Feelings/Body Investigators:Interoceptive Exposure for Children w/Abdominal Pain

感受/身体调查员：腹痛儿童的内感受暴露

• 批准号: 8512185
• 负责人: HELEN L. EGGER
• 金额: $ 25.66万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-26 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8512185
• 关键词: 8 year old; Abdominal Pain; Adaptive Behaviors; Address; Adult; Aftercare; Age; Anxiety; Awareness; Basic Science; Behavior; Behavior Therapy; Behavioral; Brain; Butterflies; Caregivers; Caring; Child; Childhood; Clinic; Curiosities; Development; Diagnostic tests; Disease; Distress; Early Intervention; Eating; Educational Intervention; Educational process of instructing; Emotions; Enrollment; Epidemiologic Methods; Esthesia; Evaluation; Facial Affective Scale; Family; Feeling; Fright; Future; Health; Home environment; Homeostasis; Hunger; Impairment; Internet; Intervention; Label; Laboratories; Lead; Learning; Link; Longevity; Medical; Mental Health; Mental disorders; Mission; Modification; Moods; Neurosciences; Neurosciences Research; Nursery Schools; Pain; Pain Disorder; Pain management; Parent-Child Relations; Parenting Education; Parents; Participant; Pattern; Phase; Prevention; Primary Health Care; Psychopathology; Psychophysiologic Disorders; Public Health; Randomized; Recurrence; Recurrent pain; Regulation; Research; Research Personnel; Research Support; Risk; Safety; Sampling; Schools; Signal Transduction; Social Environment; Solutions; Stress; Symptoms; Syndrome; Testing; Time; Training; Translating; Translational Research; Viscera; Visceral; Visceral pain; Weight; Work; active control; base; chronic abdominal pain; chronic pain; clinically significant; cost; design; diaries; early childhood; emotion regulation; emotional experience; experience; fascinate; fundamental research; group intervention; health care service utilization; improved; improved functioning; innovation; neural circuit; neurodevelopment; novel; physical conditioning; prevent; public health relevance; research and development; response; role model; satisfaction; success; therapy development; treatment program

DESCRIPTION (provided by applicant): This application, Feelings and Body Investigators (FBI): Interoceptive Exposure for Child Abdominal Pain is in response to PA-11-177, Translational Research for the Development of Novel Interventions for Mental Disorders (R21/R33). We propose development and pilot-testing of an acceptance- based behavioral treatment for young children (5-8 years old) with functional abdominal pain (FAP; R21, n=26, R33, n=100). FAP is one of the most frequent somatic syndromes in young children, causes significant impairment, and is predictive of psychiatric and pain disorders later in childhood and in adulthood. No treatments exist for very young children with FAP. Research supports that FAP is influenced by: (1) early pain on the neurodevelopment of the gut-brain axis and (2) maladaptive interactions with the social environment that inadvertently increase somatic fear. These vulnerabilities provide targets for early intervention. OBJECTIVE: To develop and pilot an intervention for FAP based on fundamental neuroscience research on the aberrant neurodevelopment of the gut-brain axis and subsequent modification by the social environment. Our treatment 1) links intervention strategies to unique patterns of neural circuit maturation associated with early visceral pain on the gut-brain axis, 2) adapts acceptance-based behavioral strategies used to address psychopathology in older children to younger children, and 3) incorporates caregivers as role models and facilitators based on attachment research. METHODS: Our ten session intervention trains children to be "Feeling and Body Investigators". Half of the sessions will be done in clinic and half at home via web-camera to facilitate generalization. During the treatment child/caregiver dyads will 1) gather body clues (Learn), 2) investigate (Experience: perform interoceptive mystery missions to explore a body sensation), 3) organize body clues (Contextualize: recall other contexts that evoke similar sensations), and 4) go on increasingly daring missions (Challenge: decrease avoidance and safety behaviors). In the R21 phase we will develop and refine the FBI intervention in 26 child- caregiver dyads. In the R33 phase we will randomize 100 children with FAP to FBI or an active control (parent education with standard medical care) to conduct a pilot-test of the feasibility, acceptability, an clinical significance of FBI compared with an active control treatment. We will use epidemiological methods to screen all eligible children attending primary care practices so that our sample will be representative of young children with FAP, not simply a convenience sample. If we are successful, young children with FAP who complete our FBI early intervention will learn to experience changes in the viscera as fun and fascinating, rather than scary, and will develop new capacities for pain management, adaptive functioning, and emotion regulation. The success of our early intervention for FAP in young children will also have broad implications for the treatment and prevention of mental illness and chronic abdominal pain.

描述（由申请人提供）：本申请，感觉和身体研究者（FBI）：儿童腹痛的内感受性暴露是对PA-11-177，精神疾病新型干预措施开发的转化研究（R21/R33）的回应。我们建议开发和试点测试的接受为基础的行为治疗幼儿（5-8岁）功能性腹痛（FAP; R21，n=26，R33，n=100）。FAP是幼儿中最常见的躯体综合征之一，导致显著的损害，并且是儿童期和成年期后期精神和疼痛障碍的预测。对于患有FAP的非常年幼的儿童没有治疗方法。研究支持FAP受到以下因素的影响：（1）肠-脑轴神经发育的早期疼痛;（2）与社会环境的适应不良互动，无意中增加了躯体恐惧。这些脆弱性为早期干预提供了目标。目的：根据对肠-脑轴异常神经发育的基础神经科学研究以及社会环境的后续修改，开发并试点FAP干预措施。我们的治疗1）将干预策略与肠-脑轴上早期内脏疼痛相关的神经回路成熟的独特模式联系起来，2）将用于解决年龄较大儿童精神病理学的基于接受的行为策略适应于年龄较小的儿童，3）将照顾者作为角色模型和基于依恋研究的促进者。方法：我们的10次干预训练儿童成为“感觉和身体调查员”。一半的课程将在诊所完成，一半在家里通过网络摄像头进行，以促进推广。在治疗过程中，儿童/看护者二人组将1）收集身体线索（学习），2）调查（体验：执行内感受神秘任务以探索身体感觉），3）组织身体线索（情境化：回忆唤起类似感觉的其他情境），以及4）继续进行越来越大胆的任务（挑战：减少回避和安全行为）。在R21阶段，我们将发展和完善联邦调查局对26个儿童看护者的干预。在R33阶段，我们将100名FAP儿童随机分为FBI组或积极对照组（父母教育和标准医疗护理），对FBI与积极对照治疗相比的可行性、可接受性和临床意义进行初步试验。我们将使用流行病学方法来筛选所有符合条件的儿童参加初级保健的做法，使我们的样本将是有代表性的幼儿与FAP，而不仅仅是一个方便的样本。如果我们成功的话，完成FBI早期干预的FAP幼儿将学会体验内脏的变化，这是有趣和迷人的，而不是可怕的，并将发展疼痛管理，适应功能和情绪调节的新能力。我们对幼儿FAP早期干预的成功也将对精神疾病和慢性腹痛的治疗和预防产生广泛的影响。