INTRODUCTION: Schizophrenia is a chronic mental disorder that adversely affects patients' self-esteem. Activity therapy has been shown to positively influence self-esteem. This study aims to examine the efficacy of activity therapy in improving self-esteem among patients with schizophrenia. METHODS: In this randomized controlled study, 79 patients diagnosed with schizophrenia were enrolled using a consecutive sampling technique. The participants were assigned into intervention (39 participants) and control groups (40 participants) using computer-generated randomization. Researchers used The Rosenberg Self-Esteem Scale (RSES) to assess the participants' self-esteem. The intervention group underwent activity therapy of making bags and envelopes using paper for seven days. The control group received routine psychiatric care. The post-test assessment was done using RSES after 7 and 15 days of intervention. Data was analyzed using descriptive and inferential statistics using SPSS software version 21. RESULTS: The total self-esteem score at both 7 days and 15 days post-intervention were significantly higher in the intervention group compared to the control group. CONCLUSION: Evidence suggests that structured manual activities, such as the fabrication of paper bags and envelopes, may contribute to enhanced self-esteem and greater self-efficacy in patients, thereby facilitating improved psychosocial functioning. However, additional rigorous research is required to substantiate these observations.