ABSTRACT
Background: Visual stimuli are frequently incorporated into interventions that use narratives to meet counseling, therapy, education, and clinical needs. However, the treatment efficacy of visual stimuli is unclear. This systematic review synthesizes and evaluates visual narrative interventions addressing anxiety.Methods: Databases (n = 9) and extended reference searches identified 13 original studies using visual artifacts in narrative interventions for adult anxiety. The visual stimulations were analyzed based on artifact origin, user interactivity, and functions of the stimuli.Results: Three types of visual artifacts- virtual reality (VR) (n = 4), videos (n = 4), and drawings (n = 5) were found. Dichotomous patterns of artifact origin (native vs. foreign) and interactivity (participatory vs. non-participatory) characterized the applications. A hierarchy of functions- engage, externalize, internalize, and rescript was observed. Most studies confirmed the positive effects on the varied anxiety conditions; however, unclear risk of bias and extraneous factors was present.Conclusions: Future visual narrative studies addressing adult anxiety are recommended to strengthen the current body of knowledge by using double-blinded randomized control trials with robust anxiety measures, incorporating artifact origin and user interactivity in intervention designs, considering alternative stimuli with high accessibility, such as images, and including employment-related anxiety conditions.
