Effects of a Cognitive Behavioral Therapy Intervention Trial to Improve Disease Outcomes in Children with Inflammatory Bowel Disease

Levy, Rona L.; Tilburg, Miranda A.L. van; Langer, Shelby L.; Romano, Joan M.; Walker, Lynn S.; Mancl, Lloyd; Murphy, Tasha; Claar, Robyn Lewis; Feld, Shara I.; Christie, Dennis L.; Abdullah, Bisher; DuPen, Melissa M.; Swanson, Kimberly; Baker, Melissa D.; Stoner, Susan A.; Whitehead, William E.

doi:10.1097/mib.0000000000000881

Cited by 50 publications

(49 citation statements)

References 56 publications

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“…This study is a secondary data analysis of an existing dataset from a randomized controlled treatment trial for cognitive behavioral therapy versus an education/support control condition for pediatric patients with IBD 4, 17, 18 (ClinicalTrials.gov number NCT00679003). Although the trial was registered in May 2008, participants were enrolled beginning in April 2008.…”

Section: Methodsmentioning

confidence: 99%

Psychological Factors May Play an Important Role in Pediatric Crohn's Disease Symptoms and Disability

Tilburg

Claar

Romano

et al. 2017

The Journal of Pediatrics

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Objective To examine the relative contributions of disease activity and psychological factors to self-reported symptoms and disability in children with Crohn’s Disease. Study design Participants (n= 127 children age 8–18 years old) completed questionnaires on symptom severity and disability, as well as psychological measures assessing anxiety, depression, pain beliefs and coping. Disease activity was measured by the Pediatric Crohn’s Disease Activity Index. Structural equation modeling was used to test the effects of disease activity and psychological factors on symptoms and disability. Results In the hypothesized model predicting symptoms, psychological factors (β=0.58; p <0.001) were significantly associated with disease symptoms but disease activity was not. The model for disability yielded significant associations for both psychological factors (β=0.75; p<0.001) and disease activity (β =0.61, p<0.05). Conclusion Crohn’s disease symptoms in children and adolescents are not only driven by disease activity. Coping, anxiety, depression and illness cognitions are important in the patient-reporting of symptom severity and disability. Physicians need to be aware that symptom self-reporting can be driven by psychological factors and may not always be simply an indicator of disease activity.

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Section: Methodsmentioning

confidence: 99%

Psychological Factors May Play an Important Role in Pediatric Crohn's Disease Symptoms and Disability

Tilburg

Claar

Romano

et al. 2017

The Journal of Pediatrics

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“…The results extend the literature on CAT among significant others of those with pain and highlight avenues for intervention in pediatric settings. Effective cognitive-behavioral approaches [16, 20, 21] could be tailored to parents identified as high in CAT about their child’s pain to modify maladaptive cognitions, enhance flexibility of responses, and expand their repertoire of adaptive coping responses to child pain behavior.…”

Section: Discussionmentioning

confidence: 99%

Sequential analysis of child pain behavior and maternal responses: an observational study

Langer

Romano

Brown

et al. 2017

PAIN

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This laboratory-based study examined lagged associations between child pain behavior and maternal responses as a function of maternal catastrophizing (CAT). Mothers completed the parent version of the Pain Catastrophizing Scale. Children participated in a validated water ingestion procedure to induce abdominal discomfort with mothers present. Video recordings of their interactions were edited into 30-second segments and coded by 2 raters for presence of child pain behavior, maternal solicitousness, and nontask conversation. Kappa reliabilities ranged from 0.83 to 0.95. Maternal CAT was positively associated with child pain behavior and maternal solicitousness, P values <0.05. In lagged analyses, child pain behavior during a given segment (T) was positively associated with child pain behavior during the subsequent segment (T + 1), P <0.05. Maternal CAT moderated the association between (1) child pain behavior at T and maternal solicitousness at T + 1, and (2) solicitousness at T and child pain behavior at T + 1, P values <0.05. Mothers higher in CAT responded solicitously at T + 1 irrespective of their child's preceding pain behavior, and their children exhibited pain behavior at T + 1 irrespective of the mother's preceding solicitousness. Mothers lower in CAT were more likely to respond solicitously at T + 1 after child pain behavior, and their children were more likely to exhibit pain behavior at T + 1 after maternal solicitousness. These findings indicate that high CAT mothers and their children exhibit inflexible patterns of maternal solicitousness and child pain behavior, and that such families may benefit from interventions to decrease CAT and develop more adaptive responses.

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“…These are factors that can be addressed by treatment. Cognitive behavioral treatment and hypnosis addressing gut specific cognitions, emotions, and behaviors—rather than stress, anxiety, and depression alone—are effective in reducing symptoms and disability in children with gut disorders [ 28 , 29 , 30 , 31 ]. Most of this evidence refers to gut symptoms that were initially thought to be biologically unexplained and became labeled as functional gastrointestinal symptoms (the healthy gut functions differently) and now are referred to as Disorders of Gut–Brain Interaction [ 3 , 32 ].…”

Section: Psychogastroenterology: the Brain–gut Axismentioning

confidence: 99%

Psychogastroenterology: A Cure, Band-Aid, or Prevention?

Tilburg

2020

Children

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Psychogastroenterology is a field that focuses on the brain–gut connection. Many children with gut disorders also struggle with psychological and social factors that affect their disease outcomes. Psychological factors have been suggested to be a cure, a band-aid, or a prevention. This article examines the underlying models of disease and health that determine how we understand and treat psychosocial factors in gut diseases. The biomedical and biopsychosocial models are presented and applied to pediatric gut disorders. This article should familiarize clinicians as well as children and their families to the challenges and opportunities for addressing psychosocial factors in gut disease. Psychogastroenterology is best thought of as a cog in a complex treatment machine.

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Effects of a Cognitive Behavioral Therapy Intervention Trial to Improve Disease Outcomes in Children with Inflammatory Bowel Disease

Cited by 50 publications

References 56 publications

Psychological Factors May Play an Important Role in Pediatric Crohn's Disease Symptoms and Disability

Psychological Factors May Play an Important Role in Pediatric Crohn's Disease Symptoms and Disability

Sequential analysis of child pain behavior and maternal responses: an observational study

Psychogastroenterology: A Cure, Band-Aid, or Prevention?

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