The Effectiveness of Cognitive-Behavioral Play Therapy on Alexithymia and Behavioral Problems in Children with Behavioral Disorders

Abstract

This study aimed to determine the effectiveness of cognitive-behavioral play therapy on alexithymia and behavioral problems in children with behavioral disorders. This quasi-experimental study used a pretest-posttest design with a control group. The statistical population included 10- to 12-year-old children with behavioral disorders and their parents who referred to counseling centers supervised by the Welfare Organization in Karaj from July to December 2025. After initial screening, 30 eligible children were selected through purposive sampling and assigned to 10-member groups. The cognitive-behavioral play therapy intervention was implemented in eight 60-minute sessions. The research instruments included the parent version of the Rutter Children’s Behavioral Disorder Questionnaire, the Goodenough Draw-a-Man Test, the Toronto Alexithymia Scale for Children and Adolescents, and the Achenbach Child Behavior Checklist. Data were analyzed using multivariate analysis of covariance and follow-up tests. The multivariate combined effect of cognitive-behavioral play therapy on the dependent variables was statistically significant (Wilks’ λ=0.75, F=46.77, p<0.001, η²=0.61). The intervention had a significant effect on total alexithymia (F=149.85, p<0.001, η²=0.87). Significant effects were also observed for difficulty identifying feelings (F=32.07, p<0.001, η²=0.65), difficulty describing feelings (F=47.35, p<0.001, η²=0.74), and externally oriented thinking (F=12.67, p=0.003, η²=0.46). In addition, the intervention significantly affected total behavioral problems (F=11.37, p=0.004, η²=0.40), internalizing problems (F=12.33, p=0.003, η²=0.43), and externalizing problems (F=17.14, p=0.001, η²=0.52). Cognitive-behavioral play therapy appears to be an effective intervention for reducing alexithymia and behavioral problems in children with behavioral disorders by improving emotional awareness, emotional expression, self-regulation, problem-solving skills, and adaptive behavioral responses.