Mental Disease, şizofreni
Conditions
Keywords
Expressive Arts Therapy, Art Therapy, Hope, Psychiatric Nursing, Psychosocial Intervention, Randomized Controlled Trial, Positive Psychotherapy
Brief summary
This randomized controlled trial aimed to evaluate the effectiveness of an expressive arts therapy programme based on positive psychotherapy principles in strengthening hope among individuals diagnosed with schizophrenia. Hope is a central component of recovery in schizophrenia, yet structured nursing interventions specifically targeting hope remain limited. The study was conducted with 50 inpatients diagnosed with schizophrenia at a mental health hospital in Türkiye. Participants were randomly assigned to either an intervention group or a control group. The intervention group participated in an eight-session expressive arts therapy programme delivered in small groups, while the control group received standard psychiatric care. Hope levels were assessed before and after the intervention using the Herth Hope Scale. The findings demonstrated that participants who received expressive arts therapy showed significant improvements in overall hope and its key dimensions, including future orientation, positive readiness and expectancy, and connectedness, compared with those receiving standard care. This study suggests that expressive arts therapy may be an effective recovery-oriented nursing intervention to strengthen hope and support psychological recovery in individuals with schizophrenia.
Detailed description
Schizophrenia is a chronic psychiatric disorder that significantly affects individuals' functioning, quality of life, and recovery processes. Hope has been identified as a central component of recovery in individuals with schizophrenia, as it supports coping, motivation, and engagement with treatment. However, structured psychosocial and nursing interventions specifically targeting hope remain limited. Expressive arts therapy is a therapeutic approach that integrates creative expression processes such as drawing, collage, storytelling, and metaphor work to facilitate emotional expression, self-awareness, and psychological healing. Within psychiatric nursing, expressive arts therapy may offer a recovery-oriented approach that helps individuals express their experiences, reconstruct meaning, and strengthen hope. This randomized controlled trial aimed to evaluate the effectiveness of an expressive arts therapy programme based on positive psychotherapy principles in strengthening hope among individuals diagnosed with schizophrenia. The study was conducted with 50 inpatients diagnosed with schizophrenia in a mental health hospital in Türkiye. Participants were randomly assigned to either an intervention group or a control group using a computer-generated randomization list prepared by an independent statistician. Participants in the intervention group received an eight-session expressive arts therapy programme delivered face-to-face in small groups in addition to standard psychiatric care. Each session included psychoeducation, creative expression activities (such as drawing, collage, storytelling, and metaphor work), and group sharing processes aimed at strengthening emotional expression and hope. The control group received standard psychiatric inpatient care only. Hope levels were assessed before and after the intervention using the Herth Hope Scale. The primary outcome of the study was the change in hope level measured by the Herth Hope Scale total score. Secondary outcomes included changes in the scale's subdimensions, including future orientation, positive readiness and expectancy, and interconnectedness. The findings of this study are expected to contribute to the development of recovery-oriented psychosocial nursing interventions for individuals with schizophrenia and to provide evidence regarding the effectiveness of expressive arts therapy in strengthening hope.
Interventions
BEHAVIORALExpressive Arts Therapy
Intervention Description (Kopyalayın) An expressive arts therapy programme based on positive psychotherapy principles was delivered in small groups. The programme consisted of eight structured sessions conducted face-to-face. Each session included psychoeducation, creative expression activities such as drawing, collage, storytelling, and metaphor work, and group sharing. The intervention aimed to strengthen hope, enhance emotional expression, and support psychological recovery in individuals with schizophrenia.
Sponsors
Ondokuz Mayıs University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The study was single-blind. The data analyst responsible for statistical analysis was blinded to group allocation. Participants and care providers were not blinded due to the nature of the intervention.
Intervention model description
Participants were randomly assigned in a 1:1 ratio to either the expressive arts therapy intervention group or the control group using a computer-generated randomization list prepared by an independent statistician. The intervention group received an eight-session expressive arts therapy programme delivered in small groups, in addition to standard psychiatric care. The control group received standard psychiatric care only. Outcome measures were assessed at baseline and immediately after completion of the intervention. The study followed a parallel-group design, and the data analyst was blinded to group allocation.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of schizophrenia according to clinical evaluation * Age between 18 and 65 years * Hospitalized in a psychiatric inpatient unit * At least six months since diagnosis * Ability to read and understand assessment tools * Clinically stable without acute psychotic symptoms * Provided written informed consent
Exclusion criteria
* Severe cognitive impairment * Acute psychotic symptoms requiring intensive treatment * Severe physical illness preventing participation * Refusal to participate or withdrawal of consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Hope Level Measured by the Herth Hope Scale | Baseline and immediately after completion of the intervention (4 weeks) | Hope level will be assessed using the Herth Hope Scale (HHS), a validated 12-item self-report instrument with scores ranging from 12 to 48. Higher scores indicate higher levels of hope. |
| Herth Hope Scale | Baseline and immediately after completion of the 8-session intervention (approximately 4 weeks) | Changes in Herth Hope Scale subscale scores (future orientation, positive readiness and expectancy, and interconnectedness) will be evaluated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Herth Hope Scale Subscale Scores | Baseline and immediately after completion of the intervention | Changes in the subscale scores of the Herth Hope Scale, including future orientation, positive readiness and expectancy, and interconnectedness, will be evaluated. |
Countries
Turkey (Türkiye)
Outcome results
None listed