Brief CBT for Pediatric Abdominal Pain and Anxiety

描述(申请人提供)：拟议的研究将开发和测试简单的认知行为心理疗法(BCBT)，用于在传统医学环境中出现功能性复发性腹痛(RAP)和临床上显著的焦虑症状的年轻人。RAP是常见的和损害的，在没有解释性身体疾病的情况下被认为是有功能的。因此，说唱被认为是由情感原因造成的。近80%的功能性RAP儿童符合至少1种焦虑症的完整诊断标准，其余儿童患有抑郁症或躯体形式障碍。这项拟议的研究集中在最具典型性的说唱与焦虑共存的呈现方式上。对于RAP的最佳实践干预，目前还没有达成共识。CBT已经显示出治疗与RAP相关的疼痛的前景，而且有证据表明CBT对儿童焦虑有好处。拟议的治疗发展研究将测试适合于在医疗环境中取得成功的BCBT，其优点是简洁明了、相对简单、将躯体症状与行为干预联系起来的基本原理以及对精神共病的适用性，目的是为未来的有效性和传播试验奠定基础。在3年的时间里，60名患有功能性说唱和焦虑症的儿童和青少年，年龄在7岁到16岁之间，接受6次BCBT治疗，并在8周的治疗阶段由健康教练提供2个可选的电话增强器，或由转介到常规护理(UC) 医生包括诊断性解释、安慰和鼓励恢复正常活动。结果将由独立评估员在初次评估后8周和20周由不了解参与者状况的独立评估员进行评估。主要结果将是全球临床改善、腹痛和焦虑。将评估抑郁、其他躯体症状和功能损害，并将次级检查全球治疗反应的潜在调解人和调节者，以及BCBT的可接受性和持久性。

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.