Research Article
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The Effects of Mandala on the Hope Levels of Women Diagnosed with Gynecologic Cancers: A Randomized-Controlled Study

Year 2025, Volume: 7 Issue: 3, 302 - 308, 27.09.2025
https://doi.org/10.35365/ctjpp.25.3.10

Abstract

This study was conducted to determine the effects of the practice of mandala on the hope levels of women diagnosed with gynecologic cancers. This randomized-controlled experimental study was carried out between 1 March and 1 September 2021 with the participation of inpatients at the oncology service of a private hospital in western Turkey, including 90 patients. There was no significant difference between the pretest Herth Hope Index (HHI) scores of the patients in the intervention and control groups (p>0.05), whereas the posttest scores of the intervention group were significantly higher than those of the control group. While HHI scores of the intervention group significantly increased from the pretest to the posttest, the scores of the control group significantly decreased from the pretest to the posttest (p<0.05). The mandala activity in this study was determined to be effective in increasing the hope levels of the women diagnosed with gynecologic cancers.

References

  • Akbulak, F. & Can, G. (2023). Effectiveness of mandala coloring in reducing anxiety in women with early stage breast cancer receiving chemotherapy for the first time, Explore, 19(1), 42-47. https://doi.org/10.1016/j.explore.2022.04.007
  • Altay, N., Kilicarslan-Toruner, E., & Sari, Ç. (2017). The effect of drawing and writing technique on the anxiety level of children undergoing cancer treatment. European Journal of Oncology Nursing. 28: 1-6. https://doi.org/10.1016/j.ejon.2017.02.007
  • Aslan, Ö., Sekmen, K., Kömürcü, Ş., & Özet, A. (2007). Kanserli Hastalarda Umut, C.Ü. Hemşirelik Yüksekokulu Dergisi, 11(2): 1-3.
  • Babouchkina, A., & Robbins, S. J. (2015). Reducing negative mood through mandala creation: A randomized controlled trial. Art Therapy, 2015, 32 (1), 34-39. https://doi.org/10.1080/07421656.2015.994428
  • Bell, J. G., McHale, J., Elliott, J. O. & Heaton, W. (2022). The impact of art therapy on anxiety and hope in patients with gynecologic cancer undergoing chemotherapy. The Arts in Psychotherapy, 80, 101947. https://doi.org/10.1016/j.aip.2022.101947
  • Czamanski-Cohen J, Wiley JF, Sela N, Caspi O, Weihs K. F. (2019). The role of emotional processing in art therapy (REPAT) for breast cancer patients. J Psychosoc Oncol, 37(5), 586–98. https://doi.org/10.1080/07347332.2019.1590491
  • Çelik M, Uğur Ö, Karadağ E. (2021). Relationship between hope and fatigue levels in cancer patients. J Health Sci Med, 4(6), 858-864. https://doi.org/10.32322/jhsm.974176
  • Doğan, R., & Özkan, M. (2022). Meme Kanserli Hastalarda Ameliyat Sonrası Resim Sanatının Umutsuzluk Ve Yorgunluk Üzerine Etkisi/Yarı Deneysel Bir Çalışma. Göbeklitepe Sağlık Bilimleri Dergisi, 5(7), 45-55. https://doi.org/10.55433/gsbd.127.
  • Ehsani, M., Ashghali Farahani, M., Haghani, S., & Negari, F. (2021). The Relationship Between Hope and Received Information About Cancer Among Women with Breast Cancer: A Descriptive-Correlational Study. International Journal of Cancer Management, 14(8), e114586 https://doi.org/10.5812/ijcm.114586.
  • Elimimian, E. B., Elson, L., Stone, E., Butler, R. S., Doll, M., Roshon, S., ... & Nahleh, Z. A. (2020). A pilot study of improved psychological distress with art therapy in patients with cancer undergoing chemotherapy. BMC Cancer, 20(1), 1-11. https://doi.org/10.1186/s12885-020-07380-5
  • Erdoğan Yüce, G. & Muz, G. (2020). Kanser hastalarında tedaviye bağlı bulantı ve kusmanın yönetimi. Nevşehir Bilim ve Teknoloji Dergisi, 9(2), 116-124. https://doi.org/10.17100/nevbiltek.697291
  • Forzoni, S., Perez, Mç, Martignetti, A., & Crispino, S. (2010). Art therapy with cancer patients during chemotherapy sessions: an analysis of the patients’ perception of helpfulness. Palliat Support Care. 8(1):41–48 https://doi.org/10.1017/S1478951509990691.
  • Geue, K., Goetze, H., Buttstaedt, M., Kleinert, E., Richter, D., & Singer, S. (2010). An overview of art therapy interventions for cancer patients and the results of research. Complement Ther Med, 18(3–4):160–70 https://doi.org/10.1016/j.ctim.2010.04.001. Gözüyeşil E, Düzgün A.A, Taş F. Bir Aile Sağlığı Merkezine Başvuran Kadınların Jinekolojik Kanser Farkındalıklarının Değerlendirilmesi. TJFMPC www.tjfmpc.gen.tr 2020; 14(2): 177-185. https://doi.org/10.21763/tjfmpc.730022
  • Hammer,K., Hall, E.O.C., & Mogensen, O. (2013). Hope pictured in drawings by women newly diagnosed with gynecologic cancer. Cancer Nursing, 36, 4,: 42–50 https://doi.org/10.1097/NCC.0b013e31826c7af2.
  • Henderson, P., Rosen, D., & Mascaro, N. Empirical study on the healing nature of mandalas. Psychology of Aesthetics, Creativity, and the Arts. 2007; 1 (3): 148 https://doi.org/10.1037/1931-3896.1.3.148.
  • Iżycki, D., Woźniak, K., Iżycka, N. (2016). Consequences of gynecological cancer in patients and their partners from the sexual and psychological perspective. Prz Menopauzalny, 15(2):112–116 https://doi.org/10.5114/pm.2016.61194.
  • Kavradim, S. T., Özer, Z. C., & Bozcuk, H. (2013). Hope in people with cancer: a multivariate analysis from T urkey. Journal of Advanced Nursing, 69(5), 1183-1196 https://doi.org/10.1111/j.1365-2648.2012.06110.x
  • Kim, H., Kim, S., Choe, K., & Kim, J.-S. (2018). Effects of mandala art therapy on subjective well-being, resilience, and hope in psychiatric inpatients. Archives of Psychiatric Nursing. 32 (2): 167-17 https://doi.org/10.1016/j.apnu.2017.08.008.
  • Kirshbaum, M.N., Ennis, G., Waheed, N., & Carter, F. (2017). Art in cancer care: exploring the role of visual art-making programs within an energy restoration framework. Eur J Oncol Nurs. 29:71–8 https://doi.org/10.1016/j.ejon.2017.05.003.
  • La Rosa, V. L., Shah, M., Kahramanoglu, I., Cerentini, T. M., Ciebiera, M., Lin, L. T., ... & Tesarik, J. (2020). Quality of life and fertility preservation counseling for women with gynecological cancer: an integrated psychological and clinical perspective. Journal of Psychosomatic Obstetrics & Gynecology, 41(2), 86-92. https://doi.org/10.1080/0167482X.2019.1648424
  • Lee, J., Choi, M.Y. & Kim, Y.B. (2017). Art therapy based on appreciation of famous paintings and its effect on distress among cancer patients. Quality of Life Research, 26,3: 707–715. https://doi.org/10.1007/s11136-016-1473-5
  • Lopez, A. L. J., Butow, P. N., Philp, S., Hobbs, K., Phillips, E., Robertson, R., & Juraskova, I. (2019). Age‐related supportive care needs of women with gynaecological cancer: a qualitative exploration. European Journal of Cancer Care, 28(4), e13070. https://doi.org/10.1111/ecc.13070.
  • Mengqin, Z., Xing, L., Yan, H., & Jianhua, R. (2024). Does mandala art therapy improve psychological well-Being of gynecological cancer patients during the perioperative period? A quasi-experimental study. Integrative Cancer Therapies, 23, 15347354241259180. https://doi.org/10.1177/15347354241259180
  • Monti, D. A., Kash, K. M., Kunkel, E. J., Moss, A., Mathews, M., Brainard, G., ... & Newberg, A. B. (2013). Psychosocial benefits of a novel mindfulness intervention versus standard support in distressed women with breast cancer. Psycho‐Oncology, 22(11), 2565-2575. https://doi.org/10.1002/pon.3320
  • Monti, D. A., Kash, K. M., Kunkel, E. J., Brainard, G., Wintering, N., Moss, A. S., ... & Newberg, A. B. (2012). Changes in cerebral blood flow and anxiety associated with an 8‐week mindfulness programme in women with breast cancer. Stress and Health, 28(5), 397-407. https://doi.org/10.1002/smi.2470
  • Nural, N., Yaşar, Y. Ç., & Güner, S. G. (2019). Hope and life engagement of cancer patıents at the advanced stage. Asian Pacific Journal of Cancer Care, 4(2), 19-25. https://doi.org/10.31557/apjcc.2019.4.2.19-25
  • Ozen, B., Ceyhan, O., & Büyükcelik, A. (2020). Hope and perspective on death in patients with cancer. Death studies, 44(7), 412-418. https://doi.org/10.1080/07481187.2019.1626942
  • Sabancıoğulları, S., & Taşkın Yılmaz., F. (2021). The Efect of Religious Coping on Hope Level of Cancer Patients Receiving Chemotherapy, Journal of Religion and Health, 60:2756–2769 https://doi.org/10.1007/s10943-019-00944-1
  • Sandmire, D. A., Rankin, N. E., Gorham, S. R., Eggleston, D. T., French, C. A., Lodge, E. E., ... & Grimm, D. R. (2016). Psychological and autonomic effects of art making in college-aged students. Anxiety, Stress, & Coping, 29(5), 561-569. https://doi.org/10.1080/10615806.2015.1076798
  • Tang, Y., Fu, F., Gao, H., Shen, L., Chi, I., & Bai, Z. (2019). Art therapy for anxiety, depression, and fatigue in females with breast cancer: A systematic review. Journal of Psychosocial Oncology, 37,1:79–95. https://doi.org/10.1080/07347332.2018.1506855
  • Teker, A. G., & Ay, P. (2022). Has the cancer-related death trend been changing in Turkey? An evaluation of the period between 2009 and 2019. Cancer Epidemiology, 80, 102228. https://doi.org/10.1016/j.canep.2022.102228
  • Uslu-Sahan, F., Terzioglu, F., & Koc, G. (2019). Hopelessness, death anxiety, and social support of hospitalized patients with gynecologic cancer and their caregivers. Cancer Nursing, 42(5), 373-380. https://doi.org/10.1097/NCC.0000000000000622
  • Yakar, H. K., Yilmaz, B., Ozkol, O., Gevher, F. & Celik, E. (2021). Effects of art-based mandala intervention on distress and anxiety in cancer patients. Complementary Therapies in Clinical Practice, 43, 101331. https://doi.org/10.1016/j.ctcp.2021.101331
  • Yaman, Ş. ve Ayaz, S.( 2016). Psychological problems experienced by women with gynecological cancer and how they cope with it: a phenomenological study in Turkey. Health Soc Work. 41(3):173–181. https://doi.org/10.1093/hsw/hlw030
  • Wood, M.J.M., Molassiotis, A., & Payne, S. (2011). What research evidence is there for the use of art therapy in the management of symptoms in adults with cancer? A systematic review. Psycho-Oncology, 20,2: 135–145. https://doi.org/10.1002/pon.1722
  • Zhang, M. Q., Liu, X., & Huang, Y. (2024). Does mandala art improve psychological well-being in patients? A systematic review. Journal of Integrative and Complementary Medicine, 30(1), 25-36. https://doi.org/10.1089/jicm.2022.0780

Jinekolojik Kanserli Kadınlarda Mandala Aktivitesinin Umut Düzeyine Etkisi: Randomize Kontrollü Çalışma

Year 2025, Volume: 7 Issue: 3, 302 - 308, 27.09.2025
https://doi.org/10.35365/ctjpp.25.3.10

Abstract

Araştırma, mandala aktivitesinin jinekolojik kanserli kadınların umut düzeylerine etkisini belirlemek üzere yapılmıştır. Randomize kontrollü deneysel tipteki çalışma, Türkiye’nin batısında hizmet veren bir özel hastanenin onkoloji servisinde yatarak tedavi gören 45 girişim ve 45 kontrol hastası ile 1 Mart-1 Eylül 2021 tarihleri arasında gerçekleştirilmiştir. Araştırma kapsamında yer alan, girişim ve kontrol grupları arasında Hearth Umut İndeksi bakımından ön testte istatistiksel olarak anlamlı farklılık bulunmamakta iken (p>0,05); son testte girişim grubunun Hearth Umut İndeksi düzeyleri kontrol grubundan anlamlı derecede daha fazladır. Girişim grubunda son testte Hearth Umut İndeksi düzeyleri ön teste göre anlamlı derecede artarken; kontrol grubunda son testte Hearth Umut İndeksi düzeyleri ön teste göre anlamlı derecede azalmıştır (p<0,05). Mandala aktivitesinin jinekolojik kanserli kadınların umut düzeyini artırmada etkili olduğu saptanmıştır. Kontrol grubunda umut düzeyini azaltan etmenlere yönelik çalışmaların yapılması önerilmektedir.

Ethical Statement

Etik süreçlere uyulmuştur.

Supporting Institution

Yok

Thanks

Çalışmaya katılan tüm kadınlara teşekkür ederiz.

References

  • Akbulak, F. & Can, G. (2023). Effectiveness of mandala coloring in reducing anxiety in women with early stage breast cancer receiving chemotherapy for the first time, Explore, 19(1), 42-47. https://doi.org/10.1016/j.explore.2022.04.007
  • Altay, N., Kilicarslan-Toruner, E., & Sari, Ç. (2017). The effect of drawing and writing technique on the anxiety level of children undergoing cancer treatment. European Journal of Oncology Nursing. 28: 1-6. https://doi.org/10.1016/j.ejon.2017.02.007
  • Aslan, Ö., Sekmen, K., Kömürcü, Ş., & Özet, A. (2007). Kanserli Hastalarda Umut, C.Ü. Hemşirelik Yüksekokulu Dergisi, 11(2): 1-3.
  • Babouchkina, A., & Robbins, S. J. (2015). Reducing negative mood through mandala creation: A randomized controlled trial. Art Therapy, 2015, 32 (1), 34-39. https://doi.org/10.1080/07421656.2015.994428
  • Bell, J. G., McHale, J., Elliott, J. O. & Heaton, W. (2022). The impact of art therapy on anxiety and hope in patients with gynecologic cancer undergoing chemotherapy. The Arts in Psychotherapy, 80, 101947. https://doi.org/10.1016/j.aip.2022.101947
  • Czamanski-Cohen J, Wiley JF, Sela N, Caspi O, Weihs K. F. (2019). The role of emotional processing in art therapy (REPAT) for breast cancer patients. J Psychosoc Oncol, 37(5), 586–98. https://doi.org/10.1080/07347332.2019.1590491
  • Çelik M, Uğur Ö, Karadağ E. (2021). Relationship between hope and fatigue levels in cancer patients. J Health Sci Med, 4(6), 858-864. https://doi.org/10.32322/jhsm.974176
  • Doğan, R., & Özkan, M. (2022). Meme Kanserli Hastalarda Ameliyat Sonrası Resim Sanatının Umutsuzluk Ve Yorgunluk Üzerine Etkisi/Yarı Deneysel Bir Çalışma. Göbeklitepe Sağlık Bilimleri Dergisi, 5(7), 45-55. https://doi.org/10.55433/gsbd.127.
  • Ehsani, M., Ashghali Farahani, M., Haghani, S., & Negari, F. (2021). The Relationship Between Hope and Received Information About Cancer Among Women with Breast Cancer: A Descriptive-Correlational Study. International Journal of Cancer Management, 14(8), e114586 https://doi.org/10.5812/ijcm.114586.
  • Elimimian, E. B., Elson, L., Stone, E., Butler, R. S., Doll, M., Roshon, S., ... & Nahleh, Z. A. (2020). A pilot study of improved psychological distress with art therapy in patients with cancer undergoing chemotherapy. BMC Cancer, 20(1), 1-11. https://doi.org/10.1186/s12885-020-07380-5
  • Erdoğan Yüce, G. & Muz, G. (2020). Kanser hastalarında tedaviye bağlı bulantı ve kusmanın yönetimi. Nevşehir Bilim ve Teknoloji Dergisi, 9(2), 116-124. https://doi.org/10.17100/nevbiltek.697291
  • Forzoni, S., Perez, Mç, Martignetti, A., & Crispino, S. (2010). Art therapy with cancer patients during chemotherapy sessions: an analysis of the patients’ perception of helpfulness. Palliat Support Care. 8(1):41–48 https://doi.org/10.1017/S1478951509990691.
  • Geue, K., Goetze, H., Buttstaedt, M., Kleinert, E., Richter, D., & Singer, S. (2010). An overview of art therapy interventions for cancer patients and the results of research. Complement Ther Med, 18(3–4):160–70 https://doi.org/10.1016/j.ctim.2010.04.001. Gözüyeşil E, Düzgün A.A, Taş F. Bir Aile Sağlığı Merkezine Başvuran Kadınların Jinekolojik Kanser Farkındalıklarının Değerlendirilmesi. TJFMPC www.tjfmpc.gen.tr 2020; 14(2): 177-185. https://doi.org/10.21763/tjfmpc.730022
  • Hammer,K., Hall, E.O.C., & Mogensen, O. (2013). Hope pictured in drawings by women newly diagnosed with gynecologic cancer. Cancer Nursing, 36, 4,: 42–50 https://doi.org/10.1097/NCC.0b013e31826c7af2.
  • Henderson, P., Rosen, D., & Mascaro, N. Empirical study on the healing nature of mandalas. Psychology of Aesthetics, Creativity, and the Arts. 2007; 1 (3): 148 https://doi.org/10.1037/1931-3896.1.3.148.
  • Iżycki, D., Woźniak, K., Iżycka, N. (2016). Consequences of gynecological cancer in patients and their partners from the sexual and psychological perspective. Prz Menopauzalny, 15(2):112–116 https://doi.org/10.5114/pm.2016.61194.
  • Kavradim, S. T., Özer, Z. C., & Bozcuk, H. (2013). Hope in people with cancer: a multivariate analysis from T urkey. Journal of Advanced Nursing, 69(5), 1183-1196 https://doi.org/10.1111/j.1365-2648.2012.06110.x
  • Kim, H., Kim, S., Choe, K., & Kim, J.-S. (2018). Effects of mandala art therapy on subjective well-being, resilience, and hope in psychiatric inpatients. Archives of Psychiatric Nursing. 32 (2): 167-17 https://doi.org/10.1016/j.apnu.2017.08.008.
  • Kirshbaum, M.N., Ennis, G., Waheed, N., & Carter, F. (2017). Art in cancer care: exploring the role of visual art-making programs within an energy restoration framework. Eur J Oncol Nurs. 29:71–8 https://doi.org/10.1016/j.ejon.2017.05.003.
  • La Rosa, V. L., Shah, M., Kahramanoglu, I., Cerentini, T. M., Ciebiera, M., Lin, L. T., ... & Tesarik, J. (2020). Quality of life and fertility preservation counseling for women with gynecological cancer: an integrated psychological and clinical perspective. Journal of Psychosomatic Obstetrics & Gynecology, 41(2), 86-92. https://doi.org/10.1080/0167482X.2019.1648424
  • Lee, J., Choi, M.Y. & Kim, Y.B. (2017). Art therapy based on appreciation of famous paintings and its effect on distress among cancer patients. Quality of Life Research, 26,3: 707–715. https://doi.org/10.1007/s11136-016-1473-5
  • Lopez, A. L. J., Butow, P. N., Philp, S., Hobbs, K., Phillips, E., Robertson, R., & Juraskova, I. (2019). Age‐related supportive care needs of women with gynaecological cancer: a qualitative exploration. European Journal of Cancer Care, 28(4), e13070. https://doi.org/10.1111/ecc.13070.
  • Mengqin, Z., Xing, L., Yan, H., & Jianhua, R. (2024). Does mandala art therapy improve psychological well-Being of gynecological cancer patients during the perioperative period? A quasi-experimental study. Integrative Cancer Therapies, 23, 15347354241259180. https://doi.org/10.1177/15347354241259180
  • Monti, D. A., Kash, K. M., Kunkel, E. J., Moss, A., Mathews, M., Brainard, G., ... & Newberg, A. B. (2013). Psychosocial benefits of a novel mindfulness intervention versus standard support in distressed women with breast cancer. Psycho‐Oncology, 22(11), 2565-2575. https://doi.org/10.1002/pon.3320
  • Monti, D. A., Kash, K. M., Kunkel, E. J., Brainard, G., Wintering, N., Moss, A. S., ... & Newberg, A. B. (2012). Changes in cerebral blood flow and anxiety associated with an 8‐week mindfulness programme in women with breast cancer. Stress and Health, 28(5), 397-407. https://doi.org/10.1002/smi.2470
  • Nural, N., Yaşar, Y. Ç., & Güner, S. G. (2019). Hope and life engagement of cancer patıents at the advanced stage. Asian Pacific Journal of Cancer Care, 4(2), 19-25. https://doi.org/10.31557/apjcc.2019.4.2.19-25
  • Ozen, B., Ceyhan, O., & Büyükcelik, A. (2020). Hope and perspective on death in patients with cancer. Death studies, 44(7), 412-418. https://doi.org/10.1080/07481187.2019.1626942
  • Sabancıoğulları, S., & Taşkın Yılmaz., F. (2021). The Efect of Religious Coping on Hope Level of Cancer Patients Receiving Chemotherapy, Journal of Religion and Health, 60:2756–2769 https://doi.org/10.1007/s10943-019-00944-1
  • Sandmire, D. A., Rankin, N. E., Gorham, S. R., Eggleston, D. T., French, C. A., Lodge, E. E., ... & Grimm, D. R. (2016). Psychological and autonomic effects of art making in college-aged students. Anxiety, Stress, & Coping, 29(5), 561-569. https://doi.org/10.1080/10615806.2015.1076798
  • Tang, Y., Fu, F., Gao, H., Shen, L., Chi, I., & Bai, Z. (2019). Art therapy for anxiety, depression, and fatigue in females with breast cancer: A systematic review. Journal of Psychosocial Oncology, 37,1:79–95. https://doi.org/10.1080/07347332.2018.1506855
  • Teker, A. G., & Ay, P. (2022). Has the cancer-related death trend been changing in Turkey? An evaluation of the period between 2009 and 2019. Cancer Epidemiology, 80, 102228. https://doi.org/10.1016/j.canep.2022.102228
  • Uslu-Sahan, F., Terzioglu, F., & Koc, G. (2019). Hopelessness, death anxiety, and social support of hospitalized patients with gynecologic cancer and their caregivers. Cancer Nursing, 42(5), 373-380. https://doi.org/10.1097/NCC.0000000000000622
  • Yakar, H. K., Yilmaz, B., Ozkol, O., Gevher, F. & Celik, E. (2021). Effects of art-based mandala intervention on distress and anxiety in cancer patients. Complementary Therapies in Clinical Practice, 43, 101331. https://doi.org/10.1016/j.ctcp.2021.101331
  • Yaman, Ş. ve Ayaz, S.( 2016). Psychological problems experienced by women with gynecological cancer and how they cope with it: a phenomenological study in Turkey. Health Soc Work. 41(3):173–181. https://doi.org/10.1093/hsw/hlw030
  • Wood, M.J.M., Molassiotis, A., & Payne, S. (2011). What research evidence is there for the use of art therapy in the management of symptoms in adults with cancer? A systematic review. Psycho-Oncology, 20,2: 135–145. https://doi.org/10.1002/pon.1722
  • Zhang, M. Q., Liu, X., & Huang, Y. (2024). Does mandala art improve psychological well-being in patients? A systematic review. Journal of Integrative and Complementary Medicine, 30(1), 25-36. https://doi.org/10.1089/jicm.2022.0780
There are 36 citations in total.

Details

Primary Language Turkish
Subjects Health Psychology
Journal Section Research Articles
Authors

Kerime Derya Beydağ 0000-0002-7251-4882

Nursel Alp Dal 0000-0002-9364-3683

Publication Date September 27, 2025
Submission Date October 19, 2024
Acceptance Date July 7, 2025
Published in Issue Year 2025 Volume: 7 Issue: 3

Cite

APA Beydağ, K. D., & Alp Dal, N. (2025). Jinekolojik Kanserli Kadınlarda Mandala Aktivitesinin Umut Düzeyine Etkisi: Randomize Kontrollü Çalışma. Kıbrıs Türk Psikiyatri Ve Psikoloji Dergisi, 7(3), 302-308. https://doi.org/10.35365/ctjpp.25.3.10