By now art therapies are more frequently included into multi-modal therapy concepts in medicine and implemented in some of the S3 guidelines. A research interest in art therapies exists for a long time but there is a lack of standardized reporting and often only vague descriptions of the treatment interventions are provided. Therefore it is difficult to compare different study procedures. The therapeutic efficacy of art therapies are often assumed in the non-verbal, emotional communication and expression. The “Brain Based Image Therapy” („Lösungsorientierte Maltherapie – LOM®“) stands in contrast to this assumptions. It is developed by Dr. Bettina Egger und Jörg Merz, M.Sc. since 1980. LOM has a comprehensible therapy manual with very structured flowcharts for treatments of different concerns combined with distress. No classical analysis or interpretation of the images takes place. The main focus is on the solution of the concern. Another major difference is the preoccupation with the impression produced by the painted picture and not the expression or non-verbal, emotional communication. The assumed effects of LOM are the replacement or “repainting” of distress sourced emotional memories and images through a structured guided painting process with newly painted not stressful simple images. This hypothesis is supported by neurobiological research on the influence of emotional distress in certain situations. The aim of this thesis is to analyze the outcome short-term and long-term of LOM on the basis of a group of 60 patients with severe and long-term distress. Dr. B. Egger treated all patients personally in her atelier in a single setting. The patients painted with their non-dominant hand, in standing position in front of a board. Data were collected using standardized questionnaires and detailed documentation of the therapy sessions. Additionally, the therapeutic effect was evaluated after completion of therapy and short- as well as long-term follow-up. Subjective units of distress (SUD by Wolpe), positive approach (PA by Egger and Merz) to attain a defined goal and the Validity of Cognition (VoC by Shapiro) were evaluated to assess the extent of the distress. These parameters were analyzed at four points of time: immediately before and after the intervention, shortly after the end of treatment and at least 7 months to 57 months after the end of the treatment. For this group of patients average values and standard deviations were calculated (in parenthesis). Following results are provided at the four points of time: SUD - reduction of distress 8,5 (1,3); 1,6 (1,7); 1,4 (1,4); 0,8 (1,2), PA - positive approach to the defined goal of therapy 3,2 (2,2); 8,2 (1,7); 8,4 (1,5); 9,0 (1,7) and VoC - positive cognition 2,9 (1,5); 6,0 (0,9); 6,0 (1,0); 6,5 (0,8). The difference between the basic values and the values at the end of treatment as well as the values in the long-term follow-up showed a significant reduction of distress (SUD: -7,0 (2,2); 0,8 (1,2); p =<0,0001), a significant positive approach to the defined goal of therapy (PA: 4,9 (2,6); 9,0 (1,7); p =<0.0001) and a significant increased positive cognition (VoC: 3,1 (1,9); 6,5 (0,8); p =<0.0001). This first observational study evaluated a standardized intervention of art therapy, not yet randomized and without a control group. The result showed a variety of hints that LOM is effective to reduce short- and long-term severe and long-lasting distress caused by various reasons and creates therefore a perfect foundation to build on with further research. Further studies with appropriate therapists trained therapists in LOM, additional clinical instruments to enlarge the evaluation, larger patient cohorts and a prospective randomized and controlled study design recommended to verify these results. Of further scientific interest would be the effect of LOM on patients with different psychological distress induced by cancer or chronical disorders.