Psychosocial Intervention for Children with IBD

描述（由申请人提供）：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，通常与医疗保健使用率高和残疾率相关，包括缺课。虽然人们不认为社会心理因素会导致IBD，但研究表明，它们可能会增加与疾病相关的功能障碍。我们小组先前的研究表明，对慢性疾病的反应部分是在儿童时期通过社会学习过程获得的，并可能通过社会心理干预加以改变。尽管这些干预措施在病情较轻的患者中取得了令人鼓舞的结果，但目前还缺乏针对IBD患儿的精心设计的此类干预试验。本研究的目的是进行一项随机对照试验，比较社会学习和认知行为治疗（SLCBT）与教育和支持条件（ES）。180名患有IBD的儿童将被招募并随访12个月。假设SLCBT的参与者，与ES组相比，将在一年的随访中表现出IBD症状、IBD就诊次数和功能残疾的更大减少，生活质量的更大提高；2)表现出更多的认知应对、放松和压力管理技能的使用，他们的父母对疾病行为的适应不良反应将会大大减少；3)焦虑、抑郁和躯体化表现出更大的减少。次要目标是调查其他变量，如儿童年龄、性别、医疗保健和社会心理变量，如社会和学术能力，是否适中的治疗效果，并探讨两组在IBD住院和手术以及一般疾病行为方面的差异。在基线、治疗后、治疗后3个月、6个月和12个月从父母和儿童收集有关儿童症状、疾病行为、功能残疾、医疗保健利用、父母对儿童疾病行为的反应、关于疼痛的信念和生活压力源的数据。结果可能导致IBD和其他慢性儿童疾病的创新干预措施。

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.