The Effect of Mandala Coloring on Perceived Stress and Anxiety Levels in Type-2 Diabetes Patients: Randomized Controlled Study

Diabetes is a frequently encountered chronic metabolic disease characterized by increased plasma glucose levels as a result of inadequate insulin secretion and/or increased insulin resistance. The most common type of diabetes is type-2 diabetes, accounting for approximately 90% of all cases. Type 2 diabetes is more common in middle and older ages, but today it is also seen in children and young adults due to negative changes in lifestyle habits.

Diabetes is typically a manageable disease through lifestyle changes and treatment. However, diabetes care can create additional stress for people with diabetes due to the never-ending demands of maintaining nutritional and physical health, exercising, monitoring blood sugar, regular monitoring, and managing fears about the reality of symptoms and complications. As a result, they experience feelings of depression, anxiety, and stress, which affects their health and overall quality of life. Patients with diabetes have significantly higher levels of anxiety and depression than the general population. The coexistence of diabetes and anxiety and stress results in poor glycemic control and self-management, increases the risk of diabetes complications, and reduces overall quality of life and life expectancy. Therefore, prevention, early recognition and treatment of these conditions are necessary to achieve optimal goals in the management and overall quality of life of patients.

A holistic approach should be adopted when planning the care practices of patients during this difficult period, and non-pharmacological practices should be planned, especially those that will allow the patient to perform daily life activities with minimum energy and maximum function. Mandala painting, one of the non-pharmacological practices, is an art therapy technique that can provide psychological support and healing. This circular art has traditionally been used for meditation in various Eastern cultures and is a symbol of psychological wholeness. Mandala coloring is a safe and accessible activity that does not require any special skills and can be used as a complementary strategy to support mental health. It is stated in the literature that painting mandalas improves psychological symptoms and relaxes the person. The artistic perspective of nursing is to understand the individual's needs, sources of worry, anxiety and stress, and then to develop practices that will increase his self-confidence and resilience by increasing his level of capability and competence. For this reason, this study was planned to examine the effect of mandala painting on the perceived stress and anxiety levels of Type-2 diabetic patients.