A creative Journey Through Advanced Cancer: A Pilot Randomized Controlled Study of Existential Art Therapy

Objective: This pilot randomized controlled study examined the preliminary effects of Existential Art Therapy (EAT) on cancer response styles, spiritual well-being, and hopelessness in individuals with stage IV cancer. Method: Thirty participants were randomly assigned in a 1:1 ratio to the EAT intervention or a wait-list control condition. Twenty-eight participants completed the study and were included in the analyses (13 EAT, 15 control). The intervention comprised eight weekly group sessions. Change scores, calculated as posttest minus pretest, were compared between groups using Mann–Whitney U tests with Holm correction. Cliff’s delta with 95% bootstrap confidence intervals (CIs) was used to estimate effect sizes. Results: The principal between-group finding was a greater reduction in cancer-related Helplessness/Hopelessness in the EAT group (median change: −2 vs. 1; U = 38.50, adjusted p = 0.043; δ = −0.61, 95% CI [−0.85, −0.19]). Spiritual well-being increased more in the EAT group (median change: 5 vs. 1; δ = 0.44, 95% CI [−0.06, 0.78]), although this difference did not remain statistically significant after Holm correction (adjusted p = 0.280). Fighting Spirit decreased within the EAT group, but the change did not differ significantly between groups. No statistically significant between-group differences were found for the remaining outcomes. Conclusions: EAT provided preliminary evidence of a reduction in cancer-specific Helplessness/Hopelessness, but broader effects were not established. Larger, adequately powered trials with active control conditions and follow-up assessments are needed.