Now we are really in a rhythm. The only thing that changes from now to the end of the treatment are the characters, related body sensations, and lessons about the body. The Zoomies and Shakies are the first session in which we really focus on emotional experience. If you think of an over-simplified classification system for emotions in terms of valence and arousal, then Session 4 focuses on high-arousal negative emotions (e.g., fear, anger). Betty the Butterfly, Tommy the Thunderbolt, and Julie Jitters are sample characters in this session. A sample investigation would be to try several activities and compare them to see which brings out the most butterflies. In this way, we directly alter the way that children are experiencing their emotions – rather than running or being afraid of them, they are actively seeking these emotional experiences in a playful context.

In this final session, we celebrate! We have a formal graduation ceremony complete with a certificate honoring the graduate of the FBI-Academy, Tummy Pain Division. In the context of the clinical trial, this was celebrated with the award of a memory card game that had a match for every new character that was learned throughout the treatment. This game served as a fun reminder of all that was learned in a way to ensure that the children and parents remember the characters and help maintain their progress towards emotion awareness, self-regulation, and reduced distress about pain. This last chapter also serves as the beginning of the journey for clinicians. We provide suggestions for how the FBI intervention can be integrated into mental health and pediatric primary care practices. We introduce the reader to all the online resources, including our online support community, and invites them to participate in online supervision groups for providers and support groups for families. We are excited to continue this lifelong investigation as we all learn to trust in ourselves and wonder at the wisdom of our bodies.

Clinicians begin the Explosions! with familiar routines: a Henry Heartbeat activity, reviewing homework and adding data to the Body Map, and a new ritual: checking in with our energy and seeing if we need a snack. New characters related to processes of eating and digesting food are introduced: Victor Vomit, Gaggy Greg, Gordon Gotta Go. Investigations explore activities that may induce gagging. Equipped with garbage cans and paper towels, families are prepared for any result of these disgusting but fun investigations. Body Brainstorms explore questions such as who passes the most gas in the family and what foods produce the smelliest farts. Clinicians introduce a decision-tree in the Body Clues Worksheet that helps family members notice their body sensations, figure out what those sensations may mean (e.g., is Betty the Butterfly telling me I am excited?), and design a corresponding investigation (e.g., what happens to Betty the Butterfly if I take some deep breaths while facing my fears?). Families practice using their Body Clues Worksheet to review the highs and lows of the day or to explore the meaning of an intense moment. Armed with these new investigative tools, families are prepared for any intense situation even if it’s disgusting!

Our step-by-step clinician guide continues with Session 2 – the Eats! a fun exploration of the sensations that constitute hunger, fullness, thirst, and utter deliciousness! Every session from this one forward begins with a Henry Heartbeat investigation, which helps children (a) expend their energy so that they can focus on the remainder of the session, and (b) become comfortable and proficient with raising and lowering arousal, a foundation of self-awareness and emotion regulation. The ritual of homework review is introduced: new things learned about the body between sessions are added to the Body Map. Children meet new characters including Georgia the Gut Growler, Solomon Satisfied, and Umm-ma Una. Children and parents conduct investigations such as learning to sense their changing energy from food as they eat, whether food tastes more delicious if you eat it slowly – and more. A body wisdom might be: “your body tells you how much energy you need if you learn to listen.” Following Body Brainstorms, families begin the first two steps of the Body Clues Worksheet to practice monitoring what they are feeling and what their bodies might be communicating. With worksheets, workbooks, and coloring pages, the investigators are off to explore the week ahead!

The Feeling and Body Investigator Program

The Drowsies is our session about sleep. As a restful night of sleep is an important part of any pain management routine, we wanted to devote a session just to that. We explore that sensations that make it hard to get into bed (e.g., Stuck Stephanie – the feeling that you can’t stop doing something that you like doing (like playing video games) to do something you would rather not do (like get ready for bed). We remember some old friends that that may make it hard to fall asleep like Mind-Racing Mikella and Betty Butterfly and we investigate all the sensations that may contribute to a wonderful and cozy night of rest. Cozy Celeste, Sleepy Steven, Cool Cyrus, and Stretched-Out Comfy Cayla are some sensations we explore this session. Wait till you try out all of our different bedtime routines!

Session 5 focuses on the sensations that comprise low-arousal emotions such as sadness, guilt, and boredom. The pit of dread in your gut when you have done something wrong (Ricky the Rock), the feeling of being weighted down with sand that can happen when one is sad (Bertha Blah), or when your mind and body feel like you are utterly empty but still eager for something to do (Empty Eliza) are some friends we meet this session. Seeing what happens to feelings of heaviness when you snuggle with someone or something and challenging an empty mind to come up with 50 things to do are some of the adventures in this session.

In my 35 years as a practicing pediatrician, I saw many children for abdominal pain. This chapter provides a brief overview of my approach to evaluating abdominal pain in children ages 5 to 11 years old (pre-pubertal). This outline is not meant to be comprehensive or exhaustive, and it assumes its readers are clinical providers with training in the medical evaluation of children. We hope that its inclusion will help to provide a structure for excluding medical causes prior to starting the FBI treatment program. However, we include this caveat: your own clinical judgement must be your guide; no outline can substitute for your own evaluation of an individual patient.

Children with sensory superpowers live life out loud! They have a vivid experience of themselves and the world around them that adds richness to life. Pain sensitivity does not have to be a vulnerability. This chapter is about reframing visceral hypersensitivity as an asset that contributes to three specific superpowers. First, children with visceral sensitivity have spell-binding powers of perception. Because of their history of pain, children may become hyper-vigilant and scared of all the sensations they notice. As they become FBI agents, children learn to harness this perception and use playfulness and curiosity to detect body clues and investigate body mysteries. Second, children with visceral hypersensitivity have awe-inspiring self-awareness. Readers learn about the function, power, and experience of emotions. The intensity with which children feel their bodies runs parallel to strong emotions that can provide vital information to help them get to know and trust themselves. Finally, children with sensory superpowers have faster-than-lightening intuitive decision-making capacities. We explore how sensitivity to physical sensations in the gut can translate to strong feelings that help one “go with their gut” reaction. This chapter links how the tools of the FBI intervention are designed to harness and build each of these superpowers.

This chapter discusses the literature on parent-child attachment and the qualities and skills required in responsive parenting (as well as in responsive healthcare provision). Readers are introduced to how the steps of the FBI –Pain Division protocol concretely guide parents in the implementation of responsive parenting strategies. There is an emphasis on the mutability of the system: it is never too late to gain and provide potent benefit by honing responsive parenting skills. This approach establishes a secure base of attachment between parent and child, yielding not dependency but the courage and sense of safety necessary for confident exploration of one’s environment. Responsive parenting also facilitates self-parenting in offspring. One of the tasks of childhood and adolescence is to become our own “self-parents”: attune to our needs, game for investigating further when our needs are elusive, and ready, willing, and able to respond to our needs effectively. When children are taught to be masterful “self-parents”, their self-knowledge and self-trust further contribute to their confidence in venturing out to experience what the world has to offer.