This study aims to present the effects that a bibliotherapy program based on picture books and paper craft art activities had on middle school students' stress recognition and the changes in their reactions. To this end, we adopted an experimental research design model with pre/post-test measurements of stress recognition and reactions using first grade middle school students with emotional difficulties. The results show that a bibliotherapy program based on picture books and paper craft art activities does have significant effects on the stress recognition and reactions of middle school students. The 5 of 5 sub-domains of the stress recognition had significant difference. The sub-domains are: family environment, friends, study, teacher/school. The 6 of 7 sub-domains of the stress reactions except fatigue had significant difference. The sub-domains are: tention, frustration, anger, depression, somatization, aggression.