%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 Am J Gastroenterol %D 2010 %T Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. %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 Feld, Andrew D %A Ballard, Sheri A %A Welsh, Ericka M %A Jeffery, Robert W %A Young, Melissa %A Coffey, Melissa J %A Whitehead, William E %K Abdominal Pain %K Adaptation, Psychological %K Adolescent %K Child %K Cognitive Therapy %K Disability Evaluation %K Female %K Humans %K Linear Models %K Male %K Pain Measurement %K Parent-Child Relations %K Parents %K Prospective Studies %K Treatment Outcome %X

OBJECTIVES: Unexplained abdominal pain in children has been shown to be related to parental responses to symptoms. This randomized controlled trial tested the efficacy of an intervention designed to improve outcomes in idiopathic childhood abdominal pain by altering parental responses to pain and children's ways of coping and thinking about their symptoms.

METHODS: Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to one of two conditions-a three-session intervention of cognitive-behavioral treatment targeting parents' responses to their children's pain complaints and children's coping responses, or a three-session educational intervention that controlled for time and attention. Parents and children were assessed at pretreatment, and 1 week, 3 months, and 6 months post-treatment. Outcome measures were child and parent reports of child pain levels, function, and adjustment. Process measures included parental protective responses to children's symptom reports and child coping methods.

RESULTS: Children in the cognitive-behavioral condition showed greater baseline to follow-up decreases in pain and gastrointestinal symptom severity (as reported by parents) than children in the comparison condition (time x treatment interaction, P<0.01). Also, parents in the cognitive-behavioral condition reported greater decreases in solicitous responses to their child's symptoms compared with parents in the comparison condition (time x treatment interaction, P<0.0001).

CONCLUSIONS: An intervention aimed at reducing protective parental responses and increasing child coping skills is effective in reducing children's pain and symptom levels compared with an educational control condition.

%B Am J Gastroenterol %V 105 %P 946-56 %8 2010 Apr %G eng %N 4 %R 10.1038/ajg.2010.106