Iranian Journal of Psychiatry

Effect of Play Therapy versus Virtual Reality on Reducing Anxiety in Children Pre-Cardiac Catheterization: A randomized Single-Blind Trial

Sabreen Kareem Flayh, Adraa Hussein Shawq — Sun, 02 Aug 2026 13:12:14 +0430

Objective: This study aimed to compare the effectiveness of virtual reality (VR) versus play therapy in reducing pre-procedural anxiety among children scheduled for cardiac catheterization, and to evaluate parental satisfaction with these interventions.

Method: A randomized, assessor-blinded, pretest-posttest comparative trial was conducted at Al-Nasiriyah Heart Hospital between December 2025 and February 2026. A total of 75 children aged 3-7 years with congenital heart defects were randomly allocated into three equal groups (n = 25 each): VR (15 minutes of immersive 3D video), play therapy (15 minutes of coloring activity), and control (standard care). Anxiety was assessed using the Modified Yale Preoperative Anxiety Scale (mYPAS) at four time points (two pre-intervention and two post-intervention measurements). The outcome assessor was blinded to group allocation. Data were analyzed using analysis of covariance (ANCOVA) with Bonferroni-adjusted post-hoc comparisons to control for baseline age and anxiety differences.

Results: The VR group demonstrated the lowest mean anxiety score post-intervention (mean = 5.04 ± 0.20), followed by the play therapy group (mean = 5.88 ± 1.33), while the control group maintained consistently higher anxiety levels (mean = 12.24 ± 1.39). ANCOVA, controlling for baseline anxiety and age, revealed a statistically significant main effect of intervention group on post-intervention anxiety scores [F 2, 70) = 38.24, P < 0.001, η² = 0.52]. Post-hoc pairwise comparisons with Bonferroni correction showed that, compared with the control group, both VR (P < 0.001) and play therapy (P < 0.001) significantly reduced anxiety. Furthermore, VR produced significantly greater anxiety reduction than play therapy (P = 0.03, Cohen's d = 0.83). Parental satisfaction was uniformly high across both intervention groups, with no significant difference between them (P = 0.568).

Conclusion: Both VR and play therapy are effective non-pharmacological interventions for reducing pre-catheterization anxiety in children. VR demonstrated superior anxiolytic effects compared to play therapy, with a large effect size. Integrating VR-based distraction into routine pre-procedural nursing care may enhance pediatric procedural experiences

and improve clinical outcomes.

Mind-Body Benefits of Eye Movement Desensitization and Reprocessing (EMDR) in Acute Respiratory Infections: A Randomized Clinical Study of Psychophysiological Outcomes

Sat, 01 Aug 2026 11:23:04 +0430

Objective: Acute respiratory infection (ARI) represent one of the foremost contributors to worldwide mortality. Psychological factors, notably anxiety, commonly obstruct patient recovery. Conventional medical approaches rarely account for the interplay between these psychological and physiological factors. This study aimed to determine the effects of EMDR on hemodynamic indices, anxiety levels, and sleep quality in hospitalized patients with ARI.

Method: In 2022, a six-month parallel-group randomized controlled trial was conducted in Yasouj, Iran, including 89 hospitalized patients with ARI. Participants were randomly assigned to either an intervention group receiving three bedside Eye Movement Desensitization and Reprocessing (EMDR) sessions (45–90 minutes each) or a control group receiving standard care. Outcomes included the Hamilton Anxiety Rating Scale (HARS), a hemodynamic monitoring checklist, and the Pittsburgh Sleep Quality Index (PSQI), assessed at baseline and post-intervention. Data were analyzed using SPSS version 26 with descriptive and inferential statistical methods.

Results: In the intervention group, mean heart rate, respiratory rate, blood pressure, and anxiety scores decreased significantly compared with the control group, whereas blood oxygen saturation increased significantly (P ≤ 0.05). Sleep quality indices in the EMDR group exhibited statistically significant improvements relative to the control group at both the one-month and three-month follow-up assessments (P = 0.001). Within-group analyses further confirmed notable pre- to post-intervention changes across the key outcome variables exclusively in the EMDR arm (P ≤ 0.05). In contrast, the control group displayed no statistically meaningful alterations in these parameters.

Conclusion: Taken together, the present findings position EMDR as a clinically viable, rapidly applicable, and pharmacologically independent therapeutic option for patients hospitalized with ARI.

A Systematic Review of Narrative-Based Therapy for Enhancing Self-Esteem and Psychological Well-Being in Children and Adolescents

Yifei Pan, Saeid Motevalli, Abbas Abdollahi, Richard Peter Bailey — Mon, 20 Jul 2026 12:29:10 +0430

Objective: Self-esteem and psychological well-being are key determinants of mental health in children and adolescents. Narrative-based interventions (NBIs) are increasingly used to promote these outcomes. This systematic review aimed to evaluate the effectiveness of NBIs on self-esteem and psychological well-being in children and adolescents.

Method: A systematic search was conducted in Scopus and PubMed (January 2010 – March 2025). MeSH terms included narrative therapy, storytelling, self-esteem, psychological well-being, child, and adolescent. Two reviewers independently screened records, extracted data, and assessed quality using the Mixed Methods Appraisal Tool (MMAT). A total of 18 studies were included: seven randomized controlled trials (RCTs), three quasi-experimental, four qualitative, and four mixed-methods designs. Narrative synthesis was used due to heterogeneity.

Results: Fifteen studies (83.3%) reported positive effects on self-esteem or psychological well-being. Effect sizes ranged from small to large. Digital storytelling was most consistently associated with improved self-esteem (4 of 5 studies). Group narrative therapy showed stronger effects on behavioral symptoms (3 of 3 studies). Two studies reported null or mixed findings. Moreover, qualitative studies consistently reported themes of empowerment, healing, and identity transformation.

Conclusion: NBIs show promise for enhancing self-esteem and well-being, particularly digital storytelling and group narrative therapy. However, evidence quality is variable. High-quality RCTs with diverse populations and longer follow-ups are needed.

Self-Esteem, Social Anxiety, and Affective Lability as Predictors of Academic Achievement in Pediatric Nursing Students: A Mediation Analysis

Wed, 17 Jun 2026 10:21:49 +0430

Objective: To assess levels of self-esteem, social anxiety, and affective lability among pediatric nursing students; to examine their associations with academic achievement; and to test whether social anxiety and affective lability mediate the self-esteem–achievement relationship.

Method: A descriptive cross-sectional study was conducted among 370 nursing students aged 17-24 years using purposive sampling. Instruments included the Coopersmith Self-Esteem Scale (self-esteem), the Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR), the Affective Lability Scale (ALS-18), and academic achievement records from the pediatric nursing course. Sociodemographic variables were also collected. Data were analyzed using Pearson correlations and mediation analysis with Hayes PROCESS Model 4.

Results: Students demonstrated moderate self-esteem, mild-to-moderate social anxiety, and clinically notable affective lability (mean ALS-18 = 42.3 ± 11.7; scores > 40 indicate clinically notable emotional dysregulation). Self-esteem showed a significant positive correlation with academic achievement (r = 0.42, P < 0.01). Social anxiety (r = -0.38, P < 0.01) and affective lability (r = -0.36, P < 0.01) were each negatively correlated with both self-esteem and academic achievement. Mediation analysis revealed that social anxiety and affective lability partially mediated the relationship between self-esteem and academic achievement (indirect effect = 0.19, 95% CI: 0.08 to 0.33), accounting for 41% of the total association between self-esteem and academic achievement (proportion mediated = 0.41). No significant associations were found between sociodemographic variables and self-esteem.

Conclusion: Self-esteem is positively associated with academic achievement among pediatric nursing students. Cross-sectional mediation analysis indicates that this association is statistically consistent with a model in which social anxiety and affective lability together account for 41% of the total association. However, causal interpretation requires longitudinal replication. Psychiatric screening for emotional dysregulation and social anxiety using validated tools such as the ALS-18 and LSAS may help identify at-risk students, but experimental studies are needed to test whether interventions targeting these constructs improve academic outcomes.

Early-Onset Somatic Delusional Presentation: A Case Report and Two-Decade Comparative Synthesis

Lakshmi Dorai B Dorai B, Alluri Swetha Reddy, Mukesh B M, Arbind Kumar Choudhary — Mon, 15 Jun 2026 00:00:00 +0430

Objective: Somatic-type delusional disorder is characterized by fixed false beliefs related to bodily changes or illness. This report describes an unusual early-onset case associated with significant functional decline and compares its features with previously published cases.

Method: Clinical information was collected through psychiatric assessment, family interviews, physical and neurological examinations, laboratory investigations, and six months of follow-up. A narrative review of relevant English-language case reports published between 2003 and 2025 was also undertaken.

Results: A 22-year-old woman developed a persistent belief that self-inflicted cuts on her feet had permanently altered her joints and skin. Despite repeated reassurance and normal medical findings, she remained convinced of the perceived deformity. The condition was associated with depressed mood, social isolation, poor self-care, reduced food intake, and academic impairment. Investigations did not identify an underlying medical cause. Treatment with olanzapine, psychoeducation, supportive psychotherapy, and family counselling resulted in gradual improvement. During follow-up, delusional conviction decreased substantially, accompanied by better self-care, social interaction, and academic functioning. Review of the literature indicated that severe impairment and early onset are relatively uncommon in somatic-type delusional disorder.

Conclusion: Early-onset somatic delusions can lead to marked psychosocial dysfunction and may differ from the traditionally described pattern of preserved functioning. Comprehensive assessment, ongoing diagnostic review, and combined pharmacological and psychosocial interventions are important for achieving favorable outcomes.