Arts psychotherapies for adolescents with mental health difficulties: A systematic review and logic model of mechanisms of action and outcomes

There is a lack of evidence base to understand and evaluate arts psychotherapies (Art Psychotherapy, Dance Movement Psychotherapy, Dramatherapy and Music Therapy) interventions increasingly provided for adolescents with mental health difficulties, a population with rising need. We aimed to understand which arts psychotherapies interventions are used with adolescents with mental health difficulties and what their mechanisms of action are. We aimed to assess what the outcomes of arts psychotherapies interventions are, and how they are measured. Literature was sourced through database searches (CINAHL, EMBASE, the Cochrane Library, PsycINFO, PubMed, Scopus, APA PsycNet) and hand searches (January 2007 - June 2023). 3403 papers were screened, 47 met inclusion criteria for synthesis. Risk of bias in included studies was assessed. Findings were narratively synthesised, and a logic model drawn, mapping out intervention components, potential mechanisms of action (generic psychotherapy factors and factors unique to arts psychotherapies), and intervention outcomes. The logic model produced can inform more consistent evaluation strategies across arts psychotherapies approaches. Despite shared outcomes recognised through narrative synthesis, there is wide range of outcome measures used to assess benefits of these approaches. This is a barrier to establishment of a strong evidence base as it emphasizes differences rather than commonalities.