A Study of Supportive Intervention for Stress Reduction andPerceived Confidence of Child-Rearing Mothers

Kyoko Yajima and Sayuri Hashimoto

Department of Human Care Science
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba、Japan
Correspondence：

Kyoko Yajima

E-mail Adｄress： kodomonokokoro@nifty.com

Abstract
With increasing numbers of mothers affected by anxiety and stress relating to child care as well as the
problem of increasing numbers of abuse cases, support is needed to help mothers develop child-careconfidence and alleviate the stress of parenting.
In this study, a 90-minute lecture on child-care support was held for a group of mothers with infants (n=31).
The lecture comprised the essential needs of the soul support method utilizing the SAT theory-based guidance
method and reward-system images. The purpose of the study was to examine 1) the perceived child-careconfidence of child-rearing mothers and the short-term effects of stress reduction around the time of theintervention, and 2) the extended effects for three month after the intervention.
The results were: 1) around the time of the intervention, significant improvements were observed in thelevel of self-esteem, emotional support network, child-care confidence, self-repression, depression andsubjective stress, while a significant reduction was observed in the cortisol level of the saliva; and 2) the3extended effects were raised levels of self-esteem and child-care confidence, and a significant, continual
reduction in depression level. Compared with the pre-intervention period, the anxiety trait was significantly lower
in the analysis conducted three months after the intervention.
These results suggest that a group intervention using the essential needs of soul support method iscapable of increasing mental health conditions and child-care confidence, and providing support for the
reduction of child-care anxiety and stress

Key words: child-care support, essential needs of soul support method, self-esteem, child-care confidence,
image-script

I. Introduction
Accompanying the reduction in the number of live births and spread of the nuclear family starting in the
1980s, the number of mothers suffering from child rearing anxiety and parenting stress began to increase andthe rise in child abuse cases became a serious issue. The number of child abuse cases increased by nearly 17
fold, from 1,961 cases in 1994 to 32,979 cases in 2004, with those cases involving the biological motheraccounting for the largest number of child abuse cases.1) Child-rearing anxiety is one cause of parenting stress,
2) 3) and child rearing anxiety coupled with lack of confidence is believed to lead to child abuse.4)

The government has adopted various measures to tackle these problems, including the Angel Plan, the
New Angel Plan, Sukoyaka (i.e., healthy and happy) Family 21, Plus One Proposal to End the Falling Birthrate,and Support for Nurturing the Next Generation. At the community level, support measures include setting up
child-rearing support centers and family support centers that provide, among other things, a place of recreation
4

and relaxation for parents and children alike and a place where mothers can drop off their children while they goout.
In an intervention study of home visitations by nursing professionals to provide postpartum care one
month after childbirth, over 90 percent of the participating mothers said that the visitations were useful, as they
helped reduce their anxiety and improve their self-confidence, thus suggesting that home visitations by nursing
professionals serve as an effective support for child-rearing mothers.5) By contrast, in a study of a pediatrician
who provided child-rearing guidance in a class for child-rearing mothers, mothers with one month or younger
babies said that the guidance did not help reduce their child-rearing anxiety.6) A study conducted in a parenting
course attended by six mothers suffering from child-rearing anxiety found that although action group work
designed to help these mothers develop an effective coping behavior toward their children helped increased
their knowledge about behavior modification, it did not result in any systematic change in their actual coping
behavior toward child rearing.7) Such conventional methods of providing support are basically conduit for
conveying knowledge and information for reducing anxiety or stop-gap measures mainly designed to bringabout behavioral modification. Thus support is clearly needed to help mothers reduce child-rearing anxiety andstress in a fundamental way.
Stress is perceived when things do not turn as expected, 8) and today’s perception is related to theimage-scripts generated by past images. 9) According to T. Munakata, 9) our perception or understanding ofreality or future predictions are based on scripts that are reconstructed to match our expectations (predictions)drawn from our past knowledge and experience. Additionally, Munakata refers to (i) images based on sensory
information input from all sensory spheres (including the sense of smell, taste and balance, somatic sensations,5etc.) and images based on sensory information (including sadness, enjoyment, fear, etc.) that generates value
by being stored in the amygdala, and (ii) images based on stories of behavioral information output from these
two sets of images as image-scripts. Munakata then points out that today’s self-image-scripts are triggered bymemories of past images rooted in the growth environment of one’s parents.
Image memories differ depending on whether the essential needs of the soul are fulfilled or not.
According to the essential needs of the soul theory, 9) human beings possess three basic needs of the soul
expressed: (a) “I want my own needs to be fulfilled with other person’s love”; (b) “I want to develop self
confidence so I can fulfill my needs by myself”; and (3) “I want to fulfill other people’s needs unconditionally with
my own love.” A negative image of unfulfilled essential needs of the soul formed in the growth environment andthe like stored in the amygdala will develop into a trauma, which in turn will make a person more prone todevelop a negative self image-script. 9) Removing a negative self-images script is difficult once it has been
formed, and the presence of a negative self image-script makes a person more prone to perceive each of thevarious stimuli provided by the environment as stress.
It is common knowledge that when a stimulus is perceived as stress, CRH (corticotropin-releasing
hormone), which induces the secretion of ACTH (adrenocorticotropic hormone), is released from the
hypothalamic area of the brain, ACTH is secreted from the pituitary gland, and the stress hormone cotisol issecreted from the adrenal cortex. 10) Since the cortisol level in the blood is quickly reflected in the cortisol levelin the saliva, 11) in recent years, four separate studies have been conducted to measure the cortisol level in thesaliva as a stress indicator, 12-15) All four studies found a correlation between the rise in the cortisol level and theincrease in stress. Thus it is believed that cortisol triggers a variety of diseases. 9)
6

From the perspective of the cerebral nervous system, an image is a transfer pattern of a cranial nerve
circuit formed when two neurons are joined at a synapse. 9) The SAT theory asserts that the synopsis
connections are strengthened through the creation of cranial nerve activity patterns. These patterns are
created (i) by forming a reward-system (positive) image-script that satisfies the cranial nerve activity patterns fora cranial nerve activity pattern that up to now responded only negatively to external stimuli because the essential
needs of the soul were not satisfied, and (ii) by acting repeatedly on the basis of that positive image-script over along period of time.9) Under this SAT theory, counseling utilizing images that support behavioral modification andself-growth is provided on a daily basis, resulting in reduced stress.16) Past studies have confirmed theeffectiveness of individual counseling in improving the child-rearing mother’s self-esteem and child-careconfidence. In order to lower the level of anxiety and stress of child-rearing mothers, it is hoped a support
method will be designed to raise the level of their child-care confidence and self-esteem. 17)
This study examines, both quantitatively and qualitatively, the short-term effects of intervention and theirextended effects three months after the intervention. The objective is to reduce stress and improve child-careconfidence for groups of child-rearing mothers in a fundamental way. The intervention is carried out by using theessential needs of soul support method using a guidance method based on the theory and technique of SAT
support method and the reward-system images that fulfill the essential needs of the soul.

II. Research Methods
1. Targets and survey methods
With the cooperation of the healthcare center of Town A, Prefecture S, a group of child-rearing mothers
7were selected as the intervention group using a snowball sampling technique and urged them to participate in a“child-rearing support course.” A total of 31 child-rearing mothers participated in the course, five of whom
either came late or were not rearing a child at the time of the intervention. Thus 26 of the 31 participants (84%)
were targeted for the analyses. Sixteen of the original participants (62%) cooperated in the analyses conducted
three-month after the intervention.
With the cooperation of the Town A health center, the same snowball sampling method was used to
select a group of child-rearing mothers as the non-intervention group and the first survey was conducted while
the intervention group was participating in the child-rearing support course. Questionnaires were distributed to all
17 mothers of the intervention group. They all filled out the questionnaires and returned them. Sevenchild-rearing mothers (41%) cooperated in the second survey, which was timed to dovetail with the three-monthafter analysis of the intervention group.
For the intervention group, the pre-course questionnaires and post-intervention questionnaires werecollected in individual envelopes before and after the course, respectively. For the non-intervention group, thequestionnaires were distributed at the healthcare center and collected in individual envelopes. In the survey
conducted three months after the intervention, a questionnaire packet enclosed with a return envelope and awritten request for cooperation was mailed out to each participant and collected through the mail. The survey
was conducted over a period of three months, from August to November 2004.
In this study, around the time of the intervention, samples of saliva were taken using the essential needsof soul support method to measure the cortisol level in the saliva of the participants as a stress indicator. Since
saliva secretion reacts sensitively to stress, the saliva sampling was taken during rest hours.
8Out of ethical consideration, this study was subject to epidemiological review by the Tsukuba University
Ethics Committee and approved. Before implementation, among other things, the authors explained in writingthat the objective of the study and stressed that cooperation in the study was optional, that the respondents were
free to decide whether to put down their names or not, that the answers they write down should reflect their own
views, and that the collected data will be treated quantitatively. For those participating in the child-rearing support
course, the authors verbally explained the purpose of the course and asked for cooperation. The participants
agreed to cooperate. Those in the intervention group were asked to submit a certificate of consent, which theydid.
The standardized Japanese versions of two existing psychological scales were used: the State Trait
Anxiety Inventory 18) and the Self-Rating Depression Scale. 19 The developers of both scales consented to theauthors’ request to utilize them.

2. Composition of the questionnaire
The questionnaire consists of existing psychological scales on child-care confidence, and child-careanxiety (whose attributes, reliability and validity have been reviewed). Table 1 shows the contents of the scales
and the alpha coefficients ascertained in the study.

9

Table １ Composition of the questionnaire
Scale

Developed
Rosenberg 1965,Japaneseversion Munakata et al 1987

Item

Score

10

0〜10 Measures the degree of affirmative self-image.

.860

2 Self-repression

Munakata 1996

10

Measures the inclination to repress one's feeling or
0〜20 thoughts so that others do not come to dislike theindividual.

.772

3 Emotional support network

Munakata 1996

10

0〜10

Measures the degree of awareness of emotional
support from family and others,respectively.

.854

4 Problem-solving

Munakata 1990

10

0〜20

Measures the tendency towerd effective andpositive problem-solving.

.652

18

0〜18

Measures the degree of excessive interpersonal
dependency.

.742

1 Self-esteemContent of measurement

α coefficient20

20〜80 Measures the tendency to feel anxious.

7 Depression（SDS）

Hirschfeld1977,compiled by
P.McDonald Scott
Spielberger 1970,compiled by
Mizuguti et al
Zung 1965 compiled by Hukuda

20

20〜80 Measures the tendency towerds depression.

.841

8 Child-care confidence

Yajima et al 2004

10

10〜40 Measures the degree of the child-care confidence.

.880

9 Child-care anxietry

Extraction from Profile-scaleby Kawai et al 199713

13〜52 Measures the degree of the child-care anxietry.

.853

5 Interpersonal dependency
6 Trait anxietry（STAI）

3. Method of intervention
The intervention was conducted by two SAT counselors licensed by the Academy of Health Counseling.
The intervention lasted 90 minutes – 30 minutes for guidance, 45 minutes for on-site training, and 15 minutes forfilling out the post-intervention questionnaire.

4. Contents of the Intervention(1) The intervention involved on-site training using the method of communication with children based on SAT
therapy, the essential needs of soul theory, the guidance based on the flashback theory, and the essential needsof soul support method.

(2) What is the essential needs of soul support method?
The essential needs of soul support method is based on the essential needs of soul theory. The method
10

.912

is built from the three techniques discussed below to help child-rearing mothers cope with the problems they
currently face by (a) creating a positive image-script that fulfills the essential needs of the soul that are at preset
unfulfilled, and (b) by using the positive image-script formed with the essential needs of soul method even if
there is a negative image-script that flashes back, and forth between past and future at the time of stressperception. Additionally, free-description sheets used to have the participants indicate for each of the threetechniques discussed below their subjective stress levels, their impressions, and the way they cope with stress.
(a) Making physical contact: In this technique, the participants, in pairs, empathetically make physical contact.
This is done by imagining the person one loves with the region or force one prefers and in such a way that asignal of unconditional love is sent from one’s hand to the hand of the person one is paired with.
Noradrenalin is secreted when stress is perceived, and this causes symptoms to appear in various regionsof the body. 9) The physical contact technique aims to control negative emotions, promote pleasurable
sensations and reduce the present somatic symptoms by inducing the release of dopamine and serotoninfrom the brain by producing somatosensory stimuli through physical contact.

(b) Forming a favorable inner-womb image and love signaling method: These techniques aim to help theparticipants fulfill the essential needs of their soul by having them create a favorable image of themselves intheir mother’s womb by applying structured regressive hypnosis and offering words that convey a signal oflove so that the participants will be able to hold a positive image-script, and thereby weaken the flashback ofnegative images from the past and also apply that same positive image-script for the coming child.

11(c) Forming a future self-image: This technique aims to fulfill the essential needs of the soul by creating andforming an image of the self enjoying life and living with exuberance and full of confidence. The techniquealso aims to help child-rearing mothers perceive the self acting in accordance with one’s own values
believes.

5. Analytical method
The survey results were analyzed using the statistics analysis software SPSS Ver. 11.0. The Friedman
test was then administered to evaluate changes in the participants’ subjective stress level during the intervention,
the effects of psychological traits on their stress level around the time of the intervention, and the extended
effects of the intervention. For the purpose of multiple comparisons, after administering the Wilcoxon codedranking test, corrections were made using the Bonferroni inequalities

III. Findings
1. Average psychological trait values of child-rearing mothers
Average psychological trait values of a total of 43 child-rearing mothers (belonging to either theintervention group or to the non-intervention group) were calculated and the following results were obtained: theself-esteem level rose 6.16 points; the self-suppression behavioral trait level, 9.14 points; the emotional support
network family level, 8.53 points; the other than family level, 8.14 points; the problem solving behavioral trait level,
10.44 points; the interpersonal dependence type behavioral trait level, 6.53 points; and the trait anxiety level,
43.86 points
122. Comparison of the basic attributes and psychological trait of mothers in the intervention group and those in
the non-intervention group

Table 2 shows the results of the Mann-Whitney test on the intervention and non-intervention groups
administered to determine whether it is possible for the non-intervention group to serve as the control group interms of basic attributes and psychological traits. Although differences were observed in the case of the mother’s
age and the age of her spouse, no significant differences were found in the case of other items. Thus it was
concluded that the non-intervention group cannot serve as the control group.

Table 2 Comparison of the basic attributes and psychological traits of mothers in the intervention group andthose in the non-intervention group,changes around the time of the intervention(intervention group ｎ=26、nonintervention group ｎ=17)

Age of person in questionAge of consort
Number of those who cohabit
Number of children
Self-esteem
Self-repression
Emotional support network(family)
Emotional support network(others)
Problem-solving
Interpersonal dependency
Trait anxietry（STAI）
Depression（SDS）
Child-care confidenceChild-care anxietry
Cortisol level in the saliva

Intervention group
Mean value
Mean value
before intervention
after intervention
32.12（±4.11）
34.81（±5.93）
4.50（±1.50）
1.58（±0.86）
5.96（±2.76） 8.04（±2.03）
9.58（±3.36） 8.77（±2.70）
8.58（±2.04） 9.35（±1.55）
8.12（±2.49） 8.81（±2.25）
10.58（±3.01） 10.27（±2.66）
6.77（±3.37） 6.35（±3.69）
43.12（±11.43） 41.65（±10.80）
40.15（±9.02） 37.46（±7.55）
26.46（±5.37） 29.81（±4.61）
23.19（±6.42） 23.50（±7.00）
0.28（±0.12） 0.23（±0.09）

Non-intervention group Both crowd comparison
p-value

.000
.070
.007
.007
.542
.289
.252
.005
.000
.806
.002

beforep-value

28.94（±2.33）
30.88（±3.36）
4.06（±1.44）
1.41（±0.51）
6.47（±2.38）
9.18（±3.43）
8.48（±2.50)
8.18（±2.63）
10.24（±2.56）
6.29（±3.18）
45.12（±9.56）
41.12（±7.96）
28.41（±4.29）
21.76（±4.86）

.013
.049
.305
.819
.707
.644
.883
.655
.515
.546
.384
.645
.178
.508

3. Changes in psychological traits and child-care self confidence around the time of the intervention
Changes in psychological traits around the time of the intervention are shown in Table 2. After theintervention, the average score rose significantly for self-esteem, family with perceived emotional support, other13

than family, and child-care confidence, while the average score for depression and self-suppression behavioral
traits tended to decline. However, no significant differences were found around the intervention for problem
solving behavioral traits, interpersonal behavioral traits, anxiety traits, and child-care anxiety.

4. Changes in the subjective stress level during the intervention using the essential needs of soul support
method.

Figure 1 shows the results of an assay of descriptions of stress levels the participants wrote down in the freedescription sheets distributed to them to determine the effect of the intervention on their subjective stress levelaround the time of the intervention. The average value of the subjective stress levels before the intervention
declined significantly in each technique.
Figure 1

Changes in the subjective stress level during the intervention（ ｎ ＝26）

％
100

＊＊＊
＊＊＊

80
＊＊＊
＊＊＊

60

65.3

†
＊＊＊

40

39.6

32.6

20

23.3

0
beforeintervention

Friedman：ｐ＝.000

after the physicalcontact

after thafavorable innerwomb image andlove signaling
method14

post hoc test(Bonferroni)

after the futureself-image＊＊＊：ｐ＜.001†：ｐ＜.1

5. Regarding the change in cortisol level in the saliva around the time of the intervention using the essential
needs of soul support method

The cortisol level in the saliva was measured to ascertain the effects of the intervention around the time of theintervention. After the intervention with the essential needs of sour support method, the cortisol level in the saliva
declined significantly (Table 2). Additionally, correlational analyses (Speaman) were conducted to observe therelationship between the cortisol level and the variation in the psychological traits around the time of theintervention (ρ=.440 p=.024) and the variation in the child-care anxiety level (ρ=.404 p=.01)

6. Comparison of the psychological traits of child-rearing mothers in the intervention group and those in the
non-intervention group before the intervention and three months after the intervention

With regard to the intervention group (n=16) and the non-intervention group (n=7), the average value of
psychological traits before the intervention and three months after were compared. The age of the child-rearing
mothers in the non-intervention group was significantly lower (intervention group: 32.131 [±4.34] years old;
non-intervention group: 28.14 (±2.4) years old, p=0.21). Before the intervention, the average child-careconfidence level tended to be significantly higher for the non-intervention group (p=003) and the average15depression level tended to be lower (p=056). Three months after the intervention, no significant difference wasobserved between the two groups (for the scores obtained, see Tables 3 and 4).

Table 3 Change of the psychological traits in the intervention group before and three months after the intervention（ｎ＝16）
Mean valueFriedman①−③①−②①before②after
③three months afterSelf-esteem
5.13（±2.94） 7.75（±2.38）
6.56（±2.58）
Self-repression
10.13（±3.38） 9.06（±2.89）
9.31（±2.92）
Emotional support network(family) 8.25（±2.11） 9.25（±1.81）
7.94（±2.91）
Emotional support network(others) 7.69（±2.94） 8.56（±2.76）
7.75（±3.53）
Problem-solving
10.25（±3.36） 10.25（±2.84） 10.13（±4.67）
Interpersonal dependency
7.06（±3.42） 6.63（±3.67）
5.94（±4.01）
Trait anxietry（STAI）
46.88（±12.37） 44.25（±12.20） 43.50（±11.79）
Depression（SDS）
43.94（±8.04） 40.38（±7.50） 40.25（±8.93）
Child-care confidence
24.25（±5.30） 28.38（±4.84） 27.00（±4.24）
Child-care anxietry
25.38（±7.11） 25.63（±7.70） 24.13（±6.89）

p-value
.000
.601
.111
.067
.645
.154
.219
.004
.002
.442

Bonferroni
ｐ<.01

Bonferroni
ｐ<.01

ｐ<.05
ｐ<.01

ｐ<.05
ｐ<.05

Table 4 Change of the psychological traits in the non-intervention group before
and three months after the intervention（ｎ＝7）
Non-intervention group
Mean value three
Mean value before
p-valuemonths after
28.14（±2.04）
Age of person in question
Self-esteem
7.14（±2.27）
7.86（±2.41）.059
9.71（±3.04）
9.57（±3.41）
1.000
Self-repression
Emotional support network(family)
9.43（±1.13）
9.57（±0.79）.317
8.71（±2.63）
9.14（±1.57）.317
Emotional support network(others)
Problem-solving
10.86（±1.46）
9.57（±1.72）.202
Interpersonal dependency
5.43（±0.98）
7.14（±3.13）.140
41.86（±6.31）
37.86（±10.29）.223
Trait anxietry（STAI）
Depression（SDS）
36.71（±6.24）
36.00（±7.72）.674
30.29（±2.93）
30.43（±3.46）.891
Child-care confidenceChild-care anxietry
22.86（±5.40）
21.43（±6.73）.352

7. With regard to the extended effects for three months after the intervention

In order to measure the extended effects of intervention in the intervention group, the effects were measured
before, immediately after, and three months after the intervention. Improvements in self esteem and child-care16

confidence and decline in depression were sustained at a significant level for three months after the intervention(Table 3). In the non-intervention group, no significant change was observed (Table 4).

8. Change in the mother’s subjective stress level three months after the intervention

Table 5 shows (a) all the cases involving the subjective stress of child rearing written in the free-description

17

18

sheets during the intervention using the essential needs of soul support model, and (b) the stress coping
methods and changes in the mother’s attitude toward the child described in the survey three-month after theintervention.

IV. Discussion
In this study, direct intervention of a group of child-rearing mothers was implemented by applying the SAT
theory-based guidance method and the essential needs support method. The effects of the intervention wasthen examined, both quantitatively and qualitatively, on the basis of the changes in the psychological traits of thechild-rearing mothers observed around the time of the intervention and three months after the intervention, as
well as on the basis of the impressions they wrote down in the free-description sheets.

1. Regarding the present state of child-rearing mothers
Child rearing is a regular part of life, but at the same time, it is said that a child-rearing mother is in apeculiar situation characterized by many stressors. Stress is perceived when things do not go as expected, andwhen a stress is perceived negatively, self control of feelings, behaviors and bodily functions declines, resulting
in the appearance of somatic, behavioral and neurological symptoms. 8)
The subjective stress that emerges from the free descriptions provided by the child-rearing mothers in the
study shows neurological symptoms such as: “I get irritated when I compare my baby with other babies”; “I
become irritated and lose my temper when my baby doesn’t listen to me”; or “I become irritated when I can’t do
the household chores [because I have to take care of my baby].” The mothers’ subjective stress is also19manifested in behavioral symptoms such as: ”I get mad at my baby easily”; “I find myself shouting at my baby”;
and “I often hit my baby.” With regard to somatic symptoms, in the free description distributed during theintervention, the participants were asked write down where they felt most uncomfortable when they were understress. Their answers contained a large range of symptoms including stiff shoulders, stomach ache, lower backproblem and headache. From these stress symptoms, it is possible to infer that child-rearing mothers are undera lot of stress.
The self-esteem of mothers in this study was 6 points, and from the interpretation of this measure, 21)mothers in this study have low self-esteem and negative self-image. And given that their average value for trait
anxiety was 44 points, (which is considered high), while their average value for depression was 40 points, (whichmeans they are in a light depression territory), it is hardly possible to say that the mothers in this study are ingood mental health. It is can be assumed that the mothers’ stress symptoms and poor mental health, conveyed
either directly or indirectly through their expressions, tone of voice, attitude and so on, have a negative impact on
their children. 22) 32)

2. Regarding the intervention’s short-term effects
After the intervention using the essential needs of support method, the self-esteem level, awareness ofemotional support level and child-care confidence level were improved, while the self-repression level anddepression level were lower.
Stress is closely related to the image of the situation that has triggered the stress. According to a reportby Hashimoto et al, 24) in image research it is said that when one has a good image of one’s parents, one tends

20to also have a good self-image, and good self-image is said to be conducive good mental health, but no study
has been done to determine how self-image can be improved. Additionally, according to a study by Higuchi et al,25) there is evidence that having a positive image-script of one’s parents has an effect of changing one’s mental

health in a favorable way. Group intervention was carried out in this study with the view to improving theparticipating mothers’ self-image and the image of their parents by using the SAT physical contact method,favorable inner-womb image method, love signaling method, and future self-image method.
The somatosensory stimulus triggered by physical contact releases dopamine and serotonin from thebrain, which in turn repress negative emotions and heighten the feeling of pleasure, thereby reducing stress. 20)
The SAT physical contact method used in carrying out the intervention of this study works directly on the painand discomfort the body feels when it is under stress. First, the participants are instructed to form an image ofthe stress they currently feel and perceive the discomfort and pain felt by the body, and reduce the discomfort
and pain by instinctively answering the question “What part of the body do you want me to stroke?” These steps
activate the intuitive faculties of the brain’s right hemisphere in a manner peculiar to the SAT method. Stroking
the other party endearingly where she wants to be stroked and with the amount of force she desires releases
serotonin in the brain, thereby easing the stress felt by the body. This reduction of the stress felt by the body isbelieved to be what enables the patient to feel psychologically good or relaxed. The level of subjective stress is
reduced to its lowest level after the physical contact. The impressions the participants had after the psychicalcontact included “I feel comfortable”; “I feel relaxed”; “I feel lighter”; and “I feel safe,” suggesting that theintervention using the SAT physical contact method had the desired effects. It is believed that the support ofothers can be perceived by experiencing a feeling of comfortableness and feeling of security through the touch21

by others, thus raising awareness of the emotional support being provided.
The awareness and emotions one has today are influenced by the past and future images that exist in
the subconscious. One is unable to exercise self-control when one develops stress because there is a flashbackof negative images stored in the mind. 9) However, in the SAT theory-based guidance method or image therapy,
support is provided to help patients modify their behaviors or achieve self-growth usually by urging them to recall
images of past traumas and transform their negative image-scripts to positive ones. However, in the groupintervention conducted for this study, the participants are urged to form a positive image-script from theinner-womb stage to the infant stage without having to recall past traumas by using the favorable inner-womb
image method and love signaling method. Images represent cranial nerve activity patterns, and for the brain,
whether the images are perceived images rooted in experience or imagined, and even if they contain different
quantities of information, the path through which the brain is aroused is the same.9) That is to say, forming
imagined images using the favorable inner-womb method and love signaling method enables one to freshly
form cranial nerve activity patterns of positive images of being amply loved and accepted from the inner-womb
period to the infant stage. Recalling an image of being loved in the past enables some people to change theimage they have of their parents and even their own self images in a favorable way, thus in turn enabling themto improve their self esteem.
In addition, the present is also influenced by future images. If one is able to imagine the future in apositive way, one will also be able to perceive the present in a positive way. 9) The future image method usedin this study guides the child-rearing mother to imagine the future and form a fresh positive image-script basedon that imagined image of the future. According to humanistic psychology, 26) 27) human are by nature22autonomous beings with goals and values and are capable of self-determination, and mental health is realized in
the process of self-realization. However, it is probably the case that the degree to which one is able to hold afavorable self-image plays a part in self-determination that makes self-realization possible. It is believed that bydeveloping a positive image-script in which the future self is portrayed as free and self-confident, one is able toperceive the self in its true light and the self-image is changed in a favorable way, that is, in a way that shows theself able to choose a way of life that holds the self dearly, thereby improving one’s mental health and lowering
depression.
Earlier it was pointed out that the essential needs of soul support method is a support method that fulfills
three basic needs. According to Munakata’s soul development theory, 28) the period between infant and laterchildhood is the period when one is recognized and loved by a significant other (fulfillment of the desire to be
loved). Munakata cites the inability of one’s parents, one’s first significant others, to resolve the problems ofself-repression and dependence of their souls as a factor that prevents resolution of problems that arise when
one is an infant. Self-repression and reliance on others are formed by a feeling of being affection-deprived or
receiving only conditional love (as opposed to unconditional love) in the process of growing up. That is to say, by
not being loved unconditionally by one’s significant others in the process of growing up, the parents themselves
developed a proclivity to suppress their feelings and depend on others, which continued into their adulthood.
The mother herself is designed to fulfill her desire to be loved because she is so worried about how others viewher that she does not have her own standard of judgment, but has such a strong expectation of others that shelacks the confidence required for self-determination. Thus she is unable to give her children unconditional love,and finds herself shouting at them when they do not listen to her. The latter is a manifestation of her dependence23

on her children. Properly speaking, the level of self-repression and dependence on others need to be lowered
before these issues can be resolved. However, in this survey, although there was a tendency for the level ofself-repression to become significantly lower, there was no change in the average score on the dependence ofothers measure.
One reason there was no clear change in the self-repression level is that no self-assertion training wasprovided. The actual amount of housework and work related to child-rearing did not change. Since the soulwants self-repression, even if the wife feels a desire to have her husband help in child-rearing, she concludes
that she should not ask her husband to help. Because she is unable to ask, her desire to have her husband
understand how hard it is to keep the house and at the same time raise children and the sense that she wants
him to help remains unfulfilled. Moreover, limiting its objective to clarifying the nature of stress in child rearing, thesurvey clarified the impressions the participating mothers gave for each support method, their method of copingwith stress and awareness of its presence, and in the process of clarifying these points, the participating mothers
developed the skills for making physical contact with their children as a way of coping with stress. However, it isunclear whether the intensity of the feeling of dependence on others as expressed by their desire to get their
toddlers to listen was completely reduced, although evidence suggests it remains. Thus it can be inferred that inthis survey the score on the dependence on others measure did not change, and it can be expected that thelevel of self-repression and dependence on others may be lowered by repeatedly applying the essential needsof soul support method.
In this study, in order to measure the stress reduction effect of the essential needs of support method, thecortisol level in the saliva of the participating mothers was measured around the time of the intervention. The
24

standard cortisol level in the saliva is said to range in the vicinity of 0.03 to 0.2 μ g/d 1 with the level being high inthe morning and low in the evening.10) In this study, a quiet rest time was provided to eliminate the impact of
the rise in the stress level at the time the participating mothers arrived at the health center. The cortisol level foreach participant was measured at around 11 am (before intervention) and around 11 pm (after intervention).
Thus the impact of the time of the day factor was kept to a minimum. The average cortisol level in the saliva of
the participating mothers was 0.28 μ g/d 1, suggesting that the mothers targeted in this study were under stress.
The cortisol levels in their saliva were significantly lower after the intervention. In addition, a correlational analysisof the degree of change around the time of the intervention found a correlation between the degree of change inthe trait anxiety level and the degree of change in the child-care anxiety level, suggesting that the essential
needs of soul support method was effective in reducing the psychological stress of child-bearing mothers.
According to the contents of the descriptions entered in the free-description sheets distributed during theintervention using the essential of soul support method, the average subjective stress level before theintervention was 64.5%, but it declined to 39.6% after the physical contact intervention and to 32.6% after theapplication of the inner-womb image method. Then, after the future self-image method was applied, it declined
significantly to 23.4%. As a result of these changes, together with the decline of the cortisol level in the saliva, it
can be inferred that the intervention had an effect in reducing the stress perceived at the present. Moreover,since the individual techniques were all effective in reducing stress, intervention using one of the techniques isbelieved possible.

2. Regarding the extended effects of intervention
25

Quantitative changes in psychological traits and child-care confidence and quantitative changes in
attitude toward children, both recorded three months after the intervention, as well as changes in stress levels
achieved through the application of stress-coping methods were studied qualitatively. In the quantitative changes,
improvements in self-esteem and child-care confidence as well as the declines in depression were sustained
significantly. Around the time of the intervention, the child-care confidence level of the intervention group was
significantly higher and their depression level was significantly lower, while mothers in the non-intervention groupwere caring for their children with more confident and less stress. Three months after the intervention, the levelof self-esteem tended to rise significantly in the non-intervention group, but there was no statistically significant
difference between the two groups. It can be inferred from this that there was no significant difference precisely
because significant improvements in self-esteem and child-care confidence and a significant decline indepression were both sustained among those in the non-intervention group. Moreover, changes in attitude
toward one’s children and changes in actions taken toward oneself could be inferred from the responses thechild-rearing mothers gave in the questionnaire survey conducted three months after the intervention, Thissuggests that, based on quantitative and qualitative analyses of the data, the essential needs of support method
has the extended effect of improving the levels of self-esteem and child-care confidence, thereby reducing
child-rearing anxiety and stress of mothers.
The participating mothers said that they felt comfortable and safe after the intervention using the SAT
physical contact. Given that the state of a mother’s soul impacts her attitude toward child-rearing, Hashimoto S.
29) states that child-rearing mothers should create an environment where their children can feel reassured andreceive safe and unshakable love unconditionally by (i) sending out a lot of messages of unconditional love, (ii)26realizing their susceptibility to respond emotionally to suit their own convenience, and (iii) letting their children go
through experiences that will fulfill the three basic desires of their soul. It is believed that to be able to send out
safe and reassuring signals to their children, first of all, mothers need to be able to relax as when the physicalcontact method is applied. Moreover, although physical contact with babies, such as the post-delivery kangaroocare and touch care, are stressed, 30) it is believed that knowing how good it feels to have physical contact
enables mothers to hug their own children. However, in the questionnaire survey conducted three months after
the intervention, the participating mothers said they changed their behavior, as in: “I hugged my daughter when
she crawled close to my feet”; “I hug my daughter even though she’s in school now.”Moreover, from the viewpoint of what Hashimoto S. terms “the ease with which mothers respondemotionally to suit their own convenience,” 29) it is significant that the participating mothers made such comments
as: “I lose my temper, despite myself, and end up screaming at my baby”; “The more difficulty I have figuring out
what’s making me angry, the more angry I get”; and “When I’m inundated with housekeeping chores, I get
irritated and find myself scolding my baby.” But three months after the intervention, the same mothers showedbehavioral modification, that is, changed the way they thought about their kids, the way they expressed their love
for them, and how they accepted them into their heart. Here are some examples “I’ve learned to see things frommy child’s perspective. I pause to take breaths to control my anger and avoid unilaterally scolding him”; “Mybaby seems much cuter than before”: “I’m more sensitive to my baby’s needs now than I used to be.” “When I’m
about to lose my temper, I take a deep breath and recall my childhood days when I was really loved. I do mybest to slow down and relax more.”
The reason the intervention had positive effects may be that the significant rise in self-esteem level and27

child-care confidence level, coupled with the significant reduction in depression level, enabled mothers to be
more relaxed with their babies, thus rendering the interaction between mother and child more comforting。
Additionally, as can be see by the comment, “Recalling the words used in the love signaling method at a time
when I was irritated enabled me to show real affection for my baby, which I couldn’t do before,” even whenmothers had flashbacks of negative images, by repeatedly changing their attitude toward their children by
applying the positive image-script formed in their minds further strengthened that active pattern and enabledmothers to continue forming the positive image-script even three months after the intervention.
Three months after the intervention, not only was there modification in the mothers’ behavioral toward
their babies, there was also modification in the mothers’ behavior toward themselves. The mothers continued tobehave in a way that placed importance on the self, as in “Now I’m interested in things other than raising mybaby. When the baby’s asleep, I read a newspaper or a book I’ve wanted to read. I’ve pulled myself together, so
now, I can as a human being, calmly face my baby,” or “I’ve taken up something I’ve always wanted to do.” “I set
aside time to be alone,” or “For a change of air, I take my baby to a park or take her out with me.” This suggeststhat undergoing the intervention using the future self-imaging method helped the mothers find what they reallywant to do, thus enabling them to modify their behavior.
It is believed that, thanks to these favorable behavioral modifications, the mothers in the intervention
group were able to continue to direct their coping behavior at their children and at themselves, resulting in thecontinued improvement of self-esteem and child-care confidence, thereby enabling these mothers to continue
lowering their depression level. Regarding child care anxiety, Kawai N. et al 17) believes that, since mothers’
psychosomatic condition is related to the psychosomatic condition of their children, their tendency to be anxious
28

about child-rearing is believed to originate in their lack of self-esteem and feeling of incompetence andhelplessness. Kawai et al point out the necessity of intervention centering on assistance to mothers to develop aproper sense of motherhood, and it can be said that the essential needs of soul support method, which supports
the change in lifestyle to one that places importance on the mother’s attitude towards her child and herself byincreasing her self-esteem and child-care confidence, is precisely the kind of support designed to assist mothers
to develop such a sense of motherhood.
The foregoing discussion describes the extended effects of the essential needs of soul support method,
but it is unreasonable to think that the method, as it is, will be effective for everyone. Consequently, for improving
the essential needs of soul support method, it is important to examine the cases where mothers were not able toeffect behavioral modifications either towards their child or toward themselves.
In case 12 of the analysis conducted three months after the intervention, the mother remarked, “I had myhusband read the description I wrote down. I think that helped him understand why I was so stressed out caring
for our baby.” But the mother did not say that the intervention helped change their behavior toward themselvesor their children. In case 13, the mother said, “The situation has not changed,” showing that the intervention was
not effective. The psychological traits that characterize case 12 were: low levels of self-esteem, emotional
support awareness, child-care confidence, and high levels of self-repression, problem avoidance, reliance onothers, trait anxiety, depression, and child-care anxiety. An infant treated for a psychogenetic visual impairment iscited in a study undertaken by Higuchi N. et al. 25) Right after the treatment, the mother showed some signs ofimprovement, but later relapsed. She manifested the following characteristics: a high level of anxiety,self-repression, and reliance on others, and a low level of self-esteem and support awareness. These are the29characteristics of mothers who did not show any extended effects three months after the intervention, but they
resemble those observed in case 12. The mother in case 12 wrote down in her free-description sheet, “I recall
being alone as a child,” suggesting that she has a negative image of her parents as she grew up.
The psychological traits that characterize case 13 were: a low level of reliance on other and a high levelof problem avoidance, and a low level of child-care confidence. The mother acts in ways that avoid problem
solving, as in: “I’m overwhelmed by what I have to do every day” and “I clean the house just to relieve stress, ortake my baby out to a department store or the like where we just walk around.” Here, the mother seems neither
to understand nor accept how the child feels, as when she says, “I gets emotional and take it out on my kid.” In
her free-description sheet, the mother remarks, “I end up recalling my real parents and the environment I grew
up in, and marvel at how lucky babies are when they are brought into this world by parents who love them as
depicted by this image,” reflecting the negative image she has of her parents.
Common to these two cases where neither mothers got good results from the intervention is that theyboth have negative images of their parents in the environment they grew up in, and frequently resort to problem
avoidance. The high level of problem avoidance means that these mothers are so anxious about child-rearingthat they are unable look straight at the problems. As a result, they are susceptible to becoming excessively
optimistic and are likely to turn their backs on reality on regular basis. 31)
From the foregoing discussion, the method of intervention adopted in this study by itself is believed to beinadequate to enable parents to solve their child-rearing problems if they have strong negative images ofthemselves going back when they were very young, including when they were in their mothers’ womb, and lackthe strength to look straight at and solve the problems they face. For children’s soul to develop, it is important
30

give them experience receiving ample amount of love during their fetal life and infancy. However, the love they
get from their parents must be unconditional love. To provide a safe and secured environment for their children
to grow in, mothers must be able to care for them with tender love. 29) Those mothers participating in this study
for whom the essential needs of support method proved effective apparently all had traumatic experiences
hidden in their subconsciousness.
In individual counseling cases, counseling provided is designed to meet the needs of the individual client,but since this study targeted groups rather than individuals, the intervention could not be customized to meet theneeds of individual participants. Using the essential needs of soul support method, together with thepersonalized SAT-based therapy support, was deemed effective in addressing the shortcomings of applying theessential needs of soul support method to groups.

V. Conclusions

1. After the intervention, the essential needs of soul support method used to provide guidance for child-rearing
mothers proved effective in significantly raising their self-esteem level, support awareness level and child-careconfidence level, and significantly lowering their depression level, cortisol level of the saliva and subjective stresslevel.
2. Three months after the intervention, the extended effects were favorable behavioral modifications towards
one’s children and towards oneself, higher levels of self-esteem and child-care confidence, and a lower
depression level.
31

3. The essential needs of soul support method using positive image-scripts based on quantitative andqualitative data analyses is believed to be effective in reducing stress borne by child-rearing mothers andimproving their confidence in caring for their children.

Acknowledgement
This study was conducted as a category B basic research of the Ministry of Education, Culture, Sports,
Science and Technology’s Grant-Aid for Scientific Research (Proposal No. 16300219; title: “A Study of aLong-Distance Support System for Sustained Health Behavior Using a Counseling Method for Supporting
Prevention of Lifestyle Diseases among Local Residents, Patients and Patients-to-Be,” Research Leader: Sayuri
Hashimoto. We would like to express our sincere gratitude to all who cooperated in this study.

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Koshueise-shi, 46 (4), 250-261 (1999)
3) Shimizu, K., Nishida, K., “Ikuji Sutoresu Kozo no Kenkyu,” Nihon Kaigo Kenkyuu Gakkai Zasshi, 23 (5),55-67 (2000)
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Seishin Igaku-teki Shiten – ,“ Nagoya Daigaku Shuppankai, Nagoya, 14-22 (2003)
32

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