Comparative Effectiveness of Expressive Arts Therapy Modalities Among Chinese University Students: A Randomized Controlled Trial Analysis of Music, Visual Arts, and Combined Interventions

Abstract

Mental health challenges among Chinese university students necessitate culturally adapted therapeutic interventions, yet comparative effectiveness studies of expressive arts therapy modalities remain limited. This randomized controlled trial examined the comparative effectiveness of music therapy, visual arts therapy, and combined interventions among 200 Chinese university students experiencing psychological distress. Participants were randomly allocated to four groups receiving either single-modality interventions, combined therapy, or waitlist control over 8 weeks. The primary outcome was psychological distress measured by the Symptom Checklist-90-Revised global severity index. Combined therapy demonstrated superior effectiveness with the largest effect size (Cohen's d = 0.88), followed by music therapy (d = 0.72) and visual arts therapy (d = 0.49). Clinical remission rates reached 28.2% for combined therapy, establishing clear therapeutic benefits. Female participants showed significantly greater treatment response compared to males, while academic specialization influenced intervention effectiveness. Cultural analysis revealed that most participants experienced emotional expression tensions, with many exhibiting performative engagement patterns that reflected misalignment between Western therapeutic assumptions and Chinese cultural values. These findings establish combined expressive arts therapy as the optimal intervention while highlighting the critical importance of cultural adaptation in therapeutic design for Chinese university populations seeking mental health support.