Social anxiety is characterized by an intense, enduring anxiety or fear of social situations in which individuals could potentially be rejected or judged negatively, and it can have a serious negative impact on daily life and well-being (Orme-Johnson, & Barnes, 2014). Social anxiety is evident from behavioral patterns and can also be measured using physiological signals, such as electrodermal activity (EDA), which is an indicator of activity in the autonomic nervous system. When an individual is nervous and anxious, their sweat glands secrete more, which increases EDA, and when a person is calm and peaceful, EDA decreases (Blechert & Wilhelm, 2014; Kreibig, 2010). Many researchers have shown that EDA is significantly higher among people with (vs. without) social anxiety (Asbrand, Blechert, Nitschke, Tuschen-Caffier, & Schmitz, 2017; Deiters, Stevens, Hermann, & Gerlach, 2013; Panayiotou, Karekla, Georgiou, Constantinou, & Paraskeva-Siamata, 2017).

Mandala drawing has been increasingly favored by art therapists (Ashlock, Miller-Perrin, & Krumrei-Mancuso, 2017; Babouchkina & Robbins, 2015; Drake, Searight, & Olson-Pupek, 2014; Muthard & Gilbertson, 2016; Schrade, Tronsky, & Kaiser, 2011). Mandala is a Sanskrit word and concept that refers to a sacred circle or axial center, of which there are two types: predrawn (structural) and created (nonstructural). In art therapy, a predefined template of a structural mandala is colored in, whereas creating a mandala involves free drawing of a mandala within a circle. Creating mandalas can provide a connection between the conscious and unconscious (Palmer, Dowrick, & Gunn, 2014). Drawing activities depend on the interaction between multiple brain systems (Schnetz, 2003), and have also been found to aid in identity formation and self-awareness after experiencing trauma (Gantt & Tripp, 2016; Van der Kolk, 2014; Walker, Kaimal, Gonzaga, Myers-Coffman, & DeGraba, 2017).

Although many scholars have shown that mandala drawing can reduce anxiety, their results have been inconsistent. Some have shown that coloring in a predrawn mandala is more effective than free drawing in reducing anxiety (Ashlock, Miller-Perrin, & Krumrei-Mancuso, 2017; Muthard & Gilbertson, 2016; Van der Vennet & Serice, 2012), whereas others have reported no difference between the two activities (Drake, Searight, & Olson-Pupek, 2014; Duong, Stargell, & Mauk, 2018; Flett et al., 2017). Furthermore, in most of the above studies the researchers explored the effectiveness of predrawn (structural) mandalas in reducing anxiety. By contrast, few scholars have investigated the effectiveness of creating nonstructural mandalas in this context (Babouchkina & Robbins, 2015; Potash et al., 2013; Schrade, Tronsky, & Kaiser, 2011). However, Jung (1972), who used the mandala as a tool for psychoanalysis and treatment, believed that free creation of mandalas is the active element that produces psychological changes; therefore, creating nonstructural mandalas is more in line with the organization of the individual mind. However, Jung’s ideas are largely clinical and have not been supported by sufficient experimental evidence.

To address this issue, we explored the effectiveness of creating nonstructural mandalas in reducing social anxiety by conducting two experiments. In Experiment 1 we compared social anxiety changes, as measured using the Interaction Anxiety Scale (IAS; Leary, 1983), between creating a mandala and free drawing. To further explore the specific effect of the circular form of the mandala, in Experiment 2 we compared social anxiety changes between creating a mandala and drawing within a square, as assessed using the IAS and EDA. We proposed the following hypotheses:
Hypothesis 1: Creating a mandala will result in a more significant reduction in social anxiety than will free drawing.
Hypothesis 2: Creating a mandala will result in a more significant reduction in electrodermal activity and social anxiety than will drawing within a square.

Experiment 1: Comparing the Effects of Creating a Mandala Versus Free Drawing on the Social Anxiety of College Students

Method

Participants. We distributed 2,200 IAS forms to college students at a university in China. The mean IAS score was 42.44 and the standard deviation was 9.01. From the original sample of 2,200 we included in the two experiments 369 participants who scored more than one standard deviation above the mean on the IAS and who did not meet the clinical diagnostic criteria for social anxiety. From these students, we randomly selected 71 participants (40 women, 31 men; M_age = 21.69 years, SD = 1.56, range = 18–22), all of whom were Chinese, for Experiment 1.

Participants with the same level of social anxiety were randomly assigned to one of three groups: creating-a-mandala group (n = 24), free-drawing group (n = 23), and nondrawing-activity control group (n = 24). All participants provided informed consent prior to their inclusion and the experiment received ethical approval from the Committee on Human Research Protection of East China Normal University.

Measure.
The Interaction Anxiety Scale. The IAS for college students consists of a series of self-evaluated items that are designed to assess changes in present-moment social anxiety (Leary, 1983). A sample item is “Parties often make me feel anxious and uncomfortable.” IAS responses are rated on 5-point scale ranging from 1 = not at all consistent with me to 5 = extremely consistent with me. We used a version of the IAS that has been previously translated into Chinese by Peng, and Gong, and Zhu (2004). In this study the scale’s correlation coefficient was .80, the total correlation coefficient was .45, and Cronbach’s alpha was .87.

Research design. We used a two-factor mixed experimental repeated-measures design, with a 3 (drawing type: creating a mandala vs. free drawing vs. control) × 2 (measurement time: pretest vs. posttest) factor structure. Drawing type was the between-subjects variable and measurement time was the within-subjects variable; the dependent variable was IAS score.

Procedure. Participants were asked to engage in an art activity for 30 minutes after completing a paper copy of the IAS to determine their pretest scores. The creating-a-mandala and free-drawing groups were given a sheet of paper measuring 8.5 inches × 11 inches. For the creating-a-mandala group, there was a circle already drawn on the sheet of paper. The control group completed a nondrawing activity (sitting quietly). The interventions were performed once a week for 4 weeks. All participants completed the IAS in the fourth week to determine their posttest scores.

Results

We analyzed the data using a repeated-measures analysis of variance (ANOVA). Analysis of the main effect of measure time showed that pretest IAS scores (55.79 ± 1.47) were higher than posttest IAS scores (53.44 ± 2.71), F(1, 68) = 203.41, p < .001, η²_p = .75. In addition, the main effect of drawing type was significant, F(2, 68) = 17.31, p < .001, η²_p = .34. A post hoc test showed that IAS scores were lower in the creating-a-mandala group (53.38 ± 1.59) than in both the free-drawing group (54.48 ± 1.40, p = .02) and the control group (55.98 ± 1.61, p < .001), and IAS scores were lower in the free-drawing group than in the control group (p = .001).

However, these main effects were qualified by a significant interaction, F(2, 68) = 59.25, p < .001, η²_p = .64. Simple effects analyses (see Figure 1) show that drawing type did not significantly affect pretest IAS scores, F(2, 68) = 0.70, p = .50, η²_p = .02, but did significantly affect posttest IAS scores, F(2, 68) = 39.19, p < .001, η²_p = .54. Results of a post hoc test show that IAS scores were lower in the creating-a-mandala group (51.25 ± 1.85) than in both the free-drawing group (53.04 ± 1.89, p = .005) and the control group (56.00 ± 1.89, p < .001), and IAS scores were lower in the free-drawing group than in the control group (p < .001).

Simple effects analyses (see Figure 1) also show that posttest IAS scores (51.25 ± 1.85) were lower than pretest IAS scores (55.50 ± 1.56) in the creating-a-mandala group, F(1, 68) = 223.21, p < .001, η²_p = .77. Similarly, posttest IAS scores (53.04 ± 1.89) were lower than pretest IAS scores (55.91 ± 1.47) in the free-drawing group, F(1, 68) = 97.52, p < .001, η²_p = .59. However, pretest and posttest IAS scores did not differ significantly in the control group, F(1, 68) = 0.02, p = .88, η²_p < .001.

Discussion

The results from Experiment 1 indicate that creating a mandala reduced social anxiety more effectively than free drawing did, supporting Hypothesis 1. This also supports previous findings that coloring in a predrawn mandala results in a greater reduction in anxiety than free drawing does among people who experience chronic anxiety or other stress-related problems (Curry & Kasser, 2005; Van der Vennet & Serice, 2012). It was also reported in these previous studies that both creating a nonstructured mandala and coloring in a predrawn (structured) mandala more effectively reduce anxiety than free drawing does. The benefits of creating a mandala over free drawing in reducing anxiety could be a result of its circular form. The mandala is a sacred space, often a circle, which reveals an inner truth about an individual and the world (Watts, 2000). Mandalas also offer individuals the opportunity to create something meaningful and integrate their feelings, thoughts, and behaviors (Jung, 1972; Mulcahy, 2013). The circular boundaries of the mandala have been reported to support, protect, and integrate an individual’s psyche (Babouchkina & Robbins, 2015). Indeed, Jung (1972) wrote that artwork within a circle can promote psychological healing.

Therefore, it is possible that the circular form of the mandala is an active component in reducing social anxiety. To investigate this possibility, Slegelis (1987) randomly assigned participants to a creating-a-mandala group or a drawing-within-a-square group; the drawing-within-a-square group drew more angles. Thus, when people take part in a drawing experiment, those presented with a circular shape create fewer angular shapes than do people who are presented with a square shape. However, Slegelis did not measure external mood, which makes it difficult to interpret her results. Henderson (2012) randomly assigned participants with trauma symptoms to either a group that created a mandala to express their feelings about their trauma or a group that drew a specific object (e.g., a cup or a pen). The creating-a-mandala group exhibited greater improvements in alleviation of trauma symptoms than did the object-drawing group. However, no alpha correction for multiple tests was applied, so this result could be attributed to Type I error. Babouchkina and Robbins (2015) returned to the design of Slegelis’s study by comparing the effects on mood of creating a mandala versus drawing within a square. They found that creating a mandala results in a greater reduction in negative mood compared with drawing within a square. However, the results were based on self-reports via completing the Profile of Mood States (McNair, Lorr, & Droppleman, 1971).

Thus, we performed Experiment 2 to further explore if the mandala’s circular form drives the social anxiety-reducing effect we obtained in Experiment 1. We measured EDA and IAS scores in this experiment.

Experiment 2: Comparing Effects of Creating a Mandala Versus Drawing Within a Square on the Social Anxiety of College Students

Method

Participants. As in Experiment 1, participants were selected at random from the sample pool of 369 people who had scored more than one standard deviation above the mean on the IAS and did not meet the clinical diagnostic criteria for social anxiety. There were 75 participants in Experiment 2 (41 women, 34 men; M_age = 21.85 years, SD = 1.24, range = 18–22), all of whom were Chinese. Participants with the same level of social anxiety were randomly assigned to one of three groups: creating-a-mandala group (n = 25), drawing-within-a-square group (n = 25), and control group (n = 25). The experiment received ethical approval from the Committee on Human Research Protection of East China Normal University and all participants provided signed informed consent before the experiment began.

Instruments.
The Interaction Anxiety Scale. As in Experiment 1.
MP150 MindWare. MP150 MindWare (BIOPAC, USA) is equipped with a variety of sensors and can collect real-time human physiological data, such as EDA, electrocardio readings, and electroencephalography readings. We used this system in this study to collect EDA data.

Research design. We used a two-factor mixed experimental repeated-measures design with a 3 (drawing type: creating a mandala vs. drawing within a square vs. control) × 2 (measurement time: pretest vs. posttest) factor structure. Drawing type was the between-subjects variable and measurement time was the within-subjects variable. The dependent variables were EDA and IAS scores.

Procedure. Each participant was tested separately in a quiet room. Participants were asked to sit in a comfortable position and to eliminate physical and psychological tension as much as was possible. The skin surface of the fingers was cleaned with 95% alcohol degreaser to ensure the electrodes adhered. After we took baseline EDA recordings for 2 minutes, participants completed a paper copy of the IAS to determine their pretest scores. Next, participants received instructions about the drawing task, before we recorded EDA for 2 minutes. Then, participants completed a 30-minute activity: either creating a mandala, drawing within a square, or a nondrawing activity (sitting quietly). The two experimental groups were given a sheet of paper measuring 8.5 inches × 11 inches, with either a circle (creating-a-mandala group) or a square (drawing-within-a-square group) on it. Immediately after completing their drawing, participants’ EDA was recorded for 2 minutes. Finally, they completed the IAS to determine their posttest scores.

Results

We analyzed the data using a repeated-measures ANOVA. The main effect of measure time shows that pretest IAS scores (55.65 ± 1.50) were higher than posttest IAS scores (54.16 ± 2.11), F(1, 72) = 132.86, p < .001, η²_p = .65. In addition, the main effect of drawing type was significant, F(2, 72) = 8.64, p < .001, η²_p = .19. Results of a post hoc test show that IAS scores were lower in the creating-a-mandala group (54.00 ± 1.39) than in both the drawing-within-a-square group (55.00 ± 1.35, p = .02) and the control group (55.72 ± 1.65, p < .001), and IAS scores tended to be lower in the drawing-within-a-square group than in the control group (p = .09).

However, these main effects were qualified by a significant interaction, F(2, 72) = 50.88, p < .001, η²_p = .59. Simple effects analyses (see Figure 2) show that drawing type did not significantly affect pretest IAS scores, F(2, 72) = 0.08, p = .93, η²_p = .002, but did significantly affect posttest IAS scores, F(2, 72) = 26.24, p < .001, η²_p = .42. Results of a post hoc test show that IAS scores were lower in the creating-a-mandala group (52.44 ± 1.64) than in both the drawing-within-a-square group (54.28 ± 1.31, p < .001) and the control group (55.76 ± 1.88, p < .001), and IAS scores were lower in the drawing-within-a-square group than in the control group (p = .006).

Simple effects analyses (see Figure 2) also show that posttest IAS scores (52.44 ± 1.64) were lower than pretest IAS scores (55.56 ± 1.50) in the creating-a-mandala group, F(1, 72) = 193.31, p < .001, η²_p = .73. Similarly, posttest IAS scores (54.28 ± 1.31) were lower than pretest IAS scores (55.72 ± 1.46) in the drawing-within-a-square group, F(1, 72) = 41.18, p < .001, η²_p = .36. However, pretest and posttest IAS scores did not differ significantly in the control group, F(1, 72) = 0.13, p = .72, η²_p = .002.

We analyzed the data using a repeated-measures ANOVA. The main effect of measure time shows that pretest EDA (24.88 ± 2.39) was higher than posttest EDA (23.72 ± 3.11), F(1, 72) = 110.35, p < .001, η²_p = .61. In addition, the main effect of drawing type was significant, F(2, 72) = 6.26, p = .003, η²_p = .15. Results of a post hoc test show that EDA was lower in the creating-a-mandala group (22.97 ± 2.43) than in both the drawing-within-a-square group (24.64 ± 2.23, p = .02) and the control group (25.28 ± 2.48, p = .001), and EDA did not significantly differ between the drawing-within-a-square and control groups (p = .34).

However, these main effects were qualified by a significant interaction, F(2, 72) = 162.25, p < .001, η²_p = .82. Simple effects analyses (see Figure 3) show that the drawing type did not significantly affect pretest EDA, F(2, 72) = 0.14, p = .87, η²_p = .004, but did significantly affect posttest EDA, F(2, 72) = 24.02, p < .001, η²_p = .40. Results of a post hoc test show that EDA was lower in the creating-a-mandala group (21.12 ± 2.42) than in both the drawing-within-a-square group (24.20 ± 2.47, p < .001) and the control group (25.84 ± 2.44, p < .001), and EDA tended to be lower in the drawing-within-a-square group than in the control group (p = .06).

Simple effects analyses (see Figure 3) also show that posttest EDA (21.12 ± 2.42) was lower than pretest EDA (24.82 ± 2.57) in the creating-a-mandala group, F(1, 72) = 379.04, p < .001, η²_p = .84. Similarly, posttest EDA (24.20 ± 2.47) was lower than pretest EDA (25.08 ± 2.09) in the drawing-within-a-square group, F(1, 72) = 21.22, p < .001, η²_p = .23. However, posttest EDA (25.84 ± 2.44) was higher than pretest EDA (24.73 ± 2.39) in the control group, F(1, 72) = 34.59, p < .001, η²_p = .33.

Discussion

In Experiment 2 we found that creating a mandala reduced social anxiety more effectively than drawing within a square did, as evidenced by the changes in both IAS scores and EDA levels; thus, Hypothesis 2 was supported. This could suggest that creating a mandala makes an individual feel that they have more freedom and ease than does drawing within a square. Our results are consistent with Babouchkina and Robbins’s (2015) findings that the circular form drives the social anxiety-reducing effect of drawing a mandala. In contrast, Muthard and Gilbertson (2016) found that the EDA of their creating-a-mandala group (paired with simultaneous focused breathing) was higher than that of a control group, which is indicative of higher anxiety levels. That said Muthard and Gilbertson’s participants completed focused breathing exercises and creating a mandala at the same time, which means that it is not possible to distinguish which technique led to a reduction in anxiety. Furthermore, some researchers have reported that mindfulness can increase, rather than decrease, physiological arousal (Arch & Craske, 2006), which could explain the significantly higher EDA levels of the creating-a-mandala group in Muthard and Gilbertson’s study. In our study, the physiological arousal level of the creating-a-mandala group was significantly lower than that of the drawing-within-a-square group, which indicates that drawing within a circle is more relaxing than is drawing within a square.

General Discussion

Since ancient times, the circle has been an important part of human culture; almost all ethnic groups believe that circles are a satisfactory and profound expression (Lusebrink, 1998). Simon (1997) used symbolic images in art therapy and stated that a circle is a symbol of the self as an entity, whereas a square surrounding it denotes all that is nonself (see also Lusebrink, 1998). We found that creating a mandala more effectively reduced social anxiety than free drawing or drawing within a square did. Therefore, creating mandalas could represent a new approach for the relief and treatment of social anxiety.

However, this study has several limitations that should be addressed in future research. First, the sample was limited to college students; hence, the results are not generalizable to other populations. Further, the long-term impact of art activities on social anxiety under different instructional conditions remains to be explored. Third, the mechanism underlying the reduction in social anxiety by the drawing of a mandala should be further explored.

References

Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44, 1849–1858. https://doi.org/10.1016/j.brat.2005.12.007

Asbrand, J., Blechert, J., Nitschke, K., Tuschen-Caffier, B., & Schmitz, J. (2017). Aroused at home: Basic autonomic regulation during orthostatic and physical activation is altered in children with social anxiety disorder. Journal of Abnormal Child Psychology, 45, 143–155. https://doi.org/10.1007/s10802-016-0147-7

Ashlock, L., Miller-Perrin, C., & Krumrei-Mancuso, E. (2017, March). The effectiveness of coloring methods for anxiety reduction. Poster session presented at the Research and Scholarly Achievement Symposium, Malibu, CA. Retrieved from https://bit.ly/2KahAyo

Babouchkina, A., & Robbins, S. J. (2015). Reducing negative mood through mandala creation: A randomized controlled trial. Art Therapy: Journal of the American Art Therapy Association, 32, 34–39. https://doi.org/10.1080/07421656.2015.994428

Blechert, J., & Wilhelm, F. H. (2014). Psychophysiology. In P. M. Emmelkamp & T. Ehring (Eds.), The Wiley handbook of anxiety disorders (pp. 274–294). Chichester, UK: Wiley.

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

Deiters, D. D., Stevens, S., Hermann, C., & Gerlach, A. L. (2013). Internal and external attention in speech anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 44, 143–149. https://doi.org/10.1016/J.JBTEP.2012.09.001

Drake, C. R., Searight, H. R., & Olson-Pupek, K. (2014). The influence of art-making on negative mood states in university students. American Journal of Applied Psychology, 2, 69–72. https://doi.org/10.12691/ajap-2-3-3

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, 318–330. https://doi.org/10.1080/15401383.2018.1437001

Flett, J. A. M., Lie, C., Riordan, B. C., Thompson, L. M., Conner, T. S., & Hayne, H. (2017). Sharpen your pencils: Preliminary evidence that adult coloring reduces depressive symptoms and anxiety. Creativity Research Journal, 29, 409–416. https://doi.org/10.1080/10400419.2017.1376505

Gantt, L., & Tripp, T. (2016). The image comes first: Treating preverbal trauma with art therapy. In J. King (Ed.), Art therapy, trauma and neuroscience: Theoretical and practical perspectives (pp. 67–99). New York, NY: Routledge.

Henderson, P. G. (2012). Empirical study of the healing nature of artistic expression: Using mandalas with the positive emotions of love and joy (Unpublished doctoral dissertation). Texas A&M University, College Station, TX. Retrieved from https://bit.ly/2MovvDD

Jung, C. G. (1972). Mandala symbolism. Princeton, NJ: Princeton University Press.

Kreibig, S. D. (2010). Autonomic nervous system activity in emotion: A review. Biological Psychology, 84, 394–421. https://doi.org/10.1016/j.biopsycho.2010.03.010

Leary, M. R. (1983). Social anxiousness: The construct and its measurement. Journal of Personality Assessment, 47, 66–75. https://doi.org/10.1207/s15327752jpa4701_8

Lusebrink, V. B. (1998). Symbolic images in art as therapy. Art Therapy: Journal of the American Art Therapy Association, 15, 129–131. https://doi.org/10.1080/07421656.1989.10758726

McNair, D. M., Lorr, M., & Droppleman, L. F. (1971). The Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service.

Mulcahy, M. (2013). Mandalas as a tool for transformation to enable human flourishing: The influence of Carl Jung. International Practice Development Journal, 3(2). Retrieved from https://bit.ly/32VDSMR

Muthard, C., & Gilbertson, R. (2016). Stress management in young adults: Implications of mandala coloring on self-reported negative affect and psychophysiological response. Psi Chi Journal of Psychological Research, 21, 16–28. https://doi.org/10.24839/2164-8204.JN21.1.16

Orme-Johnson, D. W., & Barnes, V. A. (2014). Effects of the transcendental meditation technique on trait anxiety: A meta-analysis of randomized controlled trials. The Journal of Alternative and Complementary Medicine, 20, 330–341. https://doi.org/10.1089/acm.2013.0204

Palmer, V. J., Dowrick, C., & Gunn, J. M. (2014). Mandalas as a visual research method for understanding primary care for depression. International Journal of Social Research Methodology, 17, 527–541. https://doi.org/10.1080/13645579.2013.796764

Panayiotou, G., Karekla, M., Georgiou, D., Constantinou, E., & Paraskeva-Siamata, M. (2017). Psychophysiological and self-reported reactivity associated with social anxiety and public speaking fear symptoms: Effects of fear versus distress. Psychiatry Research, 255, 278–286. https://doi.org/10.1016/J.PSYCHRES.2017.05.044

Peng, C. Z., Gong, Y. X., & Zhu, X. Z. (2004). Reliability and validity of the Interaction Anxiety Scale and its applicability in Chinese college students [In Chinese]. Chinese Journal of Mental Health, 12, 39–41.

Potash, J. S., Bardot, H., Wang, X. L., Chan, F., Ho, A. H. Y., & Cheng, C. (2013). Mandalas as indicators of burnout among end-of-life care workers. Journal of Applied Arts & Health, 4, 363–377. https://doi.org/10.1386/jaah.4.3.363_1

Schrade, C., Tronsky, L., & Kaiser, D. H. (2011). Physiological effects of mandala making in adults with intellectual disability. The Arts in Psychotherapy, 38, 109–113. https://doi.org/10.1016/j.aip.2011.01.002

Schnetz, M. (2003). The healing flow: Artistic expression in therapy. London, UK: Kingsley.

Simon, R. M. (1997). Symbolic images in art as therapy. London, UK: Routledge.

Slegelis, M. H. (1987). A study of Jung’s mandala and its relationship to art psychotherapy. The Arts in Psychotherapy, 14, 301–311. https://doi.org/10.1016/0197-4556(87)90018-9

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Viking.

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

Walker, M. S., Kaimal, G., Gonzaga, A., Myers-Coffman, K., & DeGraba, T. (2017). Active-duty military service members’ visual representations of PTSD and TBI in masks. International Journal of Qualitative Studies on Health and Well-Being, 12, 1267317. https://doi.org/10.1080/17482631.2016.1267317

Watts, L. J. (2000). Mandalas: Spiritual circles for harmony and fulfillment. London, UK: Southwater.

Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44, 1849–1858. https://doi.org/10.1016/j.brat.2005.12.007

Asbrand, J., Blechert, J., Nitschke, K., Tuschen-Caffier, B., & Schmitz, J. (2017). Aroused at home: Basic autonomic regulation during orthostatic and physical activation is altered in children with social anxiety disorder. Journal of Abnormal Child Psychology, 45, 143–155. https://doi.org/10.1007/s10802-016-0147-7

Ashlock, L., Miller-Perrin, C., & Krumrei-Mancuso, E. (2017, March). The effectiveness of coloring methods for anxiety reduction. Poster session presented at the Research and Scholarly Achievement Symposium, Malibu, CA. Retrieved from https://bit.ly/2KahAyo

Babouchkina, A., & Robbins, S. J. (2015). Reducing negative mood through mandala creation: A randomized controlled trial. Art Therapy: Journal of the American Art Therapy Association, 32, 34–39. https://doi.org/10.1080/07421656.2015.994428

Blechert, J., & Wilhelm, F. H. (2014). Psychophysiology. In P. M. Emmelkamp & T. Ehring (Eds.), The Wiley handbook of anxiety disorders (pp. 274–294). Chichester, UK: Wiley.

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

Deiters, D. D., Stevens, S., Hermann, C., & Gerlach, A. L. (2013). Internal and external attention in speech anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 44, 143–149. https://doi.org/10.1016/J.JBTEP.2012.09.001

Drake, C. R., Searight, H. R., & Olson-Pupek, K. (2014). The influence of art-making on negative mood states in university students. American Journal of Applied Psychology, 2, 69–72. https://doi.org/10.12691/ajap-2-3-3

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, 318–330. https://doi.org/10.1080/15401383.2018.1437001

Flett, J. A. M., Lie, C., Riordan, B. C., Thompson, L. M., Conner, T. S., & Hayne, H. (2017). Sharpen your pencils: Preliminary evidence that adult coloring reduces depressive symptoms and anxiety. Creativity Research Journal, 29, 409–416. https://doi.org/10.1080/10400419.2017.1376505

Gantt, L., & Tripp, T. (2016). The image comes first: Treating preverbal trauma with art therapy. In J. King (Ed.), Art therapy, trauma and neuroscience: Theoretical and practical perspectives (pp. 67–99). New York, NY: Routledge.

Henderson, P. G. (2012). Empirical study of the healing nature of artistic expression: Using mandalas with the positive emotions of love and joy (Unpublished doctoral dissertation). Texas A&M University, College Station, TX. Retrieved from https://bit.ly/2MovvDD

Jung, C. G. (1972). Mandala symbolism. Princeton, NJ: Princeton University Press.

Kreibig, S. D. (2010). Autonomic nervous system activity in emotion: A review. Biological Psychology, 84, 394–421. https://doi.org/10.1016/j.biopsycho.2010.03.010

Leary, M. R. (1983). Social anxiousness: The construct and its measurement. Journal of Personality Assessment, 47, 66–75. https://doi.org/10.1207/s15327752jpa4701_8

Lusebrink, V. B. (1998). Symbolic images in art as therapy. Art Therapy: Journal of the American Art Therapy Association, 15, 129–131. https://doi.org/10.1080/07421656.1989.10758726

McNair, D. M., Lorr, M., & Droppleman, L. F. (1971). The Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service.

Mulcahy, M. (2013). Mandalas as a tool for transformation to enable human flourishing: The influence of Carl Jung. International Practice Development Journal, 3(2). Retrieved from https://bit.ly/32VDSMR

Muthard, C., & Gilbertson, R. (2016). Stress management in young adults: Implications of mandala coloring on self-reported negative affect and psychophysiological response. Psi Chi Journal of Psychological Research, 21, 16–28. https://doi.org/10.24839/2164-8204.JN21.1.16

Orme-Johnson, D. W., & Barnes, V. A. (2014). Effects of the transcendental meditation technique on trait anxiety: A meta-analysis of randomized controlled trials. The Journal of Alternative and Complementary Medicine, 20, 330–341. https://doi.org/10.1089/acm.2013.0204

Palmer, V. J., Dowrick, C., & Gunn, J. M. (2014). Mandalas as a visual research method for understanding primary care for depression. International Journal of Social Research Methodology, 17, 527–541. https://doi.org/10.1080/13645579.2013.796764

Panayiotou, G., Karekla, M., Georgiou, D., Constantinou, E., & Paraskeva-Siamata, M. (2017). Psychophysiological and self-reported reactivity associated with social anxiety and public speaking fear symptoms: Effects of fear versus distress. Psychiatry Research, 255, 278–286. https://doi.org/10.1016/J.PSYCHRES.2017.05.044

Peng, C. Z., Gong, Y. X., & Zhu, X. Z. (2004). Reliability and validity of the Interaction Anxiety Scale and its applicability in Chinese college students [In Chinese]. Chinese Journal of Mental Health, 12, 39–41.

Potash, J. S., Bardot, H., Wang, X. L., Chan, F., Ho, A. H. Y., & Cheng, C. (2013). Mandalas as indicators of burnout among end-of-life care workers. Journal of Applied Arts & Health, 4, 363–377. https://doi.org/10.1386/jaah.4.3.363_1

Schrade, C., Tronsky, L., & Kaiser, D. H. (2011). Physiological effects of mandala making in adults with intellectual disability. The Arts in Psychotherapy, 38, 109–113. https://doi.org/10.1016/j.aip.2011.01.002

Schnetz, M. (2003). The healing flow: Artistic expression in therapy. London, UK: Kingsley.

Simon, R. M. (1997). Symbolic images in art as therapy. London, UK: Routledge.

Slegelis, M. H. (1987). A study of Jung’s mandala and its relationship to art psychotherapy. The Arts in Psychotherapy, 14, 301–311. https://doi.org/10.1016/0197-4556(87)90018-9

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Viking.

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

Walker, M. S., Kaimal, G., Gonzaga, A., Myers-Coffman, K., & DeGraba, T. (2017). Active-duty military service members’ visual representations of PTSD and TBI in masks. International Journal of Qualitative Studies on Health and Well-Being, 12, 1267317. https://doi.org/10.1080/17482631.2016.1267317

Watts, L. J. (2000). Mandalas: Spiritual circles for harmony and fulfillment. London, UK: Southwater.

Yongfang Liu, Department of Psychology and Cognitive Science, East China Normal University, Junxiu Building, 3663 Zhongshan West Road, Putuo District, Shanghai 200062, People’s Republic of China. Email: [email protected]