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Cognitive mediators of treatment outcomes in pediatric functional abdominal pain
Rona L Levy1, Shelby L Langer, Joan M Romano
1*School of Social Work †Department of Psychiatry & Behavioral Sciences, University of Washington #Department of Gastroenterology, Seattle Children's Hospital, Seattle, WA ‡Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA §Department of Pediatrics, Vanderbilt University, Nashville, TN ∥Department of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC ¶Mt. Sinai School of Medicine, New York, NY.
Insights
Cognitive-behavioral therapy for childhood abdominal pain works by reducing parent threat perception and child catastrophic thinking. These changes in thinking mediate symptom improvement, highlighting cognitive processes as key mechanisms for treatment success.
Area of Science:
- Pediatric Psychology
- Clinical Psychology
- Gastroenterology
Background:
- Cognitive-behavioral (CB) interventions show promise for pediatric health conditions.
- Mechanisms underlying CB intervention effectiveness in children are not well understood.
- Idiopathic childhood abdominal pain is a common condition requiring effective treatments.
Purpose of the Study:
- To identify mediating mechanisms of a brief CB intervention for childhood abdominal pain.
- To examine whether changes in targeted process variables mediate treatment outcomes.
- To investigate the role of parental responses and child cognitions in treatment efficacy.
Main Methods:
- A randomized controlled trial with 200 children with functional abdominal pain.
- Comparison of a 3-session social learning and CB treatment versus an educational control.
- Assessment of outcomes at 3-, 6-, and 12-month follow-ups using multiple mediation analyses.
Main Results:
- Reductions in parents' perceived threat mediated improvements in child GI symptom severity and pain.
- Decreased catastrophic cognitions in children mediated reduced child-reported GI symptom severity.
- Parental solicitousness changes did not mediate treatment outcomes.
Conclusions:
- The effectiveness of CB interventions for childhood abdominal pain is partly mediated by reductions in maladaptive parent and child cognitions.
- Targeting parental threat perception and child catastrophic thinking are crucial components of successful interventions.
- Understanding these mechanisms can inform the development of more targeted and effective treatments.
Objectives:
Cognitive-behavioral (CB) interventions improve outcomes for many pediatric health conditions, but little is known about which mechanisms mediate these outcomes. The goal of this study was to identify whether changes in targeted process variables from baseline to 1 week posttreatment mediate improvement in outcomes in a randomized controlled trial of a brief CB intervention for idiopathic childhood abdominal pain.
Materials And Methods:
Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to 1 of 2 conditions: a 3-session social learning and CB treatment (N=100), or a 3-session educational intervention controlling for time and attention (N=100). Outcomes were assessed at 3-, 6-, and 12-month follow-ups. The intervention focused on altering parental responses to pain and on increasing adaptive cognitions and coping strategies related to pain in both parents and children.
Results:
Multiple mediation analyses were applied to examine the extent to which the effects of the social learning and CB treatment condition on child gastrointestinal (GI) symptom severity and pain as reported by children and their parents were mediated by changes in targeted cognitive process variables and parents' solicitous responses to their child's pain symptoms. Reductions in parents' perceived threat regarding their child's pain mediated reductions in both parent-reported and child-reported GI symptom severity and pain. Reductions in children's catastrophic cognitions mediated reductions in child-reported GI symptom severity but no other outcomes. Reductions in parental solicitousness did not mediate outcomes.
Discussion:
Results suggest that reductions in reports of children's pain and GI symptoms after a social learning and CB intervention were mediated at least in part by decreasing maladaptive parent and child cognitions.
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