- This study was designed to explore the use of a protocol that combines art based and cognitive behavioral interventions (CB-ART) to help thirteen women cope with pain, anxiety and depressive symptoms. We used a qualitative evaluation to understand the women's experience as participants in the protocol. In addition we measured changes in levels of distress using the subjective units of distress measure (SUDS) following the sessions. Client feedback regarding the experience of being part of the CB-ART treatment helped identify how art making can enhance the use of mental imagery in psychotherapy. We found that the CB-ART protocol is beneficial in reducing distress of women coping with pain, anxiety and depressive symptoms. We also found that the protocol is equally efficacious in individual and group modalities. Art making provides an opportunity to externalize distressing experiences. The concrete nature of the art product provides a platform for examining mental imagery, practicing coping skills, examining and changing maladaptive cognitions and behaviors.