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Abstract

Background

Emotional distress, anxiety, and depressive symptoms are highly prevalent among adults with cancer. Digital art therapy (DAT), encompassing immersive, musical, visual, and narrative digital modalities, has emerged as a potential approach to expand access to creative psychosocial interventions; however, the evidence base remains fragmented and methodologically heterogeneous.

Objective

This scoping review aimed to map the characteristics, digital design features, and reported psychosocial outcomes of DAT interventions targeting anxiety and depression in adults with cancer.

Methods

A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews and the Joanna Briggs Institute methodological framework. Electronic databases were searched through August 2025 for studies evaluating digitally delivered art-based interventions in adult oncology populations. Data on intervention modality, study design, sample size, outcome measures, effect estimates, and feasibility indicators were extracted and synthesized descriptively.

Results

Ten studies (2016–2025; N = 434) were included, comprising randomized controlled trials (n = 6), quasi-experimental studies (n = 1), mixed-methods studies (n = 1), and qualitative or developmental studies (n = 2). Interventions included immersive virtual reality, digital music therapy, online visual art programs, and digital storytelling. Most studies were early-phase with small to moderate samples and short follow-up. Reported reductions in anxiety and distress ranged from small to very large (Cohen's d ≈ 0.24–2.38; η² ≈ 0.25). Larger effects were primarily observed in small or pilot trials involving multi-session, therapist-guided or immersive interventions, often measured immediately post-intervention or within short follow-up intervals.

Conclusions

DAT appears feasible and acceptable, with preliminary evidence of psychosocial benefit. However, effect magnitudes are context-dependent, and adequately powered randomized trials with longer-term follow-up are needed to clarify clinical effectiveness.

Keywords

Digital art therapy digital health emotional well-being psychosocial outcomes psycho-oncology

Introduction

Cancer is increasingly understood within the framework of integrative oncology, a patient-centered and evidence-informed model that extends beyond disease control to address the psychological, behavioral, and quality-of-life dimensions of cancer care.¹ Rather than focusing solely on survival outcomes, integrative oncology emphasizes the management of the biopsychosocial burden associated with cancer and its treatment, recognizing emotional well-being and interpersonal functioning as essential components of comprehensive care.²

Across the cancer care continuum, emotional challenges are common, often arising from treatment uncertainty, symptom burden, and fear of disease recurrence.³ Recent evidence suggests that a substantial proportion of adults with cancer—often approaching or exceeding 40%—experience clinically significant psychological distress, with prevalence varying by tumor type, treatment phase, and sociocultural context.⁴ These emotional disturbances extend beyond transient mood changes; they exacerbate fatigue, undermine treatment adherence, and substantially diminish overall quality of life.⁵ Despite growing recognition of these needs, access to timely and sustained psychotherapeutic support remains uneven, particularly in resource-constrained or high-demand clinical settings where mental health professionals are limited.⁶

In response to these gaps, expressive and mind–body interventions have gained increasing attention within integrative oncology, with growing interest in digitally mediated art-based approaches.⁷ Digital art therapy (DAT) builds upon the longstanding therapeutic capacity of art to externalize emotion and facilitate meaning-making through symbolic expression.⁸ When mediated through digital technologies, art-based interventions extend beyond traditional studio settings, enabling patients to engage in creative practices—such as painting, music-making, or narrative construction—within virtual, mobile, or web-based environments.⁹ In this context, DAT refers to digitally mediated creative interventions in which therapeutic processes may be influenced by features such as interactivity, immersion, personalization, and technology-enabled feedback.¹⁰ Rather than simply delivering traditional art therapy remotely (e.g., via video conferencing), digital platforms may extend or reshape creative engagement in ways that warrant systematic examination.¹¹

A growing range of digitally enabled art-based modalities has been explored in oncology contexts, including virtual reality environments designed to support relaxation¹²; digital music-based interventions delivered via mobile or web platforms¹³; online group-based visual art programs facilitating peer interaction and creative exchange¹⁴; and digital storytelling approaches supporting narrative expression and identity reconstruction.¹⁵ Together, these modalities illustrate the potential breadth of DAT applications at the intersection of creativity and digital health. However, the current evidence base remains fragmented, with substantial variation in theoretical orientation, digital design features, intervention intensity, outcome selection, and implementation reporting.¹⁶ Many interventions remain early-phase, with small samples and short follow-up, and a primary focus on feasibility or acceptability rather than effectiveness.¹⁷ Although recent meta-analyses support the broader psychosocial benefits of digital interventions in oncology, the specific therapeutic contribution of DAT has yet to be clearly delineated.¹⁸

To date, no review has systematically mapped digitally mediated creative interventions specifically targeting anxiety and depression in adult oncology populations. Accordingly, the aim of this scoping review is to systematically map DAT interventions designed to address anxiety and depression in adults with cancer. Specifically, the review seeks to (1) characterize the types of DAT interventions and digital platforms used in oncology settings, (2) summarize reported psychosocial outcomes and feasibility indicators, and (3) identify key methodological and implementation gaps to inform future digital psychosocial oncology research.

Methods

Study design and framework

This scoping review followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines¹⁹ and the methodological framework of the Joanna Briggs Institute (JBI).²⁰ The review aimed to systematically map the range and diversity of DAT interventions in oncology, with a particular focus on supporting emotional well-being. All stages of the review—including systematic literature search, title/abstract and full-text screening, and data charting—were independently performed by two reviewers (Jia-Ying Li, Dong-Chi Ma), with disagreements resolved by discussion or third reviewer (Xu Liu) arbitration. Retrieved records were managed in EndNote 21, with duplicates removed. A standardized data charting form captured bibliographic details, study design, sample characteristics, digital platforms, intervention modality and dose, theoretical framework, outcome measures, and key findings. Extracted data were cross-checked and tabulated by intervention type.

Search strategy

A systematic literature search was conducted across nine databases: PubMed, Embase, Cochrane Library, PsycINFO, Web of Science, CNKI, Wan Fang Data, VIP Information, and SinoMed, from inception through 31 August 2025. Controlled vocabulary terms and free-text keywords in English and Chinese were used to balance precision and comprehensiveness, covering digital health technologies, art- and music-based therapies, virtual reality-assisted interventions, digital storytelling, and oncology. The full electronic search strategy for PubMed, including Boolean operators and applied limits, is presented in Appendix Table A1.

Eligibility criteria

Studies were eligible for inclusion if they met the following criteria:

involved adult participants (aged ≥18 years) with a diagnosis of any cancer;

evaluated a digitally delivered art-based intervention, including but not limited to virtual reality-based interventions, digital visual art creation, online music therapy, or digital storytelling;

reported psychological outcomes, such as anxiety, depression, and/or quality of life;

employed an empirical study design, including randomized controlled trials, quasi-experimental studies, mixed-methods studies, or qualitative intervention evaluations;

were published as peer-reviewed articles in English or Chinese.

Exclusion criteria

Studies were excluded if they met any of the following criteria:

focused exclusively on pediatric populations or caregivers, without including adult patients with cancer;

evaluated interventions lacking an art-based therapeutic component;

consisted of non-empirical publications, such as editorials, commentaries, or opinion pieces;

were conference abstracts without an accompanying full-text publication.

Exclusion reasons were documented at each stage to comply with PRISMA-ScR recommendations for transparency.

Quality appraisal

Each study was independently assessed across relevant domains of methodological quality, including randomization and allocation procedures, blinding of participants or outcome assessors where applicable, completeness of outcome data, and transparency of analytic methods. Based on these assessments, studies were categorized as having low, moderate, or high risk of bias. For mixed-methods designs, both quantitative rigor and qualitative credibility were considered to ensure balanced appraisal across methodological paradigms. Consistent with established scoping review methodology, quality appraisal was undertaken to contextualize the strengths and limitations of the existing evidence rather than to exclude studies or derive summary judgments of intervention effectiveness.²¹

Data synthesis

Consistent with the objectives of a scoping review and JBI guidance, narrative synthesis was planned a priori. Given the anticipated heterogeneity in intervention modalities, study designs, and outcome measures, quantitative pooling (e.g., meta-analysis) was not undertaken. Extracted data were synthesized descriptively to map intervention characteristics and reported psychosocial outcomes, and were organized by intervention modality to identify patterns and evidence gaps.

Ethical considerations

This review did not involve direct interaction with participants or the collection of identifiable personal data; therefore, formal ethical approval was not required. All primary studies included had received prior approval from their respective institutional review boards or ethics committees. The review protocol was preregistered on the Open Science Framework (OSF; DOI: 10.17605/OSF.IO/56ZNC), ensuring methodological transparency and adherence to ethical standards for secondary analyses of published literature.

Results

Study selection

A total of 691 records were identified through database searching. After removal of duplicates, 476 records underwent title and abstract screening, of which 62 articles were assessed in full text. Ten studies met the inclusion criteria and were included in the final synthesis (Figure 1).

Figure 1.

PRISMA flow diagram of the literature search and study selection process.

Study characteristics

The ten included studies were published between 2016 and 2025 and conducted across eight countries, with a total sample of 434 adult patients with cancer (range per study: 7–85; mean age approximately 50 years). Study designs included six randomized controlled trials (RCTs),^22–27 one quasi-experimental study,²⁸ one mixed-methods study,²⁹ and two qualitative or intervention development studies.^30,31 Interventions varied in modality (immersive virtual reality, digital music therapy, online visual art, digital storytelling), duration, session frequency, and levels of therapist guidance. Appendix Table A2 presents detailed study characteristics, intervention parameters, and pre-to post-intervention outcomes.

Types of DAT interventions

Virtual reality-assisted relaxation (n = 5)

Chirico et al.²² conducted a pilot RCT (N = 47) comparing a single 20-min immersive VR distraction session with music therapy during chemotherapy. VR participants engaged interactively with a virtual natural environment, whereas music therapy involved passive listening. VR significantly altered patients’ perception of time compared with music therapy (η² ≈ 0.25), indicating attentional engagement; however, quantitative mood-related effect sizes were not reported.

Iturri et al.²³ conducted an RCT among hospitalized patients with advanced cancer (N = 60), examining a single-session receptive music therapy combined with VR immersion. Compared with usual care, the intervention group demonstrated immediate and 24-h reductions in pain, anxiety, and depression, alongside improvements in well-being and sleep quality. Although group differences were statistically significant across multiple outcomes, effect sizes could not be calculated due to insufficient reporting of descriptive statistics.

Mogahed et al.²⁶ evaluated a three-week VR-assisted physical therapy program for post-mastectomy patients (N = 30). Participants in the VR plus physical therapy group demonstrated greater reductions in pain and anxiety compared with standard physical therapy alone. Large effect sizes were reported (d ≈ 0.64–1.02); however, the intervention was delivered over a three-week period in a relatively small sample, and the timing of follow-up assessment was not clearly specified.

Wu et al.²⁷ conducted an RCT (N = 85) delivering multiple VR relaxation sessions over approximately five weeks. Reductions in negative affect were observed among participants with Type D personality traits (characterized by negative affectivity and social inhibition), although between-group differences were modest and effect sizes were not fully reported. Minor transient vertigo was reported in 2.9% of participants, with no serious adverse events.

Aydin et al.²⁸ implemented a quasi-experimental study of immersive VR-assisted relaxation during radiotherapy (N = 60). Participants in the VR group demonstrated moderate reductions in anxiety (d ≈ 0.44) and large reductions in distress (d ≈ 0.88) compared with standard care. Outcomes were assessed immediately following repeated radiotherapy sessions.

Digital music therapy (n = 2)

Rabinowitch et al.²⁹ conducted a mixed-methods single-arm study involving a single-session online music listening intervention followed by therapist-facilitated group reflection (N = 30), with pre–post assessments conducted within the same participant cohort. Quantitative analyses demonstrated moderate reductions in pain (d ≈ 0.61) and distress (d ≈ 0.48), while anxiety effects were minimal (d ≈ 0.05). Qualitative findings highlighted emotional resonance and perceived social connection.

Fleszar-Pavlovic et al.³¹ reported a qualitative development study of an eHealth mindfulness-based music therapy platform for patients undergoing hematopoietic stem cell transplantation (N = 11). The platform demonstrated high usability and acceptability, assessed using a validated usability measure (the Usefulness, Satisfaction, and Ease of Use [USE] questionnaire), though the study was not designed to assess intervention efficacy.

Online visual art therapy (n = 2)

Collie et al.³⁰ conducted a qualitative pilot study of professionally facilitated online art therapy groups for young adults with cancer. Participants reported enhanced emotional expression, comfort, and peer connectedness. The authors suggested that these outcomes were facilitated by therapeutic group processes including collective meaning-making through shared discussion of artwork, perceived commonality of cancer experiences among participants, and the semi-anonymous online environment that reduced social barriers to self-disclosure and interpersonal connection.

Shen et al.²⁵ conducted a randomized controlled trial (N = 64) evaluating a therapist-guided virtual interactive painting intervention delivered over a 12-week period. Participants in the intervention group completed repeated, structured sessions, with outcomes assessed at a three-month follow-up. Compared with standard care, the intervention group demonstrated substantial reductions in anxiety and depressive symptoms at the three-month follow-up, assessed using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Mean SAS scores decreased from approximately 54 at baseline to about 18 at three months in the intervention group, compared with reductions from roughly 55 to 24 in the control group. Similarly, SDS scores declined from approximately 67 to 30 versus 67 to 35, respectively. Between-group effect sizes at the three-month assessment were large to very large across outcomes (anxiety d = 2.38; depression d = 1.26; stigma d = 1.28; quality of life d = 1.88) in a parallel-group RCT design.

Digital storytelling (n = 1)

Kim et al.²⁴ conducted an RCT (N = 40) examining a single-session digital storytelling intervention involving exposure to four short survivor narratives. Participants viewed the digital stories in one session (approximately 15 min in total), and outcome assessments were conducted at baseline and immediately after the intervention. Moderate improvements in depressive symptoms (d ≈ 0.60) and perceived social support (d ≈ 0.68) were observed, while anxiety reductions were small and non-significant (d ≈ 0.24).

Feasibility and safety

Across included studies, intervention feasibility and acceptability were generally supported by qualitative feedback and high completion rates, particularly in single-session interventions, whereas multi-session programs reported slightly greater variability in adherence. No serious adverse events were reported. Minor and transient discomfort, such as mild vertigo during immersive VR exposure, was occasionally observed.^23,27 Overall, digitally delivered art-based interventions were well tolerated in adult cancer populations.

Methodological quality

Among the included studies, seven employed randomized or quasi-experimental designs.^22–28 Early-phase and developmental studies (Collie et al., 2017; Fleszar-Pavlovic et al., 2025; Rabinowitch et al., 2023) were also included. Overall, approximately two-thirds of studies were assessed as having moderate to high risk of bias due to small sample sizes, limited blinding, and heterogeneous outcome measures. Collectively, the evidence base primarily reflects early-phase exploratory research.

Discussion

This scoping review aimed to map the scope, characteristics, and reported psychosocial outcomes of DAT interventions targeting anxiety and depression among adults with cancer. Across ten studies encompassing immersive virtual reality, digital music therapy, online visual art, and digital storytelling, the current evidence base remains predominantly early-phase, with small to moderate sample sizes and substantial heterogeneity in intervention format, duration, and outcome measurement. Overall, digitally delivered art-based interventions were feasible and generally well accepted. Preliminary findings suggest potential benefits for anxiety, distress, depressive symptoms, stigma, and quality of life, particularly in interventions incorporating immersive technologies and sustained therapist guidance.

Interpretation of reported effect sizes and intervention structure

Effect size estimates varied substantially across the included studies, reflecting heterogeneity in intervention intensity, delivery format, outcome timing, and measurement sensitivity. Several studies^25,26,28 reported relatively large effect sizes, particularly for anxiety, distress, stigma, and quality of life outcomes; however, these effects appeared closely linked to specific intervention contexts rather than representing a uniform effect across all DAT modalities.

Interventions combining immersion, interactivity, and therapist guidance²⁵ tended to report broader psychosocial outcomes and larger effect sizes. In the multi-session, therapist-guided digital painting program delivered over 12 weeks, large to very large between-group effects were observed at three-month follow-up (anxiety d ≈ 2.38; depression d ≈ 1.26; stigma d ≈ 1.28; quality of life d ≈ 1.88). The cumulative and structured nature of the intervention—repeated creative engagement, symbolic expression, and reflective support—may have facilitated sustained emotional processing and psychosocial adjustment. At the same time, this was an early-phase trial with a modest sample size, and effect estimates of this magnitude should be interpreted cautiously, as large effects in small psychosocial studies may be sensitive to sample variability and analytic approach.

Similarly, immersive VR-based interventions²⁸ administered during high-stress clinical procedures reported substantial short-term reductions in anxiety and distress. In radiotherapy settings, repeated synchronous VR exposure directly targeted situational anxiety, and outcome measures designed to capture transient emotional change may have amplified observed effects (distress d ≈ 0.88). Notably, several of these studies employed quasi-experimental or pilot designs with proximal post-intervention assessments, which may partially contribute to larger short-term effect estimates.

In randomized postoperative rehabilitation trials,²⁶ moderate to large effects (anxiety d ≈ 1.02; pain d ≈ 0.64) were reported when immersive VR was delivered as an adjunct to conventional physiotherapy over a three-week period. In this context, additive or synergistic effects during acute recovery, combined with repeated exposure and short follow-up intervals, may have influenced the magnitude of between-group differences.

By contrast, single-session or minimally guided passive interventions—such as music listening or pre-recorded digital storytelling—generally reported modest or non-significant effects (η²≈0.25,²² Anxiety d ≈ 0.24,²⁴ Anxiety d ≈ 0.05²⁹), consistent with short-lived attentional distraction rather than sustained emotional or cognitive change. These studies frequently involved brief exposure and immediate post-session measurement. While such designs capture short-term emotional responses, they provide limited insight into the durability or endurance of therapeutic effects over time. Consequently, observed improvements may reflect proximal intervention responses rather than sustained psychosocial change.

Collectively, these findings suggest that effect magnitude in the current DAT literature is strongly shaped by intervention dose, multimodal engagement, therapist involvement, study design, and timing of measurement. Accordingly, large effect sizes should be viewed as context-dependent indicators of potential therapeutic benefit rather than definitive evidence of durable efficacy, pending replication in adequately powered randomized trials with longer-term follow-up.

Mechanisms and digital therapeutic pathways

Although few studies^32,33 explicitly articulated mechanistic frameworks, intervention designs and qualitative findings allow tentative inference of potential therapeutic pathways. Immersive VR interventions appear to operate partly through attentional modulation and sensory immersion, reducing anxiety and distress via distraction, altered time perception, and environmental engagement, mechanisms that have been discussed in prior virtual reality-based psychological intervention research.^34–36 Digital music therapy may engage emotional regulation processes through guided listening and reflective dialogue, which are commonly described pathways in music therapy literature.³⁷ Digitally mediated visual art and storytelling provide structured opportunities for emotional expression, symbolic representation, and narrative meaning-making, particularly when accompanied by therapist guidance or peer interaction. Importantly, digital technologies do not merely deliver traditional art therapy content through new channels.³⁸ Rather, digital affordances—such as immersion, interactivity, portability, and remote accessibility—may actively shape therapeutic processes. Immersion may enhance attentional capture, interactivity may increase user engagement, and flexible delivery formats may allow participation across diverse treatment contexts and time points, as suggested in digital mental health intervention research.^39,40 These features suggest that DAT may represent a distinct modality within psychosocial oncology rather than a simple digital replication of face-to-face art therapy.

Comparison with existing literature and non-DAT

Previous reviews⁴¹ in psychosocial oncology have primarily examined broad digital mental health interventions or traditional face-to-face art therapy, without explicitly distinguishing digitally mediated creative modalities or analyzing how specific digital affordances shape therapeutic processes.^42,43 As a result, immersive, musical, visual, and narrative digital interventions are frequently subsumed under broad digital psychosocial care frameworks, which may overshadow the specific role of creative processes as distinct therapeutic mechanisms.

Traditional art therapy has demonstrated benefits in emotional expression, coping, and psychosocial adjustment among individuals with cancer⁴⁴; however, it is typically resource-intensive, reliant on sustained in-person therapist involvement, and constrained by physical settings.⁴⁵ In contrast, DAT introduces advantages related to accessibility, flexibility, and scalability, with several interventions delivered remotely or in semi-guided formats that reduce geographic and treatment-related barriers.⁴³

Importantly, findings from this review suggest that DAT does not merely replicate face-to-face art therapy through technological delivery. Rather, digital affordances—such as immersion, interactivity, portability, and mediated presence—actively shape therapeutic engagement. Interventions incorporating therapist guidance, structured creative tasks, or multimodal immersion tended to demonstrate broader psychosocial engagement than fully passive formats, indicating that relational and expressive components remain central even within digital environments.

By mapping DAT across immersive, musical, visual, and narrative modalities and linking these formats to reported outcomes, the present review extends prior literature by conceptualizing creativity as a core mechanism within technology-enabled psychosocial care. These findings suggest that DAT may complement, rather than replace, traditional art therapy by extending its reach while adapting therapeutic processes to digitally mediated contexts.

Implementation implications and digital design considerations

Digital interventions were generally feasible across variable durations, ranging from single 15–20 min exposures^22,24 to multi-week programs.^25,31 User adherence and satisfaction were generally high,^28,31 and technical issues were mostly minor, related to device familiarity. However, most programs delivered content in a fixed format without systematic adaptation to individual user needs or context (e.g., personalized pacing, algorithm-driven feedback, or interactive prompts), which was infrequently reported in the results. As such, while these features have been suggested in the literature to potentially enhance engagement and maintenance, our review cannot confirm their effectiveness, because included studies provided only limited empirical data on these components.

Future directions

Future research should prioritize adequately powered randomized trials with longer follow-up periods to determine whether the psychosocial benefits observed immediately after DAT interventions translate into sustained and clinically meaningful improvements over time. Future studies should also clarify potential mechanisms of action by examining how immersion, creative expression, therapist interaction, and digital engagement jointly influence emotional outcomes. In addition, comparative studies across cancer types, treatment phases (e.g., active treatment vs survivorship), and clinical contexts may help identify which patient groups benefit most from specific DAT modalities. Research exploring optimal intervention dose, session frequency, and the role of therapist guidance will be particularly important. Finally, integrating adaptive digital features—such as personalization, real-time feedback, and hybrid therapist–technology models—may enhance engagement and improve the durability of intervention effects.

Limitations

Most included studies were early-phase or pilot trials with small, heterogeneous samples and varied outcome measures, limiting generalizability and causal inference. Randomized trials were generally at moderate risk of bias, while quasi-experimental and developmental studies lacked key methodological safeguards. Inconsistent outcome measures and short follow-up periods further constrained cross-study comparison. In addition, the mechanisms through which DAT exerts psychosocial benefits remain insufficiently clarified, as few studies explicitly examined mediating processes such as emotional expression, attentional engagement, or therapeutic alliance. The extent to which intervention effects may differ across cancer types, treatment stages, or clinical contexts also remains uncertain. Furthermore, most studies assessed outcomes immediately after intervention delivery, limiting understanding of the durability and long-term sustainability of observed effects. As a scoping review, this synthesis maps the current landscape of DAT interventions rather than providing graded estimates of effectiveness.

Conclusion

This scoping review indicates that DAT is a feasible and acceptable digital psychosocial intervention for adults with cancer, with preliminary evidence suggesting potential benefits for emotional well-being and related psychosocial outcomes. Findings from randomized, quasi-experimental, and mixed-methods studies show that DAT interventions—delivered through immersive, visual, musical, or narrative digital modalities—are associated with improvements in emotional regulation, reflective processing, and perceived engagement.

Interventions incorporating therapist guidance or group-based formats appear to support greater self-reflection and social connectedness, although these observations are primarily derived from small-scale or exploratory studies. Across the included literature, DAT interventions were generally well tolerated and demonstrated favorable user engagement; however, substantial variability in study design, outcome measures, and methodological rigor limits definitive conclusions regarding effectiveness.

Overall, current evidence suggests that DAT represents a promising and adaptable form of digital health-enabled psychosocial care, rather than a fully established therapeutic approach. Future research should prioritize adequately powered randomized trials, standardized outcome frameworks, longer follow-up periods, and clearer articulation of digital design features to clarify mechanisms of action and clinical relevance. Within these constraints, DAT may offer a valuable complementary option for supporting emotional well-being in adults with cancer.

Footnotes

Acknowledgments

The authors would like to thank all members of the School of Nursing, Zhejiang Chinese Medical University, for their academic and logistical support during this study. The authors also acknowledge the constructive feedback from peer colleagues that helped improve the quality of this manuscript. Artificial intelligence tools (e.g. large language models) were used to assist with language editing and clarity of expression during manuscript preparation. No AI tools were used for data extraction, data analysis, or generation of study results. All interpretations and conclusions remain the responsibility of the authors.

ORCID iDs

Jia-Ying Li

Xu Liu

Wen-Jie Wang

Ethical approval

Ethical approval was not required for this study as it is a secondary analysis based solely on previously published literature. All included primary studies reported having obtained ethics approval from their respective institutional review boards.

Author contributions

Jia-Ying Li: Conceptualization, methodology, data curation, formal analysis, and writing–original draft. Dong-Chi Ma: Methodological guidance and data integrity supervision. Xu Liu: Literature search, data extraction, and writing–review and editing. Han Yan: Visualization, data validation, and reference management. Wen-Jie Wang: Critical revision of the manuscript. Yu-Xing Xie: Data synthesis and preparation of figures and tables. Ning Jiang: Review coordination and language editing. Li Ning: Supervision, project administration, and corresponding author responsibilities.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Construction Fund of Key MedicalDisciplines of Hangzhou, Zhejiang Provincial Medical and Health Science and Technology Program, and Key Project of Hangzhou Health Science and Technology Plan (Grant Number 2025HZZD05, 2024KY1306, and ZD20240013).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

Data sharing is not applicable to this article as no new datasets were generated or analyzed during this scoping review.

Guarantor

Li Ning, Hangzhou First People's Hospital, serves as the guarantor for this article and takes full responsibility for the integrity of the data and the accuracy of the analysis.

Other identifying information

The review protocol was preregistered on the Open Science Framework under the registration DOI: 10.17605/OSF.IO/56ZNC.

Appendix

Table A2.

Overview of included studies.

Study	Design	Sample (N, age)	Intervention	Dose/duration	Therapist involvement	Digital features	Active components	Theoretical/behavioral mechanism	Outcomes (Pre → post)	Effect size
Chirico et al.	pilot RCT	N = 47, breast cancer patients, age 18–70 y	VR distraction: 20 min immersive VR session (interactive natural landscape via headset + joystick) Music therapy (MT) distraction: 20 min passive listening to pre-recorded relaxing music during chemotherapy	Single session per chemotherapy infusion; 20 min total; VR = interactive immersion, MT = passive listening; no follow-up	Minimal: researcher/clinician present for setup and safety; no active guidance during session	VR: Vuzix Wrap 1200 HMD, interactive 3D environment on Second Life^®, joystick for navigation MT: portable audio device + headset; pre-selected relaxing music Both: individual delivery, passive (MT) or interactive (VR); no adaptive feedback or personalization	VR: immersion in virtual natural environment, attention redirection, active engagement with environment MT: passive listening to music, sensory distraction from chemotherapy	Pacemaker–accumulator (PA) cognitive model of time perception: immersive attention reduces pulse accumulation → perceived time compression Attention distraction, stress/anxiety reduction	Actual session duration: 20 min VR perceived time: 15.44 ± 4.98 min (underestimated) MT perceived time: 21.36 ± 5.60 min (overestimated)	η²≈0.25 (time perception)
Iturri et al.	RCT	N = 60 (Intervention = 30 Control = 30), hospitalized adult patients with advanced cancer receiving palliative care, baseline characteristics similar	Single-session Receptive Music Therapy combined with VR (RMT + VR); patients listened to pre-selected music while immersed in a calming, nature-based VR environment; music selected based on patient preference	1 session, 30 min total; passive music listening and VR immersion; no follow-up	Semi-guided: staff assisted with VR setup and music start; patients self-experienced intervention; no continuous therapist interaction	VR immersion; audiovisual stimuli; individual, passive engagement; no interactivity or personalization; hospital-based (not remote)	Passive emotional exposure; symptom-focused attention shift; reflection on coping strategies; no creative production by participant	Attention distraction / symptom-focused attention shift; emotional regulation; relaxation response reducing physiological stress; immersion + music synergistically enhance symptom relief	Pain (VAS 0–100): Significant decrease immediately post-intervention and at 24 h; Control: no change Anxiety (HADS 0–21): Significant decrease immediately post-intervention and at 24 h; Control: no change Depression (HADS 0–21): Significant decrease immediately post-intervention and at 24 h; Control: no change Well-being: Significant improvement immediately post and at 24 h; Control: no change Sleep quality: Improved post-intervention and at 24 h; Control: no change Heart rate: Decreased post-intervention and at 24 h; Control: no change Other symptoms (ESAS: exhaustion, drowsiness, nausea, appetite loss, dyspnea): Reduced in intervention group; no change in control	Data insufficient (means/SD not reported)
Kim et al.	RCT	N = 40, (Intervention n = 24 Control n = 16), leukemia (34%), multiple myeloma (26%), myelodysplastic syndrome (13%), mean age 59.2 ± 9.6 y	Participants viewed 4 pre-recorded personal digital stories (3–4 min each, total ∼15 min) created by HCT survivors; emotionally rich, first-person narratives incorporating images, music, audio, and text; private, individual viewing immediately post-baseline survey.	1 session, 15 min total; passive viewing of digital stories; no follow-up.	Semi-guided: study staff facilitated access and surveys; no therapist-led discussion or interpretation during intervention.	Web-based digital delivery; short video narratives; audio-visual content; individual viewing; no interactivity, no algorithm-driven personalization; remote access not emphasized (clinic-based in pilot).	Passive emotional exposure to survivor narratives; vicarious social modeling; identification with storytellers; reflection on coping strategies; no creative production by participant.	Narrative theory & social modeling: emotional identification and transportation; vicarious social learning; perceived social support enhancement; emotional processing through observing coping strategies of similar others.	Depression (POMS): 0.51 → 0.42 (DS); 0.50 → 0.04 (IC); d ≈ 0.60, p = 0.010 Anxiety (POMS): 1.14 → 0.54 (DS); 1.27 → 0.35 (IC); d ≈ 0.24, p = 0.228 Perceived Social Support (PROMIS): 4.66 → 4.72 (DS); 4.80 → 4.75 (IC); d ≈ 0.68, p = 0.030	d ≈ 0.24 (Anxiety), d ≈ 0.60 (Depression), d ≈ 0.68 (Social Support)
Mogahed et al.	RCT	N = 30, (Intervention n = 15 Control n = 15), breast cancer, mean age 48.4 ± 4.08, 48.33 ± 4.13y	intervention group: VR + Traditional PT; Control: standard care	3 sessions/week × 3 weeks, 30 min/session	Semi-guided: therapist monitors VR use and PT exercises	Immersive VR, interactive, real-time feedback, adjustable session duration	Immersive, interactive VR environment- Functional shoulder ROM exercises- Gradual self-paced engagement	Attention distraction from pain/anxiety- Behavioral reinforcement via active movement- Emotional regulation and anxiety reduction- Mind-body integration (VR + physical therapy)	Pain (VAS 0–100): 5.68 → 4.13 (VR + PT); 5.65 → 5.03 (PT only) Anxiety (ARS 0–10): Significant decrease (VR + PT), NS in PT	d ≈ 0.64 (Pain), d ≈ 1.02 (Anxiety)
Shen et al.	RCT	N = 64, (Intervention n = 32 Control n = 32), carcinoma of mouth, mean age 52.5 ± 9.8 y	Virtual interactive painting therapy via a motion-sensing, computer-based system, combined with therapist-guided art interpretation and psychological counseling	13 sessions, 60 min each; once at discharge + weekly sessions for 12 weeks; total intervention period: 3 months	High: psychologist-led sessions with real-time observation, guided reflection, interpretation of artwork, and individualized psychological counseling.	Motion-sensing interaction; virtual painting environment; gesture-based input; real-time therapist monitoring; remote appointment system; no algorithm-driven personalization.	Expressive art creation; emotional projection; guided self-reflection; therapist–patient dialogue; stigma processing; meaning-making through symbolic imagery.	Art therapy (projective techniques); emotional expression and catharsis; cognitive–emotional integration; stigma reduction; enhancement of self-concept and psychological adjustment.	Anxiety (SAS): 54.25 → 18.37 (Intervention); 55.19 → 23.97 (Control) Depression (SDS): 66.97 → 29.97 (Intervention); 67.41 → 34.94 (Control) Stigma (SIS): 64.75 → 39.56 (Intervention); 67.28 → 46.25 (Control) Quality of Life: 24.69 → 52.22 (Intervention); 24.38 → 43.50 (Control)	d ≈ 2.38 (Anxiety), d ≈ 1.26 (Depression), d ≈ 1.28 (Stigma), d ≈ 1.88 (Quality of Life)
Wu et al.	RCT	N = 85, (Intervention n = 44 Control n = 40), breast cancer, mean age 46.4 ± 10.6y	intervention group: VR + natural landscapes + music + relaxation; Control: standard care	3–5 sessions/5 ± 2 w, 15 ± 3 min/session	Semi-guided: supervised VR sessions within physiotherapy; no individualized real-time guidance reported	Immersive VR environment; visual–sensory distraction; non-personalized content; no adaptive feedback reported	Passive immersive exposure; distraction and relaxation through virtual environments (no creative or expressive output)	Not explicitly stated; inferred mechanisms include distraction theory and stress reduction through immersive sensory engagement	Negative affect (PANAS): −5.0 (VR) vs −2.0 (control), P = 0.046 (Type D only) Positive affect (PANAS): ↑ trend (VR, Type D), NS vs control Distress (DT 0–10): Significant baseline difference (Type D > non–Type D); post-intervention NS Safety: Minor vertigo 2.9% (VR); NS vs control	Data insufficient (means/SD not reported)
Aydin et al.	Quasi-experimental study	N = 60 (Intervention n = 30 Control n = 30), Adult women with breast cancer undergoing radiotherapy, mean age 51.5 ± 8.7 y	IVR - assisted relaxation during radiotherapy; participants viewed a 360° natural environment with meditation music via VR headset during each radiotherapy session. Comparator: standard radiotherapy care without digital intervention	Once per radiotherapy session (daily); ∼25–26 min per session; total exposure throughout full radiotherapy course (5–6 weeks)	Semi-guided: initial instruction, headset setup, brief tolerance check; no real-time guidance or interaction during intervention	Standalone immersive VR headset (e.g., Oculus Quest 2); pre-recorded 360° video + audio; individual delivery; no adaptive feedback or personalization	Immersive visual exposure to natural landscapes; auditory stimulation (meditation music, nature sounds); attention distraction and emotional relaxation; stress reduction via sensory immersion	Attentional distraction and sensory immersion; stress reduction through immersive exposure to calming natural environments; emotional regulation by redirecting attention from anxiety-inducing stimuli; relaxation response triggered via multisensory stimulation; aligns with Cognitive-Behavioral and Attention Distraction frameworks	Anxiety (BAI, 0–63): 18.1 ± 8.3 → 9.2 ± 8.8 (Intervention); 19.1 ± 7.2 → 12.7 ± 6.9 (Control) Distress (DT, 0–10): 6.0 ± 2.3 → 2.7 ± 1.5 (Intervention); 5.5 ± 2.4 → 4.5 ± 2.5 (Control) Radiotherapy Comfort (RTCQ, 1–6): – → 3.9 ± 0.5 (Intervention); – → 2.7 ± 0.2 (Control) Satisfaction (0–10): – → 8.9 ± 1.5 (Intervention only)	d ≈ 0.44 (anxiety), d ≈ 0.88 (distress)
Collie et al.	Qualitative study	N = 7, adults, professionals/therapists, including a young adult cancer survivor	Professionally facilitated online art therapy groups; 12 weekly sessions, 90 min each (pilot format); activities include “Identity and Self-care,” “Empowerment and Presenting Oneself to the World,” “Self-Discovery and Overcoming Creative Inhibition”; mixture of synchronous (live chat) and asynchronous (discussion board) formats; participants create and share art digitally.	Sessions: 1–2 demonstration online sessions per participant Duration: Each session ∼90 min; optional introduction activity asynchronous on discussion board Intensity: Guided participation with creative art-making and discussion	High: fully guided by professional art therapists; active facilitation including validating, prompting discussion, supporting expression, managing group dynamics	Online delivery via CancerChatCanada platform Synchronous chat (live discussion + art creation) and asynchronous discussion board (pre-post art submission) • Participants shared artwork digitally for discussion; optional web-based art tools or self-selected tools	Creative output: participants created digital or photographed physical art; passive receipt: viewing others’ artwork, participating in discussion about peers’ work	Liminality framework: art therapy facilitates comfort, expression, and connectedness during transitional experiences; collective meaning-making: shared discussion of personal art fosters bonding, emotional safety, and psychosocial support	Experiences reported: Comfort: Feeling safe, playful, and engaged with creative activities Connection: Sense of community and bonding, even across distances Expression: Enhanced emotional and artistic self-expression	/
Fleszar-Pavlovic et al.	Qualitative study	N = 11, Acute Myeloid Leukemia, mean age 43.6 ± 17.8 y	eHealth Mindfulness-Based Music Therapy (eMBMT); integrates mindfulness meditation, mindfulness-based stress reduction (MBSR), and music therapy; tailored to allo-SCT treatment trajectory; sessions led by board-certified music therapists (MT-BC); includes video/audio exercises, journaling, guided mindfulness attitudes (nonjudging, patience, letting go, acceptance, trust, beginner's mind, nonstriving)	8 sessions × 60 min; delivered throughout allo-SCT trajectory (pre-admission to ∼75–115 days post-transplant); MT-BC guidance + independent practice; no formal follow-up yet	High: MT-BC leads sessions, guides exercises, supports patient engagement; provides personalized feedback during video conferencing; facilitates platform use; no continuous 1:1 therapy outside sessions	Web-based platform (SmartManage) accessible via tablets or smartphones; audiovisual materials; patient-centered, HIPAA-compliant; interactive elements include guided exercises, video conferencing, and independent session review; supports real-time engagement and self-paced practice; personalization options limited (e.g., patient name displayed, some music selection)	Guided mindfulness-based music therapy; music listening, music exercises, journaling; reinforcement of mindfulness attitudes through MT; integration with patient's real-world treatment and recovery experiences	Mindfulness-based stress reduction and music therapy improve psychosocial adaptation (coping, emotional regulation, optimism), symptom management (fatigue, pain, anxiety), and physiological adaptation (immune recovery support) via attentional focus, mood regulation, and engagement with pleasant, structured stimuli	Qualitative development study; not powered for efficacy Usability (USE questionnaire): Usefulness 6.47 ± 0.29, Ease of use 6.92 ± 0.60, Ease of learning 7.39 ± 0.75, Satisfaction 6.16 ± 0.82 Participant feedback: Intervention perceived as helpful, easy to navigate, holistic, accessible; recommended enhancements included more diverse music genres, interactive features (chat, journaling), reduced text, more relatable content, and enhanced guidance	/
Rabinowitch et al.	Mixed-methods, single-arm pre–post study	N = 30, (Intervention n = 14; Control n = 16), adult cancer patients (mostly breast cancer), mean age 54.3 ± 11.5 y	Single-session (1 × 60 min); passive music listening with therapist-led reflective discussion; no follow-up	1 session × 60 min (30 min music listening + 30 min group discussion); single-session, no follow-up	Semi-guided: two certified music therapists present; provided instructions, facilitated post-listening group discussion, and supported reflection without interpretation	Synchronous videoconferencing (Zoom) with pre-recorded audio; individual simultaneous playback; remote group-based delivery; no system interactivity or personalization.	Passive music listening (originally composed music with low frequencies and binaural beats) combined with guided relaxation and post-listening experiential verbal sharing; no creative or expressive music production	Not explicitly stated; inferred mechanisms include relaxation response, attentional distraction from pain, emotion regulation, mind–body awareness, and music-induced physiological regulation	Pain (VAS 0–10): Music: 3.6 → 2.2 (−29.1%), Control: 4.2 → 3.6 (−10.6%), Between-group difference: significant, Distress (NCCN Distress Thermometer 0–10): Music: 4.7 → 2.5, Control: 4.6 → 3.0, Between-group difference: NS, Anxiety (STAI-6): Music: 14.3 → 14.7, Control: 14.7 → 14.5, Between-group difference: NS	d ≈ 0.61 (pain)， d ≈ 0.48 (Distress)， d ≈ 0.05 (Anxiety)

Note: Effect sizes are reported as Cohen's d where available. “Pre → Post” indicates the outcome measure change from baseline to immediately post-intervention (or as reported in the original study). Some outcomes were assessed only qualitatively or did not report sufficient data for effect size calculation. For interventions with multiple modalities, the primary digital component is listed first. DAT: digital art therapy; VR: virtual reality; MT: music therapy; RMT: receptive music therapy; DS: digital story intervention group; IC: intervention control group; RCT: randomized controlled trial; POMS: profile of mood states; PROMIS: patient-reported outcomes measurement information system; VAS: Visual Analog Scale; HADS: Hospital Anxiety and Depression Scale; BAI: Beck Anxiety Inventory; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; SIS: Stigma Scale; QoL: Quality of Life; ARS: Anxiety Rating Scale; DT: distress thermometer; RTCQ: Radiotherapy Comfort Questionnaire; ESAS: Edmonton Symptom Assessment System; IVR: immersive virtual reality; MBSR: mindfulness-based stress reduction; eMBMT: eHealth mindfulness-based music therapy; HCT: hematopoietic cell transplant; PT: physical therapy.

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Digital art therapy for emotional well-being in adults with cancer: A scoping review of digital health interventions

Abstract

Background

Objective

Methods

Results

Conclusions

Keywords

Introduction

Methods

Study design and framework

Search strategy

Eligibility criteria

Exclusion criteria

Quality appraisal

Data synthesis

Ethical considerations

Results

Study selection

Study characteristics

Types of DAT interventions

Virtual reality-assisted relaxation (n = 5)

Digital music therapy (n = 2)

Online visual art therapy (n = 2)

Digital storytelling (n = 1)

Feasibility and safety

Methodological quality

Discussion

Interpretation of reported effect sizes and intervention structure

Mechanisms and digital therapeutic pathways

Comparison with existing literature and non-DAT

Implementation implications and digital design considerations

Future directions

Limitations

Conclusion

Footnotes

Acknowledgments

ORCID iDs

Ethical approval

Author contributions

Funding

Declaration of conflicting interests

Data availability statement

Guarantor

Other identifying information

Appendix

References