Write your message
Volume 24, Issue 154 (12-2025)                   Journal of Psychological Science 2025, 24(154): 79-97 | Back to browse issues page

XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

ALIABADIFARAHANI M, Yarmohamadi Vasel S, Mohagheghi H, Zoghi Paydar M. (2025). The Effect of Cognitive-Behavioral Play Therapy on Anxiety Symptoms in Children, with the Moderating Role of Cognitive Flexibility in 11-12-Years old. Journal of Psychological Science. 24(154), 79-97.
URL: http://psychologicalscience.ir/article-1-2835-en.html
Professor, Department of Psychology, Faculty of Economics and Socials Sciens, Bu- Ali Sina University, Hamedan, Iran , yarmohamadivasel@basu.ac.ir
Abstract:   (741 Views)
Background: Separation anxiety disorder is one of the most common behavioral disorders in children, leading to disruptions in academic performance, social adjustment, family life, and peer relationships. Despite numerous studies investigating the efficacy of cognitive-behavioral therapy on children's separation anxiety, there is a research gap regarding the moderating role of cognitive flexibility in this efficacy.
Aims:: This study aimed to investigate the efficacy of cognitive-behavioral play therapy on separtion anxiety in in children 11 to 11 years old, considering the moderating role of cognitive flexibility.
Methods: The method of this quasi-experimental study was a pre-test-post-test type with a control group and a three-month follow-up. The statistical population of the study included all children aged 11-12 with separation anxiety who had referred to specialized child and adolescent clinics in the west of Tehran (Gisha) in the 2023-2024 academic year. Among them, 110 were selected through a clinical interview with the mother using DSM-5 diagnostic symptoms and the separation anxiety assesment scale (parent version) (Hahn et al., 2003) through purposive sampling. Finally, 30 people with high cognitive flexibility and 30 people with low cognitive flexibility were selected and assigned to two experimental (30 people) and control (30 people) groups. To collect data, the separation anxiety assesment scale (parent version) (Hahn et al., 2003) and cognitive flexibility inventory (Dennis & Vander Wal, 2010) were used. To train the experimental group, the cognitive-behavioral therapy protocol for anxiety for children (Kendall & Hedtke, 2006) was used during 12 sessions, 45 minutes each. Also, univariate analysis of covariance and repeated measures analysis of variance and SPSS-26 software were used to analyze the data.
Results: The results of univariate analysis of covariance indicated a significant effect of the flexibility variable on the effectiveness of cognitive-behavioral play therapy on improving clinical symptoms of separation anxiety in children (P< 0.05). The results of repeated measures analysis of variance and Bonferroni test in the follow-up phase also showed that the effect size of the high-flexibility cogntive-behavioral play therapy group was significantly higher than the effect size of the low-flexbiity cognitive-behavioral play therapy group. Therefore, the moderating role of cognitive flexibility was confirmed.
Conclusion: According to the findings of the present study, cognitive-behavioral play therapy is effective in reducing symptoms of separation anxiety in children, but its effectiveness depends on the level of cognitive flexibility in children. Therefore, it is necessary to include games to increase cognitive flexibility in the treatment of children with separation anxiety disorder.
 
Full-Text [PDF 1540 kb]   (346 Downloads)    
Type of Study: Research | Subject: Special
Received: 2025/02/10 | Accepted: 2025/04/14 | Published: 2025/12/28

References
1. اسمعیل‌زاده، زهره (1398). اثربخشی آموزش فرزندپروری بر اساس تئوری انتخاب بر رابطه والد-کودک و نشانه های بالینی اختلال نافرمانی مقابله ای. توانمندسازی کودکان استثنایی، 10 (3)، 97-108. https://doi.org/10.22034/ceciranj.2020.200510.1263
2. برجعلی، احمد، رضایی، سعید و نیافر، هاله (1398). اثربخشی بازی درمانی شناختی رفتاری بر اضطراب کودکان با دلبستگی ناایمن. پایان‌نامه کارشناسی ارشد رشته روان‌شناسی و آموزش کودکان استثنائی. دانشگاه علامه طباطبایی.
3. تختی، معصومه؛ شفیع‌آبادی، عبدالله؛ کلانترهرمزی، آتوسا و فرخی، نورعلی (1399). اثربخشی برنامه مداخله ای تعامل والد - کودک مبتنی بر مربی گری هیجان بر علائم اختلال اضطراب جدایی کودکان. مجله علوم روانشناختی، ۱۹ (۹۵)، 1423-1437. http://psychologicalscience.ir/article-1-760-fa.html
4. حسنی، راحله؛ میرزاییان، بهرام و خلیلیان، علیرضا (1392). اثربخشی بازی درمانی مبتنی بر رویکرد شناختی- رفتاری بر اضطراب و عزت نفس کودکان مبتلا به اختلال نارسایی توجه/بیش‌فعالی (ADHD). پژوهش‌های نوین روانشناختی، 8 (29)، 180-163. https://psychologyj.tabrizu.ac.ir/article_4279.html
5. درویشی چالشتری، فاطمه و غضنفری احمد (1402). اثربخشی بازی درمانی شناختی- رفتاری بر قلدری، اضطراب جدایی و اشتیاق تحصیلی دانش‌آموزان دختر پایه اول ابتدایی شهرشهرکرد. فصلنامه ایده‌های نوین روانشناسی، ۱۷ (۲۱). http://jnip.ir/article-1-949-fa.html
6. سرگزی، سمیه و فرنام، علی (1398). اثربخشی بازی‌های بومی و محلی در بهبود انعطاف‌پذیری شناختی، هم‌جوشی شناختی و کاهش نشانه‌های اضطراب در نوجوانان. پایان‌نامه کارشناسی ارشد روانشناسی عمومی، دانشگاه سیستان و بلوچستان.
7. سلطانی، اسماعیل؛ شاره، شاره؛ بحرینیان، سیدعبدالمجید و فرمانی، اعظم (1392). نقش واسطه‌ای انعطاف‌پذیری شناختی در ارتباط بین سبکهای مقابله‌ای و تاب‌آوری با افسردگی. پژوهنده، ۱۸ (۲)، 88-96. http://pajoohande.sbmu.ac.ir/article-1-1518-fa.html
8. شریفی، پریسا؛ موسوی، سید علی‌محمد و دهقان، مجتبی (1397). تأثیر القای تنیدگی بر نارسایی شناختی و حافظه کاری: نقش انعطاف‌پذیری شناختی. روانشناسی تحولی: روانشناسان ایرانی، 58 (15)، 151-164. https://sanad.iau.ir/fa/Journal/jip/Article/1054627
9. قاسمی‌زاده، پریسا؛ شاملی، لیلا و هادیان فرد، حبیب (1400). اثربخشی درمان چشم‌انداز زمان بر ابعاد چهارگانه تاریک شخصیت مادران و علائم اضطراب جدایی کودکان پیش‌دبستانی. مجله روان‌پزشکی و روانشناسی بالینی ایران، 27 (2)، 162-179. https://doi.org/ 10.32598/ijpcp.27.2.2849.3
10. قاسمی، هاجرالسادات؛ ابراهیمی قوام، صغری؛ درتاج، فریبرز و فرخی، نورعلی (1401). تأثیر آموزش فرزندپروری مبتنی بر کارکردهای اجرایی بر انعطاف‌پذیری شناختی و کنترل بازداری کودکان. پژوهش در نظام‌های آموزشی، 16 (58)، 5-19. https://doi.org/10.22034/jiera.2022.167793
11. نجفعلی قندهاری، الهه؛ مختاری، ستاره و برهانی، خاطره (1401). بررسی تحولی اثر خلق مثبت بر انعطاف پذیری شناختی و رابطه آن با خلاقیت. فصلنامه روان‌شناسی کاربردی، 16(2)، 59-81. https://doi.org/10.52547/apsy.2021.224313.119
12. ولی‌زاده، شاهرخ؛ مکوندی، بهنام؛ بختیارپور، سعید و حافظی، فریبا (1399). اثربخشی رفتاردرمانی شناختی بر انعطاف‌پذیری شناختی زندانیان. روان پرستاری. ۸ (۴)، ۱-9. http://ijpn.ir/article-1-1576-fa.html
13. Arici-Ozcan, N., Cekici, F., & Arslan, R. (2019). The relationship between resilience anddistress tolerance in college students: the mediator role of cognitive flexibility and dficulties in emotion regulation. International Journal of Educational Methodology, 5(4), 525-533. https://doi.org/10.12973/ijem.5.4.525
14. Banneyer, K. N., Bonin, L., Price, K., Goodman, W. K., & Storch, E. A. (2018). Cognitive behavioral therapy for childhood anxiety disorders: a review of recent advances. Current psychiatry reports, 20, 1-8. https://doi.org/10.1007/s11920-018-0924-9
15. Bernardo, A. B. I., & Presbitero, A. (2018). Cognitive flexibility and cultural intelligence: Exploring the cognitive aspects of effective functioning in culturally diverse contexts. International Journal of Intercultural Relations, 66, 12–21. https://doi.org/10.1016/j.ijintrel.2018.06.001
16. Bonilla-Sierra, P., Manrique-G, A., Hidalgo-Andrade, P., & Ruisoto, P. (2021). Psychological inflexibility and loneliness mediate the impact of stress on anxiety and depression symptoms in healthcare students and early-career professionals during COVID-19. Frontiers in psychology, 12, 729171. https://doi.org/10.3389/fpsyg.2021.729171
17. Borjali, A., Rezaei, S & Niafar, H (2019). The effectiveness of cognitive behavioral play therapy on anxiety in children with insecure attachment. Master's thesis in Psychology and Education of Exceptional Children. Allameh Tabataba'i University. [Persian]
18. Darvishi Chaleshtari F, Ghazanfari A. (2023). The Efetiveness of Cognitive-Behavioral Play Therapy on Bullying, Separation Anxiety and Academic Motivation of First Grade Elementary School Girls in Shahrekord. Journal of Psychology New Ideas, 17 (21). [Persian] http://jnip.ir/article-1-949-fa.html
19. Dawson, P., & Guare, R. (2018). Executive skills in children and adolescents: A practical guide to assessment and intervention. Guilford Publications.
20. Dennis, J. P., & Vander Wal, J. S. (2010). The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research, 34, 241-253. https://doi.org/10.1007/s10608-009-9276-4
21. Eisen, A. R., & Schaefer, C. E. (2007). Separation anxiety in children and adolescents: An individualized approach to assessment and treatment. Guilford Press.
22. Esmailzadeh, Z. (2019). Effectiveness of parenting education based on Choice Theory on parent-child relationship and clinical symptoms of Oppositional Defiant Disorder. Empowering Exceptional Chidren, 10(3), 97-108. [Persian] https://doi.org/10.22034/ceciranj.2020.200510.1263
23. Ghasemi, H. A., Ebrahimi ghavam, S., Dortaj, F. and Farrokhi,.. N. A. (2022). The Effectiveness of Executive Function Based Parenting Education on Children’s Cognitive Flexibility and Inhibitory Control. Journal of Research in Educational Systems, 16(58), 5-19. [Persian] https://doi.org/10.22034/jiera.2022.167793
24. Ghasemizadeh P, Shameli L, Hadianfard H. (2021). Effect of Time Perspective Therapy on Dark Tetrad Personality Traits of Mothers and Separation Anxiety Disorder of Their Preschool Children. Iranian Journal of Psychiatry and Clinical Psychology, 27 (2), 162-179. [Persian] https://doi.org/ 10.32598/ijpcp.27.2.2849.3
25. Hahn, L., Hajinlian, J., Eisen, A. R., Winder, B., & Pincus, D. B. (2003). Measuring the dimensions of separation anxiety and early panic in children and adolescents: The Separation Anxiety Assessment Scale. Recent Advances in the Treatment of Separation Anxiety and Panic in Children and Adolescents.
26. Hassani, R., Mirzaeeian, B. and Khalilian, A. (2013). Effectiveness of Cognitive Behavior-based Play Therapy on Anxiety and Self-steem of Children with Attention Deficit/Hyperactivity Disorder (ADHD) Children. Journal of Modern Psychological Researches, 8(29), 163-180. [Persian] https://psychologyj.tabrizu.ac.ir/article_4279.html
27. Heydari M, Bakhshipour A, Jajarmi M. (2024). Evaluaing the Effectiveness of Cognitive-Behavioral Play Therapy on Reducing Separation Anxiety in Boys in the First Grade of Primary School. J Health Rep Technol, 10(3):e150514. https://doi.org/10.5812/jhrt-150514.
28. K e, T., & Barlas, J. (2020). Thinking about feeling: Using trait emotional intelligence in understanding the associations between early maladaptive schemas and coping styles. Psychology and Psychotherapy: theory, research and practice, 93(1), 1-20. https://doi.org/10.1111/papt.12202
29. Kendall, P. C., & Hedtke, K. A. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual. Workbook Publishing.
30. Koukourikos, K., Tsaloglidou, A., Tzeha, L., Iliadis, C., Frantzana, A., Katsimbeli, A., & Kourkouta, L. (2021). An overview of play therapy. Materia socio-medica, 33(4), 293. https://doi.org/10.5455/msm.2021.33.293-297
31. Lyneham, H.J., Wignall, A. & Rapee, R.M., (2008). Helping Your Anxious Child Children’s Workbook (2nd Ed). Centre for Emotional Health, Macquarie University: Sydney, Australia.
32. Marko, M., & Riečanský, R. (2018). Sympathetic arousal, but not disturbed executive functioning, mediates the impairment of cognitive flexibility under stress. Cognition, 174, 94-102. https://doi.org/10.1016/j.cognition.2018.02.004
33. Mofrad, S., Abdullah, R., & Uba, I. (2010). Attachment patterns and separation anxiety symptom. Asian Social Science, 6(11), 148. https://doi.org/10.5539/ass.v6n11p148
34. Najafali Ghandehari, E., Mokhtari, S., & Borhani, K (2022). A Developmental Study of the Effect of Positive Mood on Cognitive Flexibility and its Relationship with Creativity. Journal of Aplied Pschology, 16(2), 59-81. [Persian] https://doi.org/10.52547/apsy.2021.224313.119
35. Rudel, R (2020). "Purposeful Play: A Literature Review of Play Therapy and Projective Techniques of Drama Therapy". Expressive Therapies Capstone Theses. 279. https://digitalcommons.lesley.edu/expressive_theses/279
36. Sargazi, S., & Farnam, A (2019). The Effective ness of Native and Local Games in Improving Cognitive Flexibility, Cognitive Fusion and Reducing Anxiety Symptoms in Adolescents. Master Thesis in General Psychology, University of Sistan and Baluchestan. [Persian]
37. Shareh H, Farmani A, Soltani E. (2014). Investigating the reliability and validity of the Cognitive Flexibility Inventory (CFI-I) among Iranian university students. Practice in Clinical Psychology, 2(1), 43-50. http://jpcp.uswr.ac.ir/article-1-163-en.html
38. Sharifi, P., Mousavi, A.M & Dehghan, M (2018). Athar al-Qai Tanidgi bar narsayi shanakhti wa hafizah kari: inscription of inflection of shanakhti, rwenchnasi transformation: Iranian Rawanshansan.58(15), 164-151. [Persian] https://sanad.iau.ir/fa/Journal/jip/Article/1054627
39. Shorey, R. C., Strauss, C., Zapor, H., & Stuart, G. L. (2017). Dating violence perpetration: Associations with early maladaptive schemas. Violence and Victims, 32(4), 714–727. https://doi.org/10.1891/0886-6708.VV-D-14-00175.
40. Soltani, E., Shareh, H., Bahrainian, S. A., & Farmani, A. (2013). The mediating role of cognitive flexibility in correlation of coping styles and resilience with depression. Pajoohandeh Journal, 18(2), 88-96. [Persian] http://pajoohande.sbmu.ac.ir/article-1-1518-fa.html
41. Stjerneklar, S., Hougaard, E., Nielsen, A. D., Gaardsvig, M. M., & Thastum, M. (2018). Internet-based cognitive behavioral therapy for adolescents with anxiety disorders: A feasibility study. Internet interventions, 11, 30-40. https://doi.org/10.1016/j.invent.2018.01.001
42. Takhti M, Shafi' Abadi A, Kalantar Hormozi A, Farrokhi N A. (2020). The effectiveness of the parent-child interaction intervention program based on emotion coaching on the symptoms of children's separation anxiety disorder. Journal of Psychological Scence, 19(95), 1423-1437. [Persian] http://psychologicalscience.ir/article-1-760-fa.html
43. Tello-Ramos, M. C., Branch, C. L., Kozlovsky, D. Y., Pitera, A. M., & Pravosudov, V. V. (2019). Spatial memory and cognitive flexibility trade-offs: to be or not to be flexible, that is the question. Animal Behaviour, 147, 129-136. https://doi.org/10.1016/j.anbehav.2018.02.019
44. Valizadeh S, Makvandi B, Bakhtiarpour S, Hafezi F. (2020). The Effectiveness of Cognitive Behavioral Therapy (CBT) on Prisoners Cognitive Flexibility. Iranian Journal of Psychiatric Nursing (IJPN), 8 (4), 1-9. [Persian] http://ijpn.ir/article-1-1576-fa.html
45. Wheaton, M. G., & Kaiser, N. (2021). Anxiety sensitivity and intolerance of uncertainty as factors related to adult separation anxiety disorder symptoms. International Journal of Cognitive Therapy, 14, 473-484. https://doi.org/10.1007/s41811-021-00114-w
46. Woźniak‐Prus, M., Gambin, M., Sękowski, M., Cudo, A., Pisula, E., Kiepura‐Nawrocka, E., ... & Kmita, G. (2024). Positive experiences in the parent–child relationship during the COVID‐19 lockdown in Poland: The role of emotion regulation, empathy, parenting self‐efficacy, and social support. Family Process, 63(1), 443-468. https://doi.org/10.1111/famp.12856

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License.

© 2026 CC BY-NC-ND 4.0 | Journal of Psychological Science

Designed & Developed by : Yektaweb

Creative Commons License
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)