The Central Role of Group Cohesion in Recovery from Adolescent Somatization: Adapting a Multifamily Treatment for Virtual Delivery During the COVID-19 Pandemic

• In Event: Implementation and Evaluation of TeleGroup Interventions for Youth in the Wake of the COVID-19 Pandemic

Abstract

Introduction: Clinically-significant somatization occurs when physical symptoms are intensified by emotional distress and impede academic, social, and recreational pursuits. Somatization increases with puberty, affecting 8-13% of adolescents (Barsky et al., 2005; LeResche et al., 2005). Regrettably, families frequently feel stigmatized by psychiatric implications, distrust doctors, seek multiple medical opinions, and decline mental healthcare. Heightened risk for viral exposure, illness anxiety, and social isolation in the context of the COVID-19 pandemic may particularly compound the effects of somatization among adolescents, exacerbating existing difficulties in psychosocial task achievement (concerning identity, independence, and peer orientation). Critically, psychological treatments delivered alongside medical care to help patients link physical and emotional events can improve somatization among adults (Abbass et al., 2020). A developmentally-sensitive multifamily hospital-based treatment for somatization for adolescents was developed, called the Mind-Body Connection (MBC) group. Empirical data showed our treatment was correlated with improvements in symptoms, emotion regulation, and peer belongingness (Dhariwal et al., 2018). Process research identified group cohesion as the active treatment ingredient to destigmatize somatization and guide recovery (Lui et al., 2020). It is unknown whether virtual treatment adaptations of the MBC group implemented during the pandemic would facilitate group cohesion. Given that families would attend group from physically separate locations, the current study explored whether group cohesion would continue to be central to recovery.

Methods: We employed a mixed-methods approach with adolescents (ages 10-18; 75% Female) and parents who were referred to the MBC group delivered virtually across three primary tertiary care pediatric hospitals. The MBC group explained the mind-body connection, normalized somatization, identified common developmental stresses during adolescence, and fostered emotional responsiveness between parents and their children. Twenty-three caregivers (of an expected total of 50) completed satisfaction surveys with Likert-style response options to measure satisfaction with content delivery, group process, and social connectedness. One site provided data from 2 focus groups, and another site from 6 (of 12 expected) individual interviews. Sites explored transcripts using thematic analysis.

Results: Preliminary survey data revealed 88% of respondents felt they could see other group members as easily as if they met in person, with 71% reporting that they were able to connect with others who had similar experiences, which felt normalizing. Overall, 82% reported that the virtual sessions were as effective as in-person sessions and would recommend the virtual groups to others. Themes that emerged from the interviews and focus groups consistently showed value added through peer belongingness, social connection, and community, and a reduction in social isolation. Narratives further emphasized the importance of peer group engagement as the mechanism that allowed participants to make meaning of the material presented. A strong theme featured a desire for clinicians to enhance virtual care with unstructured social time to optimize therapeutic effects.

Conclusion: Findings revealed that group cohesion and social connection remained essential to outcomes with the virtual delivery of the MBC group. This work highlights the importance of facilitating social connection and community among virtual treatment groups and informs improvements in future virtual clinical care.

Authors

• Erin Romanchych, The hospital for sick children
  Presenting Author

• Amrit Dhariwal, University of British Columbia (UBC)
  Non-Presenting Author

• Janice Cohen, Children's Hospital of Eastern Ontario
  Non-Presenting Author