CBT Group Intervention for Children With Food Allergy and Anxiety
Condition: Food Allergy in Children
MeSH terms: Hypersensitivity; Food Hypersensitivity
Study type: Interventional

Summary: 
      The research will design and evaluate a CBT based intervention to support children aged 11-17
      with food allergies. The research on this population has shown that they can experience high
      levels of anxiety in management of their allergy which can have a significant impact on
      quality of life. However, the research exploring psychological interventions is limited. CBT
      has a wide evidence base from NHS settings delivering interventions to support those with
      various health conditions. In addition, CBT has been shown to be effective for supporting
      adolescents manage their health-related anxiety. The investigators are interested in the
      feasibility of designing and implementing a one day workshop aimed at adolescents with food
      allergy and self-reported anxiety. The group workshop will involve psychoeducation on
      anxiety, skills and techniques to manage anxiety, relaxation and how to set goals in relation
      to their food allergy. It will involve 2 'arms', one where participants will attend the group
      and the other 'control arm' where they will not attend the group but they will receive
      materials from the group once the evaluation is complete. All participants will be asked to
      complete questionnaires that measure level of anxiety, food allergy quality of life and
      coping skills at baseline, time of workshop, one month follow up and three month follow up.
      There will also be an opportunity for participants to volunteer to take part in a follow up
      interview to evaluate the workshop and also to contribute more to the research on what this
      population requires in terms of a psychological intervention.
    

Detailed description: 
      Food allergy is an increasing public health concern, with Westernised countries reporting
      prevalence of diagnosed allergies of up to 10%, most notably among younger children. Over the
      last few decades, the number of people diagnosed with food allergy has been increasing, as
      has the awareness of the psychological burden of living with a food allergy. As the symptoms
      lie on a spectrum with fatal anaphylaxis being a possible result of exposure, avoidance of
      the allergen and having access to emergency medication (e.g. adrenaline auto-injectors)
      remains the primary care for management Unlike other allergies which can be more easily
      avoided (i.e. animals), food can be hidden in products without awareness and so a reaction
      could occur by mistake. This can then result in a significant impact on Quality of Life (QoL)
      for those with an allergy and their family. Children with peanut allergies reporting more
      fear of an adverse event and anxiety around managing their condition compared to peers with
      insulin-dependent diabetes mellitus. In addition, the dietary and social restrictions
      accompanying the management of food allergy can result in children feeling social isolated or
      even bullied.

      Anxiety is a normal part of human experience as it is an appropriate response to uncertain or
      unpredictable situations, however when anxiety is excessive it can cause great distress and
      interfere with daily functioning. In regards to the management of an allergy, some level of
      anxiety is adaptive as anxious children are less likely to take risks in terms of exposure to
      the allergen compared to those who are less anxious. However, sometimes the anxiety around a
      fatal reaction can result in avoidance of social situations, not allowing age appropriate
      outings or having an excessively restricted diet which could have implications for children's
      growth and development. The optimal emotional response has been described as 'relaxed
      readiness' in order to allow for effective food allergy management whilst minimizing more
      maladaptive aspects of anxiety such as hypervigilance or avoidance.

      Research has identified that adolescents and young people are the age group most at risk for
      fatal anaphylaxis to foods. As well as this, having a food allergy is related to increased
      risk of anxiety within this age group. Reaching adolescence is usually the development of
      personal autonomy and independence and for those with food allergies is the time where they
      take more responsibility for the management of their allergy and the subsequent psychosocial
      impact. Adolescents report feeling misunderstood by others and speak about the psychological
      consequences of 'being different'.

      Considering the 'relaxed readiness' response, interventions for patients with food allergy
      should aim to recognise, normalise and support levels of anxiety that can allow for more
      adaptive coping strategies. Adolescents with more avoidant coping strategies (such as
      avoiding social events or places where they could be exposed to the allergen) are associated
      with higher trait anxiety, believed to be linked to years of fear of exposure to their
      allergen. Coping skills that are developed in adolescent tend to persist into adulthood and
      those which are more constructive have a more positive impact on wellbeing as well as
      adherence to medical advice. Therefore, an intervention would be beneficial to target a
      reduction in maladaptive coping techniques and increase adaptive cognitive behavioural
      problem-solving approach.

      A recent systematic review into the effectiveness of interventions to improve self-management
      for adolescents with allergic conditions found all interventions that met their criteria to
      be for asthma, highlighting the need for interventions for those with food allergies. A
      systematic review into the impact of anaphylaxis and anxiety highlighted the need for
      Cognitive Behavioural Therapy (CBT) based intervention. CBT has also shown to be effective in
      supporting children with health conditions in managing distress, increased competence in
      mastering the challenges of adolescence and improvement in coping skills. Although little is
      known about CBT for children with food allergies, interventions using CBT for parents of
      children with food allergies have shown to be effective in reducing levels of worry and
      anxiety and improving quality of life. In recent research, a single session intervention
      reduced anxiety in the long term and CBT as a single session intervention has been shown to
      reduce anxiety in young people with anxiety. As the literature has highlighted feelings of
      not being understood by peers and feeling different, it may be beneficial to offer
      adolescents the opportunity to meet others in a similar situation. Group intervention is
      recommended for adolescents as it can be reassuring that patients concerns are shared and
      discussions can promote more adaptive ways of coping.

      The current study addresses the need highlighted in the literature to provide adolescents who
      experience increased anxiety due to their food allergy with a CBT based intervention to
      manage the impact of this. This research will design and provide a one-day group CBT workshop
      for children ages 11-17 with a food allergy and self-reported anxiety. There will also be an
      optional interview for those who attended the workshop to discuss how they found it and their
      experiences of living with a food allergy. The results will contribute to the current
      literature on how anxiety and food allergy are related as well as the feasibility of
      delivering a CBT workshop for this client group.
    

Intervention name(s): CBT workshop
Intervention type(s): Behavioral
Intervention description(s): The CBT based intervention for adolescents will include psychoeducation on food allergy and anxiety and also focus on providing skills, knowledge and support.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Food Allergy; Anxiety; Young People