Comparison of the effectiveness of play therapy and story therapy on depression and anxiety separation in children with leukemia

Document Type : Research Paper


1 Department of health psychology , Kish International Branch, Islamic Azad University, Kish Island, Iran

2 professor, Department of Psychology, Kish International Branch, Islamic Azad University, Kish Island, Iran

3 Associate Professor, Army University of Medical Sciences, Tehran, Iran

4 Assistant Professor, Department of Health Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran.

5 Assistant Professor, Department of Psychology, Allameh Tabatabai University, Tehran, Iran


Introduction: Children with leukemia, in addition to physical problems, also suffer from mental problems, such as depression and separation anxiety; The aim of this study was to compare the effectiveness of play therapy and story therapy on depression and anxiety separation in children with leukemia.
Methods: The present study is a semi-experimental project with Pretest-Posttest-three-group follow-up. The statistical population of the present study included all children with leukemia who referred to the Mahak Center in 1398. In order to form three groups using purposeful sampling method, 45 children were first selected and 15 people were randomly assigned to the first experimental group, 15 to the second experimental group and 15 to the control group. Also, the follow-up phase was performed on all three groups three months after the test. The research data were analyzed using repeated measurement analysis of variance.
Results: The results of data analysis showed that compared to the control group, both treatments had a significant effect on depression and separation anxiety in children with leukemia (p <0.05). Play therapy also had a greater effect on depression and separation anxiety (p <0.05) than on storytelling.
Conclusion: The effect of play therapy on depression and separation anxiety in children with leukemia was higher than story therapy, so it is recommended to use play therapy.


Long KA, Pariseau EM, Muriel AC, Chu A, Kazak AE, Leon M, Alderfer MA. Psychosocial screening for
siblings of children with cancer: Barriers and preferences. Clinical Practice in Pediatric Psychology. 2017
2. Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, Quinn G, Wallace WH, Oktay K.
Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice
guideline update. Journal of clinical oncology. 2013 Jul 1;31(19):2500.
3. Stoppelbein L, McRae E, Greening L. A longitudinal study of hardiness as a buffer for posttraumatic stress
symptoms in mothers of children with cancer. Clinical practice in pediatric psychology. 2017 Jun;5(2):149.
4. Özkan S, Özkan M, Armay Z. Cultural meaning of cancer suffering. Journal of pediatric
hematology/oncology. 2011 Oct 1;33:S102-4.
5. Khodadadi J, Ghomi M. The effectiveness of existential psychotherapy in a group manner on increasing the
psychological well-being of mothers with cancerous children. Journal of Psychological Studies, 2018; 13 (4).
6. Linet MS, Ries LA, Smith MA, Tarone RE, Devesa SS. Cancer surveillance series: recent trends in childhood
cancer incidence and mortality in the United States. Journal of the National Cancer Institute. 1999 Jun
7. Deschler B, Lübbert M. Acute myeloid leukemia: epidemiology and etiology. Cancer: Interdisciplinary
International Journal of the American Cancer Society. 2006 Nov 1;107(9):2099-107.
8. Robin O, Mervin C. Hematology and immunology. 2008.
9. Pizzo PA, Poplack DG. Principles and practice of pediatric oncology. Lippincott Williams & Wilkins; 2015
Jun 24.
10. Douki HE, Elyasi F, Hasanzadeh R. Effectiveness of positive thinking training on anxiety, depression and
quality of life of mothers of children with leukemia. Journal of Nursing and Midwifery Sciences. 2019 Jan
11. Kentor RA, Hilliard ME. JPP Student Journal Club commentary: Considerations on depression, distress, and
resilience in parents of children with chronic health conditions. Journal of pediatric psychology. 2019 Mar
12. Seyf S, Kadivar P, KaramiNouri R, LotfAbadi H. Developmental Psychology. 2011; Tehran: Samat
13. Golestan Jahromi, F, Etesami Pour R. Comparison of Cognitive Coping Strategies with Symptoms of Anxiety
and Depression in Adolescents and Adults. JBUMS. 2012; 14 (6) :60-67
14. Lazor T, Pole JD, De Souza C, Schechter T, Grant R, Davis H, Duong N, Stein E, Cook S, Tigelaar L, Sung L.
Severity, change over time, and risk factors of anxiety in children with cancer depend on anxiety instrument
used. Psycho‐ oncology. 2019 Apr;28(4):710-7.
15. Tay AK, Rees S, Kareth M, Silove D. Associations of adult separation anxiety disorder with conflict-related
trauma, ongoing adversity, and the psychosocial disruptions of mass conflict among West Papuan refugees.
American journal of orthopsychiatry. 2016;86(2):224.
16. Schneider S, Blatter-Meunier J, Herren C, In-Albon T, Adornetto C, Meyer A, Lavallee KL. The efficacy of a
family-based cognitive-behavioral treatment for separation anxiety disorder in children aged 8–13: A
randomized comparison with a general anxiety program. Journal of consulting and clinical psychology. 2013
17. Thomson, Charles and Rudolf, Linda. Consultation with children. Translated by Javad Tahourian (2005).
Tehran: Roshd Publications.
18. Carlson R. Therapeutic use of story in therapy with children. Guidance & Counseling. 2001;16(3):92-9.
19. Heffner M. Experimental support for the use of storytelling to guide behavior: The effect of storytelling on
multiple and mixed ratio/differential reinforcement of low rate (DRL) schedule responding. Unpublished
Doctoral Dissertation, West Virginia University. 2003.
20. Ghaderi N, Asgharimoghaddam A, Shaeiri MR. Investigating the Effectiveness of Behavioral-Cognitive Play
Therapy on Aggression in Children with Behavioral Disorders. Scientific-Research Quarterly of Shahed
University, 2007; 19: 84-75.
21. Moradian Z, Mashadi A, AghaMohammadian Sherbaf H, Asghari M. The effectiveness of storytelling based
on executive actions on improving deterrence and planning / organizing students with attention deficit /
hyperactivity disorder. School Psychology Quarterly, 2015; 10 (2), 204-186.
22. Nasirzadeh R, Roshan R. The Effect of Storytelling on Aggression in Six to Eight-Year Old Boys . IJPCP.
2010; 16 (2) :118-126
23. Sheybani Sh, Yousefi M, Delavar A, Ghaffari M. The effect of story therapy on reducing depressive symptoms
in depressed children. Research in Exceptional Children, 2007; 6 (4), 916-893.
24. Leonard MA, Lorch EP, Milich R, Hagans N. Parent—Child Joint Picture-Book Reading Among Children
With ADHD. Journal of Attention Disorders. 2009 Jan;12(4):361-71.
25. Lam D. The usefulness of storytelling for ADHD children and associated
26. Hansen S, Meissler K, Ovens R. Kids together: A group play therapy model for children with ADHD
symptomalogy. Journal of child and adolescent group therapy. 2000 Dec 1;10(4):191-211.
27. Bratton SC, Ray D, Rhine T, Jones L. The efficacy of play therapy with children: A meta-analytic review of
treatment outcomes. Professional psychology: research and practice. 2005 Aug;36(4):376.
28. Meany‐ Walen KK, Kottman T, Bullis Q, Dillman Taylor D. Effects of Adlerian play therapy on children's
externalizing behavior. Journal of Counseling & Development. 2015 Oct;93(4):418-28.
29. Schroeder, Caroline, Betty Gordon (2005). Assessing and Treating Childhood Problems: A Guide to Clinical
Psychologists and Psychiatrists. Gordon; Translation: Mehrdad Firoozbakht (2006). Tehran: Danjeh.
30. Logan DE, Claar RL, Guite JW, Kashikar-Zuck S, Lynch-Jordan A, Palermo TM, Wilson AC, Zhou C. Factor
structure of the children's depression inventory in a multisite sample of children and adolescents with chronic
pain. The Journal of Pain. 2013 Jul 1;14(7):689-98.
31. Dehshiri Gh, Najafi M, Sheykhi M, Habibi M. Preliminary Study of Psychometric Characteristics of Child
Depression Questionnaire (CDI). Family Studies, 2009; 5 (18): 159-170.
32. Zarghami F, Heydarinasab L, Shaeiri M, Shahrivar Z. Evaluation of the effectiveness of Coping cat cognitivebehavioral therapy in reducing anxiety in children aged 10-8 years with anxiety. Clinical Psychology Studies,
2015; 5 (19): 183-202.
33. Ray DC, Armstrong SA, Balkin RS, Jayne KM. Child‐ centered play therapy in the schools: Review and
meta‐ analysis. Psychology in the Schools. 2015 Feb;52(2):107-23.
34. Han DH, Kim SM, Lee YS, Renshaw PF. The effect of family therapy on the changes in the severity of on-line
game play and brain activity in adolescents with on-line game addiction. Psychiatry Research: Neuroimaging.
2012 May 31;202(2):126-31.
35. ShahabiZadeh F, Khajeh Emanian F. The effectiveness of cognitive-behavioral therapy based on the anxiety of
elementary school students. Knowledge and Research in Applied Psychology, 2018; 19 (1): 70-80
36. KarimiNasab A. The effectiveness of storytelling on reducing depression in children with cancer. 2019; Third
National Conference on the Role and Status of the Mother
37. Chari U, Hirisave U, Appaji L. Exploring play therapy in pediatric oncology: a preliminary endeavour. The
Indian Journal of Pediatrics. 2013 Apr 1;80(4):303-8.
38. Rahmandoust M. Storytelling is important and its way of drawing. 2003; Tehran: Roshd
39. Ajorlou M, Irani Z, AliAkbari M. The effect of storytelling on reducing anxiety and improving sleep habits in
children with cancer under chemotherapy. Journal of Health Psychology, 2016; 5 (18): 87-107
40. Schoneveld EA, Malmberg M, Lichtwarck-Aschoff A, Verheijen GP, Engels RC, Granic I. A neurofeedback
video game (MindLight) to prevent anxiety in children: A randomized controlled trial. Computers in Human
Behavior. 2016 Oct 1; 63:321-33.