Design of the FRESH-teen study: A randomized controlled trial evaluating an adapted emotion regulation weight loss program for adolescents with overweight or obesity and their parent.

Overweight and obesity affect >40% of adolescents. Family-based behavioral treatment (FBT) is the most efficacious behavioral treatment for weight management among youth and consists of nutrition and physical activity education, behavior change skills, and parent skills training. However, the efficacy of FBT decreases for youth as they get older. Increased emotional lability and limited emotion regulation skills may contribute to the reduced efficacy of FBT for adolescents. To date, there are no treatments for overweight or obesity specifically adapted for the needs of adolescents. We developed a treatment that integrates components from Dialectical Behavior Therapy and Emotion Focused Therapy with FBT (FBT+ER or FBT-ER) to address the specific needs of adolescents. The current study randomized 166 adolescents (BMI = 32.8; 14.3 years; 57% female; 32% Hispanic, 50% Non-Hispanic White, 18% Non-Hispanic and Non-White) and one of their parents (BMI = 32.9; 45.3 years; 85% female; 27% Hispanic, 57% Non-Hispanic White, 16% Non-Hispanic and Non-White) to 6 months of either standard FBT or FBT+ at 2 sites. Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12) and 12-month follow-up (month 18). Primary outcomes are adolescent weight (BMIz/%BMIp95), emotion regulation skills, and emotional eating behaviors. Given the public health concern of adolescent obesity, FBT+ could prove extremely useful to provide more targeted and effective intervention for adolescents with overweight or obesity. CLINICAL TRIALS: # NCT03674944.

Parental coping in the neonatal intensive care unit.

Fifty-six mothers of premature infants who participated in a study to reduce symptoms of posttraumatic stress disorder (PTSD) completed the Brief COPE, a self-report inventory of coping mechanisms, the Stanford Acute Stress Reaction Questionnaire to assess acute stress disorder (ASD) and the Davidson Trauma Scale to assess PTSD. 18 % of mothers had baseline ASD while 30 % of mothers met the criteria for PTSD at the 1-month follow-up. Dysfunctional coping as measured by the Brief COPE was positively associated with elevated risk of PTSD in these mothers (RR = 1.09, 95 % CI 1.02-1.15; p = .008). Maternal education was positively associated with PTSD; each year increase in education was associated with a 17 % increase in the relative risk of PTSD at 1 month follow-up (RR = 1.17, 95 % CI 1.02-1.35; p = .03). Results suggest that dysfunctional coping is an important issue to consider in the development of PTSD in parents of premature infants.

Design of the FRESH-DOSE study: A randomized controlled noninferiority trial evaluating a guided self-help family-based treatment program for children with overweight or obesity.

Overweight and obesity affect 45% of children and increases the risk for several negative health sequelae. Family-Based Behavioral Treatment (FBT) is the most efficacious treatment for child weight management and consists of nutrition and physical activity education, behavior change skills and parenting skills training. FBT is time and staff intensive and can include 20, 60-min separate groups for parents and children, as well as 20-min behavior coaching sessions to help problem solve barriers to implementing the skills learned and individualize the program. Guided self-help (GSH) therapies involve providing families a manual to review independently and brief coaching sessions by an interventionist to facilitate adherence. We developed a GSH version of FBT (gshFBT) which provides a manual to both parents and children and includes 14, 20-min coaching sessions over 6-months. The current study randomized 150 children (mean age = 10.1 years (SD = 1.38); mean BMI% = 97.3% (SD = 2.84); mean BMIz = 2.09 (SD = 0.40); 49% female; 43% Hispanic) and one of their parents (mean age = 41.8 years (SD = 6.52); mean BMI = 32.0 (SD = 7.24); 87.3% female; 43% Hispanic) to either a group-based FBT program or a gshFBT program. Assessments are conducted at baseline, post-treatment (6 months), 6-month follow-up (12 months) and 12-month follow-up (18 months). Primary outcomes are child weight change (BMIz) and cost effectiveness. Recruitment occurred between May 2017 and October 2021 and follow-up assessments are underway. Given the public health concern for children with obesity and the low level of access to FBT, gshFBT could prove extremely useful to provide intervention to a greater proportion of the population.

Brief cognitive-behavioral intervention for maternal depression and trauma in the neonatal intensive care unit: a pilot study.

Parents of hospitalized premature infants are at risk for developing psychological symptoms. This randomized controlled pilot study examined the effectiveness of a brief cognitive-behavioral intervention in reducing traumatic and depressive symptoms in mothers 1 month after their infant's discharge from the hospital. Fifty-six mothers were randomly assigned to the intervention or control group. Results showed that mothers experienced high levels of symptoms initially and at follow-up. At follow-up, there was a trend for mothers in the intervention group to report lower levels of depression (p = .06; Cohen's f = .318), but levels of traumatic symptoms were similar for both groups. Brief psychological interventions may reduce depressive symptoms in this population. Estimates of the effect sizes can be used to inform future intervention studies.

The relationship between acute stress disorder and posttraumatic stress disorder in the neonatal intensive care unit.

BACKGROUND: Having an infant hospitalized in the neonatal intensive care unit (NICU) is a highly stressful event for parents. Researchers have proposed posttraumatic stress disorder (PTSD) as a model to explain the psychological reaction of parents to their NICU experience. OBJECTIVE: The authors sought to examine the prevalence of PTSD in parents 4 months after the birth of their premature or sick infants and the relationship of PTSD and symptoms of acute stress disorder (ASD) immediately after their infant's birth. METHOD: Eighteen parents completed a self-report measure of ASD at baseline in addition to self-report measures of PTSD and depression at a 4-month follow-up assessment. RESULTS: In the sample, 33% of fathers and 9% of mothers met criteria for PTSD. ASD symptoms were significantly correlated with both PTSD and depression. Fathers showed a more delayed onset in their PTSD symptoms, but, by 4 months, were at even greater risk than mothers. DISCUSSION: The relatively high levels of psychological distress experienced by parents coupled with the potential negative outcomes on the parent and infant suggest that it is important to try to prepare parents for the expected psychological reactions that may occur in the event of a NICU hospitalization and also to support parents during the transition to home care.

A token economy for exercise adherence in pediatric cystic fibrosis: a single-subject analysis.

OBJECTIVE: In cystic fibrosis (CF), adherence to airway clearance techniques (e.g., chest physiotherapy and exercise) is poor. Exercise is important because pulmonary difficulties are associated with the highest mortality rate. Despite this, very little research has focused on exercise adherence in CF. This study examined a token economy for increasing exercise in children with CF. METHODS: An ABAB single-subject design evaluated a token economy for increasing and maintaining exercise in three children with CF. Patient report, parent report, and physiological measures were used to assess treatment integrity, medical stability, and changes in exercise. RESULTS: Measures suggested that treatment integrity was strong. Results indicated strong treatment effects for all participants without negative medical side effects. Follow-up of 1 and 3 months supported continued exercise for all participants. CONCLUSIONS: A token economy effectively increased exercise in children with CF, and the single-subject design highlighted some of the intricacies of individualized treatment of adherence. Implications and recommendations for further research are discussed.

The clinical application of fMRI data in a single-patient diagnostic conundrum: Classifying brain response to experimental pain to distinguish between gastrointestinal, depressive and eating disorder symptoms.

Patients with eating disorders (EDs) often present with psychiatric comorbidity, and functional and/or organic gastrointestinal (GI) symptomatology. Such multidiagnostic presentations can complicate diagnostic practice and treatment delivery. Here we describe an adolescent patient who presented with mixed ED, depressive, and GI symptomatology, who had received multiple contrasting diagnoses throughout treatment. We used a novel machine learning approach to classify (i) the patient's functional brain imaging during an experimental pain paradigm, and (ii) patient self-report psychological measures, to categorize the diagnostic phenotype most closely approximated by the patient. Specifically, we found that the patient's response to pain anticipation and experience within the insula and anterior cingulate cortices, and patient self-report data, were most consistent with patients with GI pain. This work is the first to demonstrate the possibility of using imaging data, alongside supervised learning models, for purposes of single patient classification in those with ED symptomatology, where diagnostic comorbidity is common.

Traumatic stress disorders following first-trimester spontaneous abortion.

Provide counsel and support to women after a spontaneous abortion. Research indicates that many women will talk with their physician about their emotional distress and that physicians provide good information after the spontaneous abortion. Evaluate women for acute stress disorder (ASD) after a spontaneous abortion. Research found that women reporting physical, emotional, or sexual abuse are more likely to experience ASD. Patients should be assessed for post-traumatic stress disorder in follow-up visits 1 month after the initial visit. Research has found that up to 25% of women meet criteria for PTSD 1 month post the spontaneous abortion and 7% met criteria at 4 months. Physicians should refer women who are experiencing traumatic stress to a behavioral health professional.

Increasing adherence to cystic fibrosis treatment: a systematic review of behavioral techniques.

Cystic fibrosis is a fatal chronic illness that primarily affects the respiratory and pancreatic systems. Treatment includes daily medications, enzyme and vitamin supplements, a high-calorie diet, and airway clearance sessions (e.g., chest physiotherapy, exercise). Although this regimen is essential to longevity, families have difficulty adhering to the multiple treatment components. Adherence is especially problematic with diet, chest physiotherapy, and exercise. Studies utilizing behavioral techniques to increase adherence to cystic fibrosis treatment components have been conducted with varying results. In this paper, a critical review of these treatment studies and suggestions for future work are presented.

Pediatric procedural approach-avoidance coping and distress: a multitrait-multimethod analysis.

OBJECTIVE: To evaluate the construct validity of children's approach-avoidance coping and distress during immunizations, and to examine the instruments used to assess these domains. METHODS: We used a multitrait-multimethod matrix to examine the validity of the approach-avoidance coping and distress constructs for 62 4- to 6-year-old children receiving immunization injections. Assessment instruments of both constructs consisted of child, parent, and nurse ratings, and three behavior observation scales. RESULTS: Pediatric procedural distress demonstrated adequate convergent and discriminant validity, and it can be assessed in a valid manner. Whereas most approach-avoidance measures demonstrated good convergent validity, several measures did not adequately distinguish between avoidance and distress. CONCLUSIONS: It is possible that children's approach-avoidance coping may be qualitatively different than adult's approach-avoidance. Researchers should be cognizant of these differences when designing treatments for child procedural distress.

A child-focused intervention for coping with procedural pain: are parent and nurse coaches necessary?

OBJECTIVE: To examine the efficacy of training children to cope with immunization pain without the assistance of trained coaches and determine whether untrained parents or nurses are more effective at decreasing children's distress. METHODS: We compared the procedural coping and distress behavior of 31 3- to 7-year-old children trained in coping skills to 30 who did not receive training. The behavior of the untrained parents and nurses was evaluated as it related to child coping and distress. RESULTS: Children demonstrated understanding of the training, but they did not use the coping skills during the procedure. In general, the nurses' behavior was associated with child coping and parents' behavior with child distress. CONCLUSIONS: More extensive child training or the involvement of coaches for procedural distress might be necessary. Nurses' behavior appears to center on encouraging child coping, and parents tend to comfort child distress.