Assessing the Difference and Effectiveness of Art and Sand-play Therapy in Treating Post-traumatic Stress Disorders Among Syrian Refugee Children in Jordan
Phase: NA
Conditions: PTSD - Post Traumatic Stress Disorder
Sponsor: King Abdullah University Hospital

 
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Cover Page 
 
O+icial Title: 
 
Assessing the Di,erence and E,ectiveness of Art and Sandplay Therapy in Treating 
Posttraumatic Stress Disorders Among Syrian Refugee Children in Jordan 
 
NCTXXXXXXX (To be assigned upon registration)   
 
Document Date:   
[Insert Date]   
 
IRB Approval Number:  1/92/2014 
 
Principal Investigators:   
Dr. Abdallah Alzoubi   
Dr. Khalid Ahmed Abdullah Kheirallah   
Ms. Nour Khalid Bundogji   
 
Funding Source:   
Faculty Member Research Grant (FMRG), Jordan University of Science and Technology   
 
 
Ethical Approval Date:   
Approved by the Institutional Research Board (IRB) on December 16, 2014   
 
 
 
 
 

 
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1. Executive Summary 
 
This study aims to evaluate the e,ectiveness of art therapy and sandplay therapy in 
reducing symptoms of Posttraumatic Stress Disorder (PTSD) among Syrian refugee children 
aged 6–12 living in Jordan. The study employs a randomized controlled trial (RCT) design 
with three groups: sandplay therapy, art therapy, and a control group. Participants will 
undergo 12 weeks of intervention, with pre- and post-intervention assessments using the 
Harvard Trauma Questionnaire (HTQ). The study has received ethical approval from the 
Institutional Research Board (IRB) of Jordan University of Science and Technology 
(Approval No. GM7601). 
 
2. Background and Rationale 
 
Posttraumatic stress disorder (PTSD) is a signiﬁcant mental health concern among refugee 
children exposed to war-related trauma. Traditional treatments such as Eye Movement 
Desensitization and Reprocessing (EMDR) and Trauma-Focused Cognitive Behavioral 
Therapy (TF-CBT) are e,ective but may not beneﬁt all patients, particularly those with poor 
verbal memory or prolonged trauma exposure. Nonverbal therapies like sandplay and art 
therapy o,er alternative approaches that may be more accessible and culturally sensitive 
for refugee populations. This study seeks to provide evidence for the clinical use of these 
therapies in treating PTSD among Syrian refugee children. 
 
 
3. Study Objectives 
 
1. To determine the di,erence in e,ectiveness between art therapy and sandplay therapy 
compared to each other and to a control group.   
2. To evaluate whether sandplay therapy results in greater improvement in PTSD symptoms 
compared to art therapy.   
 
4. Study Design and Methodology 
 
Study Population   
- Target Population: Syrian refugee children aged 6–12 living in Jordan.   
- Sample Size: 90 children (30 per group: sandplay, art therapy, control).   
 
Inclusion Criteria   
- Diagnosed with PTSD related to war trauma (e.g., witnessed death, shrapnel injuries, war 
violence).   
- Aged 6–12 years.   
- Residing in Jordan as refugees due to the Syrian Civil War.   
 
Exclusion Criteria   
- Pre-existing psychosocial issues unrelated to war trauma.   

 
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Randomization and Group Allocation   
 
Participants will be randomly assigned to one of three groups:   
1. Sandplay therapy group.   
2. Art therapy group.   
3. Control group (no formal therapy).   
 
Interventions   
- Sandplay Therapy: Participants will create scenes in a sandbox using miniature objects. 
Sessions last 20–30 minutes.   
- Art Therapy: Participants will draw using coloring utensils on blank paper. Sessions last 30 
minutes.   
- Control Group: No formal therapy.   
 
Outcome Measures   
Primary outcome: Change in PTSD severity scores measured using the Harvard Trauma 
Questionnaire (HTQ). Scores will be categorized as mild, moderate, or severe based on a 
16-item scale rated 1–4. 
 
Location   
Zad Children Center, Amman, Jordan.   
 
Duration   
- Total duration: 14 weeks.   
- Intervention period: 12 weeks.   
- Pre- and post-assessment sessions: Weeks 1 and 14.   
 
Session Details   
- Session 1: Establish rapport, obtain consent, and conduct pre-assessment.   
- Sessions 2–13: Weekly therapy sessions for sandplay and art therapy groups.   
- Session 14: Post-assessment and closing meeting.   
 
Data Collection   
- HTQ administered at baseline and post-intervention.   
- Photographs of sandplay creations and art pieces for documentation.   
 
6. Statistical Analysis Plan 
 
Primary Analysis   
- Paired t-test: Compare pre- and post-intervention mean scores within each group.   
- Independent t-test: Compare mean di,erences between groups (sandplay vs. art therapy, 
sandplay vs. control, art therapy vs. control).   
 

 
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Secondary Analysis   
- Subgroup analysis by age and gender.   
- Correlation analysis between session attendance and symptom improvement.   
 
Signiﬁcance Level   
p-value < 0.05 will be considered statistically signiﬁcant.   
 
 
 
7. Ethical Considerations 
 
- Informed Consent: Obtained from legal guardians of all participants.   
- Conﬁdentiality: Participant data will remain anonymous.   
- Withdrawal Rights: Participants can withdraw from the study at any time without penalty.   
- Safety Measures: Therapists will ensure a safe and supportive environment during 
sessions.   
- IRB was secured from King Abdulla University Teaching Hospital in Irbid, Jordan.  
 
 
 
 
 

 
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8. References 
 
1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental 
disorders (4th ed., Text Revision).   
2. Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). 
Psychological treatments for chronic post-traumatic stress disorder: Systematic review 
and meta-analysis. *British Journal of Psychiatry*, 190, 97–104. PMID: 17290083   
3. Schoumen, T., et al. (2014). Art therapy and sandplay therapy in PTSD treatment.   
4. Harvard Trauma Questionnaire (HTQ). (2011). Harvard Program in Refugee Trauma.