The Effects of Emotion Regulation Skills Training on Anxiety in Children with Cancer

Childhood cancer is a stressful disease that disturbs the affected children and their familychr('39')s personal and social functioning. As a main cause of death, cancer is a particular source of anxiety. Between the ages of 8 and 12 years, children with cancer experience depression and anxiety, and decreased self–esteem, compared to their healthy peers. The extent to which children with cancer could understand their emotional experiences may be related to how their feelings and emotions are correlated with the complications and biopsychological demands of cancer. Patients need to be in situations where they could discuss their doubts, fears, and experiences with hospitalization, and express their ideas about their illness. Accordingly, the present study aimed to investigate the effects of Emotion Regulation (ER) skills training on the anxiety of children with cancer.

This was a quasi–experimental study with a single–group pretest-posttest design. The study population consisted of all children with cancer who were hospitalized in Tehran City, Iran. Using convenience sampling technique, the study samples were selected among children with carcinoma in two childrenchr('39')s hospitals and Bahrami Childrenchr('39')s Hospital. In total, 15 children were selected as the study samples; 5 of them were excluded from the intervention due to physical deterioration and early hospital discharge. Moreover, 10 children remained in the training group until the end of the research program. To measure the anxiety variables, the Achanbach System of Empirically Based Assessment (ASEBA) (Achenbach & Rescorla, 2001) was used. This questionnaire consists of three forms of a childchr('39')s behavioral alert, a parental report for ages 6–18 years, a teacherchr('39')s report for ages 6–18 years, as well as a self–assessment questionnaire for individuals aged ≤18 years. In this research, the parents and the teachers forms were used. The parentchr('39')s response form was completed by the children’s parents (caregiver). Furthermore, the teacherchr('39')s response form was completed by the explored children’s nurses. The curriculum was set up by the researcher based on the components of the Cognitive Emotion Regulation Questionnaire (CERQ; Garnefski and Kraaij 2007). According to this theory, ER strategies could be classified into negative and positive ones. Negative ER strategies include the following: self–indulgence, rumination, disaster, and blaming others. Positive ER strategies also include the following: acceptance, re–focus on planning, positive re-evaluation, decreased reliance, and positive re–focus. Intervention, as well as the pretest and posttest, were performed in 9 sessions of 30 minutes by the researcher; these sessions were conducted individually using the puppets method, and holding conversations between the child and the doll as the patient. After the intervention, the anxiety variables were re-evaluated by responding to the children’s behavioral disorders questionnaire. The collected data were analyzed by Paired Samples t-test in SPSS.

According to the present research results, the mean±SD score of childrenchr('39')s anxiety in the pretest was obtained as 18.60±2.349, which decreased to 11±3.112 in the posttest phase; there was a significant difference in the mean anxiety scores between the pretest and posttest phases in the study participants (t=14.905, p=0.001).

Based on the current study results, ER Skills training significantly impacted the anxiety of children with cancer. Therefore, ER skills training could be used to improve mental health and reduce anxiety symptoms among children with cancer.