Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a problem-oriented treatment that seeks to identify and modify maladaptive behavior and cognitions. It is based on the premise that patients and their families develop cognitive distortions (e.g., passive locus of control, learned helplessness) and/or maladaptive behaviors (e.g., inactivity, poor self-soothing) that adversely affect their functioning (see Table 28-3). For example, the belief that important medical information is being withheld may lead a child to the misconception that the prognosis is hopeless and undermine the willingness of the child to cooperate with medical treatment. CBT can be used to address specific emotional responses that result in distress about an illness or interfere with its treatment as well as to promote more positive coping behaviors. It also can be used to address disabling comorbid mood or anxiety symptoms. CBT techniques can also be utilized to help children differentiate factors that are realistically under their control from those that are not. For example, Weisz et al. (1994) found that children with leukemia who used secondary coping techniques (i.e., attempts to minimize the impact of an objective stressor) to deal with painful but necessary medical procedures reported better adjustment than those children who used primary coping techniques (i.e., attempts to alter the objective stressor itself). Finally, relaxation and hypnosis have been used to target symptoms of anxiety and pain and to improve immune functioning (Gold et al. 2007; Noll et al. 1994).

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