The effectiveness of cognitive-behavioral play therapy (CBPT) and resiliency based play therapy on parenting stress in children with functional abdominal pain

One of the most common chronic childhood disorders that have a significant impact on childchr('39')s health is functional abdominal pain. Children with functional abdominal pain often provide increased parental stress due to their disorder. Parental stress, which reflects the perception of tension and stress in the parent-child communication system, is one of the factors associated with abdominal pain in children. Long-term restrictive conditions, especially for children, lead to stress for the individual and his family, which is why parents of children with different disorders experience different levels of stress. Numerous studies have shown that the levels of anxiety and depression in mothers of children with chronic abdominal pain are higher than in mothers who do not have such children. Researchers believe that parental stress has many negative consequences and in addition to endangering the proper functioning of the family, it leads to a decrease in mental health and well-being of parents.In addition, parental stress has many negative effects on the child. Evidence from previous studies suggests that one of the treatments that can be used to control pain is play therapy. There are different approaches to play therapy. One of these approaches is cognitive-behavioral play therapy which integrates behavioral and cognitive interventions in the play therapy model. In this method of play therapy, contradictory thoughts related to cognitive and behavioral problems in children are identified and replaced with more adaptive thoughts and behaviors. Numerous studies have shown that cognitive-behavioral therapy reduces parental stress in children with chronic illness and improves childrenchr('39')s anxiety.On the other hand, creating resilience as a relatively new perspective on improving health is a valuable topic. Resilient people use effective coping strategies to deal with life issues and see problems as opportunities for learning and growth. Over the past 15 years, research has been conducted to identify strengths and protective processes that promote resilience related to childrenchr('39')s health status. Resilience programs can also be used as stress prevention and control interventions. Based on the findings of various studies, resilience promotion programs increase resilience and reduce the level of stress and anxiety of parents. The aim of this study was to determine the effects of resiliency based play therapy and cognitive-behavioral play therapy on parenting stress in children with functional abdominal pain.

The research method was quasi-experimental with three-group research design consisted of a resilience-based play therapy group, a cognitive-behavioral play therapy group and a control group alongside three stages of pre-test, post-test and follow-up. The statistical population of the study included all children aged 5 to 10 years with their mothers who had functional abdominal pain and referred to the specialized clinic of Amin Hospital for Pediatric Gastroenterology in Isfahan, Iran. Among these children, 24 were selected by purposive sampling according to the inclusion and exclusion criteria and randomly assigned to three groups of 8 children with their mothers. Complete confidentiality, having complete freedom to withdraw from the research, informing about the research, obtaining written consent and using the data only for the purposes of the research were among the ethical considerations that were observed. At the end of the research period, the control group underwent one of the two types of play therapy freely and intensively. Barry and Jones (1995) parenting stress questionnaire was used to measure the dependent variable in the pretest, posttest and follow-up stages. Two experimental groups received a treatment course on cognitive-behavioral play therapy and resiliency-based play therapy in 8 sessions and the control group did not receive any treatment. In the statistical analysis of the data, at the descriptive level, the mean and standard deviation and at the inferential level, the repeated measures analysis of variance and Bonferroni post hoc test was used. The normality of data distribution was assessed by Shapiro-Wilk test, the equality of error variances was assessed by Levene test, and the Sphericity assumption of repeated-measures ANOVA was assessed by Mauchly test.

Comparison of age, number of siblings, fatherchr('39')s education and motherchr('39')s education through Chi-square test showed that there was no significant difference between the three groups (p>0.05). The results of repeated measure analysis of variance revealed that there is a significant difference on parental stress between pre-test, post-test and follow-up (F=5.50, df=2 and p<0.01) and also there is a significant difference in the interaction of time with the group (including control group, resilience-based play therapy group and cognitive-behavioral play therapy group) (F=4.74, df=4 and p<0.01) . This means that there is a significant difference between pre-test, post-test and follow-up in the two experimental groups (two treatments) and the control group (p<0.01). The results of Bonferroni post hoc test showed that in the parental stress variable, there is only a significant difference between resilience-based play therapy with the control group (p<0.05), but there is no significant difference between cognitive-behavioral play therapy with the control group and between the two treatments with each other (p<0.05).

Based on the results of the present study, resilience-based play therapy reduced parental stress in children with functional abdominal pain. Therefore, in addition to educating mothers with functional abdominal pain for effective use of this play therapy at home, to reduce parental stress in children with abdominal pain, it is recommended that this type of play therapy have been use in medical centers by psychologists. Limitations of the present study include the limitation of the research sample group to children with functional abdominal pain and their parental stress, along with a small sample of eight children for each of the three research groups due to the limited research time. In line with the above mentioned limitations, it is recommended that a resilience-based play therapy package be used with sample groups beyond children with abdominal pain to determine the effectiveness of this therapy package for other groups as well. In addition, it is suggested that in future studies, by increasing the length of the research, it will be possible to use larger samples for experimental and control groups.