Table 1.
Characteristics of Studies
| Author, year | Study design | Region | n (EG/CG) | Patient | Intervention | Intervention duration | Intervention session | Intervention implementer | Control | Outcome measure | Results |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Gürcan and Atay Turan (2021)38 | RCT | Turkey | 60 (30/30) | Hospitalized adolescents with cancer | Mandala drawing | 5–6 days | Two sessions, for ∼1–2 h each | Not mentioned | TAU | 1. The Hospital Anxiety and Depression Scale 2. The Memorial Symptom Assessment Scale (Psychological subscale) |
The anxiety and depression scores, and the psychological symptom scores significantly decreased in the intervention group, compared with the CG |
| Khademi et al. (2021)22 | RCT | Iran | 70 (35/35) | Hospitalized patients with COVID-19 | Mandala coloring | 6 consecutive days | Six sessions, for 30 min each | Not mentioned | TAU | The Spielberger STAI | The anxiety scores significantly decreased in the intervention group as compared with the CG |
| Choi et al. (2021)20 | RCT | Korea | 36 (21/15) | Building and facilities management employees with chronic widespread musculoskeletal pain | MBMC coloring | 4 h | Single session | Registered art psychotherapist | A nonguided sightseeing bus tour | 1. The Manual Tender Point Survey 2. The Fatigue Severity Scale 3. The Stress Response Inventory-Modified Form 4. Stress hormone cortisol |
Significant improvements in tender points, total stress level, depressive symptoms, anger symptoms, and salivary cortisol in the MBMC group |
| Czamanski-Cohen et al. (2019)39 | RCT | Israel | 15 (8/7) | Breast cancer patients | Mandala coloring | 8 weeks | Eight sessions, 1 day a week, for 1 h each | Art therapist | Art therapy | 1. The Levels of Emotional Awareness Scale 2. The AE Scale 3. The Center for Epidemiologic Studies-Depression scale 4. Physical symptoms: the Breast Cancer Prevention Trial Symptom Scale |
Statistically significant between-group differences in emotional awareness and AE were found. Large effect sizes between groups and over time in AE, emotional awareness and depressive symptoms |
| Stinley et al. (2015)19 | RCT | United States | 40 (20/20) | Pediatric patients undergoing venipuncture procedure | Creating a mandala by coloring or drawing anything inside or outside the circle on an iPad | 30 min | Single session | Not mentioned | TAU | 1. Heart rate and blood oxygen saturation 2. The Hospital Fears Rating Scale 3. The Wong–Baker visual analog scale pain instrument 4. Behavioral Indicators of Stress (e.g., fidgeting, crying, screaming, physical struggle) |
Physiological stress behaviors were significantly reduced in the Treatment Group compared with the CG. Psychological anxiety decreased significantly in Treatment Group participants |
| Schrade et al. (2011)40 | RCT | United States | 18 (6/6/6) | Individuals with intellectual disability | Mandala making | 15 min | Single session | Occupational therapist | Free drawing, and a neutral control condition: provided puzzles and/or table games | 1. Systolic blood pressure, diastolic blood pressure, and/or pulse | Blood pressure change in the mandala making condition indicated a statistically significant reduction in both diastolic and systolic pressure between the first and third reading |
| Akbulak and Can et al. (2023)41 | Quasi-experimental study | Turkey | 84 (41/43) | Women with early-stage breast cancer receiving chemotherapy for the first time | Mandala coloring | 30 min | Single session | Not mentioned | TAU | 1. The Distress Thermometer 2. The STAI |
Patients in the intervention group who had high distress levels before premedication showed a significant decrease in state anxiety score after premedication |
| Yakar et al. (2021)18 | Quasi-experimental study | Turkey | 12 | Breast cancer patients | Art-based mandala intervention combined with different meditation techniques | 8 weeks | Eight sessions, 1 day a week, for 2 h each | Mandala meditation therapy specialist | / | 1. The Distress Thermometer 2. The 20-item Spielberger STAI-State Anxiety Scale (STAI-S) |
Anxiety scores decreased significantly after the program compared with before the program. The distress scores increased after the program compared with before the program |
| Barati et al. (2020)36 | Quasi-experimental study | Iran | 30 (15/15) | Multiple sclerosis patients | Software-based therapeutic coloring (mandala coloring) | 4 weeks | Twelve sessions, 3 sessions per week | Not mentioned | TAU | 1.The Depression Questionnaire 2.The Depression Anxiety Stress Scale (DASS-21) |
Anxiety score was significantly lower in the intervention group as compared with the controls. A significant reduction in score of stress was observed in the intervention group as compared with preintervention. Stress score significantly reduced more in the intervention group as compared with the control |
| Kim et al. (2017) | Quasi-experimental study | Korea | 28 (15/13) | Psychiatric inpatients | Mandala art therapy (mandala coloring) | 4 weeks | Eight sessions, two sessions per week, for an hour each | Mandala art therapist | TAU | 1. The Concise Measure of Subjective Well-being 2. The Resilience Scale 3. The Schizophrenia Hope Scale-9 |
Hope significantly increased in both groups, but the overall increase was greater in the EG at pre- and post-test, respectively than in the CG |
| Gürcan and Atay Turan. (2020)35 | Qualitative study | Turkey | 12 | Adolescents with cancer | Unstructured mandala drawing | 1–2 h | Single session | Not mentioned | / | Analyze the mandala drawing and the interview texts | Two main themes with related subthemes each were obtained: being an adolescent with cancer, with the subthemes of changes in health, restriction of freedom and feeling lonely; and coping with cancer with the subthemes of psychological growth and hope for healing |
AE, Acceptance of Emotions; CG, control group; COVID-19, coronavirus disease 2019; EG, experimental group; MBMC, mindfulness-based mandala; RCT, randomized controlled trial; STAI, State-Trait Anxiety Inventory; TAU, treatment-as-usual.