Psychosocial Intervention for Children with IBD

描述(申请人提供)：炎症性肠病(克罗恩病和溃疡性结肠炎；IBD)，是一种影响儿童和青少年的严重疾病，通常与高卫生保健利用率和残疾有关，包括缺课。虽然心理社会因素被认为不是导致IBD的原因，但研究表明，它们可能会增加与疾病相关的功能障碍。我们小组以前的研究表明，对慢性病的反应在一定程度上是在童年时期通过社会学习过程获得的，并可能通过心理社会干预来改变。尽管在病情不那么严重的患者中看到了令人鼓舞的结果，但缺乏针对IBD儿童的精心设计的此类干预试验。这项研究的目的是进行一项随机对照试验，将社会学习和认知行为疗法(SLCBT)与教育和支持条件(ES)进行比较。180名IBD儿童将被招募并随访12个月。据假设，与ES患者相比，SLCBT参与者在一年的随访中将表现出更大的IBD症状、IBD就诊次数和功能障碍的减少，以及生活质量的更大提高；2)表现出更多地使用认知应对、放松和压力管理技能，他们的父母将表现出对疾病行为的适应不良反应的更大减少；以及3)焦虑、抑郁和躯体化的更大减少。次要目标是调查其他变量，如儿童年龄、性别、医疗保健和心理社会变量，如社会和学习能力，中等治疗效果，并探索两组在IBD住院和手术以及一般疾病行为方面的差异。将在基线、治疗后以及治疗后3、6和12个月从父母和儿童那里收集关于儿童的症状、患病行为、功能残疾、卫生保健利用、父母对儿童患病行为的反应、关于疼痛的信念和生活压力源的数据。结果可能导致对IBD和其他慢性儿童疾病的创新干预。

DESCRIPTION (provided by applicant): Inflammatory Bowel Disease (Crohn's and ulcerative colitis; IBD), a serious medical condition that affects children and adolescents, is often associated with high rates of health care utilization and disability, including school absence. While psychosocial factors are not believed to cause IBD, research suggests they may increase illness-related dysfunction. Prior studies from our group suggest that response to chronic illness is, in part, acquired during childhood through social learning processes and may be modified with psychosocial interventions. Although encouraging results of such interventions have been seen in patients with less severe conditions, well-designed trials of such interventions for children with IBD are lacking. The aim of the proposed study is to conduct a randomized controlled trial comparing social learning and cognitive behavior therapy (SLCBT) to an education and support condition (ES). 180 children with IBD will be recruited and followed for 12 months. It is hypothesized that SLCBT participants, compared to those in the ES condition, will, at one-year follow-up 1) exhibit greater decreases in IBD symptoms, medical visits for IBD, and functional disability, and greater increases in quality of life; 2) demonstrate greater use of cognitive coping, relaxation and stress management skills, and their parents will demonstrate greater reductions in maladaptive responses to illness behavior; and 3) exhibit greater reductions in anxiety, depression, and somatization. Secondary objectives are to investigate whether other variables, e.g., child age, gender, medical care and psychosocial variables such as social and academic competence, moderate treatment effects, and explore differences between the two groups in hospitalizations and surgeries for IBD, as well as general illness behavior. Data on children's symptoms, illness behaviors, functional disability, health care utilization, parental responses to children's illness behavior, beliefs regarding pain, and life stressors will be collected at baseline, post-treatment, and 3, 6, and 12 months post-treatment from parents and children. Results may lead to innovative interventions for IBD and other chronic childhood medical conditions.