EXPRESSIVE ARTS THERAPY FOR HOPE IN PEOPLE WITH SCHIZOPHRENIA

Schizophrenia is a chronic psychiatric disorder that significantly affects individuals' functioning, quality of life, and recovery processes. Hope has been identified as a central component of recovery in individuals with schizophrenia, as it supports coping, motivation, and engagement with treatment. However, structured psychosocial and nursing interventions specifically targeting hope remain limited.

Expressive arts therapy is a therapeutic approach that integrates creative expression processes such as drawing, collage, storytelling, and metaphor work to facilitate emotional expression, self-awareness, and psychological healing. Within psychiatric nursing, expressive arts therapy may offer a recovery-oriented approach that helps individuals express their experiences, reconstruct meaning, and strengthen hope.

This randomized controlled trial aimed to evaluate the effectiveness of an expressive arts therapy programme based on positive psychotherapy principles in strengthening hope among individuals diagnosed with schizophrenia. The study was conducted with 50 inpatients diagnosed with schizophrenia in a mental health hospital in Türkiye. Participants were randomly assigned to either an intervention group or a control group using a computer-generated randomization list prepared by an independent statistician.

Participants in the intervention group received an eight-session expressive arts therapy programme delivered face-to-face in small groups in addition to standard psychiatric care. Each session included psychoeducation, creative expression activities (such as drawing, collage, storytelling, and metaphor work), and group sharing processes aimed at strengthening emotional expression and hope. The control group received standard psychiatric inpatient care only.

Hope levels were assessed before and after the intervention using the Herth Hope Scale. The primary outcome of the study was the change in hope level measured by the Herth Hope Scale total score. Secondary outcomes included changes in the scale's subdimensions, including future orientation, positive readiness and expectancy, and interconnectedness.

The findings of this study are expected to contribute to the development of recovery-oriented psychosocial nursing interventions for individuals with schizophrenia and to provide evidence regarding the effectiveness of expressive arts therapy in strengthening hope.

Inclusion criteria

• Diagnosis of schizophrenia according to clinical evaluation
• Age between 18 and 65 years
• Hospitalized in a psychiatric inpatient unit
• At least six months since diagnosis
• Ability to read and understand assessment tools
• Clinically stable without acute psychotic symptoms
• Provided written informed consent

Exclusion criteria

• Severe cognitive impairment
• Acute psychotic symptoms requiring intensive treatment
• Severe physical illness preventing participation
• Refusal to participate or withdrawal of consent