The effect of mandala therapy on anxiety, pain severity and distress of primary dysmenorrhea: A randomized clinical trial

Document Type : Original Article

Authors

1 B.Sc. of Nursing, Student Research Committee Center, School of Nursing, Arak University of Medical Sciences, Arak, Iran.

2 Instructor, Department of Psychiatric Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran.

3 Assistant Professor, Department of Biostatistics, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran.

4 Assistant Professor, Department of Midwifery, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran.

Abstract

Introduction: Dysmenorrhea is a common, painful, and debilitating problem of personal activity with psychological symptoms of anxiety and distress. The present study was performed with aim to investigate the effect of Mandela therapy on anxiety, pain intensity, and distress in primary dysmenorrhea.
Methods: This randomized clinical trial study was conducted in 2022 on 80 university students in Arak city who had a pain intensity score of 4 to 8. People were placed in the intervention and control groups. The intervention group painted the mandala for five days in two menstrual cycles. The questionnaires of Spielberger's anxiety, Moos menstrual distress, and numerical pain measure were completed by two groups before and after two intervention periods. Data were analyzed using SPSS statistical software (version 28) and Fisher's exact, independent t and paired t, and Mann-Whitney and Wilcoxon tests. P<0.05 was considered statistically significant.
Results: Although the mean score of dysmenorrhea distress after the intervention had a significant decrease in the intervention group (35.76±8.18) compared to the control group (40±7.93) (d=0.645, p=0.01), but the reduction in mean pain intensity in the intervention group (5.82±2.08) was not significantly different compared to the control group (6.45±1.96) (p>0.05). Also, there was no significant difference between the mean of trait and state anxiety in the two groups after the intervention (p>0.05).
Conclusion: Mandala therapy can be effective in reducing the distress caused by primary dysmenorrhea.

Keywords

References

  1. Dağlı SS, Dağlı R. Pain relief effects of aromatherapy with rose oil (Rosa damascena Mill.) inhalation in patients with primary dysmenorrhea: A randomized controlled clinical trial. Journal of Herbal Medicine 2023; 38:100637.
  2. Berek JS. Berek & Novak's gynecology. Lippincott Williams & Wilkins; 2019.
  3. Shabani F, Narenji F, Vakilian K, Zareian MA, Bozorgi M, Bioos S, et al. Comparing the Effect of Chamomile and Mefenamic Acid on Primary Dysmenorrhea Symptoms and Menstrual Bleeding: A Randomized Clinical Trial. The Open Public Health Journal 2022; 15(1).
  4. Unnisa H, Annam P, Gubba NC, Begum A, Thatikonda K. Assessment of quality of life and effect of non-pharmacological management in dysmenorrhea. Annals of Medicine and Surgery 2022; 81:104407.
  5. Alsaleem MA. Dysmenorrhea, associated symptoms, and management among students at King Khalid University, Saudi Arabia: An exploratory study. Journal of family medicine and primary care 2018; 7(4):769-74.
  6. Shirooye P, Adhami S, Hashem-Dabaghian F, Mokaberinejad R. General temperament and uterine temperament in patients with primary dysmenorrhea. Iran J Obstet Gynecol Infertil 2022; 25(4):35-42.
  7. Kerami A, Momeni H, Mahmodi M, Nasiri A, Shokhmgar Z, Sanagoo A, et al. The effects of the medicinal plant of marigold and mefenamic acid capsules on pain in girls with primary dysmenorrhea. Iran J Obstet Gynecol Infertil 2023; 26(2):56-64.
  8. Samani RO, Hashiani AA, Razavi M, Vesali S, Rezaeinejad M, Maroufizadeh S, et al. The prevalence of menstrual disorders in Iran: A systematic review and meta-analysis. International journal of reproductive biomedicine 2018; 16(11):665.
  9. Shabani F, Chabra A, Vakilian K, Bioos S, Bozorgi M, Ayati MH, et al. The Effect of Ginger-chamomile Sachet with Honey on Primary Dysmenorrhea and Associated Symptoms: A Randomized, Double-Blind, Controlled Trial. Current Women's Health Reviews 2020; 16(4):348-58.
  10. Itani R, Soubra L, Karout S, Rahme D, Karout L, Khojah HM. Primary dysmenorrhea: pathophysiology, diagnosis, and treatment updates. Korean journal of family medicine 2022; 43(2):101-8.
  11. Liu N, Li Y, Hong Y, Huo J, Chang T, Wang H, et al. Altered brain activities in mesocorticolimbic pathway in primary dysmenorrhea patients of long-term menstrual pain. Frontiers in Neuroscience 2023; 17:1098573.
  12. Kim SD. Quality of safety reporting for complementary and alternative therapies for dysmenorrhea. Complementary Therapies in Clinical Practice 2020; 39:101160.
  13. Armour M, Smith CA, Steel KA, Macmillan F. The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: a systematic review and meta-analysis. BMC complementary and alternative medicine 2019; 19(1):1-6.
  14. Bajalan Z, Moafi F, MoradiBaglooei M, Alimoradi Z. Mental health and primary dysmenorrhea: a systematic review. Journal of Psychosomatic Obstetrics & Gynecology 2019; 40(3):185-94.
  15. Kabukcu C, Başay BK, Başay Ö. Primary dysmenorrhea in adolescents: Association with attention deficit hyperactivity disorder and psychological symptoms. Taiwanese Journal of Obstetrics and Gynecology 2021; 60(2):311-7.
  16. Narenji F, Nahidi F, Ebadi A, Nasiri M. Maternal care for spiritual health of unborn child during pregnancy: A qualitative study with content analysis approach. Spirituality in Clinical Practice 2018; 5(4):251-60.
  17. Narenji F, Nejat N. Nurses and Midwives Are on the COVID-19 Frontline: Spiritual Care Matters. Iranian Journal of Psychiatry and Behavioral Sciences 2020; 14(4).
  18. Narenji F, Nahidi F, Ebadi A, Nasiri M. Spiritual health care during pregnancy from Iranian mothers’ perspective: a qualitative study with content analysis approach. Mental Health, Religion & Culture 2018; 21(5):458-69.
  19. Yonglitthipagon P, Muansiangsai S, Wongkhumngern W, Donpunha W, Chanavirut R, Siritaratiwat W, et al. Effect of yoga on the menstrual pain, physical fitness, and quality of life of young women with primary dysmenorrhea. Journal of bodywork and movement therapies 2017; 21(4):840-6.
  20. Payne LA, Seidman LC, Romero T, Sim MS. An open trial of a mind–body intervention for young women with moderate to severe primary dysmenorrhea. Pain Medicine 2020; 21(7):1385-92.
  21. Griffin C, Fenner P, Landorf KB, Cotchett M. Art therapy and eating disorders: A mixed methods feasibility study. The Arts in Psychotherapy 2023; 82:101994.
  22. Feen-Calligan H, Grasser LR, Smigels J, McCabe N, Kremer B, Al-Zuwayyin A, et al. Creating through COVID: Virtual art therapy for youth resettled as refugees. Art Therapy 2023; 40(1):22-30.
  23. Borzabadi Farahani Z, Rahgoi A, Fallahi-Khoshknab M, Hosseinzadeh S. The Effect of Art Therapy (Mandala Coloring) on the Attention Level of Children With Attention Deficit/Hyperactivity Disorder. Art Therapy 2023: 1-6.
  24. Duong K, Stargell NA, Mauk GW. Effectiveness of coloring mandala designs to reduce anxiety in graduate counseling students. Journal of Creativity in Mental Health 2018; 13(3):318-30.
  25. Kim H, Kim S, Choe K, Kim JS. Effects of mandala art therapy on subjective well-being, resilience, and hope in psychiatric inpatients. Archives of psychiatric nursing 2018; 32(2):167-73.
  26. Van Der Vennet R, Serice S. Can coloring mandalas reduce anxiety? A replication study. Art therapy 2012; 29(2):87-92.
  27. Noor SM, Saleem T, Azmat J, Arouj K. Mandala-coloring as a therapeutic intervention for anxiety reduction in university students. Pakistan Armed Forces Medical Journal 2017; 1(6):904-7.
  28. Khademi F, Rassouli M, Rafiei F, Moayedi S, Torres M, Marzban N, et al. The effect of mandala colouring on anxiety in hospitalized COVID‐19 patients: A randomized controlled clinical trial. International Journal of Mental Health Nursing 2021; 30:1437-44.
  29. Fong JS, Hui AN, Ho KM, Chan AK, Lee A. Brief mindful coloring for stress reduction in nurses working in a Hong Kong hospital during COVID-19 pandemic: A randomized controlled trial. Medicine 2022; 101(43).
  30. Jenabi E, Ebrahimzadeh S. Chamomile tea for relief of primary dysmenorrhea. Iran J Obstet Gynecol Infertil 2010; 13(1):39-45.
  31. Abadi MD, Vakilian K, Aghdam NS, Ranjbaran M. The effect of valerian and ginger on dysmenorrhea: a randomized clinical trial. Int J Women's Health Reprod Sci 2020; 8:101-5.
  32. Lu IC. Dysmenorrhea and related factors in Taiwanese adolescent girls. The University of Texas at Austin; 2010.
  33. Qorbanalipour K, Ghaderi F, Asghari Jafarabadi M, Mohammadalizade Charandabi S. Validity and reliability of the Persian version of modified Moos Menstrual Distress Questionnaire. Iran J Obstet Gynecol Infertil 2016; 19(29):11-8.
  34. Upadhyay C, Cameron K, Murphy L, Battistella M. Measuring pain in patients undergoing hemodialysis: a review of pain assessment tools. Clinical kidney journal 2014; 7(4):367-72.
  35. Mahram B. Validity and reliability of Spielberger anxiety test in Mashhad city. Tehran: Allame Tabatabayee University; 1998.
  36. Hosseini M, Borzabadi Farahani Z. Evaluating the Effectiveness of Mandala Coloring on Mental Health in Iran: A Systematic Review. Journal of Health Sciences & Surveillance System 2022; 10(2):144-9.
  37. Asgari S, Alimoardi Z, Soleimani MA, Allen KA, Bahrami N. The effect of psychoeducational intervention, based on a self-regulation model on menstrual distress in adolescents: a protocol of a randomized controlled trial. Trials 2020; 21:1-8.
  38. Choi H, Hahm SC, Jeon YH, Han JW, Kim SY, Woo JM. The effects of mindfulness-based mandala coloring, made in nature, on chronic widespread musculoskeletal pain: randomized trial. InHealthcare 2021; 9(6):642.
  39. Oh ST, Choi BC. The Study of Art Therapy using Mandala for Chronic Pain of Endometriosis. Virol & Immunol Journal 2023; 7(1).
  40. Mantzios M, Giannou K. When did coloring books become mindful? Exploring the effectiveness of a novel method of mindfulness-guided instructions for coloring books to increase mindfulness and decrease anxiety. Frontiers in psychology 2018; 9:56.
  41. Akbulak F, Can G. Effectiveness of mandala coloring in reducing anxiety in women with early-stage breast cancer receiving chemotherapy for the first time. EXPLORE 2023; 19(1):42-7.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 26, Issue 6
August 2023
Pages 83-93

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