Sharpen Your Pencils: Preliminary Evidence that Adult Coloring Reduces Depressive Symptoms and Anxiety

The effect of mandala coloring on anxiety and quality of life of women in the climacteric period: a randomized controlled study

OBJECTIVE

This study was conducted to determine the effect of mandala coloring on anxiety and quality of life of women in the climacteric period.

METHODS

This research was conducted as an experimental study based on a randomized controlled pre-test and post-test model (single-blind). The study was conducted with women in the climacteric period who presented to a training and research hospital in a western city of Turkey between November 1, 2022, and April 28, 2023. Participants were divided into mandala coloring (n=38) and control groups (n=38).

RESULTS

According to the women's socio-demographic and descriptive characteristics, mean age, body mass index, and frequency of menopausal symptoms were similar in both groups. The mean post-test scores of the women in the mandala coloring group on the state-trait anxiety inventory and menopause-specific quality of life questionnaire vasomotor, psychosocial, physical, and sexual subscales (29.71±5.22, 0.86±0.97, 0.53±0.61, 0.79±0.84, and 0.92±1.24, respectively) were lower than the mean post-test scores of the women in the control group on the same scales (41.02±1.20, 1.79±1.76, 1.49±1.39, 1.72±1.38, and 1.95±1.82, respectively) (p=0.000).

CONCLUSION

Mandala coloring reduces menopause-related anxiety levels and improves quality of life effectively.

The effect of mandala coloring on pregnancy-related anxiety

PURPOSE

In the literature, the efficacy of mandala coloring on pregnancy-related anxiety has been investigated, and no study has been found on its effect on anxiety. This randomized controlled trial was designed to assess the efficacy of mandala coloring application on pregnancy-related anxiety.

METHODS

The study included 77 primiparous pregnant women: 39 in the control group and 38 in the experimental group, and was carried out in an education-research hospital's obstetric clinic. Data for the study were gathered using Information Form, the Pregnancy-related Anxiety Scale, and the State Anxiety Inventory. While the experimental group did mandala coloring during a month twice in a week, and the control group was not do anything. The "Pregnancy-related Anxiety Scale" and "The State Anxiety Inventor" were used to assess anxiety in all groups before and after application. In the statistical analysis of the data, the SPSS 23.0 package program was used. In all tests, p < 0.005 was considered statistically significant.

RESULTS

Immediately post-intervention, the women in the experimental group had a significantly higher reduce pregnancy-related anxiety (p < 0.05). Especially in the mandala group within according to control group were found to have significantly reduced anxiety the application (PrAS-1 82,50 ± 2,47 vs. 84,41 ± 4,12; PrAS-2 77,92 ± 2,16 vs. 83,89 ± 3,80; PrAS-3 72,05 ± 3,97 vs. 84,10 ± 4,35; PrAS-Total 77,49 ± 5,21 vs. 84,13 ± 4,07; STAI-1 52,39 ± 2,50 vs. 51,17 ± 1,16; STAI-2 49,73 ± 0,75 vs. 49,05 ± 1,27; STAI-3 48,84 ± 3,17 vs. 49,02 ± 1,22; STAI-Total 50,32 ± 2,8 vs. 49,75 ± 1,58).

CONCLUSIONS

Mandala coloring is effective in reducing pregnancy-related anxiety.

CLINICAL TRIAL NUMBER

(NCT05534867).

The relaxation zone: Initial analysis of stress management services for university students

Objective: We evaluated the Relaxation Zone (RZ), a room with "relaxation stations" designed to reduce stress in college students. Participants: Participants (N = 994) were enrolled during the 2019 calendar year. Most participants were female (62.8%), freshmen (59.3%), and African American (44.9%). Methods: Students visiting the RZ completed a brief pretest and posttest that measured self-reported stress. Results: Paired sample t-tests across class groups (e.g., freshman, sophomore) revealed a significant reduction in stress from pretest (Mpooled = 6.0) to posttest (Mpooled = 4.5), with medium to large effect sizes (Cohen's d ranging from 0.53 to 0.88) during their first visit. For students having at least two visits (N = 348), an exploratory dose-response analysis demonstrated that an optimal dose of self-guided relaxation ranged from two to eight visits. Conclusions: These findings provide initial evidence that programs like the RZ can reduce student stress within a few visits.

Brief mindful coloring for stress reduction in nurses working in a Hong Kong hospital during COVID-19 pandemic: A randomized controlled trial

BACKGROUND

Effective interventions to promote well-being at work are required to reduce the prevalence and consequences of stress and burnout especially during the COVID-19 pandemic. This study determined the effects of mindful coloring on perceived stress levels, mental well-being, burnout, and state and trait mindfulness levels for nurses during COVID-19.

METHODS

This was a single-center, two-armed, parallel, superiority, blinded randomized controlled trial. Seventy-seven participants were randomly allocated (by computer-generated sequence) to either mindful coloring (n = 39) or waitlist control groups (n = 38). Twenty-seven nurses in the mindful coloring group and 32 in the control group were included in the full compliance per protocol analysis. The mindful coloring intervention included participants viewing a 3-minutes instructional video and coloring mandalas for at least 5 working days or 100 minutes in total during a 10-day period. Participants in both groups completed the Perceived Stress Scale (total score 0-40), short Warwick-Edinburgh Mental Well-being Scale (total score 7-35), Maslach Burnout Inventory-Human Services Survey for Medical Personnel (3 subscales), Five Facets Mindfulness Questionnaire-Short Form (total score 24-120) and Mindful Attention Awareness Scale-State version (total score 0-30) instruments. The primary outcome was the perceived stress level.

RESULTS

Baseline prevalence of moderate to high perceived stress level was high (79.2%). There was a large mindful coloring effect on reducing mean perceived stress levels (Mean difference [MD] in change between groups -3.0, 95% CI: -5.0 to -1.00; Cohen's d = 0.80). Mindful coloring may lead to a small improvement in mental well-being level (P = .08), with an improvement found in the intervention group (MD 0.9, 95% CI 0.0-1.8, P = .04) through enhanced state mindfulness (P < .001). There were no effects on changing burnout subscales or trait mindfulness levels. No adverse reactions were reported.

CONCLUSION

Coloring mandalas may be an effective low-cost brief intervention to reduce perceived stress levels through enhancing state mindfulness and it may promote mental well-being. Hospitals may promote or provide mindful coloring as a self-care and stress-relief practice for nurses during their off hours or work breaks.

Mindfulness, anxiety, and perceived stress in university students: Comparing a mindfulness-based intervention (MBI) against active and traditional control conditions

ObjectivesUniversity students experience heightened levels of stress and are seeking mental health services with increasing frequency. Mindfulness-based interventions (MBIs) may be an effective resource for managing stress. The present study examined the effectiveness of an MBI in reducing stress, anxiety, and rumination compared to active and traditional control conditions.MethodsUndergraduate students at a southeastern university participated in either a 4-week MBI, active control, or traditional control condition. Measures were collected pre- and post-intervention. Results: Overall the MBI had a significant impact on perceived stress over and above both traditional and active control conditions. The MBI also had a significant impact on trait mindfulness and anxiety compared to the traditional control condition. No significant differences were observed for rumination. Conclusions: The MBI significantly impacted trait mindfulness, perceived stress, and state anxiety. MBIs may be a useful approach to successfully alleviating stress in a highly stressed population.

The effects of coloring therapy on patients with generalized anxiety disorder

Generalized anxiety disorder (GAD) has harmful effects on physical and mental health and quality of life. Coloring therapy has been reported to have a positive effect on improving patient anxiety and depression. But there are no reported clinical trials examining their effectiveness as a treatment for GAD. This study was planned to evaluate the effectiveness of coloring therapy combined with conventional therapy in improving anxiety, depression, and positive and negative emotions with GAD. This randomized controlled study comprising 88 GAD patients was selected for intervention in different wards. The control group (n = 45) was given conventional antianxiety medication and physical therapy, and the experimental group (n = 43) received coloring therapy combined with conventional therapy. The Self-Rating Depression Scale, Self-Rating Anxiety Scale (SAS), Hamilton Depression Scale, Hamilton Anxiety Scale (HAMA), and Positive and Negative Affect Scale were assessed in both groups before and 3 weeks after the intervention. After the intervention, there were statistical differences in intra- and inter-group comparisons of anxiety, depression, and positive and negative mood scales in the experimental and control groups (p < .05). The minus in anxiety/positive emotions pre- and postintervention in the experimental group was statistically significant compared to that in anxiety/positive emotions pre- and postintervention in the control group (HAMA: d = 1.45, 95% confidence interval [CI] (0.34, 2.57), p = .011; SAS: d = 3.87, 95% CI (1.73,6.00), p = .001; positive: d = 1.76, 95% CI (0.17, 3.34), p = .030). The minus in depressive/negative emotions pre- and postintervention in the experimental group was not statistically significant compared with that in depressive/negative emotions pre- and postintervention in the control group (p > .05). For GAD patients, adding coloring therapy based on conventional drug therapy and physical therapy can not only reduce depression and negative emotions but also have better effects on reducing anxiety and improving positive emotions than conventional therapy.

Effect of Mindfulness-Based Art Therapy (MBAT) on Psychological Distress and Spiritual Wellbeing in Breast Cancer Patients Undergoing Chemotherapy

Objectives

Psychological distress and spiritual well-being (SWB) are directly related to the quality of life in cancer patients. Mindfulness-Based Art Therapy (MBAT) integrates mindfulness practices with art therapy and has shown to decrease distress levels and improve SWB in women with breast cancer. The objective of the study was to identify the effects of a 1-week MBAT intervention on psychological distress and SWB in breast cancer patients undergoing chemotherapy.

Materials and Methods

This was a single group, pre-test post-test study carried out in a clinical setting. The psycho-oncology assessment questionnaire, Distress Thermometer (DT) and Functional Assessment of Chronic Illness Therapy-SWB Scale 12 (FACIT-SP12) Version 4 were administered before, post1^st supervised MBAT session and post 1 week of home practice to breast cancer patients undergoing chemotherapy (n = 30). The MBAT intervention included mindfulness meditation for 15 min and mindful coloring for 30 min daily for 1 week. Data analysis was done using R i386 4.0.3.

Results

The median DT score significantly decreased from pre-session to immediate post-session and pre-session to post 1-week session. The median of meaning, peace, and faith subscales of FACIT SP12 scores along with total FACIT SP12 score significantly increased from pre-session to immediate post-session as well as from pre-session to post 1 week.

Conclusion

One-week MBAT intervention for breast cancer patients undergoing chemotherapy significantly decreased the psychological distress and significantly improved the SWB in terms of meaning, peace, and faith.

The effect of mandala colouring on anxiety in hospitalized COVID-19 patients: A randomized controlled clinical trial

COVID-19 significantly affects patients' mental health, triggering a wide range of psychological disorders, including anxiety. The aim of this study was to investigate the effect of mandala colouring on the anxiety of hospitalized COVID-19 patients. In this randomized controlled clinical trial, 70 hospitalized patients with COVID-19 were randomly divided between the intervention and control groups. Standard care was provided for both groups. The intervention group spent 30 min/day for six consecutive days performing mandala colouring. Patient anxiety was measured prior and subsequent to the intervention in both groups using the Spielberger State-Trait Anxiety Inventory. Data were analysed using SPSS software version 25. The mean anxiety score was not significantly different between the two groups before the intervention (P = 0.08). Subsequent to the intervention, the mean anxiety score in the intervention and control groups was 44.05 ± 4.67 and 67.85 ± 6.25, respectively, indicating a statistically significant (P = 0.0001) decrease in the anxiety measured among the intervention group as compared with that of the control group. The results of this study show that 30 min of mandala colouring daily is an effective strategy for reducing anxiety in hospitalized COVID-19 patients. Mandala colouring can complement routine treatment and provides a non-pharmaceutical option for decreasing patient anxiety.

Cooperative and Individual Mandala Drawing Have Different Effects on Mindfulness, Spirituality, and Subjective Well-Being

Mandala drawing was first practiced by Tibetan buddhists and then developed by Carl Gustav Jung, who felt certain that mandala drawing has the function of integrating psychological division, enhancing psychological harmony, and preserving personality integrity. Previous studies on mandala drawing have mainly focused on alleviating people’s negative emotions, such as anxiety and depression. Therefore, this study explored the effect and mechanism of mandala drawing on the improvement of subjective well-being (SWB), mindfulness, and spirituality from positive psychology’s viewpoint and compared the different effects of cooperative mandala drawing (CMD) and individual mandala drawing (IMD) on mindfulness, spirituality, and SWB. A total of 76 students were recruited from Chang Gung University, and the aforementioned three main variables were measured before and after the coloring experiment. The results indicated that both CMD and IMD significantly enhanced the subjects’ spirituality. Compared with IMD, CMD has a more significant improvement and promotion effect on SWB of subjects by affecting PA, while IMD had no significant effect on PA, and the enhancement effect of SWB was weaker than that of CMD. Mindfulness, spirituality, and SWB all positively correlated with each other. This study highlights the mechanism of mandala drawing and the theoretical understanding of the relationship between mindfulness and SWB. Mandala drawing especially CMD has a positive effect on spirituality and SWB, which may provide individuals with a simple and easy method to improve their happiness.

There is a non-evidence-based app for that: A systematic review and mixed methods analysis of depression- and anxiety-related apps that incorporate unrecognized techniques

BACKGROUND

Recent studies have utilized available online data to examine the impact of depression- and anxiety-related apps that incorporate evidence-based techniques; however, the impact of apps incorporating non-evidence-based techniques is unknown. Understanding this impact is important in order to assess the potential benefits or harm from their use.

METHODS

We systematically reviewed apps incorporating relevant techniques aimed at depression- and anxiety-related conditions, found through Google Play search. We conducted quantitative and qualitative analyses of user reviews, and analyzed app usage utilizing an independent user panel.

RESULTS

Compared to apps incorporating evidence-based techniques (n = 14), user ratings of apps classified as non-evidence-based (n = 27) were lower (4.0 versus 4.5, p=.001, η²=0.24) and a smaller percentage of users found these apps to be beneficial for mental health (76.2% versus 100%, p=.003, η²=0.23). Users found apps incorporating non-evidence-based techniques to be mostly helpful in providing in-the-moment relief; however, some users described these apps as containing content that could be harmful for a person in such a mental state.

LIMITATIONS

The data do not enable the differentiation of user experiences based on user groups (e.g. according to the severity of symptoms), which should be examined in future studies.

CONCLUSIONS

This study indicates that depression and anxiety apps incorporating non-evidence-based techniques are viewed less favorably and have more potential to cause harm. However, many users found them helpful mostly in providing in-the-moment relief. Examining user experiences with these apps is an important way to learn about unmet user needs and potential benefits or harm.

Effectiveness of mindfulness-based coloring for university students' test anxiety

Objective: This study compared the effectiveness of mindfulness coloring (mandala), free drawing/coloring, and a noncoloring control activity for university students' test anxiety, and assessed the relationship of dispositional mindfulness and response to intervention on mindfulness and test anxiety states. Participants: University students (n = 167; 81.4% female; M_age = 21.29 years, SD = 4.46) were randomly assigned to a mandala (n = 57), free draw/coloring (n = 58), or noncoloring condition (n = 52). Methods: Participants completed standardized measures assessing test anxiety and state mindfulness pre-postactivity before completing a test, and two dispositional mindfulness measures. Results: Participants in both coloring conditions reported significant decreases in test anxiety and significant increases in state mindfulness pre-postintervention, and participants in the control condition reported significant increases in test anxiety. Reports of preintervention state mindfulness and test anxiety fully mediated relations between dispositional mindfulness and postintervention state mindfulness and test anxiety. Conclusions: Implications for research and practice on mindfulness coloring and test anxiety are discussed.

Randomized Controlled Trial of Adult Therapeutic Coloring for the Management of Significant Anxiety in the Emergency Department

BACKGROUND

Anxiety and acute distress are significant concerns in the emergency department (ED). Adult coloring books are often utilized as an effective means of relaxation in waiting rooms and newsstands, but there are no reported randomized trials examining their effectiveness as a treatment for anxiety.

METHODS

We set out to examine the effectiveness of adult coloring books using a randomized placebo-controlled trial at a university-affiliated tertiary ED. Anxiety was measured using a validated self-reporting score, the Hospital Anxiety and Depression Scale (HADS-A), with a range of 0 to 21. Patients with HADS-A ≥ 7 were randomly assigned to either an adult coloring pack (n = 26) or placebo pack (n = 27). The primary outcome measure was the within-patient change in HADS-A scores following 2 hours of exposure.

RESULTS

A convenience sample of 117 patients were screened, and 53 patients were randomized. Characteristics of allocated groups were similar in terms of sex, diagnosis, and ethnicity. A higher proportion of intervention subjects spent ≥1 hour engaged with their activity (46.2% vs. 4.0%, p = 0.01). For the primary outcome measure, the mean within-patient decrease in HADS-A score at 2 hours for intervention subjects was 3.7 (95% confidence interval [CI] = 2.4 to 5.1, p < 0.001) versus a decrease of 0.3 (95% CI = -0.6 to 1.2, p = 0.51) in the placebo group.

CONCLUSIONS

Among ED patients, exposure to adult coloring books resulted in lower self-reported levels of anxiety at 2 hours compared to placebo.

Adult colouring: the effect of app-based vs. pen-and-paper colouring on mindfulness and anxiety

Background

The rise in popularity of “mindfulness colouring books” has led to the development of colouring applications as an alternative to the traditional pen-and-paper versions. There have been no investigations exploring these applications in regards to mindfulness.

Participants and procedure

In two randomised experiments, this study examined whether there were any differences in state mindfulness and anxiety between (a) paper-and-pen and a colouring application (i.e., Experiment 1; n = 100), and (b) two different methods of colouring within an application (i.e., tapping or swiping; i.e., Experiment 1; n = 100).

Results

Experiments 1 and 2 showed a significant decrease in anxiety symptoms following a single colouring session, irrespective of different conditions. Also, Experiment 1, but not Experiment 2, revealed that colouring through the application significantly aided the increase in mindfulness.

Conclusions

App-based colouring may be a contemporary time- and cost-effective intervention in reducing anxiety. However, the non-significant increase in mindfulness appears challenging when attempting to justify the results. The effectiveness of colouring apart from mindfulness is seen through potential constructs such as flow, and display a limitation that requires further reflections on guidance to enhance mindfulness through colouring. Future directions are discussed.