Designing Coloring-Based Digital Art Therapy to Treat Alexithymia in Chinese College Students: Qualitative Study.

Background: Alexithymia is a cognitive-emotional condition characterized by difficulties in identifying and expressing emotions. It lacks recognition among Chinese college students due to cultural norms that emphasize emotional restraint. Traditional interventions often rely on verbal expression, which poses challenges for students with alexithymia. Coloring-based digital art therapy provides a nonverbal, low-cognitive-load alternative that facilitates emotional expression through visual and interactive methods. Objective: This study aimed to explore expert opinions on developing a coloring-based digital art therapy intervention for alexithymia among Chinese college students, develop an intervention framework, and create a digital game prototype tailored to this population. Methods: This study was conducted in 2 phases. First, semistructured expert interviews were conducted with 10 experts to gather insights and create the intervention framework for coloring-based digital art therapy. In the second phase, a co-design process with the same experts refined the framework into a game prototype, with their feedback on design recommendations and game elements guiding the iterative development of Coloring the Emoji. Results: Experts identified four core design themes: (1) visual over verbal expression, (2) creating a natural and everyday experience, (3) supporting implicit expression, and (4) ensuring psychological safety and data protection. These principles were incorporated into Coloring the Emoji, which guides students through color selection, emoji-based pattern selection, and free drawing to promote emotional expression. Key features of the game include the use of familiar emojis, customizable options for emotional expression, and robust privacy protections. The game is freely accessible and is well-suited for Chinese college students dealing with academic pressures and financial constraints. Conclusions: This study presents a novel intervention framework for coloring-based digital art therapy tailored to Chinese college students with alexithymia. The game Coloring the Emoji provides a nonverbal, intuitive platform for emotional regulation and self-reflection, addressing the cultural and emotional challenges specific to this population. Future research should focus on user testing and explore its applicability to other cultural and age groups.