Introduction: Once diagnosed with breast cancer, many women may experience psychological complications, such as anxiety. The grueling treatments that such patients may undergo, for example, chemotherapy, not only cause specific complications for them but also increase their anxiety level. A technique to manage these psychological consequences in patients with breast cancer is to play Sudoku or do Mandala painting. Purpose: This study aimed to compare the effects of Sudoku and Mandala painting on the anxiety level of patients with breast cancer undergoing chemotherapy. Methodology: This randomized clinical trial was conducted on 70 patients with breast cancer in Arak, Iran. The patients who met the inclusion criteria were selected through purposive sampling, and then they were assigned to one of the Mandala painting or Sudoku groups using block randomization. The data were collected using a demographics form and the Spielberger State-Trait Anxiety Inventory (STAI). All participants in both groups completed the research questionnaires before the intervention. The obtained data were analyzed using descriptive and inferential statistics in SPSS-26. Results: The results indicated that there was a significant difference between the pre-test and post-test anxiety scores in both Sudoku and Mandala painting groups (P = 0.0001). The difference between the pre-test and post-test mean anxiety scores was 6.09 ± 4.02 in the Sudoku group and 48.93 ± 13.8 in the Mandala painting group. The results of the inter-group comparison also showed a significant difference between the two groups in post-test mean anxiety score (P = 0.0001), proving that Mandala painting was more effective in reducing the anxiety of patients. Conclusion: Mandala painting was more effective than Sudoku in reducing the anxiety level of patients with breast cancer. It can be hence concluded that Mandala painting can be used as a relaxing art therapy technique in these patients.
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