A Unified, Transdiagnostic Treatment for Adolescents With Chronic Pain and Comorbid Anxiety and Depression

Abstract

Chronic pain disorders represent a significant public health concern, particularly for children and adolescents. High rates of comorbid anxiety and unipolar mood disorders often complicate psychological interventions for chronic pain. Unified treatment approaches, based on emotion regulation skills, are applicable to a broad range of emotional disorders and suggest the possibility of extending these interventions to chronic pain and pain-related dysfunction. This case report describes the use of a unified protocol for treatment of an adolescent boy with chronic daily headache and social anxiety and an adolescent girl with whole body pain and depression. Following weekly, 50-minute individual treatment sessions, the boy demonstrated notable improvement in emotional symptoms, emotion regulation skills, somatization, and functional disability. The girl showed some improvement on measures of anxiety and depression, although there appeared to be a worsening of pain symptoms and somatization. However, both patients demonstrated improvement over follow-up. This case study illustrates the potential utility of a unified treatment approach targeting pain and emotional symptoms from an emotion regulation perspective in an adolescent population.

The Influence of Anxiety Reduction on Clinical Response to Pediatric Chronic Pain Rehabilitation

“…18 Therefore, a second step for clinical research in this area is to further evaluate the benefit of specific anxietybased interventions, such as the TAPS (Treatment of Anxiety and Physical Symptoms) program 18 or the application of a unified treatment protocol for children with comorbid pain and anxiety or depression. 49 Based upon our data and program description, a fair question to ask is: does treatment of pain-related anxiety need to be explicit to be maximally effective, or are nonspecific cognitive-behavioral approaches present in rehabilitation sufficient to treat painrelated anxiety? A comparison of treatment approaches would strengthen our understanding on the link between anxiety and chronic pain.…”

Mental Health Comorbidities in Pediatric Chronic Pain: A Narrative Review of Epidemiology, Models, Neurobiological Mechanisms and Treatment

“…Pediatric researchers have stressed the importance of understanding comorbid PTSD and chronic pain within a developmental context [31] and cautioned against simply downwardly extending adult recommendations to pediatric populations. Attempts have been made to apply a unified, transdiagnostic treatment for adolescents with chronic pain and comorbid anxiety and depressive disorders (Unified Protocol for the Treatment of Emotions in Youth With Pain (UP-YP)) [190]. The UP-YP is a modular-based individual treatment protocol [190].…”

The Effect of Transdiagnostic Treatment on Mothers of Children with Autism Spectrum Disorder

“…Another reason for the effectiveness of transdiagnostic treatment on worry is the role of challenge with negative evaluations and external/internal threats such as physical feelings and emotions and the increase in cognitive flexibility. Contrary to other cognitive therapists, the emphasis of transdiagnostic treatment is not on deletion or suppression of negative thoughts and replacement of them with realistic or adaptive evaluations, but the emphasis is on the increase in the cognitive flexibility as a strategy of adaptive emotion regulation (Allen et al, 2012). The application of these techniques and other parts of transdiagnostic treatment explain the effectiveness of transdiagnostic treatment.…”

“…This issue makes mothers of children with ASD learn that thoughts and feelings result in creating a lot of behaviors (such as rumination). It helps patients have better awareness of their own emotional experiences (such as behavioral stimuli and consequences) and have a more objective view towards their own emotions rather than being involved with emotional responses (Allen et al, 2012). Achieving this awareness is considered as a main skill, which explains the effectiveness of transdiagnostic treatment such as ER-CBT, DBT, MBCT and ACT (Zargar, Mohammadi, Omidi, & Bagherian, 2013;Mehrabi et al, 2014).…”