JMIR Publications

ABSTRACT

Background:

Alexithymia is a cognitive-emotional condition characterized by difficulties in identifying and expressing emotions. It is underrecognized among Chinese college students due to cultural norms around emotional restraint. Traditional interventions often rely on verbal expression, posing challenges for individuals with alexithymia. Coloring-based digital art therapy offers a non-verbal, low-cognitive-load alternative based on visual and interactive emotional expression.

Objective:

This study aimed to explore experts' opinions on the development of color-based digital art therapy for alexithymia among Chinese university students, to develop an intervention framework and create a digital game prototype for alexithymia.

Methods:

We conducted a qualitative study using one-on-one semi-structured interviews with 10 experts in Art Therapy, Digital Health, Human-centered Design and Mobile Application Development. Thematic analysis was applied to identify key design principles and therapeutic mechanisms. Based on expert insights, we developed an intervention framework and created a digital coloring game prototype, Coloring the Emoji, that integrates color theory, symbolic expression, and interactive feedback.

Results:

Experts emphasized several critical design principles, such as prioritizing visual expression over verbal methods, utilizing symbolic communication, establishing a judgment-free environment and protecting user privacy. Four core design themes were identified: (1) visual instead of verbal; (2) create a natural and everyday experience; (3) support implicit expression; and (4) ensure psychological safety and data protection. These insights were implemented into the design of Coloring the Emoji, a mobile game that guides users through color selection, emoji-based pattern matching, and free drawing to support emotional identification and expression.

Conclusions:

This study provides a novel intervention framework for coloring-based digital art therapy and a prototype intervention tailored to individuals with alexithymia in Chinese college students. Coloring-based digital art therapy, guided by expert-informed design principles, offers a promising, accessible, and user-friendly approach to enhancing emotional regulation in individuals with limited verbal emotional awareness. Future work will focus on user testing and refinement of the game to assess its therapeutic impact.