Art Therapy for Anxiety: What the Process Actually Looks Like

By Leigh-Anne Alexander, registered art therapist (HPCSA AT0001902), MA Art Therapy (UJ) — Somerset West, Helderberg

If you live with anxiety, you already know the frustrating loop: you think about the worry, you talk about the worry, and somehow the thinking and talking become part of the worry. Many people arrive at art therapy precisely because talking about their anxiety has started to feel like running on a wheel.

Art therapy offers a different doorway. In this article I'll explain what the process actually looks like — not in abstract terms, but session by session — along with what the research says and how to know if it might be right for you.

Why anxiety is so hard to "just talk about"

Anxiety is a full-body experience: a racing heart, a tight chest, restlessness, a mind that won't switch off. Yet most of the ways we try to address it are purely verbal. For some people that works well. For others, words keep the anxiety at arm's length — you can describe it fluently without ever quite reaching it.

Art therapy works differently. By putting attention into the hands — mixing a colour, following a line, working a piece of clay — the constant analysing quietens, and feelings can surface in a form you can actually look at. In the research literature this is sometimes described as shifting from a "thinking mode" into a "feeling mode": rather than talking about the anxiety endlessly, the art-making allows a more direct, embodied connection to what's going on.

What does the research say?

An honest answer, because you deserve one: the evidence base for art therapy is younger than for long-established talk therapies, but it is growing and encouraging.

A randomised controlled trial published in Frontiers in Psychology found that art therapy significantly reduced anxiety symptoms in adult women, and also improved quality of life and emotion regulation — the ability to accept emotions and act on goals rather than being ruled by worry (Abbing et al., 2019). An earlier systematic review by the same research group noted that while many older studies had methodological weaknesses, there were consistent indications of benefit, including for exam-related anxiety in students (Abbing et al., 2018; Sandmire et al., 2012).

There is also intriguing physiological evidence: a study in the journal Art Therapy found that just 45 minutes of art-making measurably lowered cortisol — the body's main stress hormone — in a majority of participants, regardless of artistic experience (Kaimal et al., 2016).

Art therapy in South Africa is practised by therapists registered with the Health Professions Council of South Africa (HPCSA) after master's-level clinical training — the same regulatory body that registers psychologists.

What actually happens in a session?

A typical session with me lasts about 60 minutes, in a private, unhurried space — or online from your own home. Broadly, it flows like this:

Arriving. We begin with a short check-in: how the week has been, what's felt heavy, what you'd like from the session. No agenda is forced.

Making. You work with simple materials — paint, pastels, collage, clay — sometimes around a gentle invitation ("what colour is the worry today?"), sometimes completely freely. This is usually the quietest part of the session, and many anxious clients describe it as the first genuinely calm stretch of their week. There is no standard to meet: a scribble is as welcome as a painting.

Reflecting. Afterwards, we look at what emerged — together, at your pace. The artwork is never judged or "analysed at" you. It becomes something we can be curious about: what stands out, what surprised you, what it might be holding. Often the image says something you hadn't found words for yet.

Over a series of sessions, patterns become visible — literally. Clients often notice their anxiety changing shape on the page before they notice it changing in daily life, and that visible record of progress is itself steadying.

Your first session

The first session is gentler still: it's mostly about getting comfortable, telling me as much or as little as you wish about what brings you, and asking anything you like. There's no pressure to make anything before you're ready. Everything you share — including the artwork itself — is strictly confidential within the ethical framework of an HPCSA-registered practitioner.

"But I can't draw"

The most common worry, so let me say it plainly: no artistic skill is needed — truly, none. Art therapy is about the process, not the product. If you can hold a crayon, you have all the technique required. (I've written more about this in the FAQ.)

In person or online?

I see clients in person in the Somerset West and Helderberg area, and offer online art therapy via secure video conferencing across South Africa. Online sessions work remarkably well for anxiety — being in your own familiar space can make the first step easier, and paper and something to draw with is enough to begin.

When anxiety needs more than one kind of support

Art therapy can stand on its own or work alongside other care. If your anxiety is severe, has changed suddenly, or comes with physical symptoms that worry you, it's wise to speak to your GP as well — anxiety disorders sometimes benefit from a combination of approaches, and a good therapist will always support that rather than compete with it.

Taking the first step

If reading this has made you curious — or quietly hopeful — you're welcome to get in touch. Tell me as much or as little as you like; I answer every message personally, usually within one to two working days, and there's no obligation of any kind.

Leigh-Anne Alexander is a registered art therapist (HPCSA Reg: AT0001902, Practice Nr: 1155946) and SANATA member practising in Somerset West, serving the Helderberg and Winelands. Read more about Leigh-Anne or what art therapy is.

References

• Abbing, A., Baars, E.W., de Sonneville, L., Ponstein, A.S. & Swaab, H. (2019). The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial. Frontiers in Psychology, 10:1203.

• Abbing, A., Ponstein, A., van Hooren, S., de Sonneville, L., Swaab, H. & Baars, E. (2018). The effectiveness of art therapy for anxiety in adults: A systematic review of randomised and non-randomised controlled trials. PLOS ONE, 13(12).

• Kaimal, G., Ray, K. & Muniz, J. (2016). Reduction of Cortisol Levels and Participants' Responses Following Art Making. Art Therapy, 33(2).

• Sandmire, D.A., Gorham, S.R., Rankin, N.E. & Grimm, D.R. (2012). The influence of art making on anxiety: a pilot study. Art Therapy, 29(2).