{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:05:24Z","timestamp":1789452324216,"version":"build-2803163510"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Direct verbal disclosure may be evaluatively demanding for university students with social anxiety. Group art therapy (GAT) offers an externally focused, materially mediated mode of engagement, but its active processes remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In an assessor-blinded, two-arm randomized trial, 120 students with elevated social anxiety were assigned to eight weekly sessions of GAT or a structurally matched supportive discussion group (SDG). Clinical outcomes were assessed at baseline, post-intervention, and 3-month follow-up; an adapted AEQ-derived session score and two study-specific cognitive process measures were assessed after each session and analyzed exploratorily.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      GAT produced larger LSAS-SR reductions at post-intervention (adjusted difference\u202f=\u202f\u22129.5, 95% CI [\u221215.3, \u22123.7], d\u202f=\u202f0.63) and follow-up (\u221210.9, 95% CI [\u221216.7, \u22125.1], d\u202f=\u202f0.71). Relative reductions calculated from group means were 35.6% and 41.4% in GAT, compared with 19.6% and 23.6% in SDG. The Condition \u00d7 Session coefficient for the adapted AEQ-derived score was 0.27 (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and exploratory indirect associations were observed through self-focused attention (\u22120.088) and negative self-evaluation (\u22120.061).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GAT was associated with greater and sustained improvement in social anxiety, while the repeated process findings support aesthetic engagement as a candidate process for further testing rather than an established causal mechanism.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1953607","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:35:52Z","timestamp":1789450552000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Aesthetic experience as a candidate process linking group art therapy to social anxiety relief: a randomized trial with repeated process assessment"],"prefix":"10.3389","volume":"17","author":[{"given":"Wei","family":"Long","sequence":"first","affiliation":[{"name":"Education Center for Mental Health, Guangxi Minzu University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Luo","sequence":"additional","affiliation":[{"name":"School of Architectural Engineering, Kaili University","place":["Kaili, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangnan","family":"Du","sequence":"additional","affiliation":[{"name":"Education Center for Mental Health, Guangxi Minzu University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhuan","family":"Tang","sequence":"additional","affiliation":[{"name":"Cui Zhu Campus, Nanning Tian Tao Experimental School","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.3389\/fpsyg.2019.01203","article-title":"The effectiveness of art therapy for anxiety in adult women: a randomized controlled trial","volume":"10","author":"Abbing","year":"2019","journal-title":"Front. Psychol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e0208716","DOI":"10.1371\/journal.pone.0208716","article-title":"The effectiveness of art therapy for anxiety in adults: a systematic review of randomised and non-randomised controlled trials","volume":"13","author":"Abbing","year":"2018","journal-title":"PLoS One"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"104759","DOI":"10.1016\/j.brat.2025.104759","article-title":"Attention mechanisms of social anxiety in daily life: unique effects of negative self-focused attention on post-event processing","volume":"191","author":"Adamis","year":"2025","journal-title":"Behav. Res. Ther."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"102860","DOI":"10.1016\/j.janxdis.2024.102860","article-title":"Group schema therapy versus group cognitive behavioral therapy for patients with social anxiety disorder and comorbid avoidant personality disorder: a randomized controlled trial","volume":"104","author":"Balj\u00e9","year":"2024","journal-title":"J. Anxiety Disord."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1037\/1082-989x.11.2.142","article-title":"Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: new procedures and recommendations","volume":"11","author":"Bauer","year":"2006","journal-title":"Psychol. Methods"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1016\/j.tics.2014.03.003","article-title":"Neuroaesthetics","volume":"18","author":"Chatterjee","year":"2014","journal-title":"Trends Cogn. Sci."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"105008","DOI":"10.1016\/j.brat.2026.105008","article-title":"Three-day intensive group cognitive behavioral therapy for social anxiety in Chinese college students: a randomized controlled trial with an exploratory analysis of underlying mechanisms","volume":"200","author":"Cui","year":"2026","journal-title":"Behav. Res. Ther."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1588745","DOI":"10.3389\/fpsyt.2025.1588745","article-title":"VR sculpting as a therapeutic intervention for alleviating anxiety: a case study from a university art class","volume":"16","author":"Ding","year":"2025","journal-title":"Front. Psychiatry."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1037\/a0026909","article-title":"Confronting sadness through art-making: distraction is more beneficial than venting","volume":"6","author":"Drake","year":"2012","journal-title":"Psychol. Aesthet. Creat. Arts"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1156","DOI":"10.3390\/healthcare12111156","article-title":"Effects of visual art therapy on positive symptoms, negative symptoms, and emotions in individuals with schizophrenia: a systematic review and meta-analysis","volume":"12","author":"Du","year":"2024","journal-title":"Healthcare"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e0211362","DOI":"10.1371\/journal.pone.0211362","article-title":"How do artistic creative activities regulate our emotions? Validation of the emotion regulation strategies for artistic creative activities scale (ERS-ACA)","volume":"14","author":"Fancourt","year":"2019","journal-title":"PLoS One"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.3758\/brm.41.4.1149","article-title":"Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses","volume":"41","author":"Faul","year":"2009","journal-title":"Behav. Res. Methods"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"9559056","DOI":"10.1155\/da\/9559056","article-title":"The shared and distinct mechanisms underlying fear of evaluation in social anxiety: the roles of negative and positive evaluation","volume":"2025","author":"Gao","year":"2025","journal-title":"Depress. Anxiety"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1186\/s40359-025-03084-2","article-title":"Subthreshold anxiety in Chinese college students: prevalence, gender differences, and correlates","volume":"13","author":"Han","year":"2025","journal-title":"BMC Psychol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2409","DOI":"10.1002\/sim.1047","article-title":"A solution to the problem of separation in logistic regression","volume":"21","author":"Heinze","year":"2002","journal-title":"Stat. Med."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"621","DOI":"10.4088\/jcp.v69n0415","article-title":"Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials","volume":"69","author":"Hofmann","year":"2008","journal-title":"J. Clin. Psychiatry"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e12882","DOI":"10.1002\/capr.12882","article-title":"Clients' reasons for dropping out of therapy: a qualitative study","volume":"25","author":"Homan","year":"2025","journal-title":"Couns. Psychother. Res."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"6103362","DOI":"10.1155\/da\/6103362","article-title":"Autistic traits and social anxiety in Chinese college students: the longitudinal mediating role of rumination","volume":"2025","author":"Hou","year":"2025","journal-title":"Depress. Anxiety"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1111\/jpm.70003","article-title":"The effects of visual art therapy on improving anxiety symptoms in adults: a systematic review and meta-analysis","volume":"32","author":"Huang","year":"2025","journal-title":"J. Psychiatr. Ment. Health Nurs."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1080\/07421656.2016.1166832","article-title":"Reduction of cortisol levels and participants' responses following art making","volume":"33","author":"Kaimal","year":"2016","journal-title":"Art Ther."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1146\/annurev.clinpsy.3.022806.091432","article-title":"Mediators and mechanisms of change in psychotherapy research","volume":"3","author":"Kazdin","year":"2007","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1348\/0007126042369811","article-title":"A model of aesthetic appreciation and aesthetic judgments","volume":"95","author":"Leder","year":"2004","journal-title":"Br. J. Psychol."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e0247703","DOI":"10.1371\/journal.pone.0247703","article-title":"Self-focused attention and safety behaviours maintain social anxiety in adolescents: an experimental study","volume":"16","author":"Leigh","year":"2021","journal-title":"PLoS One"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1080\/00029157.2025.2544170","article-title":"Combined HRT-WB and mandala art therapy in university groups: a mixed-methods study","volume":"67","author":"Li","year":"2025","journal-title":"Am. J. Clin. Hypn."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"105399","DOI":"10.1016\/j.actpsy.2025.105399","article-title":"The effects of mandala group art therapy on bereaved college students: an exploratory study","volume":"259","author":"Li","year":"2025","journal-title":"Acta Psychol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1159\/000414022","article-title":"Social phobia","volume":"22","author":"Liebowitz","year":"1987","journal-title":"Mod. Probl. Pharmacopsychiatry"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1037\/met0000075","article-title":"Testing measurement invariance in longitudinal data with ordered-categorical measures","volume":"22","author":"Liu","year":"2017","journal-title":"Psychol. Methods"},{"key":"ref30","first-page":"159","volume-title":"Advances in Group Psychotherapy: Integrating Research and Practice","author":"MacKenzie","year":"1983"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/s0005-7967(97)10031-6","article-title":"Development and validation of measures of social phobia scrutiny fear and social interaction anxiety","volume":"36","author":"Mattick","year":"1998","journal-title":"Behav. Res. Ther."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1016\/s2215-0366(14)70329-3","article-title":"Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis","volume":"1","author":"Mayo-Wilson","year":"2014","journal-title":"Lancet Psychiatry"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1480304","DOI":"10.3389\/fpsyg.2024.1480304","article-title":"A volitional account of aesthetic experience","volume":"15","author":"McCrae","year":"2024","journal-title":"Front. Psychol."},{"key":"ref34","first-page":"46","article-title":"The impact of visual art therapy on anxiety: a systematic review","author":"Mizera","year":"2025","journal-title":"Psychiatr. Danub."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1159\/000228248","article-title":"The selection and design of control conditions for randomized controlled trials of psychological interventions","volume":"78","author":"Mohr","year":"2009","journal-title":"Psychother. Psychosom."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1017\/bec.2016.2","article-title":"Self-focused cognition in social anxiety: a review of the theoretical and empirical literature","volume":"33","author":"Norton","year":"2016","journal-title":"Behav. Change"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1176\/appi.ajp.157.4.521","article-title":"Barriers to the treatment of social anxiety","volume":"157","author":"Olfson","year":"2000","journal-title":"Am. J. Psychiatry"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e66430","DOI":"10.2196\/66430","article-title":"Psychedelic art and implications for mental health: randomized pilot study","volume":"8","author":"Peng","year":"2024","journal-title":"JMIR Form. Res."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1328449","DOI":"10.3389\/fpsyg.2024.1328449","article-title":"Aesthetic experiences and their transformative power: a systematic review","volume":"15","author":"Pizzolante","year":"2024","journal-title":"Front. Psychol."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1016\/s0005-7967(97)00022-3","article-title":"A cognitive-behavioral model of anxiety in social phobia","volume":"35","author":"Rapee","year":"1997","journal-title":"Behav. Res. Ther."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1002\/da.20503","article-title":"Screening for social anxiety disorder with the self-report version of the Liebowitz social anxiety scale","volume":"26","author":"Rytwinski","year":"2009","journal-title":"Depress. Anxiety"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1007\/s10935-024-00789-9","article-title":"Global prevalence of social anxiety disorder in children, adolescents and youth: a systematic review and meta-analysis","volume":"45","author":"Salari","year":"2024","journal-title":"J. Prev."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1080\/07421656.2012.683748","article-title":"The influence of art making on anxiety: a pilot study","volume":"29","author":"Sandmire","year":"2012","journal-title":"Art Ther."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"c332","DOI":"10.1136\/bmj.c332","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials","volume":"340","author":"Schulz","year":"2010","journal-title":"BMJ"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1037\/1089-2680.9.4.342","article-title":"Emotional responses to art: from collation and arousal to cognition and emotion","volume":"9","author":"Silvia","year":"2005","journal-title":"Rev. Gen. Psychol."},{"key":"ref47","volume-title":"Manual for the State-Trait Anxiety Inventory (Form Y)","author":"Spielberger","year":"1983"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1214928","DOI":"10.3389\/fpsyg.2023.1214928","article-title":"Polish version of the aesthetic experience questionnaire: validation and psychometric characteristics","volume":"14","author":"\u015awi\u0105tek","year":"2023","journal-title":"Front. Psychol."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"e54287","DOI":"10.2196\/54287","article-title":"Effectiveness of the Minder Mobile mental health and substance use intervention for university students: randomized controlled trial","volume":"26","author":"Vereschagin","year":"2024","journal-title":"J. Med. Internet Res."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1002\/cpp.2179","article-title":"Liebowitz social anxiety scale (LSAS): optimal cut points for remission and response in a German sample","volume":"25","author":"von Glischinski","year":"2018","journal-title":"Clin. Psychol. Psychother."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1037\/aca0000203","article-title":"Experiencing flow while viewing art: development of the aesthetic experience questionnaire","volume":"14","author":"Wanzer","year":"2020","journal-title":"Psychol. Aesthet. Creat. Arts"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1037\/h0027806","article-title":"Measurement of social-evaluative anxiety","volume":"33","author":"Watson","year":"1969","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/S0005-7894(98)80037-3","article-title":"Social phobia: effects of external attention on anxiety, negative beliefs, and perspective taking","volume":"29","author":"Wells","year":"1998","journal-title":"Behav. Ther."},{"key":"ref54","doi-asserted-by":"publisher","first-page":"e50535","DOI":"10.2196\/50535","article-title":"The efficacy of web-based cognitive behavioral therapy with a shame-specific intervention for social anxiety disorder: randomized controlled trial","volume":"11","author":"Wen","year":"2024","journal-title":"JMIR Ment. Health"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1002\/sim.4067","article-title":"Multiple imputation using chained equations: issues and guidance for practice","volume":"30","author":"White","year":"2011","journal-title":"Stat. Med."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1037\/0021-843X.105.1.61","article-title":"Effects of focus of attention on anxiety levels and social performance of individuals with social phobia","volume":"105","author":"Woody","year":"1996","journal-title":"J. Abnorm. Psychol."},{"key":"ref57","doi-asserted-by":"publisher","first-page":"1387847","DOI":"10.3389\/fpsyg.2024.1387847","article-title":"The effect of group art therapy on the stress coping ability of Chinese international students in South Korea: using the person-in-the-rain test","volume":"15","author":"Yin","year":"2024","journal-title":"Front. Psychol."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1953607\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:35:54Z","timestamp":1789450554000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1953607\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":55,"alternative-id":["10.3389\/fpsyg.2026.1953607"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1953607","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]},"article-number":"1953607"}}