Changes in Coping, Pain, and Activity After Cognitive-Behavioral Training

Abstract

Objectives We examined the outcomes of a cognitive-behavioral therapy (CBT) intervention for pain in pediatric sickle cell disease (SCD) using smartphones as a novel delivery method. Methods Forty-six children with SCD received CBT coping skills training using a randomized, waitlist control design. The intervention involved a single-session of CBT training and home-based practice using smartphones for eight weeks. Pre-post questionnaires between the randomized groups were used to evaluate changes in active psychological coping and negative thinking using the Coping Strategies Questionnaire. Daily diaries completed by the full sample during the treatment period were used to assess if CBT skill use was related to reductions in next day pain intensity and increases in same day functional activity. Results The pre-post group comparison suggested that youth increased active psychological coping attempts with the intervention. Daily diary data indicated that when children used CBT skills on days with higher pain, there were reductions in next day pain intensity. There was no such association between skill use and functional activity. Discussion CBT coping skills training supported via smartphones can increase coping and reduce pain intensity for children with SCD; however, additions to the study protocols are recommended in future studies. Advantages and caveats of using smartphones are also discussed.

Benefits of Mobile Apps in Pain Management: Systematic Review

“…Therefore, description of results but no graphic representation was possible [ 26 ]. Schatz et al [ 24 ] did not compare baseline to follow-up mean pain values, and consequently, the study could also not be included in the graphical representation. Authors of studies with missing data were contacted through email (corresponding email address on publication), but none of them responded.…”

“…One study showed a statistically significant decrease in chronic pain; the other showed no decrease in patients with acute pain [ 28 , 29 ]. Schatz et al [ 24 ] did not report about the severity of pain at baseline and follow-up. Therefore, we were not able to depict the results graphically.…”

Cognitive Behavior Therapy for Anxious and Depressed Youth: Improving Homework Adherence Through Mobile Technology

“…Only a handful of apps are relevant to CBT homework and all of these are in the early stages of development. Of those designed for adolescents, several focus specifically on self-monitoring: Mobile Mood Diary [49,50], mobiletype [51-55], and a daily pain diary [56,57]. Research on these tools suggests that they are useful and acceptable to adolescents.…”

“…Mood graphs appeared to facilitate discussion in the therapy session. An intervention to facilitate self-monitoring as well as skills practice for pain management was evaluated as usable and acceptable by adolescents and their parents, and preliminary evidence indicated that it had a beneficial effect on coping skills [57]. …”

<p>Depression and Anxiety as Moderators of the Pain-Social Functioning Relationship in Youth with Sickle Cell Disease</p>

“…25 Also, pain is a subjective experience; thus, guardian-report may have led to underestimates of youth pain as it would be reflective of guardian observed pain behaviors and pain as reported to the guardian by the youth. However, parentproxy reports for pain experiences are commonly used and have been validated for pediatric pain populations, 26,27 and the measure used in the current study has been validated for youth with SCD and used across multiple studies, [28][29][30][31] allowing for comparison of findings. Still, future studies should incorporate youth reports of their pain.…”