Therapeutic Use of Fact Sheets in Family Therapy with Children and Adolescents With Functional Somatic Symptoms

Abstract

Functional somatic symptoms signal distress and reflect an activation of the body's stress-regulation systems. Many different types of stressors -physical, emotional or both -may activate the body's stress-regulation systems. If stress-related disruptions are extreme or are not limited in time, functional somatic symptoms may emerge, signalling that the body remains in a state of activation and somatic distress. In this paper, we describe the development of therapeutic fact sheets, which are used as part of our multimodal, family-based, rehabilitation intervention for children and adolescents presenting with functional somatic symptoms. The fact sheets provide information about functional somatic symptoms -including their assessment and treatment -from a stress-system framework. They are used in the context of a family intervention to facilitate engagement with the family and to reduce parental anxiety and reactivity. Whilst the fact sheets were initially developed for parents, over time we found that the sheets were also useful in managing anxiety in the medical and school systems. A key goal of this article is to share this resource with other clinicians working with children/adolescents with functional somatic symptoms.Keywords: fact sheets, functional somatic symptoms, medically unexplained symptoms, parent education, system anxiety Key Points 1 Functional somatic symptoms signal distress and reflect an activation of the body's stress-regulation systems. 2 There is growing evidence for the efficacy of multimodal rehabilitation programs for the treatment of functional somatic symptoms that cause significant functional impairment. 3 To engage effectively in treatment, families need a clear explanation to understand their child's symptoms and how these symptoms can be treated. 4 Creating a framework and language for thinking and talking about functional somatic symptoms decreases family anxiety, improves information processing and facilitates engagement with the treating team. 5 Written information in conjunction with verbal information increases the family's capacity to retain information, reflect about the therapeutic process and make appropriate decisions regarding their child's treatment needs. IntroductionFunctional somatic symptoms are physical symptoms that occur in the absence of organic pathology and reflect deregulations in the body's stress systems (Kozlowska, 2013a,b). Our consultation-liaison team based at the Children's Hospital at Westmead (Australia) has developed a multimodal, family-based, rehabilitation program for

A qualitative study of adolescents with medically unexplained symptoms and their parents. Part 2: How is healthcare perceived?

“…Adolescents with MUS and their parents reported encountering many challenges with the healthcare system. In line with previous studies (Cruz et al., 2014), our samples confirmed that families have experienced, and continue to experience, significant stress and anxiety. These are caused by the impact of life events, interactions within and outside of the family, difficulties in negotiating the medical system and the attempt to receive an explanation that makes sense to them.…”

“…Moreover, our results emphasize that ascribing a psychiatric origin to the adolescent's symptoms changed their trust in their doctor and enhanced the feeling of not being understood. Previously reported work has supported this and indicated that parents are often anxious about their child's illness and may not understand why psychological issues are being raised (Cruz et al., 2014). Therefore, we recommend clinicians to assure the patient that the condition is being taken seriously and precede this with a careful history taking and a detailed physical examination (Nunes et al., 2013).…”

“…Furthermore, telling adolescents and their parents that clinicians could not diagnose the condition is not effective and may even result in more medical care‐seeking (Dowrick, Ring, Humphris, & Salmon, 2004; Olde Hartman, Hassink‐Franke, Lucassen, van Spaendonck, & van Weel, 2009; Salmon, Peters, & Stanley, 1999) and can increase the levels of anxiety (Cruz et al., 2014). Indeed, almost all adolescents and parents reported that they underwent multiple investigations.…”

“…Although the majority of MUS are benign, transient, self‐limiting conditions that have no significant impact on functioning or wellbeing and need no further medical attention beyond one or two consultations (Fink, Rosendal, & Olesen, 2005; Mayou, 1991; Swanson, Hamilton, & Feldman, 2010), some patients who have chronic or multiple symptoms pose a serious challenge to healthcare providers and health systems (Verhaak, Meijer, Visser, & Wolters, 2006). Indeed, clinicians experience difficulties managing these patients and communicating with them, mainly because they misunderstand the patients' needs and worries (Cruz, Chudleigh, Savage, & Kozlowska, 2014; Epstein et al., 2006). Medical teams, although usually very competent with regards to organic illnesses, often lack a framework and language for thinking of and talking about functional somatic symptoms.…”

The body comes to family therapy: Treatment of a school-aged boy with hyperventilation-induced non-epileptic seizures

“…This dialogue acknowledged Evan’s role in the bullying, as well as his reactivity to other children in the context of past trauma. It also involved education of the staff regarding PNES (Cruz, Chudleigh, Savage, & Kozlowska, 2014).…”