Psychotherapy may have a role in the treatment of children with conversion disorder. Hiller et al. (2003) found that cognitive-behavioral therapy (CBT) reduced depressive symptoms, somatization, hypochondriasis, and inadequate cognitions about body and health in patients with somatoform disorder. The paucity of pediatric studies in the area is readily apparent.
The concept of psychotherapy may be introduced by informing patients that the goal of treatment initially is to help them adjust to the stress of their illness and to learn new coping strategies. In individual psychotherapy, patients are encouraged to express their underlying emotions and to develop alternative ways with which to express their feelings of distress. Individual psychotherapy can play an important role in helping change a child's erroneous cognitions about his or her ability to resume functioning. Encouragement of more adaptive coping strategies can become a focus of the therapy. Patients should benefit from exploring potential sources of stress and gaining understanding into the emotional factors that may perpetuate pain behaviors.
Because no data are available from child studies, one must look at adult studies using CBT. A review of the effectiveness of CBT revealed that 71% of 31 controlled trials in adults showed improvement in the treatment group lasting up to 12 months with as little as five CBT sessions (Kroenke and Swindle 2000). Treatment effects have been reported to last 15 months or longer when therapy is extended to 10 sessions (L.A. Allen et al. 2006).
Psychoeducation, an important component of CBT, is used to teach the individual about his or her symptoms and to help modify dysfunctional perceptions and thoughts (Hiller et al. 2003). Techniques have included efforts to assess patient illness beliefs, explain the role of selective perception in the development of illness fears, and modify misinterpretations of bodily sensations (Looper and Kirmayer 2002). Treatment studies have also incorporated psychoeducation, progressive muscle relaxation, systematic desensitization, and cognitive strategies to correct automatic thoughts (Looper and Kirmayer 2002). Symptom-focused strategies appear to have greater benefits than general stress management.
Two randomly controlled studies of CBT with patients with hypochondriasis have shown that deliberate focus on physical symptoms, graded exposure to address avoidance behaviors, and response prevention for bodily checking may help to improve global problem severity as well as reduce anxiety and mood symptoms (Clark et al. 1998; Warwick et al. 1996). CBT involving psychoeducation on the roles of attention, attribution, and stress as well as relaxation training has been found to be effective in reducing illness fears and attitudes, somatic symptoms, and dysfunctional beliefs of patients with hypochondriasis (Avia et al. 1996; Barsky et al. 1988a). CBT has been used successfully in the treatment of recurrent abdominal pain (Sanders et al. 1989, 1994) and BDD (Butters and Cash 1987; Grant and Cash 1995; McKay 1999; Rosen and Reiter 1996; Rosen et al. 1989; Sanders et al. 1989, 1994; Veale et al. 1996).
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