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Cognitive Behavioral Therapy for Functional Abdominal Pain Disorders

  • Kari BaberEmail author
  • Kelly A. O’ Neil Rodriguez
Chapter
Part of the Autism and Child Psychopathology Series book series (ACPS)

Abstract

Gastrointestinal symptoms are experienced by pediatric patients with a range of chronic illnesses, as well as by children and adolescents who do not have a primary medical diagnosis but are encountered in mental health clinics, schools, and pediatric primary care settings. In particular, functional abdominal pain disorders (irritable bowel syndrome, functional dyspepsia, and functional abdominal pain—not otherwise specified) are common among youth and best understood from a biopsychosocial perspective. This chapter describes the utility of cognitive behavioral case conceptualization and interventions in addressing functional gastrointestinal symptoms and the impact of these symptoms on daily functioning.

Keywords

Functional abdominal pain disorders Functional gastrointestinal disorders Irritable bowel syndrome Functional dyspepsia Functional abdominal pain Cognitive behavior therapy 

References

  1. Anderson, B. J., & Coyne, J. C. (1991). “Miscarried helping” in the families of children and adolescents with chronic diseases. In J. H. Johnson & S. B. Johnson (Eds.), Advances in child health psychology (pp. 167–177). Gainesville: University of Florida Press.Google Scholar
  2. Ballou, S., & Keefer, L. (2017). Psychological interventions for irritable bowel syndrome and inflammatory bowel diseases. Clinical and Translational Gastroenterology, 8, e214.  https://doi.org/10.1038/ctg.2016.69.PubMedPubMedCentralCrossRefGoogle Scholar
  3. Bonnert, M., Olen, O., Lalouni, M., Benninga, M. A., Engelbrektsson, J., Hedman, E., et al. (2017). Internet-delivered cognitive behavioral therapy for adolescents with irritable bowel syndrome (IBS): A randomized controlled trial. American Journal of Gastroenterology, 112, 152–162.PubMedPubMedCentralCrossRefGoogle Scholar
  4. Bradford, K., Shih, W., Videlock, E., Presson, A. P., Naliboff, B. D., Mayer, E. A., et al. (2012). Association between early adverse life events and irritable bowel syndrome. Clinical Gastroenterology and Hepatology, 10(4), 385–390.PubMedPubMedCentralCrossRefGoogle Scholar
  5. Brent, M., Lobato, D., & LeLeiko, N. (2008). Psychological treatments for pediatric functional gastrointestinal disorders. Journal of Pediatric Gastroenterology and Nutrition, 48, 13–21.CrossRefGoogle Scholar
  6. Brodwall, A., Glavin, K., & Lagerløv, P. (2018). Parents’ experience when their child has chronic abdominal pain: A qualitative study in Norway. BMJ Open.  https://doi.org/10.1136/bmjopen-2017-021066.PubMedPubMedCentralCrossRefGoogle Scholar
  7. Campo, J. V., Bridge, J., Ehmann, M., Altman, S., Lucas, A., Birmaher, B., et al. (2004). Recurrent abdominal pain, anxiety, and depression in primary care. Pediatrics, 113(4), 817–824.  https://doi.org/10.1542/peds.113.4.817.PubMedCrossRefGoogle Scholar
  8. Carlson, C. R., & Hoyle, R. H. (1993). Efficacy of abbreviated progressive muscle relaxation training: A quantitative review of behavioral medicine research. Journal of Consulting and Clinical Psychology, 61(6), 1059–1067.PubMedPubMedCentralCrossRefGoogle Scholar
  9. Claar, R. L., Simons, L. E., & Logan, D. E. (2008). Parental response to children’s pain: The moderating impact of children’s emotional distress on symptoms and disability. Pain, 138, 172–179.PubMedCrossRefGoogle Scholar
  10. Coakley, R., & Wihak, T. (2017). Evidence-based psychological interventions for the management of pediatric chronic pain: New directions in research and clinical practice. Children.  https://doi.org/10.3390/children4020009.PubMedCentralCrossRefGoogle Scholar
  11. Craske, M. G., Wolitzky-Taylor, K. B., Labus, J., Wu, S., Frese, M., Mayer, E. A., et al. (2011). A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behavior Research and Therapy, 49, 413–421.CrossRefGoogle Scholar
  12. Crombez, G., Eccleston, C., van Damme, S., Vlaeyen, J. W. S., & Karoly, P. (2012). Fear-avoidance model of chronic pain: The next generation. Clinical Journal of Pain, 28, 475–483.PubMedPubMedCentralCrossRefGoogle Scholar
  13. Cunningham, N. R., Cohen, M. B., Farrell, M. K., Mezoff, A. G., Lynch-Jordan, A., & Kashikar-Zuck, S. (2015). Concordant parent child reports of anxiety predict impairment in youth with functional abdominal pain. Journal of Pediatric Gastroenterology and Nutrition, 60(3), 312–317.PubMedPubMedCentralCrossRefGoogle Scholar
  14. Cunningham, N. R., Jagpal, A., Tran, S. T., Kashikar-Zuck, S., Goldschneider, K. R., Coghill, R. C., et al. (2016). Anxiety adversely impacts response to cognitive behavioral therapy in children with chronic pain. Journal of Pediatrics, 171, 227–233.PubMedPubMedCentralCrossRefGoogle Scholar
  15. Cunningham, N. R., Nelson, S., Jagpal, A., Moorman, E., Farrell, M., Pentiuk, S., et al. (2018). Development of the Aim to Decrease Anxiety and Pain Treatment for pediatric functional abdominal pain disorders. Journal of Pediatric Gastroenterology and Nutrition, 66, 16–20.PubMedPubMedCentralCrossRefGoogle Scholar
  16. Drossman, D. A. (2016). Functional gastrointestinal disorders: History, pathophysiology, clinical features, and Rome IV. Gastroenterology, 150, 1262–1279.CrossRefGoogle Scholar
  17. Drossman, D. A., Tack, J., Ford, A. C., Szigethy, E., Tornblom, H., & van Oudenhove, L. (2018). Neuromodulators for functional gastrointestinal disorders (disorders of gut-brain interaction): A Rome Foundation working team report. Gastroenterology, 154, 1140–1171.PubMedPubMedCentralCrossRefGoogle Scholar
  18. DuPen, M. M., van Tilburg, M. A. L., Langer, S. L., Murphy, T. B., Romano, J. M., & Levy, R. (2016). Parental protectiveness mediates the association between parent-perceived child self-efficacy and health outcomes in pediatric functional abdominal pain disorder. Children.  https://doi.org/10.3390/children3030015.PubMedCentralCrossRefGoogle Scholar
  19. Finney, J. W., Lemanek, K. L., Cataldo, M. F., Katz, H. P., & Fuqua, R. W. (1989). Pediatric psychology in primary health care: Brief targeted therapy for recurrent abdominal pain. Behavior Therapy, 20, 283–291.CrossRefGoogle Scholar
  20. Harris, M. A., Antal, H., Oelbaum, R., Buckloh, L. M., White, N. H., & Wysocki, T. (2008). Good intentions gone awry: Assessing parental “miscarried helping” in diabetes. Families, Systems and Health, 26(4), 393–403.CrossRefGoogle Scholar
  21. Horst, S., Shelby, G., Anderson, J., Acra, S., Polk, B., Saville, B. R., et al. (2014). Predicting persistence of functional abdominal pain from childhood into young adulthood. Clinical Gastroenterology and Hepatology, 12(12), 2026–2032.PubMedPubMedCentralCrossRefGoogle Scholar
  22. Humphreys, P. A., & Gevirtz, R. N. (2000). Treatment of recurrent abdominal pain: Components analysis of four treatment protocols. Journal of Pediatric Gastroenterology and Nutrition, 31(1), 47–51.PubMedPubMedCentralCrossRefGoogle Scholar
  23. Hunt, M. G., Milonova, M., & Moshier, S. (2009). Catastrophizing the consequences of gastrointestinal symptoms in irritable bowel syndrome. Journal of Cognitive Psychotherapy, 23, 160–173.CrossRefGoogle Scholar
  24. Hyams, J. S., Di Lorenzo, C., Saps, M., Shulman, R. J., Staiano, A., & van Tilburg, M. (2016). Childhood functional gastrointestinal disorders: Child/adolescent. Gastroenterology, 150(6), 1456–1468.CrossRefGoogle Scholar
  25. Jensen, M. P., Day, M. A., & Miro, J. (2014). Neuromodulatory treatments for chronic pain: Efficacy and mechanisms. Nature Reviews Neurology, 10(3), 167–178.PubMedPubMedCentralCrossRefGoogle Scholar
  26. Kennedy, P. J., Cryan, J. F., Dinan, T. G., & Clarke, G. (2014). Irritable bowel syndrome: A microbiome-gut-brain axis disorder? World Journal of Gastroenterology, 20(39), 14105–14125.PubMedPubMedCentralCrossRefGoogle Scholar
  27. Lackner, J. M., Brasel, A. M., Quigley, B. M., Keefer, L., Krasner, S. S., Powell, C., et al. (2010). The ties that bind: Perceived social support, stress, and IBS in severely affected patients. Neurogastroenterology & Motility, 22(8), 893–900.CrossRefGoogle Scholar
  28. Lackner, J. M., Gudleski, G. D., Firth, R., Keefer, L. A., Brenner, D. M., Guy, K., et al. (2013). Negative aspects of close relationships are more strongly associated than supportive personal relationships with illness burden of irritable bowel syndrome. Journal of Psychosomatic Research, 74(6), 493–500.PubMedPubMedCentralCrossRefGoogle Scholar
  29. Lalouni, M., Olen, O., Bonnert, M., Hedman, E., Serlachius, E., & Ljotsson, B. (2016). Exposure-based cognitive behavior therapy for children with abdominal pain: A pilot trial. PLoS One.  https://doi.org/10.1371/journal.pone.0164647.PubMedPubMedCentralCrossRefGoogle Scholar
  30. Lalouni, M., Ljótsson, B., Bonnert, M., Hedman-Lagerlöf, E., Högström, J., Serlachius, E., et al. (2017). Internet-delivered cognitive behavioral therapy for children with pain-related functional gastrointestinal disorders: Feasibility study. JMIR Mental Health, 4(3), 1–21.CrossRefGoogle Scholar
  31. Langer, S. L., Romano, J. M., Levy, R. L., Walker, L. S., & Whitehead, W. E. (2009). Catastrophizing and parental response to child symptom complaints. Children’s Health Care, 38(3), 169–184.PubMedPubMedCentralCrossRefGoogle Scholar
  32. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer Publishing Company.Google Scholar
  33. Levy, R. L., Whitehead, W. E., Walker, L. S., Von Korff, M., Feld, A. D., Garner, M., et al. (2004). Increased somatic complaints and health-care utilization in children: Effects of parent IBS status and parent response to gastrointestinal symptoms. American Journal of Gastroenterology, 99, 2442–2451.PubMedPubMedCentralCrossRefGoogle Scholar
  34. Levy, R. L., Langer, S. L., & Whitehead, W. E. (2007). Social learning contributions to the etiology and treatment of functional abdominal pain and inflammatory bowel disease in children and adults. World Journal of Gastroenterology, 13(17), 2397–2403.PubMedPubMedCentralCrossRefGoogle Scholar
  35. Levy, R. L., Langer, S. L., Walker, L. S., Romano, J. M., Christie, D. L., Youssef, N., et al. (2010). Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. The American Journal of Gastroenterology, 105(4), 946–956.PubMedPubMedCentralCrossRefGoogle Scholar
  36. Levy, R. L., Langer, S. L., Romano, J. M., Labus, J., Walker, L. S., Murphy, T. B., et al. (2014). Cognitive mediators of treatment outcomes in pediatric functional abdominal pain. Clinical Journal of Pain, 30(12), 1033–1043.PubMedPubMedCentralCrossRefGoogle Scholar
  37. Lewandowski, A. S., Palermo, T. M., Stinson, J., Handley, S., & Chambers, C. T. (2010). Systematic review of family functioning in families of children and adolescents with chronic pain. The Journal of Pain, 11(11), 1027–1038.PubMedPubMedCentralCrossRefGoogle Scholar
  38. Ljotsson, B., Hesser, H., Andersson, E., Lackner, J. M., El Alaoui, S., Falk, L., et al. (2014). Provoking symptoms to relieve symptoms: A randomized controlled dismantling study of exposure therapy in irritable bowel syndrome. Behavior Research and Therapy, 55, 27–39.CrossRefGoogle Scholar
  39. Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150, 971–979.PubMedCrossRefGoogle Scholar
  40. Nieto, R., Hernandez, E., Boixados, M., Huguet, A., Beneitez, I., & McGrath, P. (2015). Testing the feasibility of DARWeb: An online intervention for children with functional abdominal pain and their parents. Clinical Journal of Pain, 31, 493–503.PubMedPubMedCentralCrossRefGoogle Scholar
  41. Palermo, T. M. (2012). Cognitive-behavioral therapy for chronic pain in children and adolescents. New York: Oxford University Press.CrossRefGoogle Scholar
  42. Palermo, T. M., Valrie, C. R., & Karlson, C. W. (2014). Family and parent influences on pediatric chronic pain: A developmental perspective. American Psychologist, 69(2), 142–152.PubMedCrossRefGoogle Scholar
  43. Pinto-Sanchez, M. I., Ford, A. C., Avila, C. A., Verdu, E. F., Collins, S. M., Morgan, D., et al. (2015). Anxiety and depression increase in a stepwise manner in parallel with multiple FGIDs and symptom severity and frequency. The American Journal of Gastroenterology, 110, 1038–1048.PubMedPubMedCentralCrossRefGoogle Scholar
  44. Reed-Knight, B., Maddux, M., Deacy, A. D., Lamparyck, K., Stone, A. L., & Mackner, L. (2017). Brain-gut interactions and maintenance factors in pediatric gastroenterological disorders: Recommendations for clinical care. Clinical Practice in Pediatric Psychology, 5(1), 93–105.CrossRefGoogle Scholar
  45. Robin, S. G., Keller, C., Zwiener, R., Hyman, P. E., Nurko, S., Saps, M., et al. (2018). Prevalence of pediatric functional gastrointestinal disorders utilizing the Rome IV criteria. The Journal of Pediatrics, 195, 134–139.PubMedPubMedCentralCrossRefGoogle Scholar
  46. Rosen, J. M., Cocjin, J. T., Schurman, J. V., Colombo, J. M., & Friesen, C. A. (2014). Visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia. World Journal of Gastrointestinal Pharmacology and Therapeutics, 5(3), 122–138.PubMedPubMedCentralCrossRefGoogle Scholar
  47. Rutten, J. T. M., Reitsma, J. B., Vlieger, A. M., & Benninga, M. A. (2013). Gut-directed hypnotherapy for functional abdominal pain or irritable bowel syndrome in children: A systematic review. Archives of Disease in Childhood, 98, 252–257.PubMedPubMedCentralCrossRefGoogle Scholar
  48. Rutten, J. T. M., Korterink, J. J., Venmans, L. M. A. J., Benninga, M. A., & Tabbers, M. (2015). Nonpharmacologic treatment of functional abdominal pain disorders: A systematic review. Pediatrics, 135(3), 522–535.PubMedPubMedCentralCrossRefGoogle Scholar
  49. Sanders, M. W., Rebgetz, M., Morrison, M., Bor, W., Gordon, A., Dadds, M., et al. (1989). Cognitive-behavioral treatment of recurrent nonspecific abdominal pain in children: An analysis of generalization, maintenance, and side effects. Journal of Consulting and Clinical Psychology, 57(2), 294–300.PubMedPubMedCentralCrossRefGoogle Scholar
  50. Saps, M., Velasco-Benitez, C. A., Langshaw, A. H., Ramirez-Hernandez, C. (2018). Prevalence of functional gastrointestinal disorders in children and adolescents: Comparison between Rome III and Rome IV criteria. Journal of Pediatrics, 199, 212–216.PubMedCrossRefGoogle Scholar
  51. Schurman, J. V., Wu, Y. P., Grayson, P., & Friesen, C. A. (2010). A pilot study to assess the efficacy of biofeedback-assisted relaxation training as an adjunct treatment for pediatric functional dyspepsia associated with duodenal eosinophilia. Journal of Pediatric Psychology, 35(8), 837–847.PubMedPubMedCentralCrossRefGoogle Scholar
  52. Schurman, J. V., Friesen, C. A., Dai, H., Danda, C. E., Hyman, P. E., & Cocjin, J. T. (2012). Sleep problems and functional disability in children with functional gastrointestinal disorders: An examination of the potential mediating effects of physical and emotional symptoms. BMC Gastroenterology.  https://doi.org/10.1186/1471-230X-12-142.
  53. Shelby, G. D., Shirkey, K. S., Sherman, A. L., Beck, J. E., Haman, K., Shears, A. R., et al. (2013). Functional abdominal pain in childhood and long-term vulnerability to anxiety disorders. Pediatrics, 132(3), 475–482.PubMedPubMedCentralCrossRefGoogle Scholar
  54. Sherman, A. L., Morris, M. C., Bruehl, S., Westbrook, T. D., & Walker, L. S. (2015). Heightened temporal summation of pain in patients with functional gastrointestinal disorders and history of trauma. Annals of Behavioral Medicine, 49(6), 785–792.PubMedPubMedCentralCrossRefGoogle Scholar
  55. Sowder, E., Gevirtz, R., Shapiro, W., & Ebert, C. (2010). Restoration of vagal tone: A possible mechanism for functional abdominal pain. Applied Psychophysiology and Biofeedback, 35(3), 199–206.PubMedPubMedCentralCrossRefGoogle Scholar
  56. Stone, A. L., & Walker, L. S. (2017). Adolescents’ observations of parent pain behaviors: Preliminary measure validation and test of social learning theory in pediatric chronic pain. Journal of Pediatric Psychology, 42, 65–74.PubMedPubMedCentralGoogle Scholar
  57. Tsao, J. C. I., & Zeltzer, L. K. (2005). Complementary and alternative medicine approaches for pediatric pain: A review of the state-of-the-science. eCAM, 2(2), 149–159.PubMedPubMedCentralGoogle Scholar
  58. Valrie, C. R., Bromberg, M. H., Palermo, T., & Schanberg, L. E. (2013). A systematic review of sleep in pediatric pain populations. Journal of Developmental and Behavioral Pediatrics, 34(2), 120–128.PubMedPubMedCentralCrossRefGoogle Scholar
  59. Van der Veek, S. M. C., Derkx, B. H. F., De Haan, E., Benninga, M. A., Plak, R. D., & Boer, F. (2011). Do parents maintain or exacerbate pediatric functional abdominal pain? A systematic review and meta-analysis. Journal of Health Psychology, 17(2), 258–272.CrossRefGoogle Scholar
  60. Van der Veek, S. M. C., Derkx, B. H. F., Benninga, M. A., Boer, F., & De Haan, E. (2013). Cognitive behavior therapy for pediatric functional abdominal pain: A randomized controlled trial. Pediatrics, 132(5), e1163–e1172.PubMedPubMedCentralCrossRefGoogle Scholar
  61. Van Oudenhove, L., Levy, R. L., Crowell, M. D., Drossman, D. A., Halpert, A. D., Keefer, L., et al. (2016). Biopsychosocial aspects of functional gastrointestinal disorders: How central and environmental processes contribute to the development and expression of functional gastrointestinal disorders. Gastroenterology, 150, 1355–1367.CrossRefGoogle Scholar
  62. Van Tilburg, M. A. L., Chitkara, D. K., Palsson, O. S., Turner, M., Blois-Martin, N., Ulshen, M., et al. (2009). Audio-recorded guided imagery treatment reduces functional abdominal pain in children: A pilot study. Pediatrics, 124, e890–e897.PubMedPubMedCentralCrossRefGoogle Scholar
  63. Van Tilburg, M. A. L., Palsson, O. S., & Whitehead, W. E. (2013). Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model. Journal of Psychosomatic Research, 74(6), 486–492.PubMedPubMedCentralCrossRefGoogle Scholar
  64. Van Tilburg, M. A. L., Claar, R., Romano, J. M., Langer, S. L., Walker, L. S., Whitehead, W. E., et al. (2015). The role of coping with symptoms in depression and disability: Comparison between inflammatory bowel disease and abdominal pain. Journal of Pediatric Gastroenterology and Nutrition, 61(4), 431–436.PubMedPubMedCentralCrossRefGoogle Scholar
  65. Varni, J. W., Bendo, C. B., Nurko, S., Shulman, R. J., Self, M. M., Franciosi, J. P., et al. (2015). Health-related quality of life in pediatric patients with functional and organic gastrointestinal diseases. The Journal of Pediatrics, 166, 85–90.PubMedPubMedCentralCrossRefGoogle Scholar
  66. Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85, 317–332.PubMedPubMedCentralCrossRefGoogle Scholar
  67. Walker, L. S., Williams, S. E., Smith, C. A., Garber, J., Slyke, D. A., & Lipani, T. A. (2006). Parental attention versus distraction: Impact on symptom complaints by children with and without chronic functional abdominal pain. Pain, 122, 43–52.PubMedPubMedCentralCrossRefGoogle Scholar
  68. Wassom, M. C., Schurman, J. V., Friesen, C. A., & Rapoff, M. A. (2013). A pilot study of “Gutstrong” for adolescents with functional gastrointestinal disorders. Clinical Practice in Pediatric Psychology, 1(3), 201–213.CrossRefGoogle Scholar
  69. Weersing, V. R., Gonzalez, A., Campo, J. V., & Lucas, A. N. (2008). Brief behavioral therapy for pediatric anxiety and depression: Piloting an integrated treatment approach. Cognitive and Behavioral Practice, 15, 126–139.CrossRefGoogle Scholar
  70. Weersing, V. R., Rozenman, M. S., Maher-Bridge, M., & Campo, J. V. (2012). Anxiety, depression and somatic distress: Developing a transdiagnostic internalizing toolbox for pediatric practice. Cognitive Behavioral Practice, 19(1), 68–82.PubMedPubMedCentralCrossRefGoogle Scholar
  71. Williams, S. E., & Zahka, N. E. (2017). Treating somatic symptoms in children and adolescents. New York: Guilford Press.Google Scholar
  72. Wilpart, K., Tornblom, H., Svedlund, J., Tack, J. F., Simren, M., & Van Oudenhove, L. (2017). Coping skills are associated with gastrointestinal symptom severity and somatization in patients with irritable bowel syndrome. Clinical Gastroenterology and Hepatology, 15, 1565–1571.PubMedPubMedCentralCrossRefGoogle Scholar
  73. Yacob, D., Di Lorenzo, C., Bridge, J. A., Rosenstein, P. F., Onorato, M., Bravender, T., et al. (2013). Prevalence of pain-predominant functional gastrointestinal disorders and somatic symptoms in patients with anxiety or depressive disorders. The Journal of Pediatrics, 163, 767–770.PubMedPubMedCentralCrossRefGoogle Scholar
  74. Zucker, N., Mauro, C., Craske, M., Wagner, H. R., Datta, N., Hopkins, H., et al. (2017). Acceptance-based interoceptive exposure for young children with functional abdominal pain. Behaviour Research and Therapy, 97, 200–212.PubMedPubMedCentralCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Child and Adolescent Psychiatry and Behavioral SciencesThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of Pediatrics/Division of Gastroenterology, Hepatology and NutritionThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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