Forty years of sandplay therapy research: A systematic review with insights into emerging digital applications

This study systematically reviewed the development of sandplay therapy (SPT) from 1985 to 2025 in terms of theoretical foundations, practical applications, and research methods, as well as recent progress and future directions in cultural adaptation and digital integration. Seventy-one eligible studies were reviewed, covering qualitative, quantitative, and mixed-methods research. The results showed that symbolic and imaginal expression, core mechanisms of SPT, are strongly influenced by the cultural context. This promotes the development of local symbolic systems and enhances SPT’s cross-cultural adaptability. Practically, SPT has been widely applied with children, adolescents, and adults, showing notable positive effects on trauma recovery, emotional regulation, and social adaptation. Methodologically, research has increasingly used scales, neuroimaging, and physiological indicators to strengthen understanding of relevant therapeutic mechanisms. Artificial intelligence and augmented reality technologies have been explored in SPT assessment and intervention, showing potential to improve standardisation and remote accessibility. Future studies could focus on theoretical construction, ethical evaluation, and clinical validation of intelligent sandplay systems to support innovative development. This review offers a comprehensive overview of four decades of SPT and provides theoretical and practical insights that will enhance its cultural and digital integration.