CBT Group Intervention for Children With Food Allergy and Anxiety
CBT Group Intervention for Children With Food Allergy and Anxiety
The research will design and evaluate a CBT based intervention to support children aged 12-17
 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.
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 12-17 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.
Inclusion Criteria:

 -  Children and Adolescents ages 12-17 years with a food allergy.

 -  To have reported anxiety or worry in relation to management of food allergy.

 -  Able to attend the one-day workshop at the University of Surrey to complete the
 intervention in full (or online alternative).

 -  Willing and able to comprehend English and provide assent/consent.

 Exclusion Criteria:

 -  Child does not speak English.

 -  Able and willing to engage and understand the content of the workshop.

 -  Currently under a mental health team and receiving ongoing psychological input.

 -  Do not have the capacity to provide informed assent/consent and/or consent not gained
 from caregivers.