Catastrophizing, Child Pain Behavior, and Parental Response

灾难化、儿童疼痛行为和家长反应

• 批准号: 8239964
• 负责人: Shelby Langer
• 金额: $ 21.75万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8239964
• 关键词: Abdomen; Abdominal Pain; Adult; Affect; Affective; Age; Anxiety; Attention; Beds; Behavioral; Books; Caring; Child; Childhood; Chronic; Code; Cognition; Cognitive; Development; Disease; Distress; Environment; Etiology; Exhibits; Family; Frequencies; Functional disorder; Health Care Costs; Home environment; Impairment; Intervention; Investigation; Irritable Bowel Syndrome; Lead; Learning; Maintenance; Measures; Mediating; Medical; Methodology; Modification; Mothers; Outcome; Pain; Pain intensity; Paper; Parent-Child Relations; Parents; Participant; Pathway interactions; Pattern; Personal Satisfaction; Persons; Pilot Projects; Play; Prevalence; Procedures; Process; Questionnaires; Recurrence; Research; Risk; Role; Schools; Sick Role; Simulate; Social Environment; Source; Symptoms; Testing; Toy; Videotape; Water; Work; aged; behavior observation; chronic pain; coping; cost; design; disability; drinking water; experience; functional disability; health care service utilization; in vivo; innovation; insight; pain behavior; peer; psychosocial; response; social; therapy design

DESCRIPTION (provided by applicant): Functional Abdominal Pain (FAP) of childhood is a disorder for which there is no identifiable organic etiology, yet which is associated with illness behavior of significant personal and societal cost. Prior research suggests that responses from the environment contribute to such illness behavior and dysfunction through social learning processes, as when parents respond solicitously to child symptom complaints, e.g., with increased attention and relief from responsibility. Catastrophizing (CAT), an overly negative appraisal in which pain is seen as signifying a high degree of threat or harm, is known to amplify the experience and expression of pain, but the relationship of CAT to social learning processes has not been adequately examined. In the present proposal, we focus on CAT cognitions on the part of significant others, specifically, mothers of children with FAP. Mothers' CAT about their child's pain may lead them to interpret pain behaviors exhibited by their child as indicative of harm, damage or threat to the well-being of the child, and thus may increase the likelihood that they intervene by taking action to reduce demands on the child or allay the child's discomfort via solicitous responding, thereby encouraging illness behavior. This project aims to: 1) assess feasibility of a symptom provocation and behavioral observation paradigm designed to examine FAP child pain behavior and maternal response, and 2) determine whether the association between child pain behavior and maternal solicitousness is mediated by maternal CAT. Seventy-five children with FAP aged 8-12 and their mothers will serve as participants. Mothers will complete measures designed to assess generalized anxiety, CAT cognitions regarding their child's pain, and typical responses to their child's symptom complaints. Children will rate their pain intensity and then participate in a safe and validated water load procedure intended to simulate abdominal discomfort; in so doing, they will be asked to drink water until they are completely full, not to exceed 15 minutes. Next, children will clean a room much as they would at home (e.g., put away books and toys and make a bed). Children will be instructed to take the lead in this task but may ask their mother for assistance; similarly, mothers may offer assistance with or without a request from their child. The water load procedure and ensuing cleaning task will be videotaped, affording behavioral coding of child pain behavior and maternal response. Post-task questionnaires will assess acceptability of the paradigm. Findings will lay the groundwork for conducting a larger study using this methodology to explore the cognitive, affective, and behavioral pathways by which FAP may be maintained. This in turn will help to determine appropriate targets for intervention for children with FAP and their families, with the aim of reducing associated dysfunction and distress. PUBLIC HEALTH RELEVANCE: This research will afford heightened understanding of the mechanisms by which recurrent functional abdominal pain (FAP) of childhood is maintained, a disorder of significant personal and societal cost. Findings will aid in the development of targeted interventions designed to reduce pain-related maladaptive cognitions and/or maladaptive parent/ child interaction patterns, thereby reducing associated disability and health care utilization. While focused specifically on FAP, findings from this and subsequent projects could offer insight into a wide range of medical conditions for which intra- and inter-personal factors play a role in the illness experience.

描述（由申请人提供）：儿童功能性腹痛（FAP）是一种没有可识别的器质性病因的疾病，但与造成重大个人和社会成本的疾病行为有关。先前的研究表明，环境的反应通过社会学习过程导致这种疾病行为和功能障碍，例如当父母对孩子的症状投诉做出热切的反应时，例如，增加注意力并减轻责任。灾难化（CAT）是一种过度负面的评价，其中疼痛被视为意味着高度的威胁或伤害，众所周知，它会放大疼痛的体验和表达，但 CAT 与社会学习过程的关系尚未得到充分研究。在本提案中，我们重点关注重要他人（特别是 FAP 儿童的母亲）的 CAT 认知。母亲对孩子疼痛的 CAT 可能会导致她们将孩子表现出的疼痛行为解释为对孩子健康的伤害、损害或威胁，因此可能会增加她们采取行动减少需求进行干预的可能性或通过关心的回应来减轻孩子的不适，从而鼓励疾病行为。该项目旨在：1) 评估旨在检查 FAP 儿童疼痛行为和母亲反应的症状激发和行为观察范式的可行性，2) 确定儿童疼痛行为和母亲关心之间的关联是否由母亲 CAT 介导。 75 名 8-12 岁的 FAP 儿童及其母亲将作为参与者。母亲们将完成旨在评估广泛性焦虑、对孩子疼痛的 CAT 认知以及对孩子症状的典型反应的措施。孩子们将评估他们的疼痛强度，然后参加安全且经过验证的水负荷程序，旨在模拟腹部不适；在此过程中，他们将被要求喝水直至完全饱为止，但时间不得超过 15 分钟。接下来，孩子们将像在家里一样打扫房间（例如，收起书籍和玩具并铺床）。孩子们将被要求带头完成这项任务，但也可以向母亲寻求帮助；同样，无论是否有孩子的请求，母亲都可以提供帮助。水加载过程和随后的清洁任务将被录像，提供儿童疼痛行为和母亲反应的行为编码。任务后调查问卷将评估范例的可接受性。研究结果将为使用这种方法进行更大规模的研究奠定基础，以探索维持 FAP 的认知、情感和行为途径。这反过来将有助于确定对 FAP 儿童及其家人进行干预的适当目标，以减少相关的功能障碍和痛苦。 公共健康相关性：这项研究将加深对儿童复发性功能性腹痛 (FAP) 维持机制的理解，这是一种对个人和社会造成重大损失的疾病。研究结果将有助于制定有针对性的干预措施，旨在减少与疼痛相关的适应不良认知和/或适应不良的父母/儿童互动模式，从而减少相关的残疾和医疗保健的利用。虽然专门关注 FAP，但该项目和后续项目的研究结果可以深入了解各种医疗状况，这些医疗状况中的个人内部和人际因素在疾病经历中发挥着作用。