New psychological therapies for irritable bowel syndrome: mindfulness, acceptance and commitment therapy (ACT)

Abstract

The current goal of treatment in irritable bowel syndrome (IBS) focuses primarily on symptom management and attempts to improve quality of life. Several treatments are at the disposal of physicians; lifestyle and dietary management, pharmacological treatments and psychological interventions are the most used and recommended. Psychological treatments have been proposed as viable alternatives or compliments to existing care models. Most forms of psychological therapies studied have been shown to be helpful in reducing symptoms and in improving the psychological component of anxiety/depression and health-related quality of life. According to current NICE/NHS guidelines, physicians should consider referral for psychological treatment in patients who do not respond to pharmacotherapy for a period of 12 months and develop a continuing symptom profile (described as refractory irritable bowel syndrome). Cognitive behavioral therapy (CBT) is the best studied treatment and seems to be the most promising therapeutic approach. However, some studies have challenged the effectiveness of this therapy for irritable bowel syndrome. One study concluded that cognitive behavioral therapy is no more effective than placebo attention control condition and another study showed that the beneficial effects wane after six months of follow-up. A review of mind/body approaches to irritable bowel syndrome has therefore suggested that alternate strategies targeting mechanisms other than thought content change might be helpful, specifically mindfulness and acceptance-based approaches. In this article we review these new psychological treatment approaches in an attempt to raise awareness of alternative treatments to gastroenterologists that treat this clinical syndrome.

Effectiveness of Acceptance and Commitment Therapy on Psychosomatic Symptoms and Mindfulness in Patients With Psychosomatic Disorders

“…The collected results indicated the effectiveness of ACT in the reduction of anxiety in these patients (Eilenberg, Hoffmann, Jensen, & Frostholm, 2017). Sebastián Sánchez et al (2017) People with psychosomatic problems are drowned in their past-and future-related thoughts. ACT teaches them to focus on the present moment with the use of metaphors, including the metaphor of "body's touch", and reminds the clients that "life is here and now".…”

Mechanisms of Food-Induced Symptom Induction and Dietary Management in Functional Dyspepsia

“…In another study of 100 FD patients with refractory symptoms, intensive medical management that incorporated a psychological intervention resulted in superior long-term-outcome than standard care [ 118 ]. Exposure and mindfulness therapy [ 119 ], acceptance and commitment therapy [ 120 ], and cognitive behavioural therapy [ 121 ] are other psychological treatment approaches that have been successfully tested in IBS but not yet applied to FD. Therefore, optimal dietetic management of FD requires an integrated view of FD as a disorder of brain–gut signalling [ 122 ], with psychological factors (such as personality traits and anticipatory anxiety) considered when assessing symptom responses to food and eating.…”

“…Tuck et al (2018) predict that targeted dietetic approaches will potentially reduce the level of dietary restriction needed to optimize symptom management, with only reduction of ‘likely triggers’ [ 120 ]. To achieve this outcome, treating dietitians will have the ability to match dietary approaches to symptomatology and to prioritise associated management strategies.…”

Efficacy of acupuncture in refractory irritable bowel syndrome: study protocol for a randomised controlled trial

“…Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder worldwide. 1 Epidemiological data show that the prevalence of IBS is approximately 5%-6% in China, 2 9.5%-9.8% in Asia 3 and 11% worldwide, 4 which indicates that IBS is a major public health issue. Owing to the complex pathogenesis of IBS, several pathogenic factors (genetic and environmental factors, visceral hypersensitivity, abnormal gut motility, postinfectious inflammatory mechanisms, gut microbiota changes, psychological morbidity, and physical and emotional factors) have been proposed as possible causes.…”