Psychological treatments for pediatric functional gastrointestinal disorders.

Our objective was to systematically review and evaluate behavioral and psychological treatments applied to pediatric functional gastrointestinal disorders. Electronic searches were conducted in bibliographic databases including PubMed, PsychInfo, and Medline. Psychological and behavioral interventions were classified into the following 5 primary treatment modalities: psychoeducation, behavior therapy/contingency management, relaxation-based therapies (including biofeedback and hypnotherapy), and cognitive-behavioral therapy (including cognitive-behavioral family therapy). There was a wide variation in the quality and quantity of studies within each treatment category. Effective interventions generally involved multiple therapeutic components and included elements of both individual and family treatment. Psychological interventions that combine psychoeducation, relaxation-based therapies, and cognitive-behavioral therapy appear superior to standard care (reassurance or dietary manipulation) in the elimination of pain and reduction in functional disability. Although many psychological treatments demonstrated evidence of positive effects, few well-designed randomized controlled trials of psychological treatments for functional gastrointestinal disorders exist. More work is needed to determine the most potent, essential elements of psychological treatments alone or in combination with standard medical intervention, and to establish their applicability with diverse populations. Clinical and research implications are discussed.