A study on the effects of art therapy with clay intervention program on emotion regulation strategies, psychological stress and cortisol rhythm of secondary school students: A randomized controlled trial

Emotional problems, such as depressive and anxious mood, are prevalent in the youth population of Hong Kong (HK) and although the etiology is complex it is widely believed that academic stress is a major factor. Locally there has been a lot of research into stress prevention but the results have been poor. A city-wide survey found that 50% of adolescents were on the brink of clinical depression.

A review of the literature suggests that depression in adolescents is the result of poor emotional regulation (ER). There has been scant research on ER in HK, but in Western countries ER mechanisms and the impacts of ER strategies on psychophysiological health have been extensively and intensively researched in recent decades. ER can be divided into three components: positive and negative affective states, physiological- psychological interaction, and cognition-emotion interaction. Built on the theoretical underpinnings of ER, art therapy with clay (clay art therapy; CAT) provides the intervention that aids emotional regulation by improving emotional regulation aspects as abovementioned and facilitating mind—body interactions in the treatment processes.

The aim of this study is to assess the effectiveness of CAT in improving the various respects of emotion regulation. The intervention starts with individuals interacting physically with clay and progressively integrates various psychological techniques. The objectives of CAT are to (1) improve emotional regulation strategies; (2) enhance positive affective states; (3) alleviate negative affective states; (4) reduce cognitive deficits in affective processing, e.g. alexithymia; (5) reduce psychological and physiological stress in secondary school students.

The effectiveness of the CAT intervention will be tested via a randomized controlled trial comparing the CAT program with a control treatment. The sample will consist of secondary school students aged 15 to 17 years. During the time that the treatment group is receiving CAT the control group will participate in non-therapeutic activities, mainly ordinary classes organized and hosted by school teachers (e.g. remedial English and mathematics classes). The treatment group is expected to show improvement in the areas targeted by the intervention. Outcome measures as listed in the Methodology section will be used to assess improvements in affective states and cognition-emotion interaction. Salivary cortisol levels will be measured to assess physiological-psychological interactions and stress reduction resulting from after the anticipated reduction in emotional problems.