Cognitive and Behavioral Practice最新文献

While many youths recover from concussions within several weeks, a subset of patients experience persistent postconcussive symptoms (PPCS), lasting 4 weeks or longer. PPCS have a significant negative impact on children’s social and academic functioning, often leading to extended absences from school, disruption of normal activities, and increased mental health burden. Cognitive-behavioral therapy (CBT) has demonstrated promise as a treatment for PPCS but requires tailoring to specifically address concussion-related targets. This paper describes the clinical adaptation of CBT for pediatric patients with PPCS, including core intervention modifications and recommendations for the implementation and delivery of CBT in medical settings. A model of an integrated concussion clinic with pediatric neurology and psychology is discussed.

Recent advances and interest in nonpharmacological treatment approaches for various chronic pain conditions in adolescent patients have increased. Cognitive behavioral therapy (CBT) is widely regarded as the leading nonpharmacological treatment for chronic pain, encompassing gynecological conditions associated with chronic pelvic pain, such as endometriosis. Adolescents with endometriosis often present with different symptoms than adults and frequently report more comorbid psychiatric disorders than the general public. This review aims to (1) justify the application of CBT interventions in the context of adolescent patients with endometriosis; (2) integrate and analyze existing empirical evidence and reviews; (3) highlight the advantages, constraints, and future research directions in CBT for this demographic; and (4) introduce a novel biopsychosocial conceptual model. This model intricately considers the interplay of thoughts, emotions, behaviors, and physical symptoms specific to adolescents with endometriosis, providing a foundation for targeted CBT interventions. This holistic approach recognizes the multifaceted nature of their experience, paving the way for comprehensive and effective nonpharmacological therapeutic strategies. Given the nuanced and intricate nature of endometriosis in adolescents, there is a pressing need for innovative conceptual models and clinical trials of behavioral interventions explicitly designed for this demographic.

This report presents the single case of Liam, a 10-year-old boy with rumination disorder (RD) and subclinical symptoms of anxiety. The primary aim was to explore the effectiveness of habit reversal therapy (HRT) in reducing regurgitation frequency in a young child. The secondary aim was to explore whether modular cognitive-behavioral techniques, based on idiosyncratic cognitive-behavioral formulations tailored to the child, may further augment the effect of habit reversal therapy on regurgitation frequency. An A-B-C design was utilized to compare regurgitation frequency and emotional distress across baseline, intervention (primary and secondary), and follow-up phases. Results demonstrated that HRT adapted for children was an effective approach to reducing regurgitation frequency. Self-monitoring alone and additional anxiety management skills provided further benefits to regurgitation frequency though to a lesser extent. Research on pediatric RD remains scarce, particularly regarding treatment for children of a younger age with additional psychological difficulties within clinical settings. Results from the current case study suggest that HRT adapted for children with RD and additional internalizing symptoms in a real-life clinical setting was feasible, acceptable, and effective. More research needs to be conducted on standardizing age-appropriate treatment adaptations for young children with RD and on exploring whether and which cognitive-behavioral techniques provide further meaningful reductions in regurgitation frequency.

Avoidant/restrictive food intake disorder (ARFID) and gastrointestinal (GI)-related somatic symptom and related disorders (SSRDs) commonly co-occur, and both are associated with confusion in the process of accessing treatment. Furthermore, health professionals report low confidence in providing care for these conditions. Using a life history methodology, we explored the journeys of children and their parents with the diagnosis and treatment of ARFID and/or SSRDs and examined themes in barriers and facilitators to care. Six families with children (4 boys and 2 girls; 8–14 years old) with a diagnosis of ARFID and/or GI-related SSRD were recruited from a pediatric tertiary-level hospital. Interviews were conducted with four parents alone, and two parent-child dyads. Participants provided rich histories of the child’s health journeys with variation in the development of ARFID and GI-related SSRDs and subsequent management. Diagnostic uncertainty, the emotional impact of this journey on families, and systemic barriers to accessing treatment were themes of the healthcare narratives. Validating the emotional impacts of the healthcare journey and building trust may be helpful to address the diagnostic uncertainty that families experience. Strategies to support adaptation of cognitive-behavioral approaches for with children with complex ARFID and/or SSRDs are discussed.

Integrated behavioral health (IBH) in primary care is growing as an approach to decrease barriers and provide earlier intervention for youth experiencing behavioral and mental health symptoms. However, increasing access to mental health providers alone without ensuring evidence-based treatment (EBT) is provided will not sufficiently address the current mental health crisis. To spread to scale, IBH needs to be implemented and tested in community-based practices with integrity to EBT. This paper provides a model for implementing cognitive behavioral therapy (CBT) in community pediatric primary care via master’s prepared therapists through an academic-community partnership. This paper describes the hiring practices, training in CBT, ongoing supervision and consultation, and use of data to inform the evolution of the model. Using a retrospective review of the rate of emergency department (ED) admissions per 1,000 patients with a diagnosis of depression, we compared practices enrolled in our academic-community partnership IBH model to practices who implemented their own IBH and practices with no IBH. Across a four-year period, we found that practices enrolled in the academic-community partnership IBH model had a lower number of patients per 1,000 patients with a diagnosis of depression admitted to the ED with behavioral health concerns compared to practices that did not incorporate an IBH therapist. There was no difference in ED admission rates per 1,000 between practices that hired their own IBH and those without IBH. Analysis of costs of the program against generated revenue from billed services demonstrated that the academic-community partnership model shows promise of sustainability.

The current pilot study evaluates a cognitive behavioral (CBT) sleep intervention specifically developed for adolescents with ADHD – Sleep IntervEntion as Symptom Treatment for ADHD (SIESTA). Based on a qualitative and quantitative evaluation, the final aim is to fine-tune SIESTA and the assessment protocol to the target population. Eight adolescents (13–17 years old) with ADHD and sleep problems completed SIESTA. Separate focus groups with adolescents and parents were conducted to evaluate their experience with SIESTA and the assessment protocol. These were analyzed using thematic analysis. Additionally, individual reliable change indices were computed from pretest to posttest for sleep hygiene practices. Thematic analysis showed that adolescents and parents reported both positive aspects and points of improvement of SIESTA and the assessment protocol during the focus groups. Reliable change indices showed that all adolescents significantly improved on at least one of the subscales of the revised Adolescent Sleep Hygiene Scale. Preliminary qualitative findings indicate satisfaction with SIESTA and the assessment protocol, with some suggestions for further improvements, and quantitative findings indicate significant improvement in sleep hygiene. The next step is to test the effectiveness of SIESTA in a randomized controlled trial, based on the adaptations after this pilot study.

Childhood constipation and painful defecation is common, affecting 68% to 86% of children. Over 90% withhold stool, some only defecating in a diaper. Behavioral therapy is effective for encopresis, but there is minimal research on treating toilet avoidance. This study investigates a novel protocol to eliminate diapers in children with toilet avoidance.

A diaper fading protocol was used with four children with toilet avoidance. Children were instructed to defecate in the bathroom, moving progressively closer to the toilet until they eventually sat on the toilet with the diaper. As needed, diapers were then faded by cutting increasingly wider slits in the base of the diaper so that stool could pass into the toilet. The cut widened until the diaper was eliminated entirely.

Four children (three boys, average 5.22 years old) successfully completed toilet training using the diaper fading protocol in an average of 9.75 sessions. Delivery of treatment via telehealth was shown to be effective. The diaper fading protocol effectively and flexibly assisted toilet training in four children with stool withholding and toileting avoidance. Future work should investigate whether caregivers can utilize the protocol without ongoing support, or on a consultation basis only, to reduce the burden on health care workers with long waitlists.

Caregivers of children with cancer face a myriad of stressors related to caring for their child that can place them at risk for mental health concerns above and beyond that of the average adult. Additionally, they grapple with the existential distress caused by the possibility that they may outlive their child. Caregiver distress is not only problematic for their own emotional, spiritual, social, and physical well-being, but also affects the family unit and can interfere with aspects of the child’s treatment. Clinicians trained in cognitive behavioral therapy (CBT) are well suited to support caregivers. Moreover, there is a strong evidence base for using interventions that incorporate cognitive and behavioral approaches with caregivers of children with cancer. We describe CBT’s application to this population through several case examples and also highlight important special considerations.

Youth living with chronic medical conditions and their families face several challenges (e.g., adjustment to a new diagnosis, ongoing daily condition management, coping with potential long-term consequences of illness). Traditional CBT approaches emphasize collaborative problem-solving with a core focus on change. At times, these approaches may feel inaccessible or unhelpful for pediatric patients and their families who are facing illness-related challenges that they cannot change or control. Dialectical behavior therapy integrates CBT-based change interventions with acceptance-based strategies to normalize challenging thoughts and emotions and help individuals feel validated. Medical providers working with pediatric patients and families can also benefit from a DBT-based conceptualization and approach to improve patient/family-provider relationships. This article summarizes the current evidence base for and justifies the use of adaptations of DBT for patients with medical illness. Further, through clinical case examples, it illustrates the use of DBT skills and concepts in improving outcomes for pediatric patients and their families.