Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C


Objective: The objective of this selective evidence based medicine (EBM) review is to determine whether or not coloring mandalas or designs that have complexity and structure can aid in reducing anxiety in those greater than 17 years of age.

Study Design: Review of three English language randomized controlled trials (RCTs), published in 2007, 2012, and 2015.

Data Sources: Three randomized controlled trials published in peer-reviewed journals obtained using PubMed and EBSCOhost.

Outcomes Measured: The Curry and Kasser study and the van dV and Serice7study both used the State Anxiety Inventory (SAI) to record anxiety. The Henderson et al study used the State Trait Anxiety Inventory (STAI) to record anxiety.

Results: The studies by Curry and Kasser2 and van dV and Serice found a statistically significant decrease in anxiety levels following 20 minutes of structured coloring, compared to free-form coloring. The study conducted by Henderson et al found that there was no statistically significant difference in anxiety reduction between those that participated in freehand mandala-coloring and those that participated in freehand coloring of specific objects.

Conclusions: The results showed that structured coloring is effective for reducing anxiety. Additional research should include a larger, more diverse population sample, as well as focus on specific designs and their complexity to determine which produce the largest anxiolytic effects.