The Feasibility of a Group CBT Intervention for Improving Psychological Outcomes in Parents of Children With Food Allergy

Food allergy is the adverse reaction of the body's immune system to the ingestion of food protein. When a food allergen is ingested, the immune system detects the food protein as a threat and releases a number of chemicals which cause the symptoms of an allergic reaction. These symptoms can include watery eyes, a running nose, itching, rashes, swelling and gastrointestinal problems, and may vary in their severity. Reactions can progress to anaphylaxis, which is a serious allergic reaction that is rapid in onset; symptoms can include a range of frightening respiratory, gastrointestinal and cardiovascular symptoms which may result in death if not treated promptly and effectively with adrenaline.

In the UK, food allergy is a prevalent problem, with an estimated 2 million people living with a diagnosed food allergy in the UK. Prevalence rates are higher in children than in adults, with an estimated 6-7% of children affected compared to 1-2% of adults, with this prevalence thought to be increasing. Currently, treatment involves avoidance of food allergens and the administration of treatment for accidently ingested foods.

The current management of food allergy involves the burden of constant vigilance, planning and preparation, with this responsibility often falling on parents (particularly the mothers) of young children. Furthermore, those with food allergy and their caregivers have to manage the unpredictable nature of food allergy and live continually with the risk and fear of accidental food ingestion which can negatively impact the Quality of Life (QoL) of allergy sufferers and their immediate family.

Research in this field has started to examine the psychological impact food allergy can not only have on the allergic child but also their parents. Previous studies have suggested that allergic children and their mothers experience higher stress and anxiety levels compared to the general population. Reasons why food allergy can cause such distress in parents include: the constant vigilance needed to check safety of foods; anxiety caused by severe and potentially fatal consequences of accidental ingestion of the food allergen; anxiety caused by handing over control of allergy management to the child (for example reading their own food labels); risk from the environment including people not understanding the impact of food allergy; worry about the future of their child, and dietary restrictions leading to social restrictions and potentially isolation. Given the impact looking after a child with food allergy can have on mental health and QoL in parents, the need for interventions to improve psychological outcomes is of high importance.

To date, there has been a paucity of research on interventions to improve psychological outcomes for parents of children with a food allergy. However, there is emerging evidence to suggest that Cognitive Behavioural Therapy (CBT) may be a promising intervention for parents experiencing poor psychological outcomes and QoL. CBT is a short-term therapy based on the rationale that what individuals think and do affects the way individuals feel. It has a strong evidence base for a range of mental health issues including anxiety and depression, and therefore may be appropriate for parents experiencing high levels of stress, anxiety and depression in relation to a child's food allergy. In the first study which reported on the effectiveness of CBT for mothers of children with a food allergy, five mothers received 12 weeks of individual face-to-face CBT, with six mothers acting as controls. All participants completed measures of anxiety, depression, worry, stress, general mental health, generic and food allergy specific QoL at baseline and at 12 weeks. Results showed that anxiety, depression and worry in the CBT group significantly reduced and overall mental health and QoL significantly improved from baseline to 12 weeks for mothers in the CBT group. A larger randomised control trial supported these promising initial findings. Two hundred mothers of children with food allergy were randomised to receive either a single-session CBT intervention or standard care, with anxiety and risk perception assessed at 6 weeks and 1 year. Results found significantly reduced state anxiety at six weeks in the intervention group, in the subgroup of mothers with moderate to high anxiety at enrolment and reduced risk perception. The study also found evidence of a reduction in physiological stress response in the intervention group, as measured by a salivary cortisol response to a simulated anaphylaxis scenario at one year. The results of both of these studies indicate that a CBT intervention may be an appropriate intervention for parents of children with food allergy.