The Impact of Mandala Coloring on Anxiety of Children with Cystic Fibrosis: A Randomized Trial
September 11th, 2025
Tehran, Iran
Ali Omidi, Reihane Moghimian Shahrbabaki, Sahar Tatlari, Poorya Babarabi, Ghamartaj Khanbabaee, Maryam Rassouli
A clinical trial with 120 children aged 6 - 18 with cystic fibrosis found that daily mandala coloring for six days significantly reduced their anxiety compared with routine care. State anxiety decreased in the coloring group, suggesting mandala coloring may be a helpful non-pharmacological anxiety reduction method.
Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Department of Pediatric and Neonatal Intensive Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Pediatric Respiratory Ward, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
DOI: 10.4103/ijnmr.ijnmr_219_24
Posted byRiley Fitzpatrick
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Abstract/Description
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).
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.
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).
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.
