Comparing the Effectiveness of Art and Sand-play in Reducing PTSD Among Refugee Children

NCT06984198 | Completed DMC

• 1 other identifier: 464-2015
• Study Type: interventional
• Target: 130
• Locations: 1 country
• Sites: 1

Brief Summary

Due to the political state of Syria, Jordan is experiencing a major increase in the number of Syrians seeking asylum each year, a quarter of which are children. The stressors these refugees are exposed to are described in three stages: (1) while in their country of origin; (2) during their escape to safety; and (3) when having to settle in a country of refuge. The available literature shows consistently increased levels of psychological morbidity among refugee children, especially post-traumatic stress disorder (PTSD). It is argued that mental health clinics could use creative art therapies as a means of reaching out to war refugees in their communities who may not respond to traditional therapy. The difference in effectiveness between art and sand-play therapy, two models of nonverbal psychosocial therapy, on Syrian refugee children with PTSD, will be evaluated using a pretest-posttest control group design with 90 preadolescents (ages 6-12) exhibiting PTSD. Children will be randomized into two experimental groups (n = 30 for each) to receive sandplay or art therapy for 12 weeks, while the control group (n = 30) will receive no formal treatment. The effectiveness of each form of therapy will be determined using a questionnaire and then compared within and between group(s). Further statistical analysis will be used to determine which therapy was more effective in mitigating PTSD.

Conditions

PTSD - Post Traumatic Stress Disorder

Keywords

Syrian refugee; PTSD; Sandplay; art therapy; mental health; Randomized trial; Children

Outcome Measures

Primary Outcomes (1)

• HTQ

  HTQ: Harvard Trauma Questionnaire, translated into Arabic. Harvard Trauma Questionnaire (HTQ) checklist will be used to assess the mental health status of children in a pre and post intervention format. The checklist, written by Harvard Program in Refugee Trauma (HPRT), inquires about a variety of trauma events, as well as the emotional symptoms considered to be uniquely associated with trauma (Harvard Trauma Questionnaire, 2011). The scoring method used in this study will be adapted from this questionnaire and will include questions to help determine the children's PTSD severity, which will be split into three degrees: mild, moderate, and severe. The questionnaire used (please refer to Appendix B for a detailed outline of the instrument) comprises of 16 questions, each with a rating of 1-4 (1: not at all and 4: extremely). Subjects with scores between 16-32, 33-48, or 49-64 were considered mild, moderate, or severe, respectively. HTQ checklist will be translated into Arabic.

  Week 1, pre-intervention, and then week 14, post-intervention.

Study Arms (3)

Sandplay therapy

EXPERIMENTAL

Sandplay Therapy - The objects involved in this form of therapy are: sandtray, sand, multiple figurines in all categories (people, animals, buildings, vehicles, vegetation, structures, natural objects and symbolic objects). The subject engaging in this therapy is instructed to build a sand picture with the minatures present. There is no time limit to these sessions; however, they tend to be 20-30 minutes long. Upon completion of their sand picture the child, if comfortable, may elaborate on their creation.

Behavioral: Sandplay Therapy

Art therapy

EXPERIMENTAL

Art Therapy - The instruments used in this form of therapy are: a blank 8" x 11" paper and coloring utensils (markers, crayons, and color pencils). During each 30-minute session, the subject is informed to draw whatever they feel with the coloring utensils provided. Possible drawing topics may include: their family, a memory of their life back in their country of origin, or something from their imagination.

Behavioral: Art Therapy

control

NO INTERVENTION

Standard care provided as per routine clinical practice.

Interventions

Sandplay Therapy BEHAVIORAL

Sandplay Therapy - The objects involved in this form of therapy are: sandtray, sand, multiple figurines in all categories (people, animals, buildings, vehicles, vegetation, structures, natural objects and symbolic objects). The subject engaging in this therapy is instructed to build a sand picture with the minatures present. There is no time limit to these sessions; however, they tend to be 20-30 minutes long. Upon completion of their sand picture the child, if comfortable, may elaborate on their creation.

Sandplay therapy

Art Therapy BEHAVIORAL

Art Therapy - The instruments used in this form of therapy are: a blank 8" x 11" paper and coloring utensils (markers, crayons, and color pencils). During each 30-minute session, the subject is informed to draw whatever they feel with the coloring utensils provided. Possible drawing topics may include: their family, a memory of their life back in their country of origin, or something from their imagination.

Also known as: art drawing

Art therapy

Eligibility Criteria

• Age: 6 Years - 12 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Syrian refugee children living in Jordan as a result of the war/conflict in Syria,
• Ages between 6 and 12 years at the time of the study.
• Reported to have experienced trauma related to the war/conflict in Syria (e.g. witnessed death, shrapnel injuries, and/or any forms of war violence) as diagnosed by the treating physician.
• Lack of any pre-existing psychosocial issues.
• Ability to secure parent or guardian consent.

Sponsors & Collaborators

• King Abdullah University Hospital: lead

Study Sites (1)

Zad Children Center

Amman, 26222, Jordan

Location

Related Publications (8)

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  PMID: 17290083 BACKGROUND

• Carmichael, Karla Delle. "Sand Play as an Elementary School Strategy." Elementary School Guidance & Counseling, vol. 28, no. 4, 1994, pp. 302-07. JSTOR, http://www.jstor.org/stable/42871132.

  BACKGROUND

MeSH Terms

Conditions

Combat Disorders; Stress Disorders, Post-Traumatic; Psychological Well-Being

Interventions

Play Therapy; Art Therapy

Condition Hierarchy (Ancestors)

Stress Disorders, Traumatic; Trauma and Stressor Related Disorders; Mental Disorders; Personal Satisfaction; Behavior

Intervention Hierarchy (Ancestors)

Sensory Art Therapies; Complementary Therapies; Therapeutics; Psychotherapy; Behavioral Disciplines and Activities; Rehabilitation; Aftercare; Continuity of Patient Care; Patient Care

Study Officials

• Abdallah Alzoubi, MD, PhD

  Medical School of Jordan University of Science and Technology

  PRINCIPAL INVESTIGATOR

• Khalid A Kheirallah, PhD

  Medical School of Jordan University of Science and Technology

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Epidemiology

Model Details: Therapy Sessions In both the art and sand groups, each child will undergo 14 sessions, once per week. The first and last sessions will serve as pre and post-assessment sessions. The remainder 12 weeks will be the intervention period, where, depending on the child's randomized group assignment, they will either undergo no formal therapy (control), art, or sandplay therapy. SESSION 1: obtain the child's background history and consent, a pre-assessment of the child's condition using (HTQ). SESSION 2-13: Children in the sandplay and art therapy intervention groups will undergo their assigned therapies once a week. Session 14: HTQ, post intervention.

Study Record Dates

• First Submitted: April 26, 2025
• First Posted: May 22, 2025
• Study Start: April 1, 2015
• Primary Completion: May 1, 2017
• Study Completion: December 1, 2018
• Last Updated: May 22, 2025

Record last verified: 2025-05

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL
• Time Frame: Dec 2025

Locations

JO (1)