Comparing the Effectiveness of Emotional Disclosure Through Drawing and Family-Based Floortime Play Therapy on Emotion Regulation Difficulties and Internalizing and Externalizing Symptoms in Children with Anxiety Symptoms

This study aimed to compare the effectiveness of emotional disclosure through drawing and family-based Floortime play therapy in improving emotion regulation and reducing internalizing and externalizing symptoms in children with anxiety symptoms. This quasi-experimental study used a pretest–posttest design with a control group and follow-up. The statistical population comprised children aged 8–10 years in Qaen, South Khorasan Province, in 2024–2025. Forty-five children with anxiety symptoms, identified by scoring at least one standard deviation above the mean on the Spence Children’s Anxiety Scale–Parent version (SCAS-P), were selected through purposive sampling and randomly assigned to three groups: emotional disclosure through drawing, family-based Floortime play therapy, and control (15 participants each). Both interventions were delivered in eight 45-minute sessions held twice weekly. Data were collected using the Difficulties in Emotion Regulation Scale for Children (DERS-C) and the Child Behavior Checklist (CBCL) and analyzed with analysis of covariance (ANCOVA) and Bonferroni post hoc tests using SPSS 26. ANCOVA results indicated a significant main effect of group on emotion regulation difficulties (F = 14.926, p = .001, η² = .421), internalizing symptoms (F = 30.363, p < .001, η² = .603), and externalizing symptoms (F = 36.531, p < .001, η² = .646). Bonferroni comparisons showed both interventions were significantly more effective than the control group at posttest and follow-up (p < .001). No significant difference was observed between emotional disclosure and Floortime groups (p > .05). Both emotional disclosure through drawing and family-based Floortime play therapy effectively improved emotion regulation and reduced anxiety-related internalizing and externalizing symptoms in children, with sustained effects at follow-up, suggesting these methods as accessible and family-friendly therapeutic options.