CBT for Children FINAL

8/3/2019 CBT for Children FINAL

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Sarah Merchant, Victoria English and David Hexter

Physiotherapy Year 3


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It is a way of talking about:

-how you think about yourself, the world

and other people

-how what you do affects your thoughts

and feelings.


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` Biopsychosocial model of pain

The experience of pain is mediated by an

integration of physiological processes with

psychological and social variables (Melzackand Wall, 1965, 1982)

The experience of anxiety, depression and

stress can increase the anticipation of pain,and intensify the physiological feeling of pain

within the body.


4/19

` MSK pain accounts for 64% of pain in

childhood

` Older children with chronic pain report

chronic disability and emotional distress

above a normal level.

` Incidence of MSK pain peaks at 14 years of

age but practitioners are increasing seeinga younger cohort.

(Rursch 1998, Rulbena 1992)


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` Chronic pain in adulthood is extremely

expensive

` We need to stop todays children with pain

becoming the futures adults.

` Costs

Direct cost (to NHS)- 7,947

Indirect cost (to the family)- 6, 213 Total cost per annum- 14,160

(Sleed 2005)


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Pain and

Children

Reduced school

attendanceIsolation

Sleep

Stress on

family

Not like

other

children

Cant play

as in too

much pain

Fear

Not being

believed

Lots of

investigation

and HCPs

Reduced

independenceTearful

Bullied

No energy

/ feeling

weakMedications


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CBT can help to make sense of problems bybreaking them down into smaller parts. Thismakes it easier to see how they are connectedand how they affect the patient.

These parts are: a situation, problem or event

From this can follow:

ThoughtsEmotionsPhysical feelingsActions


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Conditions when CBT is used? Complex regional pain syndromes

Chronic fatigue

Behavioural and psychological disorders

Areas of paediatric physiotherapy it is used in:

Rheumatological, Post surgery

Chronic Pain

Cardiorespiratory, Neurology, Outpatients

Post-surgical

THINK OF THE SCOPE OF YOUR PRACTICE!!


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THE CHILD

THE FAMILY

THE SCHOOL

THE

THERAPISTS


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A change of focus from CURING to MANAGING

the pain.

Continuing with steady amounts of activity

Focus on return to school and social activities

Independent participation in appropriate

activities for age.


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Positive

Statements

Mental

Imagery

Relaxation

techniques

Distraction

Goal Setting

Education of

pain process

Practicing

techniques

when the child

is not in painso that they are

effective when

in pain.

Positive

experiences

Education

for

parents

Positive role

models

Management

of flare ups

Pacing


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` Aids the building of a therapeutic relationship

` Improved adherence of exercises

` Pain management strategies reduced pain

behaviours and avoidance` Helps in using coping skills and goal setting

` Beneficial when used in painful or distressing

physiotherapy sessions. As CBT dampens fear

and negative pain sensation, makingphysiotherapy more effective. (Zussman 2005)


13/19

` RCTs are gold standard for evaluating therapies

in evidence-based practice.

` Lee et al (2002) Conducted an RCT on the efficacy ofCBT for

children with chronic neuropathic pain.

CBT techniques and Physiotherapy.

At the short term and long term follow ups, allpatients displayed reduction in pain and gait

impairments


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Bailey (2001)

-uses performance based procedures as well as cognitive

interventions to produce changes in thinking, feeling andbehaviour.

-More effective than non-CBT.

-Useful for conditions including:

Depression, anxiety disorders, OCD, eating disorders.Conduct disorders, ADHD

Connelly and Schanberg (2006)

-Prevalence of paediatric chronic pain is increasing but noone standard of care/framework has been established

-Paediatric CRPS- physical therapy with CBT before

pharmacological approach


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` Kashikar-Zuck et al. (2005)

` Juvenile primary Fibromyalgia syndrome. CBT waseffective for coping with pain.

` CBT in conjunction with pharmacological agents has

been proven effective, further research is necessary to

look at CBT alone.

` CBT in physiotherapy is useful and effective but requires

an MDT approach to maintain continuity for the patient.


16/19

`

9 year old female` Complex regional pain syndrome post fracture of

non dominant hand and tibia.

` Reduced ROM and RROM non dominate hand

and lower limb.` Reduced ability to carry out ADLS and pain

behaviour.

` Pain VAS 9/10 compliance with PT is limited by

pain

` Treatment......


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` Bailey` Connelly and Schanberg (2006)

` Kashikar-Zuck S, Swain NF, Jones BA, Graham TB. (2005) Efficacy

of cognitive behavioural intervention for juvenile primary

fibromyalgia syndrome. J Rheumatol, 32:15941602.

` Lee BH, Scharff L, Sethna NF, McCarthy CF, Scott-Sutherland J,Shea AM, et al. Physical therapy and cognitive-behavioral treatment

for complex regional pain syndromes. J Pediatr. 2002;141(1):135

40.

` Zussman 2005

CBT for Children FINAL

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