Cognitive-Behavioral Therapy for Children With Functional Abdominal Pain and Their Parents Decreases Pain and Other Symptoms

Abstract

OBJECTIVES Unexplained abdominal pain in children has been shown to be related to parental responses to symptoms. This randomized controlled trial tested the efficacy of an intervention designed to improve outcomes in idiopathic childhood abdominal pain by altering parental responses to pain and children's ways of coping and thinking about their symptoms. METHODS Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to one of two conditions—a three-session intervention of cognitive-behavioral treatment targeting parents' responses to their children's pain complaints and children's coping responses, or a three-session educational intervention that controlled for time and attention. Parents and children were assessed at pretreatment, and 1 week, 3 months, and 6 months post-treatment. Outcome measures were child and parent reports of child pain levels, function, and adjustment. Process measures included parental protective responses to children's symptom reports and child coping methods. RESULTS Children in the cognitive-behavioral condition showed greater baseline to follow-up decreases in pain and gastrointestinal symptom severity (as reported by parents) than children in the comparison condition (time × treatment interaction, P < 0.01). Also, parents in the cognitive-behavioral condition reported greater decreases in solicitous responses to their child's symptoms compared with parents in the comparison condition (time × treatment interaction, P < 0.0001). CONCLUSIONS An intervention aimed at reducing protective parental responses and increasing child coping skills is effective in reducing children's pain and symptom levels compared with an educational control condition.

Brief hypnotherapeutic–behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial

“…Other studies highlight the importance of parental acceptance of a biopsychosocial model for the explanation of the child's symptoms which was associated with long-term symptom recovery [9,37]. A three-session cognitive-behavioral intervention study by Levy and coauthors [35] aimed mainly at modifying the families' response on illness behavior of the child and could demonstrate a long-lasting reduction of parentreported AP in a large sample. Beyond this, the empowerment of parents to take an active role in their child's treatment might help to reduce helplessness and contribute crucially to treatment success.…”

“…This makes it easy and cheap to implement. Although children with AP are affected by this condition from months to years [53], there is growing evidence of the efficiency of very brief psychosocial interventions in treating AP [35,47,48].…”

“…Whereas dietary and pharmacological interventions are lacking in high quality evidence [26,28], cognitive-behavioral interventions seem to be effective [27,35]. Derived from good evidence in treating adults with long-standing IBS with hypnotherapy (HT) [16,18,58], this might also be a promising approach in handling FAP and IBS in childhood [47][48][49].…”

Supporting health-related parenting: A scoping review of programs assisted by the Internet and related technologies

“…An innovative approach uses CBT with adolescents with gastrointestinal functional disorders, emphasizing the use of exposure treatment to practice experiencing symptoms in difficult situations, to reduce avoidance behaviors and fear of symptoms (Bonnert et al, 2014). In this case, the role of the parents in helping and reinforcing the exposure component seems critical to the success of the intervention (Levy et al, 2010).…”

Cognitive Behavior Therapy for Pediatric Functional Abdominal Pain: A Randomized Controlled Trial

“…6,7 The effectiveness of psychological therapies for pediatric FAP has been studied in several randomized controlled trials (RCTs). [8][9][10][11][12][13] Although a recent Cochrane review described cognitive behavior therapy (CBT) as a promising psychological treatment, this review also underscored that many RCTs have considerable methodological drawbacks such as small sample sizes and high dropout rates. 14 Moreover, a well-designed RCT published after the Cochrane review did not provide unequivocal evidence for the benefit of CBT because it showed CBT to be superior to a control condition but only according to parent report of the child' s pain, not according to child-reported pain.…”