A randomized clinical trial of mindfulness-based cognitive therapy for women with irritable bowel syndrome—Effects and mechanisms.

Abstract

Objective: Irritable bowel syndrome (IBS) is a chronic disorder of brain–gut interaction. Previous studies suggest that mindfulness could be therapeutic for IBS patients, however no study has evaluated the effects of mindfulness-based cognitive therapy adapted for patients with IBS (MBCT-IBS). A 6-week MBCT-IBS course was designed to reduce symptoms and increase quality of life. This study aimed to evaluate the effects of MBCT-IBS and to investigate its therapeutic mechanisms in a randomized controlled trial. Method: Sixty-seven female patients with IBS were randomized to MBCT-IBS (MG; n = 36) or a waitlist (WL; n = 31) control condition. Patients completed standardized self-report measures of IBS symptom severity, IBS quality of life, maladaptive illness cognitions (catastrophizing, visceral anxiety sensitivity) and mindfulness at baseline, after 2 treatment sessions, at posttreatment, and at 6-week follow-up. Self-referential processing of illness and health was measured with an implicit association test (IAT). Results: The MG reported significantly greater reductions in IBS symptoms (p = .003) and improvements in quality of life (p < .001) at follow-up compared with the WL. Changes in visceral anxiety sensitivity and pain catastrophizing at posttreatment and reductions in the IAT-score after 2 sessions combined with increases in nonjudgmental awareness at posttreatment mediated reductions in IBS symptoms. Conclusions: MBCT-IBS has the potential to reduce IBS symptoms and increase quality of life. MBCT-IBS may exert its effect on IBS symptoms via reducing maladaptive illness cognitions and activating changes in self-processing (reducing biases in self-referent processing of illness and health and increasing nonjudgmental awareness).

Opioid use and social disadvantage in patients with chronic musculoskeletal pain

“…Our findings also support the growing evidence that successful chronic pain management requires the incorporation of behavioral health assessment, education, and intervention. 49,50,[58][59][60] The patients in our study who were managed with chronic opioid therapy reported worse behavioral health, and although this association does not establish causality, it is consistent with the biopsychosocial model of pain, which suggests that, in order to successfully treat patients with chronic musculoskeletal pain, we need to address their behavioral health impairments in addition to their physical pain disorders. Until nonaddictive medicines such as tricyclic antidepressants and monoamine oxidase inhibitors became available, opioids were historically used to treat anxiety and depression, 61 and now, having a behavioral health diagnosis while also being managed with chronic opioid therapy is associated with requiring a 20-50% higher opioid dosage to maintain pain control.…”

Specific and common mediators of gastrointestinal symptom improvement in patients undergoing education/support vs. cognitive behavioral therapy for irritable bowel syndrome.

“…Which specific perceptual bias underlies symptom fluctuations is beyond the scope of this article as is the relative therapeutic value of specific cognitive techniques featured in the MC-CBT protocol. The pattern of data suggests that gaining sufficient confidence to self-manage painful IBS symptoms (i.e., self-efficacy) comes about by first changing the way patients think (cognitive process) not simply the content of pain- and GI symptom-specific thoughts (e.g., pain catastrophizing, negative GI-related cognitions) as traditional CBT models have traditionally conceptualized matters (Henrich et al, 2020; Jensen et al, 2018; Windgassen et al, 2017). In our protocol, this is done through worry control strategies that target discrete cognitive biases arising from repetitive, negative thought, functional analysis via self monitoring to clarify the context and function of symptom-aggravating cognitive-behavioral processes (e.g., nonproductive worry as control mechanism over unsolvable problems with uncertain outcomes), and flexible problem solving training that targets a rigid, nondiscriminative coping style oriented toward problem-focused, control-oriented responses regardless of situational demands (e.g., stressor controllability).…”

Efficacy of Zemedy, a Mobile Digital Therapeutic for the Self-management of Irritable Bowel Syndrome: Crossover Randomized Controlled Trial

“…Over the past two decades, cognitive behavioral therapy (CBT) has repeatedly proven to be an efficacious treatment for individuals suffering from IBS [ 10 , 11 ]. Specifically, there is empirical support that CBT reduces GI symptom severity and impairment in quality of life [ 12 , 13 ]. These CBT treatments typically include components of psychoeducation about the brain-gut axis, mindfulness and relaxation training [ 14 ], reducing automatic negative thoughts related to GI catastrophizing [ 15 ], exposure therapy to feared and avoided sensations and situations [ 16 ], and reducing visceral hypersensitivity [ 12 ].…”

“…Specifically, there is empirical support that CBT reduces GI symptom severity and impairment in quality of life [ 12 , 13 ]. These CBT treatments typically include components of psychoeducation about the brain-gut axis, mindfulness and relaxation training [ 14 ], reducing automatic negative thoughts related to GI catastrophizing [ 15 ], exposure therapy to feared and avoided sensations and situations [ 16 ], and reducing visceral hypersensitivity [ 12 ]. One meta-analysis including 20 psychological treatments for IBS found that GI cognition change and GI-specific anxiety were important mediators in improving GI-related quality of life and GI symptom severity [ 17 ].…”