Diagnosis of cancer can cause significant psychological stress for individuals and their families. Research shows social support has a positive and significant relationship with cellular immunity variables and some variables of blood cell count. Using tools such as painting, a child experiences all the issues of his life, tests, and builds himself. The aim of this study was to evaluate the effectiveness of painting on cognitive regulation of emotion, anxiety, and blood cells (CBC) in children aged 7 to 12 years with cancer.

 

This research was conducted for 2 months from May 2016. The research method was quasi-experimental with pre- and post-test design and a control group. Among 43 children aged 7 to 12 years with cancer who were referred to Dr. Sheikh Hospital in Mashhad and volunteered to cooperate with the study, 30 were selected according to the entry and exit criteria and were randomly assigned to the experimental and control groups. In this study, inclusion criteria included receiving more than two rounds of chemotherapy, ability to draw, high anxiety score based on the Spence questionnaire and children aged 7 to 12 years and hospitalization for at least 5 days. Exclusion criteria included the child becoming ill during the intervention, the family not cooperating during the intervention, and the child dying during the intervention. Then painting and free therapy were performed in the subjects of the experimental group. Garnfsky et al. (2001) Emotion Regulation Questionnaire, Spence Children's Anxiety Scale (SCAS) and blood cell count test were used to collect data in pre- and post-test. Analysis of covariance was used to analyze the data.

Painting and visualization are a reflection of the child's inner thoughts and dissatisfaction with the environment, which s/he can use to convey these feelings and safely eject. On the other hand, painting therapy can improve emotional perception and emotion regulation strategies by learning the correct coping responses, problem-solving techniques and skills, increasing the sense of belonging and presentation in a hospital setting. Patients may become anxious and consequently use negative emotion regulation strategies. A good artistic activity such as painting can be beneficial in controlling and reducing these states and not only affect the psyche but also, directly and indirectly, affect the body.
When a sick child attends painting sessions, he or she feels left out of the treatment room and hospital for hours, returning to their childhood world, which they have been away from for some time due to illness. These sessions bring back the excitement and peace of mind of their childhood and make them far from the anxiety of chemotherapy sessions.
When people engage in activities that they enjoy, their physiological factors, such as blood pressure, heart rate, and respiration, slow down, so through activities and artistic connections that most children are interested in, actions in the physiology and biology of the individual can be activated. Those actions increase a person's ability to fight disease and affect his immune system.
The results of comparing emotion regulation, anxiety between experimental and control groups after removing the pre-test effect showed a significant difference between the mean of emotion regulation and the anxiety of children in the experimental group and the control group in the post-test stage (P value <0.01). As a result, it can be said that free painting has positive effects on the regulation of emotion and anxiety of children (7 to 12 years old) with cancer.
In a study of the role of emotional processing in art therapy (REPAT) in cancer patients, Sezmansky et al. (2019) found that there was a statistically significant difference between emotional awareness and emotion acceptance between groups [25].
In an attractive and symbolic way, art indirectly reconstructs children's perception of their abilities and enhances their self-concept and ability to regulate their emotions [32]. Painting and visualization are a reflection of the child's inner thoughts and dissatisfaction with the environment that the child can use to convey these feelings and release them safely. On the other hand, painting therapy can improve emotional perception and emotion regulation strategies by learning the correct coping responses, problem-solving techniques and skills, enhancing a sense of belonging, and providing non-invasive strategies for complex emotional communication.
Teaching emotion management strategies to children with cancer helps them re-evaluate their emotions in different situations to keep their emotional life healthy, thereby reducing their physical and mental problems. Findings show that participating in these programs can help children express their thoughts, emotions, and feelings through projection, thus achieving emotion regulation. In this way, children can express their annoying feelings and inner problems in a calm and safe environment and develop in a healthy and safe environment by using painting tools. Therefore, in this program, sick children are allowed to express their thoughts and feelings, communicate with others, and know and understand themselves differently. 

 

The overall goal of painting therapists is to enable clients to grow and transform in a healthy and safe environment by using painting tools. Therefore, in this program, sick children are given the opportunity to express their thoughts and feelings and communicate with others. According to the research findings, this approach can be used to work with children with cancer in counseling centers, hospitals, and schools. 

 

We would like to thank the esteemed officials and staff of Dr. Sheikh Mashhad Hospital, especially the oncology department and Dr. Kashani, who accompanied me in this research from the beginning of the project. We wish well-being and happiness to the companions of this research.
 
 

The authors declared no conflict of interest.