Abstract
Research has shown that children with separation anxiety disorder often struggle with self-regulation and emotional regulation. The purpose of this study was to investigate the impact of group play therapy, specifically painting-based therapy, on the emotional skills of children with separation anxiety disorder. The study utilized a quasi-experimental design with a pre-test-post-test approach and a control group. The study population included all sixth-grade female students with separation anxiety disorder in Ghaemshahr city during the academic year 1400. Thirty children were selected for the study and randomly assigned to either the experimental or control group. Data were collected using the Separation Anxiety Questionnaire (March et al., 1997) and Zeiman's (2001) emotion management scale. The experimental group received ten 45-minute sessions of painting-based group play therapy, while the control group received no intervention. The data were analyzed using univariate and multivariate analysis of covariance. The results showed that painting-based group play therapy significantly improved the emotional skills of children with separation anxiety disorder (P<0.001). Based on these findings, it can be concluded that group play therapy based on painting is an effective treatment method for promoting mental health and preventing psychological problems in children with separation anxiety disorder.
Extended Abstract

Introduction

Separation anxiety disorder is one of the types of anxiety disorders that can be indicative of anxiety disorders starting in childhood (Hoffman, Sterkenburg & Van Rensburg, 2019). This type of anxiety is so intense and serious that it prevents daily activities and causes severe disruption in a child's academic and social performance (Maltese & colleagues, 2018). If this anxiety continues until the end of childhood or adulthood, it can lead to an ineffective understanding of oneself and others (Tamman and colleagues, 2017). Additionally, separation anxiety disorder may be associated with various mental disorders and problems that can develop in adulthood, as reported by Agebati and colleagues (2020).
Children with separation anxiety disorder consistently use maladaptive emotional regulation strategies and use adaptive emotional regulation strategies less. In fact, maladaptive emotional regulation in children can be an important factor in maintaining their separation anxiety (Naseri, Gasempour & Mahmoudimogadam, 1394). Children with anxiety disorders tend to use more maladaptive strategies compared to those without anxiety. Identifying efficient or ineffective patterns of emotional regulation can improve anxiety (Rodrigues et al., 2021). Schneider et al. (2018) concluded that emotion dysregulation can be a potential risk factor in the development of anxiety symptoms in children and adolescents. Play therapy has a positive effect on reducing separation anxiety and avoiding harm in children (Yazdani, 2018) and is an effective intervention in improving the psychological symptoms of children suffering from separation anxiety disorder (Sidi Andi, Najafi and Rahimian Bogar, 2014). One of the other therapeutic methods used to treat children's disorders is art therapy based on painting (Mohammadi and Radin, 2016). Painting is the spontaneous drawing of pictures that provides opportunities for non-verbal communication and expression (Erickson and Blok, 2013). The research of Malekpour, Vahedi and Mirnesab (2013) showed that the implementation of painting therapy program is effective in increasing the emotional regulation of elementary school boys. Nan, Hinz and Loesbrink (2021) found that art therapy is effective in reducing stress, depression and improving the level of emotions and improving general health. Mabing-Barz, Hestercht and Ponstine (2019) concluded that art therapy reduces anxiety and improves emotion regulation and executive functioning. In general, group play therapy training based on drawing can help children to deal with their anxiety. Also, the combination of these two treatments can be a safe and useful way to promote mental health and improve the child's emotional skills. Therefore, the aim of the present study is to determine the effect of group play therapy training based on drawing on the emotional skills of children with separation anxiety disorder.

Method

The current study used a semi-experimental design with a pre-test and post-test, and a control group. The population studied consisted of all female students who were in the sixth grade and had been diagnosed with separation anxiety disorder in Ghaemshahr city during the 2019 academic year. Thirty individuals were then selected and randomly assigned to either an experimental or control group, with 15 participants in each group. The control group did not receive any intervention, while the experimental group received group play therapy training based on drawing. The study aimed to determine the effectiveness of group play therapy training on reducing separation anxiety in young girls with separation anxiety disorder.
Separation anxiety questionnaire: The separation anxiety questionnaire was developed by March et al. (1997) and contains 39 items. Mashhadi (2011) reported the reliability of this tool using Cronbach's alpha of 0.81 and a favorable face validity. Pirzadi (2017) reported a higher reliability coefficient for this questionnaire via Cronbach's alpha, with a value of 0.80.
Emotion Management Questionnaire: It was completed by Ziman et al. in 2001 and consists of 38 questions graded on a three-point Likert scale. Hashmipour and Mohammadi's research (2017) found a reliability coefficient of 0.73 and 0.86 using two-halves and retesting, respectively, for this scale.
Group play therapy based on drawing: The intervention program used in this research was a combined package of drawing therapy (Zadeh Mohammadi, 2007; quoted by Rezaei et al., 2014) and play therapy (Mohammed Ismail, 2010; quoted by Yazdani, 2018).

Results

The sample of students participating in the study was matched in terms of age, sex, and educational level.
 
Table 1. Pre-test and post-test descriptive indices of variables by groups




Post test
M±SD


Pre test
M±SD


Group


Variable


Post test
M±SD


Pre test
M±SD


Group


Variable






81/1±47/24


50/3±13/20


Experiment


Sadness


04/2±80/22


2±00/18


Experiment


Anger




66/2±07/22


96/3±67/21


Control


14/3±13/19


40/3±87/18


Control




22/5±33/83


60/7±80/66


Experiment


Emotion Management (total score)


77/1±00/23


61/3±20/27


Experiment


Anxiety




09/7±60/71


96/9±93/69


Control


88/2±53/28


93/3±53/27


Control




Table 1 presents the means and standard deviations of the research variables in both the control and experimental groups. To test the research hypothesis, the Multivariate covariance Analysis test was employed. Box and Levin's test and the test of effects between subjects indicated that the assumptions of the covariance analysis were met.
Table 2. Results of Multivariate covariance Analysis to investigate the effect of painting-based group play therapy training on emotional Skills




SS


Df


MS


F


P


Eta


OP


Variable






83/100


1


83/100


40/14


001/0>


340/0


96/0


Anger




20/43


1


20/43


36/8


001/0>


230/0


80/0


Sadness




63/149


1


63/149


23/26


001/0>


484/0


10/0


Anxiety




99/1255


1


99/1255


66/53


001/0>


665/0


1


Emotion
management




The results of the Multivariate covariance Analysis, as presented in Table 2, indicate a statistically significant difference between the experimental and control groups in the component of emotion management.

Discution

The aim of this study was to investigate the effect of group play therapy based on drawing on improving the emotional skills of children with separation anxiety disorder. The findings suggest that emotional dysregulation leads to difficulties with identifying, understanding, accepting, and adjusting emotions, and can result in a person being cognitively and emotionally helpless and confused. Drawing-based group play therapy training aims to improve the control of negative emotions in children with separation anxiety disorder, which can be effective in reducing it along with other treatments. Artistic activities have also been found to encourage healthy activities, emotional regulation, and the integration of the child's brain. This can help to reduce behavioral and emotional problems.

Final Results

In general, it can be concluded that group play therapy training based on drawing improves emotional skills. Since children with separation anxiety disorder have difficulty in regulating their emotions as well as in recognizing and describing their emotions, this causes problems in interpersonal relationships and interaction with others; therefore, group play therapy training based on drawing helps children to increase their emotional skills and also reduces their anxiety and worry.
Keywords: Separation Anxiety, Play Therapy, Emotional Skills, Painting Therapy.