Effectiveness of Cognitive-Behavioral Play Therapy on Sleep Disturbances and Pain Tolerance in Children with Recurrent Pain

Shabnam Hazrat Hosseini; Delara  Abdi; Fatemeh  Hooshmand; Maryam Shamsi Sayar; Mona Soleiman Heshmat; Samira Darvishi

Authors

Shabnam Hazrat Hosseini Department of Psychology, Bonab Center, Payame Noor University, Bonab, Iran. https://orcid.org/0009-0000-9012-6763
Delara Abdi Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran. Author https://orcid.org/0009-0006-2115-9418
Fatemeh Hooshmand Department of Psychology, Il.C., Islamic Azad University, Ilam, Iran. Author https://orcid.org/0009-0008-6927-1171
Maryam Shamsi Sayar Department of Psychology, SR.C., Islamic Azad University, Hormozgan, Iran. Author https://orcid.org/0009-0009-8375-4134
Mona Soleiman Heshmat Department of Counseling, Ka.C., Islamic Azad University, Karaj, Iran. Author https://orcid.org/0009-0003-8115-5177
Samira Darvishi Department of Psychology, Os.C., Islamic Azad University, Osku, Iran. Author https://orcid.org/0009-0008-7441-0033

Keywords:

Cognitive-Behavioral Play Therapy, Sleep Disturbances, Pain Tolerance, Recurrent Pain, Children

Abstract

This study aimed to determine the effectiveness of cognitive-behavioral play therapy in reducing sleep disturbances and increasing pain tolerance among children with recurrent pain. This randomized pretest-posttest controlled study with a two-month follow-up was conducted among children with recurrent pain in Tehran, Iran, in 2026. Thirty children aged 8–12 years who met the inclusion criteria were selected through purposive sampling and randomly assigned to an experimental group (n = 15) and a control group (n = 15). The experimental group received eight 60-minute sessions of cognitive-behavioral play therapy conducted twice weekly, while the control group continued routine care without receiving the intervention. Sleep disturbances were assessed using the Children’s Sleep Habits Questionnaire, and pain tolerance was measured through a standardized cold pressor task. Data were analyzed using mixed repeated-measures analysis of variance and Bonferroni-adjusted pairwise comparisons in SPSS version 27, with statistical significance set at p < .05. The mixed repeated-measures analysis showed a significant time × group interaction for sleep disturbances, F(1.65, 46.31) = 40.73, p < .001, partial η² = .593, and for pain tolerance, F(1.61, 45.04) = 57.68, p < .001, partial η² = .673. Bonferroni comparisons indicated significant reductions in sleep disturbance scores from pretest to posttest and from pretest to follow-up in the experimental group (p < .001), whereas posttest and follow-up scores did not differ significantly (p = .431). Pain tolerance also increased significantly from pretest to posttest and from pretest to follow-up (p < .001), with no significant decline between posttest and follow-up (p = .091). No significant changes were observed in the control group. Cognitive-behavioral play therapy was effective in reducing sleep disturbances and increasing pain tolerance in children with recurrent pain, and these improvements remained stable over a two-month follow-up period. The intervention may therefore be considered a useful developmentally appropriate adjunct to routine care for pediatric recurrent pain.

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