Participants in the experimental group will be provided with printed mandala designs on A4 sheets. The same mandala design will be used for all participants. A set of colored pencils will be provided. Participants will complete a single mandala coloring session. Psychological outcomes will be assessed at baseline and immediately after the intervention.

Participants in the control group will be provided with plain white A4 sheets and colored pencils and will engage in free-form drawing. Psychological outcomes will be assessed at baseline and immediately after the session.

This intervention involves a single-session structured mandala coloring activity using standardized printed mandala designs on A4 sheets. All participants receive the same design to ensure consistency and reduce variation across individuals. The intervention is designed as a brief, low-cost, non-pharmacological behavioral technique aimed at inducing relaxation and enhancing state mindfulness in patients undergoing hemodialysis.

State mindfulness will be assessed using the State Mindfulness Scale (SMS), a self-report questionnaire, rated on a 5-point Likert scale (1 = not at all to 5 = extremely).

Mood will be assessed using the Positive and Negative Affect Schedule (PANAS), a 20-item self-report scale rated on 5-point Likert scale ranging from 1 (very slightly or not at all) to 5 (extremely).

Psychological distress will be assessed using the Depression Anxiety Stress Scale (DASS-21), a 21-item scale rated on a 0-3 Likert scale where 0 = did not apply to me at all and 3 = applied to me most of the time.