A Comparison of the effect of expressive writing and music therapy on distress tolerance and maternal role adaptation in mothers of preterm Infants hospitalized in neonatal intensive care units of hospitals affiliated with Shiraz University of Medical Sciences, 2025-2026

Comparison of the effectiveness of expressive writing and music therapy on distress tolerance and maternal role adaptation in mothers of premature infants

Randomized clinical trial with control group, 2 intervention groups and 1 control, unblinded, on 90 patients. G*Power3 software was used for randomization.

This randomized controlled clinical trial compares expressive writing and music therapy on distress tolerance and maternal role adaptation in 90 mothers of preterm infants in Namazi and Hafez Hospitals, Shiraz. Participants are assigned to three groups and receive interventions over six 15–20 minute sessions for two weeks. Data are collected using demographic questionnaires, the Simons and Gaher Distress Tolerance Scale, and the Heydarpour et al. Maternal Role Adaptation Instrument at three time points and analyzed.

Inclusion criteria: -Maternal age above 18 years. -Preterm birth (less than 37 weeks of gestation). -Minimum level of maternal literacy sufficient for completing the questionnaires. -Absence of psychiatric disorders or use of related psychotropic medications (self-reported), and absence of chronic physical illnesses. -Singleton pregnancy. -No history of previous preterm delivery. -Hospital stay of at least 14 days. Exclusion criteria: -Mothers other than those in the neonatal ward -Mothers of infants admitted to other hospitals

Expressive writing group: Mothers in this group write down their thoughts and feelings using paper and pen. Music therapy group: Mothers in this group listen to 6 pieces of music selected by a music specialist using headphones. Control group: They receive routine ward care without any additional intervention.

Peace of mind and life of mothers of preterm infants; maternal stress and anxiety; maternal care for their infant in the ward

To randomly assign samples to the two test and control groups, a random allocation method using permuted blocks with a block size of 4 was used. Accordingly, 19 four-unit blocks were designed to maintain balance in the number of samples in each group and reduce the probability of bias. Randomization procedure in the software: After entering the website https://www.sealedenvelope.com/simple-randomiser, the number of groups was set to 2 (test and control), the allocation ratio to 1:1, the randomization method to "Permuted blocks," and the block size to 4. Then, by defining 19 blocks, the allocation list was automatically generated and downloaded by the software. This software uses a cryptographically secure random number generator, which minimizes the predictability of the allocation sequence. The order of group allocation in each block was determined randomly, and the final allocation list was attached to the proposal as an appendix. This method allows the researcher to maintain relative balance between the groups at all stages throughout the sampling process.

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