Many interventions with children aimed at preparing them for medical procedures utilize more than one of the preparation techniques described here. These interventions usually fit under the rubric of combined cognitive-behavioral interventions. In a review of the literature, Powers (1999) concluded that cognitive-behavioral therapy (CBT) is a well-established and empirically supported treatment for procedure-related pain in children and adolescents. Moreover, in a more recent meta-analysis conducted for the Cochrane Collaboration (Uman et al. 2006), combined cognitive-behavioral interventions were found to be efficacious interventions for reducing needle-related procedural distress.

Jay et al. (1987) compared the effectiveness of a CBT intervention package with a pharmacological intervention (Valium 0.3 mg/kg) and a control condition. The authors utilized a repeated-measures counterbalanced design across the three conditions with 58 children receiving bone marrow aspirations. Children in the CBT group received a treatment package that included filmed modeling, breathing exercises, positive incentives, imagery/distraction, and behavioral rehearsal. Results indicated that the CBT intervention group exhibited significantly lower behavioral distress, pain ratings, and pulse rates than the control group. Moreover, except for lower diastolic blood pressure, there were no other significant differences between the control group and the pharmacological intervention group.

Kain et al. (2007) randomly assigned 408 children undergoing elective surgeries and their parents to four different preparation groups: 1) parental presence group: parents were present for the induction of anesthesia; 2) midazolam group: children received 0.5mg/kg of oral midazolam 30 minutes prior to going to the operating room; 3) ADVANCE behavioral preparation group: children and parents received a multicomponent intervention that included parental presence, video modeling, distraction activities, and instructions to parents on how to best help their children prior to the procedure and during anesthesia induction; or 4) standard care group: no preparation, parental presence, or premedication was used. Children in the ADVANCE group exhibited significantly less anxiety prior to induction of anesthesia compared with children in the other three groups and were less anxious during the induction than children in the control and parental presence groups. Moreover, children in the ADVANCE group demonstrated a lower emergence of delirium after surgery, required significantly less analgesia in the recovery room, and were discharged from the recovery room earlier than children in the other three groups.

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Anxiety and Panic Attacks

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