Design and evaluation of a group-based integrative expressive art therapy intervention for mental health among pregnant women in China: a pilot pre-post study.

BACKGROUND: Pregnant women in China face various emotional difficulties during pregnancy but lack adequate mental health support. This study aimed to design and evaluate a group-based integrative expressive art therapy intervention for addressing emotional and psychological concerns in this population. METHODS: A quasi-experimental design with pre- and post-intervention assessments were delivered from July to December 2025. We developed a five-session expressive art therapy intervention employing multiple art modalities, including painting, doodling, hand-making, OH cards, music as well as storytelling. In the secondary analyses, we selected a control group (N = 14) to compare participants' perceptions of art therapy and willingness-to-pay against those in the intervention group (N = 14). RESULTS: After the intervention, significant reductions in both state and trait anxiety were observed (p<0.05). Qualitative analyses revealed improvements in emotional awareness, self-expression, cognitive restructuring, stress relief, social support, social connection, self-acceptance, and self-efficacy. In the secondary analyses, participants who received intervention reported more positive perceptions of its effects in emotion regulation, anxiety reduction, and mother-child relationship enhancement compared with non-participants (p<0.05), while no significant differences were found in willingness-to-pay (p=0.7). CONCLUSIONS: This pilot study demonstrates the feasibility and effects of a group-based integrative expressive art therapy for pregnant women in China. The findings support the application of expressive art therapy as a mental health service and provide implications for the development of related health policies.