Brief CBT for Pediatric Abdominal Pain and Anxiety

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DESCRIPTION (provided by applicant): The proposed study will develop and test brief cognitive behavioral psychotherapy (BCBT) for youth presenting with functional recurrent abdominal pain (RAP) and clinically significant anxiety symptoms in traditional medical settings. RAP is common and impairing, and is considered functional in the absence of explanatory physical disease. As such, RAP has been theorized to be due to emotional causes. Nearly 80% of children with functional RAP meet full diagnostic criteria for at least 1 anxiety disorder, with the remainder suffering depression or somatoform disorder. The proposed study focuses on the most prototypic presentation-RAP comorbid with anxiety. There is no consensus on best-practice interventions for RAP. CBT has shown promise for the pain associated with RAP, and there is evidence that CBT benefits pediatric anxiety. The proposed treatment development study will test BCBT adapted for success in medical settings by virtue of brevity, relative simplicity, a rationale linking physical complaints to behavioral interventions, and applicability to psychiatric comorbidity, with the goal of setting the stage for future effectiveness and dissemination trials. Over a 3 year period, 60 children and adolescents with functional RAP and anxiety between the ages of 7 and 16 years, inclusive, to 6 sessions of BCBT with 2 optional telephone "boosters" delivered over the 8 week treatment phase by a health coach or to usual care (UC) by the referring physician consisting of diagnostic explanation, reassurance and encouragement to return to usual activities. Outcomes will be assessed by an independent evaluator blind to participant status at 8 and 20 weeks following initial assessment. Primary outcomes will be global clinical improvement, abdominal pain, and anxiety. Depression, other somatic symptoms, and functional impairment will be assessed, and potential mediators and moderators of global treatment response will be secondarily examined, along with the acceptability and durability of BCBT.