Multi-Family Pediatric Pain Group Therapy: Capturing Acceptance and Cultivating Change

Samantha E Huestis; Grace Kao; Ashley Dunn; Austin T Hilliard; Isabel A Yoon; Brenda Golianu; Rashmi P Bhandari

doi:10.3390/children4120106

Multi-Family Pediatric Pain Group Therapy: Capturing Acceptance and Cultivating Change

Children (Basel). 2017 Dec 7;4(12):106. doi: 10.3390/children4120106.

Authors

Samantha E Huestis¹, Grace Kao², Ashley Dunn³, Austin T Hilliard⁴, Isabel A Yoon⁵, Brenda Golianu⁶, Rashmi P Bhandari⁷

Affiliations

¹ Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA. shuestis@stanford.edu.
² Departments of Pediatrics and Anesthesiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA. grace.kao@bcm.edu.
³ Spectrum, The Stanford Center for Clinical and Translational Research and Education, Palo Alto, CA 94304, USA. adunn2@stanford.edu.
⁴ Department of Biology, Stanford University; Stanford, CA 94305, USA. ahilliar@stanford.edu.
⁵ Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA. iayoon@stanford.edu.
⁶ Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA. bgolianu@stanford.edu.
⁷ Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA. rbhandar@stanford.edu.

Abstract

Behavioral health interventions for pediatric chronic pain include cognitive-behavioral (CBT), acceptance and commitment (ACT), and family-based therapies, though literature regarding multi-family therapy (MFT) is sparse. This investigation examined the utility and outcomes of the Courage to Act with Pain: Teens Identifying Values, Acceptance, and Treatment Effects (CAPTIVATE) program, which included all three modalities (CBT, ACT, MFT) for youth with chronic pain and their parents. Program utility, engagement, and satisfaction were evaluated via quantitative and qualitative feedback. Pain-specific psychological, behavioral, and interpersonal processes were examined along with outcomes related to disability, quality of life, pain interference, fatigue, anxiety, and depressive symptoms. Participants indicated that CAPTIVATE was constructive, engaging, and helpful for social and family systems. Clinical and statistical improvements with large effect sizes were captured for pain catastrophizing, acceptance, and protective parenting but not family functioning. Similar effects were found for functional disability, pain interference, fatigue, anxiety, and depression. Given the importance of targeting multiple systems in the management of pediatric chronic pain, preliminary findings suggest a potential new group-based treatment option for youth and families. Next steps involve evaluating the differential effect of the program over treatment as usual, as well as specific CBT, ACT, and MFT components and processes that may affect outcomes.

Keywords: acceptance and commitment therapy (ACT); adolescents; children; cognitive-behavioral therapy (CBT); group therapy; multi-family therapy (MFT); pediatric chronic pain.