<![CDATA[Background: Non-Suicidal Self-Injury (NSSI) is a self-harm behavior without suicidal intent that adolescents can use as a maladaptive coping mechanism in dealing with emotional distress. This condition is related to the problem of ineffective coping nursing, so nonpharmacological interventions are needed that can help adolescents recognize, express, and manage emotions more adaptively. One complementary approach that can be used is Zentangle-based activities. Objective: To describe the application of Zentangle-based activities in increasing effective coping in adolescents with Non-Suicidal Self-Injury (NSSI) behavior in the work area of UPTD Puskesmas Alak. Methods: This study used a multiple-case descriptive study on four adolescent girls aged 14–15 years with Non-Suicidal Self-Injury (NSSI) behavior and ineffective coping problems. Data collection was carried out through semi-structured interviews, observations, and documentation. Coping status was evaluated using the Coping Status output (SLKI L.09086). Zentangle-based activity interventions were administered individually for six weeks in 26 sessions, each lasting 30 minutes, consisting of 10 face-to-face sessions in the first week and 16 self-paced activity sessions in the second to sixth weeks with online monitoring. The interventions included gradual practice of Zentangle techniques, therapeutic communication, emotional exploration, reflection, and reinforcement of adaptive coping strategies. Results: Prior to the intervention, all respondents showed ineffective coping status with Coping Status scores of 21, 19, 21, and 24, respectively. After the implementation of Zentangle-based activities, scores increased to 37, 35, 36, and 38, with increases of 16, 16, 15, and 14 points, respectively. Descriptively, respondents also showed better ability to recognize and express emotions, use more adaptive coping strategies, and increase social participation. The findings showed a change towards a more adaptive coping status after the implementation of the intervention. Conclusion: The application of Zentangle-based activities showed potential in supporting the improvement of adaptive coping in adolescents with Non-Suicidal Self-Injury (NSSI) behavior. This activity can be considered as one of the complementary nursing interventions in supporting emotion management and coping in adolescents with NSSI, taking into account the limitations of the case study design and the need for further research with a stronger design]]>
