A Feasibility Study on Zentangle and Pastel Nagomi Art for Mental Health Patients

Not Applicable

Completed

• Conditions: Mental Health Issue

• Registration Number: NCT06779357
• Lead Sponsor: The Hong Kong Polytechnic University

Brief Summary

Background: Various studies have found that art-based workshops can reduce anxiety, stress and enhance positive emotion. Improving mental well-being plays an important role for people in the progress of recovery from mental illness. The Zentangle method and Pastel Nagomi Art promote relaxation by emphasizing no comparisons, critiques, or judgments of the finished piece with others, and appreciating the opportunity to make choices. However, there were limited studies examining the effectiveness of the artwork on people living in the community in the progress of recovery from mental illness.

Purpose: To conduct a feasibility study to test the preliminary effects of Pastel Nagomi Art and Zentangle Art on mental health well-being among persons in recovery from mental illnesses.

Methods: A 3-arm randomized control trial will be used: one arm with Zentangle workshops, the other arm with Pastel Nagomi Art, while the control group will receive usual care. Data collection from each participant will be conducted at 3-time points, at baseline (T0) before the 4-week weekly Pastel Nagomi Art or Zentangle Art program, right after the program (T1), and one month after the program (T2). The Statistical Software Package for Social sciences will be used for quantitative data analysis. All participants from each artwork group will be invited to partake 45-60 minutes focus group interview to share their experience with this intervention. The content of the focus group interview will be audio recorded. The audio recordings were transcribed verbatim in Chinese and imported into NVivo Pro 12 for data management. The qualitative data will be analyzed by using thematic content analysis.

Detailed Description

Recovery from mental illness has shifted from the clinical perspectives focusing on reducing symptoms to the personal recovery perspectives focusing on the improvement of well-being. A few studies have investigated that art-based workshops promoted positive effects on mental well-being among mental illness patients such as depression women and psychosis patients. Moreover, various studies have found that art-based workshops can reduce anxiety, stress and enhance positive emotion. Improving mental well-being plays an important role for people in the progress of recovery from mental illness. The Zentangle method and Pastel Nagomi Art promote relaxation by emphasizing no comparisons, critiques, or judgments of the finished piece with others, and appreciating the opportunity to make choices. However, there were limited studies examining the effectiveness of the artwork on people living in the community in the progress of recovery from mental illness. To fill the research gap, the purpose of this study is to conduct a feasibility study to test the preliminary effects of Pastel Nagomi Art and Zentangle Art on mental health well-being among persons in recovery from mental illnesses.

The target participants are the service users of the community psychiatric service (CPS) in Hong Kong, and had previously been clinically diagnosed with depression, anxiety or bipolar disorder before being referred to CPS. The individuals who cannot speak and understand Chinese, are currently diagnosed with psychotic symptoms, and currently taking or took Zentangle or Pastel Nagomi before will be excluded.

A 3-arm randomized control trial will be used: one arm with Zentangle workshops, the other arm with Pastel Nagomi Art, while the control group will receive usual care. Data collection from each participant will be conducted at 3-time points, at baseline (T0) before the 4-week weekly Pastel Nagomi Art or Zentangle Art program, right after the program (T1), and one month after the program (T2).

The Statistical Software Package for Social sciences will be used for quantitative data analysis. All participants from each artwork group will be invited to partake 45-60 minutes focus group interview to share their experience with this intervention. The content of the focus group interview will be audio recorded. The audio recordings were transcribed verbatim in Chinese and imported into NVivo Pro 12 for data management. The qualitative data will be analyzed by using thematic content analysis.

Study Timeline

• Study Start: 2023-09-30
• Study First Submitted: 2024-10-02
• Study First Submitted QC: 2025-01-11
• Study First Posted: 2025-01-16
• Status Verified: 2025-03
• Primary Completion: 2025-03-15
• Study Completion: 2025-03-19
• Last Update Submitted: 2025-03-19
• Last Update Posted: 2025-03-24

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 45

Inclusion Criteria

• Service users of the Community Psychiatric Services of Kowloon West Cluster
• had previously been clinically diagnosed with depression, anxiety or bipolar disorder

Exclusion Criteria

• The individuals who cannot speak and understand Chinese,
• currently diagnosed with psychotic symptoms, and
• currently taking or took Zentangle or pastel Nagomi art before

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Recruitment rate	8 weeks	The recruitment rate will be calculated by the number of participants recruited over the total number of participants approached
Consent rate	8 weeks	The consent rate will be calculated with number of participants signed the consent form over the total number of participants indicated they would participate in the study the interventions, arrangement, and the effect of the artworks on the study outcomes
Attrition rate	8 weeks	The attrition rate will be calculated with number of participants dropped out from the study over the total number of participants enrolled in the study

Secondary Outcome Measures

Name	Time	Method
Teh Depression Anxiety Stress Scale illnesses.	8 weeks	The Depression Anxiety Stress Scale (DASS-21) will be used to measure psychological distress. The sum of item scores will be calculated for each subscale, with a higher score indicating more severe leveles of distress
The Rosenberg Self-Esteem SCale	8 weeks	The Rosenberg Self-esteem Scale will be used to measure the self-esteem. The sum score will be used for analysis with higher scores indicate higher self-esteem.
The General Self-Efficacy Scale	8 weeks	The General Self-Efficacy Scale will be used to measure self-efficacy. The summation score will be used for analysis, with a higher score indicating a greater sense of self-efficacy.
The Positive and Negative Affect Scale	8 weeks	The Positive and Negative Affect Scale will be used to measure emotion states. The summation score will be used for analysis, with higher scores indicate higher levels of emtional states.
The revised Cognitive and Affective Mindfulness Scale	8 weeks	The revised Cognitive and Affective Mindfulness Scale will be used to measure mindfulness state. The summation score will be used for analysis, with a higher score indicating higher levels of mindfulness state.
The WHOQOL-BREF Scale	8 weeks	The WHOQOL-BREF scale will be used to measure quality of life. The scores will be transformed based on the scoring guidelines. Higher responses imply higher quality of life.
The Patient Activation Measure	8 weeks	The Patient Activation Measure will be used to measure the patient activation. Higher total scores indicate greated self-reported patient activation.
The Stigma Mental Illness Scale	8 weeks	The Stigma Mental Illness Scale will be used to measure Illness Acceptance. A higher total score reflects a higher level of reported internat stigma.

Trial Locations

Locations (1)

School of Nursing; 🇭🇰 Hong Kong, Hong Kong