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Changes in Coping, Pain, and Activity After Cognitive-Behavioral Training

A Randomized Clinical Trial for Pediatric Sickle Cell Disease Using Smartphones

Schatz, Jeffrey PhD*; Schlenz, Alyssa M. PhD*; McClellan, Catherine B. PhD*; Puffer, Eve S. PhD; Hardy, Steven PhD‡,§; Pfeiffer, Matthew MA; Roberts, Carla W. MD

The Clinical Journal of Pain: June 2015 - Volume 31 - Issue 6 - p 536–547
doi: 10.1097/AJP.0000000000000183
Special Topics Series

Objectives: We examined the outcomes of a cognitive-behavioral therapy (CBT) intervention for pain in pediatric sickle cell disease (SCD) using smartphones as a novel delivery method.

Materials and Methods: Forty-six children with SCD received CBT coping skills training using a randomized, waitlist control design. The intervention involved a single session of CBT training and home-based practice using smartphones for 8 weeks. Pre-post questionnaires between the randomized groups were used to evaluate changes in active psychological coping and negative thinking using the Coping Strategies Questionnaire. Daily diaries completed by the full sample during the treatment period were used to assess whether CBT skill use was related to reductions in next-day pain intensity and increases in same-day functional activity.

Results: The pre-post group comparison suggested that the youth increased active psychological coping attempts with the intervention. Daily diary data indicated that when children used CBT skills on days with higher pain, there were reductions in next-day pain intensity. There was no such association between skill use and functional activity.

Discussion: CBT coping skills training supported using smartphones can increase coping and reduce pain intensity for children with SCD; however, additions to the study protocols are recommended in future studies. Advantages and caveats of using smartphones are also discussed.

*Department of Psychology, University of South Carolina

Department of Pediatrics, University of South Carolina School of Medicine, Columbia, SC

Department of Psychology, Duke University, Durham, NC

Divisions of Hematology and Oncology, Children’s National Medical Center

§Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Washington, DC

DanlHos Computer Consulting LLC, East Lansing, MI

This work was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R21HL0923365 to J.S. and C.B.M and T32 GM081740 and F31HL108582 to A.M.S.). The authors declare no conflict of interest.

Reprints: Jeffrey Schatz, PhD, Department of Psychology, Barnwell College Bldg, University of South Carolina, Columbia, SC 29208 (e-mail:

Received July 15, 2014

Received in revised form December 12, 2014

Accepted October 31, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.