Exposure and mindfulness based therapy for irritable bowel syndrome – An open pilot study

Ljótsson, Brjánn; Andréewitch, Sergej; Hedman, Erik; Rück, Christian; Andersson, Gerhard; Lindefors, Nils

doi:10.1016/j.jbtep.2010.01.001

Cited by 64 publications

(53 citation statements)

References 30 publications

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“…The paradoxical intervention here is to facilitate letting go of absolute control so as to regain control. This echoes the core objectives of mindfulness training, which emphasize developing an ability of being de-centered and nonreactive (Gaylord et al, 2009;Ljótsson et al, 2010). Our clinical experience and the findings of the current study highlight new directions for working with patients with SSH patterns.…”

Section: Discussionsupporting

confidence: 71%

Symptoms Catastrophizing Versus Social Hypervigilance in Irritable Bowel Syndrome Patients

Chow

2012

Social Work in Health Care

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Western studies have revealed that symptoms catastrophizing (SC), a self-focused illness coping pattern, mediates poorer health outcomes in irritable bowel syndrome (IBS) patients. In light of the collective orientation of Chinese culture, an others-focused illness coping pattern named "symptoms-related social hypervigilance" (SSH) was constructed and explored together with SC in the current study. A cross-sectional questionnaire survey with 309 IBS patients recruited by 100% consecutive sampling was conducted. Exploratory factor analysis on the SSH scale provided a 9-item 3-factor solution. The three factors were 1) Anticipating negative perceptions from others; 2) Hiding symptoms in social situations; and 3) Assuming responsibility for total symptoms control. SC showed partial mediator properties between IBS symptoms severity and lowered health-related quality of life. Whereas SSH did not show similar mediating effects, it was associated with 'proactive' illness behaviors which, if excessive, can lead to relentless pursuit of total symptoms elimination.

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Section: Discussionsupporting

confidence: 71%

Symptoms Catastrophizing Versus Social Hypervigilance in Irritable Bowel Syndrome Patients

Chow

2012

Social Work in Health Care

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“…A few important studies have been conducted (Hunt, Moshier, & Milonova, 2009;Ljótsson, Falk, et al, 2010;Ljótsson, Andréewitch, et al, 2010;Ljótsson et al, 2013Ljótsson et al, , 2014Craske et al, 2011). The results of these studies are promising and show reduced gastrointestinal symptoms and improved well-being.…”

Section: Introductionmentioning

confidence: 99%

“…The results of these studies are promising and show reduced gastrointestinal symptoms and improved well-being. However, while these studies investigated cognitive behavioral treatments that included exposure in order to target gastrointestinal symptom-specific anxiety and avoidance behaviors, these studies are few in number and, and with two exceptions (Craske et al, 2011;Ljótsson, Andréewitch, et al, 2010) delivered treatment over the Internet. Also, the degree of improvement varies largely among individuals, motivating a need for further, and in-depth, study of effects.…”

Section: Introductionmentioning

confidence: 99%

Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects

Boersma

Ljótsson

Edebol-Carlman

et al. 2016

Cognitive Behaviour Therapy

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2016): Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects, Cognitive Behaviour Therapy, ABSTRACT Irritable bowel syndrome (IBS) is a highly prevalent disorder with a significant impact on quality of life. The presence of psychological symptoms in IBS patients such as catastrophic worry and behavioral avoidance suggests the possible efficacy of cognitive behavioral interventions. Exposure-based cognitive behavioral therapy (CBT) has proven to be a promising approach but has only been investigated in a few studies and mainly via the Internet. Therefore, the aims of this study were to extend and replicate previous findings and to evaluate whether an individual, face-to-face, exposure-based CBT leads to improvement in gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life in IBS patients. Thirteen patients with IBS according to Rome III criteria participated in a single-case experimental study using a five-week baseline and a subsequent twelve-session intervention phase focusing on psycho-education, mindfulness and in vivo exposure. Standardized measurement of gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life was conducted weekly during baseline as well as intervention phase and at six-month follow-up. Results showed that over 70% of patients improved significantly on gastrointestinal symptoms, pain catastrophizing, and quality of life. Effects on avoidance behavior were modest. These results strengthen and extend earlier findings and provide further support for the efficacy of exposure-based strategies for IBS.

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“…A follow-up study also showed maintenance of improvements over a 15-18 months period [16] and that the treatment was associated with considerable long-term societal cost-savings [17]. The treatment, which is based on exposure to IBS symptoms and mindfulness exercises, has also been evaluated in an uncontrolled pilot study using a group treatment format, showing similar effects [18]. …”

Section: Introductionmentioning

confidence: 99%

Acceptability, effectiveness, and cost-effectiveness of internet-based exposure treatment for irritable bowel syndrome in a clinical sample: a randomized controlled trial

et al. 2011

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BackgroundInternet-based cognitive behavior therapy (ICBT) has shown promising effects in the treatment of irritable bowel syndrome (IBS). However, to date no study has used a design where participants have been sampled solely from a clinical population. We aimed to investigate the acceptability, effectiveness, and cost-effectiveness of ICBT for IBS using a consecutively recruited sample from a gastroenterological clinic.MethodsSixty-one patients were randomized to 10 weeks of ICBT (n = 30) or a waiting list control (n = 31). The ICBT was guided by an online therapist and emphasized acceptance of symptoms through exposure and mindfulness training. Severity of IBS symptoms was measured with the Gastrointestinal symptom rating scale - IBS version (GSRS-IBS). Patients in both groups were assessed at pre- and post-treatment while only the ICBT group was assessed 12 months after treatment completion. Health economic data were also gathered at all assessment points and analyzed using bootstrap sampling.ResultsFifty of 61 patients (82%) completed the post-treatment assessment and 20 of 30 patients (67%) in the ICBT group were assessed at 12-month follow-up. The ICBT group demonstrated significantly (p < .001) larger improvements on the IBS-related outcome scales than the waiting list group. The between group effect size on GSRS-IBS was Cohen's d = 0.77 (95% CI: 0.19-1.34). Similar effects were noted on measures of quality of life and IBS-related fear and avoidance behaviors. Improvements in the ICBT group were maintained at 12-month follow-up. The ICBT condition was found to be more cost-effective than the waiting list, with an 87% chance of leading to reduced societal costs combined with clinical effectiveness. The cost-effectiveness was sustained over the 12-month period.ConclusionsICBT proved to be a cost-effective treatment when delivered to a sample recruited from a gastroenterological clinic. However, many of the included patients dropped out of the study and the overall treatment effects were smaller than previous studies with referred and self-referred samples. ICBT may therefore be acceptable and effective for only a subset of clinical patients. Study dropout seemed to be associated with severe symptoms and large impairment. Objective and empirically validated criteria to select which patients to offer ICBT should be developed.Trial RegistrationClinicalTrials.gov: NCT00844961

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Exposure and mindfulness based therapy for irritable bowel syndrome – An open pilot study

Cited by 64 publications

References 30 publications

Symptoms Catastrophizing Versus Social Hypervigilance in Irritable Bowel Syndrome Patients

Symptoms Catastrophizing Versus Social Hypervigilance in Irritable Bowel Syndrome Patients

Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects

Acceptability, effectiveness, and cost-effectiveness of internet-based exposure treatment for irritable bowel syndrome in a clinical sample: a randomized controlled trial

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