The structure of resilience in irritable bowel syndrome and its improvement through hypnotherapy: Cross-sectional and prospective longitudinal data

Abstract

BackgroundResilience refers to a class of variables that are highly relevant to wellbeing and coping with stress, trauma, and chronic adversity. Despite its significance for health, resilience suffers from poor conceptual integration. Irritable bowel syndrome (IBS) is a functional disorder with altered psychological stress reactivity and a brain-gut-microbiota axis, which causes high levels of chronic strain. Gut-directed Hypnotherapy (GHT) is a standardized treatment for IBS aimed at improving resilience. An improvement of resilience as a result of GHT has been hypothesized but requires further investigation. The aims of the study were to validate the construct and develop an integrational measure of various resilience domains by dimensional reduction, and to investigate changes in resilience in IBS patients after GHT.MethodA total of N = 74 gastroenterology outpatients with IBS (Rome III criteria) were examined in 7 resilience domains, quality of life, psychological distress and symptom severity. Of these, n = 53 participated in 7 to 10 GHT group sessions (Manchester protocol). Post-treatment examinations were performed on average 10 months after last GHT session.ResultsResilience factors proved to be unidimensional in the total sample. Greater resilience (composite score of resilience domains) and quality of life, and lower symptom severity and psychological distress were found after treatment (n = 16). Similar differences were present in cross-sectional comparisons of n = 37 treated vs. n = 37 untreated patients.ConclusionResilience factors share a common psychological dimension and are functionally connected. The absence of maladaptive behaviours contributes to resilience. Improvements in resilience after hypnotherapy with parallel increases in quality of life and reduced psychological distress and symptom severity were observed. Independent replications with larger sample sizes and randomized controlled trials are needed.

Intestinal Microbiome in Irritable Bowel Syndrome before and after Gut-Directed Hypnotherapy

“…These clinical improvements add to findings from previous studies [ 28 , 31 ]. The contrast between lack of microbial changes and improvements in IBS symptoms and psychological distress suggests that GHT acts on higher levels of the brain-gut axis, including psychological mechanisms [ 33 ], and modulation of processing of interoceptive stimuli [ 34 , 63 , 64 ]. However, further research on the precise mechanisms of therapeutic modulation of the brain-gut microbiota axis by hypnotherapy is highly required.…”

“…Despite the clinical success of this therapy, relatively little is known about its pathways of action. Studies have reported evidence for reductions in dysfunctional cognition [ 32 , 33 ], alterations in cerebral pain processing [ 34 ], rectal sensitivity [ 35 , 36 ], and change in autonomous nervous system functioning [ 37 ].…”

A Rome Working Team Report on Brain-Gut Behavior Therapies for Disorders of Gut-Brain Interaction

“…Such modulation has been demonstrated in healthy individuals, 71 but appears to be more pronounced in DGBI patients, 72,73 Lower resilience to stress in IBS is also reportedly associated with GI symptoms and altered cortisol responses in IBS 74 and may be improved with gut-directed hypnotherapy. 75 Thus, while patient conceptualization regarding the role of stress may focus more on chronic stress, it can be helpful to increase motivation for specific DGP Q3 techniques to explain the impact (and therefore the potential) of making small changes in acutely stressful situations. These have the potential to improve symptoms independently as well as reduce chronic stress and negative mood.…”

Validity and reliability of the German versions of the CD-RISC-10 and CD-RISC-2

“…However, they relied on principal component analysis to test for factorial validity and they drew only on the Big-Five trait factors and the Resilience Scale 25 (RS-25; Wagnild and Young 1993 ) to establish convergent and discriminant validity. Given that the German CD-RISC-10 is in active use (e.g., Henninger and Plieninger in press ; Matzka et al 2016 ; Peter et al 2018 ), a more thorough examination of its validity is highly needed. Harrer et al ( 2018 ) used the German CD-RISC-2, but aside from descriptive statistics and change in response to a stress management intervention, no further psychometric details were provided.…”