Integration of Cognitive-Behavioural Therapy with Adaptive Swimming Instruction for Children with Water-Related Anxiety Disorders: A Randomised Controlled Trial

Authors

DOI:

https://doi.org/10.53905/inspiree.v6i02.147

Keywords:

Aquaphobia, Swimming instruction, Cognitive-behavioral therapy, Anxiety disorders, Adaptive aquatics, Water anxiety, Therapeutic swimming

Abstract

The  purpose  of  the study. To evaluate the effectiveness of an integrated swimming instruction program combining cognitive-behavioral therapy (CBT) principles with adaptive aquatic techniques for children with water-related anxiety disorders, comparing outcomes with traditional swimming instruction methods.

Materials and methods. A randomized controlled trial involving 120 children aged 6-12 years with diagnosed anxiety disorders featuring water-related fears di kota Medan, Indonesia, Indonesia. Participants were assigned to either an intervention group (n=60) receiving specialized anxiety-focused instruction or a control group (n=60) receiving standard swimming lessons. The 12-week program included twice-weekly 45-minute sessions. Outcomes were measured using the Water Anxiety Scale for Children (WASC-R), Swimming Competency Assessment Tool (SCAT), Behavioral Observation Scale (BOS), and parent-reported anxiety measures (SCARED questionnaire).

Results. The intervention group showed significantly greater improvements across all measures: anxiety reduction (68% vs 23% in controls), swimming competency (82% vs 45%), and avoidance behaviors (85% vs 35% reduction). Program completion rates were higher in the intervention group (95% vs 82%). At 3-month follow-up, the intervention group maintained superior outcomes in anxiety reduction (92% maintenance), swimming skills (88%), and water confidence (90%) compared to controls (76%, 70%, and 65% respectively).

Conclusions. The integrated anxiety-focused swimming instruction approach significantly outperforms traditional methods for children with water-related anxiety disorders, producing superior outcomes in both psychological and physical domains while maintaining higher program adherence rates. This approach should be considered the standard of care for anxiety-affected populations in aquatic education.

Author Biographies

  • Atika Swandana, Sekolah Tinggi Olahraga dan Kesehatan Bina Guna

    Affiliation: Department of Physical Education, Sekolah Tinggi Olahraga dan Kesehatan Bina Guna.

    Address: Alumunium Raya Street No.77, Medan City, North Sumatera, Indonesia

    Disciplines: Physical Education

    Skills And Expertise: Swimming Teaching Analysis

    Authors’ Contribution: abcde

    Contact E-Mail: atikaswandana4@gmail.com

     

  • Nadhira Yasmine Ahmad , Sekolah Tinggi Olahraga dan Kesehatan Bina Guna

    Affiliation: Department of Physical Education, Sekolah Tinggi Olahraga dan Kesehatan Bina Guna.

    Address: Alumunium Raya Street No.77, Medan City, North Sumatera, Indonesia

    Disciplines: Sports Science

    Skills And Expertise: Swimming Sport Analysis

    Authors’ Contribution: abcd

    Contact E-Mail: nadhryasmine99@gmail.com

     

  • Aditya Trinanda , Universitas Mangku Wiyata

    Affiliation: Department of Physical Education, Universitas Mangku Wiyata.

    Address: Al-Ishlah Street, No.1, Cilegon City, Banten, Indonesia.

    Disciplines: Physical Education

    Skills And Expertise: Physical Education

    Authors’ Contribution: abcd

    Contact E-Mail: adityatrinanda@mangkuwiyata.ac.id

     

  • Al Azim, Department of Physical Education, Health Science and Sports, Rajuk Uttara Model College, Dhaka,Bangladesh.

    Affiliation: Department of Physical Education, Health Science and Sports, Rajuk Uttara Model College, Dhaka,Bangladesh.

    Address: Uttara, Sector-6 | Dhaka-1230, Bangladesh.

    Disciplines: Physical Education

    Skills And Expertise: Physical Education

    Authors’ Contribution: abc

    Contact E-Mail: alazim585858@gmail.com

     

  • Jerome Angelitud Porto , University of Santo Tomas

    Affiliation: Sports Education, University of Santo Tomas, Philippines

    Address: 2/F, San Martin de Porres Building, España Boulevard, Sampaloc, Manila 1015, Philippines.

    Disciplines: Physical Education

    Skills And Expertise: Physical Education

    Authors’ Contribution: bcd

    Contact E-Mail: japorto@ust.edu.ph

     

References

An Exploration of Open Water Drowning and Risks for Children. (2023). https://www.safekids.org/sites/default/files/water_safety_study_2018.pdf

Burton, D. (1988). Do Anxious Swimmers Swim Slower? Reexamining the Elusive Anxiety-Performance Relationship. In Journal of Sport and Exercise Psychology (Vol. 10, Issue 1, p. 45). Human Kinetics. https://doi.org/10.1123/jsep.10.1.45

Dadds, M. R., & Barrett, P. M. (2001). Practitioner Review: Psychological Management of Anxiety Disorders in Childhood [Review of Practitioner Review: Psychological Management of Anxiety Disorders in Childhood]. Journal of Child Psychology and Psychiatry, 42(8), 999. Wiley. https://doi.org/10.1111/1469-7610.00798

Davis, T. E., Kurtz, P. F., Gardner, A. W., & Carman, N. B. (2006). Cognitive-behavioral treatment for specific phobias with a child demonstrating severe problem behavior and developmental delays. In Research in Developmental Disabilities (Vol. 28, Issue 6, p. 546). Elsevier BV. https://doi.org/10.1016/j.ridd.2006.07.003

Jeanfreau, M. M., Holden, C. L., & Esplin, J. A. (2020). How Far is Too Far? Parenting Behaviors in Youth Sports. In American Journal of Family Therapy (Vol. 48, Issue 4, p. 356). Taylor & Francis. https://doi.org/10.1080/01926187.2020.1728202

Khatchaturian, R., & Stillwell, B. (2022). Swimming Without Fear: Equitable Instruction. In International Journal of Aquatic Research and Education (Vol. 13, Issue 4). https://doi.org/10.25035/ijare.13.04.07

King, N. J., Gullone, E., & Tonge, B. J. (1991). Childhood Fears and Anxiety Disorders. In Behaviour Change (Vol. 8, Issue 3, p. 124). Cambridge University Press. https://doi.org/10.1017/s0813483900006719

Kraft, E., Leblanc, R., & Culver, D. (2018). Strategies for Teaching Children with Autism Spectrum Disorder in Recreational Aquatics Programs. In Journal of Physical Education Recreation & Dance (Vol. 90, Issue 1, p. 24). Taylor & Francis. https://doi.org/10.1080/07303084.2018.1535338

Krieger, J. (2023). The fear of water, a formidable foe!! http://www.watersafetymagazine.com/the-fear-of-water-a-formidable-foe/

Lisinskienė, A., & Lochbaum, M. (2019). A Qualitative Study Examining Parental Involvement in Youth Sports over a One-Year Intervention Program. In International Journal of Environmental Research and Public Health (Vol. 16, Issue 19, p. 3563). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/ijerph16193563

Lyman, R. D., & Hembree-Kigin, T. L. (1994). Fears and Anxiety. In Issues in clinical child psychology (p. 163). Springer Nature. https://doi.org/10.1007/978-1-4899-0958-9_9

Milliner, E. L., & Farrell, L. J. (2014). Intensive Cognitive-Behavioural Treatment for Specific Phobia in Children and Adolescents. In Psychopathology Review (Issue 1, p. 175). SAGE Publishing. https://doi.org/10.5127/pr.033413

Misimi, F., Kajtna, T., Misimi, S., & Kapus, J. (2020). Development and Validity of the Fear of Water Assessment Questionnaire. In Frontiers in Psychology (Vol. 11). Frontiers Media. https://doi.org/10.3389/fpsyg.2020.00969

Munn, E. E., Ruby, L., & Pangelinan, M. (2021). Improvements in Swim Skills in Children with Autism Spectrum Disorder Following a 5-Day Adapted Learn-To-Swim Program (iCan Swim). In Journal of Clinical Medicine (Vol. 10, Issue 23, p. 5557). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/jcm10235557

Orr, S. C., Abeare, M. L., Cheung, S. S., & Sherman, R. A. (2015). Cognitive and motor skill performance are improved by active cooling following passive hyperthermia. Medicine &Amp; Science in Sports &Amp; Exercise, 47(5S), 459. https://doi.org/10.1249/01.mss.0000477691.62886.64

Peden, A. E., & Franklin, R. C. (2020). Learning to Swim: An Exploration of Negative Prior Aquatic Experiences Among Children. In International Journal of Environmental Research and Public Health (Vol. 17, Issue 10, p. 3557). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/ijerph17103557

Perna, G., Alciati, A., Riva, A., Micieli, W., & Caldirola, D. (2016). Long-Term Pharmacological Treatments of Anxiety Disorders: An Updated Systematic Review [Review of Long-Term Pharmacological Treatments of Anxiety Disorders: An Updated Systematic Review]. Current Psychiatry Reports, 18(3). Springer Science+Business Media. https://doi.org/10.1007/s11920-016-0668-3

Pharr, J. R., Irwin, C. C., Layne, T., & Irwin, R. L. (2018). Predictors of Swimming Ability among Children and Adolescents in the United States. In Sports (Vol. 6, Issue 1, p. 17). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/sports6010017

Rastovski, D., Zoretić, D., Šiljeg, K., & Jorgić, B. (2023). Correlation between Anxiety and Success in Swimming Training Program for Non-Swimmers. In Sport Mont (Vol. 21, Issue 2, p. 59). Montenegrin Sports Academy and Faculty for Sport and Physical Education. https://doi.org/10.26773/smj.230709

Shapiro, D. R., & Malone, L. A. (2015). Quality of life and psychological affect related to sport participation in children and youth athletes with physical disabilities: A parent and athlete perspective. In Disability and health journal (Vol. 9, Issue 3, p. 385). Elsevier BV. https://doi.org/10.1016/j.dhjo.2015.11.007

Silverman, W. K., Ginsburg, G. S., & Kurtines, W. M. (1995). Clinical issues in treating children with anxiety and phobic disorders. In Cognitive and Behavioral Practice (Vol. 2, Issue 1, p. 93). Elsevier BV. https://doi.org/10.1016/s1077-7229(05)80006-9

Sinclair, L., & Roscoe, C. M. P. (2023). The Impact of Swimming on Fundamental Movement Skill Development in Children (3–11 Years): A Systematic Literature Review. In Children (Vol. 10, Issue 8, p. 1411). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/children10081411

Stillwell, B., & Khatchaturian, R. (2020). Teaching Strategies for Beginning High School Students Afraid in Water. In Journal of Physical Education Recreation & Dance (Vol. 91, Issue 4, p. 30). Taylor & Francis. https://doi.org/10.1080/07303084.2020.1720869

Syros, I., Karantzali, A., & Anastassiou‐Hadjicharalambous, X. (2020). Innovative Strategies and Challenges for the Prevention of Pathological Anxiety in Children and Adolescents. In OBM Neurobiology (Vol. 5, Issue 3, p. 1). https://doi.org/10.21926/obm.neurobiol.2103106

Wendy K Silverman, Golda S Ginsburg, William M Kurtines, Family Psychoso. (n.d.). Clinical issues in treating children with anxiety and phobic disorders. Retrieved February 1, 2025, from https://www.sciencedirect.com/science/article/pii/S1077722905800069

Workman, C. L., & Shank, C. B. (1984). Operation F.E.A.R. N.O.T.: Fun Enrichment Activities to Reduce Negative Overpowering Tension. In Journal of Physical Education Recreation & Dance (Vol. 55, Issue 6, p. 60). Taylor & Francis. https://doi.org/10.1080/07303084.1984.10630577

Yázigi, F., Armada-da-Silva, P., & Alves, F. (2010). The cadence and water temperature effect on cardiorrespiratory responses during water cycling. Medicine &Amp; Science in Sports &Amp; Exercise, 42(5), 574. https://doi.org/10.1249/01.mss.0000385424.88192.e5

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2025-05-27

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Integration of Cognitive-Behavioural Therapy with Adaptive Swimming Instruction for Children with Water-Related Anxiety Disorders: A Randomised Controlled Trial (A. Swandana, N. Y. Ahmad, A. Trinanda, A. A. Al Azim, & J. A. Porto , Trans.). (2025). INSPIREE: Indonesian Sport Innovation Review, 6(02), 98-105. https://doi.org/10.53905/inspiree.v6i02.147

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