GI psychologists within the Suzi and Scott Lustgarten Center for GI Motility that are experts in management of motility disorders and focused therapy to support symptoms improvement and medical management. Behavioral health providers can provide the following services:

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is an evidence-based intervention that helps children and teens learn about connections between their thoughts, body sensations, emotions and behaviors. CBT is an active, problem-solving style of therapy aimed at helping children and teens achieve their goals. For many of our patients with gastrointestinal symptoms, initial treatment goals involve supporting a return to their normal daily functioning, improving stress management, and increasing healthy habits. We strive to support children and teens to resume their typical activities like school, sports and social activities, in spite of ongoing and unpredictable gastrointestinal symptoms. Given that negative or anxious thoughts often lead to avoidance of typical activities, patients and families are provided with education about the connections between these thoughts and gastrointestinal symptoms.

CBT strategies encourage identifying these patterns and supporting the development of coping thoughts, pain management skills, and participation in previously avoided activities. CBT also includes relaxation training to develop pain management and stress reduction skills. Relaxation training components often include diaphragmatic breathing exercises, guided imagery, gut-directed hypnosis, and progressive muscle relaxation (PMR). Families are encouraged to set goals for improved functioning (e.g., school attendance, engagement in social activities). Caregivers are an important part of the care team and are often asked to coach their children in using CBT strategies outside of treatment sessions.

Tele-Psychology

Functional constipation is among the most common functional GI disorders in children and is associated with significant caregiving stress and decreased patient and family quality of life.

Treatment for functional constipation includes oral medications and behavioral modifications. Available research indicates high rates of non-adherence to oral medications for functional constipation. There are no published data regarding adherence to behavioral modifications for constipation management. In practice, families frequently report difficulty consistently implementing these strategies. Treatment non-adherence can contribute to refractory symptoms with greater potential for medical complications and social consequences. Fortunately, licensed psychologists in the Division of Gastroenterology, Hepatology and Nutrition are available to provide adherence-promoting behavioral interventions.

Currently, patients and families receiving treatment for functional constipation within the Division of Gastroenterology, Hepatology and Nutrition can see a psychologist at CHOP Main Campus or at satellite offices. However, many families describe difficulty attending regularly scheduled visits in these locations due to scheduling conflicts, school/work obligations and/or geographic distance.

Pediatric psychologists in the Lustgarten Center for GI Motility are receiving support from the Office of Digital Health, the Department of Child and Adolescent Psychiatry and Behavioral Sciences, and the Center for Quality Healthcare and Analytics to use telehealth to improve patient access to services. Behavioral treatment for constipation management will be provided by video visits to CHOP’s Specialty Care Centers or to the patient/family home. Video sessions will focus on treatment adherence and symptom monitoring, with the goal of improving outcomes for patients with functional constipation and their families.

Rumination Program

Rumination has been extensively studied by our GI physicians jointly with our GI psychologists who perform individual therapy for this distressing upper-tract GI disorder in an ever-growing number of patients. Rumination occurs when food that was swallowed but not yet digested is regurgitated. The food comes back up from the stomach into the mouth through the esophagus. A child may not be able to tell that they are about to regurgitate. Parents may not be able to see or hear the regurgitation — it often does not look or sound like vomiting. Rumination is considered a reflex, not a purposeful behavior and can affect children as well as adults. In the past, rumination syndrome was considered a rare disorder. We now recognize this disorder to be more common than we thought. This may be due to healthcare providers being more aware of rumination syndrome and recognizing it more frequently.