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

NCT07461922 | Completed

• 1 other identifier: 2025-YÖNP-0105
• Study Type: interventional
• Target: 66
• Locations: 1 country
• Sites: 1

Brief 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.

Conditions

Mother-Infant Bonding

Keywords

Mandala Coloring; Mother-Infant Bonding; Art-Based Intervention

Outcome Measures

Primary Outcomes (1)

• Mother-Infant Bonding Scale (MIBS)

  The Mother-Infant Bonding Scale (MIBS) is an 8-item self-report instrument used to evaluate a mother's feelings toward her infant during the early postpartum period. Each item is scored on a 4-point Likert scale (0 to 3). Total scores range from a minimum of 0 to a maximum of 24. The scale includes five reverse-scored items reflecting negative emotions (e.g., anger, disappointment). A higher total score indicates a higher level of bonding difficulties or problematic attachment, which represents a worse outcome. A score of 13 or higher is used as a threshold to predict problematic bonding.

  Immediately after the intervention (Day 1) and post intervention

Secondary Outcomes (2)

• Karitane Parenting Confidence Scale (KPSCS)

  Immediately after the intervention (Day 1) and post intervention

• State-Trait Anxiety Inventory (STAI)

  Immediately after the intervention (Day 1) and post intervention

Study Arms (2)

Free Cloring

SHAM COMPARATOR

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.

Other: Free Coloring

Mandala Coloring

EXPERIMENTAL

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: Mandala Coloring

Interventions

Mandala Coloring OTHER

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.

Mandala Coloring

Free Coloring OTHER

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.

Free Cloring

Eligibility Criteria

• Age: 18 Years - 35 Years
• Gender Eligibility Details: Postpartum mother
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Having had a vaginal delivery
• Scoring 37 or above on the Wijma Delivery Expectancy/Experience Questionnaire Version B (W-DEQ-B)
• Being within the first seven days postpartum
• Being primiparous (first-time mother) with a singleton pregnancy
• Self-reporting a negative or adverse birth experience
• The infant being rooming-in with the mother
• Having no diagnosed psychological disorders or problems
• Voluntarily agreeing to participate in the research
• Having no communication difficulties

You may not qualify if:

• Having a diagnosed psychiatric disorder or currently receiving psychiatric treatment
• Use of psychotropic medication during the postpartum period
• Experiencing severe obstetric complications (e.g., postpartum hemorrhage, eclampsia, emergency hysterectomy)
• Neonatal complications requiring admission to the neonatal intensive care unit (NICU)
• Having a multiple pregnancy (twins, triplets, etc.) or a cesarean delivery
• Severe communication difficulties or inability to understand study procedures
• Participation in another psychosocial or art-based intervention during the study period
• Withdrawal of consent at any stage of the study

Sponsors & Collaborators

• Çanakkale Onsekiz Mart University: lead

Study Sites (1)

Çanakkale Onsekiz Mart University

Çanakkale, Turkey (Türkiye)

Location

Related Publications (6)

• Ucar, E. (2013). Wijma Doğum Beklentisi/Deneyimi Ölçeği B Versiyonu Türkçe uyarlaması ve geçerlilik-güvenilirlik çalışması [Yüksek Lisans Tezi, Hacettepe Üniversitesi].

  RESULT

• Yılmaz, E., & Oskay, Ü. (2021). Karitane Ebeveyn Kendine Güven Ölçeği'nin Türkçe uyarlaması ve psikometrik değerlendirmesi. Psikiyatri Hemşireliği Dergisi, 12(1), 34-42.

  RESULT

• Kırca, Ş., Dağlı, H., et al. (2024). Mandala art intervention as a therapy for anxiety in postpartum women: A randomized controlled trial. Women's Mental Health Journal, 18(2), 79-85.

  RESULT

• Akbulak, F., & Can, R. (2023). Mandala boyamanın ruh sağlığı üzerindeki etkisi: Bir sistematik inceleme. Sanat ve Psikoloji Dergisi, 15(2), 102-117.

  RESULT

• Amelia, S., Jones, T., & Smith, R. (2020). Art therapy through mandalas: Reducing anxiety and enhancing emotional well-being. Journal of Art Therapy, 26(1), 35-42.

  RESULT

• Hopewell, S., Chan, A. W., Collins, G. S., Hróbjartsson, A., Moher, D., Schulz, K. F., ... & Boutron, I. (2025). CONSORT 2025 statement: updated guideline for reporting randomised trials. The Lancet, 405(10489), 1633-1640.

  RESULT

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Model Details: This interventional study was designed as a randomized, parallel-group controlled trial. Eligible primiparous postpartum women with a negative birth experience were randomly assigned to one of two parallel arms: a mandala-based intervention group or a free coloring control group. Each participant received only the intervention allocated to her group, and no crossover between groups occurred. Both study arms were conducted concurrently. Outcome measures were assessed at baseline before the intervention and immediately after completion of the single-session intervention. The parallel-group design enabled direct comparison between the intervention and control groups while minimizing contamination and supporting internal validity.

Study Record Dates

• First Submitted: December 29, 2025
• First Posted: March 10, 2026
• Study Start: June 26, 2025
• Primary Completion: November 28, 2025
• Study Completion: December 29, 2025
• Last Updated: March 10, 2026

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)