Art therapy is a psychological treatment based on the therapeutic qualities of physically creating artwork.  Test anxiety is a pressure associated with test taking that is understandably common in the college student population.  The study examined the potential effectiveness of art therapy as a treatment for test anxiety.
         Twenty-five participants, all undergraduate students enrolled in a General Psychology course, took part in the study.  All participants were told they would be taking a quiz that would count towards their class grade.  Participants then completed the State-Trait Anxiety Inventory (Spielberger, 1983).  Participants in the ‘active’ condition were then given ten minutes to create artwork, while those in the ‘passive’ condition were instructed to carefully examine thirty modern artworks.  All participants completed the State-anxiety section of the measure a second time before taking the quiz.
         Three hypotheses were proposed for the study.  It was hypothesized that anxiety would decrease for participants in both the active and passive conditions, that anxiety decrease would be larger in the active condition, and that as a result of lower anxiety, active condition participants would perform better on the quiz than their passive condition counterparts.  Using a paired-samples t-test to compare State-anxiety scores pre and post-treatment in both conditions, the first hypothesis was supported: self-reported State-anxiety significantly decreased for participants in both conditions.  However, using an independent t-test to measure difference in both anxiety decrease and quiz score between groups, it was demonstrated that anxiety decrease did not significantly differ between groups, and perhaps as a result, quiz performance did not significantly differ either.
     The results of the current study are encouraging.  Offering art therapy may address other issues college students face, such as interpersonal relationships, body image and many others, and these possibilities also deserve to be fully explored.  Art therapy is successful at decreasing test anxiety in college students and thus, this service should be widely offered to this population via campus counseling centers.

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Art Therapy
        Art therapy’s development, as a profession, can be seen as the formal application of long-standing human tradition, influenced by social and intellectual trends (Junge & Asawa, 1994).  Dissanayake (1992) argues that the impulse to make art is an inherent human trait, a trait that is so crucial, it may be used to define our species.  Dissanayake also suggests that there are survival values and life-enhancing aspects of art throughout human history.  Talerico (1986) agrees to an extent by commenting that creativity is first and foremost a problem-solving process.  These authors seem to suggest that the very beginnings and the nature of creating artwork were meant to solve problems and enhance life.  This is precisely the purpose of using art as therapy. “Creativity,” Talerico (1986, p. 231) believes, “encourages expression of feelings, confidence through risk-taking, communication with the unconscious, development of new insights, resolution of conflict, reduction of anxiety and the rechanneling of psychic energy for problem-solving purposes.”
         Art therapy has since been used in a variety of populations.  Cooper & Milton (2003) used art therapy to treat a group of self-destructive young women.  Art therapy was chosen to treat these women because it was a non-threatening outlet for feelings, gave a constructive and immediate alternative to self-mutilation and allowed the patients to effectively express themselves, when their verbal abilities often fell short.  The group therapy aspect of treatment allowed patients to witness each other’s work, learn social and relational skills, and share energy.  Cooper & Milton (2003) included powerful vignettes describing individual patient’s progress, when working with clay, creating masks and overcoming personal obstacles.
         Woodcock (2003) described art therapy’s benefit to family therapy, and argues that this particular therapy reflects and communicates feelings that family members may have a hard time verbally expressing to each other.  Woodcock (2003) also assures the reader that while art therapy may seem unstructured, the process is actually very insightful and aids in opening communication.
 Art therapy has also been shown to be effective with sexually abused children and adolescents.  Pifalo (2002) finds art therapy appropriate for this population, because like self-mutilators, these patients may not be able to verbally communicate their feelings or experience.  Sexual abuse patients may also have been warned by their victimizers not to “tell,” leaving them fearful of any verbal expression.  Art therapy also contains elements of play, which is helpful for this younger population.  The therapy was demonstrated, through treatment, which included puppet making, clay shaping and drawing their ‘journeys,’ to reduce anxiety, post-traumatic stress, and a sense of threat of harm (Pifalo, 2002).
         Honig (1977) reports art therapy’s use with the schizophrenic population and suggests the mastery of skills gained in art therapy increases self-esteem.  However, the author suggests that art therapy for this population should be geared towards reality, and not spontaneous drawings, which will increase anxiety and a feeling of hopelessness.  “Contour drawings” on the other hand, whereby a patient’s body is traced by the therapist and the patient is allowed to “fill it in,” allows the patient to target symptoms of schizophrenia, which include loss of body parts, confusion, and depersonalization (Honig, 1977).
         These studies on art therapy all emphasize the non-threatening environment in which a patient feels comfortable visually expressing what they may not be able to express verbally.  Sharing these feelings allows patients to gain self-confidence and their mastery of materials helps them to gain control, while group settings allow them to learn social interactions.  A similar service seems that it could benefit not only disturbed psychiatric patients, but also normative populations.  Unfortunately, studies on art therapy are less common in normative populations and such research is still encouraged.
         College students, as a representative of a normative population, were first offered art therapy in the summer of 1978, at the Counseling Center at George Washington University in Washington D.C., as a part of its counseling services.  In a study conducted by Geller, DePalma and Daw (1981), the content and success of the program was evaluated.  The Counseling Center adopted art therapy as part of its program in its ongoing attempt to promote mental health in all aspects of campus life.  Such a program attracted clients with concerns about issues such as body image, sexual identity, eating disorders, and depression.  Within the study, details of the program were thoroughly described, but of particular interest for this research is a university wide event implemented by the Counseling Center called ‘Draw Out Exam Anxieties’.  Students were invited to draw on a large sidewalk square on campus with sidewalk chalk before final examinations.  Students who were anxious about their upcoming workload were, in this fashion, allowed to relax and release tension.  It would have been interesting had the counseling center surveyed those who participated to statistically examine decreases in test anxiety as a result of this event.  However, no such study was conducted or noted.  Many of the clients who took advantage of the art therapy program, in a follow-up questionnaire, reported that they were highly satisfied with the service.  This suggests that offering such a program on a college campus would be advantageous in promoting students’ mental health and that programs directed at test anxiety might be particularly beneficial.  The program implemented at George Washington University spurred other research  (Phillips, Geller & Ireland, 1983), and it continues to be a model for other programs.
Test Anxiety
        Anxiety is a response aroused by personally threatening conditions in the environment, which interferes with ongoing task-relevant activities and leads to a lowering of performance levels (Sarason, 1961).  Spielberger (1983) divided anxiety into two categories: State-anxiety (S-anxiety) and Trait-anxiety (T-anxiety).  S-anxiety involves an emotional state at a particular time at a particular level of intensity.  This is characterized by feelings of nervousness, tension and apprehension.  T-anxiety is a measure of anxiety proneness, or the differences among individuals in the tendencies to perceive tense situations as threatening.
Test anxiety in particular is a situation specific trait that involves anxious states and worry cognitions that are associated with test taking (Jones & Petruzzi, 1995).  Jones and Petruzzi (1995) reviewed and evaluated several existing test anxiety treatment models.  Due to the fact that test anxiety is such a multi-dimensional problem, multiple models have been developed.  The cognitive-attentional model (Sarason, 1986) suggests that two types of interference variables can impair good performance and foster test anxiety   The first type of interference variable is cognitive factors, which includes trains of thought and mental sets.  Sarason (1986) proposes that the anxious person is constantly scanning for potential dangers or failures, and in doing so, loses concentration and is less able to focus on the task at hand.  The anxious person is also preoccupied with self-doubting thoughts, negative evaluations and worries, which Sarason (1986) defines as distressing preoccupations which concern anticipated events.  The second type of interference variable is aspects of emotionality, which refers largely to a person’s awareness of bodily arousal and tension (Sarason, 1986).  In other words, emotionality    describes physiological symptoms of stress.  These might include symptoms like nausea, headache or sweaty palms.  Sarson (1986, p. 29) comments that the test-anxious person “experiences self-preoccupying worry, insecurity, and self-doubt in evaluative situations.  These internal distractors lessen attention to the task at hand and contribute to relatively poor performance.”
        Although convincing, other models have been developed, including the learning-deficit model (Hodapp & Henneberger, 1983), which removes the emphasis from cognitive factors to ill preparation.  The learning-deficit model infers that deficient test-taking skills and inadequate study habits are the main causes of poor performance.  This model seems to suggest that people with low ability become test anxious. However, this approach has been deemed inadequate by Benjamin, McKeachie, Lin & Holinger (1981), who contend that highly prepared, knowledgeable students with good study skills can also be highly test anxious. This latter approach contends that anxiety prevents the test-anxious student from expressing their full ability.
        The social learning model emphasizes concepts like self-esteem, locus of control and expectancy outcomes (Jones & Petruzzi, 1995).  Locus of control refers to whether the individual perceives reinforcement as contingent on his or her own efforts, actions and skills or on luck, fate and chance (Rosal, 1993).  This construct is very similar to attributional style, or the way in which responsibility for outcome is typically assessed (Sarason, 1986).  Self-esteem also contributes to test anxiety, as students with poor self-esteem, who belittle their personal worth or capabilities, tend to do more poorly academically (Pleasant-Metcalf & Rosal, 1997). Test anxiety is also related to individual differences in cognitive abilities, such as attention, appraisal and information retrieval (Kurtz & Wyatt, 1996).
        Dance/Movement Therapy, an approach likely challenged to defend its relevance as often as art therapy, has also been found to be effective in decreasing test anxiety in undergraduate and graduate students (Erwin-Grabner et al., 1999). The participants in Erwin-Grabner et al.’s (1999) study attended four dance and movement therapy sessions, during which they were instructed in techniques chosen to promote relaxation and designed to focus on concerns common to test anxiety, such as self-awareness and trust.  The results indicate that test anxiety scores were significantly reduced (Erwin-Grabner et al., 1999).  Dance/Movement Therapy thus offers a unique and beneficial treatment approach to test anxiety, encouraging the investigation of other potential treatments, such as the current study.
Art Therapy and Test Anxiety
        Art therapy is a recent, valuable and creative approach, considered beneficial in many areas that target issues important to test anxiety.  For example, locus of control, as previously mentioned, refers to the manner in which an individual perceives reinforcement as contingent on his or her own behavior (Rosal, 1993).  In test anxiety, this is typically how much control the student feels he or she has over his or her exam score.  Rosal (1993) conducted a study to measure the effectiveness of art therapy on locus of control for behaviorally disordered students.  Art therapy seemed to be highly beneficial in helping students internalize their locus of control and decrease antisocial conduct. These results suggest that art therapy might be successful in altering participants’ perceptions.  If art therapy can help students to internalize their locus of control, they would feel as if they had more control over the outcome of their test results.  This can motivate studying and lead to confidence, and in doing so, decrease test anxiety.
        Also relevant to test anxiety is self-esteem, which refers to self-evaluation and is understood as a strong appreciation of self (Franklin, 1992).  Brooke (1995) examined the hypothesis that art therapy would significantly increase levels of self-esteem in a population of sexually abused women.  The study provided moderate evidence that art therapy improves general and social self-esteem while in a group therapy session. Brooke (1995) speculates that personal self-esteem may improve as a result of individual art therapy sessions.  Franklin (1992) has both witnessed and experienced growth in self-esteem as a result of art therapy, and believes that the strength of art therapy lies in its ability to provide a safe and comfortable environment in which one is able to make mistakes, form relationships and be rewarded by one’s own visual gift.  Franklin (1992) contends that, for patients struggling with low self-esteem, creating images contributes to the theme of empowerment.  Such empowerment and confidence could be beneficial in making a patient less anxious, and less nervous in test taking situations.
        Such a result has been demonstrated in elementary school children, whose test-taking concerns were treated with a brief, but effective, art therapy session.  The young students first constructed raindrops and an umbrella from construction paper.  The child then wrote self-doubting or negative thoughts on the raindrops.  Secondly, on a corresponding section of the umbrella, the child would write rational and positive thoughts to combat and reject their “rainy” feelings (Hobson & Thompson, 1996).  For instance, the child would write a sad thought they experience while taking a test, such as “My parents will be mad if I do badly,” on a raindrop.  On a corresponding section of the umbrella, the child would write “My parents would be pleased if I did well, but they will love me even if I don’t” (Hobson & Thompson, 1996).  While this approach is obviously simplified for use with children, it supports the current investigation by utilizing art as an effective treatment approach for test anxiety.
        While there is no denying the obvious differences in populations between these reported studies and the current one, college students certainly are prime candidates for art therapy, as most colleges aim to provide settings that involve creative, thought-provoking atmospheres.  Taylor (1991) suggests that the years enrolled in college are marked, for most students, with dramatic and intense change, as students face a variety of developmental issues that include challenges to the individual’s competence, purpose, and identity.  These personal issues and developments might provide college students with creative impulses and inspiration.  Art therapy would offer an appropriate way to handle and transfer emotions or problems that arise while facing these issues, test anxiety among them.  Lastly, the college student population is very familiar with the examination process, and therefore, with test anxiety as well.  Up to 15% of college students experience test anxiety, with 10 million students experiencing test anxiety at a pre-college level (Register, Beckham, May & Gustafon, 1991).
        In the interest of uncovering a unique intervention or treatment for test anxiety, two separate conditions will be implemented in the current study.  Most art therapy examples previously discussed and many included in outside literature involve the active creation of artwork.  This will serve here as the ‘active’ condition.  However, a second condition will be employed here, in which participants will simply view many pieces of artwork.  This will be called the ‘passive’ condition and is partially inspired by Miller’s (1993) work involving the new technique of art-history-enriched therapy, in which participants were first asked to view artwork of a specific artist before engaging in discussion and imitating the artist’s work.  This technique was successful in decreasing anxiety for day-hospital psychiatric patients.  The question now becomes whether or not merely viewing artwork by a variety of artists could also be effective in reducing test anxiety in a different population.
The hypothesis of the current study is that implementing art therapy after the announcement of a surprise examination, or ‘pop-quiz,’ will aid in relieving the participants’ stress in both the active and passive conditions.  This will be indicated by lower test anxiety scores after the brief art therapy session.  It is also hypothesized that students in the active condition will have lower test anxiety scores than those in the passive condition, as the therapeutic quality is most often associated with the creative process to which only the participants in the active condition will have access.  Lastly, participants in the active condition are expected to demonstrate better quiz performance than those in the passive condition as a result of lowered anxiety.

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Participants: Participants for this study were voluntary undergraduate students, enrolled in a General Psychology course, at a small, private liberal arts college in New England. Students did receive course credit for their participation.  Twenty-five individuals took part in the study, and were randomly assigned, with 13 participants in the active condition and 12 in the passive condition.  Active condition participants consisted of 2 males and 11 females, while passive condition participants consisted of 2 males and 10 females.  The mean age of the participants was 19.  Participants were tested individually.
Materials:  Changes in test anxiety were measured by the State-Trait Anxiety Inventory—a self-report psychometric scale developed by Spielberger (1983) to measure both State-anxiety (S-anxiety) and Trait-anxiety (T-anxiety).  S-anxiety and T-anxiety measure how anxious one feels ‘at this moment’ and how prone one is to anxiety in general, respectively.  The two-page test includes 40 items, which the participants are asked to rate on a 4-point Likert-type scale, 1 being ‘not at all’ and 4 being ‘very much so’.  The reliability coefficient for S-Anxiety ranges from .16 to .62, which is expected because it is meant to reflect situational factors, while the T-anxiety’s reliability coefficient range is much more stable at .65 to .86.  The measure highly correlates with other psychometric tests that measure anxiety such as the Taylor Manifest Anxiety Scale (.80), the IPAT Anxiety Scale (.75) and the Multiple Affect Adjective Check List (.52) (Spielberger, 1983).
        Participants in the active condition were asked to make use of many art supplies made available to them.  The supplies included a variety of materials, such as acrylic and watercolor paints, paintbrushes, colored pencils, markers, lead pencils, crayons and paper.
         Participants in the passive condition were shown a variety of fairly well known modern artworks.  All images were taken from the book Modern Art, a collection of masterpieces gathered by Sam Hunter, Jon Jacobus and Daniel Wheeler.

"The Kiss" by Gustav Klimt  "The Cry" by Edvard Munch  "Blue Morning Glories" by Georgia O'Keeffe "Starry Night" by Vincent van Gogh

        Participants were given a quiz from a companion website of a General Psychology textbook with which they were not familiar—Psychology: An Introduction, the eleventh edition (Morris & Maisto, 2000).  The companion website of the textbook is a tool for students which offers reviews and exams on each chapter.  The quiz covers material exclusively from Chapter 1: The Science of Psychology, which is consistent with, but not identical to, the material the participants had covered in their own respective General Psychology courses.  The quiz consisted of 20 multiple-choice questions, each with four possible answers.
        A post-experimental questionnaire was used to examine participant’s suspicions involving the true nature or purpose to the study. This consisted of three open-ended questions, which asked the participants to describe the nature of the study, whether or not they believed the explanation of the experimenter, and if not, how they changed their behavior due to any disbelief.
Procedure: Participants in both conditions were told that this study sought to examine the relationship between left-hemisphere and right-hemisphere activities of the brain.  Firstly, all participants were informed that during the study, they would be engaged in a left-hemisphere task involving their academic performance, and a right-hemisphere task involving either their artistic abilities or art appreciation.  At this time, participants were asked to give their informed consent.  Following this, all participants were informed that, as their left-hemisphere task, they would take a quiz that would count as a section of an upcoming test in their General Psychology class, which actually would have no bearing on their grade.  After this announcement, all participants were asked to fill out the State-Trait Anxiety Inventory (STAI).  After completion of the STAI, participants in both conditions were then told they would be engaging in their right-hemisphere task.
        Participants in the active condition were informed their right-hemisphere activity involved art creation and they were then given access to a wide variety of artistic materials.  The art as therapy was unstructured—they were asked to make use of the materials in any way they desired.  They were instructed to merely experiment with media or use the time to express any feelings they might be experiencing.  They were given 10 minutes to engage in the creative process.
         Participants in the passive condition were told their right-hemisphere activity involved art appreciation and were then given a series of images of modern art masterpieces, which included different artists from varying time periods.  They were asked to carefully examine and think about each image and how it makes them feel.  They were given 10 minutes to carefully examine 30 images.
         Following the treatment session in each condition, all participants were instructed to retake only the first half of the State-Trait Anxiety Inventory, the first 20 items which measure State anxiety.  S-anxiety is how anxious one feels ‘at this moment.’  After this second completion of the measurement, participants were given the Chapter 1 quiz.
         Participants were then given a post-experimental questionnaire designed to examine suspicion on their behalf concerning the true purpose of the study.  After answering these brief questions, participants were completely debriefed and thanked for their participation.

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        To test the hypothesis that both groups would report lower anxiety after treatment, a paired-samples t-test was used for each condition, in order to compare within-group pre and post-treatment scores.  Both the passive group participants [t (11) = 6.330, p = .000] and the active group participants [t (12) =  4.196, p = .001] reported significantly decreased anxiety after their respective art therapy treatments.  This indicates that both groups were affected by the treatment in a way that decreased self-reported State-anxiety. (see Figure 1).

        The hypothesis that participants in the active condition would perform better on the quiz also was not supported.  An independent t-test was used to compare the quiz scores between the conditions, and there was no significant difference [t (23) = .951, p = .352].  This may be related to the lack of anxiety decrease between groups.  It is important to note that while these two groups did not differ on quiz performance, both groups did poorly, with passive group participants averaging a 68 % and active group participants, a 64 %.

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           Three hypotheses were proposed in the current study:  that State-anxiety would decrease from pre to post-treatment for all participants in both conditions, that participants in the active condition would demonstrate a larger decrease in anxiety than those in the passive condition, and finally, that as a result of lowered anxiety, participants in the active condition would perform better on the quiz than the passive condition participants.  The first of these hypotheses was supported, namely State-anxiety significantly decreased for participants in both conditions.  However, there was no significant difference in anxiety decrease between groups, indicating that the groups were equally affected by their respective art therapy treatments.  Lastly, there was no significant difference between groups on quiz performance, a result likely due to the equal anxiety decrease between groups.
         This self-reported decrease in test-anxiety, with little or no improvement on academic performance, is not uncommon (Crowley, Crowley & Clodfelter (1986); Dendato & Diener (1986); Ricketts & Galloway (1984)).  Ricketts & Galloway (1984) studied the effects of four different test anxiety treatments, including rational-emotive therapy, progressive relaxation, a study-skills treatment and a placebo group.  Each of these treatments resulted in lower anxiety, yet all failed to increase performance.  Crowley et al. (1986) advocate self-control cognitive coping methods.  This treatment involves identifying thoughts and worries experienced in stressful test situations and then separating rational from irrational thoughts.  This method was shown to be effective in both the reduction of anxiety and in an increase in academic performance.  Dendato & Diener (1986) found that study-skills treatment alone was not effective in reducing anxiety or increasing performance, that relaxation/cognitive therapy alone was effective in reducing anxiety but not increasing academic performance, and that the combined treatment was effective in both decreasing anxiety and increasing academic performance.
         Past research, therefore, certainly sheds light on the current study.  Many treatments are able to decrease self-reported anxiety, but few increase academic performance.  This seems to be true of the current study; however, only one measure of academic performance was collected and therefore, improvement could not be directly measured.  This is perhaps a potential shortcoming of the research, and if repeated, two quizzes of similar content and difficulty could be used, as pre and post-treatment measures, enabling the experimenter to track individual improvements.  The experiment could also be conducted in the context of an actual class across a semester, using exam scores as the indication of academic improvement.  It remains impossible to conclude whether poor performance resulted from lack of warning and preparation or anxiety itself.  This problem could be addressed, if, as previously mentioned, academic performance was more closely monitored in the context of a college class.
         While the art therapy treatments did not seem to result in high quiz performance, their effectiveness in decreasing test anxiety is encouraging.  Just as relaxation/cognitive therapy was only effective at both decreasing test anxiety and increasing academic performance once combined with study-skills training (Dendato & Diener, 1986), perhaps art therapy could also be more effective if combined with other modes of treatment.  This is certainly a future direction for art therapy research.  Art therapy could be combined with cognitive coping methods or study-skills sessions to see if an effective approach, one that both lowers test anxiety and increases academic performance, would result.
         Other future research options are plentiful.  Participants involved in a condition similar to the active condition involved here, where one is asked to create art, could be more guided by the experimenter.  For example, art creation may be structured similarly to the instructions given during Erwin-Grabner et al.’s (1999) study on dance therapy as a test anxiety treatment.  Participants could be asked, for example, to create a work that demonstrates “how they feel when taking a test” and “how they feel when they are tense,” and then create an image that represents the opposite of those feelings (Erwin-Grabner et al., 1999).  This may allow the patient to feel like they are actively constructing something symbolic of a defense against test anxiety, and such a creation may prove empowering.  Guiding the participant to target worries and thoughts associated with test taking may be more effective in the reduction of anxiety and may result in higher academic performance.
 However, not only the active condition participants reported a decrease in anxiety.  Passive condition participants were equally affected by their art therapy treatment.  The possibility of viewing images as a tool in anxiety reduction certainly deserves to be explored.  Perhaps Miller’s (1993) art-history enriched art-therapy, which was found to reduce anxiety and improve self-esteem in chronic psychiatric patients, could generalize to normative populations.  Viewing a series of images of one artist’s work and asking the participant to then create an image that imitates that work gives the participant a goal to strive for and something to concentrate on, which may further lower anxiety.
         The method of measuring anxiety decrease, in the future, could also be slightly altered if the experiment were to be repeated.  Participants in the current study took the same measure for State-anxiety pre and post treatment, only ten minutes apart.  Had more time been allotted, testing would be spaced out over a few days to minimize any test/retest effects, which may have led students to report lower anxiety following treatment due only to their comfort with the measure and not due to the experience of lowered anxiety.
The implications of this research are extensive—George Washington University, as reported in Geller et al. (1981) was sensible to offer an art therapy program on their campus as a part of their counseling services.  It seems as if many college students could benefit from such a program, not only in the area of test anxiety or academic performance, but also other varying issues college students face, such as interpersonal relationships or body image.  These options also ought to be further explored.  If creativity, as Talerico (1986, p. 231) states, “encourages expression of feelings, confidence through risk-taking, communication with the unconscious, development of new insights, resolution of conflict, reduction of anxiety and the rechanneling of psychic energy for problem-solving purposes,” then this creative element ought to become a strong component in the mental health services that are offered to college students.
        Students should be made aware of all of the potential treatments available and chose one that they find most suitable and effective.  Ricketts & Galloway (1984) emphasize the importance of identifying the issues of each individual in treatment in order to develop a specific intervention.  Each student feels differently about exams, his or her strengths and weaknesses, his or her expectancies and perceived capabilities, and thus may require a unique treatment plan.  Accordingly, art therapy treatment may not be the right solution for all individuals.  For instance, some students may feel more comfortable with creating artwork and may be more likely to seek this treatment to help guide their progress.  However, an individual’s pre-existing creative talents or ability does not determine the success of art therapy.  The emphasis is not on an aesthetically pleasing result, but on the progression of a piece itself, which allows patients to express themselves and learn control over their environment.
        In conclusion, both creating artwork and viewing a series of modern artworks were equally effective in significantly decreasing self-reported State-anxiety.  These unique approaches to treating test anxiety may be further improved by the addition of other test anxiety treatments, such as relaxation, cognitive therapies or study skills training.  Also, the creation of artwork could be more structured to target areas important to test anxiety.  Both of these options deserve to be fully explored in order to completely understand the benefits that an art therapy program could offer to college students.  Colleges and universities rely on exams to assess the improvements of their students and this system is not likely to change.  In other words, tests will not go away—but anxiety can.  The more test anxiety treatment options available to students at their campus counseling centers, the easier it becomes to create a personal, unique treatment plan for an individual.  The student can then learn methods which will be effective in not only decreasing his or her test anxiety, but also in increasing his or her academic performance.

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