Irritable bowel syndrome: A behavioral model

Current models for explaining irritable bowel syndrome (IBS), the most common gastrointestinal disorder, are critically reviewed and found wanting. Although inadequate to explain the complex clinical features of IBS. these models now determine treatment and research strategy. A behavioral model is offered as an alternative in the hope that it will lead to effective treatment and a progressive research program. The central features of this model are: (a) that verbal, motoric and physiological behavior characteristitic of IBS are capable of independence or desynchrony; (b) that these aspects of behavior are quantitative variations of normal; and (c) that there is a genetic predisposition to neuroticism which, in turn, predisposes to IBS. Some of the model's implications are discussed.     

Irritable Bowel Syndrome: A Misunderstood Psychophysiological Affliction

Irritable bowel syndrome is a benign, chronic, gastrointestinal disorder that affects much of the general population. Misunderstanding and lack of patient education often result in increased anxiety and physical distress. Counselors can be instrumental in recognizing the condition in afflicted clients and providing emotional support and stress management training.     

肠易激综合征发病机制研究中的几个问题

肠易激综合征是一种肠道功能性疾病,是目前消化病领域的研究热点,近10年来肠易激综合征发病机制的研究没有突破性进展,本文从哲学基本原理的视角对肠易激综合征发病机制研究中的困惑进行思考与分析,希望给今后的肠易激综合征发病机制研究带来一些启示.     

肠易激综合征发病机制研究中的几个问题

肠易激综合征是一种肠道功能性疾病,是目前消化病领域的研究热点,近10年来肠易激综合征发病机制的研究没有突破性进展,本文从哲学基本原理的视角对肠易激综合征发病机制研究中的困惑进行思考与分析,希望给今后的肠易激综合征发病机制研究带来一些启示。     

Generalised anxiety: A controlled treatment study

The effects of anxiety management training were evaluated by allocating 66 generally anxious clients to either a wait list condition, non-directive counselling, or a combination of relaxation and brief cognitive therapy. Anxiety management was significantly more effective than the wait list condition on a number of relevant measures at post-treatment, but there were relatively few differencs between anxiety management and non-directive counselling, either at post-treatment or at 6 months follow-up. Those differences which were found could plausibly be explained in terms of the demand characteristics of training in relaxation or cognitive therapy. It was concluded that anxiety management is clearly better than a non-treatment control condition, but that its superiority to plausible alternatives which lack the specific components thought to be responsible for improvement has yet to be demonstrated.     

感染后与非感染后肠易激综合征的多维特点

探讨感染后(PI)与非感染后肠易激综合征(NPI-IBS)的临床,精神心理,组织学特点。取IBS患者和正常人进行问卷调查,了解其多维特点。分别检测肥大细胞的数目。结果显示:(1)PI-IBS与NPI-IBS患者临床、心理特征不同;(2)IBS两组患者肥大细胞的数目无差异,与对照组比较差异明显。因此认为PI-IBS和NPI-IBS有特征差异,对临床治疗有一定指导意义。     

A case study of behavioral assessment and treatment of insect phobia

We assessed the academic performance of a 14-year-old boy with insect phobia in the context of feared stimuli. The dependent measure was math calculation rate across three conditions that varied therapist statements about the presence of crickets and the actual presence of live crickets. Subsequent treatment consisted of graduated exposure and contingent rewards for math problem completion. Assessment results indicated that the boy's performance was consistently low in the presence of live crickets but not when he was spuriously informed that crickets were present (the primary referral concern). Treatment results indicated no effect from exposure alone and a dramatic effect when exposure was combined with contingent rewards.     

Cognitive and Behavioral Differences Between Subtypes in Refractory Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal syndrome consisting of different bowel pattern subtypes: diarrhea predominant (IBS-D), constipation predominant (IBS-C), and alternating (IBS-A). This paper aimed to identify whether (a) psychological factors implicated in the cognitive behavioral model of IBS were differentially associated with bowel pattern subtypes, (b) whether there were differences in symptom severity and work and social adjustment across the IBS-subtypes. Analysis was conducted on baseline data of 557 individuals with refractory IBS recruited into the Assessing Cognitive Therapy in Irritable Bowel (ACTIB) randomized controlled trial. Correlations assessed the associations between psychological factors, stool patterns, symptom severity, and work and social adjustment. Hierarchical regressions identified whether cognitive and behavioral factors were significantly associated with frequency of loose/watery stools, hard/lumpy stools and symptom severity while controlling for affective (anxiety and depression) and demographic factors (age, gender, symptom duration). One-way ANOVAs were conducted to assess differences across Rome III classified subtypes (IBS-A, D and C) in cognitive, behavioral, affective, symptom severity, and adjustment measures. Psychological factors were significantly associated with symptom severity and work and social adjustment. Increased avoidance behavior and unhelpful gastrointestinal (GI) cognitions were significantly associated with higher frequency of loose/watery stools. Increased control behaviors were associated with higher frequency of hard/lumpy stools. Cognitive and behavioral differences were significant across the Rome III classified IBS subtypes. There were no differences in anxiety, depression, overall symptom severity, or work and social adjustment. The results are discussed in terms of their utility in tailoring cognitive behavioral treatments to IBS subtypes.     

Depression, Anxiety and Anger in Subtypes of Irritable Bowel Syndrome Patients

The present study aimed to elucidate the differences in depression, anxiety, anger, and quality of life in a sample of non-psychiatric IBS patients, starting from the hypothesis that IBS subtypes may have different symptomatic expressions of negative emotions with different outcomes on quality of life measures. Forty-two constipation-predominant IBS (C-IBS) subjects and 44 diarrhea-predominant IBS (D-IBS) subjects, after an examination by a gastroenterologist and a total colonoscopy, underwent a clinical interview and psychometric examination for the assessment of depression, anxiety, anger and quality of life. IBS subtypes showed different symptomatic profiles in depression, anxiety and anger, with C-IBS patients more psychologically distressed than D-IBS subjects. Affective and emotional symptoms should be considered as specific and integral to the syndrome, and recognizing the differences between IBS subtypes may have relevant implications for treatment options and clinical outcome.     

感染后与非感染后肠易激综合征的多维特点

探讨感染后(PI)与非感染后肠易激综合征(NPI-IBS)的临床,精神心理,组织学特点.取IBS患者和正常人进行问卷调查,了解其多维特点.分别检测肥大细胞的数目.结果显示:(1)PI-IBS与NPI-IBS患者临床,心理特征不同;(2)IBS两组患者肥大细胞的数目无差异,与对照组比较差异明显.因此认为PI-IBS和NPI-IBS有特征差异,对临床治疗有一定指导意义.     

Case study: Noninvasive behavioral treatment of self-injurious hand stereotypy in a child with Rett syndrome

Treatment of stereotypic hand mouthing in a 3-year-old girl with Rett syndrome by differential reinforcement of competing functional responses plus response interruption is described and evaluated in this case study. A package of graduated guidance with social and edible reinforcers successfully established stable rates of functional hand movements to activate toys, gross motor responses to verbal prompts, palmar grasp and release, and some vocal imitation. Contingent response interruption virtually eliminated hand mouthing during instructional sessions. Instruction alone did not maintain hand mouthing suppression when interruption was withdrawn, and treatment gains appeared highly discriminated. Post-hoc comparison indicated differential reinforcement plus response interruption (DR1 + 1) to be superior to hand splints in reducing hand stereotypies, with approximately equivalent increases in collateral tongue thrusting.     

Marital interaction of agoraphobic women: a controlled,behavioral observation study

Married couples with a female agoraphobic spouse (n = 22) were compared with demographically similar community control couples (n = 21) on self-report and observational measures of marital interaction. Consistent with hypotheses, husbands of agoraphobic women were more critical of their wives than were control husbands, and clinical couples were less likely to engage in positive problem solution than control couples. Contrary to hypothesis, clinical husbands were not less supportive than control husbands. Where general measures of marital distress were concerned, clinical couples, relative to control couples, evinced more distress by self-report, by their higher rate of negative nonverbal behavior, and by their longer sequences of negative exchanges.     

A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome

We randomized, at two sites, 210 patients with Rome II diagnosed irritable bowel syndrome (IBS), of at least moderate severity, to one of three conditions: group-based cognitive therapy (CT; n=120), psychoeducational support groups (n=46) as an active control, or intensive symptom and daily stress monitoring (n=44). One hundred eighty-eight participants completed the initial treatment. Those in symptom monitoring were then crossed over to CT. For an intent to treat analysis on a composite GI symptom measure derived from daily symptom diaries, both CT and the psychoeducational support groups were significantly more improved than those in the intensive symptom monitoring condition, but the CT and psychoeducational support group did not differ. Among treatment completers on the same composite measure of GI symptoms, again, both CT and psychoeducational support groups were statistically superior to symptom monitoring but did not differ on the symptom composite, or on any other measure. On individual IBS symptoms, both CT and psychoeducational support were statistically superior to symptom monitoring on reductions in abdominal pain and tenderness and for flatulence. Patient global ratings at the end of treatment showed the two active conditions statistically superior to symptom monitoring on change in Bowel Regularity, with CT superior to symptom monitoring on reduction in overall pain and in improvement in sense of well-being. Three-month follow-up data on 175 patients revealed maintenance of significant improvement or continued significant improvement on all IBS symptoms, including the McGill Pain Questionnaire. Group CT and psychoeducational support groups continued not to differ on any measure. We thus conclude that group CT is not superior to an attention placebo control condition.