Drawing for Anxiety

(D&A Trial)

Overseen By Sarah Myruski, PhD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Penn State University

Disqualifiers: Outside age range, Non-English speakers

Compensation: Varies

Number of Visits: 2

280 Participants Needed

Trial Summary

What is the purpose of this trial?

Anxiety is among the most common emotional difficulties impacting well-being, highlighting the need for approachable anxiety-reduction tools. Both mindfulness and art-based interventions have been shown to decrease anxiety symptoms. These studies integrate these approaches via a novel guided drawing intervention, and tests effects on anxiety (pre/post drawing and at one-week follow-up) and physiological regulation (respiratory sinus arrhythmia). This registration includes two separate intervention studies with similar protocols but using different samples - one consisting of adolescents ages 13 to 17.9 years, and the other consisting of adults ages 18 to 25 years. Participants complete a laboratory visit during which they complete questionnaires about their emotions and anxiety, complete pre/post measures of cardiac physiology and state anxiety, and engage in a drawing session. Participants also complete a one-week follow-up self-report of anxiety symptoms. The intervention protocol is briefly described as follows: participants in each sample are randomly assigned to one of three groups (guided drawing, free drawing control, or basic control).

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on drawing activities for anxiety, so it's unlikely that medication changes are required.

What data supports the effectiveness of the Guided Drawing Intervention treatment for anxiety?

Research shows that drawing can help reduce anxiety in children, such as those undergoing cancer treatment, by providing a way to express feelings and reduce stress. ^{1 2 3 4 5}

Is drawing therapy safe for managing anxiety in humans?

The research articles provided do not contain specific safety data for drawing therapy as a treatment for anxiety, but they do not report any harmful effects from using drawing as a method to assess or manage anxiety in children. ^{1 2 4 5 6}

How is the Guided Drawing Intervention treatment for anxiety different from other treatments?

Guided Drawing Intervention is unique because it uses drawing as a therapeutic tool to help manage anxiety, which is different from traditional treatments like medication or talk therapy. This approach focuses on creative expression to reduce anxiety, making it a novel option for those who may benefit from non-verbal therapeutic methods. ^{1 2 4 5 7}

Research Team

Sarah Myruski, PhD

Principal Investigator

The Pennsylvania State University

Eligibility Criteria

This study is for adolescents aged 13 to 17.9 years and young adults aged 18 to 25 years who experience anxiety. Participants will be asked about their emotions, engage in a drawing session, and report on their anxiety levels before, after, and one week following the intervention.

Inclusion Criteria

Able to speak, read and understand English

I am between 13 and 25 years old.

Exclusion Criteria

Not able to speak, read and understand English

I am not between 13-17.9 years or 18-25 years old.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Laboratory Visit

Participants complete questionnaires, cardiac monitoring, and a drawing session

90 minutes

1 visit (in-person)

Follow-up

Participants complete a one-week follow-up self-report of anxiety symptoms

1 week

1 visit (virtual)

Treatment Details

Interventions

• Guided Drawing Intervention

Trial Overview The trial examines how guided drawing can affect anxiety levels compared to free drawing or no specific activity (basic control). It involves measuring changes in anxiety symptoms and cardiac physiology pre/post-drawing session and at a one-week follow-up.

Participant Groups

Group I: Guided Drawing Group Experimental Treatment 1 Intervention

Participants in this group were asked to complete a guided drawing activity (\~20 min). Participants were given a pencil and blank paper to use while they watched a pre-recorded video guiding them through a mindfulness and drawing activity. In the pre-recorded video, participants are instructed to draw elements of nature from exemplar photographs (e.g., leaves, twigs). The activity incorporates drawing with aspects of mindfulness meditation (i.e., being non-judgmental of thoughts and behaviors, focusing on breathing, and embodiment).

Group II: Free Drawing Control Group Active Control 1 Intervention

In the free drawing group, participants watched a video with brief instructions and then were asked to draw whatever they would like for about 20 minutes.

Group III: Basic Control Group Placebo Group 1 Intervention

In the basic control group, participants were asked to complete simple paper and pencil activities (e.g., connect the dots, mazes) on their own for about 20 minutes.

Who Is Running the Clinical Trial?

Penn State University

Lead Sponsor

Trials

380

Recruited

131,000+

Findings from Research

A study involving 178 children aged 3 to 14 years demonstrated that analyzing children's drawings can effectively identify levels of anxiety, correlating well with Frankl's behavior rating scale.

The presence of stress markers in the drawings indicated a need for specialized behavioral techniques, suggesting that this nonverbal assessment can positively influence children's behavior in dental settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Identifying Dental Anxiety in Children's Drawings and correlating It with Frankl's Behavior Rating Scale. Mathur, J., Diwanji, A., Sarvaiya, B., et al.[2020]

A study involving 30 hospitalized children aged 9-16 years showed that drawing and writing techniques significantly reduced anxiety levels during cancer treatment, with anxiety scores decreasing from 40.46 to 36.86 after the intervention.

The intervention, which included drawing, writing, and mutual storytelling over five days, was effective in providing emotional support and reducing anxiety, highlighting the potential of creative therapies in pediatric oncology settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of drawing and writing technique on the anxiety level of children undergoing cancer treatment. Altay, N., Kilicarslan-Toruner, E., Sari, Ç.[2018]

In a study involving 78 children aged 6-12 undergoing dental treatment, their drawings were found to significantly correlate with their levels of dental anxiety, as measured by established behavior assessment scales.

The results suggest that children's drawings can serve as an effective non-verbal tool for assessing emotional status and anxiety in a dental setting, providing valuable insights into their experiences during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Children's drawing as a measurement of dental anxiety in paediatric dentistry. Guner Onur, S., Tonguc Altin, K., Demetgul Yurtseven, B., et al.[2020]

Research on anxiety indicators in the Draw-A-Person Test (DAP) has been conducted using both experimental stress induction and correlational studies with the Manifest Anxiety Scale, but there are significant methodological issues.

The review highlights that existing scoring systems for the DAP, while incorporating anxiety indices, suffer from problems such as not controlling for drawing quality and intelligence, which may affect the validity of the findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The validity of the Draw-A-Person Test as an anxiety measure. Sims, J., Dana, RH., Bolton, B.[2004]

The study involved 211 children and demonstrated that the Drawn Stories Technique is a valid method for assessing psychological distress in children, effectively identifying levels of anxiety and depression.

Results showed that children who depicted negative outcomes in their drawings reported higher levels of anxiety and depression, with girls generally exhibiting more distress than boys.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of the Drawn Stories Technique to evaluate psychological distress in children. Trombini, E., Montebarocci, O., Scarponi, D., et al.[2005]

A study involving 55 children aged 6 to 7 years used their color drawings to measure anxiety levels during dental treatment, revealing that anxiety increased after the first session but decreased after the second.

Despite the decline in anxiety after treatment, children's drawings still showed signs of anxiety, indicating that while clinical behavior may improve, underlying anxiety can persist, highlighting the importance of ongoing assessment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment of children's anxiety throughout dental treatment by their drawings. Sheskin, RB., Klein, H., Lowental, U.[2009]

Disabled individuals showed higher levels of dental fear and anxiety compared to healthy individuals, with significant differences noted in the Dental Beliefs Scale (DBS).

The presence of a disability significantly influenced the drawing parameters of tooth representations more than other forms, and dental fear had a greater impact on drawing characteristics than anxiety did.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Effect of being disabled, dental fear and anxiety on drawings]. Beck, A., Molnár, E., Fejérdy, P., et al.[2015]

References

1. India pubmed.ncbi.nlm.nih.gov

Identifying Dental Anxiety in Children's Drawings and correlating It with Frankl's Behavior Rating Scale. [2020]

2. Scotland pubmed.ncbi.nlm.nih.gov

The effect of drawing and writing technique on the anxiety level of children undergoing cancer treatment. [2018]

3. England pubmed.ncbi.nlm.nih.gov

Children's drawing as a measurement of dental anxiety in paediatric dentistry. [2020]

4. England pubmed.ncbi.nlm.nih.gov

The validity of the Draw-A-Person Test as an anxiety measure. [2004]

5. United States pubmed.ncbi.nlm.nih.gov

Use of the Drawn Stories Technique to evaluate psychological distress in children. [2005]

6. United States pubmed.ncbi.nlm.nih.gov

Assessment of children's anxiety throughout dental treatment by their drawings. [2009]

7. Hungary pubmed.ncbi.nlm.nih.gov

[Effect of being disabled, dental fear and anxiety on drawings]. [2015]