--- - |2+ Abstract Objective National attention on patients' cancer‐related emotional distress produced a need for evidence‐based, psychosocial interventions in oncology care. The purpose of this study was to evaluate the efficacy of Self‐Book© art therapy for emotional distress and psychological well‐being of female oncology patients during active oncology treatment. Methods Sixty consenting women with cancer were randomly assigned to either a 6‐session Self‐Book© art therapy program or standard care. A repeated measures randomized controlled trial design was employed. Data were collected by using the Distress Thermometer, Perceived Emotional Distress Inventory, Patient‐Reported Outcomes Measurement Information System Brief Psychological Well‐being test, and the Functional Assessment of Chronic Illness Therapy Spiritual Well‐being. Measurements were obtained at baseline, week 3, week 6, and 1 to 2 months post intervention. Results Forty participants were included in the final analysis. No significant differences between groups were found for the primary outcome measures: emotional distress and psychological well‐being. Greater improvements in Self‐Book© art therapy participants' spiritual well‐being were found compared with the standard care control participants (P = .02). Conclusions Although no statistically significant differences were present between the groups for the primary outcomes, several positive trends were noted. Thirty percent of Self‐Book© art therapy participants reported postintervention emotional distress scores that were below the abnormal range for emotional distress, compared with only 5% of standard care control participants, suggesting that Self‐Book© art therapy may have clinical value. Further studies are recommended to better understand the therapeutic mechanisms of Self‐Book© art therapy for enhancing psychological well‐being. - Psycho-Oncology, Volume 27, Issue 9, Page 2087-2095, September 2018.