Cognitive Behavior Therapy Tailored to Anxiety Symptoms Improves Pediatric Functional Abdominal Pain Outcomes: A Randomized Clinical Trial

Cunningham, N.; Kalomiris, Anne E.; Peugh, James; Farrell, Michael; Pentiuk, Scott; Mallon, Daniel; Le, Christine; Moorman, Erin; Fussner, Lauren M.; Dutta, Richa Aggarwal; Kashikar‐Zuck, Susmita

doi:10.1016/j.jpeds.2020.10.060

Cited by 17 publications

(44 citation statements)

References 52 publications

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“…All three studies required participants to endorse more than minimal disability as evidenced by the FDI, and two of the three studies [21,29] also required elevations in anxiety and pain levels. For further detail on the studies' methodologies, please refer to the original investigations [21,22,29]. Potentially eligible patients were approached to participate.…”

Section: Procedures and Samplementioning

confidence: 99%

“…Further, CBT is considered the gold standard treatment for pediatric anxiety [ 19 , 20 ]. One evidence-based approach, the Aim to Decrease Abdominal Pain Treatment (ADAPT) [ 21 , 22 ], is a 6-session weekly individual treatment (2 in-person sessions and 4 web-based sessions with interventionist phone support) incorporating CBT strategies from pain management [ 23 ] and anxiety reduction [ 24 ] protocols to treat FAPD and co-occurring anxiety. ADAPT has been shown to significantly reduce disability due to pain and anxiety symptoms in youth with FAPD in a randomized clinical trial (RCT) [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

“…Remote psychological interventions with a therapist-patient dyad and access to self-paced web tools in ADAPT has been shown to be feasible while increasing accessibility [ 21 ]. However, youth adherence to intervention/treatment regimens and particularly web tools is generally variable [ 25 ], and this was also observed in ADAPT [ 22 ]. Other programs with web-based and telehealth components to manage pediatric pain also demonstrate variable adherence (e.g., 30% completion rate [ 26 ]); yet engagement to such interventions is poorly understood [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

“…There is evidence that poor patient engagement minimizes response to a pediatric CBT intervention [ 27 ]. While there are some data on adherence to ADAPT [ 21 , 22 ], (which may be conceptualized as an aspect of micro-level engagement), youths’ broader engagement with ADAPT, including macro-level factors, are less well understood. More data are needed to better understand engagement to such treatment approaches, and how engagement is related to their effectiveness.…”

Section: Introductionmentioning

confidence: 99%

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Engagement during a Mixed In-Person and Remotely Delivered Psychological Intervention for Youth with Functional Abdominal Pain Disorders and Anxiety

et al. 2021

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Functional abdominal pain disorders (FAPD) are common disabling pain conditions frequently associated with co-occurring mental health problems such as anxiety. Psychological therapies such as cognitive behavioral therapy (CBT) have been shown to be effective. Therefore, it is important to understand participant engagement (i.e., use of intervention tools) to such approaches, and if engagement impacts treatment response. The Aim to Decrease Anxiety and Pain Treatment (ADAPT) is an effective psychological treatment approach using a blend of in-person sessions and interventionist phone support with self-paced web modules to manage pain and anxiety. The current study used a mixed-methods approach to investigate micro-level and macro-level participant engagement during the ADAPT program. In-person/phone session attendance was high (>95%) although scheduling adjustments were common (25.5%). Varied levels of engagement with web tools were observed. Thematic analysis also revealed variability in patterns of use. Additionally, while participants indicated they generally understood how to use certain skills (e.g., problem solving, detective thinking), and these skills were effective in managing symptoms during treatment, these activities were generally underutilized. Further, participant engagement did not predict response to the ADAPT intervention. These findings are important as the demand for accessible psychotherapeutic tools to manage pain and anxiety is likely to remain high.

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Section: Procedures and Samplementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Engagement during a Mixed In-Person and Remotely Delivered Psychological Intervention for Youth with Functional Abdominal Pain Disorders and Anxiety

et al. 2021

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“…For example, traditional in-person cognitive behavioral therapy (CBT) is an evidence-based approach that has been found to improve pain and associated functional disability among pediatric patients with chronic pain. More recent findings have shown that CBT for pain can also be delivered effectively using online (eHealth) modalities (i.e., implementation effectiveness) [ 5 , 6 , 7 ]. Implementation effectiveness is inventoried using implementation outcomes, characterized by Proctor and colleagues as acceptability, feasibility, and sustainability, among others [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluating Telehealth Implementation in the Context of Pediatric Chronic Pain Treatment during COVID-19

Richardson

Parker

Chavez³

et al. 2021

Children

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Telehealth has emerged as a promising healthcare delivery modality due to its ability to ameliorate traditional access-level barriers to treatment. In response to the onset of the novel coronavirus (COVID-19) pandemic, multidisciplinary pain clinics either rapidly built telehealth infrastructure from the ground up or ramped up existing services. As the use of telehealth increases, it is critical to develop data collection frameworks that guide implementation. This applied review provides a theoretically-based approach to capitalize on existing data sources and collect novel data to inform virtually delivered care in the context of pediatric pain care. Reviewed multisource data are (1) healthcare administrative data; (2) electronic chart review; (3) clinical health registries; and (4) stakeholder feedback. Preliminary telehealth data from an interdisciplinary pediatric chronic pain management clinic (PPMC) serving youth ages 8–17 years are presented to illustrate how relevant implementation outcomes can be extracted from multisource data. Multiple implementation outcomes were assessed, including telehealth adoption rates, patient clinical symptoms, and mixed-method patient-report telehealth satisfaction. This manuscript provides an applied roadmap to leverage existing data sources and incorporate stakeholder feedback to guide the implementation of telehealth in pediatric chronic pain settings through and beyond COVID-19. Strengths and limitations of the modeled data collection approach are discussed within the broader context of implementation science.

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Psychosocial Interventions for the Treatment of Functional Abdominal Pain Disorders in Children

et al. 2022

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IMPORTANCE Functional abdominal pain disorders (FAPDs) can severely affect the life of children and their families, with symptoms carrying into adulthood. Management of FADP symptoms is also a financial and time burden to clinicians and health care systems.OBJECTIVE To systematically review various randomized clinical trials (RCTs) on the outcomes of cognitive behavioral therapy (CBT), educational support, yoga, hypnotherapy, gut-directed hypnotherapy, guided imagery, and relaxation in the management of FAPDs.

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Cognitive Behavior Therapy Tailored to Anxiety Symptoms Improves Pediatric Functional Abdominal Pain Outcomes: A Randomized Clinical Trial

Cited by 17 publications

References 52 publications

Engagement during a Mixed In-Person and Remotely Delivered Psychological Intervention for Youth with Functional Abdominal Pain Disorders and Anxiety

Engagement during a Mixed In-Person and Remotely Delivered Psychological Intervention for Youth with Functional Abdominal Pain Disorders and Anxiety

Evaluating Telehealth Implementation in the Context of Pediatric Chronic Pain Treatment during COVID-19

Psychosocial Interventions for the Treatment of Functional Abdominal Pain Disorders in Children

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