Group Therapy

Group therapy has been found to be useful in physically ill adults who have a shared diagnosis or illness-related issues (Gore-Felton and Spiegel 2000; O'Dowd and Gomez 2001). The targets of group interventions include attitude and behavior changes that result in health and psychosocial outcomes. The experience of heightened social support and reduced feelings of isolation afforded by peers with a similar illness provides the foundation for group therapy. Although the evidence base for group therapy in children with physical illness is small, Plante et al. (2001) reported positive effects from skill-building groups for youth with asthma, diabetes, and obesity. There may be specific difficulties in establishing pediatric groups. For example, immuno-compromised children may not be permitted to interact with other physically ill patients, and those with cystic fibrosis may be instructed to avoid contact due to fears about the acquisition of drug-resistant infections. Adolescents in particular may express ambivalence about participating in group therapy due to perceived stigmatization or not wanting to see themselves as sick or disabled. Parents may express concerns about the participation of their children in a group in which they may be ex-

Table 28-3. Common cognitive distortions in pediatric illness

Belief that

Nothing will change the outcome of my illness.

I have no control of my illness.

Minor physical symptoms herald the return of my illness.

My illness is a punishment for bad behavior.

I will not be able to resume school or social activities.

I am different compared with other children. Fear about Inevitable progression of my illness. Inevitability of pain. Becoming a burden to my family. Friends will not want to associate with me. Medical information is being withheld. I will not be able to reach my goals. My symptoms will embarrass me in public. Source. Adapted from Shaw and DeMaso 2006.

posed to the discussion of topics related to relapse and death.

Groups follow different theoretical models. Educational groups have been used to disseminate information and introduce preventive health care practices (e.g., adolescents with high-risk sexual behaviors) (Gore-Felton and Spiegel 2000). By contrast, cognitive-behavioral groups typically provide problem-focused skills to help build coping skills. Support groups combine educational exchanges with social support and have been shown to improve quality of life in teens with chronic illness (Szigethy et al. 2006). In all situations, it is important that groups for physically ill children utilize de-velopmentally appropriate activities (i.e., young children may have art projects, storytelling, or therapeutic play as opposed to verbal discussion).

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