Journal of Childhood

Introduction
Self-efficacy refers to an individual's belief in their ability to successfully perform an activity in a specific area. It can affect various aspects of people’s behavior, including their choice of activities, goals, effort, and perseverance, and ultimately their learning and progress. Nighttime fears are part of the natural course of children's development and are usually mild and transient. Most children can overcome these fears as they grow older, but in some children these fears intensify and continue into adolescence. One type of interventions for reducing nighttime fears is exposure-based intervention by reading books. In this intervention, stories about nighttime fears are read to the child by parents and games are played to confront the anxiety-provoking situation. This treatment is presented in a format appropriate to the cognitive and developmental capacities of children. In this treatment, books are used to provide useful information and increase the child's ability to self-manage. This novel study in Iran aimed to investigate the effectiveness of this exposure-based therapy on the self-efficacy of 4-8-year-old children in dealing with nighttime fears.

Research Methods
This is a clinical trial with a multiple baseline single-case experimental design conducted in 2024. The study population consisted of 4-8-year-old children with nighttime fears living in Tehran, Iran, of whom 6 were selected using a purposive sampling method and based on inclusion criteria. Coffman’s What My Child Can Do at Night in the Dark (WICDAN) questionnaire and a sleep report form were used to collect data. The intervention was conducted using the book "Uncle Light: Turn the Light On and Off" and based on exposure-based techniques. This book with 21 chapters teaches bedtime skills to 4-8-year-old children by presenting stories and various games to reduce nighttime fears in them. After baseline assessments (9, 12, 15 days), the subjects received exposure-based intervention for 8 weeks. They were assessed again immediately after and one-month after the intervention.  In order to analyze the data, visual analysis method and calculation of percentage of recovery and effect size (Cohen’s d) were used.

Results
Participants were 4 boys and 2 girls. The results of comparing the mean WICDAN scores of the subjects indicated an increase in the subjects' self-efficacy in dealing with nighttime fears pos-intervention and in the follow-up phase. The mean total scores of children increased from 7.95 at baseline to 16.37 post-intervention period and 18.33 in the follow-up phase. The total effect size was 4.62. The total percentage of recovery was 56.75% from baseline to post-test, and 56.75%  from baseline to follow-up. In general, the treatment effectiveness was high and acceptable for 4 children, moderate for one child, and low for one child. 

Conclusion
According to the findings, it can be concluded that the used exposure-based intervention program is effective in increasing the self-efficacy of Iranian 4-8-year-old children in dealing with nighttime fears. After receiving the exposure-based therapy, children had greater self-efficacy in coping with their nighttime fears and could sleep alone in their dark rooms for more nights. 
The study had some limitations. Children were from healthy, highly educated families, which can limit the generalizability of the findings to children whose parents have less resources and time to read books and pursue treatment. Another limitation was the lack of control over some factors affecting the child's inability to sleep alone, such as parenting styles, parents’ mental disorders, and attachment styles. 
It is recommended that future studies examine the effectiveness of this intervention on larger and more diverse samples and identify the moderators and mediators of the treatment. It can also be beneficial to conduct the study with a two-group design, by including a control group, and longer follow-up periods

Ethical Considerations

Compliance with ethical guidelines
This study followed all ethical principles, including participants’ confidentiality, informed consent, and the right to leave the research. The study received ethical approval from the University of Social Welfare and Rehabilitation Sciences (Code: IR.USWR.REC.1402.223) and was registered as a clinical trial in Iranian of Clinical Trials (ID: IRCT20240129060841N1).

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

Authors contributions
All authors contributed equally to the conception and design of the study, data collection and analysis, interpretation of the results, and drafting of the manuscript. Each author approved the final version of the manuscript for submission.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all participants for their cooperation in this research.



 

Arzumanian, K., Asadi, J. & Saberi, H. (2021). [Comparing the effectiveness of mother’s cognitive behavioral group training and children’s mindfulness training on the anxiety of 9- to 12-year-old boys and girls children (Persian). Journal of Early childhood Health and Education, 3(9). [Link]

Bandura, A., & Wessels, S. (1997). Self-efficacy. Cambridge: Cambridge University Press.‏ [Link]

Cherry, S. J., & Flora, B. H. (2017). Radiography faculty engaged in online education: Perceptions of effectiveness, satisfaction, and technological self-efficacy. Radiologic Technology, 88(3), 249-262.‏ [PMID] 

Coffman, M. F. (2020). Uncle Lightfoot flip that switch: Overcoming fear of the dark. St. Petersburg, FL: Footpath Press LLC (D.C. Dusevitch, Illustrator). [Link]

Coffman, M.F. (1987). What my children do in the dark. Unpublished instrument. [Link]

Eisazadeh, M., Jahromi, R., Karimzade, M. & Dehghani -Arani, F. (2022). [Investigating the effectiveness of the combination package of Child’s Personality Type and Parent child interaction therapy in reducing anxiety symptoms and thought and attention problems (Persian)]. Journal of Early Childhood Health and Education, 2(12), 59-72.  [DOI:10.32592/jeche.4.2.59]

El Rafihi-Ferreira, R., Silvares, E. F., Asbahr, F. R., & Ollendick, T. H. (2018). Brief treatment for nighttime fears and co-sleeping problems: A randomized clinical trial. Journal of Anxiety Disorders, 58, 51-60.‏ [DOI:10.1016/j.janxdis.2018.06.008] [PMID]

Essau, C. A., & Ollendick, T. H. (2012). The Wiley-Blackwell handbook of the treatment of childhood and adolescent anxiety. New Jersey: John Wiley & Sons.‏ [DOI:10.1002/9781118315088]

Haydarian, M., Mirzaie, M., Oveasi, S. & Akbari, M. (2020). [The effectiveness of play therapy based on the cognitive-behavioral model on behavioral problems, responsibility, and self-esteem of male students with attention deficit/hyperactivity disorder (Persian)]. Journal of Early Childhood Health and Education, 5(3), 124-143. [Link]  

Kakavand, A., Keshavarz, S., & Shirmohammadi, F. (2020). [The effectiveness of theory of mind training on reducing adjustment problems in preschool children (Persian)]. Journal of Early Childhood Health and Education, 2(4), 66-78. [Link]

Kendall, P. C., Butcher, J. N., & Holmbeck, G. N. (1999). Handbook of research methods in clinical psychology. New Jersey: John Wiley & Sons.‏ [Link]

Kermanian, S., Salehi, M., & Molazadeh, A. (2021). [Comparison of emotional regulation and self-efficacy in working and normal children (Persian)]. Health Psychology and Social Behavior, 1(1), 14-1. [Link]

Kopcsó, K., Láng, A., & Coffman, M. F. (2021). Reducing the nighttime fears of young children through a brief parent-delivered treatment-effectiveness of the Hungarian version of uncle lightfoot. Child Psychiatry & Human Development, 1-12.‏   [DOI:10.1007/s10578-020-01103-4] [PMID] 

Kushnir, J., & Sadeh, A. (2011). Sleep of preschool children with night-time fears. Sleep Medicine, 12(9), 870-874.‏  [DOI:10.1016/j.sleep.2011.03.022] [PMID]

Lewis, K. M., Amatya, K., Coffman, M. F., & Ollendick, T. H. (2015). Treating nighttime fears in young children with bibliotherapy: Evaluating anxiety symptoms and monitoring behavior change. Journal of Anxiety Disorders, 30, 103-112.‏  [DOI:10.1016/j.janxdis.2014.12.004] [PMID]

Lewis, K. M., Rafihi-Ferreira, R. E., Freitag, G. F., Coffman, M., & Ollendick, T. H. (2021). A 25-year review of nighttime fears in children: past, present, and future. Clinical Child and Family Psychology Review, 24(3), 391-413.‏ [DOI:10.1007/s10567-021-00354-4] [PMID]

Mitchell, K. M., McMillan, D. E., Lobchuk, M. M., Nickel, N. C., Rabbani, R., & Li, J. (2021). Development and validation of the situated academic writing self-efficacy scale (SAWSES). Assessing Writing, 48, 100524.‏ [DOI:10.1016/j.asw.2021.100524]

Ormorad, J. A. (2012). Human Learning (Theories and Applications) [ Y. Seyed Mohammadi (Persian Translator)]. Tehran: Arasbaran. [Link]

Pittig, A., Kotter, R., & Hoyer, J. (2019). The struggle of behavioral therapists with exposure: self-reported practicability, negative beliefs, and therapist distress about exposure-based interventions. Behavior Therapy, 50(2), 353-366.‏   [DOI:10.1016/j.beth.2018.07.003] [PMID]

Santacruz, I., Méndez, F., & Sánchez-Meca, J. (2006). Play therapy applied by parents for children with darkness phobia: Comparison of two programmes. Child & Family Behavior Therapy, 28(1), 19-35.‏ [DOI:10.1300/J019v28n01_02]

Santrak, J. W. (2008). Educational Psychology [M. Omidian (Persian Trans.)]. Yazd: Yazd University. [Link]  

Shirkhanlo, Z., Tahmasebi, S., Mohammadi, A. & Rezasoltani, P. (2020). [Investigating the relationship between parental attachment styles, mental health, and parenting styles with behavioral problems in preschool children mediated by attachment: Structural equation modeling (Persian)]. Journal of Early childhood Health and Education, 93-114. [Link] 

Shokri, A., & Taghizadeh, S. (2024). [The effectiveness of positive parenting for mothers on self-efficacy and resilience of children with specific learning disabilities (Persian)]. Learning Disabilities, 13(4), 36-46. [DOI:10.22098/jld.2024.15412.2175]

Yuan, S., Zhou, X., Zhang, Y., Zhang, H., Pu, J., & Yang, L., et al. (2018). Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: A meta-analysis of randomized clinical trials. Neuropsychiatric Disease and Treatment, 14, 353-65.‏ [DOI:10.2147/NDT.S152747] [PMID]