%0 Journal Article %J Clin J Pain %D 2014 %T Cognitive mediators of treatment outcomes in pediatric functional abdominal pain. %A Levy, Rona L %A Langer, Shelby L %A Romano, Joan M %A Labus, Jennifer %A Walker, Lynn S %A Murphy, Tasha B %A Tilburg, Miranda A L van %A Feld, Lauren D %A Christie, Dennis L %A Whitehead, William E %K Abdominal Pain %K Adolescent %K Catastrophization %K Child %K Cognitive Therapy %K Female %K Humans %K Male %K Pain Measurement %K Parents %K Pediatrics %K Treatment Outcome %X

OBJECTIVES: Cognitive-behavioral (CB) interventions improve outcomes for many pediatric health conditions, but little is known about which mechanisms mediate these outcomes. The goal of this study was to identify whether changes in targeted process variables from baseline to 1 week posttreatment mediate improvement in outcomes in a randomized controlled trial of a brief CB intervention for idiopathic childhood abdominal pain.

MATERIALS AND METHODS: Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to 1 of 2 conditions: a 3-session social learning and CB treatment (N=100), or a 3-session educational intervention controlling for time and attention (N=100). Outcomes were assessed at 3-, 6-, and 12-month follow-ups. The intervention focused on altering parental responses to pain and on increasing adaptive cognitions and coping strategies related to pain in both parents and children.

RESULTS: Multiple mediation analyses were applied to examine the extent to which the effects of the social learning and CB treatment condition on child gastrointestinal (GI) symptom severity and pain as reported by children and their parents were mediated by changes in targeted cognitive process variables and parents' solicitous responses to their child's pain symptoms. Reductions in parents' perceived threat regarding their child's pain mediated reductions in both parent-reported and child-reported GI symptom severity and pain. Reductions in children's catastrophic cognitions mediated reductions in child-reported GI symptom severity but no other outcomes. Reductions in parental solicitousness did not mediate outcomes.

DISCUSSION: Results suggest that reductions in reports of children's pain and GI symptoms after a social learning and CB intervention were mediated at least in part by decreasing maladaptive parent and child cognitions.

%B Clin J Pain %V 30 %P 1033-43 %8 2014 Dec %G eng %N 12 %R 10.1097/AJP.0000000000000077 %0 Journal Article %J JAMA Pediatr %D 2013 %T Twelve-month follow-up of cognitive behavioral therapy for children with functional abdominal pain. %A Levy, Rona L %A Langer, Shelby L %A Walker, Lynn S %A Romano, Joan M %A Christie, Dennis L %A Youssef, Nader %A DuPen, Melissa M %A Ballard, Sheri A %A Labus, Jennifer %A Welsh, Ericka %A Feld, Lauren D %A Whitehead, William E %K Abdominal Pain %K Adaptation, Psychological %K Adolescent %K Adult %K Child %K Cognitive Therapy %K Female %K Follow-Up Studies %K Gastrointestinal Diseases %K Humans %K Illness Behavior %K Linear Models %K Male %K Middle Aged %K Pain Measurement %K Parent-Child Relations %K Prospective Studies %K Treatment Outcome %X

OBJECTIVE: To determine whether a brief intervention for children with functional abdominal pain and their parents' responses to their child's pain resulted in improved coping 12 months later.

DESIGN: Prospective, randomized, longitudinal study.

SETTING: Families were recruited during a 4-year period in Seattle, Washington, and Morristown, New Jersey.

PARTICIPANTS: Two hundred children with persistent functional abdominal pain and their parents.

INTERVENTIONS: A 3-session social learning and cognitive behavioral therapy intervention or an education and support intervention.

MAIN OUTCOME MEASURES: Child symptoms and pain-coping responses were monitored using standard instruments, as was parental response to child pain behavior. Data were collected at baseline and after treatment (1 week and 3, 6, and 12 months after treatment). This article reports the 12-month data.

RESULTS: Relative to children in the education and support group, children in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month follow-up decreases in gastrointestinal symptom severity (estimated mean difference, -0.36; 95% CI, -0.63 to -0.01) and greater improvements in pain-coping responses (estimated mean difference, 0.61; 95% CI, 0.26 to 1.02). Relative to parents in the education and support group, parents in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month decreases in solicitous responses to their child's symptoms (estimated mean difference, -0.22; 95% CI, -0.42 to -0.03) and greater decreases in maladaptive beliefs regarding their child's pain (estimated mean difference, -0.36; 95% CI, -0.59 to -0.13).

CONCLUSIONS: Results suggest long-term efficacy of a brief intervention to reduce parental solicitousness and increase coping skills. This strategy may be a viable alternative for children with functional abdominal pain.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00494260.

%B JAMA Pediatr %V 167 %P 178-84 %8 2013 Feb %G eng %N 2 %R 10.1001/2013.jamapediatrics.282