A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations

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Abstract

Background

Irritable bowel syndrome (IBS) is a chronic and debilitating medical condition with few efficacious pharmacological or psychosocial treatment options available. Evidence suggests that visceral anxiety may be implicated in IBS onset and severity. Thus, cognitive-behavioral treatment (CBT) that targets visceral anxiety may alleviate IBS symptoms.

Methods

The current study examined the efficacy of a CBT protocol for the treatment of IBS which directly targeted visceral sensations. Participants (N = 110) were randomized to receive 10 sessions of either: (a) CBT with interoceptive exposure (IE) to visceral sensations; (b) stress management (SM); or (c) an attention control (AC), and were assessed at baseline, mid-treatment, post-treatment, and follow-up sessions.

Results

Consistent with hypotheses, the IE group outperformed AC on several indices of outcome, and outperformed SM in some domains. No differences were observed between SM and AC. The results suggest that IE may be a particularly efficacious treatment for IBS.

Conclusions

Implications for research and clinical practice are discussed.

Highlights

► CBT with interoceptive exposure (IE) was investigated for the treatment of IBS. ► IE was compared to stress management (SM) and attention control (AC). ► IE outperformed AC on several indices of outcome. ► IE outperformed SM on some indices of outcome. ► Treatment for IBS targeting fear and avoidance of visceral sensation is efficacious.

Section snippets

Design

Eligible participants completed a baseline screening/pre-treatment assessment and were then randomized to 10 weekly sessions of AC, SM, or IE. Participants completed a mid-treatment, post-treatment, and a follow-up assessment three months after the end of treatment. Mid, post and follow-up assessments were completed by independent, blinded assessors. Therapists were blind to these assessments.

Participants

Participants were recruited from a digestive disease clinic at a large university in California, and

Equivalence at baseline

There were no statistically significant differences among the three treatment groups on any demographic variable (all ps > .10). See Table 1 for descriptive information.

Attrition analyses

The treatment groups did not differ in terms of dropout/completer status, χ2 (df = 1, N = 111) = 3.98, p = .14. None of the demographic variables [i.e., sex, age, race (Caucasian vs. non-Caucasian), bowel habit, income, marital status] nor pre-treatment severity variables (BSS, VSI and PVAQ) significantly predicted attrition

Discussion

The present study had two general aims. The first was to design and test a new theory-driven version of CBT that focused on changing fear and avoidance of IBS symptoms using cognitive restructuring, attentional control, and behavioral exposures to IBS-related sensations and situations. The second aim was to compare this new treatment procedure against both a stress management oriented CBT and an active educational control condition. All three treatment conditions led to significant reductions

Acknowledgments

The authors wish to acknowledge Drs. Jayson Mystkowski and Janice Jones for their role as therapist on this study, as well as Dr. Joseph DeCola for first developing an IE model of CBT for IBS, Dr. Brenda Toner for her help with the Attention Control Protocol and Suzanne Smith, NP, RN for participant screening. Supported in part by NIH Grants NR007768 (BDN), P50 DK64539 (EAM) and VA Medical Research (BDN).

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