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Efficacy of Creative Clay Work for Reducing Negative Mood: A Randomized

Controlled Trial

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DOI: 10.1080/07421656.2012.680048

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Efficacy of Creative Clay Work for Reducing Negative

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 Art Therapy: Journal of the American Art Therapy Association, 29(2) pp. 74–79

Efficacy of Creative Clay Work for Reducing Negative
Mood: A Randomized Controlled Trial
Elizabeth R. Kimport, Philadelphia, PA, and Steven J. Robbins, Glenside, PA
Abstract
Clay work has long been used in art therapy to achieve ther-
apeutic goals. However, little empirical evidence exists to docu-
ment the efficacy of such work. The present study randomly as-
signed 102 adult participants to one of four conditions following
induction of a negative mood: (a) handling clay with instruc-
tions to create a pinch pot, (b) handling clay with instructions to
manipulate it freely, (c) handling a soft stress ball with instruc-
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tions to toss the ball in a structured manner, or (d) handling
a soft stress ball with instructions to manipulate it freely. Self-
reports revealed greater mood enhancement following clay han-
dling compared to ball handling. This randomized controlled
trial (RCT) documents that clay work has specific efficacy for
reducing negative mood states.
Introduction
In recent years, art therapists have turned increasing at-
tention toward providing evidence for the efficacy of spe-
cific art therapy practices. This movement parallels the call
throughout the field of clinical psychology for the documen-
tation of empirically supported therapies (see Chambless &
Hollon, 1998). As Chambless and Hollon (1998) discussed
at length, the randomized controlled trial (RCT) remains the
gold standard design for establishing psychotherapy treat-
ment efficacy. Accordingly, a number of reviews and articles
have appeared to promote the use of RCTs to evaluate claims
that art therapy interventions improve emotional function-
ing (Carolan, 2001; Deaver, 2002; Reynolds, Nabors, &
Quinlan, 2000; Slayton, D’Archer, & Kaplan, 2010).
Although the experimental research base supporting art
therapy has grown dramatically in recent years, the RCTs
identified by Slayton, D’Archer, and Kaplan (2010) in their
recent review paper focused almost exclusively on drawing
as an agent of emotional change. Other areas of art ther-
apy have yet to become the focus of systematic outcome tri-
als. One such neglected area, and the focus of the present
Editor’s Note: Elizabeth R. Kimport, BA, is currently a grad-
uate art therapy student at Drexel University, Philadelphia, PA.
Steven J. Robbins, PhD, teaches in the Department of Psychology
at Arcadia University, Glenside, PA. This research was completed
as part of the requirements for a bachelor’s degree in psychology
with an emphasis in art therapy by E. R. Kimport. Correspondence
concerning this article may be addressed to the second author at
robbins@arcadia.edu
74
C AATA, Inc. 2012
study, is the use of clay work to help clients express and work
through negative emotional states.
The use of clay in art therapy has a long history and has
been the source of a great deal of theoretical writing, often
within the psychoanalytic tradition (see Henley, 2002; Sholt
& Gavron, 2006). Sholt and Gavron (2006) identified six
therapeutic purposes for which clay typically is used. A cen-
tral theme across their categories is the use of clay to reveal,
express, and cope with emotional states. Two specific prop-
erties of clay emerged in their review as important in produc-
ing therapeutic effects. First, the tactile sensations and mal-
leability associated with clay are thought to help produce a
nonverbal route to emotional expression. Second, the phys-
ical process of clay modeling is thought to activate an in-
dividual’s creative impulses, particularly through the ability
to transform a formless mass into a concrete and meaningful
object (for more extensive theoretical discussions, see Ander-
son, 1995; Banker, 2008; Elkis-Abuhoff, Goldblatt, Gaydos,
& Corrato, 2008; Henley, 2002; Or, 2010; Sholt & Gavron,
2006). To our knowledge, no RCTs have yet been performed
to evaluate these and other claims regarding the therapeutic
benefits of clay work.
Consequently, the present study was designed to pro-
vide some initial evidence for the efficacy of clay therapy.
Clay work is used for a variety of purposes in art therapy; we
chose to investigate the “art as therapy” approach (Kramer,
1971; 1973), which posits that art production in and of itself
can have mood enhancing effects. We focused on mood en-
hancement as a target outcome for several reasons. First, the-
oretical treatments of clay work repeatedly claim enhanced
emotional expression and catharsis as primary benefits of
the medium. For example, Henley (2002) discussed cases
in which clay work allowed clients to express and discharge
negative emotional states such as aggression. Second, this ar-
ticle’s second author had success in previous studies docu-
menting the mood-enhancing effects of other creative arts
therapies, namely drawing (Bell & Robbins, 2007) and lis-
tening to music (Boothby & Robbins, 2011). Other studies
have similarly demonstrated that art therapies can enhance
mood compared to control conditions (Curry & Kasser,
2005; De Petrillo & Winner, 2005; Drake, Coleman, &
Winner, 2011; Puig, Lee, Goodwin, & Sherrard, 2006). Fi-
nally, negative mood states are easily induced and readily
measured in the nonclinical sample that was available to us
for study.
In designing the study, we had two central goals in
mind. We wanted to employ an RCT design to permit us
to isolate clay work as the cause of any observed mood
 KIMPORT / ROBBINS
enhancement. As discussed more extensively elsewhere
(Bell & Robbins, 2007; Boothby & Robbins, 2011),
nonexperimental designs leave open the possibility that
observed improvements in functioning might result from
factors such as selection bias, history, maturation, regression
to the mean, testing, or subject–observer bias (Campbell &
Stanley, 1966; Cook & Campbell, 1979). We also wanted to
focus our study on two aspects of clay work thought to rep-
resent the “active ingredients” in proposed treatment effects:
the creative nature of clay due to its composition and the
importance of having a structured task with a specific goal.
Toward these ends, we randomly assigned participants
in the present study to one of four groups following induc-
tion of a negative mood state: (a) handling clay with instruc-
tions to create a pinch pot, (b) handling clay with instruc-
tions to manipulate it freely, (c) handling a soft stress ball
with instructions to toss the ball in a structured manner, or
(d) handling a soft stress ball with instructions to manip-
ulate it freely. Quantitative assessments of mood were col-
lected before and after the interventions. This design per-
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mitted us to compare mood changes between groups and
to examine whether the clay medium has special value for
enhancing mood as compared to a condition in which par-
ticipants similarly hold and manipulate a soft, physical ob-
ject. We also examined whether participating in a structured
activity that produces a concrete result is mood enhancing
as compared to the aimless manual manipulation of objects.
Finally, we looked for an interaction between the medium
(clay or stress ball) and the instructions (free or structured).
We hypothesized that the structured manipulation of clay
would produce the greatest mood benefits.
Method
Participants
A sample of 102 adult participants (74 female, 28 male)
between the ages of 18 and 63 years (mean age = 22.3,
SD = 7.0) was employed in this study. The majority of the
participants were college students between the ages of 18 and
22 years. Of the total sample, 33 participants were currently
(or previously) college art majors or minors. Recruitment for
the study took place through posted sign-up sheets at Arca-
dia University, Glenside, PA, and through individual contact
with the first author. None of the participants disclosed that
they were suffering from a diagnosed mood disorder; be-
cause neither of the experimenters was a licensed clinician,
such information was not solicited from the participants.
Design
The study employed a 2 × 2 × 3 factorial design in
which Materials (clay or stress ball) served as one between-
groups factor, Instructions (structured or free) served as a
second between-groups factor, and Time (baseline, pre, and
post) served as a within-groups factor. Participants were
placed in the four conditions through stratified, blocked ran-
dom assignment. Specifically, we stratified individuals based
75
on whether they had ever studied art in college as either a
major or minor. To ensure an equal representation of each
group across conditions, we then employed blocked ran-
domization separately for the two groups (art training, n =
33; no art training, n = 69). Group A (n = 27) was given
clay and received instructions to make a pinch pot, Group B
(n = 24) was given clay and received no formal instructions,
Group C (n = 27) was given stress balls and received in-
structions to squeeze the ball and toss it from hand to hand,
and Group D (n = 24) was given stress balls and received
no formal instructions.
Prior to receiving the intervention materials and
instructions, all four groups were exposed to laboratory
stimuli designed to induce negative mood states. Negative
mood was assessed through two structured inventories:
the Profile of Mood States (POMS; McNair, Lorr, &
Droppleman, 1971) and the State-Trait Anxiety Inventory
(STAI; Spielberger, 1983). These paper-and-pencil tests
were given at three points in time: prior to mood induction
(baseline), just following mood induction but prior to the
clay/ball intervention (pre-treatment), and following 5
minutes of object manipulation (post-treatment).
Materials
In the two clay conditions, participants each took a seat
at a table in front of two baseball-sized mounds of clay (one
porcelain and one terra-cotta), a wooden board to serve as a
support, a small bowl of water, a sponge, a metal rib, and a
few wooden carving tools. Participants in the two stress ball
conditions each received two different baseball-sized stress
balls, one made of foam and the other filled with sand. Thus,
participants in each of the groups received two differently
textured substances or objects with which to work in order
to avoid preference bias. Because stress balls are explicitly
used to reduce anxiety through squeezing, all four groups in
this study were assigned to a condition that could plausibly
be expected to enhance mood.
Two dependent variables were used in this study. The
POMS requires participants to rate on a 5-point scale (from
0 to 4) each of 65 adjectives that describe their current state.
Items are then combined into six mood subscales (Tension,
Depression, Fatigue, Confusion, Anger, and Vigor); the six
subscale scores are further combined into a single overall
negative mood score. Using the STAI, participants self-rate
20 items to identify their “state” or present level of anxi-
ety and a second set of 20 “trait” items aimed at measur-
ing stable, long-term anxiety. Both 20-item scales yield sin-
gle summary scores: a trait score (STAI-T) and a state score
(STAI-S). On all three scales (POMS overall negative mood,
STAI-T, and STAI-S), higher values represent greater levels
of negative mood.
Procedure
All participants took part in a single laboratory session
lasting about 45 minutes. Upon entry into the lab, each
individual reviewed and signed a written, informed,
voluntary consent document. Next, participants filled out
 76 EFFICACY OF CREATIVE CLAY WORK
Table 1 POMS Overall Negative Mood Scores at Baseline, Pre-Treatment, and Post-Treatment (Means and Standard
Deviations)
Group N Baseline
Clay Structured 27 17.1 (29.9)
Clay Free 24 14.3 (22.3)
Clay Total 51 15.8 (26.4)
Stress Ball Structured 27 21.5 (32.4)
Stress Ball Free 24 12.7 (24.8)
Stress Ball Total 51 17.3 (29.1)
Note. For the Pre–Post scores, positive values indicate improved mood.
a brief demographics form asking for their age, sex, and
whether they were currently or had been previously an art
student. The experimenter (first author) asked participants
to complete the POMS and the STAI for the first of three
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times (baseline) and left the room while these forms were
being filled out. Following the first mood assessment,
participants put on headphones and watched a 12-minute
video containing 16 different traumatic news stories that
had occurred in the past 10 years (covering, for example,
the 2010 earthquake in Haiti, U.S. school shootings, and
the Gulf of Mexico oil spill). When the video ended, each
individual was asked to reflect upon something negative
that was weighing on his or her mind and to write the event
down on a piece of paper (not collected). These stimuli were
intended to induce a similar level of negative mood across
participants; the success of the stimuli to induce a negative
mood was then assessed through a second administration
of the POMS and the STAI (pre-treatment).
Participants then were placed in one of four interven-
tion conditions based on the randomization schedule de-
scribed earlier. As already stated, we separately randomized
the art students and non-art students to avoid biased sam-
ples across the four conditions. For Group A (clay + struc-
tured instructions), the experimenter gave a brief (15 sec-
ond) demonstration on how to make a pinch pot. She then
left and waited outside the room for 5 minutes while the
participants each made a pinch pot of their own. Group
B (clay + free instructions) was given the same clay sup-
plies and asked to manipulate the clay any way they wished.
For Group C (stress ball + structured instructions), the ex-
perimenter gave participants 2 different textured stress balls
and asked them to hold and squeeze a ball in one hand, toss
the ball to the other hand, and then repeat. As in the pinch
pot condition, the experimenter demonstrated this task for
about 15 seconds. In Group D (stress ball + free instruc-
tions), participants were told to handle the balls however
they chose. In all four cases, the experimenter gave verbal
instructions and then left the room during the 5-minute in-
tervention.
After the 5-minute intervention period, the experi-
menter returned to the room and gave participants the
third and final POMS and STAI forms to complete (post-
treatment). Once again, she left the room while the inven-
tories were being filled out. Upon completion of the mood
Pre Post Pre–Post
49.4 (41.9) −0.5 (19.9) 49.9 (33.4)
46.1 (38.4) 6.3 (25.7) 39.8 (39.8)
47.8 (39.9) 2.7 (22.8) 45.2 (31.5)
43.4 (48.5) 16.7 (32.5) 26.4 (27.9)
37.5 (29.5) 6.0 (21.6) 31.5 (25.1)
40.6 (40.4) 11.8 (28.2) 28.8 (26.4)
assessments, participants were thanked for their participa-
tion and debriefed as to the nature of the study.
Results
Two primary outcome measures were analyzed in this
study. We used the POMS overall score as a global measure
of negative mood and the STAI-S (“state anxiety” score) as a
more specific measure of anxiety. Although the trait anxiety
scale (STAI-T) was used to confirm that the groups were well
matched for baseline trait anxiety, this scale was not used to
assess changes in mood because we did not expect our 5-
minute intervention to produce alterations in stable, long-
term anxiety.
Baseline Assessments
In order to examine whether the randomization created
equivalent groups, we used 1-way ANOVAs to compare age
and STAI-T scores across the four groups at baseline. Nei-
ther analysis approached significance (p > .20 for both).
Thus, the four groups were well matched for both age and
trait anxiety levels.
Negative Mood Induction
Negative mood induction was assessed through the use
of 2-way repeated measure ANOVAs in which Group (A,
B, C, or D) served as a between-group factor and Time
(baseline/pre-treatment) served as the within-group factor.
We conducted separate analyses for the POMS and STAI-S
scores. For this analysis, we did not break the groups out into
the factors Materials and Instructions because both measure-
ment points took place before the intervention occurred. Re-
sults from the POMS and the STAI-S are shown in Tables 1
and 2, respectively.
For both analyses, we did not find a main effect of
Group, nor did we find a Group × Time interaction (all
p values > .05). In other words, the four groups did not
differ in overall levels of negative mood across the two
time points and did not show differential levels of mood
change. In both analyses there was a significant main effect
of Time, POMS: F (1, 98) = 67.8, p < .001; STAI-S: F( 1,
98) = 101.6, p < .001. As shown in Tables 1 and 2, all
 KIMPORT / ROBBINS
Table 2 STAI-S Scores at Baseline, Pre-Treatment, and Post-Treatment (Means and Standard Deviations)
Group N Baseline
Clay Structured 27 39.6 (12.6)
Clay Free 24 39.2 (10.4)
Clay Total 51 39.4 (11.5)
Stress Ball Structured 27 41.1 (12.5)
Stress Ball Free 24 38.4 (7.5)
Stress Ball Total 51 39.9 (10.4)
Note. For the Pre–Post scores, positive values indicate improved mood (reductions in state anxiety).
four groups had substantial increases in negative mood
from baseline to pre-intervention. Thus, we were successful
in inducing comparable levels of negative mood across the
four intervention groups.
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Clay/Stress Ball Intervention Outcome
Primary outcome analyses for this study consisted of
3-way repeated measure ANOVAs conducted separately for
the POMS and STAI-S scores. For each analysis, Materials
(clay or stress ball) and Instructions (structured or free)
served as the between-group factors, and Time (pre- or
post-treatment) served as the within-group factor. Treat-
ment effects would be revealed as either 2-way interactions
of Materials × Time and Instructions × Time or as a
3-way interaction of Materials × Instructions × Time. In
all cases, treatment effects would take the form of greater
improvement in negative mood over time in some treatment
groups compared to others. Pre- and post-treatment scores
on the POMS and the STAI-S can be seen in Tables 1 and 2,
which also depict change scores for each of the conditions.
Results of the ANOVAs are easily summarized. In both
cases, there was a significant Materials × Time interaction,
POMS: F (1, 98) = 7.6, p < .05; STAI-S: F (1, 98) = 4.4,
p < .05. As depicted in Tables 1 and 2, this interaction re-
flected a greater improvement in negative mood in the two
clay groups compared to the two stress ball groups. The
“Clay Total” and “Stress Ball Total” rows in each table reveal
the magnitude of this effect. Overall negative mood score
on the POMS decreased an average of 45 points follow-
ing the two clay interventions and 29 points following the
two stress ball interventions. Thus, participants in the clay
conditions experienced more than 50% greater mood im-
provement than individuals exposed to the stress balls. Par-
ticipants in the clay groups also showed almost 15 points
of improvement in STAI-S scores compared to a little more
than 10 points for the stress ball groups; once again, these
values represent nearly 50% greater improvement in mood
for the clay intervention conditions.
No other significant interactions were revealed in the
analyses. However, there was a trend toward a 3-way Ma-
terials × Instructions × Time interaction for the STAI-S,
F (1, 98) = 3.6, p = .06. A much weaker trend toward
a 3-way interaction existed in the POMS analysis, F (1,
77
Pre Post Pre–Post
50.3 (14.5) 33.8 (7.7) 16.5 (12.0)
50.0 (13.5) 37.3 (11.7) 12.7 (9.6)
50.1 (13.9) 35.4 (9.8) 14.7 (11.0)
50.0 (12.9) 41.4 (12.4) 8.6 (7.9)
50.8 (10.3) 38.5 (10.0) 12.3 (10.2)
50.4 (11.6) 40.1 (11.3) 10.3 (9.2)
98) = 1.7, p = .19. Tables 1 and 2 reveal similar patterns
of change across the four conditions. For both measures,
the advantage of the clay over the stress ball conditions
was more pronounced in the structured conditions (Clay
Structured vs. Stress Ball Structured) compared to the free
conditions (Clay Free vs. Stress Ball Free). However, these
differences were not sufficiently strong to produce a signif-
icant 3-way interaction. Furthermore, the highest score in
each table reflecting the change between pre-treatment and
post-treatment belonged to the Clay Structured condition.
Discussion
The results of this study clearly document that a 5-
minute period spent manipulating clay produced more
mood enhancement than the same amount of time spent
manipulating a soft stress ball. On both the POMS and
the STAI-S, the two groups that worked with clay showed
greater reductions in negative mood from pre-treatment to
post-treatment than the two groups that used stress balls.
This finding supports the claim that clay work has unique
properties for emotional expression and regulation that go
beyond the simple manual manipulation of an object. Al-
though neither primary outcome analysis revealed a signifi-
cant 3-way interaction (Materials × Instructions × Time),
there was a trend in both cases towards a larger effect in the
Clay Structured condition. These trends are consistent with
the idea that art therapy interventions are most effective at
alleviating negative mood states when they entail a struc-
tured task leading to a specific end result or goal state (in
this case, the creation of a pinch pot).
The present design has a number of advantages in al-
lowing us to isolate the use of clay as the “active ingredient”
in improved mood in our participants. First, the laboratory-
based mood induction ensured that the four groups were
experiencing comparable levels of negative mood at the
start of the treatment phase (pre-treatment). Second, the
use of a random assignment design meant that improve-
ment of mood in the groups working with clay could
not be attributed to internal validity threats such as test-
ing, maturation, selection bias, history, or regression to the
mean. Furthermore, individual participants were left alone
both during mood assessments and during handling of the
clay or stress balls, thus reducing the potential impact of
 78 EFFICACY OF CREATIVE CLAY WORK
observer/experimenter bias on the study results. Third, the
use of soft, squeezable stress balls in the control conditions
meant that the effects of clay could not be simply attributed
to the manual manipulation of an object, to the simple act
of squeezing, or to exposure to tactile contact with some-
thing soft. Fourth, the use of the stress ball control reduced
the possibility that the results were contaminated by demand
effects; participants in the ball conditions had every reason
to expect as much mood improvement as participants in the
clay conditions (after all, stress balls are explicitly meant to
reduce stress). Finally, the factorial design employed allowed
us to independently assess the effects of clay itself, the ef-
fects of performing a structured task, and the interaction
of these two factors. As described above, the results showed
clear support for the efficacy of using clay manipulation to
produce mood enhancement and partial support for the idea
that therapeutic clay work should be structured in order to
relieve anxiety and negative mood.
The present study has a number of limitations as well.
Chief among them was our decision not to employ an actual
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art therapy intervention involving facilitation by a registered
art therapist. Instead, the first author (a student studying art
therapy as an undergraduate concentration) provided some
simple instructions for manipulating the clay (or stress ball)
and then allowed participants to work on their own. The
study also did not involve clients with diagnosed emotional
disorders; rather, it involved a convenience sample of mostly
college students and an induced negative mood state. An-
other limitation is that the treatment phase of this study
took place in a single 5-minute session whereas true art ther-
apy interventions typically last for much longer periods of
time and often over multiple days. Although these factors
all reduce the generalizability of our findings to actual clin-
ical practice, they also highlight the magnitude of the clay
work effects obtained. In other words, despite the absence
of an art therapist, the lack of emotional disorders among
the participants, and a very brief exposure period, we still
saw substantially greater mood improvement in individuals
who worked with clay compared to those who manipulated
a soft stress ball.
To our knowledge, the present results represent the first
evidence from a randomized controlled trial documenting
the efficacy of clay work for remediating negative emotional
states. As such, they contribute to the growing body of
research aimed at establishing art therapy interventions as
evidence-based practices. We hope that the present study
motivates further research into the therapeutic uses of clay
and into the specific aspects of clay work that function as
active ingredients in treatment success. The results of this
study should provide some encouragement for the future
success of that endeavor.
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