The Effect of Mandala Art Therapy on the Psychological Well-Being and Perception of Social Support in Elderly People

The Effect of Mandala Art Therapy on the Psychological Well-Being and Perception of Social Support in Elderly People: A Randomized Controlled Trial

This study aims to examine the effects of mandala art therapy on psychological well-being and perceived social support in elderly individuals.

Research Hypotheses H1: Mandala art therapy significantly increases the psychological well-being of elderly individuals (p < 0.05).

H2: Mandala art therapy significantly increases the perceived social support scores of elderly individuals (p < 0.05).

H3: There is a positive and significant relationship between psychological well-being and perceived social support scores after mandala art therapy (p < 0.05).

Study Overview

• Status: Completed
• Conditions: Elderly
• Intervention / Treatment: Other: MANDALA

Detailed Description

The proportion of the elderly population is rapidly increasing worldwide, and it is projected that the number of individuals aged 60 and over will reach two billion by 2050 (World Health Organization [WHO], 2022).The aging process is closely linked not only to physiological changes but also to changes in mental and social health. Social isolation, loneliness, role loss, and physical limitations in advanced age can lead to negative consequences such as depression, anxiety, and decreased life satisfaction (Holt-Lunstad et al., 2015; Courtin and Knapp, 2017). Therefore, supporting the mental well-being of older individuals and strengthening social ties are among the priority goals of healthy aging policies (WHO, 2021). Psychological well-being in older individuals is related to social support. A study on older individuals found that high perceived social support in older adults increases life satisfaction and psychological well-being (Antonucci et al., 2014). Social support plays a protective role in preventing negative mental states such as loneliness, hopelessness, and anxiety in older adults (Chao, 2011). Family and peer support, in particular, strengthen the psychological well-being of older adults (Gariépy et al., 2016). Consequently, there is a strong and positive relationship between the perception of social support and psychological well-being in older adults. Therefore, interventions implemented for older adults by strengthening their social support networks play an important role in protecting their mental and physical health. Art therapy and creative activities are among the effective interventions that support the mental well-being of older adults. Group practices, particularly those involving mandala programs, have positive effects on anxiety and stress (Czamanski-Cohen et al., 2021). Mandala practices implemented in a group setting increase social interaction and strengthen perceptions of social support (Moon and Kim, 2020). While the existing literature has examined the effects of art therapy, music therapy, and creative activities on depression, anxiety, and life satisfaction in the elderly (Windle et al., 2018; Tymoszuk et al., 2019), studies examining psychological well-being and perceived social support together are limited. Studies evaluating mandala practices for the elderly population in Turkey using standardized scales are also limited. This study will be one of the first studies conducted in Turkey to examine the effects of mandala activities on both psychological well-being and perceived social support using the same model.It is believed that the findings will contribute to the evidence-based use of art-based group programs for older adults in clinical care and community-based studies. This study aims to examine the effects of mandala art therapy on psychological well-being and perceived social support in older adults.Studies on mandala art therapy have shown that it supports depression, anxiety, and spiritual well-being in the elderly mental health field. In a randomized controlled trial conducted in Taiwan, older adults were randomly assigned to a 20-minute activity of mandala painting, plaid painting, free drawing, or reading. The mandala painting group showed significant decreases in feelings of "relaxation," "safeness," and "comfort" (more positive feelings) compared to the control group (Koo et al., 2020). In a quasi-experimental single-group pre-post study conducted in Tehran, elderly people attending a daycare center painted mandalas twice a week for two weeks; When DASS-21 scores were examined, a significant decrease (p = 0.001) was observed in depression, anxiety, and stress levels (Amadi et al., 2023). In a study in India, mandala coloring was applied to elderly individuals living in nursing homes, a significant decrease (p < 0.01) was noted in Beck Depression Inventory (BDI) scores compared to pre- and post-test (Sreetha et al., 2021). In a 20-week art therapy intervention for depressed elderly women in Brazil, the therapy was found to significantly reduce depression and anxiety symptoms in the Geriatric Depression Scale (GDS), Beck Depression Inventory, and Beck Anxiety Inventory (Ciasca et al., 2018).

• Study Type: Interventional
• Enrollment (Actual): 35
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ankara
    • Ankara, Ankara, Turkey (Türkiye), 06490
      • Gazi University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:Participation criteria for the study include willingness to participate, being 60 years of age or older, scoring 24 or higher on the Mini Mental State Examination -

Exclusion Criteria:Exclusion criteria include severe Alzheimer's disease and dementia, having undergone regular art therapy/psychotherapy within the last three months, and being visually impaired.

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Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mandala; The Mandala Art Therapy Program was developed by researchers based on literature (Chen et al., 2025; Omidivd, 2025; Ergür et al., 2021).The program, consisting of four sessions, will be conducted face-to-face once a week.Each session will last approximately 40-60 minutes.The sessions will be facilitated by the first researcher (FBÖD), who holds a mandala practitioner certification.The second researcher (ND), who holds an art therapy practitioner certification, will attend all sessions and serve as co-leader.The program will be implemented in a room approved by the administration at the location where the participants are registered, where participants will feel comfortable and where the session will not be interrupted.Session content is as follows:Session Content 1: Introduction, Group Rules, Focus and short breathing exercise (2 minutes), Mandala introduction (10 minutes), Coloring the prepared Mandala Drawing (symmetrical patterns) (30-40 minutes), Sharing of feelings (5-10 minutes)	Other: MANDALA; The Mandala Art Therapy Program was developed by researchers based on literature (Chen et al., 2025; Omidivd, 2025; Ergür et al., 2021).The program, consisting of four sessions, will be conducted face-to-face once a week.Each session will last approximately 40-60 minutes.The sessions will be facilitated by the first researcher (FBÖD), who holds a mandala practitioner certification.The second researcher (ND), who holds an art therapy practitioner certification, will attend all sessions and serve as co-leader.The program will be implemented in a room approved by the administration at the location where the participants are registered, where participants will feel comfortable and where the session will not be interrupted.Session content is as follows:Session Content 1: Introduction, Group Rules, Focus and short breathing exercise (2 minutes), Mandala introduction (10 minutes), Coloring the prepared Mandala Drawing (symmetrical patterns) (30-40 minutes), Sharing of feelings (5-10 minutes).
No Intervention: CONTROL; Elderly individuals who agree to participate in the study and meet other criteria will be administered the SMMT, and those who score 24 or higher will be included in the study. After administering the data collection tools to both the intervention and control groups, the intervention group will receive a four-week Mandala Art Therapy Program. All materials used during the program (paper, pencils, compasses, rulers, crayons, etc.) will be provided free of charge by the researchers. The control group will not receive any intervention during this period. After the intervention, participants in both groups will complete a posttest and a follow-up test. After the study is completed, the Mandala Art Therapy program will be administered by the researchers to volunteer participants in the control group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Psychological Well-Being Scale in the Elderly	Psychological Well-Being Scale in the Elderly (YPWB): The scale was used to measure the psychological well-being of elderly individuals. It was developed by Gümüş Demir (2023) and consists of 15 items on a 5-point Likert-type scale (1 = completely disagree - 5 = completely agree) (Appendix 2). Based on the scale's scoring system, there is no set cut-off score for the well-being of elderly individuals. Higher scores indicate increased well-being. The lowest possible score on the scale is 15, and the highest is 75. Additionally, items 8 and 13 were reverse-coded. The scale's Cronbach's alpha coefficient was calculated as 0.89, and the composite reliability coefficient was 0.90. The scale's item-total correlation values ranged between 0.48 and 0.69 (Gümüş Demir, 2023).	four weeks after the preliminary test

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Multidimensional Scale of Perceived Social Support	The Multidimensional Perceived Social Support Scale (MPSSS) was developed in 1988 by Zimet et al. (Zimet et al., 1988). The Turkish validity and reliability study of the scale was conducted in 2001 by Eker et al. (Eker et al., 2001). The scale consists of a total of 12 questions and is evaluated on a 7-point Likert scale. Participants select one of the options ranging from "Definitely No" to "Definitely Yes" to express their perceived support. The scale consists of three subscales reflecting support sources: family, friends, and special person support. A high score is interpreted as indicating a high level of social support.	four weeks after the preliminary test

Collaborators and Investigators

• Sponsor: Gazi University

Study record dates

Study Major Dates

• Study Start (Actual): November 24, 2025
• Primary Completion (Actual): December 25, 2025
• Study Completion (Actual): January 26, 2026

Study Registration Dates

• First Submitted: February 2, 2026
• First Submitted That Met QC Criteria: March 4, 2026
• First Posted (Actual): March 9, 2026

Study Record Updates

• Last Update Posted (Actual): March 9, 2026
• Last Update Submitted That Met QC Criteria: March 4, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Psychological well-being, Social support
• Additional Relevant MeSH Terms: Behavior; Personal Satisfaction; Psychological Well-Being
• Other Study ID Numbers: GazıUnıversity-FBOz

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: After the research is completed, it can be forwarded to researchers who request it.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No