Among diverse art therapy modalities, craft-based art therapy has garnered increasing academic attention due to its unique advantages in tactile experience, emotional connection, and cultural expression. Craft art not only possesses therapeutic mechanisms inherent in artistic creation but is also deeply rooted in human culture and daily practices, characterised by its intuitiveness, accessibility, and universal applicability.

Currently, craft-based art therapy lacks a clearly defined conceptual framework. Within rehabilitation medicine, scholars predominantly refer to craft-making activities as “manual training” or “manual production”; whereas in the field of art therapy, it is often termed “craft therapy” or “manual therapy” [8] . Regardless of terminology—be it manual training, craft production, or manual healing—the core principle lies in creation. Through hands-on artistic activities such as pottery, beadwork, carving, or textile crafts, individuals enhance self-awareness and empathy towards others, thereby alleviating stress, soothing trauma, or treating psychological and somatisation disorders. Yet, judging by the current state of art therapy development in China, it has not yet attained a truly therapeutic level [9] . Therefore, this paper contends that the term “handicraft healing” is more rigorous at this stage, hence adopting the term “handicraft art therapy”.

Concretely, what makes handicraft art therapy different from general craft activities is the inclusion of qualified therapists, formally structured sessions, and well-defined therapeutic goals targeting measurable emotional or behavioral improvement. Compared to two-dimensional creations like painting, handicrafts can materialise intangible consciousness and emotions into three-dimensional forms. During the creative process, the multi-dimensional perception and manipulation of materials can activate the parasympathetic nervous system and promote sensory coordination, thereby providing richer mechanisms for art therapy.

Handicraft art therapy emerged as a distinct branch within the field of art therapy, aiming to foster mental wellbeing and emotional expression through craft creation. Its origins can be traced back to the early 20th century. As an art form characterised by its immediacy and hands-on nature, handicrafts offer unique tactile experiences and emotional connectivity, demonstrating particular advantages in promoting psychological recovery and emotional regulation.

Manual labour is regarded as a foundational mechanism of craft-based art therapy, with multiple scholars investigating its impact on mental health. Wu Ping further elucidated, from a psychological perspective, how the “rhythmic repetitive motions” inherent in craft creation can induce emotional soothing. She posited that crafting constitutes a meditative-like activity, aiding individuals in liberating themselves from anxiety [10] . Building upon this, Pan Rusheng emphasised from cultural and philosophical perspectives that manual labour serves as a vital conduit for human “tactile memory”. Through direct interaction with materials, craft-based healing helps restore cognitive connections between the body and nature, offering a potential “return” within modern technological societies [11] . Compared to Feng Ting and Wu Ping’s focus on individual psychological healing, Pan Rusheng’s research expands the theoretical scope of manual labour, situating it within a broader socio-cultural perspective.

The significant value of handcrafted art therapy also manifests in evoking individual emotional resonance and cultural identity through traditional cultural symbols. Xu Yan’s research, centred on “women’s needlework”, explores the vital role of traditional handicrafts in female healing. She contends that needlework creations serve not only as vessels for emotional expression but also aid creators in finding psychological belonging and identity affirmation [12] . Whereas Xu Yan focuses on the psychological identity-forming function of culture, Zhang Jiayan proposes the symbolic value of handicrafts from a consumer society perspective. Using felted wool crafts as an example, she indicates that handicrafts not only satisfy individual emotional needs but also convey social values through symbolic expression [13] . Collectively, these studies demonstrate the central role of cultural symbols in the therapeutic efficacy of handicrafts. This manifests both in the emotional resonance of traditional culture and in the realisation of new value transformations within contemporary contexts.

Handicraft therapy not only focuses on improving individual mental health but also emphasises its vital role in social interaction. Liu Yiqing’s research proposes that group handicraft activities promote communication among participants, strengthen social support systems, and help foster a sense of belonging [14] . Yang Lizhi further demonstrates through empirical studies with post-stroke depression patients that group handicraft activities improve emotional states while positively influencing patients’ social adaptation abilities [15] . Moreover, Fang Xiong introduced craft art therapy into social work practice, proposing that collaborative group creation can strengthen social cohesion within communities and offer new avenues for cultural reconstruction [16] . Collectively, these studies illustrate craft art therapy’s transition from individual psychological intervention to group relationship restoration, revealing its broad potential for application at the societal level.

Theoretical and Mechanistic Research on Handicraft Art Therapy reveals multidimensional healing mechanisms spanning the physical, psychological, cultural, and social domains. From the therapeutic value of labour to cultural and emotional connections, and from emotional release and cognitive restructuring to social interaction effects, diverse studies complement one another, collectively enriching the theoretical framework of handicraft art therapy. Whether Feng Ting used various relevant items such as Jebsen Hand Function Assessment, Montreal Cognitive Assessment Scale (MoCA), Chinese Version of Cognitive Emotion Regulation Questionnaire (CERQ-C), and Rosenberg Self-Esteem Scale (RSS) as evaluation tools for therapeutic efficacy, or whether Yang Zhi-liang’s team obtained the quantitative conclusion through a controlled experiment that the HAMD score of the observation group decreased significantly more than that of the control group after treatment (P < 0.05), all these prove that manual art therapy still shows significant effects in the data-based quantitative results and achieves good therapeutic efficacy. However, existing research predominantly focuses on single mechanisms, lacking perspectives that integrate and intersect multiple mechanisms. Future research may explore deepening theoretical investigations into craft-based art therapy from an interdisciplinary perspective, particularly by integrating mechanisms involving cultural symbols and social interaction effects, thereby providing more comprehensive theoretical support for this field.

1) Ceramic Materials

The movements of the “hand” in emotional regulation lead to a reduction in emotional fluctuations and an improvement in attention after engaging in handicrafts. This interaction between the body and the mind is particularly prominent when working with ceramic materials ( Figure 1 ). Pottery therapy facilitates emotional expression and stress release through non-verbal means during clay creation. Centred on ceramic art as its primary medium, it offers low-cost, widely accessible engagement. This approach provides participants with a simple, gentle pathway to effectively articulate and reflect inner emotions and moods through ceramic crafting [17] . The core of pottery therapy lies in “creation” and “expression”. Through artistic creation, it externalises an individual’s subconscious content and emotions, enabling their expression and release under the dual sensory stimulation of sight and touch. Through pottery creation, individuals not only perceive shifts in their own emotions but also gain inner peace and fulfilment through the completion of their work [18] .

Yang Shuo posits in his study The Artistic Healing Mechanisms of Handcrafted Pottery that the tactile experience inherent in ceramic creation—particularly during shaping and carving—enables individuals to externalise inner emotions, alleviate anxiety, and enhance psychological resilience [19] . During pottery creation, individuals must engage with the form, texture, and unpredictable transformations of clay. This process not only tests manual dexterity but also stimulates creative thinking, facilitating emotional regulation and psychological recovery. Smalley’s -based experimental study validated the efficacy of combining pottery with mindfulness therapy in alleviating stress and anxiety [20] . Furthermore, Gerity’s research with patients exhibiting dissociative identity disorder revealed that the process of assembling clay pieces reflects psychological integration, enabling patients to achieve self-cooperation and cohesion through manipulating ceramic figures [21] . Wang Zhen’s investigation found that Jinsha Road Primary School in Liuyang City, Hunan Province, has offered pottery art courses since 2019. Her study on the application of pottery therapy for primary school pupils demonstrated that pottery effectively captures students’ interest and enhances their emotional state [22] . Meanwhile, Joshua K.M. Na employed a randomised controlled trial design to compare a Ceramic Art Therapy (CAT) group with a non-directed Visual Arts (VA) control group, assessing reductions in depressive mood alongside associated signs and symptoms of Major Depressive Disorder (MDD). This RCT demonstrated significant therapeutic effects of ceramic art therapy on both depressive mood and physical health outcomes [23] ( Figure 2 ).

2) Fibre Materials

Fibre materials possess a soft texture that conveys a sense of warm envelopment. The interwoven density of fiber materials often evokes thoughts of the connection and mutual healing between individuals and groups. In studies exploring the therapeutic value of fibre materials, scholars have examined their unique psychological healing properties from both cultural connotations and sensory experience perspectives.

Zhang Yifan posits that the soft texture of fibre materials and the act of weaving provide tactile comfort, while the repetitive nature of the weaving process plays a significant role in alleviating anxiety and enhancing focus. She emphasises the cultural significance of fibre art in emotional regulation, noting its capacity to evoke creators’ emotional connections to family and tradition [24] . Meng Shuyu further extends the research perspective to the cultural dimension, examining the therapeutic function of fibre art in conjunction with traditional Chinese culture, and exploring how cultural elements can be transformed into healing media through fibre art [25] . Yuan Shu approaches the subject from the perspective of tactile healing, discussing the unique properties of fibre art materials and their close association with tactile experiences. The article reveals how fibre art provides unique mind-body healing experiences through multisensory interaction and emotional projection, particularly addressing modern society’s demand for emotional support [26] . Rui Qiyang and Wang Xueying elucidate the fundamental concepts of sensory design and its application in fibre art through literature review and questionnaire surveys, emphasising the core role of sensory experiences like vision and touch in fibre art therapy [27] ( Figure 3 ). Chen Jingwen focuses on the unique function of “fabric” as a healing medium, arguing that its softness and natural properties render it an effective vehicle for emotional and psychological healing. The article reveals fabric’s role in emotional catharsis and psychological trauma repair, confirming the feasibility and efficacy of fibre art in psychological recovery [28] .

3) Paper Materials

Paper materials often identify an individual’s identity by associating with traditional cultural symbols, and link culture with emotions. Research on paper materials remains relatively sparse. The author primarily explores its unique therapeutic mechanisms and cultural value from the perspective of paper-cutting art. Chen Mingdian notes in his study that the complexity and repetitive actions involved in paper-cutting enhance the creator’s focus and psychological calm. Traditional paper-cutting patterns often contain rich cultural symbols, evoking the creator’s cultural memories and sense of belonging, effectively alleviating loneliness and anxiety [29] ( Figure 4 ). Wang Ziqi et al. investigated the application of paper-cutting art among rural empty-nest elderly populations, exploring its efficacy in alleviating loneliness and depressive emotions. The article proposed design strategies involving the revitalisation of traditional motifs, enhanced interactivity, and emotional narrative expression, validating the therapeutic effects of focus and accomplishment derived from the paper-cutting creative process [30] . Chen Jiawen analysed the distinctive role of paper-cutting from an art therapy perspective, examining its therapeutic function as a tool for emotional expression and the visualisation of the subconscious. The paper further proposed integrating paper-cutting’s therapeutic properties with installation art to enhance healing effects and broaden its audience, particularly for individuals experiencing psychological sub-health [31] . Additionally, Ju Gaofeng examined the emotional healing potential of paper materials in environmental art design education. Research revealed that the material properties, malleability, and emotional interaction of paper effectively alleviate students’ anxiety and depressive states. Through innovative teaching models such as the “Paper Art Healing Workshop”, students not only enhance their creativity but also achieve greater self-awareness and emotional expression within a creative space fostering emotional release and psychological equilibrium [32] .

Different materials manifest distinct roles in art therapy through their tactile properties, operational processes, and cultural connotations. Ceramics facilitate emotional release through the tactile experience of wetting and shaping; fibres foster a sense of emotional belonging via soft textures and weaving motions; while paper offers creators dual experiences of focus and inner tranquillity through cutting and cultural symbolism. These materials not only provide diverse mediums for therapeutic intervention but also imbue psychological treatment with deeper cultural and emotional value.

Research into craft-based art therapy for specific groups primarily focuses on mental health and emotional support, particularly among autistic children, left-behind children, and individuals with depression. Jin Hailu investigated the application of craft therapy courses in the education of children with autism, discovering that they not only foster creativity but also strengthen social interaction [33] .

Left-behind children face emotional deprivation and psychological challenges. Guo Xinyi emphasised that craft-based healing alleviates emotional isolation, fostering emotional expression and psychological development. She proposed integrating traditional craft techniques into therapeutic approaches, effectively enhancing children’s emotional bonding capabilities, with particular attention to the psychological impact of family absence [34] . Furthermore, in intervention studies with individuals experiencing depression, Bao Hua noted that secondary school students participating in craft projects could alleviate depressive symptoms and strengthen self-identity [35] .

Research into craft-based art therapy extends beyond psychological interventions for specific populations to encompass emotional connection and aesthetic living among the general public. Zhao Juan emphasised the sensory therapeutic effects of botanical materials, positing that plant-based craft therapy can draw individuals back to nature from the fast pace of modern life, thereby enhancing psychological regulation [36] .

Despite the rise in research on handicraft art therapy, studies still encounter limitations such as small sample, use of self-report data, and lack of cross-cultural comparison. Future research should aim at increasing sample diversity, combining qualitative and quantitative research methods, and improving cross-cultural validation to enhance their scientific rigor.