ArticleJMIR serious games2026
Coloring-Based Serious Game in Chinese College Students With Alexithymia: Prospective Longitudinal Exploratory Mixed Methods Study.
Article in JMIR serious games, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Alexithymia, characterized by difficulty identifying, describing, and expressing emotions, is prevalent among Chinese college students. Traditional art therapies face barriers, such as high psychological thresholds and limited accessibility. Accessible, low-threshold digital tools are needed to help address this challenge. Coloring the Emoji, a coloring-based serious game designed as a digital art therapy, offers a low-threshold tool to support emotion regulation for this population. Objective: This study aimed to evaluate the effectiveness of Coloring the Emoji as a digital art therapy in improving alexithymia symptoms and examine the user experience of the game, thereby providing empirical support for the application of coloring-based digital art therapy in alexithymia intervention. Methods: A prospective, exploratory convergent parallel mixed methods longitudinal design was used, involving a 15-day daily game intervention with Chinese college students exhibiting alexithymic tendencies. Participants were purposively sampled from 332 prescreened students. Eligibility criteria included age 18-30 years, basic smartphone operation, and no ongoing psychotherapy or psychiatric medication. In total, 20 participants completed the intervention. Quantitative assessments used the 20-item Toronto Alexithymia Scale to measure alexithymia and the Game Experience Questionnaire to assess user experience. Statistical analyses comprised Wilcoxon signed-rank tests for pre-post comparisons, Mann-Whitney Results: Total TAS-20 scores decreased significantly post intervention ( Conclusions: Coloring the Emoji is an effective, acceptable intervention for improving emotional identification in Chinese college students with alexithymia. Its innovation lies in a localized low-threshold design that meets daily emotional needs. Unlike mainstream Western interventions emphasizing open emotional expression and social sharing, this tool adapts to the reserved emotional disclosure norms of Chinese college students. It advances the field by supplementing culturally contextualized evidence for nonverbal digital art therapy. As a low-stress, demedicalized solution, it provides a scalable, feasible supplement to traditional mental health services for campus emotional regulation.
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