This study is a preliminary investigation of the efficacy of a brief intervention for recurrent abdominal pain (RAP) via a multiple baseline across subjects design. The intervention consisted of a single 1-hour session including psychoeducation and coaching of breathing retraining; the length, duration, and content of the intervention were designed with a goal of maximum portability to primary-care settings. Five children with recurrent abdominal pain participated in this study, 1 of whom served as a pilot participant. Children received the intervention at 1-week intervals. Parent and child reports of each child's abdominal pain, general somatic complaints, functional disability, and anxiety were collected throughout the study. All children participated in a 3-month follow-up session. Results indicated that this brief intervention was successful in lessening abdominal pain, as demonstrated by decreased Abdominal Pain Index (API) scores in two children and decreased abdominal pain following breathing retraining practice in all children. The intervention was also successful in decreasing some children's general somatic symptoms. Functional disability and anxiety symptoms remained consistent for all children throughout the study, which may be due to low levels of these symptoms pretreatment. Limitations and directions for future research are discussed.
Recurrent abdominal pain (RAP) is a prevalent chronic pain condition in children that has been implicated in the development of other gastrointestinal disorders over time (Colletti, 1998, Feuerstein and Dobkin, 1990, Stickler and Murphy, 1979, Walker et al., 1995 and Walker et al., 1998). Children with RAP experience abdominal pain in the absence of an identifiable biological cause and generally have functional impairment in a variety of settings (Apley, 1975 and Kaminsky et al., 2006).
Anxiety has been hypothesized to be a causal factor in the development of RAP, because parental anxiety predicts the occurrence of RAP in children and because somatic complaints such as stomach pain are common in anxious individuals (Garber et al., 1990, Liakopoulou-Kairis et al., 2002, Ramchandani et al., 2006, Wasserman et al., 1988 and Woodbury, 1993).
Children with RAP are typically treated by their pediatricians or family practitioners; however, standard medical treatment has not proven to be effective with this population (Frazer and Rappaport, 1999 and Walker et al., 2001). Some cognitive-behavioral treatments for RAP have appeared promising (e.g., Banez and Gallagher, 2006, Janicke and Finney, 1999 and Robins et al., 2005), but multiple barriers to these types of treatments for RAP exist, including length of the interventions and service setting (Robins et al., 2005 and Walker et al., 2001). Brief treatments for anxiety may be beneficial in lessening costs, increasing compliance, and improving RAP complaints (Ramchandani et al., 2006). With the goal of creating a brief, one-session intervention that could be implemented in a physician's office, where most children with RAP do seek treatment (Walker et al., 2001), the aim of this multiple baseline across subjects study was to create a preliminary investigation of the effect of psychoeducation and breathing retraining on RAP symptoms. These two interventions are commonly used in cognitive-behavioral treatments of anxiety disorders and can be taught in one session. Breathing retraining can directly affect physiological responding (Chorpita and Southam-Gerow, 2006, Hazlett-Stevens and Craske, 2003, Houghton and Saxon, 2007 and Ley, 1999) and can also provide its users with a sense of control (Garssen, de Ruiter, & Van Dyck, 1992), which is related to lower levels of anxiety (e.g., Sanderson et al., 1989 and Weems et al., 2003). The hypotheses of this study were that children would report fewer and less intense abdominal pain episodes, less functional disability, fewer somatic complaints, and fewer anxiety symptoms following the intervention.
