Multiple studies confirm that taking part in arts and cultural activities has measurable effects on mental and physical health, with cost-related benefits for healthcare systems, too.
Painting, singing, dancing and writing are not only passions: they’re tools for treatment, prevention and well-being that everyone can access.
Just like the active ingredients of a medicine, art and culture have an effect on our bodies.
It’s not just about entertainment or general well-being: creative experiences activate psychological, biological and social mechanisms that can affect our health, relieve stress and foster profound change. And science is now starting to explain how.
So, what are the active ingredients of art and culture?
It isn’t just a placebo effect or a general feeling of well-being that comes from having leisure time. Even cultural participation and creative expression contain “active ingredients”. These stimulate the nervous, endocrine and immune systems, relieving the symptoms of anxiety, depression, stress and chronic pain to foster positive change through social interaction.
One of the first studies attempting to explain these processes in a systematic fashion was the one led by Professor Daisy Fancourt at University College London, published in The Lancet Psychiatry in 2021. According to this study, arts activities operate on multiple levels, from the individual to the societal dimension, producing their effects through four key processes: psychological, biological, social and behavioural.
In parallel with this research, another scoping review, entitled From Therapeutic Factors to Mechanisms of Change in the Creative Arts Therapies: A Scoping Review, conducted by an international team of researchers (M. de Witte, H. Orkibi, R. Zarate, V. Karkou, N. Sajnani, B. Malhotra, R. Ho, G. Kaimal, F. A. Baker and S. C. Koch), evaluated approximately 70 studies to identify the agents of change of specific arts-based therapies. It showed that the non-verbal nature of dance reduces stress levels by releasing tension, and that bodily sensations serve as sources of information, reinforcing self-perception and improving balance and movement control. Music also helps regulate emotions, and neurological responses show how a slow and steady rhythm can provide relaxation and calm by acting on the body’s autonomic rhythms, such as heart rate.
The impact of arts and cultural activities on health and well-being takes shape through a network of interactions, in which change emerges from the interconnection between engagement and meaning-making. In “complex” interventions, like arts-based ones, the active ingredients may overlap and interconnect with each other to prompt mechanisms of action that affect participants’ health.
Human flourishing: art as a eudaimonic practice
In this context, the concept of eudaimonia offers a valuable insight into how the artistic experience can promote a state of well-being, as well as wider personal fulfilment. According to Aristotle, human flourishing is achieved through activities that cultivate virtue, stimulate thinking and enrich the meaning of life. Taking part in arts activities not only helps people express their emotions and manage stress, but it also builds their resilience and increases their sense of belonging, which are vital if we want to achieve a eudaimonic state. In this sense, the arts are genuine practices of human flourishing, capable of initiating transformational processes that harmonise the body, mind and spirit.
With a view to understanding and mapping these processes, a further step forward was taken in 2022 by Katey Warran, Alexandra Burton and Daisy Fancourt, of the Research Department of Behavioural Science and Health at University College London. The researchers published an important study entitled What are the active ingredients of ‘arts in health’ activities? Development of the INgredients iN ArTs in hEalth (INNATE) Framework. The study provides a mapping of the mechanisms of action of arts and cultural interventions integrated into health programmes, offering a valuable tool for identifying the most effective elements and optimising health outcomes.
A total of 139 active ingredients were identified and divided into the overarching categories of project, people and contexts.
The active ingredients in the overarching category of project were broken down into attributes and engagement. The attributes include the quality and characteristics of the arts activities. The dose, which indicates the duration and frequency of the intervention, influences participants’ level of engagement. Engagement concerns stimuli that prompt the active involvement of participants, such as sensory (visual, auditory, tactile) and cognitive stimuli. Physical movement, which may be expressed through dance, gestures or other physical exercises, helps release tension and improve self-awareness.
The role of facilitators
Whether or not an arts or cultural intervention will be a success depends on the people involved – both participants and facilitators. This category is broken down into two main aspects: social composition, or how participants interact with each other, and activity facilitation, in other words, the role of those guiding and structuring the intervention. Social diversity within the group can enhance the experience, opening up new possibilities and forming meaningful connections. The effects vary depending on the type of facilitation, how many facilitators there are, their training and the approach they use.
The role of the environment
The environment where an arts activity takes place is just as important when it comes to ensuring its effectiveness. The contexts category consists of two key elements related to the activity set-up: the setting and the structure of the project, or in other words, the organisational aspects that make the activities possible. The physical environment, with its spatial and material characteristics, and the emotional and relational atmosphere play an important role in creating a welcoming and stimulating ambiance.
Understanding these mechanisms of action allows us not only to optimise arts- and culture-based interventions, but also to integrate them more systematically into care and prevention pathways, bringing art ever closer to the world of health.
Mechanisms of action of Arts on Prescription (AoP)
One of the most recent studies on Arts on Prescription was published in 2024 by A. Jensen, N. Holt, S. Honda and H. Bungay, entitled The impact of arts on prescription on individual health and wellbeing: a systematic review with meta-analysis. This is the first systematic review dedicated to analysing the impact and mechanisms of action of AoP programmes. The study looks at 25 interventions carried out between 1994 and 2023 in Australia, Denmark, Sweden, the United Kingdom and the United States, offering an in-depth overview of the effectiveness of this approach. The interventions include a wide range of arts activities, from visual arts and singing, to dance and literature, including dramaturgy, creative writing and poetry. Film- and theatre-related experiences, and cultural activities, such as visiting galleries and museums, are also included.
The most common reasons for Arts on Prescription programmes are associated with conditions such as grief, loneliness and symptoms of anxiety, depression and stress, including due to chronic illness. After taking part in the interventions, participants reported numerous psychological benefits, including improved self-esteem and a greater sense of personal achievement.
The review highlights the main factors contributing to a statistically significant positive change in patients. These include participation in programmes lasting at least eight weeks and the use of creative and manual activities that promote a deeply absorbed state. Overall, the results suggest that factors such as duration and level of involvement in Arts on Prescription interventions have a direct impact on the extent of the well-being improvement.
The research confirms that art and culture are not just a pastime, but can become part of strategies for health promotion, treatment and prevention, in conjunction with drug therapies. The challenge ahead is to integrate these interventions into the healthcare system more systematically, making them accessible to those who need them the most. In a society where mental and social well-being is increasingly under pressure, we need to see art not only as a form of expression, but as a “medicine” for the soul.
By Catterina Seia (Presidente CCW – Cultural Welfare Centre) and Elena Rosica ( Cultural Welfare Center (CCW), Research Area)
