Effectiveness of Coloring Mandala Designs to Reduce Anxiety in Graduate Counseling Students

The effect of mandala coloring and free coloring on the happiness in veterans with post-traumatic stress disorder in the Covid-19 pandemic: a randomized clinical trial

BACKGROUND

Post-traumatic stress disorder (PTSD) can lead to complications such as depression and grief, which are more prevalent in veterans than in the general population. Recently, art-making, including mandala coloring, has gained attention as a potential treatment for PTSD patients.

METHODS

This randomized clinical trial was conducted on 84 male veterans diagnosed with PTSD and hospitalized at the Milad Psychiatric Center in Tehran, Iran. The patients were recruited using a convenience sampling method and were assigned to either the mandala coloring group or the free coloring group. The Post-Traumatic Stress Disorder Checklist DSM-5 and the Oxford Happiness Scale were used to collect data. The intervention group colored mandala designs, while the control group colored squares freely. Coloring was done twice a week for three weeks.

RESULTS

The mean baseline happiness scores did not differ significantly between mandala coloring group and free coloring group (p = 0.376). However, at the end of study, happiness scores were significantly higher in mandala coloring group than in free coloring group (p < 0.001). After the intervention, happiness score of both groups increased significantly (p < 0.001).

CONCLUSION

Both coloring methods increased veterans' happiness scores; however, mandala coloring was more effective than free coloring. It is recommended that art-making be added to conventional treatments for veterans with PTSD.

TRIAL REGISTRATION

This study was registered in Iranian Registry of clinical trials (No. IRCT20210604051491N1, 29/08/2021).

Does Mandala Art Improve Psychological Well-Being in Patients? A Systematic Review

Objectives: Psychological disorders and symptoms are common and can significantly impair functioning in some areas in patients. We aimed to investigate the effects of mandala art (MA) on psychological well-being in patients. Design: A systematic review. Methods: We did a systematic review to assess the associations between MA and psychological well-being among patients. A systematic search of PubMed, EMBASE, Web of Science, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trial databases was conducted by independent reviewers from database inception to April 2023. We include randomized controlled trials, quasi-experimental studies, and qualitative studies. Outcome measures included any measurement of subjective and objective psychological well-being outcomes, such as stress, anxiety, depression, distress, mindfulness, hope, resilience, pain, mood, fatigue, and trauma symptoms. Results: Eleven studies of 405 participants were identified in the systematic review. Overall, the included studies provided preliminary evidence to suggest that MA may improve negative symptoms and hope, relieving pain, and reducing some physiological indicators of stress in patients. However, the quality of the existing evidence limited the generalization of results. Conclusions: According to the current evidence, the therapeutic benefits of using mandalas for improving the psychological well-being of patients are uncertain. More well-designed and high-quality studies in the field of MA are needed in the future.

Creative arts intervention in support of women experiencing a high-risk pregnancy: A qualitative descriptive thematic analysis

BACKGROUND

Mental illness can have negative effects on both the pregnant woman and her unborn child. Studies that use the creative arts as interventions have proven to be beneficial to women's antenatal mental health and wellbeing, however, these studies are limited and emergent. Music, drawing and narrative (MDN) is an established music therapy intervention, stemming from guided imagery and music (GIM), that has the potential to support positive mental health and wellbeing. Yet, to date, there have been limited studies on the use of this form of therapy with inpatient antenatal women.

AIM

To describe antenatal inpatient women's experiences of participating in a MDN session.

METHODS

Qualitative data were collected from a sample of 12 inpatient pregnant women who participated in MDN group sessions of drawing to music. Post intervention interviews explored the mental and emotional health of participants. A thematic analysis of the transcribed interview data was performed.

FINDINGS

Through reflection women were supported to acknowledge both the positives and difficulties of pregnancy as well as establish meaningful connections through shared experience. These thematic findings highlighted that MDN enabled this group of pregnant women to better communicate their feelings, validate emotions, engage in positive distractions, develop greater connections, improve optimism, experience calmness, and learn from others.

CONCLUSION

This project demonstrates that MDN may offer a viable method for supporting women experiencing high risk pregnancies.

The effect of mindfulness-based mandala activity on anxiety and spiritual well-being levels of senior nursing students: A randomized controlled study

PURPOSE

This study aimed to determine the effectiveness of mindfulness-based mandala activity on the anxiety levels and spiritual well-being of nursing students who started clinical practice after distance education during COVID-19 period.

DESIGN AND METHODS

This study is a randomized controlled study employing a pre-/posttest design with a single-blind, parallel group. The study was completed with a total of 170 participants (n = 84, intervention group; n = 86, control group). Data were collected using the Descriptive Characteristics Form, State-trait Anxiety Inventory, Spirituality Well-Being Scale, and Scale of Positive and Negative Experience. The intervention group participated in three mindfulness-based mandala sessions. This study was registered with ClinicalTrials.gov as NCT05053178.

FINDINGS

In three sessions, there was a significant decrease in the intervention group compared with the control group regarding the mean values of pretest and posttest anxiety levels. Evaluation of the mean scores Spiritual Well-Being Scale before and after the intervention showed a significant decrease in the scores between groups (p < 0.05).

PRACTICE IMPLICATIONS

With mindfulness-based mandala activity, the well-being of nursing students can be increased.

The effect of mandala colouring on anxiety in hospitalized COVID-19 patients: A randomized controlled clinical trial

COVID-19 significantly affects patients' mental health, triggering a wide range of psychological disorders, including anxiety. The aim of this study was to investigate the effect of mandala colouring on the anxiety of hospitalized COVID-19 patients. In this randomized controlled clinical trial, 70 hospitalized patients with COVID-19 were randomly divided between the intervention and control groups. Standard care was provided for both groups. The intervention group spent 30 min/day for six consecutive days performing mandala colouring. Patient anxiety was measured prior and subsequent to the intervention in both groups using the Spielberger State-Trait Anxiety Inventory. Data were analysed using SPSS software version 25. The mean anxiety score was not significantly different between the two groups before the intervention (P = 0.08). Subsequent to the intervention, the mean anxiety score in the intervention and control groups was 44.05 ± 4.67 and 67.85 ± 6.25, respectively, indicating a statistically significant (P = 0.0001) decrease in the anxiety measured among the intervention group as compared with that of the control group. The results of this study show that 30 min of mandala colouring daily is an effective strategy for reducing anxiety in hospitalized COVID-19 patients. Mandala colouring can complement routine treatment and provides a non-pharmaceutical option for decreasing patient anxiety.

Coloring Activities for Anxiety Reduction and Mood Improvement in Taiwanese Community-Dwelling Older Adults: A Randomized Controlled Study

To investigate the effect of mandala coloring, plaid pattern coloring, and free-form drawing activities on anxiety and mood in older Taiwanese adults. A total of 120 older adults aged 55 years to 75 years were recruited from 18 community-based learning centers for older adults in southern Taiwan. They were randomly assigned to engage in one of the following four activities for 20 minutes: (1) mandala coloring group, (2) plaid pattern coloring group, (3) free-form drawing group, and (4) reading group (control). Information on sociodemographic, lifestyle, and perceived health status was collected at the baseline. In addition, anxiety levels, measured using the 20-item State-Trait Anxiety Inventory–State Anxiety Scale (STAI-S), were ascertained at the baseline (T1), after a brief anxiety induction (T2), and at the end of the assigned activity (T3). The mean anxiety levels among the four groups at T3 were analyzed using analysis of covariance, followed by Šidák multiple comparison test, as appropriate. The mean age of the 120 study participants was 65.1 years and 73.3% were females. A significantly lower anxiety level was observed only in the mandala coloring group (least square mean = 28.2; 95% confidence interval = 24.7–31.7) compared with the control group (least square mean = 36.0; 95% confidence interval = 32.9–39.2) (P=0.004, partial eta-squared = 0.113). Furthermore, when the STAI-S was analyzed at the item level, the mandala coloring group was significantly different from the control group in the following six feelings: calmed down, safe, at ease, rested, satisfied, and I feel good. In conclusion, short-term mandala coloring activity could significantly alleviate self-induced anxiety in community-dwelling older adults. Further studies on the long-term effects of mandala coloring activity in improving the emotional well-being of older adults are warranted.