Provoking symptoms to relieve symptoms: A randomized controlled dismantling study of exposure therapy in irritable bowel syndrome

Ljótsson, Brjánn; Hesser, Hugo; Andersson, Erik; Lackner, Jeffrey M.; Alaoui, Samir El; Falk, Lisa; Aspvall, Kristina; Fransson, Josefin; Hammarlund, Klara; Löfström, Anna; Nowinski, Sanna; Lindfors, Perjohan; Hedman, Erik

doi:10.1016/j.brat.2014.01.007

Cited by 120 publications

(121 citation statements)

References 60 publications

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“…14,56 This is recognized and supported by accumulating findings showing the efficacy of cognitivebehavioral treatments that incorporate learning-based elements such as exposure therapy for chronic pain, 57 including visceral pain conditions. 58,59 Hence, targeting pain-related fear and maladaptive cognitive and emotional processes is an important future research area in visceral and somatic chronic pain conditions.…”

Section: Discussionmentioning

confidence: 99%

Learning by experience? Visceral pain‐related neural and behavioral responses in a classical conditioning paradigm

Icenhour

Labrenz

Theysohn

et al. 2017

Neurogastroenterology Motil

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We report changes in neural activation patterns during anticipation and visceral stimulation induced by prior conditioning. In the absence of behavioral effects, markedly altered neural responses may indicate conditioning with visceral signals to induce hypervigilance rather than hyperalgesia, involving altered attention, reappraisal, and perceptual acuity as processes contributing to the pathophysiology of visceral pain.

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Section: Discussionmentioning

confidence: 99%

Learning by experience? Visceral pain‐related neural and behavioral responses in a classical conditioning paradigm

Icenhour

Labrenz

Theysohn

et al. 2017

Neurogastroenterology Motil

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“…This greatly reduces the risk of therapist drift,68 and ensures that all patients receive exactly the same treatment. The control over content delivered also opens up for dismantling studies, as modules can easily be added or taken out to test the specific effect of a treatment component, as shown by Ljótsson et al 69 where the specific effect of systematic exposure on Irritable Bowel Syndrome symptoms was tested.…”

Section: Discussionmentioning

confidence: 99%

Therapist-guided, Internet-based cognitive–behavioural therapy for body dysmorphic disorder (BDD-NET): a feasibility study

et al. 2014

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ObjectivesCognitive–behavioural therapy (CBT) is an effective treatment for body dysmorphic disorder (BDD). However, most sufferers do not have access to this treatment. One way to increase access to CBT is to administer treatment remotely via the Internet. This study piloted a novel therapist-supported, Internet-based CBT program for BDD (BDD-NET).DesignUncontrolled clinical trial.ParticipantsPatients (N=23) were recruited through self-referral and assessed face to face at a clinic specialising in obsessive–compulsive and related disorders. Suitable patients were offered secure access to BDD-NET.InterventionBDD-NET is a 12-week treatment program based on current psychological models of BDD that includes psychoeducation, functional analysis, cognitive restructuring, exposure and response prevention, and relapse prevention modules. A dedicated therapist provides active guidance and feedback throughout the entire process.Main outcome measureThe clinician-administered Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS). Symptom severity was assessed pretreatment, post-treatment and at the 3-month follow-up.ResultsBDD-NET was deemed highly acceptable by patients and led to significant improvements on the BDD-YBOCS (p=<0.001) with a large within-group effect size (Cohen's d=2.01, 95% CI 1.05 to 2.97). At post-treatment, 82% of the patients were classified as responders (defined as≥30% improvement on the BDD-YBOCS). These gains were maintained at the 3-month follow-up. Secondary outcome measures of depression, global functioning and quality of life also showed significant improvements with moderate to large effect sizes. On average, therapists spent 10 min per patient per week providing support.ConclusionsThe results suggest that BDD-NET has the potential to greatly increase access to CBT, at least for low-risk individuals with moderately severe BDD symptoms and reasonably good insight. A randomised controlled trial of BDD-NET is warranted.Trial registration numberClinicaltrials.gov registration ID NCT01850433.

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“…A few important studies have been conducted (Hunt, Moshier, & Milonova, 2009;Ljótsson, Falk, et al, 2010;Ljótsson, Andréewitch, et al, 2010;Ljótsson et al, 2013Ljótsson et al, , 2014Craske et al, 2011). The results of these studies are promising and show reduced gastrointestinal symptoms and improved well-being.…”

Section: Introductionmentioning

confidence: 93%

Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects

Boersma

Ljótsson

Edebol-Carlman

et al. 2016

Cognitive Behaviour Therapy

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2016): Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects, Cognitive Behaviour Therapy, ABSTRACT Irritable bowel syndrome (IBS) is a highly prevalent disorder with a significant impact on quality of life. The presence of psychological symptoms in IBS patients such as catastrophic worry and behavioral avoidance suggests the possible efficacy of cognitive behavioral interventions. Exposure-based cognitive behavioral therapy (CBT) has proven to be a promising approach but has only been investigated in a few studies and mainly via the Internet. Therefore, the aims of this study were to extend and replicate previous findings and to evaluate whether an individual, face-to-face, exposure-based CBT leads to improvement in gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life in IBS patients. Thirteen patients with IBS according to Rome III criteria participated in a single-case experimental study using a five-week baseline and a subsequent twelve-session intervention phase focusing on psycho-education, mindfulness and in vivo exposure. Standardized measurement of gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life was conducted weekly during baseline as well as intervention phase and at six-month follow-up. Results showed that over 70% of patients improved significantly on gastrointestinal symptoms, pain catastrophizing, and quality of life. Effects on avoidance behavior were modest. These results strengthen and extend earlier findings and provide further support for the efficacy of exposure-based strategies for IBS.

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Provoking symptoms to relieve symptoms: A randomized controlled dismantling study of exposure therapy in irritable bowel syndrome

Cited by 120 publications

References 60 publications

Learning by experience? Visceral pain‐related neural and behavioral responses in a classical conditioning paradigm

Learning by experience? Visceral pain‐related neural and behavioral responses in a classical conditioning paradigm

Therapist-guided, Internet-based cognitive–behavioural therapy for body dysmorphic disorder (BDD-NET): a feasibility study

Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects

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