The Impact of Mandala Coloring on Anxiety of Children with Cystic Fibrosis: A Randomized Trial.

Background: Mandala coloring is effective in reducing anxiety. However, it has received little attention as an adjunctive therapy to manage children's anxiety. This study aimed to explore the impact of mandala coloring on the anxiety of children with Cystic Fibrosis (CF).

Materials and methods: The participants in this clinical trial study were 120 children aged 6-18 years with CF with mild-to-moderate anxiety admitted to Mofid Hospital in Tehran. The children were randomly divided into two groups: intervention and control. The children in the intervention group performed mandala coloring exercises every evening for 30 minutes for 6 consecutive days. The level of anxiety in the children in both groups was measured using the Spielberger State-Trait Anxiety Inventory before the intervention and 6 days after the first measurement. The collected data were analyzed using the independent t-test.

Results: An analysis of the mean anxiety scores before and after the intervention showed a significant decrease in the anxiety level in the Mandala group (Z = -3.74, p < 0.05). Moreover, a significant decrease was observed after the intervention between the children in the mandala and control groups in terms of average anxiety levels (U = 1206, p < 0.05). An intergroup comparison showed that state anxiety was significantly different between the two groups (U = 1143, p < 0.05), but no statistical difference was observed in terms of trait anxiety (p > 0.05).

Conclusions: The results indicated that holding six mandala coloring sessions reduced the anxiety of children with CF. Thus, mandala coloring is recommended as a complementary non-pharmacological method to reduce children's anxiety.