Keywords
anxiety
bilateral stimulation
Butterfly Hug
school nursing
Data Availability Statement
The datasets generated and analyzed during the current study are not publicly available because they contain confidential information from student participants. However, the data are available from the corresponding author upon reasonable request and with permission from the related institution.
How to Cite
Abstract
Background: Adolescent anxiety can interfere with concentration, sleep, school participation, and academic functioning. Brief self-regulation strategies that can be delivered in schools without equipment may be useful. Still, evidence for the Butterfly Hug - a self-administered form of alternating tactile bilateral stimulation - remains limited, particularly among Indonesian junior-high-school students.
Objective: To examine within-group change in anxiety scores following a brief school-based Butterfly Hug program among ninth-grade students.
Methods: This one-group pretest-posttest pilot study included 91 ninth-grade students selected through purposive sampling at a public junior high school in Lamongan, Indonesia. Participants completed three weekly Butterfly Hug sessions over three weeks. Anxiety was assessed before the first session and after the final session using the 14-item Hamilton Anxiety Rating Scale (HARS). Because score distributions were non-normal, paired change was examined with the Wilcoxon signed-rank test. Effect size was calculated as r = |Z|/sqrt(N).
Results: Mean HARS scores were 27.55 (SD 5.75; 95% CI 26.35-28.75; median 26, IQR 8) at pretest and 11.98 (SD 3.95; 95% CI 11.15-12.80; median 12, IQR 5) at posttest. Ninety participants had lower posttest scores, one had a higher score, and none were tied. The Wilcoxon test indicated a statistically detectable within-group difference (Z = -8.284, p < .001), with a large rank-based effect size (r = .87).
Conclusion: Participation in the brief Butterfly Hug program was associated with lower immediate post-intervention anxiety scores. Because the study had no comparison group and used purposive sampling with no longer-term follow-up, the findings do not establish causal effectiveness. Controlled studies using adolescent-validated measures and longer follow-up are required.
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Copyright (c) 2026 Wahyu wulandari wulan, Arifal Aris, Abdul Rokhman (Author)