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

描述(申请人提供)：功能性腹痛(FAP)是一种常见且代价高昂的儿童疼痛状况，导致日常功能和心理社会障碍的显着中断。患有FAP的青年中有很大一部分也患有严重焦虑(如广泛性焦虑、分离焦虑和社交焦虑)。这些患有FAP和共生焦虑的年轻人功能障碍的风险最大，如果治疗不成功，这种损害可能会持续到他们的成年。因此，迫切需要对患有FAP和共生焦虑的青少年进行早期有效的干预。虽然认知行为(CBT)技术在治疗青少年FAP方面显示出希望，但这些治疗通常侧重于教授疼痛应对技能，通常不是为了直接解决特定类型的焦虑症状而设计的。这样的年轻人可能受益于一种针对疼痛和焦虑的治疗方法，以实现最佳和持久的结果。PI在一家儿科医院对患有FAP的年轻人进行的试点研究的结果证实了过去研究的结果，即1)大量FAP患者(在试点研究中为53.4%)经历了明显的临床焦虑，2)焦虑增加与更高水平的疼痛和损害有关。根据试点研究的结果，申请人建议开发和测试一种量身定做的CBT干预措施(旨在减少焦虑和疼痛治疗，“适应”)。Adapt被设计为一种简短的CBT干预，其内容来自两种成熟的焦虑和疼痛治疗方法。它将针对疼痛和三种最常见的焦虑症状(广泛性焦虑、分离焦虑/逃学和社交焦虑)进行个性化介绍，并将包括面对面和基于网络的模块。目标是增加患者和家属对干预措施的可及性，并 以确保内容交付的一致性。当前项目的目的是：1)通过焦点小组评估Adapt干预的可行性和可接受性；2)进行一项小型随机临床试验(n=38，或每组19个)，以测试在产生临床显著疼痛减轻(E30%)和将焦虑降低到低于临床水平方面，Adapt是否优于常规护理(UC)。这项研究符合NICHD儿科行为和健康促进研究计划的资金优先事项，该计划鼓励开发专门针对儿科疼痛领域的行为干预措施。该项目将通过为长期损害风险最大的FAP青少年开发一种简短的、量身定制的CBT干预措施，大大推动这一领域的发展。申请者的长期目标是制定一系列方案研究，为患有FAP的青少年设计简短和可传播的干预措施，采用循序渐进的护理方法，使治疗内容和强度与患者的具体需求相一致。

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.