NCT07461922

Mandala Intervention on Mother-Infant Bonding and Parenting Self-Efficacy After Negative Birth Experiences

The Effect of a Mandala-Based Intervention on Mother-Infant Bonding and Parenting Self-Efficacy in Primiparous Women With a Negative Birth Experience: A Randomized Controlled Trial

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 66 (actual)
• Sponsor: Çanakkale Onsekiz Mart University · Academic / Other
• Sex: Female
• Age: 18 Years – 35 Years
• Healthy volunteers: Accepted

Summary

The purpose of this randomized controlled trial is to evaluate the impact of a mandala-based art intervention on mother-infant bonding and parenting self-efficacy among primiparous women (first-time mothers) who have had a negative birth experience. The study focuses on how structured creative activities can support emotional recovery and maternal confidence in the early postpartum period. A total of 66 participants were randomly assigned to either a Mandala Coloring Group or a Free Coloring Group. The intervention group participated in a structured session involving guided breathing, imagery, and symbolic mandala drawing designed for stress reduction and emotional expression. The control group engaged in a non-guided, free coloring activity. Data were collected using standardized tools, including the Mother-Infant Bonding Scale, the Karitane Parenting Confidence Scale, and the State-Trait Anxiety Inventory. The primary goal is to determine if the mandala-based intervention leads to significant improvements in the bond between mother and infant and increases the mother's confidence in her parenting abilities. Secondary outcomes include changes in anxiety levels following the intervention. All procedures were conducted in a supportive environment under researcher supervision to ensure participant safety and data integrity.

Detailed description

This randomized controlled trial evaluates the effects of a mandala-based intervention on mother-infant bonding and parenting self-efficacy in primiparous women (first-time mothers) who experienced a negative birth experience. Study Design and Population The study was conducted in the obstetrics clinic of a hospital. Power analysis indicated a minimum sample size of 44 participants to achieve 80% power at a 0.05 significance level. To account for potential attrition, the study aimed for 70 participants and was completed with 66 mothers (34 in the Mandala Group and 32 in the Free Coloring Group). Inclusion Criteria Eligible participants included women who had a vaginal delivery, were within the first seven days postpartum, were primiparous with a singleton pregnancy, and self-reported a negative birth experience confirmed by a score of 37 or above on the Wijma Delivery Expectancy/Experience Questionnaire Version B. Participants were required to have no diagnosed psychological disorders and no communication difficulties. Randomization and Procedure Participants were randomly assigned to either the Mandala Coloring Group or the Free Coloring Group using random allocation software. Data collection occurred at two time points: before and after the intervention. Intervention Protocols The intervention was conducted face-to-face in a quiet, supportive environment under researcher supervision, typically when the infant was asleep. Each session lasted approximately 30 minutes. Mandala Coloring Group: This structured relaxation process included brief information on mandala philosophy, five minutes of "box breathing" relaxation, and guided imagery of a seaside scene. Participants created and colored a "wish mandala" representing personal intentions, accompanied by shamanic drum rhythm music. The session concluded with the creation of a "stress mandala" using spiral drawings to symbolically release stress. Free Coloring Group: This activity allowed participants to express emotions spontaneously without guidance. Participants began drawing without prior planning, and the resulting images were evaluated as personal reflections rather than artistic products. Outcome Assessments The primary outcomes include changes in the Mother-Infant Bonding Scale and the Karitane Parenting Confidence Scale. Secondary outcomes include changes in anxiety levels measured by the State-Trait Anxiety Inventory. Ethical approval was obtained prior to the study, and all participants provided written informed consent in accordance with the Declaration of Helsinki.

Conditions

• Mother-Infant Bonding

Interventions

Type	Name	Description
OTHER	Mandala Coloring	The mandala practice was carried out as a structured relaxation and expression process with the following steps (Sarı Öztürk et al., 2022): Information: The participant was given brief information about the philosophy of mandalas. Breathing Exercise: Relaxation was practiced for approximately 5 minutes using the "square breath" technique. Guided Visualization: The participant was asked to imagine a scene by the sea and clear their mind. Wish Mandala: The participant was asked to draw and color a mandala representing their own feelings and wishes. It was suggested that the mandala be named and hung in their room if desired. Visualization and Music: The guided visualization process was supported by the rhythm of a shamanic drum in the background. Stress Mandala: The participant released their stress with drawings spiraling outwards from the center, and if desired, completed this work symbolically by tearing it or releasing it into water.
OTHER	Free Coloring	The free painting activity aims to allow the mother to freely express her feelings without any guidance. Initiation: The participant began drawing without any plan. Creative Flow: The drawings reflected the participant's current mood and emotional state. Exploration and Expression: Inner exploration was achieved through the images and themes that emerged during the process. Completion: Upon completion of the work, the participant evaluated the resulting picture as a personal reflection. This activity was evaluated solely for the purpose of emotional expression, not based on artistic skill.

Timeline

• Start date: 2025-06-26
• Primary completion: 2025-11-28
• Completion: 2025-12-29
• First posted: 2026-03-10
• Last updated: 2026-03-10

Locations

1 site across 1 country: Turkey (Türkiye)