Mind-body treatments of irritable bowel syndrome symptoms: An updated meta-analysis

Shah, Khushbu; Ramos-Garcia, Maria; Bhavsar, Jay; Lehrer, Paul M.

doi:10.1016/j.brat.2019.103462

Cited by 37 publications

(30 citation statements)

References 75 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

Hunt¹,

Miguez²,

Dukas³

et al. 2021

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

Background Patients with irritable bowel syndrome (IBS) experience abdominal pain, altered bowel habits, and defecation-related anxiety, which can result in reduced productivity and impaired health-related quality of life (HRQL). Cognitive behavioral therapy (CBT) has been shown to reduce symptoms of IBS and to improve HRQL, but access to qualified therapists is limited. Smartphone-based digital therapeutic interventions have potential to increase access to guided CBT at scale, but require careful study to assess their benefits and risks. Objective The aim of this study was to test the efficacy of a novel app, Zemedy, as a mobile digital therapeutic that delivers a comprehensive CBT program to individuals with IBS. Methods This was a crossover randomized controlled trial. Participants were recruited online and randomly allocated to either immediate treatment (n=62) or waitlist control (n=59) groups. The Zemedy app consists of 8 modules focusing on psychoeducation, relaxation training, exercise, the cognitive model of stress management, applying CBT to IBS symptoms, reducing avoidance through exposure therapy, behavioral experiments, and information about diet. Users interact with a chatbot that presents the information and encourages specific plans, homework, and exercises. The treatment was fully automated, with no therapist involvement or communication. At baseline and after 8 weeks, participants were asked to complete the battery of primary (Irritable Bowel Syndrome Quality of Life [IBS-QOL], Gastrointestinal Symptom Rating Scale [GSRS]) and secondary (Fear of Food Questionnaire [FFQ], Visceral Sensitivity Index [VSI], Gastrointestinal Cognition Questionnaire [GI-COG], Depression Anxiety Stress Scale [DASS], and Patient Health Questionnaire-9 [PHQ-9]) outcome measures. Waitlist controls were then offered the opportunity to crossover to treatment. All participants were assessed once more at 3 months posttreatment. Results Both intention-to-treat and completer analyses at posttreatment revealed significant improvement for the immediate treatment group compared to the waitlist control group on both primary and secondary outcome measures. Gains were generally maintained at 3 months posttreatment. Scores on the GSRS, IBS-QoL, GI-COG, VSI, and FFQ all improved significantly more in the treatment group (F1,79=20.49, P<.001, Cohen d=1.01; F1,79=20.12, P<.001, d=1.25; F1,79=34.71, P<.001, d=1.47; F1,79=18.7, P<.001, d=1.07; and F1,79=12.13, P=.001, d=0.62, respectively). Depression improved significantly as measured by the PHQ-9 (F1,79=10.5, P=.002, d=1.07), and the DASS Depression (F1,79=6.03, P=.02, d=.83) and Stress (F1,79=4.47, P=.04, d=0.65) subscales in the completer analysis but not in the intention-to-treat analysis. The impact of treatment on HRQL was mediated by reductions in catastrophizing and visceral sensitivity. Conclusions Despite its relatively benign physical profile, IBS can be an extraordinarily debilitating condition. Zemedy is an effective modality to deliver CBT for individuals with IBS, and could increase accessibility of this evidence-based treatment. Trial Registration ClinicalTrials.gov NCT04170686; https://www.clinicaltrials.gov/ct2/show/NCT04170686

show abstract

Section: Introductionmentioning

confidence: 99%

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

Hunt¹,

Miguez²,

Dukas³

et al. 2021

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

show abstract

“…In previous studies, 40–50% of patients utilized complementary medicine for functional disorders ( 33 , 34 ). Studies in adults and children have shown that mind–body techniques (MBTs) have efficacy in IBS, along with pain modification likely related to the brain–gut axis ( 9 , 35 ). Our retrospective cohort study confirms that a readily applicable technique can be applied in most outpatient settings with a brief intervention of 4-6 weeks.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Short Course of Preksha Dhyana for Functional Abdominal Pain Disorder in a Busy Pediatric Clinic

Mehta

Patel³

et al. 2021

Front. Pediatr.

View full text Add to dashboard Cite

Introduction: Mind body techniques such as meditation improve symptoms in children and adults with IBS. Typical courses, however, are lengthy and difficult to administer. We report our experience with a short course of Preksha Dhyana (PD), a child-friendly focused meditation with yoga.Method: Physicians deliver focused meditation while medical assistants taught yoga. Three sessions were administered biweekly with recommendations for daily practice. Pain severity Likert scores were compared with a treatment as usual (TAU) historical control. Anxiety scores were compared from baseline in the PD group.Results: Thirty PD patients aged 9–17 (20 female) and 52 consecutive TAU group aged 5–17 (33 female) were reviewed. The biweekly sessions had high (71%) completion rates. Utilization rates of PD were similar to TAU despite added sessions. The PD group had an average time of follow-up of 8.9 ± 9.4 vs. 6.0 ± 3.9 months in the TAU group (p = 0.522). Changes in pain scores from baseline showed improvement in the PD group, 0.67 ± 0.13 vs. TAU 1.39 ± 0.11 (p = 0.0003). In the PD group, anxiety scores improved significantly from baseline (0.5 vs. 1, P < 0.001). Pain improved in 93% (28/30) and resolved in 47% (14/30).Conclusion: A short course of PD was successfully embedded in a busy pediatric office without additional staffing. The approach proved cost-effective without increasing overall healthcare utilization and showed significant benefits over TAU. Pending RCT confirmation, this offers a cost-effective method to incorporate mind–body techniques into a pediatric office practice.

show abstract

“…Combining data from 5 studies that contained both visceral pain sensitivity and symptom reports, Grinsvall et al [ 59 ] found that when IBS patients were divided into sensitivity tertiles based on laboratory pain/discomfort thresholds, there were significant differences in abdominal pain reports, that is, greater overall symptom severity was associated with increased visceral sensitivity. Increasingly, dysbiosis and ‘leaky gut’ due to psychosocial stress through the brain-gut axis are proposed as mechanisms that may account for the diverse pain-related symptoms in at least a subset of patients with overlapping pain symptoms [ 57 ].Psychosocial distress is considered a valuable target for IBS symptom management [ 60 ]. Maladaptive behaviors have been associated with IBS symptoms [ 61 , 62 ].…”

Section: Factors Influencing Gastrointestinal Health In Midlife Womenmentioning

confidence: 99%

“…These medications generally include laxatives, smooth muscle relaxants, chloride channel activators, guanylate cyclase agonists, antidepressants, bile acid sequestrants, and antimicrobials. Non-pharmacologic interventions for general IBS populations include education, nutrition counseling, hypnosis, stress reduction, mindfulness training, sleep hygiene, and exercise [ 60 , 126 ]. Cognitive behavioral therapy (CBT) has received much attention in the IBS literature.…”

Section: Management Of Gastrointestinal Disturbances In Midlife Womenmentioning

confidence: 99%

“…Zia et al [ 133 ] followed up a cohort of participants receiving the CSM intervention and found 94% of the participants still used at least 6 strategies, particularly relaxation, diet composition, and identifying thought distortions after 1 year of follow up. Likewise, the effects of combined non-pharmacologic interventions on IBS symptoms are also supported by a recent meta-analysis incorporating 53 RCT studies with various psychological-mind-body therapies such as meditation, relaxation, yoga, autogenic training, progressive relaxation, stress coping, hypnotherapy, and CBT showing medium to high effects of mind-body therapies on IBS symptom severity [ 60 ].…”

Section: Management Of Gastrointestinal Disturbances In Midlife Womenmentioning

confidence: 99%

See 1 more Smart Citation

Irritable bowel syndrome in midlife women: a narrative review

Yang

Heitkemper

Kamp

2021

womens midlife health

View full text Add to dashboard Cite

Midlife women between the ages of 40 and 65 years have reported multiple challenges due to menopausal, developmental, and situational transitions from younger to older adulthood. During the midlife period, many women seek health care for gastrointestinal symptoms and irritable bowel syndrome (IBS). Multiple factors including stress, poor sleep, diet, and physical inactivity may contribute to IBS or gastrointestinal symptoms in midlife women. As such, a comprehensive assessment and treatment approach is needed for midlife women suffering gastrointestinal symptoms. This article reviews the main aspects of the menopausal transition, sex hormonal changes, abdominal and pelvic surgery, psychosocial distress, behavioral factors, and gut microbiome, as well as their relevance on IBS and gastrointestinal symptoms in midlife women. Also, management strategies for IBS in midlife women are discussed. To date, gastrointestinal symptoms during midlife years remain a critical area of women’s health. Additional research is needed to better understand the contributors to gastrointestinal symptoms in this group. Such efforts may provide a new window to refine or develop treatments of gastrointestinal symptoms for midlife women.

show abstract

Mind-body treatments of irritable bowel syndrome symptoms: An updated meta-analysis

Cited by 37 publications

References 75 publications

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

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

Efficacy of Short Course of Preksha Dhyana for Functional Abdominal Pain Disorder in a Busy Pediatric Clinic

Irritable bowel syndrome in midlife women: a narrative review

Contact Info

Product

Resources

About