The effect of the mandala method in reduction of psychological distress during anogenital examination of sexually abused children aged 9-12

ABSTRACT Ph.D. THESIS THE EFFECT OF THE MANDALA METHOD İN REDUCTİON OF PSYCHOLOGİCAL DİSTRESS DURİNG ANOGENİTAL EXAMİNATİON OF SEXUALLY ABUSED CHİLDREN AGED 9-12 Nurgül BOZKURT İstanbul University-Cerrahpaşa Institute of Graduate Studies Department of Mental Health and Psychiatric Nursing Mental Health and Psychiatric Nursing Programme Supervisor : Assoc. Prof. Dr. Sevil YILMAZ Objective: This study was to assess the efficacy of mandala coloring in mitigating psychological distress manifested during anogenital examinations of children aged 9–12 who have been subjected to sexual abuse. Method: The study was conducted at a Child Monitoring Center in Istanbul between November 2022 and June 2025, using a pretest–posttest randomized controlled experimental design. A total of 68 children were randomly assigned to an intervention (n = 34) and control (n = 34) group. The intervention group underwent a structured 30-minute mandala coloring activity before the anogenital examination, while the control group received only routine information. Data were collected using a Demographic Information Form, the State Anxiety Inventory for Children, the Children's Fear Scale, and heart rate and respiratory rate measurements. Results: Following the intervention, a significant decrease in the fear and state anxiety scores of the intervention group was observed. Additionally, a substantial decrease in heart rate and respiratory rate was noted (p < 0.001). In the control group, there was an increase or no change in fear and anxiety scores, and physiological indicators remained stable. Conclusion: A recent study has demonstrated the efficacy of mandala coloring as a method for reducing psychological and physiological tension in children undergoing anogenital examinations. It is recommended that mandala coloring be widely adopted in clinical practice at Child Monitoring Centers and other health units where anogenital examinations are performed. Furthermore, comparative studies should be conducted with other psychosocial approaches in different age groups. August 2025, 120 pages. Keywords: Anogenital examination, Sexual abuse, Child Monitoring Center, Anxiety, Fear, Mandala