Wu, Tsai-JungTsai-JungWuSheih, Chen Su-MayChen Su-MaySheihJou, Shiann-TarngShiann-TarngJouLee, Chih-YingChih-YingLeeYu, Ting-YenTing-YenYuLiu, Chieh-YuChieh-YuLiuChen, Chi-WenChi-WenChen2025-12-302025-12-302025-06https://scholars.lib.ntu.edu.tw/handle/123456789/734826This study investigated the effects of interactive versus reading bibliotherapy using picture books on emotional distress, coping strategies, and resilience among adolescents with cancer.In this multicenter pilot randomized controlled trial with qualitative interviews, 27 patients aged 10-19 years diagnosed with leukemia or osteosarcoma within the past two years and undergoing treatment were randomly assigned to interactive bibliotherapy (n = 14) or reading bibliotherapy (n = 13). Each participant completed two sessions with picture books, 1-2 weeks apart. Emotional distress, coping strategies, and resilience were measured at baseline (T0), immediately post-intervention (T1), and at a one-month follow-up (T2). Interviews at T2 explored intervention effects and participant feedback.At one-month follow-up, the experimental group showed significantly lower negative affect than the comparison group. No significant differences were found in positive affect, coping strategies, or resilience. Participants reported interactive bibliotherapy promoted support, emotional connection, and inner strength, while the comparison group experienced brief relaxation and distraction. Picture books resonated with illness experiences and were suitable during chemotherapy. Participants recommended more frequent sessions.This study provided preliminary evidence that interactive bibliotherapy was more effective than reading bibliotherapy in alleviating emotional distress. Picture books may represent a promising psychological intervention for adolescents undergoing cancer treatment.www.gov, NCT05510635.enAdolescenBibliotherapyCoping skillsNeoplasmsPsychological distressResilience psychological[SDGs]SDG3journal article10.1016/j.ejon.2025.10290040381380