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.

Study Overview

• Status: Enrolling by invitation
• Conditions: Art Therapy
• Intervention / Treatment: Behavioral: Art Therapy

• Study Type: Interventional
• Enrollment (Estimated): 44
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul
    • Istanbul, Istanbul, Turkey (Türkiye), 34408
      • Istanbul Atlas University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Art Therapy Group; In the study, it was planned to apply art therapy program the independent variable to the intervention group in 8 sessions of 90-120 minutes, one days a week, and no intervention was planned for the control group.	Behavioral: Art Therapy; Intermodal art therapy program; Other Names: Intermodal art therapy
No Intervention: Comparison group; No intervention was planned for the control group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Depression, anxiety, stress	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	Pre-test (8 weeks before intervention) Post-test (8 weeks after intervention) Follow-up (1 month after post-test evaluation)
Emotion Regulation Skills	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	Pre-test (8 weeks before intervention) Post-test (8 weeks after intervention) Follow-up (1 month after post-test evaluation)

Collaborators and Investigators

• Sponsor: Atlas University

Study record dates

Study Major Dates

• Study Start (Estimated): April 29, 2026
• Primary Completion (Estimated): June 18, 2026
• Study Completion (Estimated): July 18, 2026

Study Registration Dates

• First Submitted: April 24, 2026
• First Submitted That Met QC Criteria: April 24, 2026
• First Posted (Actual): May 1, 2026

Study Record Updates

• Last Update Posted (Actual): May 1, 2026
• Last Update Submitted That Met QC Criteria: April 24, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Depression; Anxiety; Stress; Nursing Students; Intermodal Art Therapy; Emotion Regulation Skill
• Additional Relevant MeSH Terms: Mental Disorders; Behavioral Symptoms; Behavior; Anxiety Disorders; Depression; Therapeutics; Complementary Therapies; Patient Care; Psychotherapy; Behavioral Disciplines and Activities; Rehabilitation; Aftercare; Continuity of Patient Care; Sensory Art Therapies; Art Therapy
• Other Study ID Numbers: 01313

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: We can share if necessary
• IPD Sharing Time Frame: 6 months
• IPD Sharing Access Criteria: Contacting authors
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No