Catastrophizing, Child Pain Behavior, and Parental Response

描述（由申请人提供）：儿童期功能性腹痛（FAP）是一种没有可识别的器质性病因的疾病，但与具有重大个人和社会成本的疾病行为相关。先前的研究表明，来自环境的反应通过社会学习过程促成了这种疾病行为和功能障碍，例如当父母对儿童症状的抱怨做出关心的反应时，例如增加关注和减轻责任。灾难化（CAT）是一种过度消极的评价，其中疼痛被视为高度威胁或伤害的标志，已知会放大疼痛的体验和表达，但CAT与社会学习过程的关系尚未得到充分研究。在本提案中，我们将重点放在重要他人的CAT认知上，特别是患有FAP儿童的母亲。母亲对孩子疼痛的CAT可能会导致她们将孩子表现出的疼痛行为解释为对孩子健康的伤害、损害或威胁，因此可能会增加她们通过采取行动减少对孩子的要求或通过关心的回应来减轻孩子的不适来进行干预的可能性，从而鼓励疾病行为。本项目旨在：1)评估症状激发和行为观察范式设计的可行性，以检验FAP儿童疼痛行为和母亲反应；2)确定儿童疼痛行为和母亲关怀之间的关联是否由母亲CAT介导。75名8-12岁的FAP儿童及其母亲将作为参与者。母亲将完成旨在评估广泛性焦虑的测量，对孩子疼痛的CAT认知，以及对孩子症状投诉的典型反应。儿童将评估他们的疼痛强度，然后参与一个安全且有效的水负荷程序，旨在模拟腹部不适；在这样做的过程中，他们将被要求喝水，直到他们完全饱了，不超过15分钟。接下来，孩子们会像在家里一样打扫房间（例如，整理书本和玩具，整理床铺）。孩子们将被指示带头完成这项任务，但可以向他们的母亲寻求帮助；同样，母亲可能会主动或不主动地提供帮助。用水过程和随后的清洁任务将被录像，提供儿童疼痛行为和母亲反应的行为编码。任务后问卷将评估范式的可接受性。研究结果将为使用该方法进行更大规模的研究奠定基础，以探索FAP可能维持的认知、情感和行为途径。这反过来将有助于为患有FAP的儿童及其家庭确定适当的干预目标，以减少相关的功能障碍和痛苦。

DESCRIPTION (provided by applicant): Functional Abdominal Pain (FAP) of childhood is a disorder for which there is no identifiable organic etiology, yet which is associated with illness behavior of significant personal and societal cost. Prior research suggests that responses from the environment contribute to such illness behavior and dysfunction through social learning processes, as when parents respond solicitously to child symptom complaints, e.g., with increased attention and relief from responsibility. Catastrophizing (CAT), an overly negative appraisal in which pain is seen as signifying a high degree of threat or harm, is known to amplify the experience and expression of pain, but the relationship of CAT to social learning processes has not been adequately examined. In the present proposal, we focus on CAT cognitions on the part of significant others, specifically, mothers of children with FAP. Mothers' CAT about their child's pain may lead them to interpret pain behaviors exhibited by their child as indicative of harm, damage or threat to the well-being of the child, and thus may increase the likelihood that they intervene by taking action to reduce demands on the child or allay the child's discomfort via solicitous responding, thereby encouraging illness behavior. This project aims to: 1) assess feasibility of a symptom provocation and behavioral observation paradigm designed to examine FAP child pain behavior and maternal response, and 2) determine whether the association between child pain behavior and maternal solicitousness is mediated by maternal CAT. Seventy-five children with FAP aged 8-12 and their mothers will serve as participants. Mothers will complete measures designed to assess generalized anxiety, CAT cognitions regarding their child's pain, and typical responses to their child's symptom complaints. Children will rate their pain intensity and then participate in a safe and validated water load procedure intended to simulate abdominal discomfort; in so doing, they will be asked to drink water until they are completely full, not to exceed 15 minutes. Next, children will clean a room much as they would at home (e.g., put away books and toys and make a bed). Children will be instructed to take the lead in this task but may ask their mother for assistance; similarly, mothers may offer assistance with or without a request from their child. The water load procedure and ensuing cleaning task will be videotaped, affording behavioral coding of child pain behavior and maternal response. Post-task questionnaires will assess acceptability of the paradigm. Findings will lay the groundwork for conducting a larger study using this methodology to explore the cognitive, affective, and behavioral pathways by which FAP may be maintained. This in turn will help to determine appropriate targets for intervention for children with FAP and their families, with the aim of reducing associated dysfunction and distress.