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Arts-based interventions to reduce anxiety levels among college students


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The current study examined the therapeutic utility of creative endeavors for the reduction of anxiety among undergraduate college students enrolled in a public university in the United States. Students were randomly assigned to participate in one of three conditions: an individual art project (n = 30), a group art project (n = 30), or a non-art control project (n = 30). An overall within-subjects effect of anxiety was noted in which participants reported reduced anxiety levels following intervention. A statistical interaction showed that anxiety was reduced by both individual and group arts interventions, but not by the control condition in which participants completed puzzles. The extent of anxiety reduction did not differ between the individual and group conditions. In conclusion, although presently underutilized, arts interventions may be a viable form of anxiety-reduction among college students.
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Arts-based interventions to reduce anxiety levels among
college students
Ragan E. Aaron, Kimberly L. Rinehart and Natalie Ann Ceballos*
Texas State University, Department of Psychology, San Marcos, TX, USA
(Received 13 January 2010; final version received 25 May 2010)
The current study examined the therapeutic utility of creative endeavors for the
reduction of anxiety among undergraduate college students enrolled in a public
university in the United States. Students were randomly assigned to participate in one
of three conditions: an individual art project (n¼30), a group art project (n¼30), or a
non-art control project (n¼30). An overall within-subjects effect of anxiety was noted
in which participants reported reduced anxiety levels following intervention.
A statistical interaction showed that anxiety was reduced by both individual and
group arts interventions, but not by the control condition in which participants
completed puzzles. The extent of anxiety reduction did not differ between the
individual and group conditions. In conclusion, although presently underutilized, arts
interventions may be a viable form of anxiety-reduction among college students.
Keywords: arts intervention; anxiety; college; stress; creativity
For many students, college life represents their first experience with true independence in
an environment in which their activities are not scheduled or monitored by parental
figures. As a result, students may become anxious when confronted with multiple
obligations and time constraints. Recent studies indicate that students are increasingly
likely to work while in college; for instance, over half of students (e.g. 57%) report paid
employment, with many students working full-time (Orszag, Orszag, & Whitmore, 2001).
For these reasons, it is not surprising that the rates of anxiety among students have not yet
declined (American College Health Association, 2008). Anxiety itself, in all of its forms,
is a major concern among college and university institutions in the United States,
especially since college students are particularly prone to stress (Johnson & Arbona, 2006;
Larson, 2006; Robotham & Julian, 2006). The American College Health Association
(ACHA) reported in a National College Health Assessment consisting of over 26,500
students that 18.2% consider anxiety their greatest stressor in that it interferes with their
individual academic performance and disrupts progressive working habits (ACHA, 2008).
It has long been known that for students, anxiety has a significant debilitating effect on
learning and achievement (Gaudry & Spielberger, 1971). Research has also shown that in
the past 12 years, enrollment has increased at a faster rate of 26%, producing over 18
million students in the US alone (US Department of Education, 2009), making anxiety an
increasingly prominent issue among campuses. Not only are students frequently arriving at
ISSN 1753-3015 print/ISSN 1753-3023 online
q2011 Taylor & Francis
DOI: 10.1080/17533015.2010.481290
*Corresponding author. Email:
Arts & Health
Vol. 3, No. 1, March 2011, 27–38
college feeling overwhelmed (28% of freshmen polled), but for most, the anxiety remains
throughout the college years (Kitzrow, 2003). From this, many conclusions can be made:
current methods of anxiety prevention may not be as effective, students are not taking
steps to ensure a stress-free situation, academia is increasingly raising expectations, and
many more.
Although the extent of anxiety and stress in the average, healthy college student may
not reach clinical levels, it is obvious that students could none the less benefit from
incorporating anxiety-reducing activities into their lives. Although currently under-
utilized, art therapy and/or arts-based interventions may be a viable form of anxiety
reduction among college students. Art therapy has frequently been used to examine the
emotions and personalities of cancer patients, convicts, those with both psychotic and
mental disorders, and children in play (Gussak, 2007; Nainis, Paice, & Ratner, 2006;
Pepper, 2009; Watts & Garza, 2008). Many different forms of art therapy have been
practiced, such as art, drama, music, and movement. It has been said that “the essence of
art therapy lies in creating something,” and that the act of making personal marks on
something is innate to human existence, leaving the definition for art open as a broad
expression of creativity that anyone can partake (Case & Dalley, 1992, p. 50). Dance-
movement therapist Helen Payne suggests that all of us have the ability to react to the arts,
and for those who may struggle to understand the communication system of an
environment, art therapy might be the essential medium to clearly express themselves
(Payne, 1993). Given these discussions, art may simply be defined as a form of creative
expression a way to get out what cannot be identified inside. Payne goes on to emphasize
the non-verbal communication aspect of art therapy as what makes it a distinct and non-
threatening process of self-expression, meaning anyone can use it if properly introduced
(Payne, 1993). It is said that a person’s art is validated through its effect on the psychology
of that person (Payne, 1993); thus, no specific definition of “art” is needed as long as that
person believes their work is a meaningful creation.
In addition to art therapy as practiced by an art therapist, there is research showing an
adaptive response to the beneficial techniques that art therapy offers. Research within the
field of art therapy has inspired various attempts at simpler, art-based interventions with
clients and participants, rather than the full art-therapy process one would experience
while seeing an art therapist. For instance, in one study, an art intervention program was
effectively used to decrease the gap in educational progress scores in white versus black
sixth-grade students (Wright, 2008). Other research by Wallace-DiGarbo and Hill (2006)
describes an art intervention that was used to explore empowering at-risk (truant) youth in
the mid-Atlantic area; however, results showed no significant changes from levels of
empowerment observed at baseline examinations (Wallace-DiGarbo & Hill, 2006). In a
different study, art-based therapy was used to improve the lives of stroke patients
(Higgins, McKevitt, & Wolfe, 2005). Although no standardized measures were used,
observational data suggest that participants derived emotional benefits from this exercise.
While the majority of studies suggest beneficial effects of art-based interventions,
effectiveness data are limited; thus, additional investigation is warranted.
Other than in the populations mentioned above, the literature remains sparse with
regard to therapeutic applications of arts interventions to reduce anxiety and stress in
normal, non-institutionalized populations. In related literature, numerous studies have
shown that art may be a useful means of identifying discrepancies (i.e. inconsistent
internal emotions and external behaviors) and subconscious thought patterns within a
given therapy session (Case & Dalley, 1992; Chambala, 2008; Pepper, 2009); however,
additional work is needed to clarify the function of creative expression, as opposed to
28 R.E. Aaron et al.
focusing merely on the meaning of artistic work. The current study sought to fill this gap in
the research on the therapeutic use of art. The authors hypothesized that creative endeavors
would reduce anxiety in a normal population of healthy, undergraduate college students at
a large, public university with a diverse population.
Informed consent was obtained from each student prior to participation in the study; in
addition, all study materials were approved by the Texas State University Institutional
Review Board.
The participant sample was composed of 90 undergraduate college students (29 male).
Statistical results with degrees of freedom corresponding to Ns of less than 90 reflect
missing data. Participants ranged from traditional college freshman to non-traditional
students up to the age of 54 years; however, data regarding participants’ ages were
collected verbally as part of the scheduling processes and were not included as
exclusionary or demographic factors. Students were recruited through in-class
announcements and fliers at a large, public university in central Texas, USA. There was
no monetary compensation for participants; however, professors in the Department of
Psychology agreed to offer extra credit to participating students.
Materials and Procedures
Participants were randomly assigned to participate in one of three conditions: individual
art project, group art project or non-art project (e.g. a control group which performed an
academic activity). Thirty participants were assigned to each condition. Because it is
possible that the idea of being asked to create a form of “art” may be intimidating and in
itself stressful for some, the decision was made to provide a guided art project with the
administration of concrete instructions to avoid confusion. However, the project was also
designed to allow for individual interpretation and the utilization of expressive creativity.
Thus, the participants in the group intervention condition were allowed to discuss and
reach consensus with regard to their ideas about the ultimate outcome of the group’s art
Anxiety levels were assessed using the state version of the Spielberger State/Trait
Anxiety Inventory (SSAI; Spielberger, 1983a,b) both before and after all sessions,
regardless of condition (e.g. individual, group and non-art control), to determine the
impact of an arts intervention vs. control conditions on state anxiety. In addition, prior to
the artistic session, participants completed a brief demographic questionnaire. For all
groups, completion of the project period required approximately 30 – 45min. At the end of
the session, participants were asked to complete a short debriefing questionnaire, which
included ratings of their feelings about the project and its effectiveness at reducing
Demographic Information. Background characteristics, including self-reported gender,
ethnicity (Caucasian, Hispanic, African American, other), marital status (married,
divorced, widowed, engaged), living arrangements (on campus, off campus apartment,
rented home or owned home), employment status (unemployed, one job, multiple jobs),
number of hours enrolled in school, and number of hours spent working per week, were
Arts & Health 29
assessed. Time of day that testing session was conducted (morning or afternoon) was also
recorded. See Table 1.
Anxiety Measures. State and trait anxiety were measured using the Spielberger State-Trait
Anxiety Inventory (STAI; Spielberger, 1983a,b). The STAI is a standard instrument for
the assessment of anxiety in the laboratory setting, and it is particularly amenable to
repeated-measures assessments in which interventions may lead to modulation of emotion
(Spielberger, 1983a,b). The STAI is composed of two forms, the T-scale, which measures
trait anxiety, and the S-scale, which measures state anxiety. Each scale is composed of the
same 20 statements to which participants indicate their level of agreement using a Likert-
type scale. The difference between the T- and S-scales is in their instructions. The trait
anxiety form asks participants to respond to the statements by indicating how they
“generally” feel, while the state version asks participants to respond to the statements by
indicating how they feel “right now at this moment”. The state version was designed to be
sensitive to the conditions under which the instrument is given; that is, if changes in
anxiety occur over a short period of time due to an intervention of some kind, then these
changes in anxiety should be evident in the scores of repeated assessments of the STAI
state version. It is important to note that the statements included in the STAI are not
designed to address which aspects of life or a given situation may be responsible for
modulation of anxiety. In the current study, trait anxiety was determined as part of the
demographic/background variables assessment; whereas the S-scale of the STAI was used
to measure changes in anxiety before vs. after the arts intervention.
The STAI has been normed by Spielberger and colleagues (1983a,b): the mean state
anxiety value for college students was 36.47 (SD ¼10.02) for the 324 males tested and
38.76 (SD ¼11.95) for the 531 females tested. The mean trait anxiety value for college
students was 38.30 (SD ¼9.18) for males and 40.40 (SD ¼10.15) for females. Baseline
values for both state and trait anxiety observed in the current study are, therefore,
comparable to what one might expect to observe in a healthy college student population.
As reported by Spielberger (1983a,b), the STAI has good reliability and validity (see also
Barnes, Harp, & Jung, 2002). Test retest reliability of the T-scale is reasonably high for
college students, with values ranging from .73 to .86. Because of the transitory nature of
state anxiety, measures of internal consistency such as the alpha coefficient may provide a
better index of reliability for the S-scale, which has a median Cronbach’s alpha value of
.93. The trait version of the STAI shows good concurrent validity, as evidenced by
relatively high correlations between the T-anxiety scale and other classic anxiety
measures (e.g. the IPAT Anxiety Scale; Cattell & Scheier, 1963; r¼.79 .80). Further,
both the T- and S-scales show high construct validity, as T-scale values are higher among
clinically anxious groups (mean value ¼49.02, SD ¼11.62) vs. healthy college students,
and S-scale values are higher when collected under conditions of stress (i.e. immediately
before an exam; mean ¼54.99) vs. under non-stressful conditions (i.e. mean ¼40.02).
Further, the S-scale is sensitive to reductions in stress as well (i.e. mean under normal
conditions ¼36.99; under relaxed conditions ¼32.70). For these reasons, the STAI
was selected as the most appropriate instrument for the study reported in the current
Arts Intervention Protocol
Individual Condition. In the individual condition, two paper towels, a cup of water, a
paintbrush, a marker, a pallet of watercolors and a pre-labeled sheet of watercolor paper
30 R.E. Aaron et al.
Table 1. Description of Participant Population.
Characteristic Frequency Percent
Demographic characteristics of participants
Total 90 100
Male 29 33.2
Female 60 66.7
Unidentified 1 .1
Caucasian 57 63.3
Hispanic/Latino 26 28.9
African American 3 3.3
Other 3 3.3
Missing 1 1.1
Marital status
Single, never married 80 88.9
Engaged 3 3.3
Married 3 3.3
Divorced 2 2.2
Widowed 2 2.2
Academic characteristics of participants
Total 90 100
Liberal arts or science 51 56.7
Education or health professions 20 22.2
Fine arts and communication 7 7.8
University college (undecided majors) 7 7.8
Applied arts or business 5 5.6
Credit hours of current enrollment
0 12 29 32.2
13 16 55 61.1
17 20 5 5.6
More than 20
Habitation characteristics of participants
Total 90 100
Residential status
Apartment or townhome 41 45.6
Dormitory or on-campus living 29 32.2
Home – rent 10 11.1
Home – own 6 6.7
Other 4 4.4
Roommates or Cohabitants
None 13 14.4
One 31 34.5
Two 19 21.1
Three 18 20
Four or more 9 10
Employment characteristics of participants
Total 90 100
Employment status
Not working 38 42.2
Working one job 43 47.8
Working two jobs 9 10
Employment schedule (N¼53)
Part-time 40 44.4
Arts & Health 31
were placed on a table in front of the participant. The following script was then read to the
You will now participate in a guided art project. I would like to emphasize that the meaning of
each direction I give will be left to your own interpretation. There are no right or wrong ideas
nor a specific way to draw and paint in this project. You are encouraged to use the entire
canvas. There will be no time constraint on the guided part of this project. I am not here to
judge your artwork, only to give basic instructions of the project and answer any questions you
may have.
The students began by drawing 12 lines with a marker on their paper, instructed only
on the type of line. The instructions proceeded as follows:
Instructor: Draw a wavy line on your paper.
(Participant draws a line).
Instructor: Draw a horizontal line on your paper.
The 12 line types included horizontal, thin, dotted, parallel, wavy, perpendicular,
rhythmic, spiral, vertical, zigzag, radiating and thick, in that specific order. After finishing
the 12 lines, the participant was read the following:
Pick up your canvas, spin it around, and look for a pattern or picture that you like. Choose
which side you want to be at the top of your picture, and set it back down.
The next step is to add color with the watercolors however you would like. You can use any
color or mixture of colors. You will have 15 minutes to complete this portion of the project.
I will give you a two minute warning when your time is running out. When painting, dip your
brush in water and mix it with the color you prefer. After finishing with a color, rinse the brush
in the water cup and wipe it on the towel to get the previous color off. Repeat for each color.
When you are finished with your painting, please return to the main room where I will have
you complete the last written sections.
After the participants finished the art project, a photograph was taken of the painting
and a label with the corresponding ID number for further research.
Group Condition. The students assigned to the group projects were divided into eight
groups varying from two to five people. Participants were given the same instructions as in
the individual condition, except that they were told to take turns drawing the lines on the
16 £20 sheet of paper. They were also told to use group consensus to decide how to apply
the watercolors by talking and deciding among themselves. At this point, the investigator
exited the intervention room, allowing for characteristics of individuals’ participation in
the group arts intervention to remain undisclosed.
Table 1 – continued
Characteristic Frequency Percent
Full-time 3 3.33
Volunteer basis 9 10
Work-study*1 1.1
Employment hours (per week) (N¼53)
1 20 34 37.8
21 30 15 16.7
More than 30 4 4.4
*Work-study is a program in which the student is employed by the university, and paychecks are directly
deposited into tuition accounts to pay the tuition balance. **Statistical results with degrees of freedom
corresponding to Ns of less than 90 reflect missing data.
32 R.E. Aaron et al.
Control Condition. The control group was given their choice of Sudoku and word puzzles
to complete during the 20-min session.
Participants were given the following instructions:
You will now have 15 minutes to work on this puzzle packet or read from this newspaper. You
are not required to go in any particular order or finish any puzzle. When the time is up, I will
return to bring you back to the main room to finish your surveys and take your puzzle-packet.
After the individual, group, or control projects, participants were escorted to a separate
room and asked to complete the SSAI once again, in order to detect any changes in anxiety
levels, which could be related to the arts condition. Following the final SSAI, participants
completed a debriefing questionnaire and were presented with their own copy of a
debriefing form.
Debriefing Questionnaire. Participants involved in the individual and group art projects
were given a short survey asking questions regarding the participants’ feelings as well as
the effectiveness of the project they had just completed. We also asked approximately how
often the participant takes part in artistic activities on a regular basis.
Students participating in the non-art project were given a separate questionnaire asking
about their feelings regarding the puzzles they had finished as well as the effectiveness of
the project in reducing anxiety. We also asked these participants how often they participate
in puzzle or word activities and if they found any of the puzzles difficult. Once the data had
been gathered, we compared the answers as well as the amount of positive and negative
words that the participants used in each of the debriefing questionnaires. We also took note
of the number of puzzles that were attempted and/or completed for those who participated
in the non-art activity.
Data Analysis
Data were analyzed using SPSS 16.0. Distribution of categorical variables such as gender,
ethnicity, marital status, living arrangements, employment status and time of day that
testing session was conducted within the art groups was analyzed using Chi-squared
statistics. Group (individual art, group art or no art) differences in the continuous variable
of trait anxiety were determined via analysis of variance (ANOVA).
The main analysis of interest was designed to determine whether or not state anxiety
changed due to the group assignment (individual art, group art or no art). These data
were analyzed via repeated measures ANOVA with art group as the between-subjects
variable and state anxiety as the within-subjects variable. Bonferroni-corrected pair-wise
comparisons were employed to determine the location of between-subjects effects.
In addition, to determine whether the extent of change of the anxiety scores differed
between individual and group sessions, a difference score was created by subtracting the
post-intervention state anxiety level from the baseline anxiety level. Individual and group
sessions were compared on this variable via ANOVA.
Background Variables
Individuals within the three conditions were well matched on all background
characteristics. Across groups of participants completing the individual and group art
projects and the non-art project, the study population was predominantly female (e.g. 73%,
66% and 63% female, respectively). Gender distribution did not differ significantly across
Arts & Health 33
conditions (x
(2) ¼.75; p¼.69). Race/ethnicity was also equivalent across conditions
(e.g. 55%, 67% and 70% Caucasian, respectively; x
(6) ¼1.73; p¼.94), as was marital
status (e.g. 90%, 90% and 87% unmarried/single; x
(8) ¼4.03; p¼.86). Thirty-seven
percent of participants in the individual art project condition reported living on-campus.
For the group art project and non-art conditions, the percentage of on-campus living was
23% and 37%, respectively. Across conditions, the living situations of participants did not
differ significantly (x
(8) ¼3.34; p¼.91). The majority of participants were employed
(individual art condition ¼67%, group art condition ¼53% and no-art condition ¼53%),
and employment status did not differ across conditions (x
(4) ¼2.95; p¼.57). Expanded
demographic, academic, habitation and employment characteristics are shown in Table 1.
Further, conditions did not differ with regard to the time of day at which the testing
session was conducted (e.g. morning vs. afternoon sessions), an important experimental
control as stress hormones are known to be present in higher levels during the morning
hours. With regard to trait anxiety, participants within the individual art condition
(M ¼38.27; STD ¼9.20), group art condition (M ¼37.77; STD ¼12.8), and non-art
condition (M ¼38.57; STD ¼11.71) did not differ significantly (F(2,87) ¼.38; p¼.96).
Arts Intervention
An overall within-subjects effect of anxiety was noted in which participants reported
reduced anxiety levels following intervention (F(1,85) ¼24.25; p,.001). However,
anxiety levels were moderated by art therapy condition assignment, as evidenced by a
statistical interaction between anxiety and art intervention condition (F(2,85) ¼10.29;
p,.001). Between-group differences in overall state anxiety were not significant
(F(2,85) ¼.68; p¼.52).
Follow-up analyses consisted of repeated measures ANOVAs per group and revealed
significant reductions in anxiety as a consequence of intervention within the individual
art condition (F(1,29) ¼50.39; p,.001) and in response to the group art condition
(F(1,28) ¼28.50; p,.001); however, anxiety levels were not significantly affected by
Figure 1. State Anxiety at Baseline and after Arts Intervention. Results Indicated that Anxiety was
Reduced by both Individuals and Group Arts Interventions; Whereas Anxiety did not Change over
Time within the Non-art Control Condition. Note:*p,.001; Statistical results with degrees of
freedom corresponding to Ns of less than 90 reflect missing data.
34 R.E. Aaron et al.
the control condition (e.g. non-art condition) (F(1,28) ¼.42; p¼.52). These results are
shown in Figure 1.
ANOVA comparisons of differences scores (baseline minus post-intervention anxiety
levels) indicated no significant difference ( p¼.78) between anxiety reduction in the
individual art condition [Mean Difference ¼6.1; Std Dev ¼4.7] vs. the group sessions
[Mean Difference ¼6.5; Std Dev ¼6.6]. Examination of the effect size of the
intervention effect evident in pre-/post-intervention scores revealed a large effect size for
both the individual art condition and the group art condition (Cohen’s d¼.80 and .68,
respectively; see Table 2).
Art can be created anywhere by anyone. The above design was chosen as an easy, tangible
art project that could be used to help students calm and relax themselves during times of
increased stress. The participant population of the current study was an excellent
representation of a variety of college students and the different lifestyles they lead. In
addition to their studies, many students in our sample were employed or volunteering
while simultaneously balancing the independence of the college setting, many for the first
time. As shown in the research literature on this topic, anxiety is an increasingly dominant
factor in the lives of undergraduate college students, thus it is important to identify outlets
for this negative emotion in order to avoid adverse effects on mental and physical well-
being. Although art therapy is currently underutilized in college settings, the results of the
current study suggest that art-based interventions may be used as a tool to reduce anxiety
in many situations such as prior to important events or tests or to simply create a balanced
sense of well-being during stressful times.
In the current study, students within both individual and group art project settings
reported significantly reduced levels of state anxiety post-intervention; conversely, those
in the non-art project group showed no significant changes in state anxiety levels.
Importantly, this finding appears to be solely attributable to the art intervention, as the
three groups (individual art project, group art project and non-art project) were well
matched with regard to demographic information, as well as trait anxiety levels.
According to difference scores (pre-art/post-art state anxiety levels), the extent of the
reduction in anxiety for the art intervention groups did not differ between individual and
group projects, indicating that art-based interventions may be an effective means of
reducing state anxiety regardless of setting.
Similar to percentages reported by Orszag et al. (2001), many students in our sample
were employed (57%) with more than 75% working part-time and 10% working more than
one job. Over half (55%) of the students assigned to the individual and group art projects
reported that they believed the art intervention was “very effective” in reducing anxiety.
Table 2. State anxiety scores before and after arts intervention: Means (Standard Deviation), Range*.
condition Baseline
intervention Statistics
Individual art project 35.0 (8.3), 20 48 28.8 (7.1), 20 49 Cohen’s d¼.80 (large effect)
Group art project 36.3 (10.8), 20 60 29.4 (9.5), 20 58 Cohen’s d¼.68 (large effect)
Non-art (control)
33.2 (8.3), 20 48 34.8 (7.6), 20 48 n.s.
*Statistical results with degrees of freedom corresponding to Ns of less than 90 reflect missing data.
Arts & Health 35
Further, 32% agreed that it was “somewhat effective,” and only one person indicated that
the art intervention was “not at all effective.” Eleven percent of participants reported that
they were not sure whether or not the intervention was effective. Taken together, these
findings may be supported by previous reports suggesting that a piece of work is indeed
considered “art” as long as it is meaningful to the individual who created it (Case & Dalley,
1992). Based on the findings of the current study, the authors suggest that widespread
promotion of and easy access to art interventions in the college setting could lead to lower
anxiety levels and a more healthy and optimistic campus environment.
While the results of this study indicate a strong effect of artistic activities in reducing
whatever levels of anxiety existed within the population, limitations remain to be addressed
in subsequent studies. First, the current study used a “convenience sample” composed of
college students at one university in South Central United States. Although our sample was
ethnically diverse and composed of both males and females, it is possible that we would find
different results if we used a multi-site approach encompassing a wider variety of
individuals from across the country or perhaps internationally. Additionally, the current
study was limited to a single experimental session for each participant. It is possible that a
more extensive, long-term option with multiple, guided art projects would produce a larger
anti-anxiety effect. Art therapy involves an art therapist that works with the client and his or
her personal issues through the medium of art. With this therapeutic approach, the client is
much more likely to experience significant reduction of chronic anxiety levels. In addition,
examination of the potential anti-anxiety effects of artistic interventions among patients
with clinical diagnoses could lead to improvements in the prevention and treatment of
mental health issues related to stress. Finally, the current study was not limited to enrollment
of only anxious individuals; rather, all students were invited to participate regardless of
current levels of anxiety. Although the numbers of individuals with elevated anxiety prior to
participating in the intervention (using the liberal criterion of a baseline STAI score greater
than or equal to 45, based on clinical participant groups outlined in Spielberger, 1983a,b), an
exploratory, observational analysis indicated that among the 10 participants within the arts-
intervention conditions (five individual condition, five group condition), eight experienced
a reduction in anxiety post-intervention. Of those who did not experience a reduction, one
participant failed to adequately complete the questionnaire, and the remaining participant
experienced a one point increase in anxiety post-intervention (e.g. 48 pre- vs. 49 post-
Regardless of the wide range of anxiety levels included in the current study, results
suggest that, overall, any level of anxiety that existed within the population was reduced
significantly by the arts intervention but not by the non-art control intervention. These
results show promise for the development of new ways in which to help college students to
deal more effectively with even low to moderate levels of anxiety. Given that this strategy
works in the short term, it is logical to suggest that incorporation of regularly scheduled arts
interventions or activities into the daily lives of college students could ultimately provide a
healthy, constructive outlet for stress and anxiety. Such outcomes remain to be measured
via longitudinal research, and these studies are currently underway in our laboratory.
While participants, regardless of group assignment, did not differ with regard to levels of
trait anxiety, individuals within the individual art and group art project conditions
36 R.E. Aaron et al.
experienced a significant decrease in state anxiety following the arts intervention.
However, state anxiety levels were not significantly affected by the non-art control
condition. The extent of anxiety reduction, as measured via difference scores (pre-art
minus post-art state anxiety level) did not differ between the individual and group
conditions, suggesting that art may have a therapeutic effect on anxiety levels regardless of
setting. Taken together, these results suggest that art-based intervention projects may be a
viable means of anxiety reduction for college students.
1. This protocol is a modification of an unpublished exercise devised by Joan Nagel, Laura
Dickerson and Linda Kelsey-Jones in 1996 for use in the school systems of Central Texas,
available on request from corresponding author.
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Arts & Health 37
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Appendix: Protocol for Arts Intervention
Study materials for the art project included 30 9 £12 and 8 16 £20 sheets of watercolor paper,
watercolor paints in various colors, pencils, permanent markers, and paintbrushes. For the control
condition, which utilized an academic activity as opposed to a creative activity, photocopied packets
of Sudoku and four word-find puzzles were used.
Experimental Conditions
The three experimental conditions included an individual art project, a group art project, and a non
art project. The individual and group art projects were extremely similar, and differed only with
regard to the number of people who were required to work together to complete the project. In the
individual project, the participant was alone in a room, drew all 12 lines following the instructions,
and added the watercolor to the project individually. Within the group condition, sessions employed
two to five people in which the participants had a larger sheet of paper, were told to take turns
drawing the 12 lines, and were told to decide, as a group, how to apply the color. In both the
individual and group projects, the line-drawing part was guided by the experimenter, while the
individuals were left alone and given 15 min for the color-adding session.
Participants in the control group were offered exact copies of packets with a variety of word and
Sudoku puzzles to complete in their allotted time (20 min). The puzzle packet included an easy,
medium, hard, and difficult Sudoku puzzle, as well as four different word search puzzles. The
participants were told that they were not required to work in any particular order or complete any of
the puzzles.
38 R.E. Aaron et al.
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... Art therapy, yoga and meditation have been linked to positive psychosocial adjustment (Henderson et al., 2013), beneficial changes in cerebral blood flow (Kaimal et al., 2017;Monti et al., 2012), decreases in the cortisol awakening response (CAR) (Ratanasiripong, Park, Ratanasiripong, & Kathalae, 2015), perceived stress and anxiety symptoms (Aaron, Rinehart, & Ceballos, 2011;Bamber & Schneider, 2016;Caldwell et al., 2010;Deckro et al., 2002;Eaton & Tieber, 2017;Oman et al., 2008;Sundquist et al., 2015) and improved overall well-being (Caldwell et al., 2010;Prazak et al., 2012;Schure et al., 2008;Slayton et al., 2010). Researchers have identified possible hormonal and immunological evidence that mindfulness meditation can contribute to psychological resilience in treating adults with Generalized Anxiety Disorder (GAD) (Hoge et al., 2018). ...
... It has the ability to expedite emotional expression, facilitate catharsis, and concretize and symbolize more abstract concepts like thoughts and feelings (Sholt & Gavron, 2006). Furthermore, it has also been demonstrated to significantly decrease salivary cortisol levels (Kaimal et al., 2016), negative mood (Kimport & Robbins, 2012) and anxiety (Aaron et al., 2011). This literature to date has focused on the intrinsic therapeutic qualities of clay, as studies have been limited to single-session, lab-centric research designs, investigating what is happening during the art making or immediately afterwards. ...
Stress and anxiety pose a threat to college students’ academic performance as well as their long‐term mental and physical health, but the time constraints of a rigorous academic schedule make it difficult to offer even brief mental health interventions. A convenience sample of full‐time students at a public university were recruited for a five‐week study conducted mostly using an online platform. Participants were randomly assigned to a Mindfulness‐Based Art Therapy (MBAT) intervention or a Neutral Clay Task (NCT). Anxiety, perceived stress, and salivary cortisol outcomes were measured. A total of n = 77 participants completed the study. The MBAT group experienced significant reductions in anxiety and perceived stress compared to the NCT group. Significant reductions in salivary cortisol were observed, but only time could be identified as a confounding variable. Art‐making alone is not enough to induce significant positive responses, but this study suggests MBAT can, and that an online intervention could offer feasible and accessible mental health services on college campuses. Further refinement of biological data collection and analysis is needed to determine what the mediating effects MBAT could have, if any, at the molecular level. This article is protected by copyright. All rights reserved.
... A study on Arts-based interventions to reduce anxiety levels among college students (Aaron et al., 2011) examined the therapeutic utility of creative ventures for the reduction of anxiety among undergraduate college students enrolled at a public university in the United ...
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Book Available online at: PREFACE The core psycho-educational principle is education has a role in emotional and behavioral change. With an improved understanding of the causes and effects of the problem, psycho-education broadens the person's perception and interpretation of the problem, and this refined view positively influences the individual's emotions and behavior. Consequently, improved awareness of causes and effects leads to improved self-efficacy (the person believing that he can manage the situation), and improved self-efficacy leads to better self-control. In other words, the person feels less helpless about the situation and more in control of himself or herself. Educating people about their mental issues can be an effective way for them to get the facts and learn effective coping strategies so that they take the steps necessary in helping themselves. Psycho-education is not a treatment; in clinical settings, psycho-education is the first step of the overall treatment plan.
... Art-based interventions effectively increased selfknowledge and self-efficacy (Sonke et al., 2021). Among university students, art-based interventions were beneficial in both individual and group settings (Aaron et al., 2011). One such self-supportive method is art journaling, which was shown to reduce anxiety and negative affect (Mercer et al., 2010) and enhance self-discovery (Hieb, 2005). ...
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This study investigated art therapy–based self-help online tasks (ATB-SHOT) as a means to support university students during the COVID-19 lockdown by (a) measuring effectiveness on mood repair (Positive and Negative Affect Schedule and Self-Assessment Manikin scales, pre- and postintervention) and (b) correlating outcomes with participants’ personality profiles (resourced profile [resilience and emotional intelligence] and a vulnerability profile [trait anxiety and somatic complaints]). Based on data from 57 participants, findings indicate that all ATB-SHOT tasks significantly reduced negative mood and two increased positive mood and control. Participants with a vulnerability profile showed greater reduction in negative emotions. The significance of the research demonstrates that students in challenging emotional situations could benefit from ATB-SHOT tools.
... A metasynthesis conducted by Strickhouser et al. (2017) suggested that personality predicts overall health and well-being. In addition, several studies indicate that personality predicts which activities people choose to engage in (Wolfradt and Pretz, 2001;Aaron et al., 2011;Gil De Zuniga et al., 2017;Gjermunds et al., 2020). Thus, we investigated how personality, as measured by the TIPI, related to anxiety levels and which extra-curricular activities individuals chose to participate in during the pandemic. ...
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Participation in extra-curricular activities has been found to associate with increased well-being. Here we investigated in a survey (n = 786) what activities university students at a Canadian university engaged in during the stressful COVID-19 pandemic lockdown in April, 2020, which coincided with a novel online exam period, and how these activities related to perceived well-being, anxiety (STAI-S), social aspects of activities, and personality. Sixty-five percentage of students scored in the high anxiety category of the STAI-S, an alarming statistic given that only 24% had reached out for professional supports. This is consistent with reports that current supports on university campuses are inadequate. Listening to music (92%) and watching movies/series (92%) were engaged in most frequently, followed by socializing virtually (89%) and engaging in social media (85%). The activities students rated as most helpful to their well-being were somewhat different, with outdoor exercise rated highest, followed by socializing virtually and listening to music. While all activities were rated as beneficial, those with a social component tended to have high ratings, consistent with students attempting to replace lost social interactions. Linear regression models found few associations between STAI-S scores and other measures, likely because of large individual differences and lack of a pre-pandemic baseline needed to assess changes in anxiety. The importance of individual differences was evident in that those higher in conscientiousness or extraversion or emotional stability were more likely to engage in exercise, while those higher in openness to experience were more likely to engage in journaling, playing a musical instrument, or singing, with a trend for higher engagement in song writing. Individual differences were also evident in that equal numbers of students gave positive and negative comments related to their well-being during the pandemic. The individual differences uncovered here suggest that having a variety of proactive interventions would likely reach more students. Indeed, 52% indicated an interest in online group music therapy, 48% in art therapy and 40% in verbal therapy, despite music and art therapies being virtually non-existent on campuses. In sum, the findings highlight the importance of choice in extra-curricular activities and therapies that support well-being.
... Our research investigated the potential for creative movement and art to decrease stress and improve mood in college students. Although previous research has supported the benefits of movement and art on emotional states (Aaron, Rinehart, & Ceballos, 2011;Bell & Robbins, 2007;Bräuninger, 2012a), there has yet to be a direct comparison of their effectiveness. Based on past work, we hypothesized that both movement and art would lead to increased positive affect and a decrease in negative affect and stress. ...
The objective of this study was to determine if either creative movement or art were effective in decreasing stress among college students and improving their mood. Sixty participants were randomly assigned to either a movement (n = 30) or an art (n = 30) intervention. Before the intervention, participants in both conditions wrote about a current stressor, rated their perceived intensity of the stressor, and completed a mood questionnaire (Positive and Negative Affect Schedule; Watson et al., 1988). Following the intervention participants again completed the mood questionnaire, wrote about a current stressor, and rated their perceived intensity of the stressor. Two-way ANOVAs (group x time) found significant reductions in stress (p < .001) and negative affect (p < .001), in addition to increases in positive affect (p = .007) for both groups from pre- to post-intervention. Our results suggest that briefly partaking in creative movement or art can psychologically help college students in the short-term.
... Such process helps deepen the exploration and expression of the emotions, and provides opportunity for the participants to change their perspectives. To the best of our knowledge, although EABI has shown beneficial effects on the psychosocial well-being of various groups, such as students (Aaron et al., 2011), children in need (Coholic et al., 2012), family caregivers (Walsh et al., 2004), teachers (Ho et al., 2012) and domestic violence survivors (Lai, 2011), no empirical research has been conducted on adults with ID in any context. Given the increasing use of arts intervention in healthcare settings, there is an urgent need for evidence-based research to assess its effectiveness. ...
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Background People with intellectual disabilities have difficulties expressing their views and can manifest psychological and behavioral symptoms. The present study aimed to examine the effects of expressive arts–based intervention (EABI) on the behavioral and emotional well-being of adults with intellectual disabilities.Methods This study assigned 109 Chinese adults with intellectual disabilities into EABI (N = 55) or control groups (N = 54) using stratified randomization. Pre- and post-intervention quantitative assessments were conducted of aberrant behaviors, personal well-being, mood and color usage in drawings. Focus group interviews were conducted with the EABI participants and their caseworkers at the post-intervention stage. Repeated-measures analysis of covariance evaluated the EABI effects with age, gender and degree of intellectual disability as covariates, and latent profile analysis examined the patterns of color usage in drawings. Qualitative thematic analysis was performed on the interview data.ResultsThe interview findings suggest that the EABI group was more emotionally expressive and stable after the intervention. Compared to the control group, the EABI group tended to use more diverse colors and leave less empty space in their drawings. No significant overall improvements were found in the EABI group with respect to aberrant behaviors, mood or personal well-being. Among males, the EABI participants showed significantly more anger and less energetic moods than those in the control group. Among females, the EABI participants showed significantly lower levels of aberrant behavior than those in the control group.Conclusion The results of this study suggest that expressive arts–based interventions have different effects on the emotional and behavioral well-being of male and female participants. Moreover, increased color usage may imply a more positive state of emotional well-being.
... Arts-based interventions have been shown to reduce anxiety in college students (Aaron, Rinehart, & Ceballos, 2011;Harter, 2013;Willer & Kellas, 2019). Correspondingly, social identity mapping, which involves participants drawing connections to their different social groups, increases self-esteem and belongingness (Haslam et al., 2016). ...
In this dissertation, I explore the benefits of developing an intervention entitled ethnic-racial socialization mapping. Previously, researchers have developed the importance of establishing a secure ethnic-racial identity in ethnic-racial minority populations, as it is tied with increased well-being. Additionally, researchers have called for interventions that highlight the role of ethnic-racial socialization in minority populations, as this process is connected with a secure ethnic-racial identity. I answer these calls by reviewing current research, leading to the creation of ethnic-racial socialization mapping as an identity intervention. In chapter 1, I explore how ethnic-racial identity and ethnic-racial socialization has been conceptualized, as well as why ethnic-racial socialization mapping offers a unique, visual intervention. In chapter 2, I overview my methodology for answering my hypotheses and research questions. Using a three-group pre-test posttest experimental design, I tested the efficacy of the use of ethnic-racial socialization mapping for improving participant secure ethnic-racial identity and well-being. In one treatment group, participants engaged in ethnic-racial socialization mapping. In another treatment condition, participants engaged in ethnic-racial socialization mapping and reflected on their familial conversations about ethnicity and race. In chapter three, I overview the efficacy of the ethnic-racial socialization intervention. I found partial support for ethnic-racial socialization mapping as an intervention. In chapter four, I examined the ethnic-racial socialization maps to see if there were different types of families. I developed a four-group typology of maps that indicate different dimensions of ethnic-racial socialization. I also compared family types ethnic-racial identity measures and well-being measures. In chapter 5, I overview discourses of ethnic-racial socialization in participant interviews. Overall, I found five themes that characterized participant experiences. Lastly, in chapter 6, I explore the implications of these findings for future researchers, as well as how family communication can move forward using these findings. Superviser Professor Jordan E. Soliz
It is universally recognized that cadaveric dissection is an essential part of anatomy training. However, it has been reported to induce mental distress in some students and impair their intrinsic motivation to study. One of the postulated reasons for this behavior is the lack of adequate information and preparation of students for cadaveric dissection. Therefore, it is hypothesized that providing relevant information prior to cadaveric dissection will ameliorate the mental distress, enhance the intrinsic motivation of students, and improve their academic performance. A cohort of occupational therapy students enrolled in an anatomy course were psychologically prepared for cadaveric dissection. Students were provided with a curated list of YouTube videos and peer‐reviewed journal articles related to cadaveric dissection prior to the commencement of the anatomy course. All students were also required to attend an oral presentation immediately before commencing dissection. The control group included students who had not been provided with any resources in preparation for cadaveric dissection. Compared to the control group, students who had been prepared demonstrated better quality of cadaveric dissection, improved academic performance, reported less mental distress and greater intrinsic motivation. Moreover, students reported the oral presentation to be most relevant and journal articles to be least useful in their preparation. Therefore, this is an effective approach in the amelioration of mental distress and improvement of performance in anatomy students. Consequently, this study represents a paradigm shift in the pedagogy of anatomy, and could represent a vital element in the evolution of a revitalized anatomy curriculum.
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This paper presents a technique for structuring writing prompts in Narrative Medicine as a way to promote a reconsideration of medical professionals’ privilege in relation to non-medical professionals. The interest in such a reconsideration of privilege has become increasingly evident in faculties of medicine as a result of #MeToo. As well, it has evolved as a point of discussion within this journal, Survive & Thrive. That medical professionals not be overburdened has been recognized as imperative for the possibility of change. In one multidisciplinary educational setting, including equal participation with non-medical professionals, physicians’ feelings of being overwhelmed have been reduced with respect to their health research. The use of writing prompts is well known to faculties of medicine; however, the idea that there is a particular way prompts can be structured in Narrative Research for maximum benefit is not. The technique for structuring writing prompts, including the promotion of drawing by participants, is offered and a justification for the technique presented with respect to the reconsideration of privilege.
Art therapy process groups can be used at university counseling centers (UCCs) to treat the mental health needs of higher education students. The authors, art therapists employed at a UCC, developed an art therapy group to engage undergraduate students in creative self‐expression to increase social connection and learn healthy skills to improve insight and emotional well‐being. Such groups offer unique benefits to participants and would be a valuable addition to current UCC services.
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This study examined how activity and engagement qualities were related to stress. Experience sampling using e-mail pagers collected simultaneous ratings of stress and qualities of activity for 30 college women during 14 days. Surveys included narrative questions about activity types, feelings, and experience and Likert-type scales rating activity qualities and stress. A total of 2,327 surveys were analyzed using descriptive, configural frequency, and qualitative analyses. Students rated 34% of all events as stressful. Most were academic tasks (41%), overrepresented compared to overall frequency. Finding an activity to be high in complexity was most likely to lead to perceptions of increased stress for students; however, there were also social circumstances and low complexity activities in which stress was experienced.
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Art therapy has been used in a variety of clinical settings and populations, although few studies have explored its use in cancer symptom control. The specific aim of this study was to determine the effect of a 1-hour art therapy session on pain and other symptoms common to adult cancer inpatients. A quasi-experimental design was used (n = 50). The Edmonton Symptom Assessment Scale (ESAS) and the Spielberger State-Trait Anxiety Index (STAI-S) were used prior to and after the art therapy to quantify symptoms, while open-ended questions evaluated the subjects' perceptions of the experience. There were statistically significant reductions in eight of nine symptoms measured by the ESAS, including the global distress score, as well as significant differences in most of the domains measured by the STAI-S. Subjects overwhelmingly expressed comfort with the process and desire to continue with therapy. This study provides beginning evidence for the efficacy of art therapy in reducing a broad spectrum of symptoms in cancer inpatients. © 2006 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
nature of anxiety and anger as emotional states and the procedures employed in their measurement are reviewed briefly / the measures of state and trait anxiety are discussed, and the development of the State-Trait Anxiety Inventory (STAI) is described in some detail / examine conceptual ambiguities in the constructs of anger, hostility, and aggression, briefly evaluate a number of instruments developed to assess anger and hostility, and describe the construction and validation of the State-Trait Anger Scale (STAS) / expression and control of anger are considered, and the development of the Anger Expression (AX) Scale and the State-Trait Anger Expression Inventory (STAXI) are described / concludes with a discussion of the utilization of anxiety and anger measures in treatment planning and evaluation
This report describes an art-based intervention program with at-risk youth that was inspired by the Project Self- Discovery model (Milkman, Wanberg, & Robinson, 1996). Twelve middle-school students from a small city in a mid- Atlantic state participated in the program. The program goals included making art in order to empower the participants through self-expression and community building. Complete data were obtained for six of the participants. The probabilities (not chance) that the program produced positive trends in change ranged from 70% to 80%. Two dimensions— attitudes and psychological adjustment—reached the highest probabilities (p = .078). The small sample size and the brief nature of the intervention (10 hours total) limited both the ability to generalize and the statistical power of the analysis.
This paper reviews the literature on the changing mental health needs of today’s college students and the challenges posed by both the growing number of students with serious psychological problems on campus and the increase in the number of students seeking counseling. The implications of student mental health problems for students, faculty, staff, and the institution are discussed, as well as some strategies for responding to the surge in mental health needs on college campuses.
A reliability generalization study for Spielberger’s State-Trait Anxiety Inventory (STAI) was conducted. A total of 816 research articles utilizing the STAI between 1990 and 2000 were reviewed and classified as having (a) ignored reliability (73%), (b) mentioned reliability or reported reliability coefficients from another source (21%), or (c) computed reliability for the data at hand (6%). Articles in medically oriented journals were shorter and somewhat less likely to mention or compute reliability than nonmedically oriented articles, perhaps due to paradigm differences. Average reliability coefficients were acceptable for both internal consistency and test-retest, but variation was present among the estimates. State test-retest coefficients were lower than internal consistency coefficients. Score variability was predictive of internal consistency reliability for scores on both scales. Other predictors were the age of research participants, the form of the STAI, and the type of research design.