Adult colouring

1. Introduction

Version followed: research-based structured colouring of pre-drawn designs (mandala or other complex geometric pattern), as tested by Curry & Kasser (2005) and the studies that followed them, plus the mindfulness-guided variant of Mantzios & Giannou (2018, Experiment 2). Positioned as self-care/adjunct per the American Art Therapy Association (AATA) 2015 statement. No treatment manual, founder or training institute exists.

Adult colouring means filling in the blank areas of a ready-made line design (colouring book, printed sheet or app) with pencils, felt-tips, pastels or watercolours, to reduce stress and anxiety and to focus attention [source: Holt, Colouring for wellbeing]. It is an activity, not a psychotherapy or a form of art therapy. The AATA supports colouring books "for pleasure and self-care" but distinguishes them from art therapy, which needs a credentialed art therapist and a therapeutic relationship [source: Carolan & Betts 2015; GWU Columbian College]. The proposed way change happens is attentional rather than expressive: a structured, reasonably complex design absorbs attention, draws it away from worry and gives a flow-like or meditative state. Because the design is pre-set, colouring is less likely than free art-making to be cathartic or to produce new personal narratives [source: Holt chapter; Curry & Kasser 2005]. For a psychotherapist it is a brief, low-cost self-regulation tool to suggest, set as homework or use in session. It does not replace treatment.

Professional frame. No regulated profession or credential exists for colouring. Anyone may offer it, and AATA calls it a "low-risk" structured activity [source: Carolan & Betts 2015]. Do not call it "art therapy" when you offer it. AATA has asked publishers to stop that labelling [source: GWU Columbian College]. In the UK, "art therapist" and "art psychotherapist" are protected titles requiring HCPC registration (BAAT is the professional body). In the US the credentials are ATR/ATR-BC via ATCB, with AATA as the professional body [source: brief/house frame; not re-verified in this session — uncertain]. Interpreting artwork, using art as projective material, or making open-ended art-making the main treatment needs art therapy training. A psychotherapist using colouring within their own scope should keep to the procedures below.

2. Framework

The sources describe no phases. What follows is a practical scaffold built from the study protocols [synthesis, built from the sources cited inline].

Format: individual or group. Groups were used in several studies, but group benefits are untested [source: Holt chapter]. Materials in studies: 6 colours (Curry & Kasser), 10 or 12 pencils or felt-tips (Mantzios & Giannou; Holt et al.), 36 pencils (Rajendran). A4 or letter-size sheets [source: as cited].

Materials and physical safety [synthesis unless cited]:

• Use products labelled non-toxic.
• Avoid small parts and caps with young children.
• Pencil sharpeners contain blades, and pencils are potential sharps. In inpatient or self-harm-risk settings, follow local ligature and sharps policy: use crayons or pre-sharpened short pencils, count items in and out, and keep the sharpener with staff.
• Shared packs in medical settings need a cleaning or single-use policy. SGEM's commentary notes the study did not address this.
• Adapt for tremor, low vision or cognitive impairment: large, bold-outline designs with bigger spaces, thick-grip pencils, a good light and a non-slip mat. Holt flags these adaptations as under-researched.

3. Guiding principles

• Self-care, not art therapy [source: Carolan & Betts 2015; GWU]. Present it as a coping tool. Never imply that it is your treatment or a substitute for one.
• Moderate structure works best for anxious adults [source: Curry & Kasser 2005; Holt chapter]. Offer a pre-drawn, fairly complex design. A blank page gave no anxiety reduction in Curry & Kasser, where participants looked to the experimenter for direction and kept stopping to decide what to do.
• Too much structure also fails [source: Eaton & Tieber 2017 via Holt]. Don't prescribe colour schemes or "colour by number" copying. Leave colour choice to the client.
• The design itself is not magic [source: Curry & Kasser 2005]. A plaid pattern worked about as well as a mandala. Pick for complexity and preference, not symbolism. Mandala symbolism is the theory of the Jungian, Hindu and Buddhist traditions, not a mechanism shown by the studies. Curry & Kasser cite Jung but did not test his ideas.
• Client preference matters [source: Holt chapter; Holt et al. 2019; GGIE]. Offer two or three design options, or free drawing, and let the client choose.
• Mechanism is absorption or distraction, not catharsis [source: Holt chapter]. Use it to regulate arousal, not to process content. Use other methods for that.
• Mindfulness needs explicit guidance [source: Mantzios & Giannou 2018; Holt chapter]. If the aim is mindfulness, give mindful-attention instructions. Unguided colouring did not increase state mindfulness in Mantzios & Giannou. Holt et al. 2019 did find a MAAS increase, so the evidence is mixed [uncertain].
• Offer, don't impose [source: Holt chapter, on Rajendran et al.; Mantzios & Giannou 2018]. About half of the patients invited in one ED study declined, some finding it childish. Some participants disliked a narrating voice. Ask first and respect a "no".
• Keep it brief and repeatable [source: study durations above]. 10–20 minutes is the tested range. Long-term effects and the best frequency are unknown.
• Adjunct only [source: Carolan & Betts 2015; Holt et al. 2019; Mantzios & Giannou 2018]. Keep it as a complement to evidence-based treatment. Mantzios & Giannou cautioned against bringing colouring into health care before further research.
• The relationship adds what colouring lacks [source: Kaimal et al. 2017 via Drexel]. Colouring with a non-interacting art therapist present reduced stress and negative states. Only therapist-facilitated open studio raised self-efficacy, creative agency and positive affect. When the goal is expression, agency or insight, use open-ended methods or refer to an art therapist.
• No interpretation of colours or content [synthesis; house rule]. Treat colour choices and finished pages as the client's experience, never as diagnostic evidence of mood, disorder or abuse.
• Measure simply [source: GGIE]. A 1–10 stress rating before and after, plus a short reflection, tells you whether it helps this client.

4. Intervention inventory

These are the procedures in the sources. Where a study gives no instructions, the steps are adapted for clinical use and tagged [synthesis]. All example language is illustrative unless quoted.

4.1 Structured-design colouring for acute anxiety ("anxiety repair")

• Purpose / when: To bring state anxiety down after a stressor or anxious rumination in session, or for a client who freezes in front of a blank page [source: Curry & Kasser 2005; Holt chapter]. In the original study the stressor was 4 minutes of writing about the client's most fearful memory. Do not induce fear clinically. The analogue is colouring after anxiety has naturally risen [synthesis].
• Steps:
  1. Ask permission and frame it as a short calming exercise, not therapy [synthesis; AATA].
  2. Optional: take a stress rating from 1 to 10 [source: GGIE].
  3. Give a pre-drawn design with many enclosed areas. Curry & Kasser's mandala and plaid each had 324 areas of varied size. Give a small set of pencils: they used 6 basic colours, other studies 10–12.
  4. Tell the client to choose colours freely, focus on their own page and let background sounds pass.
  5. Colour for 15–20 minutes. Curry & Kasser used 20 minutes. Stay quietly present and do not chat or comment on the work [source: Curry & Kasser 2005; Kaimal et al. 2017 coloring condition].
  6. Take the stress rating again and ask what they noticed. Agree when they could use colouring themselves.
• Example language (illustrative): "Let's take fifteen minutes to let your nervous system settle. Pick any colours, there's no right way, and just let your attention stay with the pencil and the shapes."
• Watch for:
  • Working: the rating drops, breathing slows, the client is absorbed or reports "calmer" or "focused". In studies, anxiety returned to or below baseline within 20 minutes [source: Curry & Kasser 2005].
  • Not working: repeated stopping to decide, looking to you for direction (typical of too little structure), or agitation over "mistakes" (see 5.2).

4.2 Choosing and offering the design

• Purpose / when: Matching structure to the person, at the first use and whenever 4.1 isn't working [source: Holt chapter; Curry & Kasser 2005; GGIE].
• Steps:
  1. Offer two or three choices: a mandala (concentric, symmetrical; the best-studied design), a non-symbolic geometric or plaid design (as effective in Curry & Kasser), or a nature or picture design. Evidence on nature designs and grids is mixed [source: Holt chapter].
  2. Choose design complexity to suit attention span, vision and motor skill.
  3. For children, or anyone who wants it, include free drawing on blank paper as an option [source: GGIE; Carsley 2018].
  4. Avoid designs that prescribe colours. For clients who object to religious imagery, use non-mandala geometrics [synthesis].
• Example language (illustrative): "Some people like a circular pattern, some prefer a grid or a picture. Which one looks most inviting right now?"
• Watch for: Disliking the design, or finding it too detailed or too simple. Switch designs rather than abandoning colouring after one try [synthesis]. Note that mandalas are sacred objects in Hindu and Buddhist traditions. Offer them as patterns only, and do not copy or present ceremonial forms such as the Tibetan sand mandala [source: house frame (f); Curry & Kasser note mandala's spiritual use].

4.3 Mindfulness-guided colouring

• Purpose / when: To use colouring as a gateway to mindful attention for clients who find formal sitting meditation hard. In Mantzios & Giannou, guided colouring reduced anxiety more than unguided colouring, though state mindfulness did not change significantly [source: Mantzios & Giannou 2018; Holt chapter].
• Steps (structure of the authors' protocol, paraphrased; the full script was only available from the authors on request):
  1. Seat the client with an A4 mandala and about 10 pencils.
  2. Invite them to relax the whole body, rest the hands on the table, and turn attention to the drawing and its colours.
  3. While they colour, guide attention moment to moment to the colour going onto the paper, the feel of the pencil in the hand, and the body in the chair.
  4. Tell them in advance that the mind will drift to past or future. When it does, they simply label it "thought" or "emotion", without judging it good or bad, and gently return to colouring.
  5. Leave set periods of silence between prompts. Mantzios & Giannou used a fixed protocol with planned pauses, read by the same teacher, who sat in the background.
  6. Close by inviting the client to refocus the eyes, take in the room, and sit a few seconds before talking. The session lasted 10 minutes.
• Example language (illustrative): "Notice the colour as it spreads across this little space… the pressure of the pencil… your weight in the chair. If your mind wanders off into planning or remembering, just note 'thinking', and come back to the colour."
• Watch for: Some participants found the guiding voice distracting and felt it broke their absorption [source: Mantzios & Giannou 2018]. Ask beforehand whether they want guidance during colouring, or give the instructions before starting and then stay silent. The authors proposed pre-activity guidance as an option. Working: fewer anxious self-reports and the client describing returning attention without self-criticism.

4.4 Pre-stressor colouring (exams, tests, flights, procedures)

• Purpose / when: Reducing anticipatory anxiety just before a known stressor [source: Curry & Kasser 2005 (suggested use); Carsley 2018; GGIE].
• Steps:
  1. Plan the timing so the colouring ends just before the stressor. Carsley: 15 minutes of colouring, then a test. GGIE: 10–15 minutes.
  2. Before the event, discuss the client's existing calming strategies and explain the colouring rationale [source: GGIE].
  3. Take a 1–10 rating, let them choose a mandala, plaid or free drawing, then colour.
  4. Re-rate and reflect: Do I feel calmer or more focused? Would I change anything? Would I do it again? [source: GGIE].
  5. Build a portable kit (a small pad and a few pencils) for waiting areas [synthesis].
• Example language (illustrative): "Before the exam, give yourself ten minutes with the pattern — not to stop the nerves completely, just to turn the volume down."
• Watch for: Effects on actual test performance are unknown [source: Holt chapter]. Carsley found anxiety fell with both mandala and free colouring in Grade 8 students, so either can be offered. Students who are already mindful may show little change (ceiling effect) [source: Carsley 2018].

4.5 Daily home colouring practice

• Purpose / when: Ongoing reduction of stress, anxiety and low mood as a self-care routine alongside treatment [source: Flett et al. 2017 and Czerwinski et al. 2020 via Holt chapter].
• Steps:
  1. Agree on a once-daily slot, 10–20 minutes [synthesis from tested durations]. Flett used one week of daily colouring. Czerwinski's teachers coloured for 5 days after watching a short instruction video on mindful colouring.
  2. The client picks a book or printable designs they like. Avoid books marketed as "art therapy" [source: GWU].
  3. Optional: add the mindful-attention instructions from 4.3, as a recording or written card [synthesis].
  4. The client logs a before and after rating [synthesis; GGIE].
  5. Review at the next session and decide whether to continue, change the design or time, or stop.
• Example language (illustrative): "Let's treat this like a short daily experiment for a week: same time each day, fifteen minutes, quick rating before and after, and we'll look at the numbers together."
• Watch for:
  • Working: lower ratings, and the client reaching for it spontaneously when stressed.
  • Concerns: hours-long colouring that replaces agreed exposure, behavioural activation or social contact (see 5.5). Benefit beyond about a week is unstudied [source: Holt chapter].

4.6 Waiting-room and medical-setting colouring packs

• Purpose / when: Anxiety during long waits or around procedures, for patients, relatives or staff [source: Rajendran et al. 2020 via SGEM; Robinson et al. 2018, Maguire et al. 2020 via Holt chapter].
• Steps:
  1. Prepare a pack. Rajendran used 10 adult colouring pages and 36 colouring pencils.
  2. Offer it to visibly anxious people, framed as optional. SGEM's commentator suggested acknowledging the person's anxiety and the likely wait, then asking if they would like to try some colouring.
  3. Leave it with them. Rajendran measured at 2 hours, and parents in a paediatric surgery waiting area also coloured during the wait.
  4. For staff, a mandala sheet on a break [source: Maguire et al. 2020 via Holt].
  5. Have a cleaning or single-use policy for materials [synthesis].
• Example language (illustrative): "It looks like a stressful wait. Some people find colouring takes the edge off — would you like a pack, no obligation?"
• Watch for:
  • Uptake: in Rajendran, 53 of 179 screened patients were enrolled, and the Holt chapter notes that about half of those invited declined, some finding it childish or feeling too unwell.
  • In Rajendran, HADS-A fell by about 3.7 points at 2 hours versus 0.3 in the control. How long the effect lasts is unknown [source: SGEM].
  • It never replaces clinical assessment or treatment of the presenting problem.

4.7 Colouring as an entry into art-making or a warm-up

• Purpose / when: For clients intimidated by art or by a blank page, as "a non-intimidating entry into art making" [source: Holt et al. 2019]. Also as an icebreaker to explain what arts-based work involves [source: Sunderland in GWU].
• Steps:
  1. Start the session with 5–10 minutes of colouring.
  2. Gradually loosen the structure over sessions: add colour outside the lines, extend the design, then move to a free drawing [synthesis].
  3. If the work becomes expressive and open-ended, consider whether it falls within your scope or warrants referral to a registered art therapist [synthesis; AATA].
• Example language (illustrative): "We'll start with something that's already drawn, so there's nothing to get 'right'. Later, if you like, you can add your own shapes."
• Watch for: Growing confidence and willingness to make choices. Holt et al. found higher originality on a creativity task after colouring than after reading. Watch also for anxiety rising as structure is removed; step back to more structure if it does [synthesis].

4.8 Colouring to regulate after difficult material, or as closure

• Purpose / when: Bringing arousal down after trauma narrative, emotional disclosure or demanding creative work, before the client leaves [source: Holt et al. 2019; Holt chapter].
• Steps:
  1. Leave 5–10 minutes at the end of the session.
  2. Offer a familiar, simple-to-moderate design. Do not use new or emotionally loaded imagery.
  3. Colour, ideally with grounding prompts from 4.3 (hands, chair, colour).
  4. Check the client's arousal and orientation (a rating, plus time, place and plans for the rest of the day) before they leave [synthesis].
• Example language (illustrative): "We've touched some heavy things today. Let's spend a few minutes just colouring to help your body come back to the room before you head out."
• Watch for: Working: steadier voice and posture, lower rating, clear plans. Danger sign: the client becomes glazed or detached, which may be dissociation rather than calm. Switch to active grounding (see 5.6) [synthesis].

4.9 Noticing evocative images (art-therapist-led variant)

• Purpose / when: AATA describes art therapists helping a client notice images that stir emotion or insight, then exploring those areas therapeutically [source: Carolan & Betts 2015].
• Steps: This is an art-therapy intervention. A non-art-therapist psychotherapist can do a limited version: ask open, non-interpretive questions about what the client was drawn to or what came up while colouring, and work with the client's own meanings [synthesis]. Do not interpret colour choices or imagery.
• Example language (illustrative): "Was there any part of the page you kept coming back to, or anything that came to mind while you worked?"
• Watch for: Material that needs more than talk-therapy processing, or projective interpretation creeping in. Refer to an art therapist when image-based exploration becomes central [synthesis].

4.10 Group colouring

• Purpose / when: Shared calm activity in groups, wards, waiting areas or community settings. Holt suggests a shared focus may ease awkward silences and reduce loneliness, but this is untested [source: Holt chapter] [uncertain].
• Steps:
  1. Give everyone the same kind of task. Curry & Kasser gave each group one condition so participants didn't see others doing something different.
  2. Agree that talking is optional.
  3. Ask members to keep their attention on their own page.
  4. Run for 15–20 minutes.
  5. End with an optional brief round on how members feel now [synthesis].
• Example language (illustrative): "Chat if you want, or work in silence — both are fine. Focus on your own page, not anyone else's."
• Watch for: Comparison and self-criticism, and social-desirability pressure to report feeling better [source: Holt chapter]. Collect ratings privately.

4.11 Children and adolescents (classroom or school use)

• Purpose / when: Pre-test anxiety and calming routines in upper primary to university students [source: Carsley 2018; GGIE].
• Steps: Follow 4.4 in a group setting. Carsley ran 15 minutes of colouring, with mandala or free drawing in a sealed envelope plus coloured pencils, then the test. GGIE's version: discuss existing coping strategies, introduce colouring, have students rate stress from 1 to 10, let them choose mandala, plaid or free drawing, colour for 10–15 minutes, then re-rate and reflect.
• Example language (illustrative): "Choose whichever sheet you like. For the next ten minutes, just notice how your body feels as you colour."
• Watch for:
  • GGIE reports that free drawing suited upper-elementary boys better in one study. Carsley's Grade 8 data showed different gender patterns. Offer choice [source: GGIE; Carsley 2018] [uncertain].
  • Safeguarding: free drawings and conversation can bring disclosures. Respond and report under local child-protection procedures if the child says something concerning. Never treat a drawing or colour choice on its own as evidence of abuse [house frame; synthesis].
  • Get assent, let children opt out, and get parent or carer consent for any routine use in a clinical context [synthesis].

4.12 Older adults and people with cognitive or motor impairment

• Purpose / when: Anxiety reduction and engagement. Koo et al. (2020) found 20 minutes of mandala colouring reduced anxiety more than reading in community-dwelling adults aged 55–75 [source: Holt chapter; full paper not drawn on — uncertain]. Colouring is widely recommended for dementia care, but research there is scarce [source: Holt chapter].
• Steps:
  1. Use the 4.1 procedure.
  2. Choose large-format, bold-line designs and grip-friendly materials.
  3. Consider reminiscence-themed designs, suggested by Holt as a future direction [uncertain].
  4. Avoid childish-looking images [synthesis].
  5. In dementia care, keep sessions short and offer help with starting.
• Example language (illustrative): "This one shows an old market street — would you like to bring it to life with some colour?"
• Watch for: Frustration from tremor or vision problems (adapt the materials), feeling infantilised (change the design or stop), and fatigue.

5. Handling problems

The sources discuss only declining and finding it childish (Rajendran via Holt), disliking guidance (Mantzios & Giannou), blank-page indecision (Curry & Kasser), and over-structure (Eaton & Tieber via Holt). Everything else below is [synthesis].

5.1 "It's childish" / refusal / feeling patronised (a rupture risk)

• Accept the refusal. Some people won't benefit, and many decline [source: Holt chapter].
• Repair: name that it was an offer, not a judgement of their maturity, and ask what they would prefer. Offer adult-appearing geometric designs, a different medium, or a non-art regulation method such as paced breathing [synthesis].
• Illustrative: "I may have pitched that wrong — it's just one option among many. What tends to help you settle?"

5.2 Perfectionism, colour paralysis, distress over "mistakes"

• If the client freezes over choices, reduce them: fewer colours, or a smaller section of the design [synthesis]. If they freeze at a blank page, give more structure [source: Curry & Kasser 2005].
• Do not swing to prescribed colour schemes. Over-structured copying did not reduce anxiety [source: Eaton & Tieber via Holt].
• Use the mindful-guidance stance (4.3) to name the judging thought as "thinking" and return to the colour. For a perfectionism case, frame going over the lines as a small behavioural experiment [synthesis].

5.3 Rumination continues while colouring / no effect

• Check design fit: complexity, preference and enough areas to stay absorbed [source: Holt chapter; Curry & Kasser 2005].
• Add guided attention, or remove a guiding voice if it intrudes [source: Mantzios & Giannou 2018].
• If two or three adjusted trials show no change in ratings, drop it. Not everyone benefits, and effects in high or chronic anxiety are unstudied [source: Holt chapter; Holt et al. 2019].

5.4 Non-adherence to home practice

• Shrink the task: 10 minutes, a single page, or one section.
• Tie it to an existing routine, keep materials visible, and review the rating log in session.
• If it still isn't used, ask whether it actually helps. A tool the client doesn't value isn't worth pushing [synthesis].

5.5 Colouring used for avoidance or compulsively

• Signs: colouring for hours in place of agreed exposure, activation or social contact, or used to escape every feeling.
• Response: set time limits, and schedule colouring after rather than instead of planned tasks.
• In anxiety-disorder treatment, treat colouring as a safety behaviour if it is used to block feared sensations during exposure. Use it only for after-session regulation [synthesis].

5.6 Overwhelm, dissociation, trauma reactions

• Absorption can shade into dissociation in trauma clients. Signs are a glazed look, lost time, or slow responses.
• Respond: stop colouring and use active grounding. Have the client name five things in the room, press their feet into the floor, and say the date. Then debrief [synthesis].
• Avoid emotionally loaded or culturally triggering imagery. Rodak et al. found colouring reduced anxiety in veterans with PTSD, but the sample was small [source: Holt chapter] [uncertain].

5.7 Expectations that it is "art therapy" or a cure

• Correct the expectation plainly: colouring is self-care and not a substitute for professional services [source: Carolan & Betts 2015].
• Point clients to a registered art therapist if they want art-based treatment. Studies don't yet establish it as a stress treatment [source: Betts in GWU].

5.8 Religious, cultural or spiritual objections and meanings

• Some clients may object to mandalas on religious grounds, and others may value them spiritually. Offer non-symbolic geometric designs.
• Do not present mandala symbolism (for example Jungian "Self" or centering) as established fact, and do not use or imitate sacred ceremonial forms [house frame (f); source: Curry & Kasser, who did not test Jung's ideas].

5.9 Risk settings (self-harm, inpatients, young children)

• Follow sharps and ligature policy: crayons, controlled pencils and sharpeners, and counting materials in and out.
• If a self-harm risk emerges in conversation while colouring, complete a standard risk assessment and safety plan, including lethal-means counselling (safe storage and removal) [synthesis].
• For children, follow the safeguarding steps in 4.11.

5.10 Physical limitations

• For tremor, arthritis or low vision, use larger designs, thicker pencils or markers, sloped boards and good lighting. Shorten sessions if the client is fatigued [synthesis; Holt notes these adaptations need research].

Sources

Sources:

• The Adult Coloring Book Phenomenon (Carolan & Betts, AATA, 20 Aug 2015)
• Color Me Cautious: Don't Mistake Adult Coloring Books for Art Therapy (GWU Columbian College)
• Curry & Kasser (2005), Can coloring mandalas reduce anxiety? (PDF, Centre for Studies on Human Stress)
• Holt, N. J., Colouring for wellbeing: Evidence and applications (UWE repository) (same chapter also at this UWE record)
• Mantzios & Giannou (2018), When did coloring books become mindful? (Frontiers, text) and full-text XML
• Holt, Furbert & Sweetingham (2019), Cognitive and affective benefits of coloring: Two randomized controlled crossover studies (UWE repository)
• Greater Good in Education: Reducing Test Anxiety through Art (UC Berkeley)
• Carsley (2018), Effectiveness of mindfulness-based colouring for test anxiety in adolescents (McGill eScholarship)
• Drexel news (Dec 2017): Coloring books not as effective as real art therapy (Kaimal et al.)
• SGEM#285: And I see your true colours (review of Rajendran et al. 2020)

Cited, but known only via the pages above (not drawn on): Flett et al. (2017); Eaton & Tieber (2017); van der Vennet & Serice (2012); Czerwinski et al. (2020); Robinson et al. (2018); Maguire et al. (2020); Koo et al. (2020, PMC blocked); Rodak et al. (2018); Kaimal, Mensinger, Drass & Dieterich-Hartwell (2017), Canadian Art Therapy Association Journal; Rajendran et al. (2020), Academic Emergency Medicine. The HCPC/BAAT/ATCB registration details come from the house frame and were not re-verified in this session [uncertain].