Behavioral medicine interventions for sickle cell disease (SCD) utilize techniques aimed at reducing pain through the use of cognitive strategies (such as calming self-statements, hypnosis and imagery) and/or behavioral strategies (e.g., progressive muscle relaxation).

Research has examined the effectiveness of these interventions with SCD since 1979.  Studies have found that certain patterns of negative thinking are associated with greater pain and health care utilization, and other types of coping strategies are associated with increased activity and less use of health care services. Cognitive-behavioral therapy (CBT) attempts to help patients identify and change maladaptive thinking patterns  (re: interpretation of pain, self-calming) and reduce physiological stress along with the use of behavioral relaxation methods.   Research has demonstrated that patients receiving these treatments demonstrate more adaptive thinking patterns and report less pain as compared to a control group. The research also demonstrated that patients who practice the techniques more tended to have fewer contacts with other health care providers (Gil et al., 2000).  A second study with children found that children who used the active coping strategies on days of high pain used less health care services and had less decrease in activity (Gil, et al, 2001).  A study of  CBT for adolescents with SCD found that those who received the treatment reported more positive coping strategies, engaged in more behavioral activities, and demonstrated greater self-efficacy in pain management compared those who received a placebo treatment (Thomas et. al., 1999). Another study (Thomas et al, 1998) found that adult patients who had CBT had shorter hospital stays than waiting list control patients who did not have the treatment. Patients who had CBT showed a decline in health care costs 6 months after the intervention (Thomas, et. al, 2001). Anie et a., (2002) found that patients who received CBT reported increased adherence to treatment compared to their pre-treatment behavior.  Likewise, progressive muscle relaxation has showed evidence of treatment efficacy. 

Lauren Gaskill, Ph.D., who completed her Post-doctoral fellowship in Pediatric Psychology at the Children's Hospital Sickle Cell Program, is our expert in the behavioral/psychological treatment of Sickle Cell Disease.