Effects of Positive Psychology-Based Art Therapy on Self-Compassion and Hope in Hospitalized Children: A Randomized Controlled Trial

Childhood is a critical stage of life where the foundations of an individual's biological, psychological, and social development are laid. Experiences such as illness, trauma, and hospitalization during this period can negatively affect children's developmental processes; they can have lasting consequences on mental well-being, self-perception, and psychosocial adjustment. Hospitalization is not only a physical treatment requirement for children but also an experience that creates intense psychological stress, including loss of control, fear, anxiety, social isolation, and uncertainty. Long-term hospitalizations, in particular, can negatively impact children's developmental processes, self-esteem, and psychological resilience. Hope is one of the psychological resources that supports children in coping with illness during this process. Hope is defined as a dynamic force that supports an individual's ability to maintain positive expectations for the future, actively participate in the treatment process, and achieve psychosocial adjustment. Research shows that children with high levels of hope have better treatment adjustment, lower anxiety, and higher self-efficacy and quality of life. Furthermore, self-compassion is considered an important protective psychological trait for children to make healthy sense of their hospital experiences and develop a supportive attitude towards themselves.

In recent years, art-based psychosocial interventions have been reported to facilitate the expression of emotions, strengthen the sense of control, and increase hope levels in hospitalized children. However, the current literature shows a limited number of studies evaluating the effects of positive psychology-based art therapy on hope and self-compassion in hospitalized children using a randomized controlled design. Therefore, determining the effect of positive psychology-based art therapy on hope and self-compassion levels in children hospitalized in pediatric wards is an important need that will contribute to evidence-based pediatric nursing practices.

Illness and hospitalization bring not only physical but also psychosocial, mental, and existential difficulties to children. In this process, self-compassion is considered an important protective psychological resource for children to cope with the difficulties they experience, to develop an understanding attitude towards themselves, and to maintain their psychological adjustment. Self-compassion is defined as an individual's gentle and understanding approach to themselves in the face of difficulties, accepting that suffering is a natural part of the human experience, and developing conscious awareness. However, the disease process can negatively affect self-compassion levels by increasing self-judgment, isolation, and negative self-image. Research shows that interventions that support self-compassion can reduce stress and anxiety in children, strengthen emotional regulation skills, and support psychological well-being. However, there are limited randomized controlled trials examining the effect of art therapy on self-compassion in studies conducted with children. Nevertheless, it has been reported that child-centered play therapy applied to children diagnosed with cancer significantly increases self-compassion and emotion regulation skills; and that self-compassion interventions for parents indirectly contribute to the psychological well-being of children.

Hope and self-compassion stand out as two important, complementary psychological resources in supporting the psychological adjustment of hospitalized children. Hope supports the child's positive expectations for the future and motivation for treatment, while self-compassion facilitates emotional regulation by enabling the child to develop an accepting and supportive approach to the pain and difficulties they experience. Despite this, there appears to be a lack of randomized controlled trials evaluating the combined effects of positive psychology-based art therapy on hope and self-compassion in pediatric hospitalized children. This knowledge gap necessitates investigation into the effectiveness of art-based psychosocial interventions in evidence-based pediatric nursing practices. The literature reports that art therapy is effective in reducing anxiety, facilitating emotional expression, strengthening self-image, and supporting psychological well-being in hospitalized children. Painting, drawing, collage, mandala, and other creative art practices have been shown to reduce anxiety, depression, and stress levels and strengthen coping skills. However, a randomized controlled trial examining the combined effects of positive psychology-based art therapy on hope and self-compassion in hospitalized children has not been found. Therefore, determining the impact of positive psychology-based art therapy practices integrated into nursing care on children's levels of hope and self-compassion will make a significant contribution to evidence-based pediatric nursing practices.