Feelings/Body Investigators:Interoceptive Exposure for Children w/Abdominal Pain

感受/身体调查员：腹痛儿童的内感受暴露

基本信息

批准号：
8512185
负责人：
HELEN L. EGGER
金额：
$ 25.66万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-26 至 2015-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8512185
关键词：
8 year old Abdominal Pain Adaptive Behaviors Address Adult Aftercare Age Anxiety Awareness Basic Science Behavior Behavior Therapy Behavioral Brain Butterflies Caregivers Caring Child Childhood Clinic Curiosities Development Diagnostic tests Disease Distress Early Intervention Eating Educational Intervention Educational process of instructing Emotions Enrollment Epidemiologic Methods Esthesia Evaluation Facial Affective Scale Family Feeling Fright Future Health Home environment Homeostasis Hunger Impairment Internet Intervention Label Laboratories Lead Learning Link Longevity Medical Mental Health Mental disorders Mission Modification Moods Neurosciences Neurosciences Research Nursery Schools Pain Pain Disorder Pain management Parent-Child Relations Parenting Education Parents Participant Pattern Phase Prevention Primary Health Care Psychopathology Psychophysiologic Disorders Public Health Randomized Recurrence Recurrent pain Regulation Research Research Personnel Research Support Risk Safety Sampling Schools Signal Transduction Social Environment Solutions Stress Symptoms Syndrome Testing Time Training Translating Translational Research Viscera Visceral Visceral pain Weight Work active control base chronic abdominal pain chronic pain clinically significant cost design diaries early childhood emotion regulation emotional experience experience fascinate fundamental research group intervention health care service utilization improved improved functioning innovation neural circuit neurodevelopment novel physical conditioning prevent public health relevance research and development response role model satisfaction success therapy development treatment program

项目摘要

DESCRIPTION (provided by applicant): This application, Feelings and Body Investigators (FBI): Interoceptive Exposure for Child Abdominal Pain is in response to PA-11-177, Translational Research for the Development of Novel Interventions for Mental Disorders (R21/R33). We propose development and pilot-testing of an acceptance- based behavioral treatment for young children (5-8 years old) with functional abdominal pain (FAP; R21, n=26, R33, n=100). FAP is one of the most frequent somatic syndromes in young children, causes significant impairment, and is predictive of psychiatric and pain disorders later in childhood and in adulthood. No treatments exist for very young children with FAP. Research supports that FAP is influenced by: (1) early pain on the neurodevelopment of the gut-brain axis and (2) maladaptive interactions with the social environment that inadvertently increase somatic fear. These vulnerabilities provide targets for early intervention. OBJECTIVE: To develop and pilot an intervention for FAP based on fundamental neuroscience research on the aberrant neurodevelopment of the gut-brain axis and subsequent modification by the social environment. Our treatment 1) links intervention strategies to unique patterns of neural circuit maturation associated with early visceral pain on the gut-brain axis, 2) adapts acceptance-based behavioral strategies used to address psychopathology in older children to younger children, and 3) incorporates caregivers as role models and facilitators based on attachment research. METHODS: Our ten session intervention trains children to be "Feeling and Body Investigators". Half of the sessions will be done in clinic and half at home via web-camera to facilitate generalization. During the treatment child/caregiver dyads will 1) gather body clues (Learn), 2) investigate (Experience: perform interoceptive mystery missions to explore a body sensation), 3) organize body clues (Contextualize: recall other contexts that evoke similar sensations), and 4) go on increasingly daring missions (Challenge: decrease avoidance and safety behaviors). In the R21 phase we will develop and refine the FBI intervention in 26 child- caregiver dyads. In the R33 phase we will randomize 100 children with FAP to FBI or an active control (parent education with standard medical care) to conduct a pilot-test of the feasibility, acceptability, an clinical significance of FBI compared with an active control treatment. We will use epidemiological methods to screen all eligible children attending primary care practices so that our sample will be representative of young children with FAP, not simply a convenience sample. If we are successful, young children with FAP who complete our FBI early intervention will learn to experience changes in the viscera as fun and fascinating, rather than scary, and will develop new capacities for pain management, adaptive functioning, and emotion regulation. The success of our early intervention for FAP in young children will also have broad implications for the treatment and prevention of mental illness and chronic abdominal pain.

描述（由申请人提供）：本申请，情感和身体调查员 (FBI)：儿童腹痛的内感受暴露是对 PA-11-177，精神障碍新型干预措施开发的转化研究 (R21/R33) 的回应。我们建议针对患有功能性腹痛的幼儿（5-8 岁）（FAP；R21，n=26，R33，n=100）开发一种基于接受的行为治疗方法并进行试点测试。 FAP 是幼儿中最常见的躯体综合征之一，会造成严重损害，并预示着儿童后期和成年后的精神和疼痛疾病。目前还没有针对患有 FAP 的幼儿的治疗方法。研究表明，FAP 受到以下因素的影响：(1) 肠脑轴神经发育的早期疼痛；(2) 与社会环境的适应不良相互作用，无意中增加了躯体恐惧。这些漏洞为早期干预提供了目标。目的：基于对肠-脑轴异常神经发育和随后社会环境改变的基础神经科学研究，开发和试点 FAP 干预措施。我们的治疗方法 1) 将干预策略与与肠脑轴早期内脏疼痛相关的神经回路成熟的独特模式联系起来，2) 采用基于接受的行为策略，用于解决年龄较大儿童和年幼儿童的精神病理学问题，3) 将照顾者纳入其中作为基于依恋研究的榜样和促进者。方法：我们的十次干预训练孩子们成为“感觉和身体调查员”。一半的课程将在诊所进行，一半在家里通过网络摄像头进行，以促进概括。在治疗期间，儿童/看护者二人组将 1) 收集身体线索（学习），2) 调查（体验：执行内感受神秘任务以探索身体感觉），3) 组织身体线索（情境化：回忆引起类似感觉的其他情境），4）继续执行越来越大胆的任务（挑战：减少回避和安全行为）。在 R21 阶段，我们将制定和完善 FBI 对 26 个儿童看护者二人组的干预措施。在 R33 阶段，我们将随机将 100 名 FAP 儿童纳入 FBI 或主动对照（家长教育与标准医疗护理），以对 FBI 与主动对照治疗相比的可行性、可接受性和临床意义进行试点测试。我们将使用流行病学方法来筛查所有参加初级保健实践的符合条件的儿童，以便我们的样本能够代表患有 FAP 的幼儿，而不仅仅是一个方便样本。如果我们成功，完成 FBI 早期干预的 FAP 幼儿将学会体验内脏的变化，这是有趣和迷人的，而不是可怕的，并将发展疼痛管理、适应性功能和情绪调节的新能力。我们对幼儿 FAP 早期干预的成功也将对精神疾病和慢性腹痛的治疗和预防产生广泛的影响。