Discussion
The burden and effects of COVID‐19 are felt all around the world, and this is likely to cause fear and anxiety.32 This study was conducted with the aim of examining the effects of online SFBT applied to parents with high levels of anxiety during the COVID 19 pandemic. As a result of the study, it was determined that online SFBT was an effective method in reducing the state anxiety levels of parents with high anxiety levels.
In studies conducted with different sample groups in the COVID 19 pandemic, it has been reported that the epidemic significantly increases the anxiety level of children and parents.7,32 In this study, the anxiety levels of the parents of children aged 3-6 who had to spend most of their time at home by leaving the nursery, school and many social environments due to the pandemic were evaluated and it was determined that the pre-test anxiety levels of the parents were quite high in the intervention and control groups. In a study conducted in China (n = 2446), it was stated that the participants had a high level of anxiety and approximately 80% of them scored above 40 in both STAI-S and STAI-T subscales.33 In the study conducted by Lee et al., it was determined that parents’ anxiety levels were high and parental anxiety caused an increase in the anxiety level of children.7 In the study conducted by Saddik et al., it was determined that most of the participants experienced mild or severe anxiety due to the pandemic. In the same study, the participants stated that the measures taken by the government to prevent the pandemic increased their anxiety.34 In another study conducted with 1069 participants, it was stated that having a child is one of the reasons that increase anxiety during the COVID 19 pandemic.3 All these studies and our study findings show similarities in the sense that parental anxiety is high during the pandemic.
The COVID 19 pandemic places a wide range of stressors on young children, including its invisibility, the danger of infection, frustration and boredom, inadequate information, lack of face to face contact with family members, classmates, friends and teachers, and lack of personal space at home. Stress levels of children directly or indirectly cause stress and anxiety on their parents.35 In this study, more than half of the parents stated that their children’s being away from the nursery and being constantly isolated at home made them aggressive and worsened their mental health. Sudden changes in the routines of children, who previously attended a nursery or nursing facility, events they cannot understand in a home-oriented life environment and many other factors can play a role in increasing the stress and anxiety levels of children and parents.
It has been reported that correct information about the virus has a negative and significant correlation with individuals’ anxiety levels.36 In this study, almost all of the parents stated that they had access to information about COVID 19 via television (44.2%) and social media (37.8%). In the study conducted by Malesza and Kaczmarek, more than 80% of the participants stated that they had access to COVID information through television while 70% of the participants acquired information via the internet. However, only 20% of the participants had access to information through health authorities. When these findings are interpreted together with the high anxiety levels of the parents, it is thought that reaching the information from the right source may also have an effect on the anxiety level.
The global COVID-19 pandemic is a stressor that originated outside of the family system but given the novelty and uncertainty concerning this disease, it is likely to be perceived as a significant stressor for many parents and children.11 Individuals use different methods in order to cope with the anxiety experienced in the pandemic. When the coping behaviours of parents are examined; It is seen that they use different methods such as spending time with the family, trying not to think about the pandemic, cleaning, spending time by watching television and using telephone and praying. However, the high anxiety score averages of the parents indicate that these coping methods are not very effective in the pandemic process, which has very devastating effects.
It has been reported that the COVID 19 pandemic negatively affects the mental health of both parents and children and significantly reduces their psychological well-being.8,37 In our study, majority of the parents stated that they will continue to take measures even if the pandemic decreases and they believe that there will be new pandemic. These findings are important in terms of suggesting that parents experience anxiety about their future lives.
The effectiveness of SFBT in literature has been evaluated in many studies.14,24,38–40 Studies have shown that SFBT is effective in individuals with social anxiety disorder,13 reduces depression and anxiety,12,15 improves quality of life14, affects mindfulness and psychological well-being41 and is effective in solving mental problems by contributing to the development of all areas of mental health.40 In the study conducted by Novella, Ng and Samuolis, SFBT was applied to university students with mild and moderate anxiety simultaneously with two different methods using face-to-face and online programmes. As a result of the study, it was determined that both methods significantly reduced students’ anxiety levels and there was no significant difference between the effectiveness of the two methods.23 The use of video teleconferencing platforms is important in terms of providing a suitable alternative for continuity of care in times of social, economic and health-related problems, and provides more flexibility and access opportunities than face-to-face therapy.42 In our study, SFBT was applied through the online video-conference method due to the restrictions and precautions during the pandemic and it was found to be an effective method in reducing anxiety.
In order to reduce the anxiety level of individuals in the COVID 19 pandemic, different interventions were implemented and their effectiveness was evaluated. Internet-based integrated intervention focusing on relaxation, self-care, and raising sense of security applied to individuals diagnosed with COVID 19 with psychological problems was found to have a significant pleasing effect on mild and moderate depression and anxiety symptoms.43 In a study conducted, it was determined that informing via teleconference was effective in reducing the anxiety levels of mothers with chronic diseases during the pandemic period.32 In the study conducted by Chen (2020), it was aimed to administer 2-4 sessions of online solution focused brief therapy to adolescents who showed anxiety symptoms in the COVID 19 pandemic. It was hypothesized that participants who are randomly assigned to Solution Focused Brief Therapy would have betterclinical outcomes, lower depression levels, and increased coping strategies in dealing with distress during the COVID 19 pandemic.25 In our study, SFBT was applied to parents who had high levels of anxiety and it was found that the state anxiety levels of the parents were significantly reduced. In the model established in SEM analysis, it was determined that the SFBT intervention had a significant effect on anxiety (Fig. 2). After SFBT, the state and trait anxiety mean scores of the intervention group decreased compared to the pre-intervention mean scores. While this difference between state anxiety scores was statistically significant, the difference between trait anxiety scores was not statistically significant. This result can be related to the fact that the state anxiety level is a result of the individual’s direct psychological reactions related to negative events while the trait anxiety is related to the tendency to exhibit personal anxiety and it is relatively stable. This finding can be considered as an expected result, since the change in the state anxiety level must gain continuity in order for the trait anxiety level to change. However, it is noteworthy that the state anxiety score in the intervention group is still high (over 40) even in the post-test. It is anexpected result that the anxiety does not decrease to the desired level due to the continuation of the pandemic.