Volume 5, Issue 4 (January 2025)
2025, 5(4): 184-195 |
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Najmi M, Ghorban Jahromi R, Sadipour E, Karimzadeh M. (2025). Comparing the Effectiveness of Attachment-Centered Theraplay and Child-Parent Relationship Play Therapies on Emotion Regulation in Children with Separation Anxiety Disorder. Journal of Childhood Health and Education. 5(4), 184-195. doi:10.32592/jeche.5.4.184
URL: http://jeche.ir/article-1-253-en.html
URL: http://jeche.ir/article-1-253-en.html
1- PhD student in Educational Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran
2- Assistant Professor, Department of Educational and Personality Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran
3- Professor, Department of Educational Psychology, Allameh Tabataba'i University, Tehran, Iran
4- Associate professor department of preschool education, university of social welfare and Rehabilitation sciences ,Tehran.Iran
2- Assistant Professor, Department of Educational and Personality Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran
3- Professor, Department of Educational Psychology, Allameh Tabataba'i University, Tehran, Iran
4- Associate professor department of preschool education, university of social welfare and Rehabilitation sciences ,Tehran.Iran
Keywords: Attachment-centered play therapy, Emotional regulation, Parent-child relationship-based play therapy, Separation anxiety disorder
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| Background and Aim: Anxiety disorders are among the most common disorders in childhood and adolescence (Sadeghi et al., 2022; Battaglia, 2015). One of the most prevalent anxiety disorders in childhood is separation anxiety disorder. Numerous studies indicate that children with separation anxiety disorder also struggle with emotional regulation, particularly regarding their negative emotions (Hurl, Huang, Hudson, 2017; Silvers, 2022). Emotional regulation involves the appropriate management of emotional activities to achieve effective social functioning, encompassing the creation, maintenance, and alteration of the occurrence, intensity, or duration of internal emotional states and related physiological responses (Shafieitabar, Akbari, Yasavoli, 2019). Emotional regulation is an aspect of temperament that plays a crucial role in predicting coping with psychological maladjustments (Ismailian et al., 2015). Children suffering from depression and anxiety face cognitive distortions that hinder their full understanding of their emotions and thoughts (Alvarez et al., 2022). Negative emotions can be one of the fundamental causes of dysfunction among children and adolescents (Qiu Sham, 2022). In fact, negative emotionality is a key component in both internalized and externalized disorders in childhood. Children with internalizing disorders experience profound sadness, depression, anxiety, and fear (Wang, 2022). Given the prevalence and long-term impacts of separation anxiety on the child, their family, and their life, therapists and researchers are seeking effective therapeutic interventions and preventive methods for these issues in children. According to research, various methods have been employed to improve this disorder, with play therapy being one of the most prominent and effective approaches (Mani, Wild, Dawson, 2021; Erjuyar Vstanis, 2020). There are reports of lack of cooperation and participation from families in the treatment process, leading to difficulties in applying therapeutic outcomes to the child's real-life environment (Sandberg et al., 2020). Due to these challenges, relationship-based parent-child play therapy emerged as a combination of play therapy and a family-centered approach. Another form of this therapy is attachment-based play therapy, which focuses on the parent-child relationship and aims to meet children's needs by empowering parents to recognize those needs and respond accordingly so that parents and children can interact together (Heinick et al., 2019). Considering the advantages and disadvantages of both methods and the weak research background in this area, as well as the importance of treating separation anxiety disorder due to its high prevalence in childhood, it is crucial to choose effective methods that save time and costs. This study aims to compare the effectiveness of these two therapeutic methods on emotional regulation in children with separation anxiety disorder. Methods: The research method of this study was quasi-experimental, and the design used was a pre-test-post-test design with a control group and follow-up. The statistical population of this research consisted of all mother-child pairs of boys and girls aged five to six years old with separation anxiety who were registered in kindergartens or preschool centers in District 4 of Tehran during the 2022-2023 academic year. In this study, a convenience sampling method was used, and then the selected individuals were randomly assigned to experimental and control groups. To determine the sample size, considering the experimental nature and the necessity of implementing the intervention, 45 mother-child pairs were selected based on inclusion and exclusion criteria and were randomly assigned to three groups: experimental group 1 (attachment-based play therapy), experimental group 2 (parent-child relationship-based play therapy), and control group 3. After completing the form and based on the scores obtained, a clinical interview was conducted with the mother-child pairs to confirm the hypothesis of the child's separation anxiety. Among the children who met the diagnostic criteria for separation anxiety according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 45 mother-child pairs participated in the study, provided that the mothers were willing to cooperate. They were randomly placed into experimental group one, experimental group two, and the control group. Initially, the emotional regulation questionnaire was completed by the mothers. In experimental group one, attachment-based play therapy interventions were conducted on both the mother and child according to the specified protocol, and in experimental group two, parent-child relationship-based play therapy interventions were carried out according to the specified protocol. No intervention was conducted in the control group. After completing the interventions and two months later, all participants in all three groups completed the questionnaires again. The tools used in the present study included emotional regulation (Shields Cicchetti, 1995). The analysis of the data obtained from the administration of the questionnaire was conducted using SPSS v24 software in both descriptive and inferential sections (repeated measures ANOVA). Results: The mean scores in the attachment-based play therapy group and the parent-child relationship-based play therapy group at the post-test stage showed changes compared to the pre-test. It can be described that attachment-based play therapy and parent-child relationship-based play therapy increased adaptive emotional regulation and reduced negativity in children with separation anxiety disorder. Regarding the within-group factor, the calculated F value for the effect of stages (pre-test, post-test, and follow-up) was significant at the 0.05 level for emotional regulation scores (F = 9.02, p < 0.05) and (F = 4.42, p < 0.05). As a result, there is a significant difference between the mean scores of pre-test, post-test, and follow-up emotional regulation scores across the three stages. Regarding the interaction between stage factors and group, the calculated F value for the effect of stages (pre-test, post-test, and follow-up) among the three groups (attachment-based play therapy, parent-child relationship-based play therapy, and control) was significant at the 0.05 level for emotional regulation (p < 0.05). Therefore, there is a significant difference between the mean scores of pre-test, post-test, and follow-up emotional regulation among the three groups. The methods (attachment-based play therapy and parent-child relationship-based play therapy compared to the control group) had an impact on emotional regulation scores (p < 0.05). Additionally, there was no significant difference in the amount of change between the attachment-based play therapy group and the parent-child relationship-based play therapy group (p > 0.05). Discussion: The present study aimed to compare the effectiveness of attachment-based play therapy and parent-child relationship-based play therapy on the emotional regulation of children with separation anxiety disorder. The results indicated that both methods (attachment-based play therapy and parent-child relationship-based play therapy compared to the control group) had an impact on emotional regulation scores. Additionally, the degree of change in the attachment-based play therapy group and the parent-child relationship-based play therapy group did not show a significant difference. The findings of this study are consistent with those of Sadeghi et al. (2022) and Yazdani Pour et al. (2019). To explain the effectiveness of attachment-based play therapy on children's emotional regulation, it can be stated that improving attachment relationships and elements of attachment-based play therapy enhances children's self-regulation and emotional regulation. In play therapy, there is coordination between the therapist and the child, creating a kind of intersubjective state where each can sense each other's emotions through shared experiences (Salo et al., 2020). Appropriate responses to the child and therapist reflections, which demonstrate full attention to the child, are facilitated by aligning the therapist's behavior and emotions with the child's states, feelings, and needs. Furthermore, the results showed that parent-child relationship-based play therapy affects emotional regulation in children with separation anxiety disorder. This finding aligns with research by Hurl et al., Huang, and Hudson (2017), Silvers (2022), and a report by Mohammadi Pour, Zarei, and Sotoudeh (2017), which indicates the effectiveness of attachment interventions in improving parent-child relationships and reducing symptoms of separation anxiety. Conclusion: In explaining this finding, it should be noted that parent-child relationship-based play therapy can enhance parents' skills and subsequently those of their children. In this training process, parents can achieve a better understanding and acceptance regarding their child's behavior as well as their psychological and cognitive conditions. Ethical Considerations This article is the result of the researcher’s research activity, during which participants were informed and consented to participate. To comply with research ethics, the principle of confidentiality was strictly observed. Funding This research did not have a sponsor, and all costs were covered by the researcher. Authors’ Contribution Only one researcher participated in conducting this study. Conflict of Interest The results of this research are presented transparently, and this study did not entail any conflict of interest for the authors. Acknowledgements This article is taken from Mahsa Najmi’s doctoral thesis in Educational Psychology under the supervision of Dr. Reza Ghorban-Jahromi at Tehran University of Research Sciences, which was approved in the summer of 1403. Accordingly, we would like to express our gratitude and appreciation for the efforts of our supervisors, Dr. Ghorban-Jahromi and Dr. Esmaeil Saadi, as well as the advice of Dr. Mansoureh Karimzadeh, and all the parents who contributed to the conduct of this research. References Adili, Sh.; Mirzaei, R. and Abedi, A. (2018). The effectiveness of play therapy based on parent-child relationships on the quality of parent-child interactions and the quality of life related to the health of children with behavioral and emotional problems, Exceptional Children Quarterly, 19 (1), 25-37. Link Alimoradi, M.; Goorban Shiroudi, Sh. Khalatbari, J. and Rahmani, M. A. (2017). 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Article type Original research Pages: 184-195 |
| Corresponding Author’s Info E-mail: rrghorban@gmail.com |
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| Article history: Received: 2024/05/08 Revised: 2025/02/23 Accepted: 2025/02/24 Published online: 2025/02/28 |
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| Keywords: Attachment-centered play therapy Emotional regulation Parent-child relationship-based play therapy Separation anxiety disorder |
Type of Study: Research |
Subject:
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Received: 2024/05/8 | Accepted: 2025/02/24 | Published: 2025/02/28
Received: 2024/05/8 | Accepted: 2025/02/24 | Published: 2025/02/28
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