Narrative Drawing Intervention for Adolescents Following Earthquake Exposure in Rural Western China: A Quasi-Experimental Study

Background: Adolescents are particularly vulnerable to psychological distress following natural disasters, especially in low-resource settings. This study examined the short-term psychosocial outcomes associated with Narrative Drawing Intervention (NDI), a structured, trauma-informed, school-based group counselling program integrating expressive drawing and guided narrative reflection, among students affected by an earthquake in rural western China. Methods: Using a quasi-experimental design, 30 trained educators facilitated eight NDI group sessions for 150 students. Of the 120 students who completed the intervention, a randomly selected subset completed standardized psychological assessments. The final analyzed sample included 64 participants (44 intervention; 20 control). Results: The intervention group demonstrated significant reductions in anxiety (p = 0.011, d = 0.40) and PTSD symptoms (p = 0.008, d = 0.42), with a reduction in stress approaching statistical significance (p = 0.063, d = 0.29). In contrast, the control group showed significant increases in anxiety, stress, and PTSD symptoms over the same period. Depressive symptoms did not significantly change in either group. Descriptive drawing comparisons indicated increased visual elaboration and more centralized figure placement following the intervention. Conclusions: Within the context of a quasi-experimental and exploratory design, the findings provide preliminary support for the feasibility of NDI and suggest potential short-term psychosocial benefits in post-disaster school settings. While baseline group differences and the lack of randomization suggest the need for further investigation, the results provide a foundation for future randomized and longitudinal studies that further examine causal pathways and the sustainability of observed effects.