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