Cognitive-Behavioral Therapy for Children with Comorbid Physical Illness

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Overview

There is growing literature to support a reciprocal relationship between physical and mental illnesses: chronic medical conditions can have an adverse effect on psychological well-being, and psychopathology and stress can have a negative effect on physical health.1, 2, 3 Although the mechanisms responsible for the brain-body interactions are still to be determined and are not yet fully understood, a wide array of pathophysiologic mechanisms seem to converge in different illnesses, resulting in

Developmental Considerations

Developmental stages must be taken into account when providing treatment to children and adolescents with chronic physical illnesses. Emotional, cognitive, and intellectual development can be severely affected by chronic illness; youth of all ages may turn to maladaptive coping strategies in response to crises, looking to their parents to shoulder much of the burden of the chronic illness.12 Avoidant coping, or cognitive distortions such as denial and magical thinking, can cause more stress for

Diabetes

Childhood-onset diabetes is a chronic medical condition consisting of 2 subtypes (type 1 and type 2), both of which involve dysregulation of insulin and glucose metabolism leading to polyuria, extreme thirst, fatigue, and changes in weight. In its most severe forms, diabetic ketoacidosis may occur, leading to hospitalization, coma, and death. The management of diabetes necessitates conscientious daily care to regulate blood glucose concentrations. The regimen is often complex, including

Summary and future directions

The reviewed literature suggests that CBT interventions can improve treatment adherence, psychosocial adjustment, pain, and QoL of pediatric patients with chronic physical illnesses. Nevertheless, much work remains before CBT can be established as an empirically supported treatment modality for specific chronic medical conditions and related comorbidities among pediatric patients. The strongest support for CBT’s effectiveness is found in the literature examining the treatment of pain management

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    • Involving patients' perspective in the development of an internet- and mobile-based CBT intervention for adolescents with chronic medical conditions: Findings from a qualitative study

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      The effectiveness of cognitive behavioral therapy (CBT) for treating mild to moderate symptoms of depression and anxiety in children and adolescents is well established (e.g. Zhou et al., 2015; Zhou et al., 2019). There is also evidence supporting that CBT can reduce symptoms of mental comorbidities in children and adolescents with chronic medical conditions (Thompson et al., 2011). However, access to those evidence-based interventions is often limited (Stiles-Shields et al., 2016), and only a small portion of affected AYA ultimately receive psychotherapeutic treatment (Delamater et al., 2017).

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      However, although research has not yet demonstrated the best intervention practices for children with food allergy and their parents, many psychotherapy techniques that are used with other pediatric chronic illness populations are applicable. Mental health professionals who work with families of children with food allergy for either short-term care or long-term psychotherapy will likely use CBT, a well-validated and frequently used psychotherapy treatment for children with chronic illness that is goal-oriented, collaborative, and typically short-term.90-95 CBT focuses on the relationships of thoughts, feelings, and behaviors.

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      Specifically, in a controlled study, youth who participated in an IBD-focused CBT reported significantly fewer depressive symptoms, more optimistic attitudes towards having IBD, and more active coping skills posttreatment, as compared with a nondirective comparison group (Szigethy et al., 2007). Furthermore, youth in the IBD-focused CBT group showed greater reductions in disease severity 6 months following the completion of the program (Thompson, Delaney, Flores, & Szigethy, 2011). A handful of studies examining IBD adult samples with subclinical psychiatric symptoms have demonstrated that cognitive behavioral approaches were moderately successful in targeting psychological distress related to managing IBD (Boye et al., 2011; Mussell, Böcker, Nagel, Olbrich, & Singer, 2003) and may enhance quality of life and reduce somatic symptoms (Garcia-Vega & Fernandez-Rodriguez, 2004; Langhorst et al., 2007).

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    This work was supported by grant nos. R01MH077770 and 1DP2OD001210 from the National Institutes of Health.

    The authors have nothing to disclose.

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