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Visual self-expression helps with attention and improves health and well-being. Few studies have examined reward pathway activation during different visual art tasks. This pilot study is the first to examine brain activation (e.g., medial region, anterior prefrontal cortex) via functional near-infrared spectroscopy (fNIRS) during three distinct drawing tasks—coloring, doodling, and free drawing. Participants (11 men, 15 women; 8 artists, 16 non-artists) engaged in each task separated by equal intervals of rest in a block design experimental protocol. Additional data included a pre- and post survey of self-perceptions of creativity, prior experience with drawing tasks, and reflections on study participation. Overall, the three visual arts tasks resulted in significant activation of the medial prefrontal cortex compared to the rest conditions. The doodling condition resulted in maximum activation of the medial prefrontal cortex compared to coloring and free drawing; however, differences between the drawing conditions were not statistically significant. Emergent differences were seen between artists and non-artists for coloring and doodling. All three visual self-expression tasks activated the medial prefrontal cortex, indicating potential clinical applications of reward perception through art making. Participants improved in their self-perceptions of problem solving and having good ideas. Participants found the drawing tasks relaxing but wanted more time per task. Further study with varied art media and longer time on tasks are needed to determine potential interactions between participants’ backgrounds and reward activation.
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Accepted Manuscript
Title: Functional Near-infrared Spectroscopy Assessment of
Reward Perception Based on Visual Self-expression:
Coloring, Doodling, and Free Drawing
Author: Girija Kaimal Associate Professor Hasan Ayaz
Associate Professor Joanna M. Herres Associate Professor
Rebekka Dieterich-Hartwell Doctoral student Bindal
Makwana Donna H. Kaiser Jennifer A. Nasser Associate
PII: S0197-4556(16)30171-X
Reference: AIP 1455
To appear in: The Arts in Psychotherapy
Received date: 3-10-2016
Accepted date: 11-5-2017
Please cite this article as: Kaimal, G., Ayaz, H., Herres, J. M., Dieterich-
Hartwell, R., Makwana, B., Kaiser, D. H., and Nasser, J. A.,Functional Near-
infrared Spectroscopy Assessment of Reward Perception Based on Visual Self-
expression: Coloring, Doodling, and Free Drawing, The Arts in Psychotherapy (2017),
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Title Page
Functional Near-infrared Spectroscopy Assessment of Reward Perception Based on Visual
Self-expression: Coloring, Doodling, and Free Drawing
Author details
Girija Kaimal; Assistant Professor, Drexel University
Hasan Ayaz, Associate Professor, Drexel University
Joanna M.Herres, Assistant Professor, The College of New Jersey
Rebekka Dieterich-Hartwell, Doctoral student, Drexel University
Bindal Makwana, Drexel University
Donna H. Kaiser, Drexel University
Jennifer A. Nasser, Associate Professor, Drexel University
Functional near Infrared Spectroscopy (fNIRS) was used to assess mPFC activation
(reward pathways) for three different forms of visual self expression
Significant changes were seen between the rest conditions (eyes closed) and the visual
self-expression conditions (Coloring, doodling and free drawing).
Reward activation could be a way to assess health outcomes of visual self-expression
with clinical implications and applications for disorders of pleasure seeking behaviors.
Functional Near-infrared Spectroscopy Assessment of Reward Perception Based on Visual
Self-expression: Coloring, Doodling, and Free Drawing
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Visual self-expression helps with attention and improves health and well-being. Few studies
have examined reward pathway activation during different visual art tasks. This pilot study is the
first to examine brain activation (e.g., medial region, anterior prefrontal cortex) via functional
near-infrared spectroscopy (fNIRS) during three distinct drawing tasks—coloring, doodling, and
free drawing. Participants (11 men, 15 women; 8 artists, 16 non-artists) engaged in each task
separated by equal intervals of rest in a block design experimental protocol. Additional data
included a pre- and post survey of self-perceptions of creativity, prior experience with drawing
tasks, and reflections on study participation. Overall, the three visual arts tasks resulted in
significant activation of the medial prefrontal cortex compared to the rest conditions. The
doodling condition resulted in maximum activation of the medial prefrontal cortex compared to
coloring and free drawing; however, differences between the drawing conditions were not
statistically significant. Emergent differences were seen between artists and non-artists for
coloring and doodling. All three visual self-expression tasks activated the medial prefrontal
cortex, indicating potential clinical applications of reward perception through art making.
Participants improved in their self-perceptions of problem solving and having good ideas.
Participants found the drawing tasks relaxing but wanted more time per task. Further study with
varied art media and longer time on tasks are needed to determine potential interactions between
participants’ backgrounds and reward activation.
Key Words: Functional Near-Infrared Spectroscopy (fNIRS), drawing, coloring, doodling,
reward perception, adults, artists, non-artists
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Introduction and Background
Researchers have been exploring the ways that the experience of viewing and making art
affect different parts of the brain. These studies have been made possible by making use of
modern technology that identifies brain activity in different locations. Our study used functional
near-infrared spectroscopy (fNIRS) to identify brain activity during varied self-expressions of
visual art.
Visual Art and the Brain
Visual forms of self-expression, such as coloring books, are becoming increasingly
popular among adults. Little is known, however, about the differences in brain activation and the
perceived rewards of engaging visual expression. This study sought to examine differences in
brain activation during different drawing activities measured with fNIRS. Although there are
currently no fNIRS studies that examine activation during visual expression, there are a number
of investigations that have demonstrated the activation of the prefrontal cortex during visual arts
activities using other technologies. For example, Chamberlain et al. (2014) used magnetic
resonance imaging (MRI) scanning to study the brain regions associated with drawing skills and
artistic training. Their findings suggested that being able to draw from observation was
associated with an increase in gray matter density in the left anterior cerebellum and the right
medial frontal gyrus in the prefrontal cortex. Schlegel et al. (2015) showed that 3 months of art
training resulted in changes in prefrontal white matter. Bolwerk, Mack-Andrick, Lang, Dörfler,
and Maihöfner (2014) found that there was a clear difference between producing art compared to
viewing art. Visual art production has been shown to improve the functional connectivity in
several brain areas, particularly between the parietal and frontal cortices, as well as
psychological resistance to change (Bolwerk et al., 2014). In their recent study, Miall, Nam, and
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Tchalenko (2014) explored the neural systems engaged in decision making related to drawing
observed pictures. Ventral and lateral occipital areas were increasingly activated when
participants were drawing faces rather than drawing abstract objects (Miall et al., 2014).
Although these findings suggest that visual art production results in stronger brain
connectivity than cognitive art evaluation or viewing art, there is evidence that even passive
engagement in art affects the prefrontal cortex (Bolwerk et al., 2014). For example, when
viewing art, a reward circuitry is engaged that activates the ventral striatum, including the
nucleus accumbens, along with the interconnected medial prefrontal cortex (mPFC) and the
orbitofrontal cortex and amygdala (Lacey et al., 2011). Using functional MRI (fMRI)
technology, Lacey et al. (2011) found that art imagery alone activated the reward circuitry
whereas matched nonart images did not. Likewise, activation of the mPFC, along with the rest of
the reward circuitry, occurred while the individual was viewing beautiful visual images or
architectural spaces (Chatterjee & Vartanian, 2014). Comparing the brain activity of participants
who were emotionally primed with portrait art with those who were not, Baeken et al. (2012)
used fMRI and found that the former displayed higher activity in the left midline superior frontal
cortex, whereas the latter showed higher right medial frontal cortical activity.
There are no studies on fNIRS and art-making but some exploratory studies have
examined patterns in electroencephalogram (EEG) recordings and drawing. Belkofer, Van
Hecke, and Konopka (2014) investigated the differences in patterns of brain activity among
artists and non-artists during the process of drawing. Results indicated that there was more
activity in the left hemisphere of the brain for artists, and more activity reflected in the frontal
lobe for non-artists. This result may have been based on the fact that drawing was a new task for
them and that stimulation in this area of the brain is a sign of learning. There was an increased
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presence of alpha waves for both the artists and the non-artists, indicating potentially relaxed
creative opportunities generated by drawing tasks. Similarly, in a quantitative
electroencephalographic comparison of clay and drawing, activation was noted related to regions
of memory processes, meditative states, and spatiotemporal processing (Kruk, Aravich, Deaver,
& deBeus, 2014). Art therapy researchers have also focused on the relationship between art and
mood states. For instance, art-making has been found to reduce cortisol levels (Kaimal, Ray, &
Muniz, 2016) as well as improve mood and self-efficacy (Kaimal & Ray, 2017). In addition, a
number of studies have shown the benefits of coloring inside a shape, specifically a predrawn
mandala, over free-form coloring (Curry & Kasser, 2005; Drake, Searight, & Olson-Pupek,
2014; van der Vennet & Serice, 2012). Babouchkina and Robbins (2015) also observed that
coloring inside a mandala was more effective in mood enhancement than coloring in a square.
Comparing coloring to drawing, Smolarski, Leone, and Robbins (2015) reported that college
students who were prompted to draw a positive expression (“something that made them happy”
p. 199) had considerably more mood enhancement than when asked to draw their current feeling
of stress (i.e., vent or trace a coloring book drawing). Andrade (2010) examined the outcomes of
doodling on attention, demonstrating that it was beneficial in recalling information and
monitoring tasks. Schott (2011) deduced from Andrade’s study that, in some contexts, doodling
may trigger an arousal and then stabilize it at an optimal level by reducing boredom and
Functional Near-Infrared Spectroscopy
A noninvasive, safe, and portable imaging method, fNIRS detects blood flow activity in
the human prefrontal cortex. This technique was pioneered in 1977 when it was demonstrated
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that photon transmission in the near-infrared spectrum (650 to 950 nm) could be used to screen
hemoglobin concentrations and oxygenation in the brain (Jöbsis, 1977). Since then, and
especially within the last 10 years, fNIRS has emerged as a viable neuroimaging tool, used to
monitor neural activity in response to cognitive tasks, motor tasks, stimuli, and language
processing (Ayaz et al., 2013; Ferrari & Quaresima, 2012). The typical fNIRS unit is composed
of light sources and photodetectors mounted on a flexible sensor band that can be worn as a
headpiece. The light sources are made up of either light-emitting diodes (LEDs) or fiberoptic
bundles (Irani, Platek, Bunce, Ruocco, & Chute, 2007). Other parts of the equipment include a
control box for hardware organization and a computer for data acquisition (Ayaz et al., 2012).
Baseline measurements are taken, followed by continuous, real-time measurements at
predetermined time intervals. Although there are a variety of possible placements, the near-
infrared light is most commonly placed over the scalp to measure tissue oxygenation changes in
the outer cortex regions (e.g., the motor or the prefrontal cortex; Izzetoglu et al., 2011). fNIRS
uses near-infrared light with spectroscopy principles. Hemoglobin, the oxygen carrier in red
blood cells, presents a differential absorption in the near-infrared wavelengths based on whether
it is bonded to the oxygen. The optical window of the near-infrared spectrum, on the other hand,
allows for light to penetrate several centimeters through the tissue due to the low absorption of
main chromophores such as water and allows detection of the changes in concentration of
oxygenated and deoxygenated hemoglobin molecules (Ayaz et al., 2013; Ayaz et al., 2011;
Ferrari & Quaresima, 2012; Izzetoglu et al., 2011). In other words, hemoglobin absorbs light at
different specific wavelength portions of the NIR spectrum, depending on how much oxygen it is
transporting. Cerebral hemodynamic changes are associated with functional brain activity
through a process termed neurovascular coupling (Ayaz et al., 2006).
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Although fMRI has become the “gold standard for in vivo imaging of the human brain”
(Cui, Bray, Bryant, Glover, & Reiss, 2010), fNIRS has the advantage of being usable and
adaptable to measuring brain responses to activities while the activities are occurring, either in
the natural environment or under everyday field conditions. Thus, fNIRS is not limited to
hospital, clinical, or laboratory settings. Additionally, fNIRS is minimally intrusive and more
affordable than the former. Studies have shown that fNIRS signals are often highly correlated
with fMRI measurements because both measure the hemodynamic response. Researchers have
concluded that fNIRS can be an appropriate compliment to, if not a substitute for, fMRI,
especially regarding brain activity related to cognitive tasks (Cui et al., 2010; Ferrari &
Quaresima, 2012; Irani et al., 2007). In addition, fNIRS measurements have been shown to be
complementary with the event-related EEG potentials (Ehlis et al., 2009; Herrmann et al., 2008).
Research using fNIRS spans a wide range of disciplines, topics, and populations. It has been
applied in neurology, psychiatry, education, and basic research (Ayaz et al., 2014; Izzetoglu et
al., 2011; Ruocco et al., 2016; Teo et al 2016). fNIRS has been used to examine people with
varied conditions (e.g., Alzheimer disease, mood disorders, schizophrenia) and varied behaviors
(e.g., language, memory, perception, sleep, pain; Ferrari & Quaresima, 2012).
Reward Perceptions Pathway in the Prefrontal Cortex
Though it is clear that the prefrontal cortex is related to higher order cognitive
functioning (e.g., regulating our thoughts, actions, and emotions), it is less clear which area of
the prefrontal cortex is responsible for different functions and whether there is even a systematic
organization across the prefrontal cortex (O’Reilly, 2010; Ramnani & Owen, 2004). The brain is
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a complex network with functionally linked regions that share information continuously with
each other (van den Heuvel & Pol, 2010). Generally, lateral prefrontal cortex areas seem to be
involved in sensory, motor, and cognitive processing, whereas mPFC areas play a role in
emotional, affective, and motivational systems (O’Reilly, 2010) and are part of the reward circuit
(Chatterjee & Vartanian, 2014; Lacey et al., 2011; Russo & Nestler, 2013). The mPFC has been
found to be widely connected to the amygdala, the nucleus accumbens, the hypothalamus, and
temporal visual association areas and is involved in higher-order sensory processing and
regulating emotional responses and somatic states (Arnsten, 2009; Damasio, Everitt, & Bishop,
1996; Wood & Grafman, 2003). The mPFC region has been associated with social cognition,
long-term memory processing, and emotional processing (Grosmann 2013; Euston, Gruber, &
McNaughton. (2012). In addition, the mPFC, along with the perigenual anterior cingulate cortex
and the dorsal anterior cingulate cortex, has also been implicated in an inferential track that is
thought to select and learn actions that maximize reward (Donoso, Collins, & Koechlin, 2014).
fNIRS has been used successfully for assessment of reward networks in prefrontal areas,
particularly in substance abuse research (Bunce et al., 2012, 2013; Huhn et al., 2016).
The aim of our study was to assess reward perception by measuring the mPFC response
during execution of three forms of visual self-expression. The main hypothesis guiding the study
was that the free-drawing form of self-expression would evoke the most reward activation
compared to the other two forms—coloring and doodling. We also hypothesized that the reward
activation would be greater for artists compared to non-artists, given their familiarity with the art
media. With the sequence of tasks from structured (coloring) to less structured (doodling in a
circle) to unstructured (free drawing), it was also hypothesized that the participants would have
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improved self-perceptions of creativity at the end of the sessions compared with the beginning of
the sessions.
The study used a pre–post quasi experimental design. The participants served as their
own controls through the visual self-expression conditions (3 different art-making tasks) and
control conditions (4 resting periods with eyes closed). The study was conducted with the
approval of the university’s institutional review board.
Participants were recruited through e-mail announcements and flyers posted around the
campus. The recruitment announcements indicated that any healthy adult between the ages of 18
and 70 could participate in the study; an e-mail and phone number were included. Those who
responded were told (1) the study involved brain imaging and drawing; and (2) no prior artistic
experience was required. When potential participants contacted the study coordinator, they were
asked whether they identified as artists (visual artists), their gender, and dominant hand use (right
or left). Only right-handed participants were included to account for variations due to hand use.
The session was then scheduled with the participant. When the participants came to the
scheduled session, they completed informed-consent procedures that included understanding the
purpose of the study and the steps involved in the use of the fNIRS technology.
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Sequencing the study framework included a presession survey, three visual self-
expression conditions, four rest conditions, and a postsession survey. The combined sequencing
of these steps would take approximately 20 minutes; during that time the participant would wear
the fNIRS band. See Figure 1a for location of optodes on the PFC and Figure 1b for the setup of
the experimental conditions.
Figure 1a. Location of functional near infrared-spectroscopy optodes on the prefrontal cortex
(Ayaz et al., 2012)
Figure 1b. Setup of the study with the functional near-infrared spectroscopy band.
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Participants were told that they would engage in three different visual self-expression
conditions: coloring, doodling, and free drawing. They would have 3 minutes for each of the
three drawing conditions preceded and followed by 2 minutes of rest with their eyes closed. Prior
to the start of the session, participants filled out a few questions on self-perceptions of creativity
adapted from existing surveys (Beghetto, 2006; Tierney & Farmer, 2002). In addition, the
participants were asked about their prior experience on a scale of “limited,” “somewhat,” or
“extensive.” At the end of the sessions, participants were again asked to complete the same
survey questions on self-perceptions of creativity and to respond to an open-ended question
about their experiences with these drawing conditions.
They were also given the opportunity to try out the art materials: three pieces of paper
and a set of 12 fine-tipped color markers. Coloring was defined as coloring in the predrawn
shape. Doodling was defined as a personalized doodle style that the participant might have used
in the past. Free drawing was defined as any drawing the participant chose to create. Participants
were offered a predrawn mandala and two pieces of paper with circles on the paper to be used for
both the doodling and free-drawing conditions. See Figures 2, 3, and 4 for examples of the art
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Figure 2. Examples of coloring done on pre-drawn mandala designs
Figure 3. Examples of doodles using a circle
Figure 4. Examples of free drawings
After the participants completed the sequence of the study conditions, they were asked to
complete the postsurvey on self-perceptions of creativity and to respond to a question about their
experiences with the drawing conditions. They were then given the option of taking the drawings
with them. With permission from the participants, photographs were taken to document the
coloring, doodling, and free drawing art-making conditions. Participants were given $10 cash in
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compensation for participating in the study.
fNIRS data. We used a continuous wave fNIR device model 100 fNIR system (fNIR Devices
LLC, Potomac, MD; to obtain images of the cerebral hemodynamics of
the PFC. After answering the presession survey, participants were connected to the fNIRS
system and their baselines were taken while they visually fixated on a central cross presented on
the computer screen. Activation of each participant’s prefrontal cortex was monitored throughout
the entire time the participants were engaged with the art-making and rest conditions. The sensor
had a temporal resolution of 500 milliseconds per scan with 2.5 cm source-detector separation
allowing for approximately 1.25 cm penetration depth. The dual-wavelength LEDs were
activated in turn, one light source and wavelength at a time, and the four surrounding
photodetectors sampled around the active source. The positioning of the light source and
detectors on the sensor pad yielded a total of 16 active optodes. COBI Studio software was used
for data acquisition and visualization (Ayaz et al., 2011).
For each participant, raw fNIRS data (16 optodes × 2 wavelengths) were low-pass filtered
with a finite impulse response, linear phase filter with order 20 and cut-off frequency of 0.1 Hz
to attenuate the high-frequency noise, respiration, and cardiac cycle effects (Ayaz et al., 2011).
Each participant’s data were checked for any (1) potential saturation (when light intensity at the
detector was higher than the analog-to-digital converter limit); and (2) motion artifact
contamination by means of a coefficient of variation-based assessment (Ayaz et al., 2010).
fNIRS data for each condition block were extracted using time synchronization markers
indicating onset and completion of each condition. Hemodynamic changes for each of the 16
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optodes during each condition block were calculated separately using the modified Beer-Lambert
law. The hemodynamic response at each optode was averaged across time for each condition
block to provide a mean hemodynamic response at each optode for each block. The final output
of each optode was the average oxygenated hemoglobin level for each condition (Ayaz et al.,
2012). The differences were first compared between creative visual self-expression and rest
conditions and then compared across conditions and across artistic skill using a two-way
repeated measures ANOVA, with gender and age included as covariates. The fNIRS data
analysis focused on optode 7, which represented activation of the left dorsomedial PFC.
Self-perceptions of creativity: Five questions from Beghetto’s (2006) and Tierney and
Farmer’s (2002) surveys on creative self-efficacy were adapted for use in this study and were
used as both a presession and a postsession instrument. This five-item questionnaire asked
participants to rate their perceptions of their abilities to (1) have new ideas; (2) have good ideas;
(3) have a good imagination; (4) have novel ideas; and (5) solve problems. The survey data were
compared using the paired samples t tests.
In addition to the questions on self-perceptions of creativity, participants were asked two
additional questions. Before the session, they were asked to rate their prior experience with
visual self-expression or art making. They were provided with a single question with three
choices: limited, some, extensive. After the study session and the completion of the postsurvey,
participants were asked to respond to an open-ended question related to their experiences with
these art-making activities. The narrative responses about their experiences with the visual self-
expression conditions were summarized using thematic analysis (Riessman, 2008), and the
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recurring themes were tabulated with representative examples.
Study Participants
The study sample comprised 26 participants: 11 artists (4 men, 7 women) and 15 non-
artists (7 men, 8 women). Participants ranged in age from 20 to 60 years (M = 32.46, SD =
11.03). All participants were right-handed and reported being healthy (not unwell or undergoing
any medical treatments) at the time of their participation in the study.
fNIRS. We first compared whether there was higher activation of the reward pathway as
demonstrated through optode 7 (associated with the left mPFC) during the visual self-expression
conditions compared to the rest conditions. A repeated measures ANOVA showed differences in
activation across the four rest and three visual self-expression conditions: F (6,120) = 4.729, p <
.001. Results of post hoc comparisons across all intervals are presented in Table 1. As indicated
in Table 1, activation levels rose with each of the creative self-expression conditions compared
to the rest conditions and returned to baseline levels during the rests. A paired t test confirmed
that activation on optode 7 was higher during the creative self-expression conditions (M = 0.46,
SD = 0.68) compared to the rest conditions (M = -0.03, SD = 0.30, t[23] = -2.74, p = .012).
Results of the repeated measures ANOVA allowed us to compare activation on optode 7
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across the creative self-expression conditions as well. As shown in Table 1 and Figure 5, the
doodling condition resulted in the most blood oxygenation (activation of PFC) compared with
the coloring and free-drawing conditions for optode 7. However, post hoc comparisons indicated
that differences in activation across the three art-making conditions were not statistically
significant (p = .38-.69).
Table 1
Mean activation levels and mean change in activation across conditions for optode 7 (N = 26).
Condition Mean SE 95% CI Mean Change p-value
Baseline .047 .094 -.149 to .243 -- --
Coloring .388 .114 .151 to .626 .341
Rest .027 .092 -.166 to .219 -.362
Doodling .548 .162 .209 to .887 .521
Rest -.297 .165 -.640 to .047 -.845
Free-drawing .473 .165 .128 to .817 .769
Rest .044 .131 -.229 to .316 -.429 .103
*p < .05; CI: confidence interval; SE: standard error
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Figure 5. Mean levels of oxygenation (activation of the medial prefrontal cortex) for each
The results point towards a possible difference between artists and non-artists related to
the reward perception of the coloring condition; however, this difference was not evident in the
doodling or free-drawing conditions. In fact, doodling seemed to evoke more brain activation
(HbO or oxygenated hemoglobin) in the artists, whereas both artists and non-artists had similar
levels of brain activation in the free-drawing condition. The coloring condition resulted in
negative brain activation for artists compared with the other two conditions, whereas changes in
oxygenation increased brain activation in the coloring condition. For all participants, regardless
of skill level, doodling, and free drawing resulted in increased brain activation compared with the
coloring condition. The interaction between artist/non-artist and the condition was not significant
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(F [6, 114] = 1.51, p = .18), perhaps because the study was underpowered to detect the effects of
Self-perceptions of creativity. This category was assessed using an adapted survey that
included five questions asking participants to rate perceptions of their abilities to have new ideas,
good ideas, a good imagination, and novel ideas and about their ability to solve problems.
Overall, participants’ responses to the 5-item survey improved after they completed the three art-
making and four rest conditions (M = .85, SD = 1.78, t[25] = 4.42, p = .02). Self-perceptions
significantly increased following the session conditions specifically for the questions of “I have
good ideas” (M = -.269, SD = .667, t[25] = -.059, p = .050) and “I can solve problems” (M = -
.231, SD = .514, t[25] = -2.287, p = .031). See Figure 6.
Figure 6: Changes in self-perceptions of creativity among participants before and after the seven
art-making and rest conditions (p < 0.05).
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Experience with session. In their narrative responses about the experience of the art-
making conditions, the most common responses referred to enjoyment or relaxation (n = 16).
Eight individuals mentioned the fact that the experience was fun or enjoyable (“Coloring with
markers was fun! Enjoyable & relaxing”), and eight mentioned the relaxing nature of drawing
(“Overall it was a very relaxing experience”). In addition, 11 participants described aspects of
the experience that they found limiting, such as the time constraints (“The 3-min interval was
short, and I was unable to come to a stopping point with my art”), the structure provided (“The
circles on the paper for the free drawing were kind of odd in that they were almost in the way”),
or the materials that were provided (“markers don't have a lot of control. I usually draw w/ pen or
colored pencils”).
Discussion and Implications
The results of this pilot study indicate that all three creative self-expression conditions
activated the mPFC and the reward pathway in a way that was significantly different from the
rest conditions. The doodling condition evoked the most activation; however, the differences
from coloring and free drawing were not statistically significant. There were some indications
that there might be differences between artists and non-artists; however, the sample was too
small to draw any definitive conclusions. The hypothesis that free drawing would evoke the most
activation was not supported. All conditions activated the reward pathway. The hypothesis that
self-perceptions of creativity would improve following the sequence of drawing tasks was
supported, indicating that even a short series of creative self-expression or art-making tasks
completed in approximately 15 to 20 minutes can result in individuals perceiving themselves as
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having good ideas and being able to solve problems. These findings have useful implications in
empowering individuals to shift self-perceptions of creative abilities and creative problem
solving. These differences were not seen to be related to artistic skills, age, or gender, indicating
that all participants, regardless of demographic background, could potentially see such changes.
The sample used in this pilot study is small, and any conclusions must be drawn with caution. In
addition, Dietrich and Kanso (2010) highlight the challenges of defining and assessing creativity
as any one single construct. It is to be noted that we did not ask participants to define creativity
or to assess the creative qualities of their artwork in any way; rather we asked them their self-
perceptions of having novel ideas, being imaginative, and coming up with good ideas and
solutions to problems. These self-perceptions are valuable and warrant further study in terms of
what exactly changed for the participants and how they perceived these changes to manifest in
their lives.
The instructions for the drawing conditions might also have affected the results. For
example, in a previous study, Andrade (2010) found that doodling helped improve memory and
retention. The doodling condition in that study was similar to the coloring condition in our study.
Participants in Andrade’s (2010) study colored in blank squares as part of the doodling
condition. In our study, however, we asked participants to engage in doodling with only the
frame of a circle provided on an empty page. Moreover, when we invited participants to engage
in doodling, it was operationalized for this study as a personalized activity, and almost everyone
had a doodling style. Some participants said that they did not doodle much since they used
digital devices rather than paper and pencil/pen. Our participants, however, had a style that they
identified as their preferred doodling style, which helped them participate in the doodling
condition. This preference could be equated to aesthetic judgment (Ishizu & Zeki, 2013), leading
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to increased reward perception and pleasure from creating and viewing the doodle. Rather than
serving as a distraction or containing activity that coloring seems to serve, doodling might be a
way to engage the reward perception mechanism in an accessible way for artists and non-artists
alike. The free-drawing condition, however, did not evoke a distinct response. This finding could
have been based on the fact that the free-drawing condition followed the two other conditions in
the study sequence and could thus be embedding experiences of the other conditions. In addition,
for some participants, free drawing was intimidating, whereas for others, the paper, circle format,
and media were restrictive. All of these factors together might explain the indistinct responses to
the free-drawing condition.
Bolwerk et al. (2014) highlighted the positive outcomes of art-making versus simply
viewing artwork. We have built on this work and have demonstrated the perception of reward
generated by art-making through a range of creative self-expression options. We have also
provided evidence for a shift in an individual’s self-perceptions of his or her creativity in just 15
minutes of a sequence of art-making tasks. Given that the narratives also corroborated the
enjoyable aspects of art-making regardless of gender or age, these are valuable findings for
further study. We recognize that the mPFC has multiple roles, including emotion processing,
long-term memory processing, and social cognition (Grosmann 2013; Euston et al., 2012). These
roles might also be in play for the drawing tasks, especially the fact that doodling might evoke
memories and free drawing might involve making connections between long-term memories and
spatiotemporal regions to generate an image. As seen from the narrative responses, drawing itself
evokes memories for participants of early school experiences as well as individual differences in
whether these memories elicited positive emotions or negative emotions. Further research is
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needed to better understand the interaction of emotion, reward perception, and visual self-
Because this endeavor is a pilot study, further research is needed to make conclusive
clinical recommendations. We can, however, highlight some emergent directions for clinical
applications for art therapists. For example, participants reported more improvements in self-
perceptions of creativity and problem solving at the end of the three art-making conditions,
indicating a simple way to enhance perceptions of creativity in individuals. The potential
differences in activation of the reward pathways differed for artists and non-artists, which
suggests that it might be valuable for art therapists to consider some sensitivity around the
reward pathways. The narrative feedback also indicates differences in participant experiences
with the choices of creative self-expression and media. Because no therapists facilitated the art-
making conditions, these results further highlight the potential differences based on the
opportunity for self-expression and processing the experience. The finding that all drawing
conditions activated the mPFC and the related reward pathway in the brain indicates that artistic
expression can be a positive experience even if it is practiced for a short time. We did not find
any significant differences between artists and non-artists, which also indicates the potential for
all participants to enjoy positive experiences from visual self-expression. Art therapists could
cite this result as evidence to encourage participants/clients who might be intimidated by
drawing tasks and perceive themselves as unskilled in the visual arts. Furthermore, the fact that
art can evoke reward pathways indicates that it could potentially be a replacement for other
activities that are known to activate these pathways such as addictive behaviors, eating disorders,
and mood disorders. Further research is needed to examine the potential of visual self-expression
to replace other reward-seeking behaviors like addictions and loss of pleasure conditions like
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anhedonia (Huhn et al., 2016). In addition, given the evidence that impulse control disorders like
attention-deficit/hyperactivity disorder and borderline personality disorder exhibit disturbed
functioning in the mPFC, we might explore the role of art-making in addressing these symptoms
(Sebastian et al., 2014).
This study has several limitations. It was a pilot study that tested three creative self-
expression conditions set up in a sequence from structured to unstructured tasks (coloring in
predrawn shapes to doodling to free drawing). It was set up to mimic art therapy practice, which
has traditionally helped clients move from structured to more unstructured activities of self-
expression. The setup is also, therefore, one of the main limitations of the study, because the
creative self-expression conditions were implemented in the same sequence across all
participants, and there was only one iteration with each participant. We did not control for the
order effect. The participants served as their own controls, and we did not have separate groups
for each of the drawing conditions. Moreover, the number of participants is small, and the
sample size is further reduced when comparing participant characteristics such as gender, age,
and artistic skill levels. It is also possible that any “making” or “doing” task involving the hands
might have evoked the mPFC, but we did not test for this. In addition, fNIRS only measures PFC
activation, and we did not account for other mechanisms of inner brain structures that might have
offered more insight into the experiences of reward perception. In the narrative responses,
several participants spoke about not having enough time to complete the tasks. Some participants
felt restricted in their creative self-expression by the limited time (3 minutes) to complete each
condition, and others felt constrained by the media choices and the circle shape for the free-
drawing condition. The 3-minute time frame was set to accommodate the technology, because
the fNIRS band sits snugly on the participant’s forehead and might feel uncomfortable beyond
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20 minutes of wear. These short-duration experiences might have affected the reward perception
of each drawing condition. Further research might examine how brain activation varies by the
creative self-expression condition when participants are given a longer time and different media
choices. Newer fNIRS detection technology allows for longer wear, which may also facilitate
further study.
This pilot study examined brain activation measured by fNIRS for three creative self-
expression conditions—coloring, doodling, and free drawing. The study provided initial findings
to indicate that all three art-making conditions activated the mPFC and that this activation was
significantly higher than that obtained during the rest condition. Of the three art-making
conditions, doodling resulted in the mPFC activation compared with the coloring and free-
drawing conditions; however, these differences were not statistically significant. Some clinical
implications include: the recognition that art-making evokes reward pathways, that even short
spans of artistic activity can improve self perceptions of creative abilities, and, art-making could
be a way to regulate mood, addictive behaviors and evoke a sense of pleasure. Further study is
needed to better understand the specific ways in which art-making is perceived, including
expressive activities and aesthetic perceptions of the art product, reward pathways related to art
making, art media choices, time on task, identification as an artist/non-artist, and the intersection
of emotions and self expression to art making.
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The authors would like to thank the Drexel University Office of Faculty Development and
Equity for funding support for the study. In addition, we would like to thank Ms. Adele Gonzaga,
Ms. Pam Fried and Dr. Barbara Granger for assistance with the study and the manuscript.
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... However, functional Near-InfraRed spectroscopy (fNIR) devices are proposed as more flexible and less expensive tools that can identify brain activity and register cognitive tasks (Ferrari and Quaresima 2012). Moreover, fNIRs permit the registering of brain imaging while the activity is occurring in more unobtrusive environments (Kaimal et al. 2017). To be portable and noninvasive, fNIRs use light to measure oxygenation and deoxygenation levels in the blood to quantify brain activity (Ayaz et al. 2013). ...
... To be portable and noninvasive, fNIRs use light to measure oxygenation and deoxygenation levels in the blood to quantify brain activity (Ayaz et al. 2013). Higher levels of deoxygenation in the blood correlate to higher brain activity, hence higher CL (Ayaz et al. 2013;Kaimal et al. 2017). Studies have also shown that fNIR devices, through the reading of the prefrontal lobe, can not only determine CL but emotional responses as well (Kaimal et al. 2017). ...
... Higher levels of deoxygenation in the blood correlate to higher brain activity, hence higher CL (Ayaz et al. 2013;Kaimal et al. 2017). Studies have also shown that fNIR devices, through the reading of the prefrontal lobe, can not only determine CL but emotional responses as well (Kaimal et al. 2017). ...
... Jacques & Schacter, 2013;Zaidel, 2014). Creativity likely enhances serotonin and dopamine, which contribute to wellbeing, pleasurable states, and motivation for change (Hass-Cohen & Carr, 2008;Kaimal et al., 2017;Mayseless et al., 2013;Zaidel, 2014). ...
This article reports on a qualitative one-year follow-up for participants from an art therapy pain protocol study (Hass-Cohen et al., 2021). The purpose of the current study was to describe participants’ long-term outcomes related to their pain experiences and quality of life, and to identify potential therapeutic memory reconsolidation (MR) change factors. Four semi-structured interviews and response drawings were conducted with participants from the pain protocol study. For the current follow-up study, an inductive analysis of the interview transcripts and response drawings were reported as unique case outcomes and common themes. Positive outcomes included: less physiological pain, psychological and skill-based changes in pain, and more access to coping resources. Art therapy-based MR change factors were also identified, which included creative processes and protocol sequencing.
... For both groups (artists and non-artists), drawing increased alpha rhythms of EEG waves, which indicates the relaxation state of the brain during drawing [105]. In addition, the functional Near-Infrared Spectroscopy (fNIRS)-based studies show that the drawing art increases blood flow at the medial prefrontal cortex, which might be due to the activation of a reward pathway [106]. In this regard, drawing can be a possible tool for the early diagnosis of PD. ...
Full-text available
Parkinson's Disease (PD) is a neurodegenerative disorder that causes movement and behavioral problems. Pharmacological advancements for preventing disease progression have limited success for many PD patients; therefore, supportive care is necessary. The advancement of the digital world and the revolution of computerized applications pave the way for a better understanding of PD and inventing technological apparatus for helping PD patients to provide them a more normal life. In this review, the most recent technological advancements regarding the rehabilitation, monitoring, and early prognosis of PD are presented. Furthermore, the possible neurological mechanisms responsible for the positive effects of technological-based interventions are discussed.
The use of virtual reality (VR) in interior design has increased dramatically. Its interactive and visualization benefits are undeniable. Designers, clients, developers, and stakeholders can immerse themselves in future or existing design projects without the need to be physically there. Thanks to more immersive and realistic experiences, the boundaries that separate the physical and the virtual world are becoming nonexistent. Nonetheless, research has focused on the visual characteristics of the virtual space, undermining the consequences for individuals engaged within it. In this study, we assessed the effects on mental workload caused by how individuals visualize themselves in VR using a virtual body (VB). The VB is typically represented by the use of avatars. An experimental setup was carried out with a convenience sample of 72 individuals. Participants interacted in an immersive VR interface with three different conditions of the VB. They were randomly assigned to one of the three conditions and engaged for a period of approximately 20 minutes in tackling a design‐like activity. Data were collected through self‐report questionnaires in addition to a psychophysiological device accounting for the cognitive load (CL) and task difficulty. The statistical analysis supported differences in CL between conditions. A more detailed visual representation of the VB increased the sensation of being there but contributed extraneous CL that can hinder the task at hand. The findings of this study can guide interior designers in selecting the type of VB they should use for their immersive VR experiences.
In those moments when focus on creative work overrides input from the outside world, we are in a creative trance. This psychologically significant altered state of consciousness is inherent in everyone. It can take the form of daydreams generating scientific or creative ideas, hyperfocus in sports, visualizations that impact entire civilizations, life-changing audience experiences, or meditations for self-transformation that may access states beyond trance, becoming gateways to transcendence. Artist and psychologist Tobi Zausner shows how creative trance not only operates in scientific inventions and works of art in all media, but is also important in creating and recreating the self. Drawing on insights from cognitive neuroscience, clinical psychology and post-materialist psychology, this book investigates the diversity of the creative trance ranging from non-industrial societies to digital urban life, and its presence in people from all backgrounds and abilities. Finally, Zausner investigates the future of trance in our rapidly changing world.
Conference Paper
Full-text available
This bring your own experiment (BYOE) paper details two iterations of a hands-on painting project that has been well-received by fluid mechanics students. In the conception of this project the authors have explored many of the relevant parameters for different painting techniques: drip painting, pendulum painting spray painting, and acrylic pours-one subset of which is spinning pours. These methods were explored both in terms of relevant fluid mechanic phenomenon as well as with hands-on experimentation, reviewing instructional videos and talking with artists. These efforts led to creation of short instructional videos that students can watch before undertaking their own attempts at creating a work of art. To date this project has been conducted as an extra credit opportunity, though discussion is presented on how the general idea could be deployed as a more traditional experimental lab or as a fun, yet relevant, end of semester lab activity. While the act of creating the fluid art inherently involves learning outcomes related to the importance of thinking creatively, exploring curiosity, prototyping and creating a product with limited project constraints, the instructor can determine the rigor of learning outcomes related to fluid mechanic principles with an accompanying written assignment. This BYOE paper is written with the goal of making the implementation of this project, or some variation of it, straightforward for instructors. Keeping material costs low was part of this consideration and setup descriptions are provided as well as parts lists.
This chapter identifies specific ways that the field of art therapy can benefit from neuroscience. We begin by learning how and why humans began making art. To enhance the connections between these two fields, we learn about the basics of the nervous system, the neuron, and the brain. Next, we explore the process in which visual information is received by our eye, interpreted by the brain, and integrated with other sensory, emotional, and memory systems to form the basis of our behaviors and actions. Our approach demonstrates the power of transdisciplinary knowledge and provides a multilayered approach that explores why humans make art and why art-making is central in art therapy.
This chapter begins by defining mental illness and provides criteria to understand when symptoms reach a significant level to be considered a mental health condition illness. Readers will learn about the history of diagnosing mental health conditions and how therapists diagnose patients today. Historical connections are presented between art and mental illness and how these helped to shape the current field of art therapy. The chapter provides different ways art therapy supports mental health and mental health recovery and concludes with information about art therapy for specific disorders and in different settings.
In this chapter, we provided an overview of approaches to research in art therapy in the past, present, and future. Over the past decades since the discipline was established, the conceptualization of art therapy research has expanded from descriptive case studies to empirical studies, arts-based knowledge, and community-based research (Kaimal, 2017). In this chapter, we included an overview of current research in art therapy while addressing challenges of conducting research in the discipline, including limited funding and research capacity, small sample sizes, and inclusion of artwork as data. Topics we covered in this chapter include most commonly used and accepted research designs (quantitative, qualitative, mixed methods, arts-based approaches, and program evaluation), how research can be used to improve clinical practice, tools to evaluate research quality, the importance of participatory and community-based research, and ethical issues when conducting art therapy research. We also included a section on implications and future directions, as well as art experientials and reflective questions to review and further consider the materials.
Full-text available
Background: This study investigated the impact of visual art-making on self-reported positive and negative affect and perceived self-efficacy. Study participants included 39 healthy adults aged 18 to 59 years, including 33 women and 6 men. Methods: The study used a mixed methods quasi-experimental (pre–post measurements, no control group) design. The study involved 45 minutes of individual art-making in an open studio format facilitated by an art therapist. Participants completed questionnaires including the Positive and Negative Affect Schedule and General Self-Efficacy Scale, before and after the art-making session. At the end of the session, participants provided brief comments about their art-making experience and a narrative summary of their artwork. Results: Results indicate that free art-making in this context significantly lowered negative affect and improved positive affect and self-efficacy. Improved affect was also moderately correlated with improved self-efficacy. There was no difference between groups based on prior experience with art-making, gender, age, or race/ethnicity. Content themes from the participants’ artwork were very diverse including references to nature, people, activities, memories, and abstract explorations of colors and shapes. Discussion/Implications: These preliminary findings indicate the benefits of a brief studio-based art therapy free art-making session on the psychological states of affect and self-efficacy for health adults.
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In the last decade, virtual reality (VR) training has been used extensively in video games and military training to provide a sense of realism and environmental interaction to its users. More recently, VR training has been explored as a possible adjunct therapy for people with motor and mental health dysfunctions. The concept underlying VR therapy as a treatment for motor and cognitive dysfunction is to improve neuroplasticity of the brain by engaging users in multisensory training. In this review, we discuss the theoretical framework underlying the use of VR as a therapeutic intervention for neurorehabilitation and provide evidence for its use in treating motor and mental disorders such as cerebral palsy, Parkinson’s disease, stroke, schizophrenia, anxiety disorders, and other related clinical areas. While this review provides some insights into the efficacy of VR in clinical rehabilitation and its complimentary use with neuroimaging (e.g., fNIRS and EEG) and neuromodulation (e.g., tDCS and rTMS), more research is needed to understand how different clinical conditions are affected by VR therapies (e.g., stimulus presentation, interactivity, control and types of VR). Future studies should consider large, longitudinal randomized controlled trials to determine the true potential of VR therapies in various clinical populations.
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This quasi-experimental study investigated the impact of visual art making on the cortisol levels of 39 healthy adults. Participants provided saliva samples to assess cortisol levels before and after 45 minutes of art making. Participants also provided written responses about the experience at the end of the session. Results indicate that art making resulted in statistically significant lowering of cortisol levels. Participants' written responses indicated that they found the art-making session to be relaxing, enjoyable, helpful for learning about new aspects of self, freeing from constraints, an evolving process of initial struggle to later resolution, and about flow/losing themselves in the work. They also reflected that the session evoked a desire to make art in the future. There were weak associations between changes in cortisol level and age, time of day, and participant responses related to learning about one's self and references to an evolving process in art making. There were no significant differences in outcomes based on prior experiences with art making, media choice, or gender.
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Self-harm is a potentially lethal symptom of borderline personality disorder (BPD) that often improves with dialectical behavior therapy (DBT). While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, twenty-nine actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex during impulse control prior to beginning DBT and after seven months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex prior to beginning treatment, and they showed the greatest increases in activity within this region after seven months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial prefrontal cortex and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right dorsolateral prefrontal cortex even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the prefrontal cortex underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT.
Conference Paper
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There is growing evidence that there are functional changes in the brains of individuals with substance use disorders. Numerous studies utilizing functional magnetic resonance imaging (fMRI) have shown that drug cues elicit increased regional blood flow in reward-related brain areas among addicted participants that is not found among normal controls. This finding has prompted leading investigators to suggest fMRI might be useful as a diagnostic or prognostic biomarker of addiction severity. However, fMRI is too costly for routine use in most treatment facilities. Functional near-infrared spectroscopy (fNIRs) offers an alternative neuroimaging modality that is safe, affordable, and patient-friendly. This manuscript reviews evidence that fNIRs can be used to differentiate prefrontal cortical responses of current alcohol dependent participants from alcohol dependent patients in treatment for 90-180 days. Differential responses to both alcohol and natural reward cues in both groups suggests fNIRs might serve as a clinic-friendly neuroimaging technology to inform clinical practice.
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The authors examined whether instructions to express emotional states represent an active ingredient in the mood-enhancing properties of drawing. Forty-five undergraduates were asked to make a list of recent stressful events (negative mood induction) before being randomly assigned to one of three conditions: drawing to express happiness (positive expression), drawing to express current stress (venting), or tracing and coloring a simple line drawing (distraction control). Mood improved in all three conditions, but the positive expression condition showed significantly greater improvement than either the tracing or venting groups. Venting and tracing produced similar levels of mood elevation. Positive emotional expression appears to be an active ingredient in the beneficial effects of drawing on mood.
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This study examined whether the creation of a mandala has specific efficacy for reducing negative mood states. A convenience sample of 67 adult participants was randomly assigned to one of 4 conditions following negative mood induction: (a) coloring a blank circle with instructions to express feelings, (b) coloring a blank circle with instructions to draw freely, (c) coloring a square with instructions to express feelings, or (d) coloring a square with instructions to draw freely. The two circle (mandala) groups reported significantly greater mood improvement compared to the two square conditions. These results demonstrate that the circular shape of the mandala serves as an "active ingredient" in mood enhancement.