What is it? Interventions that help support student mental health via recreational activities such as writing, animal-based therapies, arts and creative approaches gardening or are included in this category.

Evidence? Though there is a good international evidence base, there is very limited evidence of the impact of recreational activities on student mental health in a UK context and more research is needed in this area.

The HE-specific studies should be viewed in the context of wider literature on the effect of recreation on mental health, particularly on writing interventions. For example, there are reviews that find expressive writing can have a positive impact on mental health among adolescents (Travagin, Margola and Revenson, 2015), healthy and subclinical adult populations (Guo, 2023) and women with pregnancy-related post-traumatic stress syndrome (PTSD) (Qian et al., 2020), but not evidence to support the effectiveness of this intervention to decrease depressive symptoms in physically healthy adults with varying degrees of psychological stress (Reinhold,  Bürkner and Holling, 2018). In sum, this broader literature provides promising evidence that writing interventions can have a small but significant effect on mental health outcomes.

A recreational intervention uses creative methods such as writing, music or art to explore feelings, thoughts and behaviours. Animal therapies are also included in this category. This sort of intervention can be intended to relieve stress and can aid self-expression. Some offer a way of communicating and exploring feelings that are non-verbal and may be considered a good alternative intervention for those who might find it hard to express themselves in words. They can also be appropriate for a wide range of experiences and mental health difficulties and can be targeted (towards specific demographics) or non-targeted. This sort of intervention is often framed as preventative.

A large variety of facilitators may run recreational interventions, ranging from untrained volunteers with a keen interest in the activity to trained art or animal therapists. Most often, they are run in small groups and have an additional benefit of reducing social isolation. This sort of intervention often requires additional materials and space. For this reason, it is sometimes difficult to run recreation interventions online unless materials are provided beforehand.

Overall, our evidence review suggests recreational activities tend to have a mixed impact on student mental health. Most of the studies referenced on this page find some short/medium-term beneficial impact on outcomes such as stress or anxiety, but there is patchy evidence for an effect on other mental health outcomes. Few of these studies also explore the link between recreational activities and student outcomes.

The HE-specific evidence on recreation interventions is split into groups of studies which look at different sorts of recreational activities. If we look at just the studies which provide causal impact evidence of a medium/high-quality, the majority focus on animal therapy/exposure and writing. There are a smaller number which focus on other recreational activities. A summary of the key evidence for each type of intervention is given below.

While the studies discussed on this page have been undertaken specifically in HE contexts, it should be noted that there is a wider literature testing the effect of recreation activities (particularly writing interventions) with different populations, which is not covered by our review. Some examples are included as context in the following sections.

Writing interventions

A handful of studies examine the effect of written interventions to improve mental health among students. These interventions are either delivered in-person (in supervised sessions), remotely (e.g. prompted by emails from the researchers) or a combination of the two.

Epstein, Sloan and  Marx (2005) report on a randomised controlled trial (RCT) in which college students in the USA were allocated to three sessions in which  they were instructed to either write about the most distressing experience of their lives, or to write about how they spend their time without any emotion or opinions. Survey data collected one month later suggested that the intervention had a small positive effect on outcomes including depression, anxiety and stress. However, a study testing a similar intervention in a similar context found more mixed results; Yu‐Hsin Liao et al. (2012) randomly allocated USA college students who had recently experienced interpersonal hurt to either write about their feelings and experiences, or to a group in which they wrote about a recent neutral event. Data collected two and four weeks later suggested there was a small positive impact on negative affect, but not on how forgiving students were to their transgressors.

Some studies report on writing interventions which have been developed and tested in specific populations of students. In one such example, Pachankis and Goldfried (2010) tested whether an expressive writing intervention could improve self-reported measures of psychological functioning and well-being for gay male undergraduates. College students in the USA were randomly allocated to either write about their most stressful or traumatic gay-related event, or to simply write about what they had done that day. Twenty-minute writing sessions occurred once a day on three consecutive days. Scores on a number of psychological scales were collected both before, directly after, and three months after the intervention. The study found a small positive effect on students’ emotional affect (i.e. mood) directly after the intervention but this wasn’t sustained at follow-up. There was also a small effect on students’ openness about and comfort with being gay three months after the intervention. However, there was no significant effect on any of the seven other outcomes measures examined.

Some writing interventions have been developed and tested for use with students with existing mental health difficulties. For example, Sloan et al. (2011) focus on an intervention developed for individuals with experience of post-traumatic stress disorder (PTSD). USA college students were randomly allocated to take part in three, 20 minute sessions in which they were asked to either write about their traumatic experience, or about how they spent their time each day. Follow-up at one month suggested no impact of the writing intervention on PTSD symptoms or depression, but it should be noted that this study had a small sample of around 40 students. In another example, LaFreniere and Newman (2016) explored the use of worry journals with USA college students with Generalized Anxiety Disorder. They tested whether those who were instructed to use a worry journal (to note down worries) or a thought journal (to note down thoughts) would experience a different impact on their mental health. Both groups journalled for ten days and were prompted to use their journals at random times by text message. Twenty days later, there was a medium sized reduction in self-reported worries among those who used the worry journal compared to the other group; however, there were no differences in terms of any other outcomes including anxiety.

Some studies focus on the effect of expressing gratitude on mental health. Renshaw and Hindman (2017) worked with college students in the USA to compare the effect of being asked to end a brief note via text message, e-mail, Twitter or Facebook to someone three times a day that expressed gratitude. Students were asked to do this for two weeks, and their mental health outcomes measured immediately afterwards. They were compared to two other groups: one in which students were instructed to message someone three times a day about something they’d learnt at college, and one in which students were asked to keep a private journal on their learning. There was not a significant effect of the gratitude journal on self-reported gratitude, but there was some evidence of positive effects on other outcomes including optimism and life satisfaction. However, the control conditions also appear to have a positive impact suggesting students may have benefited from some element of the control condition assignments, or that overall scores in all groups were naturally rising over time. Işık, Ş. and Ergüner-Tekinalp (2017) also find small positive effects of gratitude journaling in a study among Turkish college students with high levels of existing stress, however, the small sample of around 20 students limits the strength of these findings.

The broader literature on writing interventions provides useful context to the HE-specific studies outlined above. For example, Travagin, Margola and Revenson (2015) report on a meta-analysis on expressive writing interventions among adolescents between the ages of 10 and 18 years. Drawing on 21 studies they find a small positive effect on emotional distress, problem behaviour, social adjustment, and school participation and conclude that the evidence on this approach for adolescents is “promising but not decisive.” Guo (2023) report on a meta-analysis of the effect of expressive writing on depression, anxiety and stress symptoms among healthy adults and those with a sub-clinical status (i.e. those whose difficulty does not meet the diagnostic criteria for a clinical disorder but may still cause distress or impairment in their life). Based on 31 studies they find that expressive writing has an overall small but significant effect on all three outcomes measured after a delay, indicating a sustained impact. They also find studies that implemented short intervals (one to three days) between writing sessions yielded stronger effects relative to studies that implemented medium intervals (four to seven days) or long intervals (more than seven days). However, reviews do not provide universal support for this approach with all groups and for all outcomes. For example, Qian et al. (2020) review eight RCTs to assess the effectiveness of expressive writing as a psychological intervention for women and find that this is an efficient therapy for decreasing pregnancy-related PTSD, but that the intervention was not associated with the expected effects on anxiety and stress symptoms. Similarly, Reinhold,  Bürkner and Holling (2018) conducted a meta-analysis of 39 RCTs and found expressive writing did not yield significant long-term effects on depressive symptoms in physically healthy adults with varying degrees of psychological stress.

It should also be noted that there is a distinction in the literature between different types of writing interventions. Lai et al. (2023) evaluate the efficacy of expressive writing versus positive writing in different populations focusing on mood, health and writing content. While expressive writing focuses on emotional disclosure (e.g. expressing thoughts and feelings openly about a stressful or traumatic real-life event), positive writing puts an emphasis on writing down positive emotions, coping strategies, future expectations and goals. The review of 24 RCTs suggests that, for the general population, positive writing was more beneficial for mood than expressive writing.

Animal assisted interventions

There is a mature literature examining the benefits of animal assisted interventions on student mental health (Wilson, 1987). The majority of these studies focus on how therapy dogs can affect psychological outcomes. For example, Ward-Griffin et al. (2018) tested the impact of being invited to a 90 minute session with several trained therapy dogs and their handlers. Students were free to interact with the dogs as they wished. Canadian university students were randomly allocated to either participate in the session earlier or later (the so-called ‘waitlist’ group). By comparing survey data collected from both groups before the waitlist group participated, the study found that the intervention led to improvements in negative affect, stress levels and perceived social support. However, there was no effect on happiness, positive affect or life satisfaction. Other similar but smaller studies have also found a mixture of small positive, or null effects, on self-reported psychological outcomes (Barker, 2017; Binfet, 2017; Trammell, 2019) and, more rarely, on physiological outcomes (e.g. heart-rate) (Barker, 2017).

In a variation to this format, Pendry et al. (2020) tested the effect of longer-term exposure to therapy dogs via integration into stress management courses lasting several weeks. Working with a students at a USA college, they randomly varied whether students were assigned to a standard stress management course (including, for example, mindfulness activities with no therapy dog), a course in which they only interacted with dogs (with no standard stress management content) or a group who experienced both the standard content and animal interaction. When looking at students who were at risk of academic failure, the study found that, compared to those who only received the standard content, those who interacted with therapy dogs had higher scores on surveys relating to motivation to learn which were apparent immediately after the intervention and six weeks later. There were also some positive enduring effects on self-regulation and self-reported approaches to learning, but these were only apparent for one or other of the groups exposed to some degree of animal interaction.

There are two systematic reviews which summarise the strength of evidence looking across these and other literature (Huber et al., 2022; Parberry-Clark et al., 2021). In sum, they find that animal-assisted interventions can reduce acute anxiety and stress, with small to medium effect sizes; however, these effects are generally short-term. The effect on other mental health outcomes is less clear and overall there is no clear beneficial effect on physiological or cognitive outcomes.

Other interventions

The other interventions for which there are causal studies in HE span a range of diverse approaches including dance (López-Rodríguez et al., 2017), music (Wu, 2002), Poetry (Mohammadian et al., 2011) and interventions which encourage talking amongst friends (Koenig Kellas et al. 2015). These studies all comprise RCTs which use self-report measures of mental health to assess impact over the short/medium term. As for the writing and animal assisted interventions detailed above, these studies are largely characterised by mixed results, with evidence of positive impacts on some, but not all, of the mental health outcomes examined.

There is limited evidence on the efficacy for using recreation interventions specifically with students in HE. It should be noted that there are a sizeable number of medium/high-quality RCTs that have been conducted on a student population which provide causal evidence on these interventions, through comparison of a treatment group that receives the intervention and a control group that does not (or does so only after a set time period – a waitlist control). However, the majority of studies have been developed in North America. There is limited evidence on recreational activities for students in the UK and very limited evidence that measures both mental health and student outcomes. More research is needed in a UK context to draw reliable conclusions that are accurate for UK HE providers.

In lieu of HE-specific evidence, providers may learn from wider evidence on the efficacy of recreation interventions (specifically expressive writing) tested with other adult populations suggesting that this may be a promising approach with small, but potentially sustained, impact on mental health outcomes.

It should be noted that the evidence is split between the various approaches outlined above so, with the exception of writing interventions and animal therapies, there is not a sufficiently large evidence base to start drawing conclusions about the efficacy of recreational approaches for student mental health, even in a global context. There is a particular need for more studies on creative and horticultural therapies.

Furthermore, much of the HE-specific evidence captures mental health outcomes immediately or soon after the intervention has been received, and therefore further research is needed to ascertain whether effects can be sustained in the long-term. In addition, there are no causal studies which focus on student outcomes, such as attainment and continuation, as well as mental health outcomes. It is important to understand whether interventions improve student mental health but also that they contribute to success on-course.

The majority of the research studies cited here recruited volunteer students through undergraduate psychology degrees, or through general call-outs to the student population. As a result, female students are heavily over-represented and this may limit the generalisability of findings to other, or wider, student populations. The use of self-report measures is also a limitation of all of the evidence cited above, particularly as for many interventions here students will have been acutely aware of the approach being tested, leading to a strong risk of students reporting better mental health outcomes because they think they are expected to. It should also be noted that some of the studies have small samples and/or there is insufficient detail in the paper to understand if the sample is big enough for the purpose of the analysis (Parbery-Clark et al., 2021). This, and other methodological limitations mean the existing evidence cannot be characterised as high-quality, even if we set aside the other issues outlined here.

RCTs are one of the most robust ways to measure interventions as they allow comparison of two groups that have either received or haven’t received the intervention, whilst controlling for observable and unobservable differences between the two groups. These trials should take place outside of lab settings to test whether, and how, interventions translate and perform in the ‘real world’. There are many examples of RCT designs in the literature cited above, including waitlist designs (see for example López-Rodríguez et al., 2017); the key benefit of this design is that the control group is still able to receive the intervention, just at a later date once outcomes have been measured in both groups. However, this approach is less appropriate if we expect that the effect of an intervention will materialise in the longer term.

Outcomes should be measured in both treatment and control groups using validated scales before and after the intervention has been received. As we are lacking evidence on the longer-term effects of interventions, measuring outcomes at multiple time points (e.g. three-, six- and twelve-month follow-ups) is important, rather than only immediately after.

We also have a paucity of evidence that measures the impact of recreation interventions on student outcomes such as attainment, retention and progression and providers should seek to embed these into evaluation plans.

One limitation of the current literature is that interventions are sometimes outlined in insufficient detail to allow accurate replication (Parbery-Clark et al, 2021); therefore HE providers should provide thorough intervention descriptions in their evaluations to allow others to build on their work.

See our evaluation guidance for more support.

For guidance from the Mental Health Charter, please follow the links below:

Most active psychoeducation interventions fall under the following themes:

The evidence in the Toolkit was gathered via an evidence review undertaken as part of the Student Mental Health Project. For full details of this review, please see our Methodology document.

It is important to note that our review, and therefore this Toolkit, only relates to student mental health. The review did not cover other populations (e.g. school children, other adult populations) or non-HE settings. However, we have flagged some additional links to the wider literature where appropriate and included them under ‘other references’ below.

Please also note that this Toolkit page only includes Type 3 (causal) studies which have been rated as providing medium/high-quality evidence according to our evidence strength ratings. These studies are outlined in the page above and referenced below. A full list of studies collated via our evidence review, including Type 1/Type 2 studies, and those rated as providing weak/emerging evidence, can be found in our Evidence Review Spreadsheet. A breakdown of these studies by type and strength of evidence is available to download.

Key references

Barker, S.B., Barker, R.T., McCain, N.L. & Schubert, C.M. (2016) A Randomized Cross-over Exploratory Study of the Effect of Visiting Therapy Dogs on College Student Stress Before Final Exams. Anthrozoös. 29 (1), 35–46. doi:10.1080/08927936.2015.1069988

Barker, S.B., Barker, R.T., McCain, N.L. & Schubert, C.M. (2017) The Effect of a Canine-assisted Activity on College Student Perceptions of Family Supports and Current Stressors. Anthrozoös. 30 (4), 595–606. doi:10.1080/08927936.2017.1370227

Binfet, J.-T. (2017) The Effects of Group-Administered Canine Therapy on University Students’ Wellbeing: A Randomized Controlled Trial. Anthrozoös. 30 (3), 397–414. doi:10.1080/08927936.2017.1335097

Broman-Fulks, J.J. & Storey, K.M. (2008) Evaluation of a brief aerobic exercise intervention for high anxiety sensitivity. Anxiety, Stress & Coping. 21 (2), 117–128. doi:10.1080/10615800701762675

Epstein, E.M., Sloan, D.M. & Marx, B.P. (2005) Getting to the Heart of the Matter: Written Disclosure, Gender, and Heart Rate: Psychosomatic Medicine. 67 (3), 413–419. doi:10.1097/01.psy.0000160474.82170.7b

Hijazi, A.M., Tavakoli, S., Slavin-Spenny, O.M. & Lumley, M.A. (2011) Targeting Interventions: Moderators of the Effects of Expressive Writing and Assertiveness Training on the Adjustment of International University Students. International Journal for the Advancement of Counselling. 33 (2), 101–112. doi:10.1007/s10447-011-9117-5

Işık, Ş. & Ergüner-Tekinalp, B. (2017) The Effects of Gratitude Journaling on Turkish First Year College Students’ College Adjustment, Life Satisfaction and Positive Affect. International Journal for the Advancement of Counselling. 39 (2), 164–175. doi:10.1007/s10447-017-9289-8

Koenig Kellas, J., Horstman, H.K., Willer, E.K. & Carr, K. (2015) The Benefits and Risks of Telling and Listening to Stories of Difficulty Over Time: Experimentally Testing the Expressive Writing Paradigm in the Context of Interpersonal Communication Between Friends. Health Communication. 30 (9), 843–858. doi:10.1080/10410236.2013.850017

LaFreniere, L.S. & Newman, M.G. (2016) A brief ecological momentary intervention for generalized anxiety disorder: A randomized controlled trial of the worry outcome journal. Depression and Anxiety. 33 (9), 829–839. doi:10.1002/da.22507

López-Rodríguez, M.M., Baldrich-Rodríguez, I., Ruiz-Muelle, A., Cortés-Rodríguez, A.E., Lopezosa-Estepa, T. & Roman, P. (2017) Effects of Biodanza on Stress, Depression, and Sleep Quality in University Students. The Journal of Alternative and Complementary Medicine. 23 (7), 558–565. doi:10.1089/acm.2016.0365

Mohammadian, Y., Shahidi, S., Mahaki, B., Mohammadi, A.Z., Baghban, A.A. & Zayeri, F. (2011) Evaluating the use of poetry to reduce signs of depression, anxiety and stress in Iranian female students. The Arts in Psychotherapy. 38 (1), 59–63. doi:10.1016/j.aip.2010.12.002

Pachankis, J.E. & Goldfried, M.R. (2010) Expressive writing for gay-related stress: Psychosocial benefits and mechanisms underlying improvement. Journal of Consulting and Clinical Psychology. 78 (1), 98–110. doi:10.1037/a0017580

Pendry, P., Carr, A.M., Gee, N.R. & Vandagriff, J.L. (2020) Randomized Trial Examining Effects of Animal Assisted Intervention and Stress Related Symptoms on College Students’ Learning and Study Skills. International Journal of Environmental Research and Public Health. 17 (6), 1909. doi:10.3390/ijerph17061909

Renshaw, T.L. & Hindman, M.L. (2017) Expressing gratitude via instant communication technology: A randomized controlled trial targeting college students’ mental health. Mental Health & Prevention. 7, 37–44. doi:10.1016/j.mhp.2017.08.001

Sloan, D.M., Marx, B.P. & Greenberg, E.M. (2011) A test of written emotional disclosure as an intervention for posttraumatic stress disorder. Behaviour Research and Therapy. 49 (4), 299–304. doi:10.1016/j.brat.2011.02.001

Trammell, J.P. (2019) Therapy Dogs Improve Student Affect but Not Memory. Anthrozoös. 32 (5), 691–699. doi:10.1080/08927936.2019.1645514

Ward-Griffin, E., Klaiber, P., Collins, H., Owens, R.L., Coren, S. & Chen, F.S. (2018) Petting away pre‐exam stress: The effect of therapy dog sessions on student well‐being. Stress and Health. 34 (4), 468–473. doi:10.1002/smi.2804

Wilson, C.C. (1987) Physiological Responses of College Students to a Pet. The Journal of Nervous and Mental Disease. 175 (10), 606–612. doi:10.1097/00005053-198710000-00005

Wu, S.M. (n.d.) Effects of music therapy on anxiety, depression and self-esteem of undergraduates. Psychologia. 45 (2), 104–114.

Xiao, T., Jiao, C., Yao, J., Yang, L., Zhang, Y., Liu, S., Grabovac, I., Yu, Q., Kong, Z., Yu, J.J. & Zhang, J. (2021) Effects of Basketball and Baduanjin Exercise Interventions on Problematic Smartphone Use and Mental Health among College Students: A Randomized Controlled Trial J. Liu (ed.). Evidence-Based Complementary and Alternative Medicine. 2021, 1–12. doi:10.1155/2021/8880716

Yu-Hsin Liao, K., Wei, M., Russell, D.W. & Abraham, W.T. (2012) Experiential Self-Focus Writing as a Facilitator of Processing an Interpersonal Hurt: Experiential Self-Focus Writing. Journal of Clinical Psychology. 68 (10), 1089–1110. doi:10.1002/jclp.21886

Other references

Huber, A., Klug, S.J., Abraham, A., Westenberg, E., Schmidt, V. & Winkler, A.S. (2022) Animal-Assisted Interventions Improve Mental, But Not Cognitive or Physiological Health Outcomes of Higher Education Students: a Systematic Review and Meta-analysis. International Journal of Mental Health and Addiction. doi:10.1007/s11469-022-00945-4

Guo, L. (2023) The delayed, durable effect of expressive writing on depression, anxiety and stress: A meta‐analytic review of studies with long‐term follow‐ups. British Journal of Clinical Psychology. 62 (1), 272–297. doi:10.1111/bjc.12408

Lai, J., Song, H., Wang, Y., Ren, Y., Li, S., Xiao, F., Liao, S., Xie, T. & Zhuang, W. (2023) Efficacy of expressive writing versus positive writing in different populations: Systematic review and meta‐analysis. Nursing Open. 10 (9), 5961–5974. doi:10.1002/nop2.1897

Parbery-Clark, C., Lubamba, M., Tanner, L. & McColl, E. (2021) Animal-Assisted Interventions for the Improvement of Mental Health Outcomes in Higher Education Students: A Systematic Review of Randomised Controlled Trials. International Journal of Environmental Research and Public Health. 18 (20), 10768. doi:10.3390/ijerph182010768

Qian, J., Zhou, X., Sun, X., Wu, M., Sun, S. & Yu, X. (2020) Effects of expressive writing intervention for women’s PTSD, depression, anxiety and stress related to pregnancy: A meta-analysis of randomized controlled trials. Psychiatry Research. 288, 112933. doi:10.1016/j.psychres.2020.112933

Reinhold, M., Bürkner, P.-C. & Holling, H. (2018) Effects of expressive writing on depressive symptoms-A meta-analysis. Clinical Psychology: Science and Practice. 25 (1), e12224. doi:10.1111/cpsp.12224

Travagin, G., Margola, D. & Revenson, T.A. (2015) How effective are expressive writing interventions for adolescents? A meta-analytic review. Clinical Psychology Review. 36, 42–55. doi:10.1016/j.cpr.2015.01.003