Online Art Therapy in Elementary Schools During COVID-19: Results from A Randomized Cluster Trial and Impact on Mental Health.

Background: Emerging literature on the current COVID-19 crisis suggests that children may experience increased anxiety and depression as a result of the pandemic. To prevent such school and mental health-related problems, there is a timely need to develop preventive strategies and interventions to address potential negative impacts of COVID-19 on children’s mental health, especially in school settings. Results from previous child clinical research indicate that art-based therapies, including mindfulness-based art therapy, have shown promise increase children’s well-being and reduce psychological distress. Objective: The goal of the present pilot and feasibility study was to compare the impact of an emotion-based directed drawing intervention (experimental condition) and a mandala drawing intervention (active control condition), both group-based, delivered online and remotely, on mental health, in elementary school children ( N =30), in the context of the COVID-19 pandemic. A randomized cluster trial was implemented to evaluate and compare the impact of both interventions on anxiety, depression, inattention and hyperactivity symptoms. Results: ANCOVAs revealed a significant effect of the type of drawing intervention on levels of inattention, after controlling for baseline levels. Participants in the emotion-based directed drawing group showed lower inattention scores at post-test, when compared to participants in the mandala group. Conclusion:  Overall, results from this pilot and feasibility study showed that an emotion-based directed drawing intervention was more beneficial than a mandala drawing intervention on inattention symptoms of elementary school children, in the context of the current COVID-19 pandemic. From a feasibility standpoint, results indicate that the implementation of both interventions online and remotely, through a videoconference platform, is feasible and adequate in school-based settings. Further work incorporating larger sample sizes, longitudinal data and ensuring sufficient statistical power is warranted to evaluate the long-term impact of both interventions on children’s mental health.