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Exposure CBT helps pediatric functional abdominal pain disorders
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WASHINGTON — Exposure-based cognitive behavioral therapy was more effective than usual treatment at improving symptoms in children with functional abdominal pain disorders, according to research presented at Digestive Disease Week.
Maria Lalouni, of Karolinska Insitutet in Sweden, said although cognitive behavioral therapy (CBT) has shown promise for treating functional abdominal pain disorders (FAPDs) in children, its availability in pediatric medicine is low.
“These children suffer from gastrointestinal-specific anxiety,” she said in her presentation. “The children fear their own abdominal symptoms. There are also extensive avoidance and control behaviors, such as staying home from school, not engaging in physical exercise or not being with friends. This combination of avoidance and control, and also anxiety, leads us to think that maybe exposures would work for this patient group.”
An exposure-based CBT approach gradually exposes children to stimuli like foods or situations that have caused them problems regarding their FAPD symptoms.
Lalouni and colleagues conducted a randomized control trial to compare exposure-based CBT with usual treatment for young children with FAPDs. They enrolled 90 patients aged 8 to 12 years with irritable bowel syndrome, functional dyspepsia or functional abdominal pain-not otherwise specified, and randomly assigned the patients to undergo either 10 weeks of exposure-based CBT or usual treatment.
The primary outcome for the trial was child-rated abdominal symptoms measured by PedsQL Gastro score. Investigators also measured outcomes in quality of life, gastrointestinal-specific anxiety, avoidance behaviors and parental responses to children’s symptoms.
The internet-based CBT program included 10 weekly modules for the children, as well as 10 modules for their parents. The program guided patients through treatment using text, images and films, and it also offered therapist support through a text message system for about 20 minutes per week. Patients in this group could take medication and go out for health care visits, but investigators encouraged them to decrease their “as-needed” medication.
Patients in the other group continued a normal treatment course with medication and health care visits before crossing over into internet-based CBT after 10 weeks of follow-up.
Lalouni and colleagues found that children in the CBT group had significantly greater improvement in PedsQL Gastro score compared with the normal treatment group (P = .022). Internet CBT also produced bigger improvements in the secondary outcome measures.
After 6 months of follow-up, treatment effects remained stable or were further improved in children in the CBT group, and patients in the normal treatment group experienced improvements after switching to CBT.
“Exposure-based internet-CBT is clinically effective for children 8 to 12 years with [FAPDs],” Lalouni said. - by Alex Young
Resource:
Lalouni M, et al. Abstract 79. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.
Disclosures: Lalouni reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial
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Joel R. Rosh, MD, FAAP, FACG, AGAF
I found this to be a fascinating research hypothesis. The idea is that, we know that 25% of school-aged children have recurrent abdominal pain and functional gastrointestinal conditions in pediatrics are a very common reason for both primary care and subspecialty consultation. We can make positive diagnoses of irritable bowel syndrome, functional dyspepsia and other disorders. We have a lot of patients with functional gastrointestinal disorders, but our best treatments still allude us. So, for the most part, if we think about it, the way these conditions are treated is avoidance. Patients are counseled to avoid certain foods, they are told to avoid certain situations, it’s a treatment of withdrawal and avoidance to try to make the symptoms better. The researchers hypothesized that such an approach may help perpetuate the symptoms. The concept being that if a patient believes, "I need to take these things out of my life, I need to worry about whether I'm exposed,” it may help drive anxiety. So, the researchers used a cognitive behavioral therapy CBT) where a patient confronts what they think is making them sick and they learn how to deal with it. Ninety-three percent finished the 10 internet-based sessions, so it suggests that the individuals probably noted early improvement and were highly engaged in this therapy. By using exposure-based cognitive behavior therapy, researchers were able to show excellent outcomes in their primary outcome, which was decrease in abdominal pain and GI symptoms. But, a lot of secondary measures were also extremely positive. I find it to be an intriguing idea and it really could be a game changer in the way we think about how we approach the patient with functional GI disorders, but even more importantly, a game changer in how to educate our patients of how to think about their own symptoms.
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