Coloring Therapy for Pain and Anxiety in Emergency Care

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Stony Brook University

Disqualifiers: Aggression, Suicidal ideations, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

The objective of this research is to assess the effects of engaging in coloring activities on patients' self-reported pain and anxiety scores while they wait to be seen by a physician in an emergency department (ED). The current literature on patient visits in the ED highlights the significance of anxiety, stress, and frustration in patient experiences, especially when accounting for long wait times before the physician-patient encounter. The study will address this common problem by looking at the potential impact of nature-themed or geometric shape coloring activities on the ED patient experience as it relates to self-reported anxiety and pain scores. Given that long wait times are increasingly being reported across the country, this study may offer a possible meaningful low-budget, low-resource intervention which could be offered to patients.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

Is coloring therapy safe for humans?

Coloring therapy, including adult coloring books and art therapy, is generally considered safe for humans. It is often used to help with relaxation and emotional expression without any reported safety concerns. ^{1 2 3 4 5}

How does coloring therapy differ from other treatments for pain and anxiety in emergency care?

Coloring therapy is unique because it uses adult coloring books as a form of relaxation to manage anxiety and pain, unlike traditional treatments that might involve medication or talk therapy. This approach is non-invasive and allows patients to engage in a calming activity, which can help reduce stress and anxiety in a busy emergency care setting. ^{1 3 5 6 7}

Research Team

Eligibility Criteria

This trial is for adults over 18 who can consent, speak English, and are not at risk of aggressive behavior. They must have mild anxiety (HADS-A Score > 6), be fully conscious (GCS of 15), and experience moderate pain (Triage Pain Score > 3) while waiting in the emergency department.

Inclusion Criteria

My pain level is above 3 on the pain scale.

Without concern for aggressive behavior

Hospital Anxiety and Depression Scale-Anxiety (HADS-A) Score > 6

Exclusion Criteria

Glasgow Coma Scale (GCS) <15

Triage acuity requiring critical care evaluation

Concern for aggression risk, including active concern for suicidal or homicidal ideations

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 hours

Intervention

Participants engage in art therapy activities, such as coloring nature-themed or geometric shapes, to assess effects on self-reported pain and anxiety scores

8 hours

1 visit (in-person)

Follow-up

Participants are monitored for changes in self-reported anxiety and pain scores after the art therapy intervention

8 hours

Treatment Details

Interventions

• Activity Book (Behavioral Intervention)
• Blank Paper and Pencil (Behavioral Intervention)
• Geometric Shape Coloring Packet (Behavioral Intervention)
• Nature Coloring Packet (Behavioral Intervention)

Trial Overview The study tests if coloring nature or geometric shapes, doing activity books, or drawing on blank paper can lower self-reported pain and anxiety in patients awaiting treatment in the emergency room.

Participant Groups

Group I: Nature Coloring Packet Experimental Treatment 1 Intervention

Group II: Geometric Shape Coloring Packet Experimental Treatment 1 Intervention

Group III: Activity Book Experimental Treatment 1 Intervention

Group IV: Blank Paper and Pencil Active Control 1 Intervention

Who Is Running the Clinical Trial?

Stony Brook University

Lead Sponsor

Trials

225

Recruited

41,700+

Dr. James A. Hayward

Stony Brook University

Chief Executive Officer since 1990

PhD in Molecular Biology from the State University of New York at Stony Brook

Dr. Louis A. Peña

Stony Brook University

Chief Medical Officer since 2023

MD from Harvard Medical School

Findings from Research

In a randomized placebo-controlled trial involving 53 patients in an emergency department, those using adult coloring books reported a significant reduction in anxiety levels, with an average decrease of 3.7 points on the Hospital Anxiety and Depression Scale after 2 hours.

Patients using the coloring books were more likely to engage with the activity for at least an hour (46.2% vs. 4.0% in the placebo group), suggesting that the coloring books may effectively capture attention and promote relaxation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized Controlled Trial of Adult Therapeutic Coloring for the Management of Significant Anxiety in the Emergency Department. Rajendran, N., Mitra, TP., Shahrestani, S., et al.[2020]

Creative art therapies, which include music, dance, and visual arts, effectively engage children who may be struggling emotionally or behaviorally, helping them express themselves in a fun and enjoyable way.

These therapies not only foster a sense of mastery through the creative process but also serve as a means to explore and communicate deeper feelings and concerns, making them a valuable tool in mental health treatment for children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Many ways to grow: creative art therapies. Stern, RS.[2019]

A review of two studies involving 60 participants found no significant differences in cognitive and emotional outcomes between art therapy and standard activities for dementia patients, indicating a lack of clear efficacy for art therapy as an intervention.

The quality of evidence regarding the effectiveness of art therapy for dementia was rated as 'very low', highlighting the need for more robust and well-designed studies to better assess its potential benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Art therapy for people with dementia. Deshmukh, SR., Holmes, J., Cardno, A.[2022]

The trial involved 276 pediatric patients aged 3-10 years, comparing anxiety levels before and after reviewing an educational coloring book (CB) related to radiology imaging tests.

While the CB did not significantly reduce anxiety overall, it showed potential benefits for children of parents with higher baseline anxiety, as most parents found the CB informative and helpful in reducing worry.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Decreasing pediatric patient anxiety about radiology imaging tests: prospective evaluation of an educational intervention. Johnson, AJ., Steele, J., Russell, GB., et al.[2009]

Research over the past 25 years highlights the importance of education and emotional support for pediatric patients to reduce stress during hospital stays.

A preparatory coloring book can serve as an effective tool by providing factual information and allowing children to express their emotions, addressing their major fears during hospitalization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preparation book for hospitalized pediatric patients: content and design. Gross, PR.[2007]

This systematic literature review analyzed 27 studies from 2000 to 2017, highlighting the effectiveness of art therapy across various adult populations, including cancer patients, trauma survivors, and the elderly.

Art therapy shows potential benefits for diverse clinical groups, suggesting it can be a valuable therapeutic tool, but further research is needed to expand understanding and application in this field.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Art Therapy With Adult Clients in 2018-What Progress Has Been Made? Regev, D., Cohen-Yatziv, L.[2020]

A randomized controlled trial involving 59 adult women with anxiety disorders showed that anthroposophic art therapy significantly reduced anxiety symptoms and improved quality of life, with effects lasting for at least 3 months after treatment.

Participants also experienced better emotion regulation, particularly in accepting emotions and taking goal-oriented actions, indicating that art therapy can be a beneficial intervention for managing anxiety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial. Abbing, A., Baars, EW., de Sonneville, L., et al.[2023]

References

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

Randomized Controlled Trial of Adult Therapeutic Coloring for the Management of Significant Anxiety in the Emergency Department. [2020]

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

Many ways to grow: creative art therapies. [2019]

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

Art therapy for people with dementia. [2022]

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

Decreasing pediatric patient anxiety about radiology imaging tests: prospective evaluation of an educational intervention. [2009]

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

Preparation book for hospitalized pediatric patients: content and design. [2007]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Effectiveness of Art Therapy With Adult Clients in 2018-What Progress Has Been Made? [2020]

7. Switzerland pubmed.ncbi.nlm.nih.gov

The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial. [2023]