According to the Anxiety and Depression Association of America

According to the Anxiety and Depression Association of America (2016), some of the common coping strategies for anxiety involve taking time-outs or breaks from usual work, participating and practicing yoga, listening to music, getting a massage, and learning relaxation techniques, such as deep breathing exercises and counting from 1 to 10. Research has demonstrated that, nursing students employ a variety of coping strategies (Jan & Popescu, 2014), such as talking to friends, sports, crying, ignoring stress, feelings of sadness/misery and the use of alcohol, which may be adaptive or maladaptive (Reeve, Shumaker, Yearwood, Crowell, Riley, 2013). Some studies have pointed to problem solving as the most utilized strategy in nursing students (Rafati et al., 2017). Because nursing students are not able to avoid these stressors, it is necessary for students to cope with them, if they are not able to manage their stress and anxiety, it will affect their performance, health, attitude and role satisfaction as a nurse (Zhao, Lei, He, Gu, Li, 2015). Although anxiety can act as a motivator and performance enhancer, high levels can be debilitating, which can jeopardize student success in the nursing program if performance is negatively influenced (Moscaritolo, 2009).
Art therapy can be valuable in navigating anxiety (Tartakovsky, 2015). It can become another healthy tool in our collection whether anxiety is occasional or chronic. One big benefit of art therapy is its ability to calm the nervous system: When individuals are focused on creating, their attention shifts away from worrisome ruminations. Art therapy is based on the idea that the creative process of making art facilitates recovery and that it is a form of nonverbal communication of internal thoughts and feelings. The mandala is widely recognized as a meaningful reflection of its creator. Mandala art therapy is the method of art therapy, which has been successfully used in applied psychology. Mandala (from Sanskrit “a circle”) is a spontaneous picture, image, symbol, or artistic composition created in the form of a circle (Kostyunina & Drozdikova-Zaripova, 2016). Coloring the symmetrical form of the mandala with its repeating patterns and complexity purportedly helps to draw individuals into a state similar to meditation. Mandala art therapy & healing can be a great source of reflection on one’s soul (Curry ; Kasser, 2005). Ultimately, individuals create portraits of themselves when creating the mandala, indicating that an individual’s feelings at that time will be represented in the art therapy, and these feelings contribute to a greater self-expression in personal fulfillment, allowing the manifestation of the most important and deep values. At the same time, a circle is the symbol of integrity, creating space for the interaction of contradictions. As a result of this interaction, the person is given the opportunity to find his own center of balance and stability (Kostyunina & Drozdikova-Zaripova, 2016). This form of therapy has been shown to help unaddressed psychosocial distress in hospitalized patients and to promote better management of physical symptoms, overall wellbeing, and socialization (Angheluta & Lee, 2011; Kapitan, 2012).
The primary purpose of this study is to determine the effectiveness of art therapy, specifically Mandala Art Therapy, on the level of anxiety of fourth year nursing students. The use of mandala art therapy for a specific classification of anxiety would allow fourth year nursing students to have a means of relieving their anxiety, potentially further progressing and enhancing their performance in the context of academics, and develop a form of communication in order to express feelings that are often suppressed throughout their