Emotional awareness and expression training improves irritable bowel syndrome: A randomized controlled trial

Abstract

Background and Aims Current clinical guidelines identify several psychological treatments for irritable bowel syndrome (IBS). IBS patients, however, have elevated trauma, life stress, relationship conflicts, and emotional avoidance, which few therapies directly target. We tested the effects of emotional awareness and expression training (EAET) compared to an evidence-based comparison condition—relaxation training—and a waitlist control condition. Methods Adults with IBS (N = 106; 80% female, Mean age = 36 years) were randomized to EAET, relaxation training, or waitlist control. Both EAET and relaxation training were administered in three, weekly, 50-minute, individual sessions. All patients completed the IBS Symptom Severity Scale (primary outcome), IBS Quality of Life, and Brief Symptom Inventory (anxiety, depressive, and hostility symptoms) at pretreatment and at 2 weeks post-treatment and 10 weeks follow-up (primary endpoint). Results Compared to waitlist controls, EAET, but not relaxation training, significantly reduced IBS symptom severity at 10-week follow-up. Both EAET and relaxation training improved quality of life at follow-up. Finally, EAET did not reduce psychological symptoms, whereas relaxation training reduced depressive symptoms at follow-up (and anxiety symptoms at post-treatment). Conclusions Brief emotional awareness and expression training that targeted trauma and emotional conflicts reduced somatic symptoms and improved quality of life in patients with IBS. This emotion-focused approach may be considered an additional treatment option for IBS, although research should compare EAET to a full cognitive-behavioral protocol and determine which patients are best suited for each approach. Registered at clinicaltrials.gov (NCT01886027)

Ambivalence over emotional expression and perceived social constraints as moderators of relaxation training and emotional awareness and expression training for irritable bowel syndrome

“…Findings indicate that both ambivalence over emotional expression and perceived social constraints predicted the effects of RT compared to controls, but not of EAET. That is, although both interventions in the original trial were beneficial on average [1], RT was beneficial only for those patients with elevated baseline ambivalence over emotional expression or perceived social constraints. In contrast, neither of these two patient variables predicted outcomes in EAET, suggesting that this intervention is more broadly beneficial.…”

“…In conclusion, although both RT and EAET improved health outcomes in IBS [1], the effects of RT were moderated by certain patient characteristics at some timepoints. RT was particularly helpful for individuals high in ambivalence over emotional expression and perceived social constraints.…”

“…In a recent randomized trial, we tested the effects of brief (3-session) RT and EAET against a waitlist control (WLC) condition among patients with IBS [1]. Compared with the control condition, both RT and EAET improved quality of life, EAET significantly lowered IBS symptoms and anxiety, and RT significantly reduced anxiety and depression.…”

“…We conducted secondary analyses of the data from the randomized trial of RT, EAET, and control [1]. We examined two baseline patient characteristics from Lumley [17] emotional disclosure model that we thought might moderate the effects of each treatment compared to waitlist controls.…”

“…A prior randomized controlled trial found that both relaxation training (RT) and emotional awareness and expression training (EAET) were superior to a waitlist control condition for IBS symptoms, quality of life, depression, and anxiety among IBS patients [1]. …”