CBT for Anxiety and Associated Somatic Complaints in Pediatric Medical Settings: An Open Pilot Study

Objective: To examine the initial feasibility and potential efficacy of a cognitive-behavioral intervention for youth with anxiety disorders and non-medical somatic symptoms. Background: Based on a strong relationship between somatic complaints and anxiety disorders, screening youngsters seeking medical care due to physical symptoms with no organic basis may enhance the recognition of anxiety disorders and facilitate access to appropriate services. Method: Seven boys and girls, ages 8 through 15, with medically unexplained gastrointestinal complaints and anxiety disorders received a 12-session cognitive-behavioral intervention targeting anxiety and physical symptoms. Assessments were conducted at baseline and following treatment. Results: All participants were classified as treatment responders. Three of the seven participants no longer met diagnostic criteria for their principal anxiety disorder. Children\u27s physical discomfort decreased from a moderate to minimal level based on self- and parent-reports. Conclusions: Our modified cognitive-behavioral approach has promise for reducing anxiety and somatic symptoms in children seeking medical care

Illness-Specific Anxiety: Implications for Functioning and Utilization of Medical Services in Adolescents with Inflammatory Bowel Disease

Purpose. Adolescents with inflammatory bowel disease (IBD) may be at heightened risk for developing anxiety and depression. This cross-sectional pilot study examined the relationship between anxiety and depression and health-related behaviors. Methods. Thirty-six adolescents with diagnosed IBD, ages 12-17, and their parents were recruited from two pediatric gastroenterology medical centers. Results. Clinical levels of anxiety (22%) and depressive symptoms (30%) were reported by patients. Regression analyses revealed that IBD-specific anxiety was significantly associated with greater utilization of medical services and worsened psychosocial functioning. Practice Implications. Results provide preliminary support that IBD-specific anxiety may play an important role in disease management, yet concerns are rarely systematically assessed by health professionals

Integrating Illness Concerns Into Cognitive Behavioral Therapy for Children and Adolescents with Inflammatory Bowel Disease and Co-Occurring Anxiety

Purpose: To examine the feasibility and preliminary benefits of an integrative cognitive behavioral therapy (CBT) with adolescents with inflammatory bowel disease and anxiety. Design and Methods: Nine adolescents participated in a CBT program at their gastroenterologist\u27s office. Structured diagnostic interviews, self-report measures of anxiety and pain, and physician-rated disease severity were collected pretreatment and post-treatment. Results: Postintervention, 88% of adolescents were treatment responders, and 50% no longer met criteria for their principal anxiety disorder. Decreases were demonstrated in anxiety, pain, and disease severity. Practice Implications: Anxiety screening and a mental health referral to professionals familiar with medical management issues is important

Treatment for Comorbid Pediatric Gastrointestinal and Anxiety Disorders: A Pilot Study of a Flexible Health Sensitive Cognitive-Behavioral Therapy Program

Anxiety is a prevalent and impairing psychiatric condition among children and adolescents with inflammatory bowel disease (IBD). Despite the need for effective treatment, no studies have examined the benefit of cognitive-behavioral therapy (CBT) for anxiety disorders among children or adults with IBD. The aim of this paper is twofold: (a) to briefly describe a newly adapted CBT protocol, treatment of anxiety and physical symptoms related to IBD (TAPS + IBD), that concurrently addresses anxiety (including IBD-specific anxiety) and disease management among children and adolescents with IBD in pediatric medical offices; and (b) to present initial pilot data examining the feasibility and potential efficacy of TAPS + IBD compared to nondirective supportive therapy (NDST) among youth with comorbid IBD and anxiety. Twenty-Two youth (59% female; mean age 13.2 ± 2.1) with comorbid IBD and anxiety disorder were randomly assigned to a 13-session TAPS + IBD or NDST program. Following treatment, participants in TAPS + IBD demonstrated higher treatment response rates relative to the NDST control treatment. Compared with NDST, TAPS + IBD was associated with significantly greater reductions in IBD-specific anxiety immediately following treatment and 3 months later. TAPS + IBD shows initial promise for the treatment of anxiety in youth with IBD. The direct integration of behavioral health strategies into medical settings and use of a flexible CBT approach sensitive to acute disease fluctuations appears to be beneficial among youth with comorbid IBD and anxiety

Cognitive-Behavioral Treatment of Persistent Functional Somatic Complaints and Pediatric Anxiety: An Initial Controlled Trial

Background: Children and adolescents who seek medical treatment for persistent physical distress often suffer from co-occurring anxiety disorders. Treatment options for this impaired population are limited. This study tests the feasibility and potential efficacy of a cognitive-behavioral intervention targeting pain and anxiety for youth with impairing functional physical symptoms and anxiety disorders presenting to pediatricians for medical care. Methods: Children and adolescents (aged 8-16) experiencing somatic complaints, without an explanatory medical disorder (i.e., functional), were recruited from primary care and specialty (gastroenterologists and cardiologists) pediatricians. Forty children, primarily with gastrointestinal symptoms, who met criteria for a co-occurring anxiety disorder, were randomly assigned to a cognitive-behavioral treatment addressing pain and anxiety, Treatment of Anxiety and Physical Symptoms (TAPS), or to a waiting list control. Results: TAPS was found to be an acceptable treatment for this population and was superior to the waiting list condition. Eighty percent of children in TAPS were rated as treatment responders by independent evaluators compared with none of the controls. Overall, self- and parent ratings indicated reductions in children\u27s somatic discomfort and anxiety following intervention. TAPS participants maintained clinical gains 3 months following treatment. Conclusions: The study supports the feasibility and preliminary efficacy of a cognitive-behavioral intervention targeting co-occurring physical distress and anxiety in youth presenting for medical treatment. Such an approach has the potential to exert broad impact on children\u27s dysfunction and to minimize exposure to invasive, ineffective, and costly medical procedures and treatments. Depression and Anxiety, 2011

Outras famílias: a construção social da conjugalidade homossexual no Brasil Different families: the social construction of homosexual conjugality in Brazil

Este artigo propõe uma reflexão sobre a construção social da conjugalidade homossexual no Brasil contemporâneo, especialmente no âmbito do Poder Legislativo, espaço privilegiado de discussão acerca do projeto de lei que institui a parceria civil entre pessoas do mesmo sexo. A análise dos elementos estruturantes nos embates ideológicos decorrentes das disputas em torno do reconhecimento social e jurídico das uniões homossexuais como entidades familiares, também é perpassada por discursos originários da Igreja Católica e de representantes da população homossexual.<br>This article presents some reflections on the social construction of homosexual conjugality in contemporary Brazil, particularly concerning the Legislative sphere - where most of the debate on the law project for civil partnership between people of the same sex has taken place. The main objective is to analyze the structuring elements of the ideological struggles stemming from the disputes around the social and juridical recognition of homosexual unions as familial entities. The discourses that come from the Catholic Church and those of homosexual representatives are also given priority in the analysis