Cognitive behavior therapy for pediatric functional abdominal pain: a randomized controlled trial

• Published in: Pediatrics (Evanston) Vol. 132; no. 5; pp. e1163 - e1172
• Main Authors: van der Veek, Shelley M C, Derkx, Bert H F, Benninga, Marc A, Boer, Frits, de Haan, Else
• Format: Journal Article
• Language: English
• Published: United States American Academy of Pediatrics 01-11-2013
• Subjects: Abdomen; Abdominal pain; Abdominal Pain - psychology; Abdominal Pain - therapy; Adolescent; Behavior modification; Care and treatment; Child; Clinical trials; Cognitive therapy; Cognitive Therapy - methods; Cognitive-behavioral therapy; Cognitive-behavioural therapy; Female; Follow-Up Studies; Gastroenterology; Health aspects; Humans; Male; Pain; Pediatrics; Pediatrics - methods; Prospective Studies; Treatment Outcome; Netherlands; functional abdominal pain; cognitive behavior therapy; randomized controlled trial
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2013-0242

This randomized controlled trial investigated the effectiveness of a 6-session protocolized cognitive behavior therapy (CBT) compared with 6 visits to a pediatrician (intensive medical care; IMC) for the treatment of pediatric functional abdominal pain (FAP).
One hundred four children aged 7 to 18 were randomized to CBT or IMC. CBT was delivered primarily by trained master's degree students in psychology; IMC was delivered by pediatricians or pediatric gastroenterologists. Assessments were performed pretreatment, posttreatment, and at 6- and 12-month follow-up. Primary outcomes were level of abdominal pain (AP) as reported on questionnaires and diaries. Secondary outcomes were other gastrointestinal complaints, functional disability, other somatic complaints, anxiety, depression, and quality of life.
Both CBT and IMC resulted in a significant decrease in AP (P < .001), but no significant difference was found between the treatments in their effectiveness (P > .05 for all end points). According to the questionnaire-derived data, 1 year after treatment, 60% of children that received CBT had significantly improved or recovered, versus 56.4% of children receiving IMC, which did not significantly differ (P = .47). These percentages were 65.8% versus 62.8% according to the diary-derived data, which also did not significantly differ (P = .14). Additionally, nearly all secondary outcomes improved after treatment.
CBT was equally effective as IMC in reducing AP in children with FAP. More research into the specific working mechanisms of CBT for pediatric FAP is needed.