INTRODUCTION
An unmarried mother is a woman who gives birth without a legal marriage [1]. In Korea, there were 20,345 unmarried mothers in 2021, though the actual number may be higher [2]. The number of unmarried mothers raising children has increased globally [3]. These women face significant challenges balancing economic and parenting responsibilities [4], and often experience mental confusion, economic hardship, family conflict, and social prejudice [5]. Additionally, 73.5% of unmarried mothers suffer from postpartum depression, which is higher than the general population [6]. Furthermore, they are also at increased risk for mental health issues such as anxiety and parenting stress [7-9].
Parenting stress is exacerbated by lack of personal time, low confidence in parenting, and sleep deprivation, which can negatively affect psychosocial well-being and quality of life [10-12]. The accumulation of negative emotions can lead to the development of negative thought patterns, which may ultimately result in inappropriate behavior [13]. Resilience, the ability to recover from adversity, is crucial for unmarried mothers and is closely linked to negative emotions [14].
The psychological state of the primary caregiver is vital for the child’s development and parent-child interactions [3]. Mothers with depression are more likely to display irritability and negative behaviors toward their children [15]. Thus, supporting unmarried mothers benefits not only the individuals but also their children, highlighting the need for broader community or national support.
This study aimed to implement a mindfulness-based somatic psychoeducation program to enhance the physical and psychological health of unmarried mothers. Mindfulness-based programs have demonstrated psychosocial benefits [16-18], but addressing both psychological and physical health is necessary due to the challenges of pregnancy, childbirth, and parenting [19,20]. In this study, we provided the mindful somatic psychoeducation program (MSPP) to unmarried mothers, incorporating not only mindfulness but also sensory-motor learning to enhance their sensory and motor skills. Somatic psychoeducation has evolved from multidisciplinary theories that emerged from experiential inquiries into the body, breath, and states of being. It is also regarded as a form of alternative medicine, often referred to as “body therapies” or “intuitive restoration of self.” [21]
Mind-body therapy programs are gaining increasing attention in both practice and research for their proven safety and physical, psychological, and social benefits [22]. Recent implementations of mindfulness-based somatic education for female college students have shown positive changes in anxiety, stress, and social connectedness among participants [23]. The MSPP helps individuals focus on the present, experience their movements from within, and become aware of their bodily sensations, thereby inducing relaxation and reducing negative emotions connected to the body. This process enhances personal awareness, sensory perception, and positive emotions [24]. Furthermore, studies related to the practical application of MSPP have reported its effectiveness in some participants.
However, research remains limited on the effectiveness of such programs for unmarried mothers experiencing physical decline and heightened negative emotions due to childbirth and parenting. This study thus aimed to implement an MSPP for unmarried mothers and evaluate its effectiveness through both quantitative and qualitative methods.
METHODS
Study design and procedure
The study was approved by the Institutional Review Board of the University of Suwon (USWIRB 2310-045-01) and included protocols to protect participants’ rights, safety, confidentiality, and recruitment. This single-blind randomized controlled trial assigned participants to either the intervention group (IG) or control group (CG) using an SPSS-generated randomization sequence. Pre- and post-intervention measurements were conducted under blinded conditions using standardized face-to-face questionnaires. Confidentiality was ensured through anonymized, number-coded samples. Qualitative data on participants’ internal experiences were collected through one-on-one interviews.
Participants and data collection
Participants were recruited over 15 days through open calls targeting unmarried mothers with children aged 0-5 years via an internet café and social media. Twenty eligible individuals voluntarily enrolled after receiving full information and providing written consent. They were randomly assigned to either the IG or CG; four withdrew early or were excluded from analysis. Inclusion criteria were: 1) unmarried mothers with children aged 0-5, 2) no musculoskeletal or cognitive impairments, and 3) no regular exercise (less than 3 times/week). Exclusion criteria included smoking and participation in other programs.
Sample size was calculated using G*Power 3.1.9 (Kiel University), requiring 16 participants for 0.95 power, α=0.05, and effect size=0.4. Prior studies and Tisdell and Merriam [25] suggest groups of 6-10 participants enhance engagement and effectiveness, with previous evidence supporting 8-9 per group.
Intervention
The IG underwent MSPP intervention once a week, 2 hours per session, for 8 weeks, whereas the CG performed the same activities as usual in daily life for 8 weeks. The only difference between the two groups was whether MSPP was performed. The MSPP was led by a sports psychology doctor with extensive yoga experience and was conducted with guidance from various clinical experts.
The MSPP was developed based on four key components: 1) the researcher’s more than 15 years of experience teaching meditation and yoga, 2) psychoeducation content for postpartum females, 3) an adapted MSPP program for female college students, and 4) Thomas Hanna’s Somatics. The program integrates mindful meditation (e.g., breathing focus, present-moment awareness, gratitude), somatic movements (Hanna’s somatics, Nadi Shodhana Pranayama, body scans, yoga-based exercises) [26,27], and emotional expression through sharing thoughts, feelings, and daily experiences (Table 1).
The body movements of the MSPP focused on two key areas: 1) Hanna’s somatic exercises targeting trunk flexors to release tension and prevent habitual red-light reflex patterns commonly seen in single mothers under distress and 2) interventions for trunk extensors to reduce issues related to excessive green-light reflex, such as back pain, herniated discs, and temporo-mandibular joint disorders.
Measurement
Resilience
Resilience was measured using the Resilience Quotient (RQ) developed by Reivich and Shatté [28] and adapted in Korean by Kim [29]. The 53 questions assessed three main factors: self-regulation ability, interpersonal relationships, and positivity. However, considering that participants could be negatively affected by the survey process, 35 questions were used to measure self-regulation ability and positivity factors, excluding interpersonal factors (e.g., “Most of the people I meet regularly come to hate me”). This study drew upon previous research that utilized selected sub-factors of the RQ based on resilience theory [30,31].
Each item is rated on a 5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). The internal consistency (Cronbach’s α) between the questions was 0.091 overall, and was calculated as a self-regulation ability of 0.906 and a positivity of 0.947.
Anxiety and depression
Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) developed by Zigmond and Snaith [32] and translated into Korean and validated by Oh et al. [33]. This 14-item scale comprises seven anxiety (e.g., “I felt fear”) and seven depression (e.g., “I felt lonely as if I was alone in the world”), and allows you to check your emotions over the past week. Each item is rated on a 5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). The internal consistency between the items (Cronbach’s α) was 0.867 for anxiety and 0.557 for depression.
Physical Self-Description
Physical Self-Description was measured by using the Physical Self-Description Questionnaire (PSDQ) developed by Marsh et al. [34] and translated into Korean and validated by Kim [35]. For the composition of the questionnaire, appearance (e.g., “My face is handsome”), health (e.g., “It takes me a long time to get better once I am sick”), and self-esteem (e.g., “I think I’m a failure in life”) were selected among the sub-factors of the PSDQ, and the questionnaire was composed of four questions, a total of 12 questions. This study drew upon previous research that utilized selected sub-factors of the PSDQ [36,37].
Each item is rated on a 5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). Internal consistency between items (Cronbach’s α) was calculated at 0.874 for physical appearance and 0.85 for health and 0.843 for self-esteem.
One-on-one interviews
One-on-one personal interviews were conducted to confirm the content experienced by MSPP participants during the program. They were asked open-ended interview questions: “What did you experience in the process of participation in the program?” and “Have you changed physically and psychologically since the program?” and “Have you had any changes in your daily life?.”
Statistical analysis and assurance of rigor
The data collected using the questionnaires were analyzed using IBM SPSS Statistics 23.0 (IBM Corp.). First, to assess the assumptions of normality and homogeneity of variance, the Levene’s test was performed, respectively. Second, the Wilcoxon sign ranking test was used for paired nonparametric comparisons to investigate differences within and between groups, and the effect size was confirmed through Cohen’s r to compare substantial differences. The level of significance for all results was set at p<0.05.
In this study, data collected through interviews were analyzed using Giorgi’s phenomenological lens to confirm and interpret the participants’ experiences. Data obtained through the interviews were transcribed and anonymized, and qualitative data were classified using inductive content analysis.
In addition, yoga experts, psychological counselors, sports psychology professors, and psychiatrists who did not participate in this study ensured the rigorous and ethical standards of the collected data.
RESULTS
General characteristics
Of the 20 recruited study participants, two were of higher child age, and two refused to participate in the study immediately before conducting the study. Thus, 16 participants participated, and none of them were eliminated from the study over the next 8 weeks, and attendance was 100% (Figure 1).
A total of 16 unmarried mothers in their 20s to 40s were randomly assigned to IG and CG. Levene’s test indicated no significant difference in age between the groups (F=2.496, p=0.136). Although significant differences were found in the equal variance test for anxiety (F=6.588, p=0.022) and health (F=5.185, p=0.039), all variables met the assumption of normality based on the Kolmogorov-Smirnov test (Table 2).
Quantitative analysis results
Resilience
After the intervention, IG showed notable improvements in resilience, including self-regulation and positivity, while CG did not experience meaningful changes. Also, overall resilience also increased in IG compared to CG (Table 3).
Anxiety and depression
IG showed clear reductions in both anxiety and depression scores following the program, whereas CG showed no significant changes (Table 3).
Physical self-description
There were no meaningful changes in appearance or health perception in either group. However, self-esteem improved in IG, while no change was observed in CG (Table 3).
Qualitative analysis results
In-depth interviews were conducted to confirm the changes in detail while the study participants performed the program. The results of analyzing the interview contents were as follows: changes in the soma (physical, psychological, and social), changes in mind-body integration (breath-mind connectedness, movement, and mind connectedness), and changes in the subjectification of the soma (mindfulness and self-regulation).
Changes in the soma
Physical soma
In the case of single mothers who must bear childbirth and are rearing alone, their physical structure and function are likely to weaken. However, most participants experienced improvements in posture correction, imbalance relief, pain relief, bodily flexibility, and digestive problems after participating in the MSPP (Supplementary Table 1).
Psychological soma
Before the program, participants reported feeling anxious, depressed, self-destructive, or helpless. During MSPP, many experienced reduced anxiety and depression, along with increased positive thinking and a calmer mind. Some noted persistent uneasiness due to constant thoughts about their tasks, but even without major life changes, they felt slightly more at ease (Supplementary Table 1).
Social soma
When initially asked to recall things, they were grateful for, participants were unable to identify any. However, after completing the program, they recognized many aspects of their lives and people—such as parents, friends, spouses, and children—for whom they felt appreciation. Some also shared that they previously struggled to respond appropriately to their children’s words or actions, but after the program, they became more capable of observing and responding calmly (Supplementary Table 1).
Changes in mind-body interaction
Breath-mind connectedness
MSPP encouraged participants to focus on deep breathing. Initially, many felt dizzy or found it hard to follow. However, over time, they reported feeling lighter, experiencing reduced headaches and chest tightness, and overall improvement in physical and mental well-being through slow, deep breathing (Supplementary Table 2).
Movement and mind connectedness
Participants initially struggled with physical movements, especially while managing childcare. By the end, they reported feeling more relaxed and confident through stretching and gradual movement improvement. Some noted that movement improved mood and mental clarity, while others felt their mindset changed first, which then enhanced movement. They appreciated the opportunity to focus on themselves, saying it helped them recognize their needs and connect with their bodies (Supplementary Table 2).
Changes in the subjectification of the soma
Mindfulness
Participants previously believed they maintained good relationships simply by avoiding conflict. After MSPP, they realized that understanding and expressing their own thoughts and emotions was key to building healthy connections. Mindfulness helped them recognize and regulate emotions, reduce reactive behavior, and improve communication with others, including their children (Supplementary Table 3).
Self-regulation
Many had difficulty maintaining healthy routines due to parenting stress. Before MSPP, they were aware of poor habits but lacked energy or motivation to change. After the program, they reported improved breathing and calmer responses in stressful situations. They were less reactive, engaged in positive self-talk, and expressed gratitude instead of blame. Participants noted a shift from feeling powerless to feeling capable and hopeful, using internal dialogue such as “I can do it too” to support themselves (Supplementary Table 3).
DISCUSSION
Postpartum females experience various physical discomforts such as musculoskeletal pain, breast pain, digestive issues, headaches, and fatigue, and require sufficient rest and proper physical activity for recovery [38]. However, unmarried mothers often lack rest due to responsibilities like childcare and financial hardship, resulting in psychological distress including confusion, anxiety, fear, depression, and helplessness.
This study aimed to evaluate the effectiveness of the MSPP, designed to improve the physical and mental health of unmarried mothers.
First, the MSPP significantly enhanced resilience, particularly self-regulation and positivity. These findings align with Kim and Lee [26], who reported that yoga and meditation promoted resilience in unmarried mothers, and Sarkissian et al. [39], who found improved resilience in adolescents practicing yoga. Participants also reported increased emotional awareness, fewer negative responses, and reduced anger toward their children. Such improvements support better stress management and well-being [40]. While family relationships and social prejudice may intensify emotional strain for unmarried mothers, resilience improvement through MSPP may help foster emotional stability and social adaptation.
Second, reductions in anxiety and depression were observed. These conditions are common in unmarried mothers managing both caregiving and financial demands. Depression can result from genetic and environmental factors as well as neurotransmitter imbalances, often leading to posture changes known as the red-light reflex—characterized by a shrunken torso, increased front tension, and restricted breathing [27,41]. MSPP included exercises focused on chest expansion, deep breathing, and muscle relaxation to address these symptoms. These outcomes support prior findings that mindfulness and somatic movement improve psychological health [23,42], and align with studies like Forbes [41] and Simpkins and Simpkins [40] showing reductions in anxiety and depression through thoracic-expanding postures. Other yoga-based interventions have also demonstrated therapeutic value [43-45].
Third, while no significant change was seen in appearance or perceived health, MSPP did improve self-esteem, a key aspect of physical self-description (Table 3). Interviews revealed less self-loathing and more positive self-perception. Participants also reported improvements in back and pelvic pain, digestive issues, and fatigue, suggesting potential long-term benefits that may appear in future quantitative data if the intervention continues.
The limitations of this study include: 1) the small sample size, which limits generalizability; 2) the inability to control for all personal and environmental factors during the recruitment process; 3) the sample representativeness was limited due to online recruitment; and 4) the absence of follow-up data limits our understanding of the sustainability of the results. Additionally, interpersonal skills were excluded from resilience measurement after expert consultation, although qualitative responses suggested some positive changes in social perception occurred.
In conclusion, MSPP effectively enhanced resilience and selfesteem while reducing anxiety and depression in unmarried mothers. These results highlight MSPP’s potential as a practical mental health intervention and suggest its applicability in community support services and policy efforts.
Future research should explore online delivery methods for broader access, especially for single mothers constrained by time and space. Studies comparing online and offline delivery are needed, and if similar effects are confirmed, scalable content can be developed. Programs involving both mothers and children should also be considered. Furthermore, future work should revise resilience tools to include interpersonal components, given their relevance to emotional recovery and social functioning.
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