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Art Therapist-Facilitated Open Studio Versus Coloring: Differences in Outcomes
of Affect, Stress, Creative Agency, and Self-Efficacy (Studio ouvert anim
e par un
art-th
erapeute versus coloriage : diff
erences de r
esultats sur l’affect, le stress,
l’agentivit
ecr
eatrice et l’efficacit
e personnelle)
Girija Kaimal, EdD, MA
a
, Janell L. Mensinger, PhD
b
, Jessica M. Drass, MA, ATR-BC
a
,
and Rebekka M. Dieterich-Hartwell, MA, BC-DMT
a
a
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania;
b
Department
of Health Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
ABSTRACT
Background: Coloring books for adults have become a ubiquitous presence in retail outlets
worldwide and in the visual cultural landscape. The goal of this study was to determine differences
in outcomes between art therapist-facilitated open studio and individual coloring.
Methods: The study used a within-subjects experimental design. Healthy adult participants (aged
19–67 years) were invited to engage in one session each of individual coloring, and open studio
facilitated by an art therapist. A total of 36 participants enrolled in the study; 29 completed pre- and
post-surveys for both conditions. Outcomes measured included positive and negative affect,
perceived stress, self-efficacy, and creative agency.
Results: The art therapist-facilitated open studio condition resulted in superior improvements in
positive affect, creative agency, and self-efficacy compared to the coloring condition. Both
conditions resulted in lowered stress and reduced negative affect.
Discussion and implications: The results indicated that coloring might have therapeutic benefits on
distress; however, only the art therapist-facilitated open studio session showed significant
improvements in self-efficacy, self-perceptions of creativity, and positive mood. Art therapists might
consider using the phenomenon of coloring as a doorway to art therapy and more spontaneous
creative and self-expression for transformative change. Future studies should seek to identify the
unique mechanism of change through which art therapist-facilitated art making explains the shifts
in positive affect, creative agency, and self-efficacy.
R
ESUM
E
Contexte : Les livres
a colorier pour adultes sont d
esormais omnipr
esents dans les magasins partout
dans le monde et dans le paysage culturel visuel. Le but de cette
etude
etait d’
etablir les diff
erences
entre les r
esultats obtenus dans le cadre d’un studio ouvert facilit
e par un art-th
erapeute et le
coloriage individuel.
M
ethodes : L’
etude a eu recours
a un devis exp
erimental intra-sujets. Des participants adultes en
bonne sant
e(
^
ag
es de 19
a 67 ans) ont
et
e invit
es
a participer
a une session de coloriage individuel
et
a un studio ouvert anim
e par un art-th
erapeute. Au total, 36 personnes se sont inscrites
al’
etude ;
29 d’entre elles ont r
epondu
a un questionnaire avant et apr
es l’intervention. Les r
esultats mesur
es
portaient sur les affects positifs et n
egatifs, le stress per¸cu, le sentiment d’efficacit
e personnelle et
l’agentivit
ecr
eatrice.
R
esultats : La situation de studio ouvert anim
e par un art-th
erapeute a donn
e lieu
a de plus grandes
am
eliorations en ce qui concerne les affects positifs, l’agentivit
ecr
eatrice et le sentiment d’efficacit
e
personnelle, comparativement
a la situation de coloriage. Les deux situations ont entra
^
ın
e une
diminution du stress et de l’affect n
egatif.
Discussion et implications : Les r
esultats indiquent que le coloriage peut avoir des effets
th
erapeutiques sur la d
etresse ; toutefois, seule la session en studio ouvert anim
ee par un art-
th
erapeute a entra
^
ın
e des am
eliorations significatives en ce qui concerne l’efficacit
e personnelle, la
perception de sa propre cr
eativit
e et la bonne humeur. Les art-th
erapeutes pourraient envisager
d’utiliser le ph
enom
ene du coloriage comme porte d’entr
ee
al’art-th
erapie ainsi qu’
a des formes
CONTACT Girija Kaimal gk27@drexel.edu Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, 1601
Cherry Street, Room 7109, Philadelphia, PA 19102.
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/ucat.
© 2017 Girija Kaimal, Janell L. Mensinger, Jessica M. Drass, and Rebekka M. Dieterich-Hartwell. Published with license by Taylor & Francis.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/
4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in
any way.
CANADIAN ART THERAPY ASSOCIATION JOURNAL
2017, VOL. 30, NO. 2, 56–68
https://doi.org/10.1080/08322473.2017.1375827
d’expression plus spontan
ees et cr
eatives permettant un changement transformateur. D’autres
etudes devraient chercher
a cerner le m
ecanisme de changement unique qui est
al’œuvre dans la
cr
eation artistique facilit
ee par un art-th
erapeute pour expliquer les changements positifs dans
l’affect, l’agentivit
ecr
eatrice et l’efficacit
e personnelle.
Introduction
Coloring books for adults have become a ubiquitous
presence in retail outlets worldwide and a new addi-
tion to the visual cultural landscape. The popularity of
adult coloring books indicates that they fulfill a need
for visual expression among today’s adults. There is
ongoing interest in researching drawing and coloring
from fields outside of art therapy (Forkosh & Drake,
2017; Northcott & Frein, 2017), which may be increas-
ing due to the prevalence of adult coloring books in
our visual culture. They have, however, led to many
mistaken assumptions about art therapy, including
raising questions about whether and how coloring dif-
fers from art therapy in terms of psychological out-
comes. While there is a difference between the
personal use of coloring books and engaging in art
therapy with a trained professional, the use of adult
coloring activities can act as a starting point for some-
one who may be hesitant to use art materials. Kaiser
(2017a) speaks to the importance of “practice-
informed research”to help define “the role of the crea-
tive process in therapeutic change”(p. 56) unique to
the field of art therapy. In this within-subjects experi-
mental study, our aim was to determine differences
between coloring and art making in a free art-making
open studio session that was facilitated by an art ther-
apist. The open studio session was based on Allen’s
(1995;2008) work of merging art studio practices with
art therapy concepts. A variety of art materials were
laid out, and while no specific directive was given, the
art therapist offered guidance and support during the
art-making process. The art therapist also engaged in
his or her own art making alongside the participant.
Through the study, we sought to identify how these
two conditions impacted established outcomes such as
affect, perceived stress, self-efficacy, and a new dimen-
sion we refer to as creative agency.
Studies have shown that expressive techniques such
as writing, music, and art making are creative inter-
ventions that can have lasting health effects on partici-
pants’mood and self-efficacy (Chan & Horneffer,
2006; Mercer, Warson, & Zhao, 2010; Pennebaker,
1997; Pizarro, 2004). A number of studies have shown
that premade coloring pages or simple drawing tasks
and other art-making activities have been effective in
reducing anxiety (Carsley, Heath, & Fajnerova, 2015;
Eaton & Tieber, 2017; Sandmire, Gorham, Rankin, &
Grimm, 2012; van der Vennet & Serice, 2012), regulat-
ing mood (Babouchkina & Robbins, 2015; Collier &
von Karolyi, 2014; Diliberto-Macaluso & Stubblefield,
2015; Laurer & van der Vennet, 2015), reducing stress
(Abbot, Shanahan & Neufield, 2013; Curl, 2008; Huet,
2017), and increasing overall health and well-being
(Greer, Fleuriet, & Cantu, 2012; Kim, 2013), which
have led to claims about the efficacy of art therapy in
general. This research questions how the arts can be
used to heal and “increase understanding of oneself
and others, develop a capacity for self-reflection,
reduce symptoms, and alter behaviors and thinking
patterns”(Stuckey & Nobel, 2010, p. 254). What
many of these studies are lacking is the presence of a
trained art therapist during the art-making portions of
the experiments and the verbal processing of the art
product created—both are crucial components of art
therapy practice.
Literature review
Research on coloring
Coloring books for adults are more sophisticated and
detailed than traditional children’s coloring books,
and many have topped Amazon’s bestseller lists in
recent years (Lewis, 2016). Colleges and libraries have
set out coloring pages and even offered group coloring
events, especially during high-stress times such as
finals (Millam, 2017; Pells, 2016). Some claim that col-
oring offers opportunities for quick and easy deci-
sions, a convenient escape from the demands of
everyday life (Lewis, 2016), while also providing a
sense of “mindfulness without the paralysis that a
blank page can cause,”(Beck, 2015). Many have won-
dered if there is evidence to back up these sweeping
claims. Some coloring books available in bookstores
and retail outlets have been marketed with the words
“art therapy”on the cover, which have motivated
efforts by art therapists to clarify how coloring books
CANADIAN ART THERAPY ASSOCIATION JOURNAL 57
are not art therapy (Carolan & Betts, 2015; Otto,
Rattigan, & Gerber, 2015). Some suggest that intricate
details and structured designs, such as the ones pres-
ent in many adult coloring books, can induce a medi-
tative state that may promote relaxation. Curry and
Kasser (2005) set out to test this theory in an experi-
mental condition that compared coloring a pre-drawn
mandala (design within a circle) with coloring a plaid
design or on a blank page. In a group of undergradu-
ates (N D84), after a brief anxiety induction exercise,
participants were given six colored pencils and asked
to color for 20 minutes. Both the mandala and plaid
designs were found to lower participants’anxiety lev-
els, but the mandala design was slightly more effective.
The authors posited that the blank page caused confu-
sion and had no definite starting point, whereas the
pre-drawn designs provided structure, which could
have helped create a meditative-like condition for par-
ticipants that helped to decrease anxiety. This study
was replicated by van der Vennet and Serice (2012).
In this group of undergraduates (N D50), there was a
significant difference in anxiety reduction for the
mandala group versus the plaid and free-form groups,
but the results differed from those of Curry and
Kasser’s(2005) study in that there was no significant
difference between the plaid and the free-form groups,
which supports the initial hypothesis that the design
within a circle would result in a greater reduction in
anxiety.
Another study by Kersten and van der Vennet
(2010) looked at the use of color (warm versus cool)
in reference to anxiety levels. They found no correla-
tion and reported that some participants felt frustrated
with the limited colors and materials. Carsley et al.
(2015) studied the impact of a mindful coloring activ-
ity on elementary students’test anxiety. They found
significant reduction in anxiety for both the structured
mandala group and the free-drawing group, although
the mandala group had a slightly higher decrease. The
significant difference between the two groups was
present for female participants only. This study sug-
gests that males may benefit more from a less struc-
tured art task than a pre-drawn coloring page. Eaton
and Tieber (2017) studied undergraduates (N D85)
by providing an abstract line design and compared a
free-choice condition (color the design any way you
wish) with a forced-choice condition (copy the colors
from a sample). This study found that coloring for
30 minutes reduced anxiety and negative mood, but
more so for the free-choice group. The authors suggest
that there may be a connection to an increase in perse-
verance after a free-choice coloring activity.
Art making and mood regulation, anxiety reduction,
and stress reduction
A number of researchers have examined the impact
of art making on mood and anxiety reduction.
Babouchkina and Robbins (2015) looked at the impact
of mandala drawings on negative mood. After a nega-
tive mood induction, participants (N D67) were asked
to draw for 30 minutes and either focus on feelings or
on colors within a circle or a square. Negative mood
decreased more in the circle conditions. Laurer and
van der Vennet (2015) looked at the difference
between viewing and producing art on negative mood
and anxiety in a substance abuse treatment center and
found a decrease in negative mood and anxiety for the
art production group. This study offered a variety of
art materials rather than just drawing. Sandmire et al.
(2012) also looked at the effect of various types of art
making on anxiety reduction. They wanted to simulate
a drop-in art center on a college campus during the
week before finals. They compared an open studio
condition (participants could choose from 5 different
art projects) with a control group (relaxing in com-
fortable chairs), and found a significant decrease in
anxiety for the experimental group (N D57). Glinzak
(2016) also found that a drop-in open studio condi-
tion provided the greatest decrease in distress for adult
patients who had cancer (N D73). Some studies have
focused on the use of art making for short-term mood
repair in relation to sadness (e.g., Dalebroux,
Goldstein, & Winner, 2008; Drake & Hodge, 2015;
Drake & Winner 2012). These studies embrace the
view that art therapy focuses on negative emotions
and on the use of art for venting (focusing on distress-
ing emotions) versus distraction (focusing on positive
emotions). Diliberto-Macaluso and Stubblefield
(2015) explored the impact of painting on anger from
this perspective. They found a significant difference in
mood improvement for both the positive distraction
(paint something happy) and neutral (copy a still life)
conditions.
Lacking in these studies is the presence of meaning
making and reflexivity on the art productions, and
one may question the correlation of “venting”with
self-expression through art making. In a program
58 G. KAIMAL ET AL.
evaluation of a community painting class for older
adults, Greer et al. (2012) found that participants
reported an increase in mental health, self-awareness,
relaxation, and connection. Participants also felt that
they were able to express themselves differently after
the painting class than they did before the painting
class and found a greater ability to explore their evolv-
ing identities and work through intense emotions.
Huet (2017) presented a single case study of an art
therapy group aimed at reducing work-related stress
in hospice workers. In a six-month follow-up meeting,
participants noted that, although they realized art
making revealed some intense emotions, they felt they
were able to have better control over what they wanted
to disclose to the group. For some, participation in the
art groups appeared to help them make decisions
about reducing workload or setting boundaries that
led to further stress reduction (Huet & Holttum
2016). This finding points to the possibility of using
art making as a tool for enhancing self-efficacy.
Although the adult coloring books may provide a safe,
structured starting point for those who may not typi-
cally be drawn to art or creative endeavors, open stu-
dio free art making in the presence of an art therapist
may provide an opportunity to develop skills that
could lead to an increase in creative self-efficacy,
which is an individual’s perception of his or her own
ability to generate creative solutions (Bang & Reio,
2017; Puente-Diaz, 2016). Kaiser (2017b) speaks to
the need of conducting research that more closely mir-
rors the actual practice of art therapy. In a pilot study,
Kaimal and Ray (2016) found that a brief, open studio
free art making experience facilitated by a trained art
therapist had a significant impact on lowering negative
affect while increasing positive affect and self-efficacy
in a sample of nonclinical participants aged 18 to
60 years. They found a strong correlation between
improved positive affect and improved self-efficacy.
One limitation of this study was the absence of a con-
trol group or a comparison group.
In summary, there are data indicating positive out-
comes of coloring and art therapy but there has been
no systematic examination of how they might differ in
terms of altering outcomes for individual participants.
Given these gaps, our primary hypotheses were that
the art therapist-facilitated open studio condition
would result in greater (1) improvements in self-effi-
cacy, (2) improvements in creative agency, (3)
improvements in positive affect, (4) reductions in
negative affect, and (5) reductions in perceived stress
compared to the coloring condition.
Methods
Setting
The study was conducted in a dedicated art therapy
studio at a large urban university in the northeastern
United States. After receiving institutional review
board approval, the investigators recruited partici-
pants from the community of staff, faculty, and stu-
dents of the university. The inclusion criteria were
that participants needed to be healthy adults (not ill or
undergoing any medical treatment at the time of the
study) and be between the ages of 18 and 70 years.
Participants were not screened for mental illness. No
prior artistic experience was required. Participants
were recruited using listservs (group emails),
announcements, and publicly displayed flyers. The
study was described as examining health outcomes of
visual self-expression. The participants were scheduled
for two individual one-hour sessions with a trained art
therapist on a weekday at a time convenient for them.
Once the participants arrived for their scheduled
appointment, they completed procedures for informed
consent. The sequence of the two sessions (coloring or
open studio) was randomly assigned such that some
attended coloring sessions first and the others
attended open studio sessions first, but the sessions
were not conducted on the same day.
Sample
A total of 36 adult participants enrolled in the study.
Of the total, 29 (80.6%) were women. The mean age
was 37.9 years (standard deviation D11.8). The
majority of the participants self-identified as White
(n D64, 66.7%); 13.9% identified as Asian (n D5);
11.1% identified as “other”(n D4); 5.6% identified as
Hispanic (n D2); and 2.8% identified as African
American (n D1).
Instruments
Demographic information including age, gender, and
racial/ethnic identification was collected verbally.
Next, they completed the Positive and Negative Affect
Schedule (PANAS), a validated standardized measure
(Watson, Clark, & Tellegen, 1988), the General Self-
Efficacy Scale (GSE) (Schwarzer & Jerusalem, 1995),
CANADIAN ART THERAPY ASSOCIATION JOURNAL 59
the perceived stress scale (PSS) (Cohen, Kamarck, &
Mermelstein, 1983), and a set of questions we refer to
as creative agency developed from the scales of crea-
tive self-efficacy and identity (Beghetto, 2006; Tierney
& Farmer, 2002).
PANAS is a 20-item self-report measure of positive
and negative affect developed by Watson et al. (1988).
PANAS was shown to “possess adequate psychometric
properties in a large sample drawn from the general
adult population”(1,003 participants). Both the posi-
tive and negative affect scales have shown good inter-
nal consistency reliability (Cronbach’saof .89 for
positive affect and .85 for negative affect) (Crawford &
Henry, 2004). The PANAS has shown criterion and
predictive validity with significant correlations to
depression and anxiety.
The GSE is a 10-item psychometric scale to mea-
sure one’s perception of being able to cope with diffi-
cult situations. It generally captures an optimistic
disposition and has high internal consistency reliabil-
ity. Cronbach’sahave been reported to be between
.86 and .94 (Luszczynska, Scholz, & Schwarzer, 2005).
The PSS is a 10-item instrument helpful for identi-
fying and measuring both the perception of stress in
one’s life and the response to distress (Roberti,
Harrington, & Storch, 2006). Internal consistency reli-
ability (Cronbach’sa) was .89 for the 10 items, and
construct validity showed convergent evidence in a
high correlation between the PSS and the State-Trait
Anxiety Inventory (STAI).
The creative agency construct was developed with
questions on creative self-efficacy, a scale with high
internal consistency reliability (Cronbach’saD.86)
(Beghetto, 2006). We adopted five items from the scale
that were relevant to the adult population, including
self-perceptions of having good ideas, coming up with
good ideas; being imaginative; being able to solve
problems creatively; and being able to generate novel
ideas. The Cronbach’safor the creative agency con-
struct utilized in the present study was .90.
Procedures
Each session was facilitated individually with a trained
art therapist. Participants attended each of the sessions
on separate days and individually scheduled times.
After signing informed consent forms, the participants
completed standardized surveys before and after each
session. The open studio session was based on Allen’s
(1995;2008) work of merging art studio practices with
art therapy concepts. In the open studio condition,
participants were invited to work with the various art
materials, which included A4 (8
1/4
”x11’’) paper, A11
(11”x17”) paper, collage materials, modeling clay,
pencils, color pencils, oil pastels, chalk pastels, cray-
ons, and markers.
While no specific directive was given, the art thera-
pist offered guidance and support during the art-mak-
ing process. The art therapist also engaged in his or
her own art making alongside the participant. Partici-
pants had the option of creating any kind of imagery
using these media choices individually or in combina-
tion. The art therapist facilitating the session was
available to the participant to help with the media and
process the image once it was completed. Some partic-
ipants chose to work quietly whereas others talked
about their artwork, the art-making process, and other
aspects of their life as they participated in the session.
Following the principles of art therapy practice, the
participants were told that there were no expectations
about creating artwork to fulfill any external aesthetic
criteria, that their work was not going to be judged for
artistic qualities, and that they were free to work with
the materials however they chose. The art therapist
facilitating the session was available to provide any
assistance needed and followed the lead of the partici-
pants at the level of verbal interaction they sought
while making the art. The art making on average
lasted approximately 40 minutes. Participants were
offered time to reflect on any concerns after the ses-
sion and the referral of a qualified therapist was pro-
vided to participants who sought follow up support.
In the coloring condition, participants completed
the surveys before and after the session, which also
lasted about 40 minutes. Participants were offered six
potential coloring sheet options. The images were col-
lected from publicly available coloring sheets online
and included mandalas, geometric figures, and letter-
ing based sheets. Participants chose one sheet and
used either colored pencils or markers to do the color-
ing. In this condition, participants were instructed to
imagine coloring by themselves. An art therapist was
in the room but there was no interaction and no proc-
essing of the images. Some participants spontaneously
shared their perspectives at the end of the coloring ses-
sion, and these were noted.
All participants consented to having photo docu-
mentation of their artwork at the end of the session
60 G. KAIMAL ET AL.
coloring condition and the open studio condition.
Most participants took their artwork or coloring
sheets with them. See Figures 6a,b,cand 7a,b,cfor
examples of coloring and open studio art making. In
this paper we do not present analysis of the artwork or
narrative responses, only the outcomes data on pre
and post-survey responses to each session.
Data analysis
Data were analyzed using SPSS (version 24.0,
Armonk, NY: IBM Corp.). We summarized the demo-
graphic information with basic descriptive statistics
(frequencies, means, standard deviations). We exam-
ined the quantile-quantile plots, histograms, skewness,
kurtosis, and used the Shapiro-Wilk test for normality
to check distributional assumptions for the outcome
variables. To correct the significant positive skew
found in the negative affect distribution, we log trans-
formed the values of the variable for both conditions
pre- and post-session. In addition, we removed one
participant with an outlier score on negative affect
(score >2.5 standard deviations above the mean). All
other outcome variables met distributional assump-
tions, and no further outliers were found. A repeated-
measures factorial ANOVA was used to compare the
within-subjects main effect of time (pre- to post-ses-
sion), the within-subjects main effect of the condition
(open studio versus coloring), and the within-subjects
interaction effect of time by condition. The interaction
is the effect of most importance for determining if
changes in the variables differed by condition type and
hence for answering our stated hypothesis. We also
performed bivariate correlations for age and indepen-
dent samples ttests (with percentile corrected boot-
strapping due to the small sample size of men) for
gender in order to determine if they covaried with the
change scores for the outcome variables. In cases
where significant relationships or differences were evi-
dent, we added a covariate for age, and a between-sub-
jects factor (in the case of gender) to the within-
subjects repeated measures analysis to control for
potential confounding. Thirty-six participants took
part in the study; however, certain individuals did not
complete the full battery of surveys at pre- and post-
session time points for both conditions. Therefore, the
sample size for the repeated-measures factorial
ANOVA varied between 29 and 32 individuals,
depending on the specific outcome variable (sample
sizes for each analysis are shown in Table 1).
Results
Preliminary correlational analyses showed that change
in positive affect and creative agency in the open art
studio condition positively correlated with the age of
the participant: r(31) D¡.42, pD.19, r(28) D¡.43, p
D.02, respectively. Older participants tended to report
less change in positive affect and creative agency after
the session than younger participants. Women in the
Table 1 . Estimated marginal means for open studio art versus coloring pre- and post-session.
Open studio art Coloring
Time main effect Condition main effect Time by condition effect
N Mean (SE) N Mean (SE) F(df) F(df) F(df)
Self-efficacy
a
Pre-session 32 32.75 (0.76) 32 33.33 (0.61) 7.92 (1, 30) 0.15 (1, 30) 6.22 (1, 30)
Post-session 32 34.91 (0.78) 32 33.81 (0.76) pD.009 pD.699 pD.018
Effect size h
p2
D0.209 0.005 0.172
Creative agency
b
Pre-session 29 18.69 (0.80) 29 19.35 (0.68) 4.81 (1, 27) 1.76(1, 27) 14.50 (1, 27)
Post-session 29 19.51 (0.80) 29 19.90 (0.69) pD.037 pD.196 pD.001
Effect size h
p2
D0.151 0.061 0.349
Positive affect
c
Pre-session 31 28.25 (1.52) 31 30.65 (1.47) 6.57 (1, 28) 0.86 (1, 28) 4.99 (1, 28)
Post-session 31 35.34 (1.89) 31 32.54 (2.23) pD.016 pD.362 pD.034
Effect size h
p2
D0.19 0.03 0.151
Negative affect
d
Pre-session 30 2.68 (0.05) 30 2.68 (0.06) 38.33 (1, 29) 0.17 (1, 29) 0.59 (1, 29)
Post-session 30 2.52 (0.04) 30 2.49 (0.05) p<.001 pD.681 pD.448
Effect size h
p2
D0.569 0.006 0.02
Perceived stress
Pre-session 29 17.90 (1.11) 29 17.72 (0.87) 13.37 (1, 28) 0.03 (1, 28) 0.52 (1, 28)
Post-session 29 15.45 (1.06) 29 15.86 (0.92) pD.001 pD.867 pD.479
Effect size h
p2
D0.323 0.001 0.018
a
Model controlling for gender.
b
Model controlling for age.
c
Model controlling for gender and age.
d
Scores reflect log transformation performed to correct distribu-
tional skew.
CANADIAN ART THERAPY ASSOCIATION JOURNAL 61
open art studio condition changed significantly less
than the men in positive affect: t(24) D¡2.33, pD
.028, and self-efficacy, t(24) D¡2.09, pD.048. To
control for the potential confounding effects of these
variables, age was included as a covariate in the
repeated measures factorial ANOVAs for positive
affect and creative agency; gender was included as a
factor in the positive affect and self-efficacy models.
Table 1 shows the estimated marginal mean values
for both conditions pre- and post-session for each out-
come variable, as well as the F-tests, pvalues, and
effect sizes for the time main effect, the condition
main effect, and the time-by-condition-interaction
effect (the key effect of interest to us). Repeated meas-
ures factorial analysis of variance for within-subjects
effects showed a significant time by condition interac-
tion effect for self-efficacy: F(1, 31) D6.22, pD.018,
partial h
p2
D.172. About 17% of the variance in the
change in self-efficacy scores between pre- and post-
session was explained by the effect of the condition.
Open studio art produced significantly greater change
in self-efficacy scores than the coloring condition (see
Figure 1). A significant time by condition interaction
effect was found for creative agency: F(1, 28) D4.99, p
D.034, partial h
p2
D.151. About 15% of the variance
in the change in positive affect scores between pre-
and post-session was explained by the effect of the
condition. Open studio art produced significantly
greater change in creative agency scores than the col-
oring condition (see Figure 2). A significant time by
condition interaction effect was found for positive
affect scores: F(1, 27) D14.50, pD.001, partial h
p2
D
.349. About 35% of the variance in change in positive
affect scores between pre- and post-session was
explained by the effect of the condition (see Figure 3).
Open studio art produced significantly greater change
in positive affect scores than the coloring condition.
Although scores significantly improved from pre- to
post-session for negative affect and perceived stress
levels (see significant main effects for time in Table 1
and in Figures 4 and 5, respectively), degree of change
did not differ according to condition for these
variables.
Discussion
The goal of this study was to examine differences
between coloring and open studio art in order to
understand the therapeutic qualities of the two visual
Figure 1. Differences in general self-efficacy between coloring
and open studio art therapy. Note. Bars show I standard error
above and below mean.
Mean scores are estimated marginal
means from model controlling for gender.
Figure 2. Differences in perceived creative agency between col-
oring and open studio art therapy. Note. Bars show I standard
error above and below mean.
Mean scores are estimated mar-
ginal means from model controlling for age.
Figure 3. Differences in general positive affect between coloring
and open studio art therapy. Note. Bars show I standard error
above and below mean.
Mean scores are estimated marginal
means from model controlling for age gender.
62 G. KAIMAL ET AL.
expressive conditions. The hypothesis that open studio
art making facilitated by an art therapist would dem-
onstrate greater improvement on all of the outcomes
compared to coloring was partially met. We found the
open studio condition to be superior to coloring in
improving positive affect, self-efficacy, and creative
agency. The coloring condition had positive effects
that were similar to those of the open studio art condi-
tion in the measures of perceived stress and negative
affect. Moreover, correlational analyses indicated that
younger participants were particularly benefited in
creative agency and positive affect, and men made
especially significant gains in positive affect and self-
efficacy. Overall, our findings suggest that there are
distinct benefits of an art therapist-facilitated open
studio session above and beyond an individual color-
ing session. Although coloring reduced stress and neg-
ative affect as effectively as open studio art, it did not
demonstrate changes related to improved self-efficacy,
creative agency, and positive affect that were as trans-
formative as those demonstrated by open studio art.
The improvements in positive affect and self-effi-
cacy seen in the open studio art condition corrobo-
rates results from previous research (Kaimal & Ray,
2016; Walsh & Hardin, 1994). It is possible that the
art therapist-facilitated open studio setting with a
range of media and a facilitating therapist helped par-
ticipants negotiate the challenges of using media and
making decisions to create a visual image. Many par-
ticipants expressed initial anxiety when beginning the
open studio condition and stated afterward that the
guidance provided by the art therapist in choosing
materials or subject matter helped alleviate that anxi-
ety and allowed for greater access to free expression.
In addition, the process of receiving support and the
opportunity to discuss the image and associated expe-
riences with an art therapist could be a mechanism
that facilitated these changes in the individual partici-
pant. The role of the trained art therapist in the open
studio sessions is crucial to therapeutic change. Art
therapists are trained not only in understanding how
to use a variety of art media and materials, they are
also trained to support the fear and anxiety that many
people experience when faced with new and uncom-
fortable situations. For many adults, entering an art
studio, having a blank page in front of them, and being
asked to create art can be quite an anxiety-provoking
experience, so much so that most of them avoid this
experience altogether. Yet it is precisely through hav-
ing this initial discomfort and leaning into it, rather
than stepping away from it, that leads to a change in
one’s view of self. This moment is what is at the heart
of the practice of art therapy, and the analysis of and
attention paid to this moment is what has been miss-
ing in previous research on art making.
In the coloring condition, the participants only
engaged in coloring in a pre-drawn image. They did
not process the image with the art therapist or discuss
their experiences or reflections about the image. Some
participants in the coloring condition did spontane-
ously share their reflections after the post-session sur-
veys were completed. This experience highlighted the
potential therapeutic uses of coloring in art therapy.
Art therapists might consider coloring as a way to
encourage visual self-expression among participants
who are intimidated by artistic tasks. Given the refer-
ences in popular visual culture to coloring as a stress
Figure 4. Differences in general negative affect between coloring
and open studio art therapy. Note. Bars show I standard error
above and below mean.
Scores reflect log transformation per-
formed to correct distributional skew.
Figure 5. Differences in perceived stress between coloring and
open studio art therapy. Note. Bars show I standard error above
and below mean.
CANADIAN ART THERAPY ASSOCIATION JOURNAL 63
buster, our findings offer some data to suggest that it is
a valid assumption.
Coloring was also found to reduce negative mood
but had no significant impact on positive mood. This
finding could indicate that coloring might be a way to
counter distressing mental states (stress and negative
affect) but that coloring does not necessarily contrib-
ute to an enhanced sense of self-efficacy or positive
affect: these might need more deliberate creative
expression such as that offered in a session facilitated
by an art therapist. However, the participants were in
a setting with a researcher even in the coloring condi-
tion, which might have inadvertently affected the out-
comes. This presence of the researcher might have
generated effects similar to those of the Hawthorne
effect (Landsberger, 1958) such that the participant
was not truly engaging in coloring by him- or herself.
Additionally, the act of coloring is one of the few read-
ily available visual expressive opportunities for adults.
In our previous studies (Kaimal & Ray, 2016; Kaimal,
Ray, & Muniz, 2016), we found that adult participants
often reported that they had not had opportunities for
visual self-expression since they were in elementary
school. Thus, coloring might be considered a potential
self-care practice as well as a doorway to art therapy
and creative visual self-expression.
However, the constraints of the coloring condition
evoked intense negative reactions from a few partici-
pants who identified as artists. One participant drew
over the pre-drawn coloring form to create a new
visual image. Most participants reported enjoying the
condition and even made associations to the com-
pleted visual. Most participants took their artwork
from both conditions with them. One participant
reported that the coloring sheets looked too feminine,
which is a potential consideration for future studies.
The open studio free art-making session was a
one-time interaction, and the changes seen might
have been different if multiple sessions of art therapy
were offered. Given that it was a one-time interaction,
Figure 6. Examples of coloring sheets completed by participants.
64 G. KAIMAL ET AL.
we used structured art media, which also potentially
limited the range of expressive options available to
participants. The findings also highlight the potential
to introduce the benefits of art therapist-facilitated
open studio as a community-based practice. Commu-
nity-based art therapy studios could serve as a form of
outreach providing particular assistance to men and
youth in need of support and older adults in the long
term. Coloring books have inadvertently drawn atten-
tion to the field of art therapy and provide the field an
opportunity to educate the public and invite engage-
ment. Art therapist-facilitated open studio art therapy
could be a way of making the field visible in everyday
life—within healthcare, schools, community contexts,
and the workplace—building upon the spotlight on
art therapy through coloring books.
Given these findings, we propose that a potential
mechanism of change that is unique to art therapy is
the positive impact on affect, creative agency, and self-
efficacy. Luszczynska et al. (2005) found that general
self-efficacy (GSE) is correlated to social cognitive
constructs such as behavior-specific self-efficacy
beliefs, implementation intentions, goal intentions,
self-regulation, and especially effective coping. Nega-
tive correlations between GSE and negative emotions
were confirmed, indicating useful indicators of situa-
tion-specificefficacy. Visual expression through color-
ing might lower negative mood and stress, but art
therapy sessions alone can potentially improve mood
and sense of self-confidence around the ability to be
creative, solve problems, and initiate change.
The study had a number of limitations. The sample
was not large, and some participants did not complete
both conditions. In addition, the participants were
mostly women, so any potential effects related to gen-
der could not be firmly established in this sample. The
coloring condition directive required the participants
to imagine working alone; however, they were not
really alone because the researcher was in the room.
Thus, the condition did not truly mimic coloring by
oneself and could have inflated some of the positive
findings seen in the coloring condition. A few partici-
pants who had extensive prior art-making experience
were frustrated by the limitations of the coloring con-
dition, and their responses might also have skewed the
results. The open studio art therapy was a single-ses-
sion interaction, which limited the capacity for signifi-
cant changes. Although the session demonstrated
improved outcomes on all the measures, we do not
know if the results were sustained over time, or if
some participants would have liked more sessions. In
addition, the open studio art condition had several
Figure 7. Examples of artwork created during the art therapist-
facilitated open studio sessions.
CANADIAN ART THERAPY ASSOCIATION JOURNAL 65
media options and expressive choices that might also
have affected the outcomes. Lastly, we used several
measures correlated with anxiety like the PANAS for
positive and negative affect, and the PSS for perceived
stress, but we did not use a specific measure of anxiety.
In conclusion, both conditions resulted in similar
reductions in stress and negative affect, but the art
therapy open studio condition led to significantly
superior improvements in self-efficacy, creative
agency, and positive affect. The findings indicate some
potential benefits to coloring and that it might be a
simple way to introduce individuals to visual self-
expression and art therapy. These results indicate that
the insights and transformative experiences of the art
therapy open studio session can translate into real-life
situations. Age was found to be related to changes in
outcomes for positive affect and creative agency such
that younger participants were more likely to show
greater improvements than older participants. The arts-
based approaches might be considered a potentially
empowering intervention for youth in future studies. It
is also possible that older adults might need more ses-
sions to show significant shifts in these constructs.
Future research might examine differences in longer
term interventions including multiple sessions of open
studio art therapy and sustained impact of interventions
on outcomes of anxiety and mood among a range of
diverse populations. In addition, future studies should
seek to systematically study the unique mechanism of
change through art therapy that explains the shifts in
positive affect, creative agency, and self-efficacy.
Funding
Funding was provided by the College of Nursing and Health
Professions, Drexel University Neuroinflammation and Gen-
der Research Group (US).
ORCID
Girija Kaimal http://orcid.org/0000-0002-7316-0473
Janell L. Mensinger http://orcid.org/0000-0001-7675-8879
Jessica M. Drass http://orcid.org/0000-0001-9867-4019
Rebekka M. Dieterich-Hartwell http://orcid.org/0000-0002-
9788-7140
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