Do Mothers Benefit from a Child-Focused Cognitive Behavioral Treatment (CBT) for Childhood Functional Abdominal Pain? A Randomized Controlled Pilot Trial

Abstract

While the efficacy of cognitive-behavioral treatment (CBT) approaches for childhood functional abdominal pain (FAP) is well-established for child outcomes, only a few studies have reported on parent-specific outcomes. This randomized controlled pilot trial analyzed effects of a group CBT on maternal variables (i.e., pain-related behavior, worries and self-efficacy, as well as general psychosocial strain). Methods: The sample constituted of 15 mothers in the intervention group (IG) and 14 mothers in the waitlist control group (WLC). Outcome measures were assessed pre-treatment, post-treatment and at three months follow-up. Results: Analyses revealed significant, large changes in maladaptive maternal reactions related to the child’s abdominal pain in the IG compared to the WLC—i.e., reduced attention (d = 0.95), medical help-seeking (d = 0.92), worries (d = 1.03), as well as a significant increase in behaviors that encourage the child’s self-management (d = 1.03). In addition, maternal self-efficacy in dealing with a child’s pain significantly increased in the IG as well (d = 0.92). Treatment effects emerged post-treatment and could be maintained until three months follow-up. There were no effects on general self-efficacy and maternal quality of life. Conclusion: While these results are promising, and underline the efficacy of the CBT approach for both the child and mothers, further studies, including long-term follow-ups, are warranted.

Parents and Childhood Functional Abdominal Pain

“…Compared to a control condition (education), those receiving CBT showed larger child improvements in pain, as well as parents' reductions of protective responses and pain threat up to 12 months after treatment (Levy et al, 2010(Levy et al, , 2013. In a small study of group CBT for FAPD, similar outcomes were found: Mothers who participated in CBT together with their child, reported decreases in maladaptive reactions to their child's abdominal pain including reductions in pain worry and attention (Calvano, Gross, & Warschburger, 2017). Online CBT for chronic pain similarly reduced parental protectiveness and child pain disability (Palermo et al, 2016).…”

Functional abdominal pain disorders in children: An update on treatment

“…The study concluded that internet-based CBT was effective. Calvano et al conducted a novel CBT intervention directed at mothers of children with functional abdominal pain exclusively 48 . The study found that maladaptive maternal reactions toward their child's abdominal pain were greatly reduced in the treatment group compared to the control group.…”

Connecting the Mind–Body Split: Understanding the Relationship between Symptoms and Emotional Well-Being in Chronic Pain and Functional Gastrointestinal Disorders

“…These parental experiences of distress can in turn negatively influence the child’s functioning, through the impact on parental behaviour. In particular, parents reporting high levels of distress when their child is in pain have found to engage more in protective behaviours (e.g., reassuring, comforting, request to stop pain-inducing activities [ 66 , 67 , 68 , 69 ], which are associated with increased child pain, distress, functional disability [ 70 , 71 , 72 ] and use of healthcare [ 11 , 73 ]. This bidirectional, relational process whereby caregiver’s desire to help resutls into negative consequences for the child has also been referred to as miscarried helping [ 74 ].…”

“…See Figure 1 for a graphical overview of the IFAM. While the IFAM model is proposed within the context of chronic pain, the patterns proposed within the IFAM can be observed in the context of FGID, with poorer day-to-day functioning seen in children whose parents engage in protective behaviours [ 69 ]. Further highlighting the reciprocial influence between parents and children, poorer outcomes in FGID correlate with increased displays of pain and FGID diagnosis in parents; whether linked through genetics, social learning or other factors is unclear [ 76 , 77 ].…”

“…While the majority of the above discussed evidence focusses on negative influences between parents and children, parents can also be a resource for children to enable engagement in treatment, developing coping styles that increase tolerance of symptoms and support engagement in daily life. For FGID it is suggested such strategies, sometimes enhanced or developed through psychological intervention with children and/or parents, can reduce HPA activation, thereby reducing symptoms [ 69 , 83 , 84 ]. It is also the development of trusting relationships, education and support from doctors that can positively influence outcomes for parents and their children [ 13 , 24 ].…”