Reducing Negative Mood Through Mandala Creation: A Randomized Controlled Trial

The effects of mandala coloring on fatigue, psychological well-being, and coping with stress in patients receiving hemodialysis treatment

BACKGROUND

Hemodialysis is an important health problem that negatively affects psychosocial status and support systems. Through practices such as mandala coloring, individuals transfer the unknowns they experience to the outside and make them visible. This study was conducted to examine the effects of mandala coloring on fatigue, psychological well-being, and factors associate with coping with stress in patients receiving hemodialysis treatment.

METHODS

The design was a prospective, parallel-group controlled trial. The study was conducted in the dialysis unit of a university hospital in eastern Turkey between April 4 and October 31, 2022, with a total of 60 patients, 30 in the intervention group, and 30 in the control group. The patients in the intervention group colored mandala once a week for 2 h, for a total of 8 weeks. The data were collected face-to-face using a patient information form, a Fatigue Severity Scale, a Psychological Well-Being Scale, and a Ways of Coping Questionnaire.

RESULTS

There were improvements in fatigue severity and psychological well-being over the 8-week study period in both the intervention and control groups. Scores were similar at baseline in the control and intervention groups, but better in the intervention groups compared to controls at 4 and 8 weeks for both metrics (p < 0001). Five factors from the Ways of Coping Questionnaire (self-confident approach, optimistic approach, seeking social support, helpless approach, and submissive approach) each improved during the 8-week period in the intervention group (p < 0.001). Three of these five factors improved in the control group as well. Scores for each of the five coping factors were better in the intervention group compared to controls at 4 and 8 weeks (p < 0.001).

CONCLUSION

Mandala coloring improved fatigue and psychological well-being and was associated with improved patient coping strategies.

The effect of mandala coloring on pregnancy-related anxiety

PURPOSE

In the literature, the efficacy of mandala coloring on pregnancy-related anxiety has been investigated, and no study has been found on its effect on anxiety. This randomized controlled trial was designed to assess the efficacy of mandala coloring application on pregnancy-related anxiety.

METHODS

The study included 77 primiparous pregnant women: 39 in the control group and 38 in the experimental group, and was carried out in an education-research hospital's obstetric clinic. Data for the study were gathered using Information Form, the Pregnancy-related Anxiety Scale, and the State Anxiety Inventory. While the experimental group did mandala coloring during a month twice in a week, and the control group was not do anything. The "Pregnancy-related Anxiety Scale" and "The State Anxiety Inventor" were used to assess anxiety in all groups before and after application. In the statistical analysis of the data, the SPSS 23.0 package program was used. In all tests, p < 0.005 was considered statistically significant.

RESULTS

Immediately post-intervention, the women in the experimental group had a significantly higher reduce pregnancy-related anxiety (p < 0.05). Especially in the mandala group within according to control group were found to have significantly reduced anxiety the application (PrAS-1 82,50 ± 2,47 vs. 84,41 ± 4,12; PrAS-2 77,92 ± 2,16 vs. 83,89 ± 3,80; PrAS-3 72,05 ± 3,97 vs. 84,10 ± 4,35; PrAS-Total 77,49 ± 5,21 vs. 84,13 ± 4,07; STAI-1 52,39 ± 2,50 vs. 51,17 ± 1,16; STAI-2 49,73 ± 0,75 vs. 49,05 ± 1,27; STAI-3 48,84 ± 3,17 vs. 49,02 ± 1,22; STAI-Total 50,32 ± 2,8 vs. 49,75 ± 1,58).

CONCLUSIONS

Mandala coloring is effective in reducing pregnancy-related anxiety.

CLINICAL TRIAL NUMBER

(NCT05534867).

International Chinese students' experiences of participating in mandala-based art therapy in Korea: a phenomenological study

Background

Although China and South Korea share a similar East Asian culture, owing to major social and cultural differences, international students encounter several difficulties, which can lead to various psychological problems.

Objective

To explore the experiences of eight Chinese doctoral students in South Korea participating in mandala-based art therapy.

Method

Data for this phenomenological study were gathered through individual interviews and visual art from April 5 to 20, 2022. The MAXQDA software program was used for data analysis.

Results

The data analysis results yielded 355 codes, 53 subcategories, and 17 categories. Five final themes emerged: (a) sealed lips by others' eyes, (b) inner exploration and outward expression, (c) healing power of the mandala, (d) filling the inner space together, and (e) opportunities to understand art therapy.

Conclusion

The researchers hope that completing this intervention will enable participants to complete their studies more effectively and achieve their ideals as well as future career goals, helping them ultimately return home safely with both personal and academic growth.

Efficacy of Mandala Coloring Intervention on Executive Functioning and Emotional & Motivational Self-Regulation Among Children With Symptoms of Attention Deficit Hyperactivity Disorder

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric condition of childhood. There is a sizable subset of children with ADHD symptoms in whom early intervention can prevent their progression into fulminant ADHD. However, the therapeutic options for ADHD symptoms are limited. Mandala coloring is a form of art therapy that may be used in these children, but there is a dearth of literature regarding its efficacy.

METHOD

This is a prospective cohort study on 120 children aged six to 10 years diagnosed with ADHD symptoms. The children were divided into two equal groups of intervention and control. Children in the intervention group were given mandala coloring intervention for 10 weeks duration. Pre-test and post-test values of executive functioning and emotional and motivational self-regulation (EMSRQ) were compared between the two groups by using SPSS 23 (IBM Corp., Armonk, NY).

RESULTS

The demographic data and baseline characteristics were comparable in both groups. Post-test values showed significant improvement across all parameters of executive functioning in the intervention group. However, the difference was not significant in EMSRQ. At follow-up, parents reported improvement in academic performance, concentration, and mindfully focusing on a single activity for a longer duration of time.

CONCLUSION

The attention span and cognitive abilities of children at risk for ADHD may be improved with the relatively simple yet effective intervention technique of mandala coloring that can easily be administered by parents at home. Further research is needed to compare its efficacy with other treatment modalities.

A practical development protocol for evidence-based digital integrative arts therapy content in public mental health services: digital transformation of mandala art therapy

Introduction

The fundamentals of digital transformation include the conversion of the traditional method into a digital format to develop a standardized system that collects, analyzes, and processes quantitative data. This study aims to provide a comprehensive understanding of the development process and key elements of evidence-based digital integrative arts therapy.

Methods

The "Digital Mandala" service in the "Mental Health App" produced as part of a national public mental health project for personalized depression management is adopted to explain how to convert the existing mandala art therapy into digital format. A living lab approach has been applied, which can be used to address the nation's mental health challenges by promoting collaboration, innovation, and evidence-based solutions.

Results

Evidence-based digital content requires evidence that covers the structural process, the effects of existing methods, and the components and meanings of each detailed scene. In this section, we provide five stages of the development process, including preliminary research, design, development, commercialization, and advancement. Consequently, clinical elements, integrative arts therapy features, and data factors are defined as the key principles of evidence-based digital integrative arts therapy.

Discussion

Based on the data factors found in this study, it will be possible to create an evaluation dataset of digital integrative arts therapy content for managing depression. Additionally, the large-scale public data can be analyzed through artificial intelligence technology, which is expected to be used as a basis for deriving significant results in a new form, going further than the existing evaluation method. This research is significant because it establishes the foundation for digital transformation in the field of art therapy for public mental health services and investigates its potential.

Using mobile brain/body imaging to advance research in arts, health, and related therapeutics

The uses of mobile brain/body imaging (MoBI) are expanding and allow for more direct study of the neurophysiological signals associated with behavior in psychotherapeutic encounters. Neuroaesthetics is concerned with the cognitive and neural basis of art appreciation, and scientific correlations are being made in the field that might help to clarify theories claimed in the creative arts therapies. Yet, most neuroaesthetics studies are confined to the laboratory and do not propose a translation for research methods and clinical applications. The creative arts therapies have a long history of clinical success with various patient populations and will benefit from increased scientific explanation to support intervention strategies. Examining the brain dynamics and motor behaviors that are associated with the higher complex processes involved in artistic expression offers MoBI as a promising instrumentation to move forward in linking ideas from neuroaesthetics to the creative arts therapies. Tracking brain dynamics in association with behavioral change allows for more objective and quantitative physiological monitors to evaluate, and together with subjective patient reports provides insight into the psychological mechanisms of change in treatment. We outline a framework that shows how MoBI can be used to study the effectiveness of creative arts therapy interventions motivated by the 4E approach to cognition with a focus on visual art therapy. The article illuminates how a new partnership among the fields of art therapy, neuroscience, and neuroaesthetics might work together within the 4E/MoBI framework in efforts to advance transdisciplinary research for clinical health populations.

Effects of art-based mandala intervention on distress and anxiety in cancer patients

OBJECTIVE

This study was planned to determine the effect of art-based mandala intervention on the distress and anxiety experienced by cancer patients.

METHODS

This semi-experimental study with a single group pretest-posttest design was performed with 12 breast cancer survival patients. The data were collected through "Patient Diagnostic Form", "Distress Thermometer", "Trait Anxiety Inventory". Patients participated in the "Art-Based Mandala Interventıon" for eight weeks, one day a week, 2 h each. The distress and anxiety levels of the patients were measured before starting the program and at the end of the program.

RESULTS

Cancer patients experienced moderate level of anxiety (50.66 ± 6.91) and clinically significant distress (4.08 ± 2.74). Anxiety scores of cancer patients decreased significantly after the program compared to before the program (p < 0.05). The distress scores of cancer patients increased after the program compared to before the program (p > 0.05).

CONCLUSION

After the art-based mandala intervention program, anxiety scores of breast cancer survival patients decreased, and distress scores increased.

A Mindfulness-Based Brain-Computer Interface to Augment Mandala Coloring for Depression: Protocol for a Single-Case Experimental Design

Background

The regular practice of mindfulness has been shown to provide benefits for mental well-being and prevent depression relapse. Technology-mediated interventions can facilitate the uptake and sustained practice of mindfulness, yet the evaluation of interactive systems, such as brain-computer interfaces, has been little explored.

Objective

The objective of this paper is to present an interactive mindfulness-based technology to improve mental well-being in people who have experienced depression. The system, Anima, is a brain-computer interface that augments mandala coloring by providing a generative color palette based on the unfolding mindfulness states during the practice. In addition, this paper outlines a multiple-baseline, single-case experimental design methodology to evaluate training effectiveness.

Methods

Adult participants who have experienced depression in the past, have finished treatment within the last year, and can provide informed consent will be able to be recruited. The Anima system, consisting of 2 tablets and a nonintrusive mental activity headband, will be delivered to participants to use during the study. Measures include state and trait mindfulness, depression symptoms, mental well-being, and user experience, and these measures will be taken throughout the baseline, intervention, and monitoring phases. The data collection will take place in the form of a questionnaire before and after each mandala-coloring session and a semistructured interview every 2 weeks. Trial results will be analyzed using structured visual analysis, supplemented with statistical analysis appropriate to single-case methodology.

Results

Study results will offer new insights into the deployment and evaluation of novel interactive brain-computer interfaces for mindfulness training in the context of mental health. Moreover, findings will validate the effectiveness of this training protocol to improve the mental well-being of people who have had depression. Participants will be recruited locally through the National Health Service.

Conclusions

Evidence will assist in the design and evaluation of brain-computer interfaces and mindfulness technologies for mental well-being and the necessary services to support people who have experienced depression.

International Registered Report Identifier (IRRID)

PRR1-10.2196/20819

Ashes2Art: Mitigation Strategies for Short-and Long-term Distress in Emergency Services Personnel During COVID-19

Ashes2Art, a nonprofit organization working with fire fighters and first responders since 2017, promotes creativity to counter balance the exposure to extreme loss and trauma. Operating under the Northern Virginia Emergency Medical Services Council, Ashes2Art provides art supplies, art classes, and a creative community of support to mitigate the deleterious effects the stress of the job can take on fire fighters and first responders' health and mental health. During the COVID-19 pandemic, Ashes2Art has seen an increased demand for art supplies and the, now online, creative arts classes and self-care strategies. Currently, approximately 100 emergency services personnel and family members are actively participating in these initiatives during this crisis. Managing the cumulative emotional load these first responders and their families experience is paramount to COVID-19 recovery efforts and post-pandemic operations. Helping first responders and their families manage the short- and long-term emotional toll from the work they do in responding to the COVID-19 crisis is paramount to the United States' successful recovery back to a well-functioning post-pandemic society. This paper suggests that enhancing well-being through mindfulness-focused creative arts engagement might be one effective tool to be included as part of routine self-care protocols for first responders and their families.

The design and development of a hybrid off-job crafting intervention to enhance needs satisfaction, well-being and performance: a study protocol for a randomized controlled trial

Background

Employees dealing with job demands such as high workload and permeable work-life boundaries could benefit from bottom-up well-being strategies such as off-job crafting. We have developed a hybrid off-job crafting intervention to promote off-job crafting, a proactive pursuit to adjust one’s off-job time activities to satisfy one’s psychological needs. This hybrid intervention contains both on-site (two trainings) and online elements (smartphone app) to enhance employees’ well-being and performance within different life domains.

Methods

The study is designed as a randomized controlled trial with an intervention group and a waitlist control group. The study population will be Finnish knowledge workers. The intervention program focuses on six psychological needs (detachment, relaxation, autonomy, mastery, meaning, and affiliation) proposed by the DRAMMA model. The intervention will consist of the following components: 1) an on-site off-job crafting training, 2) an individual off-job crafting plan for the four-week intervention period, 3) Everydaily smartphone app usage, and 4) a training session for reflection. The study outcomes are assessed with online questionnaires once at baseline, weekly during the intervention period and twice after the intervention (two-week and six-week follow-up). Moreover, during the second training session, participants will participate in a process evaluation to shed light on the mechanisms that can affect the effectiveness of the intervention.

Discussion

We expect that the intervention will stimulate off-job crafting behaviors, which may in turn increase well-being and performance in both non-work and work domains during and after the intervention (compared to baseline and to the control group). The intervention may provide employees with additional resources to deal with various stressors in life. Furthermore, this off-job crafting intervention could also offer performance benefits for the employers such as increased organizational citizenship behaviors among employees.

Trial registration

The Netherlands Trial Register (NTR): NL8219, December 9, 2019. Registered retrospectively. https://www.trialregister.nl/trial/8219

Coloring Activities for Anxiety Reduction and Mood Improvement in Taiwanese Community-Dwelling Older Adults: A Randomized Controlled Study

To investigate the effect of mandala coloring, plaid pattern coloring, and free-form drawing activities on anxiety and mood in older Taiwanese adults. A total of 120 older adults aged 55 years to 75 years were recruited from 18 community-based learning centers for older adults in southern Taiwan. They were randomly assigned to engage in one of the following four activities for 20 minutes: (1) mandala coloring group, (2) plaid pattern coloring group, (3) free-form drawing group, and (4) reading group (control). Information on sociodemographic, lifestyle, and perceived health status was collected at the baseline. In addition, anxiety levels, measured using the 20-item State-Trait Anxiety Inventory–State Anxiety Scale (STAI-S), were ascertained at the baseline (T1), after a brief anxiety induction (T2), and at the end of the assigned activity (T3). The mean anxiety levels among the four groups at T3 were analyzed using analysis of covariance, followed by Šidák multiple comparison test, as appropriate. The mean age of the 120 study participants was 65.1 years and 73.3% were females. A significantly lower anxiety level was observed only in the mandala coloring group (least square mean = 28.2; 95% confidence interval = 24.7–31.7) compared with the control group (least square mean = 36.0; 95% confidence interval = 32.9–39.2) (P=0.004, partial eta-squared = 0.113). Furthermore, when the STAI-S was analyzed at the item level, the mandala coloring group was significantly different from the control group in the following six feelings: calmed down, safe, at ease, rested, satisfied, and I feel good. In conclusion, short-term mandala coloring activity could significantly alleviate self-induced anxiety in community-dwelling older adults. Further studies on the long-term effects of mandala coloring activity in improving the emotional well-being of older adults are warranted.

Something Is Going to Happen Here: The Use of Mandala Art in Enhancing Reflective Practice

This article focuses on the use of mandalas as part of a reflective practice journaling process. In this article, there is an approach to the science of communication, empathy, and interdependent communication. Drawing from a previous article on the "space between" in communication spirals, this article uses mandalas as preparation for and instrument of diverse communication. Emphasis is on mandala usage within reflective practice to consider depth interiority and then using the mandala as metaphor for engaging and sharing with others externally in dialogue. How to construct the mandala is included in this article, and there is an exercise for observation and assessment of mandalas. This novel structure for reflective practice supports developing transformational leaders and communication skill through expressive arts, narratives, and stories in journaling. This article considers the function of mandalas, interruptions in communication patterns, mirror neurons, possible paths, and collaborative outcomes for understanding and achieving interprofessional wisdom. This transformational discovery pathway and narrative exercises can be used for creating professional learning communities. This form of reflective practice has innovative possibilities for increased self-awareness and self-care. Included in this article is a list of awareness/mindfulness behaviors to act as a guide and encourage readers to undertake the reflective journaling process. The discovery pathway journal creates a permanent record of thoughts and anchors through the expressive art. The process refers to the Sigma Theta Tau International's Scholarship of Reflective Practice as important to the practice of nursing.

Effects of Mandala Art Therapy on Subjective Well-being, Resilience, and Hope in Psychiatric Inpatients

PURPOSE

This study investigated the effects of Mandala art therapy on subjective well-being, resilience, and hope among psychiatric inpatients.

METHODS

Recruited 36 people who had been treated as inpatients in a psychiatric ward at a university hospital in Seoul, South Korea, and divided them evenly into experimental and control groups. The experimental group was required to attend a total of 8 sessions of Mandala art therapy, twice per week, between August 11 and October 30, 2015; measures of the three main variables were administered at pre-test and post-test in both groups.

RESULTS

Hope significantly increased in both groups, but the overall increase was greater in the experimental group (mean score of 9.5 and 15.3 at pre- and post-test, respectively) than in the control group (10.9 and 11.9).

CONCLUSION

These results suggest that Mandala art therapy can have a positive effect on the hope of psychiatric inpatients. However, further research concerning its effects on subjective well-being and resilience, as well as other psychological constructs, is warranted to better understand the effects of Mandala art therapy on psychiatric inpatients.

When Did Coloring Books Become Mindful? Exploring the Effectiveness of a Novel Method of Mindfulness-Guided Instructions for Coloring Books to Increase Mindfulness and Decrease Anxiety

Mindfulness has been associated with the use of coloring books for adults; however, the question of whether they do increase mindfulness has not been addressed. In two studies, we attempted to identify whether mindfulness is increased, and whether there is a need for ongoing guidance while coloring, similar to mindfulness meditation. In the first randomized controlled experiment, university students (n = 88) were assigned to an unguided mandala coloring group (i.e., described in mainstream literature as a mindfulness practice) or to a free-drawing group. Measurements of state mindfulness and state anxiety were taken pre- and post- experiment. Results indicated no change in mindfulness or anxiety. In the second randomized controlled experiment, university students (n = 72) were assigned to an unguided mandala coloring group (i.e., same as Experiment 1), or, to a mindfulness-guided coloring group (i.e., same as the unguided coloring group with a mindfulness practitioner guiding participants as in mindfulness breathing meditation, with instructions modified and applied to coloring). Results indicated that the mindfulness-guided mandala coloring group performed better in decreasing anxiety, but no change was observed in mindfulness. Exit interviews revealed that some participants did not like the voice guiding them while coloring, which suggested further differing and significant findings. While mindfulness-guided coloring appears promising, guidance or instructions on how to color mindfully may require further development and adjustment to enhance health and wellbeing.