Anxiety disorders represent one of the most prevalent childhood psychiatric disorders. In epidemiological studies worldwide, approximately 5–20% children and adolescents have been estimated to have an anxiety disorder [1]. The high comorbidity rate of these disorders has also been documented [2], with rates for comorbid depression and anxiety ranging from 15.9 to 61.9% [3]. Childhood anxiety disorders are associated with school problems, psychosocial difficulties, increased risk for substance abuse and other externalizing disorders [4] and they tend to be stable over time [5]. Taken together, all these findings merit a serious attention to childhood anxiety disorders and indicate the need for reliable and valid screening tools.

Art therapy is a dynamic therapy. Through art making, the child participates in his/her own treatment. Therapeutic art making enables children to express their emotions and thoughts in a personal way. Sometimes it is difficult to describe things with words; however, art making encourages children to express themselves. Using art materials and creative process provides children to reconcile emotional conflicts, increase self-awareness, social skills, foster coping mechanisms, increase self-esteem, reduce anxiety and enable them to think creatively, improving their problem solving skills [6]. 

Art therapy is a form of psychotherapy often used with children suffering from anxiety. In art therapy, children are encouraged by an art therapist to express their thoughts and feelings through art materials and interventions. Art therapy services have become more common in school settings and have been shown to help children cope with the psychological distress. 

Need of the Study

Anxiety disorders represent one of the most common forms of child psychopathology. Research has shown that Child anxiety disorders are associated with a range of negative consequences in terms of social, scholastic and personal adjustment. If left untreated, may persist through adolescence and adulthood. Thus, it is important that clinically anxious children are identified as early as possible and provided with appropriate intervention.

Art therapy is based on the idea that the creative process of art making is healing and life enhancing and is a form of nonverbal communication of thoughts and feelings. It is a modality that can help individuals of all ages to create meaning, achieve insight, find relief from overwhelming emotions or trauma, resolve conflicts and problems, enrich daily life and achieve an increased sense of well-being.

Objectives of the Study

• To assess the anxiety level among school going children (6-12 years) in experimental group and control group

• To administer the art therapy among school going children (6-12 years) in experimental group

• To evaluate the effectiveness of Art therapy on anxiety level among school going children (6-12 years) in selected schools of Shimla (H.P.)

To find out the association of anxiety level among school going children (6-12 years) with selected demographic variables.

• Research Approach: Quantitative Research Approach 

• Research Design: Quasi experimental (Nonrandomised control design)

• Setting of the Study: Selected schools of Shimla (H.P)

• Study Population: School going children (6-12 years) of selected schools of Shimla (H.P.)

• Sample Size: 60 School going children (6-12 years) 

• Sampling Technique: Non-Probability, Purposive sampling technique 

Informed Consent

Was taken from students and their parents and confidentiality of the students was also maintained.

Inclusive Criteria

Children who were present, willing and anxious at the time of the study.

Exclusive Criteria

Students who were not willing to participate in the study and who were not present and anxious during data collection:

Development of tool: Visual facial anxiety scale.

Description of Tool

Section A: This part of tool consists of questions which seek information regarding demographic data such as an Age (in years), gender, educational status of child, religion, area of residency, type of family, birth order, educational status of father, educational status of mother, Occupational status of father and Occupational status of mother. 

Section: B

This part of the tool consists of the visual facial anxiety scale. The scale consists of the five facial expressions that depict the anxiety level among children:

Validity of Tool: By the experts in this field

Data Analysis and Interpretation

Section I: Description of demographic variables of school going children (6-12years) in the experimental group and control group.

Table 1 shows majority of school going children (66.7%) in Experimental group and (70%) in control group were in the age group of 11-12 years. Most of the participants (66.7%) in Experimental group and (60%) in control group were male. With respect to educational status of child majority i.e. (66.7%) in Experimental group and (70%) in control group were in the 6-7^th std. All of the participants (100%) belong to Hindu religion. With regard to area of residency (63.3%) in experimental group and (50%) in control group belongs to urban area. On the basis of type of family majority (56.7%) in experimental group and (60%) in control group belongs to joint family. With regard to birth order majority (56.7%) in experimental group and (46.7%) in control group belongs to 1^st order. On the basis of educational status of father majority (26.7%) in experimental group were secondary educations qualified whereas in control group (33.3%) were secondary education and (33.3%) post-graduation and above qualified. With regard to educational status of mother majority (60%) in experimental group were secondary educations qualified whereas in control group (26.7%) was post-graduation & above qualified. On the basis of occupational status of father majority (40%) in experimental group and (36.7%) in control group were private employees. On the basis of occupational status of mother majority (93.3%) in experimental group and (86.7%) in control group were housewives.

Section II

Findings related to assessment of pre-test and post-test anxiety level among school going children (6-12 years) in the experimental group and control group.

Table 2 shows that in Pre-test of experimental group 46.7% school going children had moderate level anxiety, 30% had severe level anxiety and 23.3% had highest level anxiety, none of the participant in experimental group had mild level anxiety and no anxiety. Whereas in Pre-test of control group 56.7% school going children had moderate level anxiety, 26.7% had severe level anxiety and 16.7% had highest level anxiety, none of the participant in control group had mild level anxiety and no anxiety.

Hence it was concluded that in Pre-test anxiety level among school going children was moderate level anxiety in experimental group and control group.

Table 3 reveals that in Post-test of experimental group 33.3% school going children had moderate level anxiety, 26.7% had no anxiety, 20% had mild level anxiety, 16.7% had severe level anxiety and 3.3% had highest level anxiety. Whereas in Post-test of control group 53.3% school going children had moderate level anxiety, 33.3% had severe level anxiety, 10% had highest level anxiety and 3.3% had mild level anxiety none of the participant in control group had no anxiety.

Table 1: Frequency and Percentage Distribution of Demographic Variables (N = 60)

Table 2:   Frequency and Percentage Distribution of Pre-Test &Post-Test Anxiety Level among School Going Children (6-12years) In Experimental Group and Control Group (N = 60)

Table 3: Comparison of Pretest and Post Test Anxiety Level among School Going Children (6-12 Years) within and between the Group with Paired ‘T’ Test and Unpaired ‘T’ Test

*Level of significance p≤0.05

Hence it was concluded that in Post-test anxiety level among school going children was improved in experimental group whereas in control group no improvement was seen in anxiety level among school going children.

Section-III

Findings related to effectiveness of art therapy on anxiety level among school going children (6-12 years) within and between the experimental group and control group.

Table 3 shows comparison within group with paired ‘t’ test, degree of freedom for both the group was 29. In experimental group value of pre-test mean was 2.77 and standard deviation was 0.817, whereas value of post-test mean was 1.50, standard deviation was 1.167 and value of ‘t’ test was 10.033 which was significant at the 0.05 level of significance. In control group value of pre-test mean was 2.600 and standard deviation was 0.770, whereas value of post-test mean was 2.50, standard deviation was 0.731 and value of ‘t’ test was 1.361 which was nonsignificant at p≤0.05 level of significance.

With regard to comparison between the groups with unpaired ‘t’ test, degree of freedom for both the group was 58. Value of unpaired ‘t’ test for pre-test was 0.813 which was nonsignificant at p≤0.05 level of significance. Value of ‘t’ test for post-test was 3.977 which was significant at ≤0.05 level of significance.

Section IV

Findings related to the association of anxiety level among school going children (6-12 years) with selected demographic variables.

In pre-test anxiety level among school going children (6-12 years) in experimental group was significantly associated with birth order and in post-test there was significant association of anxiety level among school going children (6-12 years) with age (in years) and educational status of child. Whereas in control group pre-test and post-test anxiety level among school going children (6-12 years) was not significantly associated with selected demographic variables.

Study results revealed that art therapy was effective in reducing the anxiety level among school going children (6-12 years) by comparing within the group with the paired ‘t’ test. Value of ‘t’ test was 10.033 for experimental group which was significant at p≤0.05 level of significance. Value of ‘t’ test was 1.361 for control group which was non-significant at p≤0.05 level of significance. On comparing the anxiety level between the group with unpaired ‘t’ test, value of ‘t’ test for pre-test 0.813 was which was non-significant at p≤0.05 level of significance. Value of ‘t’ test for post-test was 3.977 which was significant at p≤0.05 level of significance. Hence it was concluded that art therapy was effective in reducing the anxiety level among school going children (6-12 years).

Recommendations for the Future Studies

Based on findings of the study the investigator proposed the following recommendations:

• The same study can be done with large sample size so that the results can be generalized

• Comparison of Art therapy with other types of relaxation techniques like music therapy and play therapy can be done

• A study to assess the Knowledge and Practice of Medical and Paramedical personnel’s regarding Art therapy can be assessed

• A study can be conducted to assess the awareness and practice on Art therapy on hospital anxiety among paediatric staff Nurses

• The same study can be done on different settings

• A similar study can be done by increasing time duration and using different themes of Art therapy

• Comparative study can be done to assess the effectiveness of Mozart music intervention between children of different age groups

Comparative study can be done to assess the effectiveness of Mozart music with other non-pharmacological interventions for pain management.

1. Su, L. et al. "Reliability and Validity of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in Chinese Children." Journal of Anxiety Disorders, vol. 22, no. 4, 2008, pp. 612–621.

2. Ugurlu, N. et al. "An Art Therapy Intervention for Symptoms of Post-Traumatic Stress, Depression and Anxiety among Syrian Refugee Children." Vulnerable Children and Youth Studies, vol. 11, no. 2, 2016, pp. 89–102.

3. Beebe, A. et al. "A Randomized Trial to Test the Effectiveness of Art Therapy for Children with Asthma." Journal of Allergy and Clinical Immunology, vol. 126, no. 2, 2010, pp. 263–266.

4. "Anxiety Disorders in Children." Anxiety and Depression Association of America, Apr. 2021, https://adaa.org/sites/default/files/Anxiety%20Disorders%20in%20Children.pdf.

5. Spence, S.H. "A Measure of Anxiety Symptoms among Children." Behaviour Research and Therapy, vol. 36, no. 5, 1998, pp. 545–566.

6. Malchiodi, C.A. Handbook of Art Therapy. Guilford Press, 2011.