Cognitive-behavioral treatment of persistent functional somatic complaints and pediatric anxiety: an initial controlled trial

Abstract

Background Children and adolescents who seek medical treatment for persistent physical distress often suffer from co-occurring anxiety disorders. Treatment options for this impaired population are limited. This study tests the feasibility and potential efficacy of a cognitive-behavioral intervention targeting pain and anxiety for youth with impairing functional physical symptoms and anxiety disorders presenting to pediatricians for medical care. Methods Children and adolescents (aged 8–16) experiencing somatic complaints, without an explanatory medical disorder (i.e., functional), were recruited from primary care and specialty (gastroenterologists and cardiologists) pediatricians. Forty children, primarily with gastrointestinal symptoms, who met criteria for a co-occurring anxiety disorder, were randomly assigned to a cognitive-behavioral treatment addressing pain and anxiety, Treatment of Anxiety and Physical Symptoms (TAPS), or to a waiting-list control. Results TAPS was found to be an acceptable treatment for this population and was superior to the waiting-list condition. Eighty percent of children in TAPS were rated as treatment responders by independent evaluators compared with none of the controls. Overall, self- and parent ratings indicated reductions in children’s somatic discomfort and anxiety following intervention. TAPS participants maintained clinical gains three months following treatment. Conclusions The study supports the feasibility and preliminary efficacy of a cognitive-behavioral intervention targeting co-occurring physical distress and anxiety in youth presenting for medical treatment. Such an approach has the potential to exert broad impact on children’s dysfunction and to minimize exposure to invasive, ineffective, and costly medical procedures and treatments.

Supported self-care for children and adolescents with chronic disease and their families

“…In addition, four studies considered human diseases in general. Only three were performed in a primary care unit (13)(14)(15) , the remainder were in outpatient settings, specialized clinics, and children's hospitals. The categories of health professionals who participated in the studies as researchers or participants: doctor, nurse, psychologist, occupational therapist, pharmacist and nutritionist.…”

“…of the child/adolescent and/or the family, which may influence self-care actions (13,17,23,30,(32)(33) To evaluate the process of health care transition (HCT) from pediatric to adult-centered health care delivery systems (16,18,21,(34)(35) Counseling Inform the child/adolescent and/or family about the symptoms of the disease and/or therapeutic measures (17,27,36) , while recognizing the cultural uniqueness (19) Inform the child/adolescent and/or family that behavioral changes are as important as taking medications (20) To report the evidence on behavioral changes in health (17) Sharing evidence-based clinical guidelines to encourage the child/adolescent and/or family to participate in treatment (17,35) Provide educational material on self-management (16,20,27,(36)(37) Include motivational strategies (15) …”

“…Several studies have investigated this activity (13)(14)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) . One of the aspects discussed in the research was to determine whether activities for self-care management are adhered to along with therapies and skills already developed by health professionals (17,(24)(25)(26)(27)(28)(29) .…”

“…Thus, it is fundamental to evaluate the emotional state (depression, mood, anxiety, etc.) of the child/adolescent and/or family, as it may influence self-care actions (13,17,23,30,(32)(33) . This influence on children/adolescents can be seen chronic pain, for example, since it is a factor that can effect and cause limitations in the performance of activities, especially if the self-care measures are also based on the adoption of physical activities or the establishment of routines (23) .…”

“…From then on, techniques of relaxation, cognitive restructuring and exercises of exposure to anxiety inducing situations were promoted so that factors related to physical pain were identified. After treatment was completed, care was continued through reinforcements conducted by clinical psychologists twice per month (13) . The use of technological resources to care for people living with chronic diseases was used by several researchers (4,(16)(17)21,33,(36)(37) .…”