Investigating the effect of therapeutic play on quality of life: the role of engagement in cognitive flexibility

This study examines the impact of play therapy on the quality of life of pediatric liver transplant patients, explicitly focusing on the reduction in distress and improvement in emotional well-being. The role of therapy engagement and cognitive flexibility in this process is explored. A cross-sectional design was employed, involving 66 children aged 6–14 in Indonesia who had undergone or were undergoing liver transplantation and participated in at least four play therapy sessions. Structural Equation Modeling (SEM) using SmartPLS v.4 revealed that play therapy significantly enhanced children’s engagement during sessions, thereby improving their overall quality of life. Engagement in therapy is shown to explain how play therapy affects the reduction in distress, while cognitive flexibility influences the strength of this relationship. The results highlight the importance of tailoring psychological interventions to individual neuropsychological profiles, suggesting that enhancing engagement and cognitive flexibility can improve the effectiveness of play therapy in pediatric medical settings.