ADAPTing CBT for Youth with Functional Abdominal Pain and Co-occurring Anxiety

针对功能性腹痛和同时发生的焦虑的青少年进行 CBT 调整

• 批准号: 8708386
• 负责人: Natoshia Raishevich Cunningham
• 金额: $ 1.41万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-06 至 2014-09-06
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8708386
• 关键词: Abdominal Pain; Address; Adult; Affect; Aftercare; Age; Anxiety; Anxiety Disorders; Area; Behavior; Behavior Therapy; Behavioral; Behavioral Medicine; Caregivers; Caring; Child; Childhood; Clinic; Clinical; Cognitive; Coping Skills; Data; Development; Disease; Early Intervention; Educational process of instructing; Ensure; Family; Feedback; Focus Groups; Funding; Gastroenterology; Goals; Health; Health Promotion; Impairment; Intervention; Intervention Studies; Knowledge; Medical; Medical Care Costs; Methodology; National Institute of Child Health and Human Development; Online Systems; Outcome; Pain; Patients; Pediatric Hospitals; Persistent pain; Persons; Phase; Pilot Projects; Practice Guidelines; Preparation; Primary Health Care; Procedures; Protocols documentation; Psychology; Randomized Clinical Trials; Research; Research Design; Research Personnel; Risk; Schools; Separation Anxiety; Specialist; Structure; Symptoms; Techniques; Technology; Testing; Training; Treatment Protocols; United States National Institutes of Health; Youth; base; behavioral clinical trial; career; childhood anxiety; clinical care; clinically significant; cost effective; daily functioning; design; disability; effective intervention; evidence base; experience; high risk; innovation; meetings; peer; pilot trial; practical application; programs; psychosocial; public health relevance; randomized trial; screening; social; treatment as usual; user-friendly

DESCRIPTION (provided by applicant): Functional abdominal pain (FAP) is a common and costly pain condition of childhood that results in a marked disruption in daily functioning and psychosocial impairment. A large proportion of youth with FAP also suffer from significant anxiety (such as generalized anxiety, separation anxiety and social anxiety). These youth with FAP and co-occurring anxiety are at greatest risk for impairment in functioning, which can persist into their adult years if not successfully treated. Therefore, early and effective interventions for youth with FAP and co-occurring anxiety are critically needed. While cognitive-behavioral (CBT) techniques have shown promise in treating youth with FAP, these treatments are typically focused on teaching pain coping skills and are usually not designed to directly address specific types of anxiety symptoms. Such youth may benefit from a treatment approach that targets both pain and anxiety to achieve optimal and lasting outcomes. Findings from the PI's pilot study of youth with FAP at a pediatric hospital confirm findings from past research indicating that 1) a large number of patients with FAP (53.4% in the pilot study) experience clinically significant anxiety and 2) increased anxiety is associated with higher levels of pain an impairment. Based on the results of the pilot study, the applicant proposes to develop and test a tailored CBT intervention (Aim to Decrease Anxiety and Pain Treatment, "ADAPT"). ADAPT is designed to be a brief CBT intervention, with content derived from two well-established treatments for anxiety and pain. It will be individualized to address both pain and the three most common anxiety symptom presentations (generalized anxiety, separation anxiety/school avoidance and social anxiety), and will include a combination of in-person and web- based modules. The goal is to increase the accessibility of the intervention to patients and families and to ensure consistency of content delivery. The aims of the current project are to 1) evaluate the feasibility and acceptability of the ADAPT intervention via focus groups and, 2) conduct a small randomized clinical trial (n=38, or 19 per group) to test whether ADAPT is superior to usual care (UC) in producing clinically significant pain reduction (e30%) along with reduction in anxiety to below clinical levels. This research meets the funding priorities of the pediatric behavior and health promotion research program of the NICHD, which encourages the development of tailored behavioral interventions specifically in the area of pediatric pain. This project will significantly advance the field by developing a brief and tailored CBT intervention for youth with FAP who are at greatest risk for long-term impairment. The applicant's long-term goal is to develop a programmatic line of research designing brief and disseminable interventions for youth with FAP, using a stepped care approach to align treatment content and intensity to the specific needs of the patients.

描述（由申请人提供）：功能性腹痛（FAP）是一种常见且昂贵的儿童疼痛状况，导致日常功能和社会心理障碍的明显破坏。很大一部分患有FAP的青少年还患有严重的焦虑（如广泛性焦虑、分离焦虑和社交焦虑）。这些患有FAP和同时发生焦虑症的年轻人在功能障碍方面的风险最大，如果不成功治疗，这种情况可能会持续到成年。因此，对患有FAP和同时发生焦虑的青少年进行早期有效的干预是非常必要的。虽然认知行为（CBT）技术在治疗青少年FAP方面显示出了希望，但这些治疗通常侧重于教授应对疼痛的技巧，通常不是直接针对特定类型的焦虑症状。这样的年轻人可能会受益于针对疼痛和焦虑的治疗方法，以达到最佳和持久的效果。PI在儿科医院对患有FAP的青少年进行的初步研究的结果证实了过去的研究结果：1)大量FAP患者（在初步研究中占53.4%）经历了临床显著的焦虑；2)焦虑的增加与更高水平的疼痛和损伤有关。基于试点研究的结果，申请人建议开发和测试量身定制的CBT干预（旨在减少焦虑和疼痛治疗，“ADAPT”）。ADAPT被设计成一个简短的CBT干预，其内容来源于两种公认的治疗焦虑和疼痛的方法。它将个性化地解决疼痛和三种最常见的焦虑症状表现（广泛性焦虑、分离焦虑/逃避学校和社交焦虑），并将包括面对面和基于网络的模块的组合。目标是增加对患者和家属的干预的可及性