Art therapy has become known by its psychosocial and affective impact, but not so much by its effects on cognitive functioning. Based on a comparison between art therapy and music-making programs, we hypothesized that guided methods-dominant in music-making programs and characterized by an emphasis on execution (play the piece, produce the visual object) rather than ideation (conceive the visual object)-could boost the cognitive effects of art-making. We also hypothesized that removing ideation from the process with guided methods could decrease psychosocial/affective benefits. In order to test our hypotheses, we compared the effects of two art therapy methods on cognitive vs. psychosocial/affective domains. We implemented a short-term longitudinal study with patients with schizophrenia showing both psychosocial/affective and cognitive deficits. The sample was divided into two groups: unguided, instructed to ideate art pieces and execute them without external guidance, vs. guided, instructed to execute predefined art pieces following externally provided guidelines. There was no evidence that guided methods boost cognitive effects, since these were equivalent across groups. However, psychosocial/affective benefits were enhanced by unguided methods, suggesting that therapeutic methods can make a difference. Our study contributes to raising important new questions concerning the therapeutic mechanisms of art therapy.Behav. Sci. 2020, 10, 65 2 of 17 unguided methods could boost cognitive effects from art therapy. Please note that we do not assume that art making is necessarily a creative process. According to Schoop's definition [7], creation is an autonomous process of shaping in which all decisions are bound to the creating person, and this is not always so in artistic practice: for instance, a musician who plays a piece by following all indications from the score is not deciding anything, and the same goes for someone who copies a drawing-provided that s/he does not add anything to the drawing intentionally. Therefore, when comparing unguided with guided methods, we were contrasting creative practices (unguided method) with not-necessarily creative ones (guided).Since its beginnings, art therapy remained focused on psychosocial-e.g., improving well-being, quality of life and communication, as well as affective goals-e.g., reducing anxiety levels and enhancing positive mood [8]. Adrian Hill , the creator of the 'art therapy' designation, developed his first therapeutic experiments when trying to fight the affective and psychosocial consequences of tuberculosis [9]. Since then, empirical studies (see Table 1) have prioritized psychosocial and affective areas across various clinical and non-clinical groups [10]: In psychotic patients, case reports [11][12][13] and quantitative studies with control groups [14-18] reported decreased anxiety [11,16,17] and depression [17], reduction in negative symptoms such as apathy or anhedonia [14,17], as well as increased self-esteem [12,14,15], sense of self [12,13], socialization...