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Knowles SR, Möller SP, Stengel A, Mikocka-Walus A, Ferreira N, Trindade IA, Mokrowiecka A, Burisch J, Barreiro-de Acosta M, Bernstein CN, Lo B, Skvarc D. Exploring the Impact of Covid-19-Related Perceptions on Psychological Distress and Quality of Life in an International Gastrointestinal Cohort Over Time Guided by the Common Sense Model. J Clin Psychol Med Settings 2023; 30:804-820. [PMID: 36692701 PMCID: PMC9872753 DOI: 10.1007/s10880-023-09937-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/25/2023]
Abstract
The aim of this longitudinal study was to examine changes in COVID-19 and illness-related perceptions, gastrointestinal symptoms, coping, catastrophising, psychological distress, and QoL during the COVID-19 pandemic. A total of 831 adults with a gastrointestinal condition completed an online questionnaire at baseline (May-October 2020). Of those, 270 (32.5%) participants (85.2% female, mean age = 47.3 years) provided follow-up data (March-May 2021). Repeated-measures multiple analysis of variance and a cross-lagged panel model were used to test the study hypotheses. Gastrointestinal symptoms and COVID-19 perceptions at follow-up were strongly predicted by their baseline values, while illness perceptions were predicted by baseline gastrointestinal symptoms. Cross-lagged relationships indicated a reciprocal relationship between gastrointestinal symptoms and psychological distress. Moreover, gastrointestinal symptoms had substantial predictive utility, strongly predicting future gastrointestinal symptoms, and to a lesser extent, more negative illness perceptions, greater psychological distress, and greater use of adaptive coping strategies across time.
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Affiliation(s)
- Simon R Knowles
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia.
| | - Stephan P Möller
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universit¨Atsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Nuno Ferreira
- School of Humanities and Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Inês A Trindade
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Research in Neuropsychology and Cognitive and Behavioural Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Anna Mokrowiecka
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Johan Burisch
- Gastrounit, Medical Division, Copenhagen University Hospital - Amager and Hvidovre, University of Copenhagen, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre and Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Bobby Lo
- Gastrounit, Medical Division, Copenhagen University Hospital - Amager and Hvidovre, University of Copenhagen, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre Hospital, Hvidovre, Denmark
| | - David Skvarc
- School of Psychology, Deakin University Geelong, Geelong, Victoria, Australia
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Hunt MG, Dalvie A, Ipek S, Wasman B. Acceptability and efficacy of the Zemedy app versus a relaxation training and meditation app for IBS: protocol for a randomised controlled trial. BMJ Open 2022; 12:e055014. [PMID: 35039299 PMCID: PMC8765021 DOI: 10.1136/bmjopen-2021-055014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) has high rates of psychiatric comorbidity, and impairs health-related quality of life (HRQL). Cognitive-behavioural therapy (CBT) is an effective treatment for IBS, but access to treatment remains low. Our proposed solution is a CBT-based smartphone app, Zemedy. METHODS AND ANALYSIS This randomised controlled trial of Zemedy (V.2.0) uses an education and relaxation training active control app meant to simulate treatment as usual. A target N of 300 participants complete baseline questionnaires and consent at screening, and are then allocated to either the immediate treatment (Zemedy) or the active control. Treatment lasts 8 weeks, after which both groups complete the same battery used at baseline, and the control group is crossed over to Zemedy. After another 8 weeks, the crossed-over participants will be surveyed once more. Follow-up questionnaires are administered at 3, 6 and 12 months post-treatment. Primary outcomes include gastrointestinal symptom severity and HRQL. Clinically significant change will be defined as post-treatment scores falling within 2 SD of the healthy mean. Analysis will include intent-to-treat between-groups comparisons, controlling for baseline symptom severity, as well as moderation and mediation analyses. We hypothesise that the Zemedy app will outperform the active control app in reducing IBS symptom severity and improving HRQL. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board at the University of Pennsylvania. Results will provide essential information on the efficacy and acceptability of an app-based CBT treatment for IBS. The data gathered may help establish the Zemedy app as an empirically supported intervention for IBS and will assist funding bodies in deciding whether to invest in its further development and dissemination. The results will be disseminated to patients with IBS via the media and the company website, to healthcare professionals via professional training (e.g. webinars and grand rounds talks) and to researchers via conferences and publications. TRIAL REGISTRATION NUMBER NCT04665271 (https://clinicaltrials.gov/ct2/show/NCT04665271).
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Affiliation(s)
- Melissa G Hunt
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anika Dalvie
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Simay Ipek
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ben Wasman
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sugaya N, Shirotsuki K, Nakao M. Cognitive behavioral treatment for irritable bowel syndrome: a recent literature review. Biopsychosoc Med 2021; 15:23. [PMID: 34838129 PMCID: PMC8626893 DOI: 10.1186/s13030-021-00226-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/15/2021] [Indexed: 12/31/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a gastrointestinal psychosomatic disorder that often develops and worsens with stress. Hence, it is important to treat it from both, its physical and mental aspects. We reviewed recent research on cognitive-behavioral therapy (CBT)—one of the most widely studied psychological treatments for IBS—since it focuses on addressing the cognitions and behaviors associated with IBS symptoms, and combines diverse content, such as cognitive techniques, exposure, stress management, and mindfulness, whose effects have been widely studied. Research on CBT for IBS varies not only in terms of content of the interventions, but also in terms of implementation (individual or group, face-to-face or online). Internet-delivered CBT has recently shown the possibility of providing more accessible and cost-effective psychological intervention to IBS patients in formats, other than face-to-face. In recent years, many standardized scales that allow for IBS-specific psychological assessments have been used in clinical studies of CBT for IBS. Tools that competently deliver effective interventions and properly measure their effectiveness are expected to spread to many people suffering from IBS.
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Affiliation(s)
- Nagisa Sugaya
- Unit of Public Health and Preventive Medicine, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama City, 236-0004, Japan.
| | - Kentaro Shirotsuki
- Graduate School of Human and Social Sciences, Musashino University, Tokyo, Japan
| | - Mutsuhiro Nakao
- Department of Psychosomatic Medicine, School of Medicine, International University of Health and Welfare, Chiba, Japan
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Zickgraf HF, Loftus P, Gibbons B, Cohen LC, Hunt MG. "If I could survive without eating, it would be a huge relief": Development and initial validation of the Fear of Food Questionnaire. Appetite 2021; 169:105808. [PMID: 34798226 DOI: 10.1016/j.appet.2021.105808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fear of food and behavioral avoidance of specific foods, food groups, and food related social situations can substantially reduce health related quality of life in individuals with a wide range of conditions that affect appetite, eating behavior, and digestion, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), vomit and choking phobias, and food allergies/sensitivities. When this avoidance leads to weight/nutritional and/or psychosocial impairment, the diagnostic criteria for Avoidant/restrictive food intake disorder (ARFID) are met. Fear of food is an important target for interventions designed to improve psychosocial functioning and quality of life in such individuals. The purpose of this research was to develop and validate a novel measure of fear of food. METHODS Participants (n = 1138) were recruited from ongoing clinical trials for both IBD and IBS, from Amazon's Mechanical Turk, from Reddit support forums for IBS, IBD, and vomit phobia, and from an undergraduate subject pool. Exploratory and confirmatory factor analysis, Pearson's correlations, one-way ANOVA, and intraclass correlation coefficients were used to assess the validity and reliability of the Fear of Food Questionnaire. RESULTS The final 18 item questionnaire showed excellent internal consistency, test-retest reliability, convergent validity, discriminative (known groups) validity, as well as good factor structure. Fear of food was highly correlated with visceral hypersensitivity, catastrophizing, GI symptom severity and health related quality of life, as well as with self-reported Fear-ARFID symptoms. Individuals meeting study criteria for Fear-ARFID reported the highest scores relative to control and other analogue clinical groups. CONCLUSION The Fear of Food Questionnaire appears to be reliable and valid across populations and may be a valuable tool in the assessment and treatment of Fear-ARFID.
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Affiliation(s)
- Hana F Zickgraf
- University of South Alabama, Department of Psychology, USA; University of Pennsylvania, Department of Psychology, USA; Penn State Hershey Medical Center, Department of Psychiatry & Department of Surgery, USA.
| | - Patrick Loftus
- University of Pennsylvania, Department of Psychology, USA
| | | | - Lauren C Cohen
- University of Pennsylvania, Department of Psychology, USA
| | - Melissa G Hunt
- University of Pennsylvania, Department of Psychology, USA
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Petrik M, Palmer B, Khoruts A, Vaughn B. Psychological Features in the Inflammatory Bowel Disease-Irritable Bowel Syndrome Overlap: Developing a Preliminary Understanding of Cognitive and Behavioral Factors. CROHN'S & COLITIS 360 2021; 3:otab061. [PMID: 36776665 PMCID: PMC9802046 DOI: 10.1093/crocol/otab061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 11/15/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) patients in clinical remission may experience ongoing symptoms, such as diarrhea and abdominal pain, attributed to IBD-irritable bowel syndrome (IBS) overlap. This study aims to characterize the psychosocial needs of patients with IBD-IBS overlap, particularly in regard to cognitive and behavioral functioning. Methods Adults with an established IBD diagnosis were recruited from a gastroenterology clinic. Participants completed self-report questionnaires about psychological functioning and quality of life. The Rome IV Diagnostic Questionnaire for Adults-IBS Module assessed IBS criteria. The treating gastroenterologist completed a clinician rating of IBD activity to determine clinical disease activity. Biomarkers of inflammation collected in routine care within 90 days of the research encounter were obtained via medical record review to further contextualize IBD activity status. Participants were separated into the following groups: "inactive IBD" (IBD activity rating indicating inactive disease and no IBS criteria met), "active IBD" (IBD activity rating indicating mild, moderate, or severe regardless of IBS criteria), or "IBD-IBS overlap" (IBD activity rating indicating inactive disease and IBS criteria met). Results One hundred and seventeen participants were recruited. Those with IBD-IBS overlap reported no significant differences in ratings of anxiety, depression, somatization, catastrophic thinking patterns, and behavioral avoidance, to patients with active IBD whereas participants with inactive IBD reported significantly lower ratings on these factors. However, a significant portion of participants with IBD-IBS overlap who were rated as inactive on IBD activity measures had laboratory or endoscopic findings indicating mild inflammation within 90 days of the research encounter. Conclusions The study findings provide preliminary evidence that suggests patients with IBD-IBS overlap display similar rates of psychological distress, catastrophic thinking, and avoidance behaviors as those with active IBD. Those with mild ongoing inflammation despite meeting a definition for clinical remission may have similar psychological needs compared to those with moderate-to-severely active IBD. Incorporating a mental health provider with training in psychogastroenterology can help a patient with IBD learn how to effectively with these cognitive and behavioral patterns.
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Affiliation(s)
- Megan Petrik
- University of Minnesota Medical School, Department of Medicine, Division of General Internal Medicine, Minneapolis, Minnesota, USA
| | - Brooke Palmer
- University of Minnesota Medical School, Department of Medicine, Division of General Internal Medicine, Minneapolis, Minnesota, USA
| | - Alexander Khoruts
- University of Minnesota Medical School, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Minneapolis, Minnesota, USA
| | - Byron Vaughn
- University of Minnesota Medical School, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Minneapolis, Minnesota, USA
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Hunt MG, Loftus P, Accardo M, Keenan M, Cohen L, Osterman MT. Self-help Cognitive Behavioral Therapy Improves Health-Related Quality of Life for Inflammatory Bowel Disease Patients: A Randomized Controlled Effectiveness Trial. J Clin Psychol Med Settings 2021; 27:467-479. [PMID: 31025253 DOI: 10.1007/s10880-019-09621-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patients with inflammatory bowel disease (IBD) often have poor health-related quality of life (HRQL) and are at risk for anxiety and depression. Cognitive behavioral therapy (CBT) can help patients with IBD cope with their disease. Unfortunately, barriers to care include expense and availability of qualified therapists. Stand-alone, self-help CBT could improve access to care. This study examined the effectiveness of a self-help CBT workbook for patients with IBD. A randomized controlled trial compared the CBT workbook to an active psychoeducational control workbook. A total of 140 participants enrolled. In both groups, scores improved on a range of measures, including catastrophizing, visceral sensitivity, and HRQL, although pre-post effect sizes were generally larger in the CBT group. Only participants in the CBT group experienced significant improvements in anxiety and depression. Improvements were generally maintained or consolidated at 3-month follow-up. Self-help CBT can be an effective and inexpensive way to improve HRQL for patients with IBD.
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Affiliation(s)
- Melissa G Hunt
- Department of Psychology, University of Pennsylvania, 425 S. University Ave, Philadelphia, PA, 19104-6241, USA.
| | - Paddy Loftus
- Department of Psychology, University of Pennsylvania, 425 S. University Ave, Philadelphia, PA, 19104-6241, USA
| | - Michael Accardo
- Department of Psychology, University of Pennsylvania, 425 S. University Ave, Philadelphia, PA, 19104-6241, USA
| | - Mary Keenan
- Department of Psychology, University of Pennsylvania, 425 S. University Ave, Philadelphia, PA, 19104-6241, USA
| | - Lauren Cohen
- Department of Psychology, University of Pennsylvania, 425 S. University Ave, Philadelphia, PA, 19104-6241, USA
| | - Mark T Osterman
- Division of Gastroenterology, Penn Presbyterian Medical Center, Philadelphia, PA, USA
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Hunt M, Miguez S, Dukas B, Onwude O, White S. Efficacy of Zemedy, a Mobile Digital Therapeutic for the Self-management of Irritable Bowel Syndrome: Crossover Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e26152. [PMID: 33872182 PMCID: PMC8176342 DOI: 10.2196/26152] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/09/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
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
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Affiliation(s)
- Melissa Hunt
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Sofia Miguez
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Benji Dukas
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Sarah White
- Population Health Research Institute, St George's University of London, London, United Kingdom
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Fretz KM, Tripp DA, Katz L, Ropeleski M, Beyak MJ. Examining Psychosocial Mechanisms of Pain-Related Disability in Inflammatory Bowel Disease. J Clin Psychol Med Settings 2021; 27:107-114. [PMID: 31079280 DOI: 10.1007/s10880-019-09627-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Disability in inflammatory bowel disease (IBD) is under-investigated. Models theorize that disability is the result of a disease and its related impairments, limitations, and restrictions. This disablement process can be affected by psychosocial factors. Pain, depression, catastrophizing, and social support are associated with IBD-disability outcomes, but no studies have examined these factors concurrently. This study examined the role of psychosocial factors in the process of IBD disablement within the context of pain. Depressive symptoms, pain catastrophizing, and perceived social support were proposed as mediators in the relationship between pain and pain-related disability in cross-sectional and longitudinal models. Cross-sectionally, the mediation effects of depressive symptoms and pain catastrophizing, but not perceived social support, were significant. Longitudinally, depression was a significant mediator. Depressive symptoms and pain catastrophizing have mechanistic roles in the relationship between IBD patients' pain and pain-related disability and should be targets for intervention.
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Affiliation(s)
| | - Dean A Tripp
- Departments of Psychology, Anesthesiology and Urology, Queen's University, Kingston, ON, Canada
| | - Laura Katz
- Michael G. DeGroote Pain Clinic, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Mark Ropeleski
- Department of Medicine, Gastrointestinal Diseases Research Unit, Queen's University, Kingston, ON, Canada
| | - Michael J Beyak
- Department of Medicine, Gastrointestinal Diseases Research Unit, Queen's University, Kingston, ON, Canada
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Hunt MG, Wong C, Aajmain S, Dawodu I. Fecal incontinence in people with self-reported irritable bowel syndrome: Prevalence and quality of life. J Psychosom Res 2018; 113:45-51. [PMID: 30190047 DOI: 10.1016/j.jpsychores.2018.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 12/11/2022]
Abstract
Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) disorder characterized by recurrent abdominal pain and altered bowel habits. IBS is a risk factor for fecal incontinence (FI), the unintentional passage of solid or liquid stool. FI can substantially interfere with health related quality of life (HRQL), leading to heightened anxiety and avoidance behavior. Nevertheless, relatively little research has been conducted on the prevalence of FI in IBS patients. This study evaluated the prevalence of FI in people with self-reported IBS and the relationship between FI and HRQL. 703 people who reported a diagnosis of IBS completed questionnaires on IBS symptom severity, FI symptom severity, HRQL, fear of food, anxiety about visceral sensations, and GI specific catastrophizing. Overall, 60% of people with IBS reported experiencing at least one lifetime episode of FI. In a subsample of 360 people who met strict Rome IV criteria and reported no other GI related co-morbidities, 62% reported experiencing at least one lifetime episode. While people who experienced FI more frequently had worse HRQL statistically, the differences in HRQL between people who had experienced FI and those who had not were not clinically significant. Rather than frequency of FI or physical symptom severity, quality of life was mostly determined by psychological variables, such as fear of food, anxiety, and catastrophizing. This study suggests that FI is quite prevalent in IBS patients, but that the best way to improve HRQL for IBS patients with FI may be to focus on reducing anxiety, catastrophizing and avoidance.
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Henrich JF, Martin M. Altered attentional control linked to catastrophizing in patients with irritable bowel syndrome. Br J Health Psychol 2018; 23:612-629. [PMID: 29573051 DOI: 10.1111/bjhp.12307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/15/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Our study aimed to investigate differences in attentional control between patients with irritable bowel syndrome (IBS) and healthy participants and to examine the link between attentional control and IBS catastrophizing. Previous research has shown that patients with chronic functional illnesses have lower levels of attentional control. However, no previous study has found altered attentional control in patients with IBS or directly investigated the link between attentional control and catastrophizing. We also aimed to establish whether anxiety is associated with attentional functions in patients with IBS. DESIGN AND METHODS In this cross-sectional study, we compared 41 IBS patients with 39 healthy-matched control participants on attentional functions using an attention network task. IBS catastrophizing (Gastrointestinal Cognitions), IBS symptom severity (GSRS-IBS), Depression, Anxiety, and Stress (DASS-21), and Visceral Anxiety Sensitivity were assessed using self-report measures. RESULTS Patients with IBS had lower attentional control compared to healthy participants, t (78) = -2.75, p = .007, d = .62. Groups did not differ in alerting or orienting attention. IBS patients with lower attentional control scored higher on IBS catastrophizing than those with higher attention control, t (38.59) = 2.19, p = .032, d = .66. Anxiety was related to orienting attention in the IBS group (ρ = .38, p = .015). CONCLUSIONS Patients with IBS displayed reduced attentional control. Crucially, those patients with lower attentional control also had more catastrophizing thoughts than patients with better attentional control. These findings suggest that improving attentional control could be a valid target for psychological interventions for IBS. Statement of contribution What is already known on this subject? It has been hypothesised that psychological processes play a role in the maintenance of irritable bowel syndrome (IBS), and altered levels of attentional control have been found in patients with other functional illnesses but not yet in patients with IBS. Pain catastrophizing, a maladaptive thinking pattern, has been linked with IBS symptom severity, and previous research has shown an association between attentional control and intrusive thoughts. Whether there is an association between catastrophizing thoughts and attentional control in patients with IBS is unknown. What does this study add? Patients with irritable bowel syndrome show reduced levels of attentional control. IBS patients with lower levels of attentional control have more catastrophizing thoughts. Therapies emphasizing attentional control training may help reduce catastrophizing.
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Affiliation(s)
- Julia F Henrich
- Department of Experimental Psychology, University of Oxford, UK
| | - Maryanne Martin
- Department of Experimental Psychology, University of Oxford, UK
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Linedale EC, Mikocka-Walus A, Vincent AD, Gibson PR, Andrews JM. Performance of an algorithm-based approach to the diagnosis and management of functional gastrointestinal disorders: A pilot trial. Neurogastroenterol Motil 2018; 30. [PMID: 29094806 DOI: 10.1111/nmo.13243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/04/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent advances in the development of diagnostic criteria and effective management options for functional gastrointestinal disorders (FGIDs) have not yet been integrated into clinical practice. There is a clear need for the development and validation of a simple clinical pathway for the diagnosis and management of FGIDs which can be used in primary care. METHODS In this controlled pilot study, we designed and evaluated a non-specialist-dependent, algorithm-based approach for the diagnosis and management of FGIDs (ADAM-FGID). Patients referred to 1 tertiary referral center with clinically suspected functional gastrointestinal disorders were allocated to waitlist control or algorithm group. The algorithm group was screened for organic disease, and those without clinical alarms received a written FGID diagnosis and management options. All participants were followed up for 1 year. KEY RESULTS The ADAM-FGID was found to be feasible and acceptable to both patients and primary healthcare providers. The diagnostic component identified that 39% of referrals required more urgent gastroenterological review than original triage category, with organic disease subsequently diagnosed in 31% of these. The majority of patients (82%) diagnosed with a FGID did not receive a relevant alternative diagnosis during follow-up. Patient buy-in to the model was good, with all reading the diagnostic/management letter, 80% entering management, and 61% reporting symptom improvement at 6 weeks. Moreover, 68% of patients and all referring doctors found the approach to be at least moderately acceptable. Patients reported being reassured by the approach and found the management options useful. Primary healthcare providers acknowledged the potential of this approach to reduce waiting times for endoscopic procedures and to provide reassurance to both patients and themselves. CONCLUSIONS & INFERENCES This pilot study provides preliminary evidence to support a clinical pathway for the diagnosis and management of FGIDs which does not depend upon specialist review. Further rigorous testing within primary care is needed to conclusively establish safety and efficacy. However, this approach is safer than current management and has potential to build capacity by reducing specialist burden and expediting effective care.
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Affiliation(s)
- E C Linedale
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - A Mikocka-Walus
- School of Psychology, Deakin University, Burwood, Vic., Australia
| | - A D Vincent
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,Freemasons Foundation Centre for Men's Health, Adelaide, SA, Australia
| | - P R Gibson
- Department of Gastroenterology Alfred Hospital, Monash University, Melbourne Vic, Australia
| | - J M Andrews
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,Department of Gastroenterology Alfred Hospital, Monash University, Melbourne Vic, Australia
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Catastrophic Thinking: A Transdiagnostic Process Across Psychiatric Disorders. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9763-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Hunt MG, Ertel E, Coello JA, Rodriguez L. Empirical Support for a Self-help Treatment for IBS. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9647-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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