Cognitive behavioral therapy (CBT) role in food allergy related anxiety - Twitter summary from #CSACI18 meeting

Twitter summary:

Dr. Joanne Gillespie - When rational fear causes irrational impairments; Using cognitive behavioral therapy for patients with food allergy.

Dr. Gillespie is a pediatric psychologist discussing food allergy impact on functioning and quality of life. A very timely topic for clinicians and patients to discuss.

Lower QOL (Quality of Life) in families of children with food allergy compared to healthy children and children with chronic disease. Also increased risk of bullying.

Approximately 30% of children report food allergy bullying. It may be higher in adolescents. Family stress is higher and there are higher levels of strain in marriages of parents of food allergic children. Vigilance in food allergy is helpful and protective but over- or under-vigilance is problematic.

Impact of Food allergy on Functioning - It's expensive! Time and money. Impact on social interactions - eating out, travel, extracurricular activities. Family relationships strained. Lower QOL reported. Bullying. Anxiety. Hypo/Hyper-vigilance.

Some degree of anxiety in food allergy is to be expected - if however the anxiety is impacting day to day activities intervention with psychology can be helpful. Psychologist can support re: advocacy for management of needs in FA.

Goals of CBT- decrease stress and impairment, improve functioning, increase self-confidence and resiliency. CBT to help find balance in food allergy: Managing chronic condition and maintaining quality of life.

Anxiety is a reaction to a perceived threat - again, a certain amount is helpful and adaptive - it protects you from real threats - but too much can be maladaptive. Anxiety is a response to a perceived threat (not always a real threat); psychoeducation is one of CBT goals for FA patients.

Managing anxiety - diaphragmatic breathing (square breathing); using relaxing imagery, and progressive muscle relaxation can be helpful.

Editor’s note: Should square breathing be practiced before ingestion challenges?

One of the most difficult aspects of having food allergy and anxiety is that there is such an overlap of symptoms that makes it difficult to tell them apart. Cognitive behavioural therapy can help as will cognitive restructuring.

Many great strategies to reduce maladaptive anxiety around food allergy: cognitive interventions such as breathing techniques, imagery and muscle relaxation.

CBT in FA can help to identify patterns of unhelpful thoughts such as all or nothing thinking or catastrophization (or minimization). Systematic exposure to feared stimuli (behaviors not foods!) is an important piece of CBT.

CBT is patient focused and an evidence based treatment for anxiety: We need to consider it for patients where their anxiety due to their food allergy is impacting function.

Imaginal exposures: Getting people to imagine an environmental exposure to a food allergen as a first step to having actual environmental exposure. Even *thinking* about the food allergen can provoke anxiety in some.

CBT is an evidence-based treatment for anxiety and can be very helpful for FA patients with heightened stress due to their condition.

Health care providers should routinely assess impact of food allergy on functioning of child and family and refer as needed to psychology.

Tweets by:

Dr. Ellis @DrAnneEllis
David Fischer, MD @IgECPD
Dr. Mariam Hanna, MD @PedsAllergyDoc
Lori Connors @DrLoriConnors
Dr. A for Allergy MD @Health_Ontario_
Loubna Akhabir @lakhabir
Mary McHenry MD @maryjmchenry

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