The Effectiveness of a Mindfulness-Based Art Therapy Program on Sleep Quality among Urban Older Adults in Thailand: A Quasi-Experimental Study

Abstract

Background: Approximately 50% of older adults experience sleep disturbances. The preservation of high-quality sleep is essential; consequently, there is a pressing need for effective interventions to enhance sleep quality. Purpose: This study aimed to determine the effectiveness of the Mindfulness-Based Art Therapy (MBAT) on sleep quality, depression anxiety stress, and mindful attention awareness among older adults in urban contexts. Patients and Methods: A quasi-experimental study with a one-group pretest-posttest design was conducted from March to May 2025. A random sample of 35 older adults with sleep problems was selected from 98 volunteers in Bangkok to participate in a six-week MBAT program using Mandala coloring. Data collection included a Personal Information Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Depression Anxiety Stress Scales (DASS-21), and the Mindful Attention Awareness Scale (MAAS) at baseline (pre-test), 6 weeks (post-test), and 10 weeks (follow-up). Data were analyzed using descriptive statistics, one-way repeated measures ANOVA, and the Friedman test. Results: Significant changes in PSQI scores ( p < 0.001) and DASS-21 scores ( p < 0.050), were observed over the 10 weeks study. Multiple comparisons revealed that participants showed significant improvements in PSQI scores from baseline to the 6 weeks and from baseline to 10 weeks ( p < 0.001 and < 0.001, respectively) and DASS-21 scores were significantly different between the 6 weeks and 10 weeks ( p < 0.050). Effect sizes indicated large effects for PSQI scores and DASS-21 scores. MAAS scores showed medium effects that were not statistically significant. Conclusion: The MBAT program enhances relaxation for older adults, improving their sleep quality and mental health. It incorporates education on sleep hygiene, stimulus control, sleep restriction, relaxation techniques, and weekly telenursing sessions. The findings suggest it should be integrated into standard nursing care, and future research should consider extending the program’s duration to better change the MAAS score. Trial Registry Number: Thai Clinical Trials Registry (TCTR20250409001). ( https://www.thaiclinicaltrials.org/show/TCTR20250409001 ). Keywords: cognitive behavioral therapy, insomnia, CBT-I, aging, telehealth, mandala

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