The Effect of Mandala Coloring on State Anxiety: A Systematic Review and Meta-Analysis

Figures & data

Figure 1 An Example of a Modern Pre-Drawn Mandala (Note. Obtained from http://www.free-mandalas.net)

Figure 2 Flow Chart of the Selection Process

Table 1. Studies Included in the Review

Author (year)	Sample	Intervention Duration	Outcome Measures	Assessment Points and Anxiety Induction	Main Finding
Curry and Kasser (2005)	American undergraduate students (n = 57), age 18–22.	20 min	The State Anxiety Inventory (14 items).	Baseline, anxiety induction, pre-intervention, post-intervention.	Mandala coloring was more anxiety reducing than free-drawing.
van der Vennet and Serice (2012)	American psychology students (n = 35), age 21–59.	20 min	The State Anxiety Inventory (20 items).	Baseline, anxiety induction, pre-intervention, post-intervention.	Mandala coloring was more anxiety reducing than free-drawing.
Ashlock et al. (2018)	American undergraduate psychology students (n = 80), age 18–25.	20 min	The State Anxiety Inventory (20 items).	Anxiety induction, pre-intervention, post-intervention.	Mandala coloring was not more anxiety reducing than free-drawing.
Duong et al. (2018)	American graduate students (n = 93), age 22–56.	12 min	The State Anxiety Inventory (20 items).	No anxiety induction, pre-intervention, post-intervention.	Mandala coloring was not more anxiety reducing than free-drawing.
Mantzios and Giannou (2018)	British undergraduate students (n = 84), age 18–26.	10 min	The State Anxiety Inventory, Short-Form (6 items).	No anxiety induction, pre-intervention, post-intervention.	Mandala coloring was not more anxiety reducing than free-drawing.
Carsley and Heath (2020)	Canadian students (n = 115).	15 min	The State Anxiety Inventory (20 items).	No anxiety induction, pre-intervention, post-intervention.	Mandala coloring was not more anxiety reducing than free-drawing.
Cross and Brown (2019)	Australian students (n = 54), age 17–53.	15 min	The State Anxiety Inventory, Short-Form (6 items).	No anxiety induction, pre-intervention, post-intervention.	Mandala coloring was not more anxiety reducing than free-drawing.
Koo et al. (2020)	Older adults in Taiwan (n = 60).	20 min	The State Anxiety Inventory (20 items).	Baseline, anxiety induction, pre-intervention, post-intervention.	Mandala coloring was not more anxiety reducing than free-drawing.

Table 2. Risk of Bias Assessment of the Included Studies in the Current Review

Study	Randomization Process	Deviations from Intended Interventions	Missing Outcome Data	Measurement of the Outcome	Selection of the Reported Results	Overall Bias
Curry and Kasser (2005)	Low risk	Some concerns	Low risk	Some concerns	Low risk	Some concerns
van der Vennet and Serice (2012)	Low risk	Some concerns	Low risk	Some concerns	Low risk	Some concerns
Ashlock et al. (2018)	Low risk	Some concerns	Low risk	Some concerns	Low risk	Some concerns
Duong et al. (2018)	High risk	Some concerns	Low risk	Some concerns	Low risk	High risk
Mantzios and Giannou (2018)	Low risk	Some concerns	Some concerns	Some concerns	Some concerns	Some concerns
Carsley and Heath (2020)	Low risk	Some concerns	Low risk	Some concerns	Low risk	Some concerns
Cross and Brown (2019)	High risk	Some concerns	Low risk	Some concerns	Low risk	High risk
Koo et al. (2020)	Low risk	Some concerns	Low risk	Some concerns	Low risk	Some concerns

Figure 3 Forest Plot of the Effect of Coloring Mandala Designs to Reduce Anxiety, as Compared to Free-Drawing

Figure 4 Funnel Plot of Study-Specific Effect Sizes Against Standard Error (Note. The light gray lines indicate the triangular 95% pseudo confidence interval, each dot is a single study, and the vertical line indicate the point estimate of the treatment effect)

Curry, N. A., & Kasser, T. (2005). Can coloring mandalas reduce anxiety? Art Therapy, 22(2), 81–85. https://doi.org/10.1080/07421656.2005.10129441

 Google Scholar

van der Vennet, R., & Serice, S. (2012). Can coloring mandalas reduce anxiety? A replication study. Art Therapy, 29(2), 87–92. https://doi.org/10.1080/07421656.2012.680047

 Google Scholar

Ashlock, L. E., Miller-Perrin, C., & Krumrei-Mancuso, E. (2018). The effectiveness of structured coloring activities for anxiety reduction. Art Therapy, 35(4), 195–201. https://doi.org/10.1080/07421656.2018.1540823

 Web of Science ®Google Scholar

Duong, K., Stargell, N. A., & Mauk, G. W. (2018). Effectiveness of coloring mandala designs to reduce anxiety in graduate counseling students. Journal of Creativity in Mental Health, 13(3), 318–330. https://doi.org/10.1080/15401383.2018.1437001

 Web of Science ®Google Scholar

Mantzios, M., & Giannou, K. (2018). When did coloring books become mindful? Exploring the effectiveness of a novel method of mindfulness-guided instructions for coloring books to increase mindfulness and decrease anxiety. Frontiers in Psychology, 9(56), 56. https://doi.org/10.3389/fpsyg.2018.00056

 PubMedGoogle Scholar

Carsley, D., & Heath, N. L. (2020). Effectiveness of mindfulness-based coloring for university students’ test anxiety. Journal of American College Health, 68(5), 518–527. https://doi.org/10.1080/07448481.2019.1583239

 PubMed Web of Science ®Google Scholar

Cross, G., & Brown, P. M. (2019). A comparison of the positive effects of structured and nonstructured art activites. Art Therapy, 36(1), 22–29. https://doi.org/10.1080/07421656.2019.1564642

 Web of Science ®Google Scholar

Koo, M., Chen, H.-P., & Yeh, Y.-C. (2020). Coloring activities for anxiety reduction and mood improvement in Taiwanese community-dwelling older adults: A randomized controlled study. Evidence-Based Complementary and Alternative Medicine, 2020(6), 6964737. https://doi.org/10.1155/2020/6964737

 PubMedGoogle Scholar

Data Availability Statement

The data analyzed in this study are available upon reasonable request to the corresponding author.