Parent-delivered huggy-puppy intervention for war-related stress in children

War-related experiences in children often result in significant psychological stress, frequently requiring professional intervention. The Huggy-Puppy Intervention (HPI) has demonstrated effectiveness in alleviating stress symptoms, yet its delivery has thus far depended on healthcare professionals and the use of a single doll type. This study aimed to evaluate a parent-delivered adaptation of the intervention, and examine whether the type of doll moderates treatment efficacy. A total of 160 Israeli children aged 3-8 years (M = 5.1 ± 1.4; 57% girls) were randomized to receive one of five doll types as part of the HPI, delivered by parents during the 2023 Hamas-Israel war. Doll types included the original puppy doll, as well as monkey, teddy-bear, dog, and bunny dolls. Parents received instructional videos on how to implement the intervention. Stress symptoms were assessed using online parent-reports at baseline and three weeks post-intervention. Additional measures included child attachment to the doll, parental compliance, and satisfaction with the intervention. Linear mixed models yielded significant large reductions in stress symptoms from pre- to post-intervention across all doll types (Cohen's d = 0.94-0.97). Children exhibited lower attachment to the monkey dolls, and parents reported reduced satisfaction with these compared to other doll types. These findings support the efficacy of a parent-administered HPI in reducing war-related stress in children, with largely comparable outcomes across different doll types. This parent-delivered, adaptable approach enhances accessibility, offering a practical, cost-effective method for supporting children in crisis-affected areas where professional resources are limited.