BACKGROUND: According to flow theory, flow experience is the mental state that happens while a person is performing an activity with full involvement and is experiencing full immersion in energetic focus, action, and enjoyment during the doing process. Furthermore, on the basis of self-determination theory, “autonomy support” and “structure” were described as important contextual factors to promote motivation to engage in activities. Moreover, in occupational therapy practice, the “just right challenge” has been encouraged to help people obtain flow experience. Against this background, the aim of this study was to explore the contributions of autonomy support, structure, and perceived challenges on facilitating flow experience in persons with schizophrenia.

METHOD: This study used a cross-sectional design involving all related data being collected at the same time. Each participant was asked to complete a battery of questionnaires, including providing his or her most important and meaningful daily activity while filling in the Dispositional Flow Scale—Second Edition (DFS–2) and the Activity Participation and Restriction Questionnaire (APRQ). Then the participant was encouraged by the instructor with well autonomy support to choose one activity from nine common activities (e.g., drawing, puzzle, table games, target games, and dice stacking) and to conduct the selected activity with the clear activity structure, followed by filling in the Flow State Scale—Second Edition (FSS–2).

Data were collected at psychiatric outpatient clinics, day hospitals, and vocational rehabilitation programs in Taipei, Taiwan. Participants were 229 adults diagnosed with schizophrenia or schizoaffective disorder. Research instruments included the DFS–2, FSS–2, General Causality Orientation Scale (GCOS), APRQ, Satisfaction With Life Scale (SWLS), and Positive and Negative Symptom Scale (PANSS). The degrees (from 0 to 10) of autonomy support, structure, and perceived challenge were also measured. Analysis of variance (ANOVA), Pearson correlation, and hierarchical regression were used to analyze the data.

RESULTS: The results show that autonomy support, structure, perceived challenge, and dispositional flow tendency were correlated with the flow status while engaging in activities. The results of hierarchical regression analysis show that the flow status while engaging in activities can be positively predicted by life satisfaction, dispositional flow tendency, and activity structure; furthermore, flow status can be negatively predicted by the perceived challenge (change in F = 12.98, p < .01). DFS–2 and FSS–2 scores were not correlated to PANSS scores. FSS–2 scores did not show significant difference among different types of activity.

CONCLUSION: This study indicated that when more activity structures were applied within the autonomy support circumstance, the participant perceived less challenge, but the skill level of the participant with schizophrenia was still matched to increase flow experience in activities. A limitation of the study was that participants at acute psychiatric admission were not included.

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