Comparison of the Effectiveness of Cognitive-Behavioral Play Therapy and Theory-of-Mind-Based Training on Anxiety Disorders in Female Elementary School Students

Abstract

This study aimed to compare the effectiveness of cognitive-behavioral play therapy (CBPT) and theory-of-mind (ToM)-based training in reducing anxiety disorders among female elementary school students. This experimental study employed a pretest–posttest–follow-up design with a control group. The statistical population comprised all female elementary school students studying in Shiraz, Iran, in 2025–2026 (1404 SH). Following screening, 45 students with anxiety disorders were purposively selected and randomly assigned to three groups of 15 participants: CBPT, ToM-based training, and control. Anxiety symptoms were assessed using the Screen for Child Anxiety Related Emotional Disorders (SCARED). The CBPT group received the nine-session Jennings and Proctor cognitive-behavioral play therapy protocol, whereas the ToM group received a structured training program based on the Wellman and Liu model. The control group received no intervention. Assessments were conducted at pretest, posttest, and follow-up. Data were analyzed in SPSS using mixed repeated-measures analysis of variance and Bonferroni post-hoc comparisons. Inferential analysis demonstrated a significant effect of time on anxiety disorder scores (F=44.779, p<0.001, η²=0.542), as well as a significant between-group effect (F=21.449, p<0.001, η²=0.547). The time×group interaction was also statistically significant (F=50.225, p<0.001, η²=0.609), indicating different patterns of change across the three groups. Bonferroni comparisons showed significant reductions in anxiety from pretest to posttest and from pretest to follow-up in both intervention groups (p<0.001), whereas no significant changes occurred in the control group. Moreover, CBPT produced a significantly greater reduction in anxiety than ToM-based training at posttest (p=0.021), and this difference remained significant at follow-up (p=0.037). Both cognitive-behavioral play therapy and theory-of-mind-based training were effective in reducing anxiety disorders among female elementary school students, with treatment effects persisting at follow-up. However, cognitive-behavioral play therapy demonstrated greater effectiveness, suggesting its potential as an appropriate psychological intervention for reducing anxiety symptoms in elementary school settings.