Effects of sandplay therapy in reducing emotional and behavioural problems in school‐age children with chronic diseases: A randomized controlled trial

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Abstract

Purpose

Children with chronic diseases exhibit a higher incidence of emotional–behavioural problems. Though sandplay therapy is a universally recognized psychological treatment method, experimental evidence for this form of therapy is lacking. Our aims were to examine the effectiveness of sandplay therapy in reducing emotional and behavioural problems in school‐age children with chronic diseases as well as anxiety and depression in their caregivers.

Design and methods

A total of 60 children and their caregivers were enrolled in the present study between January and October 2019. A randomized controlled trial was conducted at the Children's Hospital of Chongqing Medical University, China. Participants were divided into an intervention and a control group. Both groups received regular treatment, and the intervention group received additional sandplay therapy. Four behavioural rating scales were used to evaluate the differences between the two groups. The children's scores on the Child Behavior Checklist (CBCL), Eysenck Personality Questionnaire (EPQ), Self‐Rating Anxiety Scale (SAS) and Self‐Rating Depression Scale (SDS) before and after the intervention were compared using the Mann–Whitney test. The Wilcoxon signed rank test was also employed to compare the median results before and after treatment.

Results

The total scores for CBCL, anxiety and depression, withdrawal, and social behavioural problems for children in the intervention group were all lower than the corresponding scores for those in the control group ( p < .05). The EPQ scores for emotional stability and psychosis in the intervention group were both lower than those in the control group ( p < .05). The SAS and SDS scores for the caregivers of children in the intervention group were also lower than the corresponding scores for those in the control group ( p < .05).

Conclusion

Sandplay therapy can reduce anxiety, withdrawal, and social behavioural problems in school‐age children with chronic diseases, as well as relieve anxiety and depression symptoms in their caregivers. Our study provided evidence for the clinical application of sandplay therapy and highlights the importance of offering and integrating psychological treatment in clinical nursing care.

Related collections

Most cited references 39

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Parenting stress among caregivers of children with chronic illness: a systematic review.

R Hazen, Melissa K Cousino (2013)

To critically review, analyze, and synthesize the literature on parenting stress among caregivers of children with asthma, cancer, cystic fibrosis, diabetes, epilepsy, juvenile rheumatoid arthritis, and/or sickle cell disease. Method PsychInfo, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature were searched according to inclusion criteria. Meta-analysis of 13 studies and qualitative analysis of 96 studies was conducted. Results Caregivers of children with chronic illness reported significantly greater general parenting stress than caregivers of healthy children (d = .40; p = ≤.0001). Qualitative analysis revealed that greater general parenting stress was associated with greater parental responsibility for treatment management and was unrelated to illness duration and severity across illness populations. Greater parenting stress was associated with poorer psychological adjustment in caregivers and children with chronic illness. Conclusion Parenting stress is an important target for future intervention. General and illness-specific measures of parenting stress should be used in future studies.

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James A Blackman, Matthew J Gurka (2007)

Asthma is the most common chronic childhood illness. Treatment is typically focused on disease management rather than developmental and behavioral comorbidities that may affect quality of life or contribute to poor disease control. The purpose of this study was to explore the prevalence of developmental and behavioral comorbidities of asthma and the role of confounding socioeconomic factors. The first National Survey of Children's Health was the data source for this study. Interviews with parents or guardians were conducted during 2003-2004 to ascertain the physical, emotional, and behavioral health of 102,353 randomly selected children ages 0-17 years. Associations were examined between asthma and rates of developmental and behavioral problems. Logistic regression was used to adjust for potential confounding effects of age, gender, race, income, and parent education on outcomes. Children with asthma have higher rates of attention-deficit/hyperactivity disorder; diagnoses of depression, behavioral disorders, learning disabilities; and missed school days (all p < .0001). The more severe the asthma is, the higher the rates are of these problems. Children with asthma are bullied more commonly and are more likely to abuse drugs. When socioeconomic factors are controlled for, asthma significantly increases the odds of having developmental, emotional, and behavioral problems. Children with asthma, especially severe asthma, are at high risk of developmental, emotional, and behavioral problems. Asthma is independently associated with these problems, although socioeconomic disadvantage adds additional risk. Asthma treatment programs must acknowledge and address these comorbidities to achieve the best overall outcomes for children with this common chronic disease.

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Psychosocial outcomes and health-related quality of life in adult childhood cancer survivors: a report from the childhood cancer survivor study.

Peter P. C. Mertens, Zhi-Qian Lu, Christopher Recklitis … (2008)

Psychological outcomes, health-related quality of life (HRQOL), and life satisfaction are compared between 7,147 adult childhood cancer survivors and 388 siblings from the Childhood Cancer Survivor Study, examining demographic and diagnosis/treatment outcome predictors. Psychological distress, HRQOL, and life satisfaction were measured by the Brief Symptom Inventory-18, the Medical Outcomes Survey Short Form-36, and Cantril Ladder of Life, respectively. A self-report questionnaire provided demographic/health information and medical record abstraction provided cancer/treatment data. Siblings' and survivors' scores were compared using generalized linear mixed models, and predictor effects of demographic and cancer/treatment variables were analyzed by multivariate logistic regression. Although survivors report greater symptoms of global distress (mean, 49.17; SE, 0.12) than do siblings (mean, 46.64; SE, 0.51), scores remain below population norms, indicating that survivors and siblings remain psychologically healthy. Survivors scored worse than siblings on overall physical (51.30 +/- 0.10 versus 54.98 +/- 0.44; P < 0.001) but not emotional aspects of HRQOL, but effect sizes were small, other than in vitality. Most survivors reported present (mean, 7.3; SD, 0.02) and predicted future (mean, 8.6; SD, 0.02) life satisfaction. Risk factors for psychological distress and poor HRQOL were female gender, lower educational attainment, unmarried status, annual household income <$20,000, unemployment, lack of medical insurance, having a major medical condition, and treatment with cranial radiation. Compared with population norms, childhood cancer survivors and siblings report positive psychological health, good HRQOL, and life satisfaction. The findings identify targeted subgroups of survivors for intervention.

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Author and article information

Contributors

Huaying Yin: sarah6524@126.com

Journal

Journal ID (nlm-ta): Nurs Open

Journal ID (iso-abbrev): Nurs Open

Journal ID (doi): 10.1002/(ISSN)2054-1058

Journal ID (publisher-id): NOP2

Title: Nursing Open

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2054-1058

Publication date (Electronic): 11 August 2021

Publication date Collection: November 2021

Volume: 8

Issue: 6 ( doiID: 10.1002/nop2.v8.6 )

Pages: 3099-3110

Affiliations

[ ¹ ] Department of child health in Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing Key Laboratory of Child Health and Nutrition Children’s Hospital of Chongqing Medical University Chongqing P.R. China

Author notes

[*] [* ] Correspondence

Huaying Yin, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Department of Child Healthcare, Children’s Hospital of Chongqing Medical University, Chongqing, P.R. China.

Email: sarah6524@ 123456126.com

Author information

Judan Tan https://orcid.org/0000-0002-8584-7619

Article

Publisher ID: NOP21022

DOI: 10.1002/nop2.1022

PMC ID: 8510721

PubMed ID: 34378869

SO-VID: 328c209f-1aa0-420e-a75a-8e1d4058d157

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date revision received : 06 June 2021

Date received : 17 October 2020

Date accepted : 10 July 2021

Page count

Figures: 2, Tables: 7, Pages: 12, Words: 8504

Funding

Funded by: Chongqing Science and Technology Commission , doi 10.13039/501100002865;

Award ID: cstc2018jscx‐msybx0065

Custom metadata

source-schema-version-number 2.0

cover-date November 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.8 mode:remove_FC converted:12.10.2021

Keywords: behavioural interventions,child and adolescent,chronic disease,mental health promotion,nursing role,sandplay therapy

Data availability:

Keywords: behavioural interventions, child and adolescent, chronic disease, mental health promotion, nursing role, sandplay therapy