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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
http://www.informaworld.com
*Corresponding author. Email: nc18@txstate.edu
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.
Method
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.
Participants
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
project.
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
anxiety.
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
manuscript.
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
Gender
Male 29 33.2
Female 60 66.7
Unidentified 1 .1
Ethnicity
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
College
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
participants:
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.
Results
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
(2) ¼.75; p¼.69). Race/ethnicity was also equivalent across conditions
(e.g. 55%, 67% and 70% Caucasian, respectively; x
2
(6) ¼1.73; p¼.94), as was marital
status (e.g. 90%, 90% and 87% unmarried/single; x
2
(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
2
(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
2
(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).
Discussion
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*.
Project
condition Baseline
Post-
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)
project
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.
Limitations
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-
intervention).
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.
Conclusion
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.
Note
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
1
Materials
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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... Conversely, Henderson et al. (2007) found no immediate effect from trauma-focused art-making after three sessions, although a decline in PTSD severity was observed at a one-month follow-up. Additionally, Aaron et al. (2011) observed that participating in art activities reduced anxiety among undergraduates, whether in individual or group projects, compared to a non-art control group. Brown et al. (2001) also showed that both an art-focused group condition and a comparison condition of group discussion reduced loneliness among students living on a college campus, but no differences were found between conditions. ...
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... Regarding negative mental states, we also expect that the CATs workshop will decrease state anxiety (H3) following the intervention, as evidenced by prior research (e.g., Aaron et al., 2011;Henderson et al., 2007;Sandmire et al., 2012), Additionally, we hypothesize that the workshop will temporarily reduce feelings of loneliness (H4), based on the premise that the interpersonal relationships developed during the workshop may reduce feelings of isolation (Braus & Morton, 2020;Brown et al., 2001). We also conducted a follow-up to examine its impact on life satisfaction and loneliness. ...
... It includes an increase in positive affect, decrease in negative affect, higher psychological well-being, and positive health outcomes (Baumann et al., 2013;Sonke et al., 2015;Tymoszuk et al., 2020;Wheatley & Bickerton, 2017). As a result, there have been multiple investigations into arts-related interventions which have led to improvements in education (e.g., Aaron et al., 2011), workplace (e.g., Karpavicˇiūte . & Macijauskiene . ...
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Support for proactive mental health interventions is imperative to reduce the number of individuals experiencing a mental health crisis. However, proactive mental health interventions are not prioritized within the current healthcare paradigm. It is well established that engaging in proactive measures such as exercise, maintaining good sleep hygiene and adhering to a balanced diet can prevent physical health ailments. Accordingly, proactive management of physical health has become a societal norm. Unfortunately, proactive management of mental health is not societal norm, despite the physical health consequences of poor mental health. Verbal based therapies remain the standard of care within mental health services, and they are primarily available to individuals diagnosed with a mental illness or experiencing a crisis. Due to the stigma associated with verbal-based therapies and seeking mental health support, many individuals are reluctant to proactively seek assistance. In contrast, music is a universally embraced activity, transcending age, ethnicity, socio-economic status and health conditions. The positive associations linked with music may make music therapy a more approachable option for support. In this thesis, I investigated undergraduate university students’ interest in participating in music therapy, as well the effectiveness of both online and in-person group music therapy as proactive interventions for stress and anxiety. Data were collected from standardized psychometric tools and the physiological markers of heart rate variability and cortisol. The research presented in Chapter 2 of this thesis provides evidence of student interest in music therapy as an option to support mental health. The research presented in Chapter 3 demonstrates the effectiveness of group music therapy as an online intervention for managing stress and anxiety, while Chapter 4 supports the effectiveness of in-person group music therapy for managing stress and anxiety. Together, this research supports the inclusion of music therapy as a cost-effective proactive intervention for stress and anxiety management on university campuses.
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Chapter
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
Article
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.
Article
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.
Article
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.