Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain
Objective To evaluate whether clinical anxiety in children presenting to a pediatric pain management center is associated with a poorer treatment response for those who completed pain-focused cognitive behavioral therapy (CBT). Study design The total sample consisted of 175 children, 40 of whom comp...
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| Veröffentlicht in: | The Journal of pediatrics 2016-04, Vol.171, p.227-233 |
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| creator | Cunningham, Natoshia Raishevich, PhD Jagpal, Anjana, BA Tran, Susan T., PhD Kashikar-Zuck, Susmita, PhD Goldschneider, Kenneth R., MD Coghill, Robert C., PhD Lynch-Jordan, Anne M., PhD |
| description | Objective To evaluate whether clinical anxiety in children presenting to a pediatric pain management center is associated with a poorer treatment response for those who completed pain-focused cognitive behavioral therapy (CBT). Study design The total sample consisted of 175 children, 40 of whom completed CBT for chronic pain. The Screen for Child Anxiety Related Emotional Disorders was completed at initial evaluation and outcome measures (average pain intensity and the Functional Disability Inventory) were collected during the initial evaluation and at the end of CBT. Group differences in outcomes were examined following CBT. The role of anxiety in CBT initiation and completion was also explored. Results Presence of clinical anxiety was associated with greater initiation and/or completion of pain-focused CBT but also a poorer treatment response. Specifically, the group with subclinical anxiety exhibited a substantial reduction in pain intensity, and the group with clinical anxiety exhibited a more limited response to treatment (F [1, 36] = 13.68 P |
| doi_str_mv | 10.1016/j.jpeds.2016.01.018 |
| format | Article |
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Study design The total sample consisted of 175 children, 40 of whom completed CBT for chronic pain. The Screen for Child Anxiety Related Emotional Disorders was completed at initial evaluation and outcome measures (average pain intensity and the Functional Disability Inventory) were collected during the initial evaluation and at the end of CBT. Group differences in outcomes were examined following CBT. The role of anxiety in CBT initiation and completion was also explored. Results Presence of clinical anxiety was associated with greater initiation and/or completion of pain-focused CBT but also a poorer treatment response. Specifically, the group with subclinical anxiety exhibited a substantial reduction in pain intensity, and the group with clinical anxiety exhibited a more limited response to treatment (F [1, 36] = 13.68 P < .01). A similar effect was observed for Functional Disability Inventory, such that the group with clinical anxiety had a significantly smaller response to treatment (F [1, 38] = 4.33 P < .05). The difference in pain and disability between groups following CBT suggest moderate effects (Cohen d = 0.77 and 0.78, respectively). Conclusions Although youths with clinical anxiety are more likely to start and/or complete pain-focused CBT, anxiety has an adverse impact on CBT treatment response in children with chronic pain. Identification of patients with anxiety and use of tailored behavioral interventions may improve clinical outcomes.</description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/j.jpeds.2016.01.018</identifier><identifier>PMID: 26879812</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Anxiety - complications ; Anxiety - drug therapy ; Caregivers ; Child ; Chronic Pain - psychology ; Chronic Pain - therapy ; Cognitive Therapy - methods ; Female ; Hospitals, Pediatric ; Humans ; Male ; Midwestern United States ; Pain ; Pain Management ; Pediatrics ; Treatment Outcome</subject><ispartof>The Journal of pediatrics, 2016-04, Vol.171, p.227-233</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c540t-7ca40769d4f7f710cd2eb519339e3430bcae349a2468df88fc6fbc795e27040a3</citedby><cites>FETCH-LOGICAL-c540t-7ca40769d4f7f710cd2eb519339e3430bcae349a2468df88fc6fbc795e27040a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpeds.2016.01.018$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26879812$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cunningham, Natoshia Raishevich, PhD</creatorcontrib><creatorcontrib>Jagpal, Anjana, BA</creatorcontrib><creatorcontrib>Tran, Susan T., PhD</creatorcontrib><creatorcontrib>Kashikar-Zuck, Susmita, PhD</creatorcontrib><creatorcontrib>Goldschneider, Kenneth R., MD</creatorcontrib><creatorcontrib>Coghill, Robert C., PhD</creatorcontrib><creatorcontrib>Lynch-Jordan, Anne M., PhD</creatorcontrib><title>Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain</title><title>The Journal of pediatrics</title><addtitle>J Pediatr</addtitle><description>Objective To evaluate whether clinical anxiety in children presenting to a pediatric pain management center is associated with a poorer treatment response for those who completed pain-focused cognitive behavioral therapy (CBT). Study design The total sample consisted of 175 children, 40 of whom completed CBT for chronic pain. The Screen for Child Anxiety Related Emotional Disorders was completed at initial evaluation and outcome measures (average pain intensity and the Functional Disability Inventory) were collected during the initial evaluation and at the end of CBT. Group differences in outcomes were examined following CBT. The role of anxiety in CBT initiation and completion was also explored. Results Presence of clinical anxiety was associated with greater initiation and/or completion of pain-focused CBT but also a poorer treatment response. Specifically, the group with subclinical anxiety exhibited a substantial reduction in pain intensity, and the group with clinical anxiety exhibited a more limited response to treatment (F [1, 36] = 13.68 P < .01). A similar effect was observed for Functional Disability Inventory, such that the group with clinical anxiety had a significantly smaller response to treatment (F [1, 38] = 4.33 P < .05). The difference in pain and disability between groups following CBT suggest moderate effects (Cohen d = 0.77 and 0.78, respectively). Conclusions Although youths with clinical anxiety are more likely to start and/or complete pain-focused CBT, anxiety has an adverse impact on CBT treatment response in children with chronic pain. Identification of patients with anxiety and use of tailored behavioral interventions may improve clinical outcomes.</description><subject>Adolescent</subject><subject>Anxiety - complications</subject><subject>Anxiety - drug therapy</subject><subject>Caregivers</subject><subject>Child</subject><subject>Chronic Pain - psychology</subject><subject>Chronic Pain - therapy</subject><subject>Cognitive Therapy - methods</subject><subject>Female</subject><subject>Hospitals, Pediatric</subject><subject>Humans</subject><subject>Male</subject><subject>Midwestern United States</subject><subject>Pain</subject><subject>Pain Management</subject><subject>Pediatrics</subject><subject>Treatment Outcome</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUk2P1DAMrRCIHRZ-ARLKkUsHJ-k06YGVhhEfK60EguUcMqm7TekkJekU-u9JmWUFXJAsWZbfe7b8nGVPKawp0PJFt-4GrOOapWINNIW8l60oVCIvJef3sxUAYzkvRHmWPYqxA4CqAHiYnbFSikpStsq-bN0Pi-NMtvWEIWI_k8vDoM0YyUeMg3cRyejJzt84O9oJySts9WR90D25bjHoYSbWkV1r-zqgI9_t2KYqeGcN-aCte5w9aHQf8cltPs8-v3l9vXuXX71_e7nbXuVmU8CYC6MLEGVVF41oBAVTM9xvaMV5hbzgsDc65UqzopR1I2VjymZvRLVBJqAAzc-zi5PucNwfsDboxrSjGoI96DArr636u-Nsq278pAoJciOrJPD8ViD4b0eMozrYaLDvtUN_jIoKUZYsHXCB8hPUBB9jwOZuDAW1eKM69csbtXijgKaQifXszw3vOL_NSICXJwCmO00Wg4rGojNY24BmVLW3_xlw8Q_f9Db5oPuvOGPs_DG4ZIGiKjIF6tPyHst30DJ9BgPGfwIGlbe3</recordid><startdate>20160401</startdate><enddate>20160401</enddate><creator>Cunningham, Natoshia Raishevich, PhD</creator><creator>Jagpal, Anjana, BA</creator><creator>Tran, Susan T., PhD</creator><creator>Kashikar-Zuck, Susmita, PhD</creator><creator>Goldschneider, Kenneth R., MD</creator><creator>Coghill, Robert C., PhD</creator><creator>Lynch-Jordan, Anne M., PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160401</creationdate><title>Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain</title><author>Cunningham, Natoshia Raishevich, PhD ; Jagpal, Anjana, BA ; Tran, Susan T., PhD ; Kashikar-Zuck, Susmita, PhD ; Goldschneider, Kenneth R., MD ; Coghill, Robert C., PhD ; Lynch-Jordan, Anne M., PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c540t-7ca40769d4f7f710cd2eb519339e3430bcae349a2468df88fc6fbc795e27040a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Anxiety - complications</topic><topic>Anxiety - drug therapy</topic><topic>Caregivers</topic><topic>Child</topic><topic>Chronic Pain - psychology</topic><topic>Chronic Pain - therapy</topic><topic>Cognitive Therapy - methods</topic><topic>Female</topic><topic>Hospitals, Pediatric</topic><topic>Humans</topic><topic>Male</topic><topic>Midwestern United States</topic><topic>Pain</topic><topic>Pain Management</topic><topic>Pediatrics</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cunningham, Natoshia Raishevich, PhD</creatorcontrib><creatorcontrib>Jagpal, Anjana, BA</creatorcontrib><creatorcontrib>Tran, Susan T., PhD</creatorcontrib><creatorcontrib>Kashikar-Zuck, Susmita, PhD</creatorcontrib><creatorcontrib>Goldschneider, Kenneth R., MD</creatorcontrib><creatorcontrib>Coghill, Robert C., PhD</creatorcontrib><creatorcontrib>Lynch-Jordan, Anne M., PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cunningham, Natoshia Raishevich, PhD</au><au>Jagpal, Anjana, BA</au><au>Tran, Susan T., PhD</au><au>Kashikar-Zuck, Susmita, PhD</au><au>Goldschneider, Kenneth R., MD</au><au>Coghill, Robert C., PhD</au><au>Lynch-Jordan, Anne M., PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain</atitle><jtitle>The Journal of pediatrics</jtitle><addtitle>J Pediatr</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>171</volume><spage>227</spage><epage>233</epage><pages>227-233</pages><issn>0022-3476</issn><eissn>1097-6833</eissn><abstract>Objective To evaluate whether clinical anxiety in children presenting to a pediatric pain management center is associated with a poorer treatment response for those who completed pain-focused cognitive behavioral therapy (CBT). Study design The total sample consisted of 175 children, 40 of whom completed CBT for chronic pain. The Screen for Child Anxiety Related Emotional Disorders was completed at initial evaluation and outcome measures (average pain intensity and the Functional Disability Inventory) were collected during the initial evaluation and at the end of CBT. Group differences in outcomes were examined following CBT. The role of anxiety in CBT initiation and completion was also explored. Results Presence of clinical anxiety was associated with greater initiation and/or completion of pain-focused CBT but also a poorer treatment response. Specifically, the group with subclinical anxiety exhibited a substantial reduction in pain intensity, and the group with clinical anxiety exhibited a more limited response to treatment (F [1, 36] = 13.68 P < .01). A similar effect was observed for Functional Disability Inventory, such that the group with clinical anxiety had a significantly smaller response to treatment (F [1, 38] = 4.33 P < .05). The difference in pain and disability between groups following CBT suggest moderate effects (Cohen d = 0.77 and 0.78, respectively). Conclusions Although youths with clinical anxiety are more likely to start and/or complete pain-focused CBT, anxiety has an adverse impact on CBT treatment response in children with chronic pain. Identification of patients with anxiety and use of tailored behavioral interventions may improve clinical outcomes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26879812</pmid><doi>10.1016/j.jpeds.2016.01.018</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Anxiety - complications Anxiety - drug therapy Caregivers Child Chronic Pain - psychology Chronic Pain - therapy Cognitive Therapy - methods Female Hospitals, Pediatric Humans Male Midwestern United States Pain Pain Management Pediatrics Treatment Outcome |
| title | Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain |
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