Volume 5, Issue 3 (Vol 5, No 3 (17) 2024)                   2024, 5(3): 77-92 | Back to browse issues page

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Karimi Farsani A, Bahramipour Isfahani M. (2024). The Effectiveness of Dual Music Therapy on Parenting Stress, Anxiety and Attachment Style of Anxious Children. Journal of Childhood Health and Education. 5(3), : 7 doi:10.32592/jeche.5.3.77
URL: http://jeche.ir/article-1-179-en.html
The Effectiveness of Dual Music Therapy on Parenting Stress, Anxiety and Attachment Style of Anxious Children
Arezoo Karimi Farsani1, Mansoureh Bahramipour Isfahani *2
1- Ms.c. of Cilinical Psychology, Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
2- Assistant Professor, Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
Keywords: Anxiety, Attachment style, Dual music therapy, Parenting stress
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Extended Abstract

Background and Aim:
In recent years, several factors have been identified in students' academic processes that can negatively impact their academic performance. One of these factors is the presence of anxiety, which leads to academic difficulties among students (Rahmati et al., 2021). The occurrence of anxiety can cause psychological distress in the student community, resulting in a marked decline in their academic efficiency (Mahmoudi-Golougahai & Khanekeshi, 2023). Studies demonstrated that parents of anxious children experience more stress compared to parents of normal children (Sadeghzadeh et al., 2023). A mother's mood affects the behavioral problems of anxious children and even impacts the mental health of fathers, which can either facilitate or hinder the recovery of these children (Abolmaali et al., 2021). Therefore, one of the critical and influential factors in child anxiety is parental stress, which refers to parents' psychological reactions to the challenges and demands of their parenting roles (Zhang et al., 2020). Parental stress and how it is managed is a significant predictor of internalizing such problems as anxiety in children (Hosseinzadeh et al., 2020).
Attachment styles also develop through the way a child interacts with their parents, and as the child grows, their attachment patterns become more stable and less vulnerable to environmental factors (Shi et al., 2021). According to John Bowlby's attachment theory, emotions are a fundamental part of attachment, and children with a secure attachment style experience a sense of safety and a lack of excessive anxiety. On the Contrary, children with insecure attachment styles (avoidant and disorganized) perceive the world as an unsafe and stressful environment and lack the ability to effectively handle stressful situations (Janssen et al., 2024).
One non-pharmacological treatment that has seen significant growth in recent years for psychological disorders is music therapy. Music therapy can effectively treat stress-related and emotional disorders in humans (Asghari et al., 2014). A study in 2019 demonstrated that music increases dopamine release in brain synapses. Dual music therapy involves the use of music to induce relaxation, improve mental function, and promote health in individuals. It is one of the creative art therapies or expressive therapies (including art therapy, poetry therapy, drama therapy, and psychodrama) (Monir et al., 2024). This therapy is a complementary treatment conducted with the simultaneous presence of both mother and child in sessions, aimed at improving well-being by increasing stress tolerance, eliminating negative emotions, enhancing regulation of internal processes, inducing calmness, and boosting immunity (Sanjari, 2018).
Given the challenges presented to anxious children, it seems necessary to develop intervention and preventive programs. This study aimed to determine the effectiveness of dual music therapy in parental stress, anxiety, and attachment styles of anxious children. The hypotheses of this research were as follows:

  • Dual music therapy has a significant effect on parental stress among parents of anxious children.
  • Dual music therapy has a significant effect on attachment styles of anxious children.
  • Dual music therapy has a significant effect on reducing anxiety in anxious children.
Methods:
This quasi-experimental study was conducted based on a pretest-posttest control group design with a follow-up. The statistical population consisted of all children aged 5-9 with anxiety in Isfahan. Using purposive sampling, 1,400 children were screened from psychological and counseling service clinic clients through the Spence Children's Anxiety Scale (Spence et al., 2001) and clinical interviews. Of these, 30 children with anxiety (scoring 56 or above) were randomly assigned to experimental and control groups. The required sample size, considering a 95% confidence level, was set at 15 participants per group. The inclusion criteria for the study entaild parents' willingness and informed consent to participate, a score above the average (56) in the Spence Anxiety Scale and clinical interview, and the absence of other confounding factors in the research. On the other hand, the exclusion criteria were withdrawal from the study, missing more than two sessions, failure to complete exercises and assignments, and undergoing other treatments or psychological interventions.
After collecting pre-test data and randomly assigning participants to either the dual music therapy group or the control group, the dual music therapy was administered in 12 sessions, each lasting 90-120 minutes. The dual music therapy was designed by Seyedanlou and Bagherpour (2018), and its validity was confirmed in a previous study by examining its effectiveness on such variables as parenting competence, parent-child interaction, and parenting stress in families with 7-9-year-old children experiencing emotional neglect (Sanjari, 2018). The sessions were held in the play therapy room of a children's psychological counseling center in Isfahan, with the simultaneous participation of the child and mother, under the supervision of a clinical psychology therapist with a master's degree, an official certification, and experience in child therapy. The control group was on a waiting list and received no intervention during the treatment period. After the therapy sessions, a post-test was conducted for both groups. The measurement tools included parenting stress questionnaires by Abidin (1991), children's anxiety form by Spence (2001), and Fanzi-Dutton (1996) attachment style. Data were analyzed in SPSS software (version 24) using descriptive statistics, such as central tendency indices (mean and standard deviation), repeated measures analysis of variance, and Bonferroni post-hoc test.
Results:
Repeated measures analysis of variance was used to assess the effectiveness of dual music therapy on parental stress, anxiety, and attachment styles in anxious children. According to the results, the mean scores of parental stress significantly increased in the experimental group, while no change was observed in the control group. In addition, the scores for secure attachment style increased slightly, while the scores for anxious and avoidant attachment styles decreased. Finally, anxiety scores in the experimental group exhibited a reduction. The Wilks' Lambda test results, with values of 0.36, 0.01, and 0.02 for between-group effects, within-group effects, and the interaction effect of dual music therapy on parental stress, anxiety, and attachment styles of the children, respectively, indicated that this intervention had a significant effect on at least one of the dependent variables.
A significant difference was detected between the three measurement times (pre-test, post-test, and follow-up) for the scales of parental stress, attachment styles (including secure and anxious attachment), and anxiety (including dimensions of generalized anxiety, social anxiety, health anxiety, and sadness) at a significance level of P<0.05. Nonetheless, no significant difference was observed for avoidant attachment style and obsessive-compulsive symptoms. Moreover, the significance of the group variable across groups indicated a significant difference between the experimental and control groups for anxiety scales (including generalized, social, health-related anxiety, and sadness) at a significance level of P<0.01, but not for anxious or avoidant attachment styles.
Overall, the findings suggested that dual music therapy was effective in reducing parental stress, improving secure attachment style, and reducing anxiety and its dimensions (generalized anxiety, social anxiety, health-related anxiety, and sadness) in children. Nevertheless,  it was not effective for anxious and avoidant attachment styles or obsessive-compulsive symptoms (P>0.05). There was a significant difference between pre-test scores and post-test and follow-up scores for parental stress, secure attachment style, generalized anxiety, social anxiety, health-related anxiety, and sadness in children. The post-test scores remained relatively stable in the follow-up phase, indicating that the effects of dual music therapy were long-lasting. These results suggest that dual music therapy improved parental stress, secure attachment style, generalized anxiety, social anxiety, health-related anxiety, and sadness in anxious children aged 5-9. Furthermore, the effectiveness of this intervention did not diminish over time from post-test to follow-up.
Discussion and conclusion:
This study, aimed at determining the effectiveness of dual music therapy on parental stress, anxiety, and attachment styles in anxious children, revealed that dual music therapy led to a reduction in parental stress, improvement in secure attachment style, and a significant decrease in generalized anxiety, social anxiety, health anxiety, and sadness in anxious children aged 5-9. While no research was found that fully matched the present study due to the novelty of the therapy, the overall direction of this study aligns with similar research, including the findings reported by Amini-Shirazi et al. (2022), Sanjari (2018), Asgari et al. (2014), as well as international studies by Denk (2023), Sun et al. (2020), and Savage et al. (2020) on the effectiveness of music therapy in reducing the symptoms of stress, anxiety, and depression.
In explaining the first finding of the study regarding the effectiveness of music therapy in reducing parental stress, it can be noted that during therapy sessions, parents learn to provide unconditional attention and be more attuned to their children's emotions. They reflect and label the child's emotions during play. As for the second finding on the impact of dual music therapy on attachment style, it seems that the therapy process created an opportunity for a secure connection between the child, parent, and therapist, allowing the child to utilize their full psychological and physical capacities. Regarding the third finding, the effectiveness of music therapy in reducing children's anxiety seems to be linked to the focus of the therapy on managing stress and anxiety through the perception of the five senses. It is believed that sensory disengagement and over-involvement in mental activities can lead to fear-based behaviors and anxiety, which in turn reduce the quality of interactions. Music, with its ability to project emotions and release energy, can bring about changes in psychological processes and neural stimulation. Providing dual music therapy to both mother and child during therapy sessions strengthens positive emotions, reduces negative emotions, and ultimately fosters a sense of calm and satisfaction by reducing brain waves. It appears that achieving this sense of calmness and satisfaction in anxious children contributed to the improvement of parental stress, secure attachment style, and the symptoms of anxiety in children. Therefore, the use of this therapy in treatment centers for mothers and their children can be considered. To increase the generalizability of the results, it is recommended that future research be conducted in other cities, include assessments of the psychological and academic conditions of parents with anxious children, and employ random sampling methods.

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Type of Study: Research | Subject: Special
Received: 2023/11/26 | Accepted: 2024/03/27 | Published: 2024/06/11
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