Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome.

We report two controlled comparisons of a previously validated multicomponent (relaxation, thermal biofeedback, and cognitive therapy) treatment for irritable bowel syndrome (IBS) to an ostensible attention-placebo control (pseudo-meditation and EEG alpha suppression biofeedback) and to a symptom-monitoring control. In Study 1 (n = 10 per condition) there were nonsignificant trends for the multicomponent treatment to be superior to the attention-placebo condition. In Study 2 (n = 30 per condition), we found no advantage for the multicomponent treatment over the attention-placebo condition. Subjects in both treatment conditions showed significant reductions in GI symptoms, as measured by daily symptom diaries, and significant reductions in trait anxiety and depression. The GI symptom reductions held up over a 6 month follow-up. Possible explanations for the results are explored.     

Behavioral interventions may prolong remission in patients with inflammatory bowel disease

Inflammatory Bowel Diseases (IBDs) are chronic, relapsing and remitting gastrointestinal conditions with no known cure. Previous studies have linked behavioral factors, including stress and medication adherence, to relapse.

Purpose

We sought to determine the effect of participation in a behavioral self-management program on incidence of flare within 12 months following behavioral intervention when compared to the natural history of flare incidence prior to program participation.

Results

Results from a 2-level regression model indicated that those participants in the treatment group were 57% less likely to flare in the following 12 months (compared to 18% in the control group). The decline in “flare odds” was about 2 times greater in treatment versus controls (OR = 0.52, t(34) = 2.07, p < 0.05). Office visits, ER visits, and disease severity (all p < 0.05) were identified as moderators of flare risk.

Conclusions

We have demonstrated 1) a statistical model estimating the likelihood of flare rates in the 12 months following a behavioral intervention for IBD (compared to a control condition), and 2) that the introduction of a behavioral intervention can alter the natural course of a chronic, relapsing and remitting gastrointestinal condition such as IBD.     

Efficacy of a psychological treatment for sex offenders

The aims of the present paper are the following: firstly, to describe the psychological treatment administered to sexual offenders in Spain; secondly, to assess the effectiveness of the application of this psychological treatment in the prison of Brians (Barcelona). For this purpose, two equivalent groups were selected: a treatment group of 49 subjects who received the whole treatment program, and an untreated control group of 74 subjects. These groups were selected taking into account various risk factors in order to guarantee group comparability. The main results not only show the efficacy of the cognitive-behavioural program for sexual offenders but also that the effectiveness of this program exceeds the average of similar programs in the meta-analytic reviews performed to date.     

Physiological reactivity to stressors in irritable bowel syndrome patients, inflammatory bowel disease patients and non-patient controls.

Irritable Bowel Syndrome (IBS) patients were compared with Inflammatory Bowel Disease (IBD) patients and non-patient controls on four separate physiological measures (heart rate, finger-tip temperature, skin resistance level, and forehead EMG) for their physical reactivity to 'laboratory stressors'. It was predicted that the IBS patients would respond to these stressors with more physiological reactivity than the two other groups. There were initial basal differences among the groups on heart rate and finger-tip temperature: in general, the IBS patients had lower basal heart rates and the non-patient controls had lower finger-tip temperatures. These findings are contrary to the previous body of literature regarding possible sympathetic nervous system (SNS) arousal states in the IBS patient. The results also indicated IBS patients were not significantly different than the IBD patients or the non-patient controls in their reactivity to stressors. Previous literature has suggested that IBS in their reactivity to stressors. Previous literature has suggested that IBS patients have an enhanced SNS arousal or an SNS mediated reactivity to environmental stressors, our current study has not found these results.     

Impact of health beliefs, quality of life, and the physician-patient relationship on the treatment intentions of inflammatory bowel disease patients.

The research tested a model of treatment decision making in chronic illness that includes health beliefs, quality of life, and relationship with the physician (shared or not). Inflammatory bowel disease patients (N = 218) reported on their physician-patient relationship, general and disease-specific quality of life, and intentions to take a drug, for which perceived benefits and costs were manipulated. For more symptomatic patients, both costs and benefits predicted intentions; however, for less symptomatic patients, costs played a more important role. Physician recommendation predicted intention primarily among those who shared a decision-making relationship with their physician. Overall, the model accounted for 57.8% of the variance in medication-taking intention. Findings suggest that an integrative consideration of relationship factors, health beliefs, and health status may help explain treatment intentions among the chronically ill.     

Gastroesophageal reflux disease (GERD) and inflammatory bowel disease (IBD): attachment styles and parental bonding

The attachment styles and parental bonding by 64 patients (M age = 43.2 yr., SD = 13.3) with Gastroesophageal Reflux Disease (GERD) were compared with those of 64 patients (M age = 42.2 yr., SD = 13.5) with Inflammatory Bowel Disease (IBD) and 126 Healthy participants (M age = 42.2 yr., SD = 12.1). Analysis of scores on the Attachment Style Questionnaire indicated insecure attachment in both the patient and control groups. The Parental Bonding scores indicated perceptions of Affectionless Control by parents in both patient groups. In particular, the mean Father-Protection subscale scores were significantly higher for in the GERD group than in the Healthy and IBD groups.     

Development of a short form of the Treatment Evaluation Inventory for acceptability of psychological interventions

The Treatment Evaluation Inventory of Kazdin, French, and Sherick is a 19-item measure of the perceived acceptability of behavioural treatments. Development of two brief forms was based on data from two sources. For Study 1, data from 218 completed questionnaires were used to develop internally consistent brief scales. In Study 2 internal consistency and the validity of the brief forms were estimated for a set of 131 questionnaires. Item reduction was achieved by analysis of item-total minus item correlations. Brief forms with 3, 6, 9, and 12 items were proposed. Their internal consistency (Cronbach alpha) and construct validity were based on correlations of scores on each short form with the full scale scores and on comparing means of different forms. Discriminant validity was based on the difference between two groups (estimated effect size 0.7). Scores for all forms showed high internal consistency and correlated highly with total scale scores. Only the 12-item brief scale yielded mean scores similar to the full scale. The 3-item form could be used as a quick screen, and the 12-item form for more intensive purposes as it is most similar to the full-scale.     

Effects of guided imagery with relaxation training on anxiety and quality of life among patients with inflammatory bowel disease

Background: Inflammatory Bowel Disease (IBD) impacts quality of life (QoL). Psychological factors influence the course of the disease and should be targeted for intervention.

Methods: Our study was a prospective, randomised control trial. Fifty-six outpatients were randomly chosen and allocated to a treatment group or a waiting-list control group. Treatment group patients attended three relaxation-training sessions and received an audio disc for home practice. Evaluations performed pre and post-treatment: state anxiety was assessed with the State-Trait Anxiety Inventory, QoL with the IBD Questionnaire. The Visual Analogue Scale assessed pain, depression, stress and mood. Patients completed a symptom monitoring diary. The control group's symptoms were monitored without study-related treatment.

Results: Thirty-nine subjects completed the study and were included in the data analysis. Following the relaxation-training intervention, the treatment group's (n?=?18) measured results showed a statistically significant improvement as compared to the control group (n?=?21) (time by treatment interaction): anxiety levels decreased (p?<?0.01), QoL and mood improved (p?<?0.05), while levels of pain and stress decreased (p?<?0.01).

Conclusions: Findings indicate IBD patients may benefit from relaxation training in their holistic care. New studies as well as further investigation of the subject are warranted.     

The logic of psychological treatment

Empirical studies of technical and therapist variables in treatment cannot yield valid generalizations because of the uniqueness of each case. Professional practice must, instead, be seen as an application of a psychological "calculus", which follows logically from definitions of given concepts. Seven necessary rules are suggested for psychological treatment: 1. Regard the client-in-her/his-surroundings-system (cs-system) as your unit of reference and get to know this system. 2. Tolerate initial ambiguity and do not generalize from other persons in other life situations. 3. In matters relevant for treatment, do not objectivize, i.e. pronounce something to be true or false, good or bad, right or wrong, but always subjectivize, i.e. emphasize that FOR P something is true or false, etc. 4. Maintain your independence relative to the cs-system you work with. 5. Understand the persons in the cs-system. 6. Respect the persons in the cs-system. 7. Care for the persons in the cs-system.     

Evaluation of a group cue-exposure treatment for opiate addicts

Twenty-four detoxified opiate addicts were randomized to an experimental group and a control group to evaluate efficacy of a group cue-exposure treatment to reduce or extinguish classically conditioned responses to drug-related stimuli. Assessment included psychophysiological responses (skin temperature, skin conductance level--SCL--, and heart rate) to a videotape and subjective measures (subjective craving, positive and negative affect) before and after the videotape. The experimental group received a group cue-exposure program to drug-related stimuli that comprised twelve treatment sessions administered three times weekly. The treatment program significantly reduced conditioned responses to drug-related stimuli, as measured by SCL and positive affect.     

Understanding psychological distress in Meniere's disease: a systematic review

It has long been suspected that psychological disturbance is common in Meniere's disease (MD), but there has been no systematic review of research on this topic since 1977. The aim of this review was to investigate whether components of post-traumatic stress disorder (PTSD) or health anxiety contribute to distress, so that support and psychological therapy can be tailored better to the particular problems of people with MD. We systematically identified all studies of psychological factors associated with MD between 1977 and 2004. We then tabulated the findings from each of the 28 studies to match them to the components of PTSD and health anxiety. Levels of psychosocial impairment and distress were comparable to patients with similar illness. Evidence was found for some of the components of both PTSD and health anxiety. We conclude that more specific research into PTSD-like symptoms and health anxiety in MD is needed. There was a general lack of research into psychological mechanisms contributing to distress in this population, many studies had methodological weaknesses, and only one qualitative and one longitudinal study had been carried out.     

The acceptability and preference for the psychological treatment of PTSD

The acceptability and preference of psychological treatments is important in understanding patient treatment seeking, choice, engagement and attrition and possibly treatment response in health care. The acceptability of, and preference for, 14 different types of psychological treatment for posttraumatic stress disorder (PTSD) were investigated in a student population through invitation to participate in a web-based survey. Respondents were asked to rate each treatment on 10 scales and to rank the treatments in order of preference. Respondents were also asked whether they would seek treatment themselves, recommend treatment to friends and family, feel stigmatised by suffering from PTSD, had any prior knowledge of the treatments and if this had been positive or negative and whether they had a history of psychological problems or treatment. A total of 330 respondents completed the survey. A past or current history of psychological problems and treatment was surprisingly high. Almost all respondents indicated that they would seek or recommend treatment in spite of high levels of stigmatisation. Factor analysis of the 10 scales indicated two factors: Endorsement and Discomfort. Rank ordering on preference and Endorsement scores was highly consistent. The highly preferred and endorsed treatments involved cognitive therapy, exposure or psycho-education in spite of high levels of discomfort anticipated with exposure. Treatments involving new technologies, EMDR and psychodynamic psychotherapy received the lowest Endorsement and preference. There was a modest influence of prior knowledge of a treatment.     

Evaluation of psychological stress before general anesthesia

Pre-operative fear is not only a psychologically stressing phenomenon for the patient, but also a considerable risk factor due to its somatical correlative. In a study, 150 patients who were to undergo planned surgery under general anaesthesia were questioned about their fears and worries concerning the anaesthetic. Self-rating scales and rating scales by doctors and a complaints analysis curve were used in addition to an interview system on illnesses and specific previous experiences. 54% of the patients were, according to specific criteria, assessed as being anxious or very anxious (for example diffused anxiety, premature weakening of the anaesthetic effect, worry about not waking up out of the anaesthetic). Several factors which could have an anxiety-lessening or increasing effect and which are of importance for the psychological preparation for an operation were deduced from the investigation.     

Cognitive-behavioral treatment of irritable bowel syndrome

There is increasing evidence that supports the view that irritable bowel disorder (IBS) is a disorder of brain-gut function. Cognitive-behavioral therapy (CBT) has received increased attention in light of this recent shift in the conceptualization of IBS. This review has two main aims. The first is to provide a critical review of controlled trials on CBT for IBS. The second is to discuss ways of further developing CBT interventions that are more clinically relevant and meaningful to health care providers and individuals with a diagnosis of IBS. A theme from a CBT intervention will be presented to illustrate how CBT interventions can be incorporated within a larger social context. A review of CBT for IBS lends some limited support for improvement in some IBS symptoms and associated psychosocial distress. This conclusion needs to be expressed with some caution, however, in light of many methodological shortcomings including small sample sizes, inadequate control conditions and failure to identify primary versus secondary outcome measures. In addition, future studies will need to further develop more relevant CBT protocols that more fully integrate the patient's perspective and challenge social cognitions about this stigmatized disorder.     

A one year follow-up of relaxation response meditation as a treatment for irritable bowel syndrome

Ten of thirteen original participants with Irritable Bowel Syndrome (IBS) participated in a one year follow-up study to determine whether the effects of Relaxation Response Meditation (RRM) on IBS symptom reduction were maintained over the long-term. From pre-treatment to one-year follow-up, significant reductions were noted for the symptoms of abdominal pain (p = 0.017), diarrhea (p = 0.045), flatulence (p = 0.030), and bloating (p = 0.018). When we examined changes from the original three month follow-up point to the one year follow-up, we noted significant additional reductions in pain (p = 0.03) and bloating (p = 0.04), which tended to be the most distressing symptoms of IBS. It appears that: (1) continued use of meditation is particularly effective in reducing the symptoms of pain and bloating; and (2) RRM is a beneficial treatment for IBS in the both short- and the long-term.     

Evaluation of a residential treatment center for emotionally disturbed adolescents

This study examines a residential treatment center for emotionally disturbed female adolescents by comparing changes in personality as measured by objective tests given while in residence and by a questionnaire sent to former residents at least six months after release. Two hypotheses were tested. The first was that the girls would be successful when they returned to their communities. "Success" was defined by a number of variables on a questionnaire. Responses to the questions indicate that the girls are doing well. The second hypothesis was that the girls would show significant improvement in their scores on two personality tests taken at the time they were admitted and at the time of their release. A comparison of the mean scores of the various factors on each test showed significant improvement.     

Risk factors for psychological morbidity in women attending a one-stop diagnostic clinic with suspected breast disease

Abstract

The present study was designed to identify risk factors for psychological morbidity in women attending a one-stop diagnostic clinic with suspected breast disease. A cohort of 158 women were recruited and were asked to complete scales measuring psychological morbidity and psychosocial factors in the period immediately before their appointment and to repeat the assessments of psychological morbidity on the day of the appointment. Relevant clinical and demographic data were also collated. Within the cohort 1.4% of respondents received a diagnosis of malignant disease. Psychological morbidity, both prior to and during the diagnostic appointment was strongly predicted by psychosocial factors (i.e., acceptance-resignation coping, personal self esteem and discrepancies in social support), accounting for 54% and 63% of the variance at pre-appointment and appointment day phases respectively. Other measured variables were found not to be correlated with and/or to account for a significant proportion of the variance in the measures of morbidity. These results suggest that these psychosocial variables should be targeted in interventions designed to reduce psychological morbidity in this patient group.