Journal of American College Health

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/vach20

A qualitative inquiry comparing mindfulness-

based art therapy versus neutral clay tasks as
a proactive mental health solution for college
students

Theresa Van Lith , Megan Beerse & Quinn Smalley

To cite this article: Theresa Van Lith , Megan Beerse & Quinn Smalley (2020): A qualitative
inquiry comparing mindfulness-based art therapy versus neutral clay tasks as a proactive
mental health solution for college students, Journal of American College Health, DOI:
10.1080/07448481.2020.1841211

To link to this article: https://doi.org/10.1080/07448481.2020.1841211

Published online: 30 Nov 2020.

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JOURNAL OF AMERICAN COLLEGE HEALTH
https://doi.org/10.1080/07448481.2020.1841211

A qualitative inquiry comparing mindfulness-based art therapy versus neutral

clay tasks as a proactive mental health solution for college students
Theresa Van Lith, PhD, ATR-BC, AThR , Megan Beerse, MS , and Quinn Smalley, MS
Department of Art Education, Florida State University, Tallahassee, Florida, USA

ABSTRACT ARTICLE HISTORY

Objective: College students experience unprecedented levels of stress and anxiety, impacting Received 17 March 2020
their desire to perform well and live a balanced life. Mindfulness-based practices along with art Revised 8 August 2020
therapy techniques have been demonstrated to improve psychological and physiological impacts Accepted 18 October 2020
of stress and anxiety among college students. Participants: 12 undergraduate college students
KEYWORDS
participated in pre and post-test interviews following their engagement in either mindfulness- Anxiety; art therapy; college
based art therapy (MBAT) or a neutral clay task (NCT) using a 5-week online format. Methods: students; gateway
Descriptive phenomenology and artful inquiry were used to elicit participants’ perspectives. intervention; stress
Results: Both MBAT and NCT elicited relaxing and calming effects, but MBAT provided more pro-
active and direct benefits, with participants reporting that they could identify and move through
stressors. While NCT participants described their experience as fun or playful. Conclusions: These
findings offer notable support for implementing online and accessible mental health strategies
such as MBAT and NCT into college settings.

Introduction (public, perceived, and self-stigma); 2) structural barriers like

Stress and anxiety on college campuses
Individuals in Generation Z were born between 1995 and
2015, and this generation makes up nearly half (41%) of the
total number of enrolled students at degree-granting univer-
sities in the U.S.1 They are also considered the most stressed
out generation of our time, with 91% of Generation Z
respondents saying they have experienced at least one physical
or emotional symptom due to stress in the last month com-
pared to 74% of adults overall.2 In a large-scale study with 73
universities across the United States, 3 more than 1 in 5 stu-
dents (22%) were found to have seriously considered suicide
in their lifetime. In the National Alliance on Mental Illness
survey, 73% of college student respondents reported having
experienced at least one mental health crisis in college.4
College students have good reasons for experiencing stress
and anxiety.5–7 Some examples of college student stressors
include: financial issues, having new responsibilities, increased
workload, peer support, and changes in sleeping and eating
habits.4,8 Navigating college stressors might be made more
confusing when individuals feel that there are barriers to
accessing mental health services. For instance, undergraduate
students reported that on-campus counseling services were
costly and difficult to schedule; they also noted that there is a
stigma in seeking out these services9 and that they prefer to
discuss these issues with their friends.10
Barriers to seeking out mental health support can be
broadly categorized into four key areas: 1) personal barriers
accessibility, cost, visibility, and convenience; 3) psychological
barriers like low self-esteem, poor emotional expression, or
excessive self-reliance; and 4) beliefs and/or concerns about
care providers regarding confidentiality, trustworthiness, and
competence.11 Those who struggle with seeking out help
might benefit from a ‘gateway’ intervention that provides an
easy-access and approachable introduction to mental health
services.12 Web-based strategies focused on addressing mental
health issues can be used to overcome some of the barriers
previously described. For instance, the Internet is relatively
accessible, low cost, anonymous, and convenient.
Mindfulness-based art therapy practices as a gateway
intervention
Mindfulness involves the practice of paying attention,
moment to moment, on purpose and without judgment.13
Mindfulness-based Art Therapy (MBAT) incorporates mind-
fulness practices like meditation and yoga into the practice
of art therapy.14 MBAT deeply embodies the theoretical
orientation of the Bodymind model,15 an art therapy model
for identifying the mechanisms of change activated through
art therapy. In this framework, the emphasis is placed on
the deeply interdependent relationship between the body
and the mind; for example, neurocognitive research indi-
cates that emotions are accessed through interoceptive and
sensory mechanisms.16 MBAT research has typically been
implemented to address physiological illnesses like breast

CONTACT Theresa Van Lith tvanlith@fsu.edu Department of Art Education, Florida State University, 1033 William Johnston building, Tallahassee, FL
32306-1232, USA.
ß 2020 Taylor & Francis Group, LLC
2 T. VAN LITH ET AL.
cancer among women; these results demonstrated psycho-
social adjustment and positive changes to cerebral blood
flow.17–19 Unfortunately, this MBAT protocol consisted of 2-
hour sessions weekly for 8 weeks, which is more time- and
cost-intensive than even Cognitive Behavior Therapy.
To address this current gap, we decided to collect prelim-
inary data by conducting two separate studies.14,20 For the
first study, full-time university students (N ¼ 15) were ran-
domly assigned to either the MBAT intervention, developed
by an art therapy professional and provided in an online
format, or a neutral clay task (NCT) for 10 weeks. The NCT
involved using the clay in any way that the participant chose
for fifteen minutes without instruction. Significant decreases
were found in anxiety symptoms and cortisol concentrations
for MBAT participants, with no significant decrease in per-
ceived stress at the 10-week mark. In comparison, partici-
pants in the NCT group did not experience any significant
decreases other than a reduction in cortisol concentrations
on Week.14
In Fall 2018, a second study was conducted, but in a
more intensive five-week time frame.20 Inclusion criteria
was that students were 18-25 years old and currently
enrolled full-time at the university. Exclusion criteria was
the habitual use of nicotine (i.e. cigarettes, e-cigarettes, per-
sonal vaporizers) due to the salivary cortisol testing. A total
of 77 participants completed all 10 modules (MBAT N ¼ 41;
NCT N ¼ 36). Retention was greatly enhanced during the
second study, with 66% of participants completing all 10
modules, but participants in the NCT group with high levels
of perceived stress and moderate/severe anxiety were the
most likely to drop out of the study. Risk of dropout
increased in both the MBAT and NCT groups with more
severe initial generalized anxiety and perceived stress scores.
Within-group analysis demonstrated that MBAT participants
experienced statistically significant decreases in perceived
stress, anxiety symptoms, and cortisol concentrations at the
last face-to-face meeting. The NCT participants also experi-
enced significant reductions in cortisol concentrations, but
no significant difference was observed in general anxiety
symptoms or perceived stress.
While these results were promising and demonstrated a
high level of impact at both the psychological and biological
levels, we also wanted to know from the participants in
the second study how they perceived this form of gateway
intervention as a tool to manage their mental health in a
real-world setting. This included examining their level of
acceptance and satisfaction toward the tools provided, as
well as determining the likelihood of continuing to use the
coping tools learned through completion of the study.
Method
This study used a Descriptive Phenomenological approach
to conducting the data collection method and analysis pro-
cedures. Descriptive phenomenology is different from inter-
pretive forms of phenomenology because it seeks to
understand the essence and structure of a phenomenon,
without addressing the multiple ways it could be understood
through external theory or “speculation.”21
Two overarching questions guided the procedures for this
study: 1) How do college students perceive and manage
stress and anxiety in the university setting?, and 2) How do
students perceive the effects of MBAT versus NCT on stress,
anxiety, and general student functioning in the col-
lege setting?
This study was reviewed and approved by the University’s
Internal Review Board (InstitutionalReviewBoard (IRB)).
Participants reviewed and signed a consent form, which asked
them to indicate if they would like to be interviewed before
and after participation in the study. Initially, numerical cod-
ing was used to protect the students’ identity, which was later
replaced with their chosen pseudonyms. The link between
their identifying number and major/minor was kept to iden-
tify potential patterns regarding stressors and stress levels. As
part of their experience in the study, participants also com-
pleted the GAD-7 and PSS-10, establishing a baseline for their
anxiety symptoms and perceived stress levels. Participants
who scored a moderate score or higher on the self-report
assessments were contacted by the first author for interviews.
Participants were then randomly assigned to either the
MBAT or NCT group and were all provided with a medium
sized ball of clay and equipment to keep their clay wet
between challenges (i.e., box, paper towels, and bag, etc.).
For the MBAT group, participants were asked to complete
eight modules dubbed ‘self-care challenges.’ They received
the modules through the university’s student management
online platform, Canvas, and were instructed to complete 2
modules each week. All modules were designed to take
approximately 15 minutes. For the MBAT group, modules
consisted of brief mindfulness practices like yoga or medita-
tion paired with complementary MBAT art directives using
earth-based clay. Prompt examples included: “create a form
out of your clay that reflects the way you conceptualize
mindfulness,” or after a restorative yoga sequence “spend
10 min on mindful clay work.” For the NCT group, all mod-
ules included the same instruction to “manipulate the clay
in any way you wish for 15 minutes.”14,22
Interview structure
The semi-structured interviews took place during the first
and last (5th) week of the study and were conducted by the
first author (see Figure 1 for interview questions). At the
end of the second interview, all participants had the oppor-
tunity to create a reflective art piece, alongside the
researcher, that depicted their overall experience with
MBAT. This was created utilizing the clay given to them
during the study. If they agreed, they were given as much
time as they needed to create an art piece.
To maintain credibility, the “phenomenological
attitude”23 was adhered to during the interview process.
This attitude encouraged an open, non-judgmental stance,
where personal biases, assumptions, and theoretical ideas
were put to the side as much as possible.
 JOURNAL OF AMERICAN COLLEGE HEALTH 3

Figure 1. Outline of study questions.

Discussion about the final art pieces were facilitated Table 1. Demographic information.
through Barry’s24 symbolic constructivist approach to elicit Pseudonym Year in School Major GAD Score
emergent meanings about the art work. This approach Mackenzie Freshman Meteorology Severe
Megan Senior Classical Archeology Moderate
invited the researcher and participant to collaboratively dis- Stephanie Junior Actuarial Science Severe
cuss the representational and symbolic meanings by moving Amanda Did not say Humanities/undecided Severe
back and forth between whole-to-parts associations. Kelsey Junior Science Moderate
Delia Senior Spanish Moderately Severe
After the recorded interviews were transcribed, codes and Jasmine Junior English Moderately Severe
themes were generated through an inductive process. There Mara Junior Communication Severe
were no expectations of what would be found in the data. Riley Senior Nursing Moderately Severe
Arianna Senior Psychology Severe
The analysis process focused on a reductionistic attitude to Rico Freshman Involved with FSU teach Moderately Severe
determine emergent themes. Errasti-Ibarando et al.25 defined Tamara Freshman Interdisciplinary Moderately Severe
Medical Sciences
reduction as a way of thinking that asks the researcher to
seek raw contact with phenomena in order to leave behind
their conceptualized worldview and be reflectively attentive to (7) interviewees were in the MBAT group, and five (5)
different phenomena. Thematic analysis was chosen to deter- interviewees were in the NCT group. As seen in Table 1, of
mine patterns in the data set and to analyze for themes.26–28 the twelve (12) participants who participated in interviews,
The steps involved 1) immersion in the data, 2) coding the eleven were female (91.67%) and one was male (8.33%).
data based on ideas found, 3) discovering broader themes Their GAD scores revealed the participants’ levels of anxiety:
and sub-themes, 4) defining and naming themes, 5) writing two students had a moderate level (16.67%), four had mod-
stories about each theme, and 6) relaying the story found in erately severe levels (33.33%), and six had severe lev-
relation to the research question. The analysis placed a focus els (50%).
on the differences in experience between the responses of the
control group (NCT) and experimental group in the
College student perceptions of stress, anxiety, and
study (MBAT).
stress management in the university setting
The themes found among both groups in the first interviews
Findings
described the nature of stress, anxiety, and mental health
A total of twelve individuals participated in both interviews, management in the university setting. The overall themes
resulting in twenty-four total interviews. At random, seven identified which represented this issue were: Pressure to
4 T. VAN LITH ET AL.
perform well, concern about the future, feeling spread thin
and unbalanced, stress with independence, difficulties imple-
menting meaningful self-care, and systemic and personal
issues with counseling.
Approximately six out of the twelve participants reported
that they want to go to graduate school, and three out of
the twelve reported they were in the Honors College, sug-
gesting this was a high achieving group. Some expressed
that there were unhealthy versions of self-care common to
college students. Participants also shared that at an intellec-
tual level, they knew self-care was important, but did not
practice it as much as they thought they should. Reasons for
not practicing self-care were: the pressure of academics, not
having enough energy, or not wanting to face stress
head on.
Participants described how they would go to extreme
measures to meet personal standards. This was manifested
in different ways by different participants. For example, one
participant reported creating a rigid schedule for herself,
which led to separating herself from friends. One participant
reported a “ridiculous” idea on college campuses that prod-
uctivity is associated with extreme stress and burnout.
Participants described how self-care can be a blurry concept
in the college setting. Some reported activities like turning
to drinking, watching Netflix, getting nails done, or choos-
ing to skip class to take “me” time. Self-care was described
as very important by many, but hard to practice as well.
Because of the need to do well in classes, participants
reported choosing unhealthy practices over self-care many
times. For example, many decided to sacrifice sleep and the
need for “stillness” (quite time) to complete more press-
ing tasks.
When asked about their perceptions of the counseling
center, participants had various perspectives. Those who had
experiences with the counseling center acknowledged that it
was under-staffed, backed up, and difficult with scheduling.
However, others had more personal reasons for not going,
such as feeling uncomfortable when counselors “dig,” believ-
ing counseling is for more serious issues, or fearing not
being understood correctly by a counselor. Others also
described how it is awkward or embarrassing to be seen at
the counseling center.
Impact of neutral clay task (NCT) on stress, anxiety, and
stress management in the university setting
The overall themes identified for the NCT group were:
Allowance for flow, refocusing/calming down in the midst
of stressors, allowance for playfulness and imperfection,
increased dedication to self-care, and desire for more guid-
ance with self-care or mental health.
Allowance for flow
Participants Tamara and Mackenzie noted feeling a sense of
control when using their clay, and how their thoughts and
process could safely flow as a result. Both commented on
how the action of using the clay gave them a sense of
control as their hands moved freely. Mackenzie specifically
highlighted how she enjoyed being able to “manipulate it
any way I felt it needed” depending on how she was feeling.
Refocusing and calming down in the midst of stressors
Three of the participants described how the study allowed
them to get out of their head and practice control placing
their stress and frustration in perspective. While participants
did not describe a drastic change, they described small
changes they felt in their stress levels. Most described a cer-
tain immediate stress relief, rather than lasting stress relief.
For example, Rico shared that he got the most out of the
study when he “needed” it. Mackenzie described how her
stress had “coincidentally” gotten better since starting the
study and that she had begun to see “more clearly”. She
described how she felt a difference in her stress levels before
and after playing with the clay, and answering the assess-
ment questions about stress/anxiety validated this for her.
Tamara also described how she was able to put her stress in
perspective and gain better control over her reactions.
Allowance for playfulness and imperfection
Participants Mackenzie and Rico described how they did not
feel pressure to make elaborate things, and they were con-
tent with imperfection when it came to their art. Mackenzie
explicitly stated that she did not feel the need to make
“elaborate” things. Even though she was not instructed by
the study to let go of the pressure to make “nice” things,
she drew this conclusion on her own. Rico also described
how it was less about the product for him and more about
the process. He described it as “something to do with your
hands,” and joked it was not a “spiritual” thing for him, but
more of a “fun thing.” He even compared his experience to
playing a sport. Rico acknowledged that the process became
“personal” for him, and he felt an “attachment” to his clay
through the process of using his hands.
Four out of the five participants in the NCT group
expressed a lack of direction when it came to their art pro-
cess, whether they enjoyed that aspect or not. Some
described how they chose to not make anything, or instead
just played with their clay.
Increased dedication to self-care
A large portion of the participants in the NCT group shared
that the study helped refocus their attention away from school
and stressors, and toward self-care. The experience of utilizing
clay was described as a “breather” by some, and as sacred
“clay time” by others, terms which relayed how the study
taught them to practice self-care. Several implied that they
found themselves increasingly dedicated to the study and its
goals. Tamara discussed how the study enabled her to priori-
tize her self-care. She stated, “I would set everything aside. I
wouldn’t do anything else. I would just be like, OK clay time.”

Figure 2. Mackenzie’s serenity.
Figure 3. Megan’s untitled.
Desire for more guidance or direction with self-care
Another theme that arose out of interviews with NCT par-
ticipants, was a desire for more guidance with self-care than
fifteen minutes of using clay twice a week. Some participants
explicitly expressed wanting more self-care tips, while others
showed that they needed “more” by going to the counseling
center or incorporating more into their clay time, such
as music.
Mackenzie shared that she decided to see an art therapist
and was planning to implement clay into her sessions.
Amanda also reported that she sought out counseling. She
mentioned that she did not know about the free ten sessions
students receive until her first interview. Amanda had also
shared during her interview that she was a bit disappointed
there was not “more” for her in the NCT group. She even
wished she could have explored her “biggest fear.”
NCT art-based responses
All five participants in the NCT group chose to respond
using clay to their experience during their second interview.
The prompt was to create something that represented their
overall experience being a part of the NCT group. The NCT
JOURNAL OF AMERICAN COLLEGE HEALTH 5
Figure 4. Rico’s ‘collection of logs’.
group’s art responses indicated participants enjoyed the
“simplicity” of things, holding themselves accountable for
self-care, and opening their eyes to new things. Rico and
Mackenzie both shared that they enjoyed being spontaneous
and appreciating the simplicity of the process, and Tamara
and Mackenzie agreed that they enjoyed trying something
new and expanding their horizons.
Mackenzie began her interview by stating she used to
plan her art, but now she “goes right into it” and she feels
more spontaneous. She made a tiny person sitting under a
tree with her clay. She described how that was her personal
idea of relaxation and peace. Mackenzie explained:
I just feel like this study was able to bring me a lot of relaxation
and open my eyes to stuff. I don’t think I would have realized
without the study. And so, it’s taking the time to sit back and try
to enjoy life more.
She acknowledged that relaxation was all about not
“overcomplicating” things, and appreciating the simpler
parts of nature (Figure 2).
Megan expressed her difficulty visualizing her feelings
about the study, but created a piece about a concept she
learned in school. She decided to create with the concept of
“structure” because the study held her accountable for relax-
ation. Amanda created a piece about “happy thoughts,”
because she found that this study was “a good overall expe-
rience” (Figure 3).
Tamara explained, “You know it’ll be an animal,” because
she said earlier on she had been making animals throughout
the study. She joked that her animals often changed into
other animals as she continued molding and saw new fea-
tures. The particular animal she made during her interview
was a bird. She expressed how birds have always been a
very powerful animal for her because they represent
“strength” and “growth.” She said they can also “fly when-
ever they want.” She made this realization (Figure 4):
They can go wherever. It’s just kind of like freedom … I’m trying
to find the words to say it, but I guess freedom in this study
showed me that I need to give myself more freedom to take care
of myself and everything.
When asked about his piece’s overall message about the
study, Rico shared this narrative:
6 T. VAN LITH ET AL.

I think it [the art] would say something like, appreciate the

process, rather than what comes out of it. Rather, it’s more like,
this process of making art helps you …

Impact of mindfulness-based art therapy (MBAT) on

stress, anxiety, and stress management in the
university setting
The themes found in the MBAT group indicated that the
MBAT intervention provided an active form of stress reduc-
tion. They overall themes identified for the MBAT group
were: Learned new methods of managing stress, positive
opportunity for mind/body connection, experienced dis-
rupted cycles of worrying, created a space conducive for
relaxation and play, handling stress proactively, and
increased sense of mastery/accomplishment. Figure 5. Riley’s tree trunk.

to just pay attention. And I’ve noticed I’ve been focusing

Learned new methods of managing and understanding
stress/anxiety
Throughout the interviews, participants reported that they
learned new coping skills, as well as new ways of looking at
stress. For instance, Arianna described how utilizing clay
was important in her process of understanding her stress.
As she shared: “One of the self-care studies had us mold the
clay to what your stress feels like, and so I kind of was just
squeezing it … I was like, that’s probably what my stress feels
like … I think being able to see it and visualize it kind of
helped me come to terms with it and then get over it more.
Positive opportunity for mind and body connection
Amid the busy college lifestyle, participants reported that
the study helped them connect with their body in positive
ways. Delia shared this excerpt: “I feel emotionally better
after being physical, if that makes sense.” Jasmine also shared
how, one day, she created her body out of the clay, and she
had a “bad day,” so it was stress relieving to poke holes in
the clay where she was feeling pain. Mara shared how she
had a “mysterious decrease” in migraines throughout the
study. Two participants shared that the experience of using
clay felt very natural as an addendum to practicing mindful-
ness. For instance, Stephanie explained: “Like the clay helped
me focus. It just gave me an awareness of what I was feeling
so that I could focus on the clay.”
Experienced disrupted cycles of worrying
Participants reported a common feeling of being able to
move through stressors with focus and clarity. Arianna
described how she was able to let go of her need for plan-
ning the outcome through her art process. She said, over
time, her process changed: “I started realizing that I wasn’t
supposed to think before about what I was supposed to make.
I was supposed to just let my mind go and let myself relax.”
Participants also shared that the process helped them pay
more attention to being calm instead of their stressors. A
few shared that their “focus” shifted and that they noticed
their bodily sensations more. Mara explained, “I actually got
more on my breathing.” Jasmine shared that the study
helped her by calming her down to the point where she
could think rationally. She described how she practiced
“thinking outside of her stress” because she would get very
wrapped up in her own worries.
Created a space conducive for relaxation and play
Many of the participants enjoyed being held accountable for
relaxation, because it helped them make a habit of it, and it
introduced relaxation and play into their life. Delia
stated that:
“the beneficial part of it was to have something in my hand and
know that my job for the next ten minutes was to think of
nothing except squishing the clay.” Riley shared how she, too,
recognized it can be very easy to make a healthy space for
relaxation. She joked that MBAT is much “cheaper” and “easier
to find” than retail therapy. Delia also explained that she was
able to play like a “child” and it reminded her of happier times.
Handling stress proactively
Some of the participants expressed that they were better able
to handle their stress, and were procrastinating and avoiding
less. Jasmine particularly noted how, prior to the study, she
did not handle her stress well. Mara also described how she
had been more focused on her breathing and paid more
attention than she used to. Similarly, Kelsey stated that she
felt she was able to deal with stress a bit better, and not take
her anger out on others.
Other participants described how the exercises from the
study carried into their outside lives. For instance, Stephanie
explained that she was using a mental health app because
the study helped her “see things differently” and she wanted
to keep up with what she was doing. She also stated that the
study helped her open-up about her mental health and said
she discussed mental health more “casually” now.
 JOURNAL OF AMERICAN COLLEGE HEALTH 7

Sense of mastery/accomplishment
The participants shared that there was an increased comfort
with the process as time went on, and they developed a
sense of confidence and comfort with creativity. For
example, Jasmine shared about completing the tasks: “It was
something small, but something that in a short amount of
time, I could accomplish something, like I’m mak-
ing something”.
Arianna described that she “got myself out of my head
and did something.” Similarly, Riley shared that she took
ownership of her clay by the end of the study, “I didn’t
tread as lightly towards the end. I was like alright, this is my
clay (laughs)”.
Figure 6. Delia’s unzipped mouth.
MBAT art-based reponses
Six out of the seven participants chose to create an art-based
response as part of the second interview. One participant,
Arianna, created a starfish, which she called ‘confidence’ and
she described how she had accessed new parts of herself to
develop “inner confidence.”
Participants Riley and Kelsey based their response on the
idea about “perspective,” by examining the notion of a “glass
half full” and “depends on how you look at it,” in regard to
the way they saw things. Riley created a “Tree trunk.”
Kelsey also shared that she made a bowl, which represented:
“A symbol of things, like if you put too much in your bowl,
it overflows. But if you put too little, you’re wasting space.” Figure 7. Jasmine’s looking from above.
She closed the interview by describing how the bowl repre-
sented this idea about the study: “What you get out of it is This is concerning given that scores from the GAD revealed
what you put in.” (Figure 5) that one third of the participants reported to have moder-
Two participants, Mara and Delia shared about “breath.” ately severe levels of anxiety and half of the participants
Delia created art about “taking a big, deep breath,” and feel- were found to have severe levels of anxiety. Several partici-
ing peace as the result of paying attention to breathing. As pants indicated that it was through participation in the
Delia said: “I think it is like taking a really big breath … It is study that they came to realize the extent of their anxiety.
just like (participant takes big deep breath). Entirely opening The participants were asked about their help-seeking
the body to take in the air … or it is almost turning itself behaviors at the student counseling center. Most reported
inside out. It is like it’s unzipped itself” (Figure 6). unsatisfying experiences, which ranged from scheduling
Jasmine decided to create a clay character on another issues such as long wait periods to more sensitive issues
planet where there is “nothing on it,” because she felt the such as fearing about not being understood or having
study allowed her to get away “from all of the mess.” Her adverse consequences. While generation Z have more aware-
overall message about the study was that it is beneficial to ness around mental health issues than previous generations,
get away from school and other stressors, “so that when you recent studies suggest that they still feel stigmatized in col-
come back, you’ll have a clearer mindset” (Figure 7). lege settings when seeking out mental health support.30,31
Wynaden et al.32 referred to this as a form of silencing men-
tal health on their campus and emphasized how this perme-
Discussion
ated the extent of the issues.
Participants shared that the pressure of doing well in college Those who participated in the neutral clay task spoke
led to difficulties managing their mental health with other about the task providing a “breather,” an opportunity to let
responsibilities. Nobiling and Maykrantz9 noted that the ten- their mind wander, where they could be imperfect, where
dency to keep busy means that students are not always playfulness was allowed, and that it enabled them to refocus
aware that they are in distress. Multiple participants in the in the middle of a stressful episode. They reported increased
study had shared that they have a busy, on-the-go lifestyle, dedication to self-care and an appreciation for the clay mak-
characterized by little stillness and down time. Eisenberg ing process. Kruk, Aravich, and Deaver16 examined partici-
et al.29 conducted a study on the use of mental health serv- pants’ brain waves while drawing and clay making using
ices among college students and found that the majority EEG and found that clay produced an increase in theta
perceive “tangible priorities, such as coursework and social power, which is associated with imagination and deep medi-
activities” as more urgent than their own mental health. tative states.
8 T. VAN LITH ET AL.
The mindfulness-based art therapy exercises were aimed
at providing the students with a less pathologizing view of
their life challenges by helping to normalize thoughts, feel-
ings, and experiences.14 For instance, Kabat-Zinn described
how mindful practices encourages individuals to appreciate
temporality and the meta-perspective.13,33 Several individu-
als, expressed how they were able to slow down and reduce
their reaction to different events because of a greater ability
to put things in perspective. Wall also discussed how mind-
fulness can help college students reflect inward during their
busy lifestyles. She wrote about the lack of an “inner voice”
in college and high levels of “external noise.”34
The findings from NCT group compared to the MBAT
demonstrated that those who were in the NCT seemed to
have shorter and less descriptive responses to their experien-
ces. For instance, they used phrases like “fun thing,” or seeing
“more clearly” and referred to the task in term of the self-
care benefits it provided. Several participants in the NCT
group expressed being disappointed that there was not more
for them to do throughout the study. They also reported
needing “more” help than just being given clay. Two partici-
pants in this group decided to seek out counseling, one
reported wanting more tips for self-care, and almost all in
this group used music during their clay time.
In contrast, the participants in MBAT provided richer
accounts of their experience. For instance, they used phrases
like “feeling emotionally better” and “thinking outside of the
stress.” This also indicated that there was a more active form
of stress and anxiety stress reduction with potentially notice-
able physiological benefits such as a reduction in migraines.
Future recommendations and study limitations
These findings may indicate that MBAT is a useful interven-
tion for college students seeking self-care tips and guidance,
and freeform clay use may be more beneficial for those look-
ing for relaxation in the short-term. The themes from the
first interviews indicated that there was certain stress associ-
ated with independence in college, suggesting that college stu-
dents benefit from having more direction when it comes to
engaging in new methods of stress reduction and self-care.
The descriptive phenomenological approach used in this
study allowed for depth into personal experiences and per-
spectives, acknowledging that each person and their world-
view is unique. Therefore, the purpose of the findings was
not to generalize the general college population, but to
gather inferences. While for some this may be regarded as a
limitation, we see this as providing personal stories and cir-
cumstantial reasoning to the biological and psychological
changes noted in our previous studies.14,22
Specific limitations noted for future studies were that the
sample was almost entirely female and some of the partici-
pants were more vocal than others, which could have influ-
enced the information obtained during interviews. Another
limitation was the inequality in number of participants in
the NCT group compared to the MBAT group (5:7).
However, to avoid potential bias during the interviews, the
interviewer was purposely not aware of which group they
were in until the analysis process. A final limitation was that
there was a self-selection bias toward those who voluntarily
decided to participate in the interviews.
Conclusion
Generation Z is among one of the most stressed and anxious
groups today. College students face high anxiety and mental
health challenges greater than past generations, and there
are multiple barriers to receiving counseling and support.
The purpose of this study was to examine college students’
perspective on their stress and anxiety, and to examine the
impact of mindfulness-based art therapy and clay use on
moderate to severe levels of anxiety. Our findings revealed
that both NCT and MBAT can help students learn how to
manage stress, understand self-care habits, and develop
relaxation techniques. One of our key finding was that
MBAT participants were able to identify specific ways their
art interventions and mindfulness exercises taught them to
relax. They noted ways in which their body/mind connec-
tion was strengthened to better manage stress, as well as
how their thinking styles changed, even in this short period
of time. Future implementation would benefit from further
programmatic evaluation of its potential uses and impact
across multiple college-based sub-populations along with
comparative case studies across several college campuses.
Conflict of interest disclosure
The authors have no conflicts of interest to report. The authors con-
firm that the research presented in this article met the ethical guide-
lines, including adherence to the legal requirements, of Florida,
United States of America and received IRB approval from Florida
State University.
Funding
This work was provided through the Florida State University (CRC)
Multidisciplinary Support Grant.
ORCID
Theresa Van Lith http://orcid.org/0000-0003-3599-4466
Megan Beerse http://orcid.org/0000-0003-4388-8030
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