Using behavioral interventions to assist with routine procedures in children with cystic fibrosis

Abstract

Routine cystic fibrosis (CF) medical care includes invasive procedures that may be difficult for young children and adolescents to tolerate because of anxiety, concern with health status, or unfamiliarity with the performed tasks. A growing body of pediatric psychology literature suggests that behavior therapy can effectively increase patient cooperation with stressful medical procedures such as tracheostomy care and needle sticks. Throat cultures are obtained at least quarterly in the outpatient setting or more frequently if a CF patient develops respiratory symptoms. Obtaining a throat culture from an anxious and uncooperative child poses a significant challenge for physicians, since the child may demonstrate emotional distress and avoidant behavior that disrupts efficient specimen collection during a routine clinic visit. The use of behavioral interventions, such as relaxation exercises, diaphragmatic breathing, differential reinforcement, gradual exposure, and systematic desensitization, is beneficial in addressing this commonly encountered problem in CF care. This case series describes the implementation of a behavioral therapy protocol utilizing two interventions, gradual exposure and systematic desensitization, in two young CF patients for the treatment of behavioral distress with routine throat cultures. The behavioral interventions were simple and transferred easily from mock procedures to actual specimen collection. Moreover, these cases highlight the important roles of the pediatric psychology staff on a comprehensive multidisciplinary CF care team to improve patient cooperation with routine clinic procedures and the medical treatment regimen overall.

Copyright (c) 2009 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Figures

Fig. 1

Treating behavioral distress with routine clinic procedures in children with CF. Prior to behavioral intervention therapy, Patients A and B exhibited significant behavioral distress and poor cooperation with obtaining routine throat cultures. After 2 weeks of therapy, neither patient exhibited behavioral distress with the procedure. Patient A demonstrated medical cooperation after 2 weeks of behavioral therapy, whereas Patient B showed full medical cooperation after 4 weeks. Closed symbols indicate mock behavioral therapy sessions, while open symbols reflect successful specimen collection during the CF clinic visit.