>https://doi.org/10.1016/S0272-7358(97)00056-1</RefLink> </Reference> <Reference refNo="115"> <RefAuthor>Breitborde NJ</RefAuthor> <RefAuthor>Srihari VH</RefAuthor> <RefAuthor>Pollard JM</RefAuthor> <RefAuthor>Addington DN</RefAuthor> <RefAuthor>Woods SW</RefAuthor> <RefTitle>Mediators and moderators in early intervention research</RefTitle> <RefYear>2010</RefYear> <RefJournal>Early Interv Psychiatry</RefJournal> <RefPage>143-52</RefPage> <RefTotal>Breitborde NJ, Srihari VH, Pollard JM, Addington DN, Woods SW. Mediators and moderators in early intervention research. Early Interv Psychiatry. 2010 May;4(2):143-52. DOI: 10.1111/j.1751-7893.2010.00177.x</RefTotal> <RefLink>https://doi.org/10.1111/j.1751-7893.2010.00177.x</RefLink> </Reference> <Reference refNo="116"> <RefAuthor>Baron RM</RefAuthor> <RefAuthor>Kenny DA</RefAuthor> <RefTitle>The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations</RefTitle> <RefYear>1986</RefYear> <RefJournal>J Pers Soc Psychol</RefJournal> <RefPage>1173-82</RefPage> <RefTotal>Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986 Dec;51(6):1173-82. DOI: 10.1037//0022-3514.51.6.1173</RefTotal> <RefLink>https://doi.org/10.1037//0022-3514.51.6.1173</RefLink> </Reference> </References> <Media> <Tables> <Table format="png"> <MediaNo>1</MediaNo> <MediaID>1</MediaID> <Caption><Pgraph><Mark1>Table 1: Overview of databases and search terms</Mark1></Pgraph></Caption> </Table> <Table format="png"> <MediaNo>2</MediaNo> <MediaID>2</MediaID> <Caption><Pgraph><Mark1>Table 2: Allocation of age in each modality</Mark1></Pgraph></Caption> </Table> <Table format="png"> <MediaNo>3</MediaNo> <MediaID>3</MediaID> <Caption><Pgraph><Mark1>Table 3: Study designs by arts modality (therapy or mere intervention), year of publication and level of evidence [33]</Mark1></Pgraph></Caption> </Table> <Table format="png"> <MediaNo>4</MediaNo> <MediaID>4</MediaID> <Caption><Pgraph><Mark1>Table 4: Allocation of gender in each modality </Mark1></Pgraph></Caption> </Table> <NoOfTables>4</NoOfTables> </Tables> <Figures> <Figure format="png" height="793" width="717"> <MediaNo>1</MediaNo> <MediaID>1</MediaID> <Caption><Pgraph><Mark1>Figure 1: PRISMA flow diagram of the data base search on creative arts interventions for stress prevention [44]</Mark1></Pgraph></Caption> </Figure> <NoOfPictures>1</NoOfPictures> </Figures> <InlineFigures> <NoOfPictures>0</NoOfPictures> </InlineFigures> <Attachments> <Attachment> <MediaNo>1</MediaNo> <MediaID filename="jat000025.a1.pdf" mimeType="application/pdf" origFilename="Attachment 1_jat000025.pdf" size="194695" url="">1</MediaID> <AttachmentTitle>Overview of the detected effectiveness studies on stress prevention and stress management with creative arts interventions</AttachmentTitle> </Attachment> <NoOfAttachments>1</NoOfAttachments> </Attachments> </Media> </OrigData> </GmsArticle>