231. Painting art therapy on self-identity reconstruction in patients with chronic mental illness from a narrative medicine perspective

Abstract Background Patients with chronic mental illness often experience fragmented self-identity and impaired social functioning. The traditional biomedical model has limitations in promoting the reconstruction of patient agency. Narrative medicine provides a humanistic framework for understanding illness experiences through attention, representation, and belonging. Painting art therapy, utilizing nonverbal expression, facilitates the exploration and integration of the self. Existing research predominantly focuses on symptom relief, with limited exploration of art therapy's profound impact on self-identity reconstruction from a narrative medicine perspective. Against this backdrop, this study investigates the effects of painting art therapy on self-identity reconstruction in chronic mental illness patients from a narrative medicine framework. It aims to validate whether painting art therapy integrated with narrative medicine principles can effectively promote self-identity reconstruction in chronic mental illness patients, offering a new pathway for mental health interventions that combines clinical efficacy with humanistic care. Methods Employing a mixed-methods design, the study recruited 60 patients diagnosed with stable chronic schizophrenia or bipolar disorder from a mental health center. Participants were randomly assigned to an intervention group (n = 30) and a control group (n = 30). The intervention group received 12 weeks of narrative medicine-guided art therapy (twice weekly), featuring structured activities such as illness story illustration, emotional symbol creation, and life map integration, supplemented by narrative interviews and reflective discussions. The control group maintained routine rehabilitation activities. Quantitative assessments were conducted using the Sense of Identity Scale (SIS), General Self-Efficacy Scale (GSES), and Symptom Checklist-90 (SCL-90) at baseline, post-intervention, and 3 months post-intervention. Semi-structured interviews were conducted with intervention group participants, and thematic analysis was performed on the textual data. Results Experimental results indicate that following the intervention, the total scores on the self-identity scale were significantly higher in the intervention group than in the control group (68.42 ± 6.31 vs. 58.15 ± 7.24, t = 5.892, p<.001), and their general self-efficacy scores also showed a marked improvement (28.50 ± 4.16 vs. 23.21 ± 4.80, t = 4.576, p<.001). The SCL-90 scale revealed that the intervention group exhibited more significant reductions in depression, anxiety, and interpersonal sensitivity factor scores compared to the control group (all p<.05). Qualitative analysis identified three core themes: “visual reconstruction of illness narratives,” “transformation of trauma symbols,” and “emergence of new self-narratives,” indicating that painting facilitated patients' acceptance of illness experiences and integration of personal life stories. Follow-up data showed stable self-identity scores in the intervention group, with sustained improvement in some indicators. Discussion This study confirms that art therapy grounded in narrative medicine effectively promotes self-identity reconstruction in chronic mental illness patients, yielding sustained effects in enhancing self-efficacy and alleviating psychological symptoms. By facilitating visual storytelling and reflective dialogue, this intervention helps patients transform fragmented illness experiences into coherent life narratives, holding significant clinical and public health implications. Future community mental health rehabilitation services should incorporate such humanities-art integrated intervention strategies. Multicenter, large-scale studies are recommended to validate long-term efficacy and underlying mechanisms, thereby providing evidence to advance holistic and humanized mental health service development.