The association between burnout and empathy in intern medical doctors rotating at Steve Biko Academic Hospital in Pretoria, South Africa.

Mental health disorders are amongst the largest burden of diseases globally, with depression being the most common one (). Depression can profoundly impact the life of individuals experiencing it, and it is estimated that around one in three people will experience a major depressive episode during their lifetime (). The costs associated with the two most common mental disorders, anxiety and depression, were estimated to be around US$ 1 trillion globally in 2020, a number expected to increase to US$ 6 trillion by the year 2030 ().The standard treatment of unipolar depression in adults, according to medical guidelines, includes the use of psychotherapy and pharmacotherapy (). However, mental health disorders, such as depression, can be difficult to treat, and acute facilities and rehab facilities often offer a wide array of non-pharmacologically and complementary treatment options, like movement therapies, light therapy, and art therapy (, ). The umbrella term ‘art therapy’ refers to therapeutic approaches that integrate artistic elements, such as music, dance, theatre or literature, into treatment. Art therapy is used for a wide range of treatment indications and may pursue curative, rehabilitative, preventive, palliative or corrective treatment goals (–), they are most widely established in the treatment of mental disorders, whereby the underlying theoretical concept may be rooted in psychodynamic or analytical, cognitive or behaviour-oriented psychotherapy (, ). In the art therapy process, the focus is not primarily on the artistic product, but on the individual expression of inner worlds of experience through visual means (). The exact mechanism through which art therapy might alleviate symptoms in patients is not yet fully established and remains a source of investigation. A non-verbal approach appears to open up alternative ways of addressing psychological conflicts, particularly in situations where language is limited or cognitive processing seems difficult (, ). Generally effective elements of art therapy include the relationship between therapist and patient, mindfulness, and positive group effects, such as a sense of belonging and connectedness (, ). Specific mechanisms of action include the safe space in which self-exploration can be approached in a playful manner (), the non-verbal approach to and engagement with one’s own feelings and emotions (), and the strengthening of self-efficacy (). Although art therapy is commonly used for a wide range of patients and conditions, the empirical evidence for its effectiveness appears to be heterogeneous (). A comprehensive scoping review by the World Health Organisation (WHO) identified and compiled numerous studies on artistic therapies (). The analysis of over 900 studies demonstrated the potential of artistic therapies to promote health, prevent illness and support people in coping with illness. However, the review lacked an assessment of the quality of the included studies and a systematic literature search. A recent systematic review examined the evidence for art therapy in patients with anxiety disorders and/or depression. The authors considered only English-language publications and did not carry out a meta-analysis ().