The Effects of Cognitive-Behavioral Play Therapy in Reducing Emotional Problems in Children with Cerebral Palsy

Cerebral Palsy (CP) is defined as disturbance in movement and balance which occurs due to damage or defect in immature brain. Children with CP are at high risks for developing emotional problems. Play therapy is among the treatment methods, i.e., effective in responding to the unique and varied developmental needs of children. Cognitive–Behavioral Play Therapy (CBPT) is specially designed for children. The current study aimed to determine the effectiveness of CBPT on the reduction of emotional problems among children with PC.

This was a single subject research with a single baseline design. Considering the complications of finding a group of problem–wised matched children with CP, a single subject study was conducted. This research was performed on 3 children who were diagnosed with CP. In total, 10 sessions of CBPT with a one–month follow–up period was conducted. The statistical population of this study included all children aged 7–10 years with CP in Tabriz City, Iran. Research sample was selected based on target–based sampling and the available sample of students of Mardani Azari Center in the academic year of 2017–18. For collecting the required data, Kovacs's Children's Depression Inventory (CDI) (1981), Reynolds & Richmond's Revised Children's Manifest Anxiety Scale (RCMAS) (1978), and Nelson et al.'s Children's Inventory of Anger (CIA) (2000) were used. Data analysis was performed using visual analysis of enhancement.

The obtained data revealed that CBPT significantly reduced anxiety, depression, and anger in the investigated children with CP. Moreover, the archived results maintained for one month (follow–up). The changes in the level of depression for all three study participants were statistically significant. In addition, children with physical disabilities often feel incompetent, worthless, or unacceptable. Depressed children are more prone to be rejected and experience higher negative social behaviors, compared to their healthy counterparts. Play therapy provides the opportunity to create communication skills in a safe and friendly environment for children. Therefore, in this study, puppet play and puppet show were used to increase self–esteem as well as social skills in the investigated children. Besides, the collected results indicated a significant reduction in the studied children's anxiety level. Using various activities and techniques of CBPT, like the recognition of emotions, thoughts, and fears in the form of a story, symbolic play, and puppet show, the children encountered anxiety–stimulating states; accordingly, we attempted to teach them emotional control skills and different strategies for anxiety management. Play therapy also had a great impact on reducing the aggression of the studied children with CP. Aggression is expressed in various manners, i.e., directly or indirectly in the child's play and dolls play, as an important strategy in controlling anger. By implementing puppet shows, we could assist the children to learn new skills in a non– invasive way.

According to present study results, CBPT could influence emotional problems among children with CP