1
|
Jin X, Wong CL, Li H, Yao W. 'I cannot accept it' distressing experiences in parents of children diagnosed with cancer: A qualitative study. J Adv Nurs 2024. [PMID: 39104125 DOI: 10.1111/jan.16339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 08/07/2024]
Abstract
AIMS To explore the distressing experiences of Chinese parents of children with cancer from the perspective of psychological inflexibility. DESIGN A qualitative study using a descriptive qualitative approach based on the model of psychological inflexibility was adopted. METHODS Individual semi-structured interviews through synchronized online video were conducted with 21 Chinese parents of children with cancer from October 2020 to May 2021. Data were analysed using content analysis. RESULTS Four themes and 11 subthemes were identified: (i) immersion in struggling and suffering, (ii) avoidance and suppression, (iii) blaming and complaint and (iv) helplessness and worthlessness. Parents were unwilling to accept the diagnosis and witness their children's suffering, trapped in uncontrollable negative emotions and thoughts. Avoiding emotions and socializing, blaming themselves or complaining of injustice were common. They felt helpless towards life and valueless without the child. CONCLUSION The research findings provide additional perspectives in understanding the distressing experiences in parents of children with cancer. Overall, the emotional and coping styles indicated the lack of psychological flexibility of parents when facing childhood cancer, which is profoundly influenced by Chinese culture. IMPLICATIONS FOR THE PROFESSION Healthcare professionals are recommended to provide culturally sensitive strategies or interventions for building psychological flexibility in addressing parental psychological distress. IMPACT The study provides insights into exploring distressing experiences and reveals the inflexible psychological and behavioural patterns in parents of children with cancer, which could benefit healthcare providers in managing parental psychological distress and helping these parents build flexible coping strategies. REPORTING METHOD The COREQ guideline was followed. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
Collapse
Affiliation(s)
- Xiaohuan Jin
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Huiyuan Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wenying Yao
- Nursing Department, Children's Hospital of Soochow University, Suzhou, China
| |
Collapse
|
2
|
Davis S, Serfaty M, Low J, Armstrong M, Kupeli N, Lanceley A. Experiential Avoidance in Advanced Cancer: a Mixed-Methods Systematic Review. Int J Behav Med 2023; 30:585-604. [PMID: 36284042 PMCID: PMC10522753 DOI: 10.1007/s12529-022-10131-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND People with advanced cancer experience psychological distress due to physical symptoms, functional decline, and a limited prognosis. Difficult thoughts, feelings, and emotions may exacerbate distress and lead to avoidance of these experiences which is sometimes referred to as experiential avoidance (EA). Advanced cancer patients may be more likely to engage in EA especially when no obvious solutions to their problems exist. This study aims to examine the terms used to describe EA, the processes that might indicate EA, associations between EA and psychological distress, and to understand why individuals might engage in EA. METHODS A mixed-methods review. Literature search of Medline, Embase, Psych INFO, and CINAHL 1980-October 2019. INCLUSION adults ≥ 18 years; advanced cancer not amenable to cure. EXCLUSION no measures of EA or psychological distress. Risk of bias and study quality assessed. Evidence of statistical techniques collected. Themes coded, grouped, and developed based on meaning. RESULTS Nineteen studies identified, 13 quantitative studies and 6 qualitative. The quantitative of which 6 compared early-stage cancers with advanced cancers and examined subscales of EA alongside mood, quality of life, and psychological distress. EA covers a range or terms of which 'avoidant coping' is the commonest. EA is manifest as cognitive, behavioural, and emotional avoidance. A thematic synthesis suggests the function of EA is to protect people from distress, and from confronting or expressing difficult emotions by avoiding communication about cancer, controlling negative information, and maintaining normality and hope and optimism. CONCLUSIONS EA may be beneficial in the short term to alleviate distress, but in the longer term, it can impair function and limit engagement in life. Greater clinical awareness of the complexity of EA behaviours is needed. Clinicians and researchers should define EA precisely and be aware of the function it may serve in the short and longer term. Future research studies may consider using specific measures of EA as a primary outcome, to assess the impact of psychological interventions such as ACT.
Collapse
Affiliation(s)
- Sarah Davis
- Division of Psychiatry, Marie Curie Palliative Care Research Dept, University College London, Maple House, Tottenham Court Road, London, W1T 7NF, UK.
| | - Marc Serfaty
- Division of Psychiatry, University College London, London, UK
| | - Joe Low
- Division of Psychiatry, Marie Curie Palliative Care Research Dept, University College London, Maple House, Tottenham Court Road, London, W1T 7NF, UK
| | - Megan Armstrong
- Primary Care and Population Health, University College London, London, UK
| | - Nuriye Kupeli
- Division of Psychiatry, Marie Curie Palliative Care Research Dept, University College London, Maple House, Tottenham Court Road, London, W1T 7NF, UK
| | - Anne Lanceley
- EGA Institute for Women's Health, Department of Women's Cancer, University College London, London, UK
| |
Collapse
|
3
|
Van Rheenen TE, Miskowiak K, Karantonis J, Furlong LS, Murray G, Rossell SL. Understanding familial liability for emotion regulation difficulties in bipolar disorder. Psychol Med 2022; 52:2614-2621. [PMID: 33327971 DOI: 10.1017/s0033291720004626] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There has been relatively limited work focused on understanding whether relatives of individuals with bipolar disorder (BD) have difficulties in the regulation of emotion, particularly in relation to perceptions about whether emotions can be effectively regulated, or trait behaviours that acknowledge emotions as self-regulators themselves. In this study, we assessed the presence and extent of difficulties in these dimensions of emotion regulation in individuals with BD compared to unaffected first-degree biological relatives (FDR) for the first time. METHODS In total, 161 participants, including euthymic individuals with BD, unaffected FDRs, and healthy controls, were compared on the Difficulties in Emotion Regulation Scale (DERS) - a multi-dimensional measure of habitual emotion regulation. Clinical data were also collected and examined in relation to DERS scores in a secondary analysis. RESULTS In the BD group, difficulties were evident for most dimensions of emotion regulation as measured by the DERS; and correlated with an earlier onset of illness and more mood episodes. FDRs displayed generally normal emotion regulation, except in terms of their beliefs that emotions can be effectively regulated; on this dimension, their reported difficulty was intermediate to the BD group and controls. CONCLUSION Habitual emotion regulation difficulties in BD persist irrespective of mood state, are related to the course of illness, and should be targeted in psychological interventions. Further, the perception that emotions cannot be effectively regulated during times of distress seems to represent an endophenotype for BD.
Collapse
Affiliation(s)
- Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Kamilla Miskowiak
- Neurocognition and Emotion in Affective Disorders Group, Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - James Karantonis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Lisa S Furlong
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
- Department of Psychiatry, St Vincent's Hospital, VIC, Australia
| |
Collapse
|
4
|
Fernández-Rodríguez C, Coto-Lesmes R, Martínez-Loredo V, González-Fernández S, Cuesta M. Is Activation the Active Ingredient of Transdiagnostic Therapies? A Randomized Clinical Trial of Behavioral Activation, Acceptance and Commitment Therapy, and Transdiagnostic Cognitive-Behavioral Therapy for Emotional Disorders. Behav Modif 2022; 47:3-45. [DOI: 10.1177/01454455221083309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studying the usefulness of contextual and cognitive transdiagnostic therapies calls for an analysis of both their differential efficacy and their specificity when acting on the transdiagnostic conditions on which they focus. This controlled trial compares the post-treatment and 3- and 6-month follow-up effects of Behavioral Activation (BA), Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Transdiagnostic Therapy (TD-CBT) on emotional symptomatology, and analyses the role played by Experiential Avoidance, Cognitive Fusion, Activation and Emotion Regulation in the clinical change. One hundred twenty-eight patients who fulfilled diagnostic criteria for anxiety and/or depression (intention-to-treat sample) were randomly assigned to three experimental group-treatment conditions (BA, n = 34; ACT, n = 27; TD-CBT n = 33) and one control group (WL, n = 34). Ninety-nine (77.34%) completed the treatment (per-protocol sample). In the post-treatment, all therapies reduced anxiety and depression symptomatology. In the follow-ups, the reduction in emotional symptomatology was greater in the condition which produced greater and more prolonged effects on Activation. Activation appears to be the principal condition in modifying all the transdiagnostic patterns and BA was the most efficacious and specific treatment. The trial was registered at ClinicalTrials.gov NCT04117464. Raw data are available online http://dx.doi.org/10.17632/krj3w2hfsj.1 .
Collapse
|
5
|
Interpersonal functioning in hoarding: An investigation of the link between hoarding symptoms and social support, social anhedonia, and social rewards. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
6
|
Tursi MM, Sellers CR, Marquis A. Managing threats: A grounded theory of counseling engagement in clients with experiential avoidance. JOURNAL OF COUNSELING AND DEVELOPMENT 2021. [DOI: 10.1002/jcad.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Michael M. Tursi
- Psychology Department Mental Health Counseling Program Dyson College of Arts and Sciences Pace University Pleasantville NY 10570 USA
| | - Craig R. Sellers
- School of Nursing University of Rochester Rochester NY 14642 USA
| | - Andre Marquis
- Department of Counseling and Human Development Warner School of Education University of Rochester Rochester NY 14627 USA
| |
Collapse
|
7
|
Meuwese D, Maas J, Krabbendam L, Dijkstra K. Viewing Nature Lets Your Mind Run Free: Three Experiments about the Influence of Viewing a Nature Video on Cognitive Coping with Psychological Distress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168842. [PMID: 34444590 PMCID: PMC8392410 DOI: 10.3390/ijerph18168842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 12/29/2022]
Abstract
Viewing nature has restorative qualities that might help people cope with their personal struggles. Three lab experiments (N = 506) studied whether environment (nature vs. built) influences cognitive coping with psychological distress. Psychological distress was induced with an autobiographical recall task about serious regret, whereafter participants were randomly assigned to view a nature or built video. Cognitive coping (i) Quantity, (ii) Content, and (iii) Quality were hereafter assessed as well as extent and vividness of the regretful memory during the video. Results showed a higher cognitive coping Quantity (Study 1 and 3) and a higher cognitive coping Quality (All studies) for the nature (vs. built) condition. Regarding cognitive coping Content, results varied across the studies. Additionally, participants reported to have thought about the experienced psychological distress to a greater extent while viewing the nature (vs. built) video. Yet they did rate viewing nature as more relaxing. We propose a two-step pathway as an underlying mechanism of restoration. In the first step the capacity for directed attention replenishes. Secondly, this renewed capacity is directed towards internal processes, creating the optimal setting for reflection. Hence, viewing nature allows people to truly process whatever is occupying their minds, which is ultimately relieving and beneficial for mental health.
Collapse
Affiliation(s)
- Daphne Meuwese
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands; (J.M.); (L.K.)
- Correspondence:
| | - Jolanda Maas
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands; (J.M.); (L.K.)
| | - Lydia Krabbendam
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands; (J.M.); (L.K.)
| | - Karin Dijkstra
- Research Group Nursing, Saxion University of Applied Sciences, 7513 AB Enschede, The Netherlands;
| |
Collapse
|
8
|
Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients. Palliat Support Care 2021; 20:167-177. [PMID: 34233779 DOI: 10.1017/s1478951521000626] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates' mental health and patient outcomes. METHOD Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15-20 min modules, totaling 1.5-2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. RESULTS Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = -0.41), peritraumatic distress (d = -0.24), and experiential avoidance (d = -0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = -0.94), depression (d = -0.23), anxiety (d = -0.29), and experiential avoidance (d = -0.30). SIGNIFICANCE OF RESULTS Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.
Collapse
|
9
|
Núñez D, Ordóñez-Carrasco JL, Fuentes R, Langer ÁI. Experiential avoidance mediates the association between paranoid ideation and depressive symptoms in a sample from the general population. J Psychiatr Res 2021; 139:120-124. [PMID: 34058650 DOI: 10.1016/j.jpsychires.2021.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/06/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
Psychotic experiences are prevalent in the general population and are associated with negative outcomes, including depressive symptoms. The mechanisms underlying this relationship remain unclear, but new insights could be obtained by exploring the role of transdiagnostic processes such as experiential avoidance, defined as a person's attempts or desires to suppress unwanted internal experiences like thoughts, emotions, memories, or bodily sensations. Studies analyzing the link between negative emotional states and psychotic experiences are scant. We explored the association between a specific kind of psychotic experience (paranoid ideation), experiential avoidance, and depressive, anxiety, and stress symptoms in a sample from the general population. We found that experiential avoidance partially mediates the associations between paranoid ideation and stress and anxiety symptoms and that it fully mediates the association between paranoid ideation and depressive symptoms. Our results suggest that the presence of paranoid ideation and the usage of experiential avoidance to cope with it are vulnerability factors associated with psychological distress.
Collapse
Affiliation(s)
- Daniel Núñez
- Faculty of Psychology, Universidad de Talca, Chile; Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Chile; Associative Research Program, Center of Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Chile
| | | | - Reiner Fuentes
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Chile; Mind-Body Lab, Centro de Salud Universitario, Dirección de Asuntos Estudiantiles (DAE), Universidad Austral de Chile, Valdivia, Chile
| | - Álvaro I Langer
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Chile; Associative Research Program, Center of Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Chile; Mind-Body Lab, Instituto de Estudios Psicológicos, Facultad de Medicina, Universidad Austral de Chile, Chile.
| |
Collapse
|
10
|
The Infinity Formulation: how transdiagnostic behaviours and endeavours for behavioural change serve to maintain co-morbid mental health presentations. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Treatment recommendations for mental health are often founded on diagnosis-specific models; however, there are high rates of co-morbidity of mental health presentations and growing recognition of the presence of ‘transdiagnostic processes’ (cognitive, emotional or behavioural features) seen across a range of mental health presentations. This model proposes a novel conceptualisation of how transdiagnostic behaviours may maintain co-morbid mental health presentations by acting as a trigger event for the cognitive biases specific to each presentation. Drawing on existing evidence, psychological theory and the author’s clinical experience, the model organises complex presentations in a theory-driven yet accessible manner for use in clinical practice. The model offers both theoretical and clinical implications for the treatment of mental health presentations using cognitive behavioural approaches, positing that transdiagnostic behaviours be the primary treatment target in co-morbid presentations.
Key learning aims
(1)
To understand the strengths and limitations of existing transdiagnostic CBT formulation models.
(2)
To learn about a novel, transdiagnostic and behaviourally focused formulation for use in clinical practice.
(3)
To understand how to use the tool in clinical practice and future research.
Collapse
|
11
|
Baziliansky S, Cohen M. Emotion regulation and psychological distress in cancer survivors: A systematic review and meta-analysis. Stress Health 2021; 37:3-18. [PMID: 32720741 DOI: 10.1002/smi.2972] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/26/2020] [Accepted: 06/29/2020] [Indexed: 01/04/2023]
Abstract
Emotion regulation may affect the levels of psychological distress of cancer survivors, but inconsistencies exist among studies regarding the direction of this effect. The systematic review and meta-analysis sought to estimate the associations between emotion regulation patterns (repression, suppression, experiential avoidance and cognitive reappraisal) and psychological distress among cancer survivors. Fifteen studies met inclusion criteria for systematic review, and seven studies focussing on suppression were included in the meta-analysis. The systematic review pointed to a marked variability in associations among the emotion regulation patterns and psychological distress. The three meta-regressions of the relationships between suppression and psychological distress found significant fixed- and random-effect sizes (except marginal significance of a random-effect model for partial correlation). Subgroup analysis showed no moderation effect of time since diagnosis or study quality, but a significant difference (fixed-effect model only, p = 0.005) was found between correlative studies and those controlling for confounders. The current study suggests that suppression is related to elevated levels of psychological distress among cancer survivors, although large inconsistencies exist among studies and publication bias could not be ruled out. Further studies with large samples and a consistent approach are thus required to evaluate the associations of emotion regulation patterns and psychological distress.
Collapse
Affiliation(s)
| | - Miri Cohen
- School of Social Work, University of Haifa, Haifa, Israel
| |
Collapse
|
12
|
Chey WD, Keefer L, Whelan K, Gibson PR. Behavioral and Diet Therapies in Integrated Care for Patients With Irritable Bowel Syndrome. Gastroenterology 2021; 160:47-62. [PMID: 33091411 DOI: 10.1053/j.gastro.2020.06.099] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/08/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
Irritable bowel syndrome (IBS) is a common, symptom-based condition that has negative effects on quality of life and costs health care systems billions of dollars each year. Until recently, management of IBS has focused on over-the-counter and prescription medications that reduce symptoms in fewer than one-half of patients. Patients have increasingly sought natural solutions for their IBS symptoms. However, behavioral techniques and dietary modifications can be effective in treatment of IBS. Behavioral interventions include gastrointestinal-focused cognitive behavioral therapy and gut-directed hypnotherapy to modify interactions between the gut and the brain. In this pathway, benign sensations from the gut induce maladaptive cognitive or affective processes that amplify symptom perception. Symptoms occur in response to cognitive and affective factors that trigger fear of symptoms or lack of acceptance of disease, or from stressors in the external environment. Among the many dietary interventions used to treat patients with IBS, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols is the most commonly recommended by health care providers and has the most evidence for efficacy. Patient with IBS who choose to follow a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols should be aware of its 3 phases: restriction, reintroduction, and personalization. Management of IBS should include an integrated care model in which behavioral interventions, dietary modification, and medications are considered as equal partners. This approach offers the greatest likelihood for success in management of patients with IBS.
Collapse
Affiliation(s)
- William D Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan.
| | | | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
| | | |
Collapse
|
13
|
Ugwu DI, Onyedibe MCC, Chukwuorji JC. Anxiety sensitivity and psychological distress among hypertensive patients: the mediating role of experiential avoidance. PSYCHOL HEALTH MED 2020; 26:701-710. [PMID: 32397750 DOI: 10.1080/13548506.2020.1764599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Hypertension is often associated with adverse psychosocial outcomes and psychological factors have been advanced for better explanatory models and to enhance the development of effective interventions in the treatment of hypertensive patients. Although the link between anxiety sensitivity (AS) and poor mental health outcomes has been established, the mechanism through which it results in psychological distress (PD) is not yet well understood. In addition to investigating the direct associations of AS and experiential avoidance (EA) to PD, the present study examines whether AS predicts adverse mental health outcomes via EA. Hypertensive patients (N = 240; women = 135; Mean age = 41.09, SD = 9.11 years) drawn from cardiology unit of a Nigerian teaching hospital completed the following measures: Psychological Distress Scale, Anxiety Sensitivity Index - 3, and Acceptance and Action Questionnaire. Results showed that that greater AS and greater EA predicted increased PD, even when controlling for age and gender. The mediation hypothesis was further supported suggesting that the association between AS with increase in PD was a function of heightened EA. These findings are consistent with the notion that acceptance of daily experiences may serve to buffer against the potential adverse mental health outcomes and may be a critical target for interventions to ameliorate PD in patients with chronic health conditions such as hypertension. Psychological interventions that deals with experiential avoidance could be used in the management of distressed hypertensive patients.
Collapse
Affiliation(s)
- Dorothy I Ugwu
- Department of Human Kinetics and Health Education, University of Nigeria, Nsukka, Nigeria
| | | | | |
Collapse
|
14
|
Coto-Lesmes R, Fernández-Rodríguez C, González-Fernández S. Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review. J Affect Disord 2020; 263:107-120. [PMID: 31818766 DOI: 10.1016/j.jad.2019.11.154] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/30/2019] [Accepted: 11/30/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Emotional disorders, such as anxiety and depression, are one of the main causes of disability worldwide. Recent reviews suggest that Acceptance and Commitment Therapy is effective in treating emotional disorders. However, they appraise mainly individual approaches. This review aimed to analyze published studies regarding the usefulness of Acceptance and Commitment Therapy, applied on a group basis, in the treatment of anxiety and depression. METHODS A systematic review of the literature was conducted using the Web of Science, from 2008 to 2019. Fifteen articles fulfilled the inclusion criteria. RESULTS Those patients who received interventions based on Acceptance and Commitment Therapy showed a better emotional state and greater psychological flexibility than patients in control groups without treatment. No differences are found with Cognitive Therapy and Cognitive-Behavioral Therapy. LIMITATIONS the studies reviewed show limitations, principally regarding sample characteristics, study design and manner in which mechanisms responsible for changes are evaluated. CONCLUSION Group-based Acceptance and Commitment Therapy proved to be useful in the psychological treatment of emotional disorders. However, the heterogeneity and limitations of the studies, make it impossible to determine the exact therapeutic elements, and if they are specific to the approach and procedure of this therapy. More research would be necessary to ascertain what patient and/or intervention characteristics might improve results and what the active and specific ingredients of the therapy are. This has clinical relevance because group-based interventions could be more cost-efficient, and it would help facilitate health-care decisions aimed at giving the public access to useful treatments.
Collapse
Affiliation(s)
- Rocío Coto-Lesmes
- Department of Psychology, University of Oviedo, Plaza Feijoo, Oviedo, 33003 Asturias, Spain.
| | | | | |
Collapse
|