Mental health is a fundamental aspect of human well-being, to effectively cope with stress. Maintaining good mental health can be a foundation of human well-being and play an important role in encouraging positive devel-opment of young people(Organization, 2021). Adolescents transitioning into adult-hood will face many common mental health challenges (Clarke et al., 2020). Addressing these issues is particularly important, as unre-solved mental health problems can hinder an individual's ability to accumulate resources and may serve as a significant determinant of future poverty and adversity (Clayborne et al., 2019).

Mental health disorders affect adoles- cents globally, both in developed and devel- oping countries. In the United States, more than one in ten adolescents experience depres- sion that interferes with their daily function- ing at school, work, home, and social life. Re- cent data shows that 16.39% of US adoles- cents (ages 12-17) reported at least one major depressive episode (MDE) in the past year, with 11.5% (over 2.7 million adolescents) experiencing severe major depression. The situation extends beyond adolescents, as 4.84% of US adults (over 12.1 million people) report serious suicidal thoughts, with notably higher rates (11%) among multiracial individuals (Reinert et al., 2022) .

Similarly concerning trends are observed in developing countries. In Indonesia, a study of adolescents aged 10-17 revealed that one in three (34.9%), equivalent to approximately 15.5 million Indonesian adolescents, experi- ence mental health challenges. These include anxiety (26.7%), concentration/hyperactivity problems (10.6%), depression (5.3%), behav- ioral problems (2.4%), and post-traumatic stress (1.8%). More critically, one in twenty adolescents (5.5%), or 2.45 million Indone- sian adolescents, are diagnosed with mental disorders, including anxiety disorders (3.7%), major depressive disorder (1.0%), behavior disorders (0.9%), ADHD (0.5%), and PTSD (0.5%) (Wahdi et al., 2022). These various mental health challenges can manifest in dif- ferent forms and may lead to self-harm behaviors (Cole et al., 2018) .

Increasing attention is being given to pro-motion, prevention, and early intervention in response to growing concerns among both de-veloping and developed countries regarding adolescent mental health and well-being (Solmi et al., 2022). The fact that a single treatment (curative) is insufficient to address mental problems in adolescents and promote mental health and well-being at the popula-tion level is becoming more widely acknowl-edged (Ormel et al., 2019). Consequently, the paradigm of mental health has shifted towards prioritizing preventive measures to reduce mental disorders (Ayuningtyas & Rayhani, 2018).

School counselors recognize the preva- lence of adolescent mental health issues; how- ever, the main problems identified in this study include inadequate infrastructure, limited collaboration with students' families, and a lack of teacher capacity-building pro- grams to address these issues effectively (Hartanto et al., 2023). Mental health issues must be addressed as early as possible given their significant impact on adolescents. Early intervention to prevent mental health prob- lems has an impact on profits, including inter- ventions that are initially carried out after a mental health problem (curative) to before (preventive) the impact the on adolescents and families are reduced, and reduce costs of mental disorder treatment (Bariyyah & Latifah, 2015); (Catalano et al., 2012); (Ormel et al., 2019)

The treatment of adolescent mental health continues to rely primarily on conven- tional face-to-face counseling models without the integration of technology. Based on the re- sults of a systematic literature review, there are very consistent findings in the relation to the prevention of depression through inter- ventions that have been carried out. However, these interventions have generally demon- strated minimal impact on post-intervention depression (Scott, 2015). Universal interven- tions also shown to reduce symptoms of anx- iety, but still in small impact measures (Shelemy et al., 2020). meta-analysis of uni- versal and targeted prevention programs for depression and anxiety found that such inter- ventions have a moderate effect on depression and a substantial effect on anxiety (Feiss et al., 2019). Therefore, alternative counseling model is needed to be a solution in dealing with mental health problems in adolescents.

Virtual art therapy offers significant ben-efits in mental health treatment, including im-proved accessibility through virtual reality (VR) technology which can be utilized re-motely (Hacmun et al., 2018)(Haeyen et al., 2021), particularly during the COVID-19 pandemic (Snyder, 2021) and for marginal-ized populations (Feen-Calligan et al., 2023). VR technology provides a more immersive therapeutic experience with three-dimensional artistic expression capabilities (Kaimal et al., 2020) and customizable therapeutic en-vironments (Li & Yip, 2023). Additionally, it enhances client engagement, particularly among technology-savvy adolescents (Zeevi, 2021)(Zubala et al., 2021). However, chal-lenges persist including technological limita-tions and ethical considerations about privacy and data security (Snyder, 2021). Further re-search is necessary to evaluate its long-term efficacy across diverse clinical settings (Giorgi et al., 2023).

Art-based interventions serve as a viable alternative for promoting adolescent mental health. The integration of arts-based services in mental health development is becoming in- creasingly prevalent (Fancourt & Finn, 2019); (Oren et al., 2019). There is a well-established belief that creative activities can promote the development of positive mental health as the art process of activity encourage individuals to express themselves freely and remove bar- riers in communicating and expressing emo- tional experiences that difficult to speak (Devlin, 2010). Emotional experiences play a fundamental role in shaping mental health, contributing to resilience and psychological strength (Junça-Silva, 2022) .

Creative arts can elicit reciprocal efforts, enhance empathic connections and communi- cation that support mental health recovery (Junça-Silva, 2022). The use of art therapy fo- cuses on cultivating a flexible, and adaptive sense of self, enabling individuals to navigate life’s challenges with rational and resilient cognitive and emotional skills (Buday, 2013) . The use of art therapy based on research re- sults is proven effective in mental health development.

The development of mental health is not solely measured by the creation of artwork, but is instead centered on fostering a collaborative environment that supports each other (Saavedra et al., 2017). These concern- ing statistics highlight the critical importance of focusing mental health research and inter- ventions on adolescents, particularly consid- ering their unique position as digital natives who have grown up immersed in technology. As digital natives (Adorjan & Ricciardelli, 2021) , adolescents are more likely to engage with and benefit from digital-based mental health interventions, making them a key target population for innovative approaches to men- tal health support.

The recent implementation of art therapy for mental health has increasingly incorpo-rated telecommunication tools (Spivak et al., 2020). The use of online media began to be widely used in preventing mental health prob-lems. Online practices for wider access are coming into use. Virtual art therapy presents a promising alternative as it enables individu-als to receive support regardless of geograph-ical barriers or financial constraints (Kaimal et al., 2020).

The distinction between conventional and technology-based art therapy can be observed through several key aspects. Conventional art therapy, rooted in longstanding practices, relies on direct interaction with physical art media to facilitate emotional expression and healing, focusing on the creative process rather than the final product (Ralston, 2018)(Adhantoro et al., 2025). In contrast, technology-based art therapy integrates digi-tal tools and virtual platforms, offering broader accessibility and convenience for dig-ital native generations. However, concerns re-main regarding the potential loss of tactile en-gagement, which is considered a crucial com-ponent of the therapeutic process (Gonchar, 2023)(Zubala et al., 2021). Both approaches offer distinct advantages and challenges, with digital therapy providing innovation and wider reach, while conventional therapy maintains the essential value of physical inter-action with artistic materials.

Global efforts to improve adolescent mental health have advanced significantly, particularly in low-and middle-income countries (LMICs). Research indicates that while barriers such as poverty, stigma, and limited treatment availability persist (Osborn et al., 2020)(Zhou et al., 2020), strategic approaches using WHO's 4-S framework have helped de-velop evidence-based policies (Fisher & Mello, 2011). Effective interventions have combined mental health literacy building (Clauss-Ehlers et al., 2020), interpersonal skill development, and culturally-appropriate programming through local partnerships (Osborn et al., 2020)(Baingana et al., 2015). Despite challenges related to inter-sectoral coor-dination and budget constraints (Roy et al., 2019), these interventions have demonstrated significant economic benefits, yielding high returns on investment and low cost per disa-bility-adjusted life year (DALY) (Stelmach et al., 2022).

Adolescence is a transformative phase characterized by unique challenges and emo- tional fluctuations. While this period fosters self-discovery, it also presents heightened vulnerabilities to mental health disorders, in- cluding anxiety, depression, and stress. (Organization, 2021) estimates that 10-20% of adolescents globally experi- ence mental health conditions; however, the majority do not receive adequate care. Barri- ers such as limited access to services, societal stigma, and logistical constraints frequently hinder adolescents from obtaining the neces- sary support.

As technology becomes an integral part of daily life, new opportunities have emerged to address gaps in mental health care. Adoles- cents, often referred to as "digital natives" (Prensky, 2005) , are particularly adept at us- ing digital tools, making them ideal candidates for technology-driven interven- tions. One promising approach is virtual art therapy, which combines the therapeutic ben- efits of creative expression with the accessi- bility of digital platforms. Unlike traditional therapy, virtual art therapy allows adolescents to explore their emotions and express them- selves creatively in a format they are familiar with online environment.

This research carries critical significance in addressing contemporary mental health challenges. It responds to the growing de- mand for accessible adolescent mental health interventions while leveraging innovative technological solutions that resonate with modern youth preferences. The study's find- ings could significantly influence the devel- opment of scalable, effective mental health in- terventions and contribute valuable insights to the expanding field of digital mental health services. This is particularly relevant in the post-pandemic era, where remote healthcare delivery has become increasingly essential

This study examines the potential of vir- tual art therapy to address the mental health needs of adolescents. Specifically, it aims to answer the following research questions:

Recent research highlight the efficacy of art therapy to help young people process emo- tions, foster resilience, and build coping skills (Blomdahl et al., 2013) . The integration of virtual reality (VR) into therapeutic practices takes this a step further, enabling interactive and engaging experiences that are accessible from virtually anywhere (Shamri Zeevi, 2021); (Haeyen et al., 2021) . VR-based therapy has been shown to not only support emotional regulation but also enhance social functioning and cognitive engagement, particularly among adolescents experiencing anxiety and social difficulties.

By examining existing literature and exploring future possibilities, this study aims to highlight how virtual art therapy can provide a meaningful and scalable solution to the increasing mental health challenges faced by adolescents.

The research employed a qualitative approach with systematic review design to synthesize and analyze existing evidence on virtual art therapy for adolescent mental health. A qualitative approach was selected as it enables an in-depth exploration and interpretation of complex interventions, therapeutic processes, and outcomes that may not be fully captured through quantitative measures alone. The methodology adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) to ensure a transparent and replicable review process (Page et al., 2021).

Relevant articles were retrieved from established academic databases, including Scopus, and Google Scholar. The search was conducted using a combination of keywords such as “virtual art therapy,” “adolescent mental health,” “digital therapeutic tools,” and “online counseling.” The inclusion criteria were as follows:

Studies were excluded if they lacked a clear focus on adolescent mental health, did not incorporate virtual art therapy components, or were not published in reputable academic sources. Initially, a total of 43 articles were identified. Following a relevance screening and the removal of duplicates, 15 articles underwent a full-text review, of which 7 met the inclusion criteria.

The selected articles underwent a com- prehensive data extraction process to identify recurring themes, methodologies, tools, plat- forms, and outcomes. Most studies utilized secure online platforms, such as Zoom or Mi- crosoft Teams, to conduct therapy sessions, with some integrating collaborative tools like Jamboard that allowed participants to create and share artwork in real time. Additionally, two studies employed virtual reality (VR) en- vironments, providing immersive therapeutic experiences where adolescents could create art in 3D virtual spaces. Any disagreements in the selection process were documented and resolved through consensus meetings be- tween the researchers. This selection process resulted in 7 articles that met all inclusion cri- teria and quality standards.

Mental health outcomes were evaluated through both quantitative and qualitative measures. Quantitative studies utilized validated instruments, such as the Beck Depression Inventory (BDI), the Generalized Anxiety Disorder-7 (GAD-7), and the State-Trait Anxiety Inventory (STAI). On the other hand, qualitative studies collected feedback from participants and therapists to evaluate engagement levels, emotional expression, and the perceived effectiveness of virtual therapy sessions.

The duration of interventionsvaried across studies, ranging from 4-week programs to 12-week sessions. Most interventions con-sisted of weekly sessions lasting between 60 and 90 minutes, ensuring consistent opportu-nities for therapeutic engagement and pro-gress monitoring.

Seven articles were identified to address the research question regarding the implementation of art therapy and virtual art therapy in maintaining adolescent mental health? The presentation of the summary of the article in the form of the author's name, research objectives, research objectives, research subjects and the implementation of interventions is presented in Table 1.

A review of eight research articles highlights a significant evolution from con- ventional art therapy to virtual art therapy in adolescent mental health treatment. Traditio- nal art therapy has demonstrated effective in addressing various mental health issues, from anxiety to clinical psychiatric disorders, through various approaches such as drawing therapy and structured programs like "The Art Room". Advances in technology Advances in advancement have introduced innovations through the integration of Virtual Reality (VR) into art therapy, enabling the creation of interactive virtual therapy spaces and automa-ted data collection for more precise asses-sment. The application of VR in art therapy primarily focuses on three key areas: social functioning, cognition, and symptoms, with therapy sessions designed in three segments allowing clients to create in 3D virtual envi-ronment while maintaining therapeutic inte-raction. While VR-based art therapy shows considerable promise in enhancing the acces-sibility and effectiveness of mental health in-terventions for adolescents, existing literature underscores the need for further research to validate its efficacy and to address challenges related to resource accessibility and ethical considerations as the field continues to evolve (Murthado et al., 2021).

The analysis provided key insights into the application of virtual art therapy. Adoles- cents participating in these interventions de- monstrated improved emotional regulation, reduced symptoms of anxiety and depression, and enhanced self-expression through virtual platforms. While most studies focused on group therapy formats, individual sessions were also found to be effective, particularly for participants experiencing more severe symptoms.

Emerging studies emphasize the potential of virtual art therapy in engaging adolescents through innovative, technology-driven approaches. For instance, (Shamri Zeevi, 2021) de- monstrates how virtual reality enhances thera- peutic experiences by immersing participants in interactive environments, while (Haeyen et al., 2021) explore the role of VR Health Ex- periences in fostering emotional regulation and self-expression. Additionally, research by (González-Zamar & Abad-Segura, 2020) un- derscores the adaptability of virtual platforms for therapeutic and educational purposes, making them ideal for adolescents who are di- gital natives. Despite these advancements, further research is required to address gaps in long-term efficacy and accessibility, particu- larly for underserved populations.

In cooperation with experts in technical advancements and their applications, the Virtual Therapy Space was created and set up as a simple multiplayer setting that is furnished for art therapy. Within this digital space, par-ticipants in therapy can move in the same di-gital realm and hear and see one another, si-mulating the experience of a physical therapy room. As if they were gazing at each other in the therapy room, the therapist intervenes in real time throughout the session and works based on the experience by wearing virtual re-ality glasses or watching through a computer screen. This immersive setting enhances the sense of presence and connection among par-ticipants. In response to feedback from the sprint session, changes can be made and pro-blems resolved throughout the project. Reco-gnizing the benefits of each technique, it is be-lieved that using music in the art therapy pro-cess provides reinforcement (Bunt & Stige, 2014). Art therapy, whether structured or im-provisational, integrates fine arts such as pain-ting, sculpture, and sketching, with or without musical accompaniment (Fotima, 2020). Mu-sic serves as apowerful medium to help peo-ple connect with their own emotions and sentiments in order to recognize, manage, and be conscious of them, as well as to give them me-aning and purpose. Additionally, music helps improve self-expression, identify different emotions, improve tolerance for frustration, and calm mood (Petruta-Maria, 2015). Music plays a significant role in virtual art therapy by influencing emotions and aesthetics through various techniques like music impro-visation, receptive listening, songwriting, lyric discussion, imagination, relaxation, and musical performance (Strohal, 2017). Although research on the integration of music with virtual reality (VR) in art therapy for adolescents is limited, techniques such as painting with music, blind drawing, finger painting, and collage-making can be integrated into VR environments to create more immersive and interactive therapeutic experiences (Strohal, 2017).

Art therapy serves as an effective tool to address anxiety issues Encourage teenagers to discuss all of the major issues they will en-counter at employment. The creative process involved in art-making allows individuals to express and process their emotions, bringing underlying issues to the surface (Sajnani et al., 2020). Engaging in artistic activities that re-quires imagination and creativity fosters a sense of inner tranquility, making it appropri-ate for someone experiencing psychological distress (Gladding, 2021). Given the preva-lence of mental health challenges, art therapy provides a place where this approach can be actively sought (Hidajaturrokhmah et al., 2022).

Children's reading comprehension, verbal and creative thinking, self-perception of mastery, and intrinsic motivation are enhanced by art, helping young people to resolve emotional conflicts by giving them a place to explore themselves and develop social interactions with others. Additionally, art therapy fosters emotional expression, resilience, and social interaction (Blomdahl et al., 2013). Art therapy can also be structured to provide young people a sense of accomplishment while they explore their creativity (Cortina & Fazel, 2015).

According to (Havsteen-Franklin, 2014) and (Havsteen-Franklin & Altamirano, 2015) responsive art therapy serves as an ad- ditional method of putting art therapy into practice. A psychodynamic technique known as "responsive art therapy" involves an art therapist (who may possess specialized training, such as a master's degree in art the- rapy) creating artwork as an interpretive rela- tional response to the artwork of a teenager who has to stay in a mental health facility (Syahmani et al., 2021). Patients are thought to benefit from responsive art therapy, which allows them to safely express suppressed fee- lings and serves as a bridge to spoken trea- tment. Additionally, visual imagery might be useful in diagnosing conditions or evaluating the effectiveness of treatment. Teenagers, who are often hesitant to engage in traditional verbal therapy, generally perceive responsive art therapy as helpful (Nielsen et al., 2019) .

Adolescents may perceive technological media as an engaging and promising alterna- tive to traditional therapeutic approaches. Children and teenagers today navigate their li- ves in two primary spaces at the same time: the digital world and the ordinary interperso- nal world (Chandra, 2016). Teenagers fre- quently believe that using technology in the- rapy can result in a comfortable and enjoyable conversation. Virtual art therapy's therapeutic method is predicated on the idea that thera- pists, teenagers, and virtual artworks form a rich triangle interaction with the art and VR worlds. Clients can engage in visual creative experiences that stimulate their imagination and enable symbolic and nonverbal expres- sion of unconscious content when virtual art resources are available in treatment rooms (Case & Dalley, 2014); (Schaverien, 2000). VR and virtual therapy rooms have different roles in the context of therapy. VR generates im- mersive experiences that enhance various forms of therapy, while virtual therapy rooms provide a platform for remote therapeutic interactions (Levac & Galvin, 2013) .

The findings indicate that the art therapy including art media, creative processes and works of art in the form of drawing, painting, coloring, sculpting and other creative activi- ties (such as making home decorations, wall clocks, flower arrangements and so on) can also be effectively implemented through vir- tual media. The use of technology is conside- red suitable to be used to provide interven- tions in adolescent mental health. Often refer- red to as "digital natives" (Prensky, 2005) , adolescents have grown up in the digital age and regard technology as an integral part of their daily lives, making virtual platforms an accessible and effective medium for therapeu- tic engagement.

The implementation of virtual art therapy necessitates a two-way interaction between counselors and counselee. According to the li-terature, the implementation of virtual art the-rapy can be started with discussions between counselors and counselee in establishing good relationships and make agreements. Furthermore, in the virtual space there are two ways that counselors could do, accompanying the counselee in the room and monitor through the screen or together with the counselee entering the virtual world through VR (Kaimal et al., 2020). The creative process of making art is facilitated through VR (González-Zamar & Abad-Segura, 2020), allowing counselees to select colors and can start drawing to inves-tigate themselves or express themselves. Through the images created by the counselee, the counselor facilitates to mediate the con-tent that appears in the virtual media based on the counselee thinks and feels. The therapy process concludes with an evaluation to ensure continuity of care.

It is anticipated that the integration of technology will enhance the therapy process, making it more comfortable and engaging for participants (Emmelkamp & Meyerbröker, 2021) . The use of VR in counseling provides an immersive experience, allowing individu- als to enter a virtual environment with the fre- edom to express themselves creatively (Pirker & Dengel, 2021); (Seabrook et al., 2020). VR has a strong influence on human perception and cognition by eliciting a sense of presence and illusion so that counsellors can respond to virtual stimuli (Emmelkamp & Meyerbröker, 2021); (Marucci et al., 2021). Additionally, VR facilitates natural interaction between humans and the virtual environment (Djawantianros, 2021).

The use of avatars in counseling are ano- ther advancement in the use of technology in the therapeutic process. J. Leff first developed and described avatar therapy, which involves of a three-way dialogue between the patient, therapist, and a digital simulation tool known as a "avatar" (Craig, 2019) . According to(Cooper et al., 2019) avatars serve as virtual re- presentations of individuals, facilitating inte- raction and communication. With exposure to disembodied sound representations and real- time guidance on "hot" cognitive, emotional, and relational processes (Herman, 2015); (Marzal et al., 2022), AVATAR therapy provides a potent therapeutic setting (O’Brien et al., 2021). While avatars cannot replace all as- pects of traditional counseling, avatar therapy has demonstrated potential as an effective tool for promoting mental health (Franco et al., 2021); (Garety et al., 2021); (Holt, XXXX) .

This literature review has several limita- tions. First, the primary data used in the study came from articles published in scientific journals from various countries. This limita- tion may result in non-empirical research con- cepts that do not fully capture the current con- ditions in a specific country. Second, the rese- arch produced a pattern of virtual art therapy implementation from various countries, but it did not yield a specific virtual art therapy mo- del tailored to enhance adolescent mental health. Third, the reviewed articles revealed some gaps, including inconsistent reporting of specific tools used and a lack of long-term fol- low-up to assess the sustainability of outco- mes. These limitations highlight the need for future research to standardize virtual art the- rapy practices and evaluate their long-term impact.

The discussion highlights several key points and practical applications of virtual art therapy. The findings align with existing lite-rature, including studies by Shamri (Zeevi, 2021) and (Haeyen et al., 2021), which em-phasize the efficacy of virtual art therapy in enhancing emotional regulation and self-expression.

Practical applications of virtual art the- rapy can be implemented in both schools and Community settings. For example, schools can collaborate with local therapists to intro- duce virtual art therapy programs, while community centers can organize online workshops to expand access to this interven- tion. The successful integration of virtual art therapy in schools and mental health centers requires careful consideration of both techno- logical implementation and professional trai- ning. Virtual Reality (VR) technology can enhance therapeutic engagement by providing immersive environments for self-expression and creativity, making it particularly appea- ling to younger clients (Zeevi, 2021). Additi- onally, dedicated virtual spaces can improve accessibility and encourage creative explora- tion through platforms such as the VR Health Experience (Haeyen et al., 2021). Additio- nally, effective implementation requires com- prehensive training for therapists, including studio-based education and continuous pro- fessional development to ensure competency with digital tools and therapeutic techniques (Cahn, 2000) .

Enhancing accessibility and scalability necessitates the use of low-cost platforms and asynchronous tools to reach underserved populations. Collaborations with NGOs and government programs could further support these efforts by providing necessary resour- ces, such as devices and internet subsidies. Additionally, ethical considerations must also be prioritized, including ensuring data pri- vacy, obtaining informed consent, and foste- ring a strong therapeutic rapport when delive- ring virtual therapy settings.

Mental health issues require significant attention, particularly during adolescence. Given that adolescents have grown up closely integrated with technology, their unique characteristics must be considered when designing interventions. Virtual art therapy provides a promising perspective as it considered interesting to use for adolescents. The use of art therapy is not just playing with material, but also a complex process to taps into people's deepest feelings and connects people with parts of the brain that words cannot reach. This enables individuals to be able to express themselves in different ways. Since many mental health disorders originate during adolescence, innovation or efforts are needed to reduce the likelihood of these issues developing.