Pediatric Psychological Services for Patients with Abdominal Pain
If you’ve ever felt butterflies in your stomach or had a “gut feeling” then you’ve experienced the strong and real connection between your mind and your stomach. When you use the skills you’ve learned over the years to calm yourself or manage your stress, that feeling in your stomach gets better or goes away completely.
Children have often not yet developed the skills that most adults have to think through their stress and cope with pain. However, children have many internal resources that can be brought out and strengthened to help them manage their symptoms.
If you’re child’s doctor has recommended that they see the GI psychologist, it is because they strongly believe that strengthening these skills will improve your child’s symptoms and their quality of life. It does not mean that they will stop working with you and your child to evaluate and manage their condition.
Cognitive Behavioral Therapy (CBT)
CBT is a form of psychotherapy that focuses on the important role our thoughts play in how we feel and how we act.
In CBT, the therapist and the child work to identify distorted thought patterns and change them to more realistic thoughts. For example, many children think that they need to perform “perfectly” in order to have performed well. Other children may begin to worry that a tornado will destroy their home as soon as storm clouds appear.
These are examples of distorted thoughts that can lead to very intense feelings. Because children with IBS or functional abdominal pain experience their intense feelings in their stomachs, changing these thoughts to more realistic ones can relieve pain and improve functioning over all.
Hypnosis is a state of mind. After people learn about hypnosis they realize they have been in hypnotic states many times.
Children are often in this state when they make-believe, daydream, listen intently to stories, or play video games. Adults often experience hypnotic states while engaged in repetitive tasks, while reading a great book, or while mowing the lawn. For example, have you ever been driving and arrived home and wondered, “How did I get here?” You were in a hypnotic state.
People in hypnosis often feel relaxed, peaceful, and detached from their worries. In hypnosis, we can better imagine sensations: sights, sounds, smells, touch. There is also increased control of the body. Breathing slows and deepens. Blood pressure, heart rate, skin temperature, and muscle tone can all be controlled. Hypnosis has also been shown to change chemicals in the gut that are often to blame for abdominal pain.
When a trained therapist uses hypnosis as part of treatment, it is called hypnotherapy: the use of guided, focused imagery, in a trance, to strengthen self-control over physical and emotional problems.
Why use hypnotherapy?
The value of treatment with a psychologist goes beyond its ability to help with physical symptoms.
- Hypnotherapy has been successfully applied to treat acute and recurrent pain, asthma, bedwetting, stool withholding, nervous tics, anxiety, fears and other problems.
- Presently, self-hypnosis is among the most effective therapies for childhood migraine headaches.
- It is also one of the only effective research-supported treatments for functional abdominal pain and irritable bowel syndrome (IBS).
A child's personal success in CBT and self-hypnosis boosts their confidence and mastery.
Young people learn to use these techniques to cope with new challenges throughout their lives.
Are there any risks?
Unlike medications or other invasive medical procedures, treatment with a psychologist has no unwanted side effects.
False ideas about hypnosis come from television and movies. Most people believe that the patient is under the control of the hypnotist. This is not true. Stage hypnotists take advantage of willing volunteers to entertain. A trained practitioner can find helpful words to suggest ways to feel, understand or behave, but cannot control the person in hypnotherapy.
What is your role in treatment?
The primary tasks for parents are to ask questions, understand, and then support the process. If your child can read, go over this information with him or her and write down your questions together. For younger children, instead of using the words hypnosis or hypnotherapy, you might say that “the doctor is going to help you pretend about your” tummy pain, asthma, headaches, etc.
The psychologist may also work with you on making changes to the environment at home or to your child’s daily routine. Sometimes, when children are allowed to stay home or avoid the stressors that are contributing to their pain, the pain actually gets stronger and harder to get rid of. Returning children to school and to activities they love is often the first step to breaking the cycle of pain. We will also need your help to understand:
- How the problem affects your child's life
- All that you have done so far to help
- Your own fears and worries about your child's problem - This is important because your anxiety and doubts are infectious. Your child feels them too.
What is the structure of treatment?
The process of treatment will partly depend on your child's age, symptoms and beliefs. For the most part, you and your child will meet with the psychologist once together to gather information and orient you to treatment.
After the first visit, your child will meet with the psychologist alone for 3-5 sessions. These sessions will be held every other week and will be about an hour long. Your child will be given assignments to complete in between visits. The psychologist will check-in with you at every visit to monitor your child’s progress and will answer any questions you may have at any time during treatment.
If it becomes clear that your child could benefit from regular therapy after treatment for abdominal pain with the GI psychologist, we will be happy to provide you with referrals to psychologists in the community.
Practice really does make perfect!
Cognitive skills and self-hypnosis grow easier with practice. Like learning to play a musical instrument, in time, the musician develops skill, creativity, and the ability to play new and more challenging songs.
Success in treatment requires that each child build their own imagery and sense of mastery. It is not your job to "make" your child "practice." As a matter of fact, if you insist that they "practice," they are more likely not to. It is their choice to use this skill. You might help by suggesting a convenient time, place, or situation in which they can do their assignments (after dinner, before homework, in a favorite chair, in the face of certain stresses).
It is our privilege to help our patients learn to use their own internal gifts and talents to improve their lives and master their pain. We look forward to answering any questions you may have. To schedule an appointment, please call us at 214-456-8000.