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RESEARCH ARTICLE
Year : 2021  |  Volume : 22  |  Issue : 1  |  Page : 57-63

Effect of aerobic dance movement therapy on anxiety among first year B. SC. (N) students


1 Tutor, Department of Mental Health Nursing, Saveetha College of Nursing, SIMATS, Chennai, Tamil Nadu, India
2 Associate Professor, College of Nursing, Madras Medical College, Chennai, Tamil Nadu, India

Date of Submission12-Sep-2020
Date of Decision20-Dec-2020
Date of Acceptance16-Apr-2021
Date of Web Publication07-Jul-2021

Correspondence Address:
Dr. Shankar Shanmugam
College of Nursing, Madras Medical College, Chennai - 600 003, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCN.IJCN_75_20

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  Abstract 


Anxiety disorders are becoming one of the most common mental health problems on college campuses worldwide. It is estimated that 1 in 13 people suffer from anxiety. Newly admitted college students are more anxious due to their transition to a new environment and a probable lack of proficiency in technology. Researchers reported that the anxiety levels among nursing students are high with a poor impact on their health and academic status. This study evaluated the effectiveness of aerobic dance movement therapy (ADMT) on anxiety level and to associate post-test level of anxiety with selected demographic variables among B.Sc. (N) first-year students. A Quasi-experimental non-randomised control group design was used. 60 students were selected by purposive sampling technique with 30 students in each group. Zung Self Rating Anxiety Scale was used. After pre-test, intervention was given to students in the study group for 45 min on alternate days for 4 weeks followed by post-test in both groups. In pre-test, the mean anxiety score in the study group and control group were 55.93 and 55.27. After administration of ADMT, the post-test mean anxiety score was 42.17 and 54.43 in the study and control group, respectively. The mean difference in the study group is 13.77 and found to be statistically significant (t = 13.63, P = 0.001). Variables such as age, type of family, area of residence and type of attending college were significantly associated with post-test anxiety level (P ≤ 0.05). ADMT was found to be cost-effective, appropriate and feasible to implement in all settings that would help the students to manage anxiety and improve their academic performance effectively.

Keywords: Aerobic dance movement therapy, anxiety, nursing students


How to cite this article:
Elakiya T, Shanmugam S. Effect of aerobic dance movement therapy on anxiety among first year B. SC. (N) students. Indian J Cont Nsg Edn 2021;22:57-63

How to cite this URL:
Elakiya T, Shanmugam S. Effect of aerobic dance movement therapy on anxiety among first year B. SC. (N) students. Indian J Cont Nsg Edn [serial online] 2021 [cited 2021 Aug 1];22:57-63. Available from: https://www.ijcne.org/text.asp?2021/22/1/57/320827




  Introduction Top


Adolescent life is the period of transition. It is the period that has both extremes of happiness and stress. The later part of adolescence is spent mostly in colleges. College life is one of the most sparkling experiences for them with a vivacious environment, a company of friends and academic life. Newly admitted college students may be more anxious due to their transition to a new environment and a probable lack of proficiency in technology. Anxiety is a normal human emotion. In a normal or moderate amount, it acts as catalyst if it exceeds a normal limit it causes harm to the individual.[1]

WHO report states that 3.6% of individuals suffer from anxiety.[2] In the United States, 40 million of adults suffer from anxiety disorder in which 75% experience their first episode within the age of 22.[3] According to Programme for International Students Assessment (PISA) report, 72% of students from the United Kingdom reported anxiety while taking a test even after adequate preparation.[4] In India, the prevalence of anxiety disorder among adolescents aged between 13 and 18 years was found to be about 31.9%, in which 8.3% had severe impairment, with the highest prevalence noted in females (38%) than males (26.1%).[5] In Tamil Nadu, the highest suicidal rate was reported due to academic pressure among adolescents. It is found that failure in examination led to 2413 suicides among students in 2016 or accounting for 25% of student suicides and necessitates the need to understand the factors contributing anxiety among students.[6]

Anxiety can be related to stress. In stressful situations, body releases a hormone called adrenaline. This adrenaline rush helps the body to prepare and deal with stressors and it is referred to as 'fight or flight response'. However when the individual constantly runs in an emergency mode, the mind and body must pay the price.[7]

Stress and anxiety are notably woven into nursing student's educational experience internationally and has an impact on their health as well as their academic and clinical performance.[8] A student nurse's first year of professional experience lays the foundation for long-term professional satisfaction. Many nursing students move away from home for the first time, leaving all previously learned support systems and have difficulties in adjusting to more academic expectations such as fear of failure due to language problems and differing cultures and beliefs which provoke anxiety.[9] A study revealed that 96.9% of first-year nursing students had moderate anxiety and 3.1% had low anxiety. Studies revealed that anxiety affects 30% of nursing students and has detrimental effects on academic performance and student success.[10]

Aerobic dance movement therapy (ADMT) is a smoother exercise program that combines physiological activity with psychological components that has positive effects on health-related psychological outcomes.[11] Aerobic exercise in form of dance is most beneficial in improving social relationship among individuals and boosting up mood.[12] Research shows that regular exercise of 30 min for 3–5 days a week can alleviate anxiety as much as anxiety medications and effects of exercise may last longer than those of drugs. During exercise adrenaline is expelled, muscles relax and heartbeat slows down all of which are associated with a sense of well-being and reduction in anxiety.[13] Thus Aerobic exercise is a powerful tool to enhance physical and mental health.

Anxiety is considered a major obstacle during student's college life that has an impact on their health as well as on academic outcomes. Students are unaware of coping methods to address their anxiety effectively. Therefore, psychiatric nurse educator should act as a liaison between students, community and educational institutions for managing anxiety and intervention aimed at facilitating positive mental health outcome among students.

Objectives

The present study was undertaken with the following objectives.

  • To evaluate the effectiveness of ADMT on anxiety levels among I-year BSc nursing students
  • To determine the association of post-test level of anxiety with selected demographic variables.



  Methods Top


A Quasi-experimental non-randomised control group research design was used to recruit B. Sc (N) I year students for the study. Nursing students who were differently-abled or with chronic illness were excluded from the study as they may have different levels of anxiety. Initially, a sampling frame was created with list of private nursing colleges, based on feasibility and availability of subjects, two nursing colleges were selected purposively. Each college had an annual intake of 50 students. Formal approval was obtained from the Principal of both the selected Nursing colleges in the Chennai district. 36 students from one college who met the inclusion criteria and who gave informed consent were selected as study group and the other college (34 students) was selected as control group with the same inclusion criteria.

Tools

Section A

The demographic data of the students included their age, type of family, breadwinner of family, education and occupation of the head of the family, family monthly income, area of residence, selection of nursing course, medium of instruction, type of attending college, previous academic performance in school, exposure to hostel life and duration of hostel life, sleeping hours, previous experience of any relaxation therapies and form of recreational activities.

Section B

Zung Self Rating Anxiety Scale is a self-administered standardised tool with 4 points consisting of 20 questions based on four domains such as cognitive, autonomic, motor and CNS symptoms. The reliability of the tool was found to be 0.84 by Cronbach's alpha method.[14] Permission for using the scale in the study was obtained.

Scoring interpretation

[Table 1].
Table 1: Interpretation of Zung self Rating Anxiety Scale

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Ethical consideration

Ethical approval was obtained from the College Ethical Committee. During the initial interview, the purpose of the study and data collection procedure was explained to the participants. Written informed consent was obtained from the study participants and informed them that participation is voluntary and they can withdraw from the study at any time. Confidentiality with the information was achieved by maintaining the anonymity of the participants.

Data collection procedure

The investigator collected data for 4 weeks from February 04, 2019 to March 04, 2019. Followed by pre-test, the samples in the study group were divided into four groups with 9 members in each group. ADMT was given on alternate days for 45 min (35 min of aerobic exercises including dance movements and 10 min for employing coping phrases) in each group for 4 weeks. After 7 days of the last session of intervention, post-test was conducted for both groups using the same tool. Booklets about aerobic exercises and coping phrases were given to the control group after post-test as an ethical consideration. 6 samples from study group and 4 samples from the control group dropped out at the time of intervention and post-test, so sample size reduced to 60 with 30 in each group. Analysis of the collected data was done using SPSS version 21 [SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp].


  Results Top


[Table 2] indicates 46.67% of students in the study group and 40% of students in the control group were in the age group of 18 years of age. 56.67% of students in the study group and 70% of students in control group were living in the nuclear family. 50% of students in the study group and 60% of students in the control group were in the income group of Rs. 5001–10,000.50% of students in the study group and 43.33% of students in the control group were residing in rural area. About 53.33% of students in the study group had selected courses by self-choice and 53.33% of students in the control group had selected the course with recommendations from parents. About 66.67% of students in the study group and 56.67% of students in the control group had Tamil as medium of instruction. 46.67% of students in the study group and 73.33% of students in control group were from hostel. About 56.67% of students in study group and 46.67% of students in the control group had recreational activities like listening to music. The groups were similar in their association of baseline characteristics.
Table 2: Frequency and percentage distribution of demographic variables of B.Sc (N) year students in study group and control group (n=60)

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In the present study, pre-test assessment in the study group showed that 43.33% of them had mild level of anxiety and 56.67% of them had moderate level of anxiety. Among control group, 50% of them mild and rest 50% of them had moderate level of anxiety. In both groups, none had normal or severe levels of anxiety.

However in the post-assessment, the study group 46.67% of the students were having normal, 43.33% had mild and 10% had moderate level of anxiety. None of the students had severe level of anxiety. Among the control group, none of the students had normal and severe levels of anxiety. 63.33% of them had mild and 36.67% had moderate levels of anxiety.

Domain-wise comparison of pre- and post-test level of anxiety in study group and control group were as follows: At pre-test the mean scores for each of the four domains were similar. The autonomic symptom score was highest at pre-test in both groups. While there were significant differences in the mean scores in all the domains in the study group after the intervention, the scores remained same for control group [Figure 1].
Figure 1: Domain wise comparison of pre- and post-test anxiety score of B.Sc. (N) I year students

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Based on cognitive symptoms, pre- and post-test score in the study group were 14.90 and 11.90 score and difference was 3.0 and it was statistically significant. In the control group, during pre- and post-test score were 14.30 with nil difference and it was not statistically significant. Based on autonomic symptoms, pre- and post-test score in the study group were 23.0 and 14.47 and the difference was 8.60 and it was statistically significant. In the control group, pre- and post-test score were 23.06 and 22.23 score. The difference is 0.83 and it was not statistically significant. Based on motor symptoms, pre- and post-test anxiety score in the study group were 11.47 and 10.27, respectively. Difference is 1.20 and it was statistically significant. In the control group, pre- and post-test score were 11.90 with nil difference and it is not statistically significant. Based on CNS symptoms, pre- and post-test score in study group were 6.50 and 5.52 score. The Difference was 0.98 and it was statistically significant. In control group, pre- and post-test score were 6.00 with nil difference and it was not statistically significant.

[Table 3] shows the paired t-test comparison of pre- and post-test level of anxiety score among B. Sc (N) Ist year students. Considering the study group, the pre-test mean and standard deviation were 55.93 and 5.54 and the post-test mean and standard deviation were 42.17 and 9.67, the difference of 13.77 was statistically significant (P < 0.001). In the control group, the difference in mean score 0.83 was not statistically significant. [Figure 2] depicts the range of anxiety scores for both groups at pre and post-test.
Table 3: Comparison of overall mean pretest and posttest anxiety score among B.Sc (N) 1 year students (n=60)

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Figure 2: Simple bar diagram with 2 standard error compares the student's pre- and post-test anxiety score

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Independent t-test showed that there was no significant difference in mean anxiety scores between the study and control group. The post-test assessment showed a significant statistical difference between the two groups again revealing that the intervention was effective in reducing anxiety in the students [Table 4].
Table 4: Difference in mean anxiety scores between control and study groups at pre- and post- tests

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[Table 5] shows the association between post-test level of anxiety reduction score and their selected demographic variables in the study group. Older students (19–20 years), living in the nuclear family, and urban area and attending college from home reported normal anxiety scores than others.
Table 5: Association between posttest level of anxiety reduction score and their demographic variables in study group

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  Discussion Top


The evidence of anxiety among B. Sc (N) Ist year students under the context of different domains was an evolving scenario. Due to the paucity of literature regarding the effect of ADMT on anxiety among nursing students in the Indian population, the nurse researcher carried out the study using Zung Self Rating Anxiety Scale. Pre-test assessment in the present study showed about half the proportion of students had mild or moderate levels of anxiety in both groups. In contrast in another study by Hiremathet et al. in which he investigated prevalence of depression, anxiety and stress among 72 first baccalaureate nursing students it was found that 36% had mild levels of anxiety, 18% had moderate and 4% had severe level of anxiety among students.[15] Another study examined anxiety and academic achievement among 440 female nursing students and identified that 70.9% had low, 19.3% had moderate and 9.8% had severe level of anxiety with a correlation between female nursing student's satisfaction and anxiety score significant at P = 0.005 level.[16] A Srilankan based study investigated depression, anxiety and stress among 92 undergraduate nursing students and found that 59.8% had anxiety symptoms with the distribution of anxiety symptoms were 40.2% had normal range of anxiety, 9.8% had mild level, 21.7% had moderate level, 12% had severe and 16.3% had extremely severe level of anxiety.[17] Compared to most of the study in the present study there were more who had moderate level of anxiety at baseline.

In the post-assessment majority had normal or mild anxiety in the study group when there were none in normal anxiety levels in the control group. In this study, it was also found that the anxiety scores were not statically different at pre-assessment. The paired test showed a significant reduction in anxiety scores in the study group. These results show that the ADM was effective in reducing anxiety in nursing students. The above study finding was consistent with other studies which looked at the effect of dance movement in reducing anxiety and depression in different groups of population. A study based in Korea examined an effect of dance movement therapy on depression, anger and psychotic symptoms among schizophrenic clients. The results revealed a significant decrease in state anger (F (1, 36) =2.26, P < 0.05), depression (F (1, 36) =5.92, P < 0.01) and negative psychotic symptoms and significant increase in anger control (F (1, 36) =5.12, P < 0.01).[18] It was also supported by another study which revealed that dance movement therapy was beneficial in the treatment of depressed adults with statistical significance (χ2 = 7.07, df = 1, P < 0.01).[19] Current findings are augmented by an Iranian study where the effect of short-term movement therapy on academic stress among female students was observed. The study results showed a statistically significant reduction in stress levels among female students (F = 26.20, P < 0.01).[20]

The results of the present study were also supported by the studies conducted by Shokri et al. who investigated the effect of 8 weeks aerobic exercise on depression, anxiety and sleep disorders among 60 middle-aged women. The results showed that significant impact on reducing depression, anxiety and improving the quality of life with pre- and post-test value of anxiety were 5.88 and 4.32 at P = 0.005.[21] A study based at Malaysia investigated the effect of low-intensity aerobic dance exercise on hostility, anxiety and depression among 40 sedentary overweight women. The results revealed a statistically significant differences between intervention group and control group (F = [4, 35) =20.79, P < 0.01, η =0.790) with positive findings concerning physical health and psychological well-being among sedentary women in intervention group.[22]

Our present study findings showed association between post-test level of anxiety with their selected demographic variables. In the study group, older students, students living in the nuclear family, students residing in urban area and students attending college from home with parents have reduced anxiety score than others. None of the demographic variables in the control group were significantly associated with post-test level of anxiety. EvangeliaGiourou et al. found that higher age (P = 0.014), females, ignorance of support services, reduction in income, area of residence at P < 0.001 were significantly associated with anxiety among students.[23] Another study found that locality of staying (χ2 = 0.2057, P < 0.05), family members relation with nursing profession (χ2 = 2.73, P < 0.05) and students willingness to join nursing profession (χ2 = 0.6231, P < 0.05) were significantly associated with stress and anxiety.[15]

Limitations

The study has some limitations. The researcher could not generalize the study findings as the sample size was relatively small and limited to 60 student nurses. Only first-year B. Sc (N) students were included into the study. Another limitation was the lack of random allocation of the groups. This was overcome by checking the association of demographic variables which were not different between groups. The anxiety level among students can differ based on their cultural differences and background. The current study has only a few supportive studies in Indian population due to the paucity of literature.


  Conclusion Top


The results of the present study showed the anxiety levels among nursing students and also evidenced that ADMT is a safe and cost-effective intervention to alleviate anxiety among nursing students. The psychiatric nurse educators should assess, guide, educate and empower students by alleviating anxiety and promote health and well-being among nursing students in an earlier stage and conduct activities to empower students for achieving positive health outcomes. ADMT can be an interesting activity powerful in reducing anxiety in students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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