Healing Beyond Words: A Randomized Controlled Trial of Sandplay and Art Therapies for PTSD Among Syrian Refugee Children in Jordan.

Abstract

Background: Expressive arts provide nonverbal therapeutic tools that can help children with post-traumatic stress disorder (PTSD) overcome language and cultural barriers. This study compared the effectiveness of sandplay therapy and art therapy in reducing PTSD symptom severity among Syrian refugee children living in noncamp, host community settings in Jordan.

Methodology: We conducted a three-arm, parallel-group, randomized controlled trial involving 102 Syrian refugee children (aged 5-13 years) with clinically diagnosed PTSD. Participants were randomly assigned to sandplay therapy (n = 32), art therapy (n = 42), or standard counseling (control, n = 28). Each group received one session per week for 12 weeks. The primary outcome was the total score on Part IV of the Arabic version of the Harvard Trauma Questionnaire (HTQ), assessed at baseline and postintervention. Between- and within-group analyses, analysis of variance, and linear regression were used to evaluate changes in PTSD severity.

Results: Baseline characteristics were comparable across groups, though severe PTSD was more prevalent in the sandplay group (40.6%), compared to the art therapy (11.9%) and control (25.0%) groups. After 12 weeks, sandplay therapy resulted in the greatest reduction in PTSD symptom severity (mean HTQ score difference: -22.4, p < 0.001), followed by art therapy (-10.8, p < 0.001) and standard counseling (-2.1, p = 0.002). Between-group analyses confirmed sandplay's superior efficacy over both art therapy and standard counseling (p < 0.001), whereas art therapy was significantly more effective than control.

Conclusion: Both sandplay and art therapies significantly improved PTSD symptoms in conflict-affected children, with sandplay demonstrating the greatest impact. These findings underscore the effectiveness of expressive, nonverbal interventions in addressing conflict-related trauma among refugee populations and support their integration into comprehensive mental health programs.

Trial registration: ClinicalTrials.gov identifier: NCT06984198.