This study aims to evaluate the effectiveness of Child-Parent Psychotherapy (CPP) in reducing trauma-related symptoms and improving attachment quality among preschool-aged children who experienced the 2023 Kahramanmaraş earthquakes in Türkiye. A total of 60 caregiver-child dyads (children aged 3-6) will be recruited from 11 earthquake-affected provinces. Participants will be randomly assigned to either the intervention group, receiving 12 weekly CPP sessions, or a no-intervention control group. CPP will be delivered by trained clinical psychologists through either online or face-to-face sessions. Assessments will be conducted at baseline, mid-intervention (after session 6), and post-intervention (after session 12). Outcomes include child trauma symptoms, social-emotional functioning, and attachment quality, as well as caregiver reflective functioning, stress, and emotional well-being.
This randomized controlled trial investigates the impact of Child-Parent Psychotherapy (CPP) on post-traumatic recovery and attachment in children aged 3 to 6 years who were exposed to the 2023 Kahramanmaraş earthquakes. CPP is a trauma-informed dyadic therapy that integrates psychodynamic, cognitive-behavioral, attachment, and developmental principles, emphasizing co-construction of trauma narratives and caregiver reflective functioning through play-based interaction. The study will enroll 60 caregiver-child dyads from the 11 most affected cities in Türkiye: Kahramanmaraş, Hatay, Adıyaman, Gaziantep, Malatya, Adana, Osmaniye, Diyarbakır, Şanlıurfa, Kilis, and Elazığ. Eligible participants include children who were between 1-4 years old at the time of the disaster and are currently aged 3-6, along with a primary caregiver (mother or father) who is consistently involved in daily care. The intervention group will receive 12 weekly CPP sessions (60 minutes each), conducted either online or in person, depending on logistical and contextual needs. Sessions will be delivered by licensed clinical psychologists trained in the CPP protocol. The control group will receive no intervention during the trial period but will complete assessments in parallel with the intervention group. Primary outcomes include reduction in child trauma symptoms and improvement in social-emotional functioning and attachment quality. Secondary outcomes include parental stress, reflective functioning, and symptoms of depression, anxiety, and stress. Data will be collected at three timepoints: baseline (T1), mid-intervention (after session 6, T2), and post-intervention (after session 12, T3). All instruments are validated in Turkish populations and age-appropriate. The child measures include the Ages \& Stages Questionnaires: Social-Emotional (ASQ:SE), Brief Attachment Scale (BAS-16), and a trauma symptom checklist appropriate for preschoolers. Caregiver measures include the Parental Reflective Functioning Questionnaire (PRFQ), Parenting Stress Index Short Form (PSI-SF), and the Depression Anxiety Stress Scale (DASS-21).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
60
CPP is a structured, evidence-based dyadic therapy designed for children aged 0-6 exposed to trauma and their caregivers. The intervention involves weekly joint sessions emphasizing safety, emotional expression, and caregiver reflective functioning. Delivered by trained psychologists either online or in person.
Beykoz University
Istanbul, Istanbul, Turkey (Türkiye)
RECRUITINGChange in Child Trauma Symptom Severity
Child trauma symptoms will be assessed using the Child PTSD Reaction Index (CPTSD-RI), a 20-item caregiver-report scale developed to evaluate post-traumatic stress reactions in children following exposure to traumatic events. Items are rated on a 5-point Likert scale ranging from 0 (none) to 4 (most of the time), yielding a total score ranging from 0 to 80. Higher scores reflect greater severity of PTSD symptoms, with cutoffs indicating doubtful (0-11), mild (12-24), moderate (25-39), severe (40-59), and very severe (60-80) symptom levels. The measure will be administered at three time points: baseline (Week 0), mid-treatment (Week 6), and post-treatment (Week 12).
Time frame: From baseline (Week 0) to 12 weeks post-intervention.
Change in Child Social-Emotional Functioning
Assessed using the ASQ:SE, a caregiver-report scale evaluating emotion regulation, social interaction, and adaptive functioning. Total scores vary by age version, typically up to \~310. Higher scores indicate more social-emotional difficulties.
Time frame: From baseline (Week 0) to 12 weeks post-intervention.
Change in Child Attachment Security
Measured using the BAS-16, a 16-item scale assessing attachment security and proximity-seeking. Scores range from 16 to 80, with higher scores indicating more secure attachment.
Time frame: From baseline (Week 0) to 12 weeks post-intervention.
Change in Parental Reflective Functioning
Evaluated using the PRFQ, an 18-item caregiver-report measure of mentalization. Scores range from 18 to 126, with interpretation based on subscale balance.
Time frame: From baseline (Week 0) to 12 weeks post-intervention.
Change in Parenting Stress
Measured by the PSI-SF, a 36-item scale with scores ranging from 36 to 180, where higher scores indicate greater stress.
Time frame: From baseline (Week 0) to 12 weeks post-intervention
Change in Caregiver Depression, Anxiety, and Stress
Assessed by the DASS-21, which yields three subscale scores (each 0-42) for depression, anxiety, and stress. Higher scores indicate greater emotional distress.
Time frame: From baseline (Week 0) to 12 weeks post-intervention.
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