Content of Interventions Tested in the Current Study

Description of Interventionn (%) of Children Who Received Module/Interventiona
CBT51 (100)
 Module 1. Relaxation training51 (100)
 Made use of following successive breathing and relaxation exercises:
  1. Breathing calmly through abdomen instead of breathing through chest.
  2. Jacobson’s progressive muscle relaxation: teaches children difference between tensing and relaxing muscles.
  3. General relaxation: teaches children to relax without tensing muscles first.
  4. Cue relaxation: teaches children to relax whole body at once on cue (eg, say “relax” in your mind and then relax the whole body).
  5. Hypnotic suggestion: teaches children to visualize their AP and change that image to decrease AP (eg, pain is visualized as red, spiky ball, during exercise child needs to imagine the ball getting less and less spiky, getting smaller, translucent, until it disappears).
 Module 2. Cognitive therapy30 (58.8)
  Focus: change negative thoughts about pain or negative thoughts about other things that aggravate pain (eg, worry about school or friends).
  Children were taught how the way they think about pain can affect the experience of pain and received exercises to try to change negative thoughts (eg, identify negative thoughts and think of alternative, more positive thoughts).
 Module 3. Behavior therapy directed at behavior child31 (60.8)
  Focus: change maladaptive pain-related coping behavior of child
  Children were educated about the benefits of continuing daily activities as a distraction from pain. In addition, children indicated what they could not do anymore because of the AP and what they would like to be able to do at the end of treatment. A hierarchy consisting of small consecutive steps was made to help guide the child to reach those activity goals (eg, goal: playing soccer again; step 1 = take a 15-min walk each day; step 2 = in addition to these walks, do two 10-min runs each week; step 3 = join soccer practice once a week; etc). A reward system was used to motivate children.
 Module 4. Behavior therapy directed at behavior of parent24 (47.1)
  Focus: change maladaptive pain-related coping behavior of parent.
  Parents were educated about the maladaptive effects of refraining children from activities and asking children frequently about their AP. Instead, parents were asked to stimulate their child to practice relaxation skills when the child complained of AP and to encourage their child to keep active. Additionally, they were taught how their own reactions to their physical complaints may serve as a model for how children respond to physical complaints.
IMC50 (100)
 Focus: pediatricians and pediatric gastroenterologists were allowed to do what they would normally do when treating children with FAP.
 Topics discussed: pain diary, education on brain-gut axis, dietary advice, advice to continue school and daily activities (without making detailed plans to achieve those goals). Types of medication prescribed: laxatives, loperamide, proton pump inhibitors, or pain medication.
  • a These numbers are based on the children who actually received the intervention not on intention to treat (eg, 1 child was allocated to IMC but received CBT instead at his request; this child is added to n for CBT in this Table).