A Clinical Research Studying Interventions for Nighttime Fears in Preschool Children
Condition: Nighttime Fears
Study type: Interventional

Summary: 
      Nighttime fears (NTF) and sleep disruptions in preschool children continue to be major
      problems in clinical services. The aim of this study is to test the efficacy of two
      interventions designed for preschool children suffering from NTF: (a) a CBT adaptation
      combining parent involved play, which will include multiple standard cognitive-behavioral
      techniques, namely psycho-education, problem solving via play, gradual exposure and
      reinforcement management; and (b) Triadic Expressive Play Therapy, based on Virginia Axline's
      (1947) eight basic principles of play therapy. Parents will take an active part both in and
      in between treatment sessions in both intervention groups. In addition to the review of the
      outcomes of these interventions, the proposed study aims to identify variables that moderate
      and mediate treatment effects.

      In an attempt to meet these aims, the investigators will recruit 90 children suffering severe
      NTF and their parents who seek treatment. At baseline the investigators will assess
      children's NTF and general fears, sleep patterns and disruptions, behavior problems and
      potential moderators (i.e. playfulness, oppositionality, desire for control and parental
      anxiety). Assessment will be based on both objective and subjective measures, including
      interviews with the child and parents, questionnaires and actigraphy. The investigators will
      then randomly assign these children to one of two conditions: CBT with parent involved play
      or Triadic expressive play therapy. Possible mediators (i.e. the therapeutic alliance,
      patient compliance, motivation etc.) will be evaluated after each of the active intervention
      sessions. The effects of the interventions will be assessed by comparing four time points:
      baseline, first week of intervention, 1 month and 6 months subsequent to administration.

      The main hypotheses of the proposed study are: (a) A positive correlation will be found
      between the severity of NTF and the severity of sleep disruption at baseline, and a reduction
      in NTF will be associated with an improvement in sleep; (b) Both interventions will
      significantly reduce nighttime fears, but greater impact will be evident in the CBT group;
      (c) Higher levels of playfulness and lower levels of oppositionality and desire for control,
      as well as parental anxiety will predict desirable outcomes. (d) Stronger therapeutic
      alliances, in addition to higher levels of motivation and compliance will be associated with
      greater intervention effectiveness.
    


Intervention name(s): CBT with parent involved play; Triadic expressive play therapy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This is a CBT adaptation designed for preschool children, which includes multiple standard cognitive-behavioral techniques, namely psycho-education, problem solving via play, gradual exposure and reinforcement management.; Based on expressive play therapy guidelines, children and their parents will express themes concerning bedtime routines and fears via play.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: nighttime fears; anxiety; sleep; actigraphy; intervention