Music and painting dual art therapy improves cognitive and social functions of hospitalized schizophrenia patients, study suggests

Antipsychotics, the standard — if often disliked—treatment for schizophrenia, allow many seriously ill patients to avoid long-term hospitalization. Effectiveness has improved and serious side effects have lessened from first- to second- to third-generation formulations.

But even the celebrated new medication Cobenfy (xanomeline and trospium chloride) entered the market just over a year ago with considerable uncertainty for clinicians.

Although there is no substitute for antipsychotics, medication alone cannot comprehensively improve cognitive deficits and social dysfunction, especially in chronic hospitalized patients where functional recovery is a major treatment challenge, according to the authors of a new study.

“Art therapy provides patients with platforms to express emotions, release stress, and rebuild self-awareness through various forms of art such as music, painting, and dance, helping alleviate symptoms, enhance cognition, and improve social skills,” they write in the introduction of the study published Dec. 5, 2025, in Medicine.

Adjunctive, non-pharmacological interventions have been getting more research attention in recent years from psychiatric rehabilitation clinicians. Most of the studies focused on single art therapies, such as music.

But different types of art therapies provide different benefits.

The new paper by corresponding author Ting Liu, MB, a member of the rehabilitation department at a Chengdu Dekang Hospital mental health center in Chengdu, China, and colleagues with affiliations in the same department as well as the Sichuan Conservatory of Music, also in Chengdu, created a dual therapy intervention of music and painting.

A group of patients who completed the program scored significantly better on multiple measures — symptoms, cognitive function, social function, activities of daily living, and quality of life — compared with those who received routine nursing care. (The study did not compare dual therapy at the hospital against either music or painting therapy alone.)

“Studies have shown that music therapy can regulate mood, evoke memories, and activate prefrontal cortex functions, thereby improving emotional regulation and attention. Painting therapy, on the other hand, helps stimulate the expression of internal emotions and subconscious content, enhancing self-awareness and interpersonal communication,” the authors write.

“The integration of music and painting dual art therapy combines 2 perceptual-expressive channels, achieving synergistic effects on multiple levels such as sensory stimulation, cognitive involvement, emotional release, and social interaction, theoretically offering greater advantages for multidimensional functional improvement in chronic schizophrenia patients.”

The researchers used existing medical records to compare two groups of adult patients, 58 members apiece, who were diagnosed with chronic schizophrenia and were hospitalized for at least three months between January 2023 and January 2025. All were on one or more antipsychotics.

Both groups received routine care, which included routine psychiatric health education, psychological interventions as needed to alleviate negative emotions like fear, rehabilitation training, and social support.

The intervention group also received two types of therapy:

Music: A daily, 1.5-hour “music prescription” tailored by a music therapist “based on a patient’s condition.” It included various kinds of music, to which they could choose to sing along or a cappella. This was followed three times a week by a sharing session, where patients could discuss their music experiences and feelings, “promoting mutual affirmation and encouragement.”

Painting: An art therapist led groups of 10 or fewer patients for two hours twice a week. Before each painting session, the therapist explained the theme, encouraged the sharing and evaluation of artwork, and “analyzed the psychological state of group members.”

Both therapies were phased in over the four-week study period.

Several scoring systems found improvements in cognitive function, social function, psychiatric symptoms and quality of life in both groups, but they were far larger in the intervention group.

There were improvements in both positive and negative symptoms. The authors noted that traditional medication treatments have limited effects on negative symptoms, “while art therapy, by stimulating emotional expression, reducing loneliness, and enhancing subjective initiative, may help improve issues such as emotional flatness, volitional decline, and social withdrawal.”

Although the study compared two matched groups, its retrospective design could not prove cause and effect. Other limitations include the short duration and single setting in one city in China.

“Future research should conduct multi-center, prospective, randomized controlled trials to further verify its efficacy,” the authors write in their conclusion. “Additionally, exploring its neuropsychological mechanisms and further elucidating its action pathways will provide a more diverse range of intervention strategies for the functional rehabilitation of schizophrenia.”