Objective: This review/protocol proposal explores whether combining three concepts Counterclockwise theory, Imagery training, and Art therapy can improve motor symptoms and enhance the quality of life in patients with Parkinson’s disease, thereby strengthening the overall effectiveness of art therapy.

Background: Parkinson’s disease (PD) displays diverse features and progression rates. Standard treatments with levodopa and non-pharmacological methods (e.g., exercise, therapy) often lead to complications in 40% of patients within five years, narrowing the levodopa window and causing polypharmacy. To combat Levodopa Phobia and polypharmacy, about 76% of PD patients use complementary therapies, with art therapy recognized for its psychological, neurological, and mental health benefits.

Method: A literature search was conducted in two electronic databases (PubMed and Google Scholar) using the keywords “Parkinson’s disease,” “art therapy,” “mental imagery,” and “Counterclockwise.” The following inclusion criteria were then established: 1. art therapy related studies evaluating motor or non-motor symptoms in Parkinson’s disease patients, 2. studies based on Ellen Langer’s “Counterclockwise” research, and 3. articles examining the application of mental imagery to Parkinson’s disease, particularly referencing Stephen M. Kosslyn et al. After reviewing the retrieved literature according to the appropriate research design criteria, the findings were synthesized to derive a “Parkinson’s art protocol.”

Results: Based on theoretical and clinical evidence, we propose an 8‑week art therapy protocol for Parkinson’s disease that integrates patients’ past and present through art and holistic breathing. Participants engage in weekly art tasks capturing life-stage-specific memories—with Week 1 overlaying past and present images via OHP and Weeks 2–7 using various media—and repeat Week 1 in Week 8 to assess qualitative change, with outcomes measured by the UPDRS and NMSS.

Conclusion: We propose an 8‑session protocol integrating Counterclockwise theory, imagery training, and art therapy as a novel intervention for Parkinson’s disease. While preliminary evidence is promising, large-scale, long-term RCTs are needed to validate its efficacy and elucidate its mechanisms. This approach shows potential to improve both motor and emotional symptoms in PD rehabilitation.

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