Effects of sandtray therapy on the life review, mental health, and cognitive ability of the community-dwelling older adults in Taiwan- A mixed-methods study

PURPOSE: Sandtray therapy is a non-pharmacological expressive intervention that enables individuals to communicate inner experiences through symbolic and metaphorical representation. Unlike traditional non-directive sandplay therapy, sandtray therapy is more structured and may include facilitator prompts. It has been associated with psychosocial benefits across diverse age groups experiencing psychological or behavioral challenges. This study examined the effects of sandtray therapy on cognition, mood, self-efficacy, life satisfaction, and gerotranscendence among community-dwelling older adults in Taiwan, and further explored participants' lived experiences. METHODS: A mixed-methods design was employed. A total of 140 participants were randomly assigned to an intervention or control group. The intervention group attended weekly 30-40-minute sandtray sessions for four weeks, while the control group received no intervention. Outcomes were assessed pre- and post-intervention using the Mini-Mental State Examination (MMSE), Geriatric Depression Scale-Short Form (GDS-SF), General Self-Efficacy Scale (GSES), Satisfaction with Life Scale (SWLS), and Gerotranscendence Scale (GS). Semi-structured interviews were conducted following the intervention. RESULTS: A one-way analysis of covariance analyses revealed significant between-group differences in self-efficacy (p < .001), life satisfaction (p < .001), and gerotranscendence (p < .001). No significant effects were observed for cognitive function or depressive symptoms. Qualitative analysis identified three overarching themes: building social connectedness, the essential role of play in later life, and engagement in cognitively demanding processes. CONCLUSIONS: Sandtray therapy appeared feasible and well-tolerated within this study sample. The findings suggest that sandtray therapy may serve as a beneficial non-pharmacological intervention for promoting positive aging, particularly through improvements in self-efficacy, life satisfaction, and psychosocial growth among older adults.