The Effects of an Intermodal Art Therapy Program on Depression, Anxiety, Stress, and Emotion Regulation Skill Levels in Nursing Students: A Randomized Controlled Study

Nursing students face stress during their education, especially when transitioning to clinical practice; poorly managed stress reduces academic achievement and increases levels of depression and anxiety. Therefore, developing students' emotional awareness and coping skills is important. Art therapy is an effective method that supports individuals in self-expression and the development of emotion regulation skills. Although the literature shows positive effects of art-based interventions on psychological well-being, there are limited randomized controlled studies that address depression, anxiety, stress, and emotion regulation skills together in nursing students. Accordingly, this study aims to determine the effect of an intermodal art therapy program on these variables in nursing students. The research was planned as a two-group, single-blind, observational, randomized controlled interventional study. The population of the study will consist of 1st and 2nd-year nursing students studying at Istanbul Atlas University, and 44 students meeting the inclusion-exclusion criteria will constitute the sample of the study. The intermodal art therapy program will be applied to the intervention group. Data; Data will be collected using an Individual Demographic Form, the Depression, Anxiety, Stress Scale, and the Emotion Regulation Skills Scale. Interventions will be administered in approximately grouped sessions, once a week, for a total of 8 sessions, each lasting 90 minutes, in a structured format. Data analysis will be performed using the SPSS 23.0 software package. Descriptive statistics such as frequency distribution, mean, and standard deviation will be used to define the sample size; pairwise pairs or the Wilcoxon pairwise test will be used for intragroup comparisons according to parametric test assumptions; and the Chi-square test will be used for the analysis of categorical data. A 95% significance level will be used to determine differences in the analyses. This study aims to contribute to strengthening the psychosocial care of nursing students by providing evidence on the effectiveness of an intermodal art therapy program applied to nursing students.

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Key information

Conditions

Art Therapy Anxiety Disorders Behavior Behavioral Symptoms Depression Mental Disorders

Age range

17 year–23 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

İstanbul Atlas University

Istanbul, 34408, Turkey (Türkiye)

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Being enrolled in the 1st or 2nd year of the Nursing Department at Istanbul Atlas University in the Spring Semester of 2025-2026,
Voluntarily participating in the research

Exclusion criteria

Having any comprehension or speech impairment,
Having any psychiatric diagnosis,
Being on any psychotropic medication,
Being enrolled in another program using a similar method that could affect the study's outcome

Treatment and study plan

Art Therapy

Behavioral

Intermodal art therapy program

Other names: Intermodal art therapy

Primary outcomes

Depression, anxiety, stress

Time frame: Pre-test (8 weeks before intervention) Post-test (8 weeks after intervention) Follow-up (1 month after post-test evaluation)

Depression, Anxiety, Stress Scale (DASS-21) Lovibond and Lovibond (1995) created DASS-21 by shortening DASS-42. Sarıçam (2018) performed psychometric tests on the Turkish version of the "Depression Anxiety Stress-21 Scale (DASS-21)" in normal and clinical samples. In the normal sample, test-retest correlation coefficients were found to be r=0.68 for the depression subscale, r=0.66 for the anxiety subscale, and r=0.61 for the stress subscale. The scale, which is a four-point Likert type, consists of 7 questions each measuring the "depression, stress, and anxiety dimensions". In the depression subscale scores, 0-4 points indicate normal, 5-6 points mild, 7-10 points moderate, 11-13 points advanced, and 14 points and above indicate very advanced depression. In the anxiety subscale, scores between 0-3 indicate normal, 4-5 indicates mild, 6-7 indicates moderate, 8-9 indicates advanced, and 10 and above indicates very advanced anxiety levels. In the stress subscale, scores between 0-7 indic
Emotion Regulation Skills

Time frame: Pre-test (8 weeks before intervention) Post-test (8 weeks after intervention) Follow-up (1 month after post-test evaluation)

Emotion Regulation Skills Scale (EDS) This is a scale developed by Berking and Znoj (2008) to determine individuals' emotion regulation skills. The adaptation of the scale into Turkish, and its validity and reliability study, were carried out by Vatan and Kâhya (2018). The scale is a self-report instrument consisting of 27 items with a five-point Likert scale (0=almost never, 4=almost always). The Emotional Behavior Test (EBT) encompasses nine sub-dimensions: awareness/attention (e.g., 'I paid attention to my feelings.'), bodily sensations (e.g., 'My physical sensations were a good indicator of how I felt.'), clarity (e.g., 'I was sure of which emotions I was experiencing.'), understanding (e.g., 'I was aware of why I felt that way.'), acceptance (e.g., 'I accepted my emotions.'), tolerance (e.g., 'I felt I could tolerate my negative emotions.'), preparedness for confrontation (e.g., 'Even though it made me feel uncomfortable or anxious, I did what I planned.'), self-support (e.g., 'I

Sponsors and collaborators

Lead sponsor

Atlas University

Other

Registry information

Important dates

Study start: 2026
Primary completion: 2026
Study completion: 2026
First posted: May 1, 2026
Registry last updated: May 1, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

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This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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