Authors (including presenting author) :
Cheng E.K.N.(1), Siu A.M.H.(2), Chan F.S.M.(1), Chan D.Y.L.(1), Lai C.Y.Y.(3)
Affiliation :
(1) Occupational Therapy Department, Kowloon Hospital
(2) Department of Health Sciences, Brunel University London, United Kingdom
(3) Department of Rehabilitation Science, The Hong Kong Polytechnic University
Introduction :
Stress causes structural changes in the brain, resulting in multiple physical and mental health issues, decline in cognitive functions, memory and mood regulation, which affects one’s social functioning, learning and work efficacy.
Stress management training is one of the most common referral aims in Occupational Therapy (OT). OT uses therapeutic activities to increase independent function, prevent disability and enable one to live to the fullest. Traditional non-pharmacological interventions, like psychotherapy and relaxation, are always the choices. Meanwhile, body-mind interventions, including mindfulness and meditation, were proven to be most effective in stress and anxiety reduction by several meta-analyses. Different obstacles to engage in practicing mindfulness, such as finding time for formal practice, sleepiness for prolonged meditation practice and mind wandering, affects the adherence of the users and the treatment effectiveness.
Zentangle, “Zen” means meditation and “tangle” means pattern, is an easy-to-learn art. According to its developing philosophy, it may address the obstacles in practicing mindfulness by drawing simple patterns repeatedly. However, limited reviews on its therapeutic values and effectiveness can be found.
Objectives :
This paper aims at reviewing the therapeutic value of Zentangle drawing as an intervention for stress reduction systematically.
Methodology :
A systematic literature search was conducted in nine electronic databases by using the following search terms “Zentangle*”. The studies were included according to following criteria: 1) using Zentangle as an intervention; 2) either conducted in person or internet live mode. A total of 103 articles were obtained initially. Eight articles were finally selected and critically reviewed.
Result & Outcome :
Result
Zentangle is a relatively new intervention with limited literatures reviewing its therapeutic values. Among these eight papers, two were qualitative studies, three were mixed-method studies and the rest were quantitative studies. Half of these papers were student theses. Four studies were of high quality, one was of moderate quality and the rest were of low quality.
A variety of treatment effects have been reported, including improvement in self-esteem and self-confidence, reduced anxiety and stress, uplifted mood, and increased sense of social support. Some of the studies emphasized the presence of mindfulness elements in Zentangle drawing. The duration of sessions varied across studies. They ranged from one-off two-hour class to eight-weekly classes. There was no conclusive recommendation on the time to reach therapeutic effect nor the learning curve. Various group leading methods were reported, with only 5 studies followed the published Zentangle Methodology, which emphasizes the key therapeutic elements of Zentangle drawing, such as non-judging, openness and acceptance, no mistakes, and appreciations. This facilitates not only the positivity during self-practice, but also the harmonic relationship in the group dynamics.
Conclusion
Some preliminary evidence appears to support the hypothesis that Zentangle can be regarded as a mindfulness-based activity and may be beneficial for stress management. It is worthwhile to incorporate Zentangle into the tool box of OT on stress management. Potential target patients will be people with mood disorders or schizophrenia, who are vulnerable to stress and daily hassles, comprising over 70% of clientele in OT(Psychiatry). Its effectiveness on improving clients’ stress management and role functioning will then be explored in the future.
