Smith_Practice Brief

Running head: PRACTICE BRIEF – CHRONIC ILLNESS IN ADOLESCENTS 1
Breona Smith
Northern Arizona University
EPS 681 Counseling Techniques
October 22nd, 2014

PRACTICE BRIEF – CHRONIC ILLNESS IN ADOLESCENTS 2
Chronic Illness in Adolescents
Breona Smith
Description of Chronic Illness in Adolescents
Definition
 Chronic illnesses are long lasting health conditions, typically more than six months.
 The illness causes physical effects, impacts emotional and mental health, and social,
educational, and vocational aspects.
 Examples of chronic diseases are: asthma, cancer, cystic fibrosis, diabetes, emphysema,
epilepsy, heart disease, HIV/AIDS, inflammatory bowel disease and juvenile arthritis.
 It can also affect the three main stages of adolescence including the early, middle, and late
stage, by disrupting the developmental processes. It may delay growth, puberty, and normal
socialization skills.
 Treatment regimen adherence is a significant behavioral health issue in adolescent chronic
illness that impacts clinical decision-making, morbidity and treatment outcomes.
 Research on early childhood stress is showing how early trauma can alter the brain’s stress
response system and contribute to future risk of anxiety and mood disorders.
 Adolescents are defined by those between 10-19 years of age.
Resources:
Michaud, P.A., Suris, J.C., & Viner, R. (2007). The adolescent with a chronic condition. World
Health Organization.
Corey, M.S., Corey, G., & Corey, C. (2013). Groups: process and practice, (9th ed.). Pacific
Grove, CA : Brooks/Cole-Thomson Learning
Society of Clinical Psychology:
http://www.psychologicaltreatments.org/
National Institute of Mental Health (NIMH):
http://www.nimh.nih.gov/health/publications/brain-development-during-childhood-and-
adolescence/index.shtml
Prevalence
 20-30% of adolescents in the U.S. have been diagnosed with a chronic illness.
 10-13% of them reported being substantially limited in their daily life because of the illness.
 Depression is found in 15% of adolescents with asthma and almost 30% of adolescents with
inflammatory bowel disease.
 Only 50% of children adequately adhere to their prescribed treatments and only 25–35% of
adolescents demonstrate adequate adherence rates.

 One in five children in the United States is affected by chronic pain
Resources:
Waters, E., Davis, E., Nicolas, C., Wake, M., & Lo, S. K. (2008). The impact of childhood
conditions and concurrent morbidities on child health and well-being. Child: Care, Health &
Development, 34(4), 418-429. doi:10.1111/j.1365-2214.2008.00825.x
Jastrowski Mano, K., Salamon, K., Hainsworth, K., Anderson Khan, K, Ladwig, R., Davies, W.,
& Weisman, S. (2013). A Randomized, Controlled Pilot Study of Mindfulness-based Stress
Reduction for Pediatric Chronic Pain. Alternative Therapies In Health & Medicine, 19(6), 8-14.
IDENTIFICATION/ASSESSMENT STRATEGIES
Several assessments can be done in order to screen adolescents with chronic illness to learn
about their medical history. Learning about the severity of the illness and its level of impact on
the adolescents physical, emotional, and mental health, and their social, educational, and
vocational aspects will help create a successful treatment plan. These assessments should lead to
a treatment plan that defines the medical, psychological and social interventions that need to
occur along with an educational and behavioral program that will systematically move the
patient and parent/guardians to greater acceptance and responsibility for the condition. Although
some psychological interventions may be effective for all types of chronic illness, other
psychological interventions may have greater effectiveness if targeted towards specific illness
types or specific aspects of chronic illness conditions.
PedsQL is a health-related quality of life assessment using a reliable and valid questionnaire for
children and adolescents with chronic diseases. It consists of four subscales that evaluate generic
aspects of health-related quality of life.
Treatment adherence interview - a semi-structured patient⁄parent interview used to examine
factors affecting treatment adherence. Parents and patients are interviewed together in order to
encourage identification and discussion of different perspectives. An important disadvantage of
this approach is the potential to have adolescent patients defer answers ⁄opinions to their parents.
When this occurs, patients should be asked to voice their thoughts about the issue being
discussed.
PHQ-9 Patient Depression Questionnaire - a self-administered screening and diagnostic tool
for depression. This screening instrument identifies depression and panic disorder and assesses
stress and functionality, including gender-specific sources of stress. It’s quick and user-friendly,
improving the recognition rate of depression and anxiety and facilitating diagnosis and treatment.

QoL measures outcomes that reflect a more holistic approach to the management of diseases.
This emphasis reflects contemporary views about the relation between mind and body, and
acknowledges the critical link between physical and psychological health. The World Health
Organization (WHO) describes the QoL as “the individual’s perception of their position in life,
in the context of culture and value systems in which they live and in relation to their goals,
expectations, standards, and concerns.”
State-Trait Anxiety Inventory for Children (STAI) is used to simplify the separation between
state anxiety and trait anxiety, feelings of anxiety and depression. The instrument is designed to
be used with upper elementary or junior high school aged children. This test is split into the S-
Anxiety scale and the T-Anxiety scale, each having 20 items. These tests are answered on the
basis of a 1-4 scale, with the focused areas including: worry, tension, apprehension, and
nervousness.
The Functional Assessment of Cancer Therapy Scale – General Version - consists of 28
questions with showing five domains assessing the: (1) physical well-being, (2) social/family
well-being, (3) relationship with the physician, (4) emotional well-being, and (5) functional well-
being. Although it is a scale developed for cancer patients, it targets the way patients deal with a
chronic illness and follows the experience of pain, stress and physical discomfort that is common
to all chronic conditions.
Automatic Thoughts Questionnaire (ATQ)- a 15-item measure of negative automatic thoughts
usually related to depression. It measures depressogenic thought frequency. This measure is
commonly used in depression studies examining the impact of cognitive therapy.
The Patient Assessment of Care for Chronic Conditions (PACIC) measures specific actions
or qualities of care that patients report they have experienced in the delivery system. Patient
centeredness has been regarded as the assessment of needs and preferences to consider social and
cultural factors affecting the clinical encounter or compliance with treatment. There is a growing
consensus that patients have a more active role to play in defining and reforming healthcare,
particularly in chronic disease management, where patients provide the majority of care in day-
to-day management of their illness.
Resources
Hommel, K. A., Odell, S., Sander, E., Baldassano, R. N., & Barg, F. K. (2011). Treatment
adherence in paediatric inflammatory bowel disease: perceptions from adolescent patients and
their families. Health & Social Care In The Community, 19(1), 80-88. doi:10.1111/j.1365-
2524.2010.00951.x
Igna, R., Stefan, S., Onac, I., Onac, I., Ungur, R., & Tatar, A. (2014). Mindfulness-based
cognitive-behavior therapy (mcbt) versus virtual reality (vr) enhanced cbt, versus treatment as

usual for chronic back pain. a clinical trial. Journal of Evidence-Based Psychotherapies, 14(2),
229-247.
Spieth, L., & Harris, C. (1996). Assessment of health-related quality of life in
children and adolescents: an integrative review. Journal of Pediatric Psychology, 21(2), 175-
193. doi: 10.1093/jpepsy/21.2.175
Clarke, S., & Eiser, C. (2004). The measurement of health-related quality of life (QOL) in
paediatric clinical trials: a systematic review. Health & Quality Of Life Outcomes, 266-5.
doi:10.1186/1477-7525-2-66
INTERVENTION STRATEGIES
Cognitive Behavioral Therapy (CBT)
CBT can be used to explore irrational or negative ways of thinking how their illness affects
them. Challenging those beliefs will increase their insight to respond to situations in more
effective manners. It involves the three important aspects of learning: cognitive (information and
understanding), affective (attitudes and feelings), and behavior (skills). The goal is to modify the
thoughts that are causing distress in order to restructure the negative thought pattern. CBT will
help them acquire positive strategies for dealing with chronic illness and the need to increase
their self-management abilities in everyday life. It also incorporates setting weekly goals that
allow clients to do something they enjoy and increase positive activities in their life.
CBT will be used to prevent and/or decrease depression and create healthy coping mechanisms
to improve adherence to their treatment plan. Helping the client develop and maintain adaptive
and flexible ways of thinking, feeling, and acting increases the development of problem-solving
skills and reduces catastrophizing. Homework is a basic component of all cognitive behavioral
approaches and allows clients to receive feedback and support about their progress to make
important changes in their daily lives.
Resources
Thorn, B. E., & Kuhajda, M. C. (2006). Group cognitive therapy for chronic pain. Journal Of
Clinical Psychology, 62(11), 1355-1366. doi:10.1002/jclp.20315
Furnes, B., Natvig, G., & Dysvik, E. (2014). Therapeutic elements in a self-management
approach: experiences from group participation among people suffering from chronic pain.
Patient Preference & Adherence, 81085-1092. doi:10.2147/PPA.S68046
Supplemental and Integrative Approaches
Existentialism
Integrating existentialism with CBT has also shown to be effective in studies treating people with
chronic illness. Results showed that the integration of an existential perspective lead to
significantly lowered pain-related disability than a cognitive behavioral program alone.
Existential aspects seemed to be particularly important for patients with a spiritual orientation.

Existential psychotherapy is a unique style of therapy that emphasizes the human condition as a
whole. It uses a positive approach that applauds human capacities while simultaneously
maintaining a genuine perception of the limitations of the human being, human spirit, and human
mind. It encourages people to address the emotional issues they face through full engagement
and to take responsibility for the decisions that caused them to develop. Clients are guided to
accept their fears and are given the necessary skills to overcome them through action. By gaining
control of the direction of their life, the client is able to design the course of his or her choosing.
This creates a sense of freedom and allows them to let go of the despair associated with
insignificance and meaningless.
Resources
Gebler, F. A., & Maercker, A. (2014). Effects of including an existential perspective in a
cognitive-behavioral group program for chronic pain: a clinical trial with 6 months follow-up.
Humanistic Psychologist, 42(2), 155-171. doi:10.1080/08873267.2013.865188
Mindfulness BasedCognitive Behavioral Therapy (MCBT)
In the last decade, cognitive-behavioral therapy (CBT) research on pain suggested that pain
catastrophizing, erroneous beliefs that pain disables, fear of movement or re-injury, maladaptive
coping strategies, and negative outcome expectancies contributed to the future pain outcomes,
associated emotional problems, and treatment-related improvement in patients.
Mindfulness-based strategies are designed to increase present-moment awareness and lower the
emotional and behavioral impact of distressing psychological experiences. It’s the practice of
broad, present-focused, and behaviorally neutral awareness. It is a way to watch the experiences,
such as physical sensations, emotions, and thoughts, as they unfold, without evaluating or
judging them, resulting in a more balanced, non-reactive, and realistic interaction with the
experiences and leading consequently to more efficient action.
Resources
cognitive-behavior therapy (mcbt) versus virtual reality (vr) enhanced cbt, versus treatment as
usual for chronic back pain. a clinical trial. Journal of Evidence-Based Psychotherapies, 14(2),
229-247.
& Weisman, S. (2013). A Randomized, Controlled Pilot Study of Mindfulness-based Stress
Reduction for Pediatric Chronic Pain. Alternative Therapies In Health & Medicine, 19(6), 8-14.

REFERENCES
Clarke, S., & Eiser, C. (2004). The measurement of health-related quality of life (QOL) in
paediatric clinical trials: a systematic review. Health & Quality Of Life Outcomes, 266-5.
doi:10.1186/1477-7525-2-66
Corey, M.S., Corey, G., & Corey, C. (2013). Groups: process and practice, (9th ed.). Pacific
Grove, CA : Brooks/Cole-Thomson Learning
Furnes, B., Natvig, G., & Dysvik, E. (2014). Therapeutic elements in a self-management
approach: experiences from group participation among people suffering from chronic
pain. Patient Preference & Adherence, 81085-1092. doi:10.2147/PPA.S68046
Gebler, F. A., & Maercker, A. (2014). Effects of including an existential perspective in a
cognitive-behavioral group program for chronic pain: a clinical trial with 6 months
follow-up. Humanistic Psychologist, 42(2), 155-171. doi:10.1080/08873267.2013.865188
Hommel, K. A., Odell, S., Sander, E., Baldassano, R. N., & Barg, F. K. (2011). Treatment
adherence in paediatric inflammatory bowel disease: perceptions from adolescent patients
and their families. Health & Social Care in The Community, 19(1), 80-88.
doi:10.1111/j.1365-2524.2010.00951.x
cognitive-behavior therapy (mcbt) versus virtual reality (vr) enhanced cbt, versus
treatment as usual for chronic back pain. a clinical trial. Journal of Evidence-Based
Psychotherapies, 14(2), 229-247.
& Weisman, S. (2013). A Randomized, Controlled Pilot Study of Mindfulness-based
Stress Reduction for Pediatric Chronic Pain. Alternative Therapies in Health & Medicine,
19(6), 8-14.
Spieth, L., & Harris, C. (1996). Assessment of health-related quality of life in children and
adolescents: an integrative review. Journal of Pediatric Psychology, 21(2), 175-193. doi:
10.1093/jpepsy/21.2.175
Thorn, B. E., & Kuhajda, M. C. (2006). Group cognitive therapy for chronic pain. Journal of
Clinical Psychology, 62(11), 1355-1366. doi:10.1002/jclp.20315
Waters, E., Davis, E., Nicolas, C., Wake, M., & Lo, S. K. (2008). The impact of childhood
conditions and concurrent morbidities on child health and well-being. Child: Care,
Health & Development, 34(4), 418-429. doi:10.1111/j.1365-2214.2008.00825.x

Smith_Practice Brief

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (19)

En vedette

En vedette (20)

Similaire à Smith_Practice Brief

Similaire à Smith_Practice Brief (20)

Smith_Practice Brief