The Effectiveness of Adlerian Play Therapy on Sleep Problems in Children With Cancer

Cancer has extensive effects on the mental health and well–being of children with cancer. One of the problems of children with cancer is sleep problems. Due to the high and persistent prevalence of sleep problems and their association with quality of life, effective intervention programs are very important for this special group of children. On the other hand, considering that helping childhood cancer survivors and children with cancer to maintain physical, mental, and social well–being is one of the most important responsibilities of health professionals and psychologists. It should be noted that the intervention was tailored to the condition of children with cancer. In Adlerian play therapy, the child is helped to express her point of view about herself, himself, others, and the world, and eventually replace self–defeating beliefs with self–enhancing beliefs. So, the purpose of this study was to evaluate the effectiveness of Adlerian play therapy in reducing sleep problems in children with cancer.

The method of this study was quasi–experimental with a pretest–posttest design with a control group. The statistical population consisted of all children with cancer in Yazd City, Iran in 2021. Using the convenience sampling method, 30 qualified volunteer children were selected as a sample based on the inclusion and exclusion criteria. They were randomly divided into experimental and control groups (n=15/group). The inclusion criteria for children included those aged 8–12 years, definitive diagnosis of cancer, at least treated with one course of chemotherapy, not being treated with psychotropic drugs, living with both parents, not having any disease other than cancer, not having neuropsychological problems such as mental retardation, hyperactivity, moderate socio–family status, hospitalized for at least one month. The exclusion criteria included reluctance to continue cooperation, not cooperating in completing the questionnaire at each stage, and more than two absences in training sessions. In the pretest and posttest stages, participants completed the Pittsburgh Sleep Quality Index (PSQI) (Buysse et al., 1989), which included subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Designing a play therapy program with an Adlerian approach was a program that was designed and compiled by researchers using the existing background. The weekly sessions of the play therapy program included eighteen 45–minute for children. While the control group did not receive such an intervention. The data obtained from completing the questionnaires were analyzed at two levels of descriptive statistics (mean and standard deviation) and inferential statistics (Levene's test, Shapiro–Wilk test, Box's M test, analysis of covariance) using SPSS software version 21. The level of significance was set at 0.05.

The results showed that after removing the pretest effect between the posttest scores of the experimental group and the control group in the overall score of sleep quality (p<0.001) and its components, including sleep latency (p=0.040), the sleep duration (p=0.028), habitual sleep efficiency (p=0.008), sleep disturbances (p=0.001) and daytime dysfunction (p=0.010) there was a significant difference. But the intervention program did not significantly affect the use of sleeping medication (p=0.190).

According to the findings, Adlerian play therapy effectivly reduces the sleep problems of children with cancer. So, use of the mentioned intervention program is recommended to experts in this field as a complementary treatment and other medical and psychological therapies for these children.