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Slouha E, Mohamed A, Patel B, Razeq Z, Clunes LA, Kollias TF. The Use of Psychotherapy for Refractory Irritable Bowel Syndrome: A Systematic Review. Cureus 2024; 16:e54138. [PMID: 38487115 PMCID: PMC10938188 DOI: 10.7759/cureus.54138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Irritable bowel syndrome (IBS) is a common yet debilitating and chronic condition that consists of disturbances in bowel habits and abdominal pain that is frequently relieved with defecation. While the first line of treatment for IBS is pharmacological treatment, this has been shown to fail, leading to the patient being classified as having refractory IBS. The quality of life (QOL) of these patients is greatly hindered; in this case, there are rarely moments of relief. Additional modalities of treatment have been employed in classical cases of IBS, such as psychotherapy, and research has started to evaluate its effectiveness with refractory IBS. Both cognitive behavioral therapy (CBT) and gut-directed hypnotherapy (GDH) are effective in treating classical IBS as they restructure and bring a state of meditation to the patient, allowing them to work through the symptoms. The question is whether it remains successful in refractory cases. This systematic review was conducted with strict adherence to PRISMA guidelines with an initial inquiry resulting in 28,978 publications through PubMed, ScienceDirect, and ProQuest databases. Through automatic and manual screening processes, articles that were peer-reviewed experimental or observation publications done between 2003 and 2023 were included in this study, resulting in 21 publications. Across all studies evaluating CBT, it was consistently found to be successful in improving symptom severity and frequency, QOL, and extracolonic symptoms such as anxiety and depression. When broken down into delivery methods, minimal contact CBT was found to be just as, if not superior, to standard contact. Within this, telephone-delivered CBT was superior to web-delivered CBT. GDH and biofeedback therapy were found to also significantly improve all domains of IBS with no difference between them. Acceptance and commitment therapy were found only to improve associated symptoms. However, there was no significant improvement in their QOL, whereas integrative group therapy found no significant improvement in any domain. Because IBS is so common and crippling to those affected, its crucial to continuously improve QOL through advancement in treatment modalities. Further research should focus more on other modes of therapy as success has been shown in standard therapeutic techniques.
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Affiliation(s)
- Ethan Slouha
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Ahmed Mohamed
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Bansari Patel
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Ziyad Razeq
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Lucy A Clunes
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Theofanis F Kollias
- Microbiology, Immunology and Pharmacology, St. George's University School of Medicine, St. George's, GRD
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Berry SK, Berry R, Recker D, Botbyl J, Pun L, Chey WD. A Randomized Parallel-group Study of Digital Gut-directed Hypnotherapy vs Muscle Relaxation for Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2023; 21:3152-3159.e2. [PMID: 37391055 DOI: 10.1016/j.cgh.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND & AIMS Gut-directed hypnotherapy (GDH) is effective for treating irritable bowel syndrome (IBS), but access limits its widespread use. We report the first randomized controlled trial comparing the safety and efficacy of a self-administered, digital GDH treatment program with that of digital muscle relaxation (MR) in adults with IBS. METHODS After a 4-week run-in period, patients were randomized to 12 weeks of treatment with digital GDH (Regulora), or digital MR accessed via a mobile app on a smartphone or tablet. The primary endpoint was abdominal pain response, defined as ≥30% reduction from baseline in average daily abdominal pain intensity in the 4 weeks following treatment. Key secondary outcomes included mean change from baseline in abdominal pain, stool consistency, and stool frequency. RESULTS Of 378 randomized patients, 362 were treated and included in the efficacy analysis. A similar proportion of the GDH (30.4%) and MR (27.1%) groups met the primary endpoint, with no significant difference between the groups (P = .5352). Significantly more patients treated with GDH than MR were abdominal pain responders during the last 4 weeks of treatment (30.9% vs 21.5%; P = .0232) and over the entire treatment period (29.3% vs 18.8%; P = .0254). Improvements in abdominal pain, stool consistency, and stool frequency were consistent across IBS subtypes. No patients experienced serious adverse events or adverse events leading to study discontinuation. CONCLUSIONS Treatment with a digital GDH program led to an improvement in abdominal pain and stool symptoms in patients with IBS, supporting a role for this intervention as part of integrated care for IBS. CLINICALTRIALS gov identifier NCT04133519.
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Affiliation(s)
- Sameer K Berry
- New York Gastroenterology Associates, New York, New York
| | - Rani Berry
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California.
| | | | | | - Lucy Pun
- Elevated Health, Huntington Beach, California
| | - William D Chey
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
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Alborzi Avanaki F, Rafiee S, Aldin Varpaei H, Taher M, Aletaha N, Allameh F. Biofeedback Treatment Can Improve Clinical Condition and Quality of Life in Patients with Pelvic Floor Dyssynergy with Irritable Bowel Syndrome: A Prospective Cohort Study. Middle East J Dig Dis 2023; 15:45-52. [PMID: 37547159 PMCID: PMC10404073 DOI: 10.34172/mejdd.2023.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/02/2022] [Indexed: 08/08/2023] Open
Abstract
Background: Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD). Methods: This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18-70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient's response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report). Results: Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 ± 11.4. The average resting pressure decreased in response to treatment; however, this decrease was statistically significant only in non-IBS patients (P = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS (P < 0.001). Conclusion: Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.
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Affiliation(s)
- Foroogh Alborzi Avanaki
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Rafiee
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Taher
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmeh Aletaha
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Allameh
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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4
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Mróz M, Czub M, Brytek-Matera A. Heart Rate Variability-An Index of the Efficacy of Complementary Therapies in Irritable Bowel Syndrome: A Systematic Review. Nutrients 2022; 14:nu14163447. [PMID: 36014953 PMCID: PMC9416471 DOI: 10.3390/nu14163447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/30/2022] [Accepted: 08/20/2022] [Indexed: 11/16/2022] Open
Abstract
Irritable bowel syndrome (IBS), as a functional and psychosomatic disease, reduces the quality of life and increases the risk of developing mental disorders. Deregulation of the autonomic nervous system (ANS) is one of the main causes of the disease. The objective of the present study was to identify the studies in which measurements of heart rate variability (HRV) were performed before and after therapeutic intervention, and to evaluate the effectiveness of IBS therapy in terms of a reduction of IBS symptoms and changes in autonomic tone. A systematic review of the literature was carried out in accordance with PRISMA standards. Six databases were searched for articles published before 2022: PubMed®, MEDLINE®, EBSCO, Cochrane, Scopus, and Web of Science. Inclusion criteria were experimental design, diagnosis of IBS (medical and/or diagnosis in accordance with the Rome Criteria), non-pharmacological intervention, and HRV measurement before and after the intervention. The quality of the studies was assessed by JBI Critical appraisal. In total, 455 studies were identified, of which, sixwere included in the review. Expected changes in HRV (increase in parasympathetic activity) were observed in four of the six studies (interventions studied: ear acupressure, transcutaneous auricular vagusnerve stimulation, cognitive behavioral therapy with relaxation elements, yoga). In the same studies, therapeutic interventions significantly reduced the symptoms of IBS. The present review indicated that interventions under investigation improve the efficiency of the ANS and reduce the symptoms of IBS. It is advisable to include HRV measurements as a measure of the effectiveness of interventions in IBS therapy, and to assess autonomic changes as a moderator of the effectiveness of IBS therapy.
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“The tonic’s not always in a bottle”: a qualitative study investigating a heart rate variability biofeedback coherence intervention for individuals with gastrointestinal disorders. JOURNAL OF COMPLEXITY IN HEALTH SCIENCES 2022. [DOI: 10.21595/chs.2021.22069] [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
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Layer P, Andresen V, Allescher H, Bischoff SC, Claßen M, Elsenbruch S, Freitag M, Frieling T, Gebhard M, Goebel-Stengel M, Häuser W, Holtmann G, Keller J, Kreis ME, Kruis W, Langhorst J, Jansen PL, Madisch A, Mönnikes H, Müller-Lissner S, Niesler B, Pehl C, Pohl D, Raithel M, Röhrig-Herzog G, Schemann M, Schmiedel S, Schwille-Kiuntke J, Storr M, Preiß JC, Andus T, Buderus S, Ehlert U, Engel M, Enninger A, Fischbach W, Gillessen A, Gschossmann J, Gundling F, Haag S, Helwig U, Hollerbach S, Karaus M, Katschinski M, Krammer H, Kuhlbusch-Zicklam R, Matthes H, Menge D, Miehlke S, Posovszky MC, Schaefert R, Schmidt-Choudhury A, Schwandner O, Schweinlin A, Seidl H, Stengel A, Tesarz J, van der Voort I, Voderholzer W, von Boyen G, von Schönfeld J, Wedel T. Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) – Juni 2021 – AWMF-Registriernummer: 021/016. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:1323-1415. [PMID: 34891206 DOI: 10.1055/a-1591-4794] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- P Layer
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - V Andresen
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - H Allescher
- Zentrum für Innere Medizin, Gastroent., Hepatologie u. Stoffwechsel, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
| | - S C Bischoff
- Institut für Ernährungsmedizin, Universität Hohenheim, Stuttgart, Deutschland
| | - M Claßen
- Klinik für Kinder- und Jugendmedizin, Klinikum Links der Weser, Bremen, Deutschland
| | - S Elsenbruch
- Klinik für Neurologie, Translational Pain Research Unit, Universitätsklinikum Essen, Essen, Deutschland.,Abteilung für Medizinische Psychologie und Medizinische Soziologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - M Freitag
- Abteilung Allgemeinmedizin Department für Versorgungsforschung, Universität Oldenburg, Oldenburg, Deutschland
| | - T Frieling
- Medizinische Klinik II, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - M Gebhard
- Gemeinschaftspraxis Pathologie-Hamburg, Hamburg, Deutschland
| | - M Goebel-Stengel
- Innere Medizin II, Helios Klinik Rottweil, Rottweil, und Innere Medizin VI, Psychosomat. Medizin u. Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - W Häuser
- Innere Medizin I mit Schwerpunkt Gastroenterologie, Klinikum Saarbrücken, Saarbrücken, Deutschland
| | - G Holtmann
- Faculty of Medicine & Faculty of Health & Behavioural Sciences, Princess Alexandra Hospital, Brisbane, Australien
| | - J Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - M E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| | | | - J Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg, Deutschland
| | - P Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin, Deutschland
| | - A Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah, Klinikum Region Hannover, Hannover, Deutschland
| | - H Mönnikes
- Klinik für Innere Medizin, Martin-Luther-Krankenhaus, Berlin, Deutschland
| | | | - B Niesler
- Abteilung Molekulare Humangenetik Institut für Humangenetik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Pehl
- Medizinische Klinik, Krankenhaus Vilsbiburg, Vilsbiburg, Deutschland
| | - D Pohl
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - M Raithel
- Medizinische Klinik II m.S. Gastroenterologie und Onkologie, Waldkrankenhaus St. Marien, Erlangen, Deutschland
| | | | - M Schemann
- Lehrstuhl für Humanbiologie, TU München, Deutschland
| | - S Schmiedel
- I. Medizinische Klinik und Poliklinik Gastroenterologie, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - J Schwille-Kiuntke
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen, Tübingen, Deutschland.,Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - M Storr
- Zentrum für Endoskopie, Gesundheitszentrum Starnberger See, Starnberg, Deutschland
| | - J C Preiß
- Klinik für Innere Medizin - Gastroenterologie, Diabetologie und Hepatologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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Exarchopoulou K, Papageorgiou A, Bacopoulou F, Malisiova EK, Vlachakis D, Chrousos GP, Darviri C. A Biofeedback-Assisted Stress Management Program for Patients with Irritable Bowel Syndrome: a Randomised Controlled Trial. ACTA ACUST UNITED AC 2021; 26. [PMID: 34722218 PMCID: PMC8553100 DOI: 10.14806/ej.26.1.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that affects the functionality and quality of life of the affected persons. There is a well-established detrimental reciprocal relationship between stress and IBS. In this randomised controlled trial, IBS patients were randomly assigned to an 8-week biofeedback-assisted stress management intervention group (n=24) or a control group (n=22). Psychometric measures were performed at baseline and following intervention to assess perceived stress, health locus of control and depressive symptoms. In patients of the intervention group, perceived stress and symptoms of depression were significantly decreased, while the sense of control over health was increased. The intervention program was beneficial to the health and quality of life of individuals with IBS. Future randomised controlled studies with larger samples and longer follow-up are required to establish the effectiveness of stress-management techniques in functional gastrointestinal disorders.
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Affiliation(s)
- Konstantina Exarchopoulou
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Papageorgiou
- University Research Institute of Maternal and Child Health & Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health & Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Elli Koumantarou Malisiova
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vlachakis
- University Research Institute of Maternal and Child Health & Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.,Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece.,Lab of Molecular Endocrinology, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - George P Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Christina Darviri
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Fournié C, Chouchou F, Dalleau G, Caderby T, Cabrera Q, Verkindt C. Heart rate variability biofeedback in chronic disease management: A systematic review. Complement Ther Med 2021; 60:102750. [PMID: 34118390 DOI: 10.1016/j.ctim.2021.102750] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Heart rate variability biofeedback (HRVB) is a non-pharmacological intervention used in the management of chronic diseases. METHOD A systematic search was performed according to eligibility criteria including adult chronic patients, HRVB as main treatment with or without control conditions, and psychophysiological outcomes as dependent variables. RESULTS In total, 29 articles were included. Reported results showed the feasibility of HRVB in chronic patients without adverse effects. Significant positive effects were found in various patient profiles on hypertension and cardiovascular prognosis, inflammatory state, asthma disorders, depression and anxiety, sleep disturbances, cognitive performance and pain, which could be associated with improved quality of life. Improvements in clinical outcomes co-occurred with improvements in heart rate variability, suggesting possible regulatory effect of HRVB on autonomic function. CONCLUSIONS HRVB could be effective in managing patients with chronic diseases. Further investigations are required to confirm these results and recommend the most effective method.
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Affiliation(s)
- Claire Fournié
- Laboratoire IRISSE EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, La Réunion, France.
| | - Florian Chouchou
- Laboratoire IRISSE EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, La Réunion, France.
| | - Georges Dalleau
- Laboratoire IRISSE EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, La Réunion, France.
| | - Teddy Caderby
- Laboratoire IRISSE EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, La Réunion, France.
| | - Quentin Cabrera
- Service d'Hématologie Clinique, CHU Sud Réunion, Saint Pierre, La Réunion, France.
| | - Chantal Verkindt
- Laboratoire IRISSE EA4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, Le Tampon, La Réunion, France.
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Krouwel M, Farley A, Greenfield S, Ismail T, Jolly K. Systematic review, meta-analysis with subgroup analysis of hypnotherapy for irritable bowel syndrome, effect of intervention characteristics. Complement Ther Med 2021; 57:102672. [PMID: 33508441 DOI: 10.1016/j.ctim.2021.102672] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/17/2020] [Accepted: 01/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypnotherapy has been shown to be effective at relieving global gastrointestinal symptoms (GGS) in irritable bowel syndrome (IBS). This study examines the impact of hypnotherapy delivery and participant characteristics on IBS outcomes. METHODS This systematic review searched CINAHL, Cochrane Library, Conference Citation Index, Embase, PubMed, PsycARTICLES, PsychINFO, Science Citation index-expanded, Social Science Citation Index. Titles and abstracts, then full-text articles were screened against inclusion criteria: trials with a concurrent comparator of hypnotherapy in adults with IBS diagnosed using Manning or ROME criteria, which provided symptom data. Included studies were extracted and assessed for bias using Cochrane Collaboration 2011 guidance. Random-effects meta-analysis was conducted with sub-group analysis to assess the impact of delivery characteristics on outcomes. RESULTS Twelve trials were included, 7 in the meta-analyses. Hypnotherapy reduced the risk of GGS, but this was not statistically significant, (standardised mean difference (SMD) 0.24, [-0.06, 0.54], I2 66 %). Higher frequency of sessions (≥1/week) reduced GGS (SMD 0.45 [0.23,0.67] I2 0 %), as did higher volumes of intervention (≥8 sessions with ≥6 h of contact) (SMD 0.51 [0.27,0.76] I2 0 %) and group interventions (SMD 0.45 [0.03, 0.88] I2 62 %). Only volume of intervention produced a significant effect between the subgroups. CONCLUSION This review suggests that high volume hypnotherapy is more beneficial than low and should be adopted for GDH. Both high frequency and group interventions are effective in reducing GGS in IBS. However, the sample size is small and more studies are needed to confirm this.
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Affiliation(s)
- Matthew Krouwel
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Tariq Ismail
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
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Damis LF, Hamilton MS. Impact of hypnotic safety on disorders of gut-brain interaction: A pilot study. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2020; 63:150-168. [PMID: 33118881 DOI: 10.1080/00029157.2020.1794434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Functional gastrointestinal disorders, i.e., abdominal conditions without identifiable structural etiologies, are seen frequently in primary care and specialty practices. As subtle physiological processes have been identified as potential contributing factors to these functional disorders, these disorders have been recently relabeled, Disorders of Gut-Brain Interaction (DGBI). Moreover, some of these processes, e.g., sympathetic nervous system activity and inflammation, are being increasingly related to psychosocial factors such as situational stress and histories of trauma, abuse, and neglect. As the activity of the autonomic nervous system (ANS) has been long considered to be a contributory factor for DGBI, the present study utilized a theory-driven model based on the Polyvagal Theory to optimize ANS activity for the promotion of healthy digestive activity. Specifically, a hypnotic intervention to increase neuroception of safety was employed with three female college students diagnosed with functional dyspepsia and irritable bowel syndrome in a single-subject design. This intervention was found to be associated with increases in the experience of safe/warm positive affect and decreases in symptoms of functional dyspepsia and irritable bowel syndrome as well as depression and anxiety. The hypnotic intervention for the promotion of a sense of safety is recommended for the treatment of other functional somatic disorders as well as trauma-related conditions. Potential complications related to individuals with prolonged trauma and attachment issues also are reviewed.
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11
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Mind-body treatments of irritable bowel syndrome symptoms: An updated meta-analysis. Behav Res Ther 2019; 128:103462. [PMID: 32229334 DOI: 10.1016/j.brat.2019.103462] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 07/31/2019] [Accepted: 08/19/2019] [Indexed: 12/18/2022]
Abstract
Irritable bowel syndrome (IBS) is a widespread chronic functional gastrointestinal (GI) disorder having bidirectional comorbidity with psychiatric disorders. This review focuses on psychological treatment of IBS, focusing on symptom severity rather than IBS diagnostic criteria. We chose this dimensional approach in order to assess mind-body effects as an alternative or complement to conventional medical treatment, which focuses on symptom relief. We calculated the effect sizes for various psychosocial-mind-body therapies (MBTs) for IBS symptoms in both children and adults. Therapies included meditation, relaxation, yoga, autogenic training, progressive relaxation, general training in stress coping, hypnotherapy, biofeedback, psycho-education, psychodynamic psychotherapy, and cognitive behavioral therapy. We performed a meta-regression analyses and mixed effects contrasts to find various outcome differences, and we analyzed their relative efficacy in both children and adults. We found 53 studies in 50 reports describing randomized controlled trials. Medium to high effect sizes were found across all methods compared with various controls, with possibly higher effects for children. We found no systematic differences among treatment methods. Meta-regression analyses showed no significant effect for the presence of psychophysiological training, meditation or explicit exposure procedures as treatment components, although most MBTs include exposure as a nonexplicit treatment characteristic, and many relaxation techniques have meditative characteristics. We conclude that there is considerable evidence that an array of mind-body and other psychological therapies can be effective complements to medical treatment for IBS symptom severity, with little evidence for relative superiority of any particular approach. We suggest that the various methods may operate through different mechanisms.
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Goldenberg JZ, Brignall M, Hamilton M, Beardsley J, Batson RD, Hawrelak J, Lichtenstein B, Johnston BC. Biofeedback for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2019; 2019:CD012530. [PMID: 31713856 PMCID: PMC6848969 DOI: 10.1002/14651858.cd012530.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a prevalent condition that currently lacks highly effective therapies for its management. Biofeedback has been proposed as a therapy that may help individuals learn to exert conscious control over sympatho-vagal balance as an indirect method of symptom management. OBJECTIVES Our primary objective was to assess the efficacy and safety of biofeedback-based interventions for IBS in adults and children. SEARCH METHODS We searched the Cochrane Inflammatory Bowel Disease (IBD) Group Specialized Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Allied and Complementary Medicine Database (AMED) from inception to 24 July 2019. We also searched reference lists from published trials, trial registries, device manufacturers, conference proceedings, theses, and dissertations. SELECTION CRITERIA We judged randomized controlled trials to be eligible for inclusion if they met the Association for Applied Psychophysiology and Biofeedback definition of biofeedback, and if they compared a biofeedback intervention to an active, sham, or no-treatment control for the management of IBS. DATA COLLECTION AND ANALYSIS Two authors independently screened trials for inclusion, extracted data, and assessed risk of bias. Primary outcomes were IBS global or clinical improvement scores and overall quality of life measures. Secondary outcome measures were adverse events, assessments of stool frequency and consistency, changes in abdominal pain, depression, and anxiety. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI). For continuous outcomes, we calculated the mean difference (MD) and 95% CI. We used GRADE criteria to assess the overall certainty of the evidence. MAIN RESULTS We identified eight randomized trials with a total of 300 adult participants for our analysis. We did not identify any trials in children. Four trials assessed thermal biofeedback. One trial assessed rectosigmoidal biofeedback. Two trials assessed heart rate variability biofeedback. Two trials assessed electrocutaneous biofeedback. Comparators were: no treatment (symptom monitoring group; three studies), attention control (pseudomeditation; two studies), relaxation control (one study), counseling (two studies), hypnotherapy (one study), standard therapy (one study), and sham biofeedback (one study). We judged all trials to have a high or unclear risk of bias. Global/Clinical improvement The clinical benefit of biofeedback plus standard therapy compared to standard therapy alone was uncertain (RR 4.20, 95% CI 1.40 to 12.58; 1 study, 20 participants; very low-certainty evidence). The same study also compared biofeedback plus standard therapy to sham biofeedback plus standard therapy. The clinical benefit in the biofeedback group was uncertain (RR 2.33, 95% CI 1.13 to 4.80; 1 study, 20 participants; very low-certainty evidence). The clinical benefit of heart rate biofeedback compared to hypnotherapy was uncertain when measured with the IBS severity scoring system (IBS-SSS) (MD -58.80, 95% CI -109.11 to -8.49; 1 study, 61 participants; low-certainty evidence). Compared to counseling, the effect of heart rate biofeedback was unclear when measured with a composite symptom reduction score (MD 7.03, 95% CI -51.07 to 65.13; 1 study, 29 participants; low-certainty evidence) and when evaluated for clinical response (50% improvement) (RR 1.09, 95% CI 0.48 to 2.45; 1 study, 29 participants; low-certainty evidence). The clinical benefit of thermal biofeedback used in a multi-component psychological intervention (MCPI) compared to no treatment was uncertain when measured with a composite clinical symptom reduction score (MD 30.34, 95% CI 8.47 to 52.21; 3 studies, 101 participants; very low-certainty evidence), and when evaluated as clinical response (50% improvement) (RR 2.12, 95% CI 1.24 to 3.62; 3 studies, 101 participants; very low-certainty evidence). Compared to attention control, the effects of thermal biofeedback within an MCPI were unclear when measured with a composite clinical symptom reduction score (MD 4.02, 95% CI -21.41 to 29.45; 2 studies, 80 participants; very low-certainty evidence) and when evaluated as clinical response (50% improvement) (RR 1.10, 95% CI 0.72 to 1.69, 2 studies, 80 participants; very low-certainty evidence). Quality of life A single trial used overall quality of life as an outcome measure, and reported that both the biofeedback and cognitive therapy groups improved after treatment. The trial did not note any between-group differences, and did not report any outcome data. Adverse events Only one of the eight trials explicitly reported adverse events. This study reported no adverse events in either the biofeedback or cognitive therapy groups (RD 0.00, 95% CI -0.12 to 0.12; 29 participants; low-certainty evidence). AUTHORS' CONCLUSIONS There is currently not enough evidence to assess whether biofeedback interventions are effective for controlling symptoms of IBS. Given the positive results reported in small trials to date, biofeedback deserves further study in people with IBS. Future research should include active control groups that use high provider-participant interaction, in an attempt to balance non-specific effects of interventions between groups, and report both commonly used outcome measures (e.g. IBS-SSS) and historical outcome measures (e.g. the composite primary symptom reduction (CPSR) score) to allow for meta-analysis with previous studies. Future studies should be explicit in their reporting of adverse events.
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Affiliation(s)
- Joshua Z Goldenberg
- National University of Natural MedicineHelfgott Research Institute2220 SW 1st AvePortlandORUSA97102
- University of Technology SydneyAustralian Research Center in Complementary and Integrative MedicineUltimoNew South WalesAustralia
| | - Matthew Brignall
- Bastyr UniversityNaturopathic Medicine14500 Juanita Dr. NEKenmoreWAUSA
| | | | | | | | - Jason Hawrelak
- University of TasmaniaSchool of MedicineHobartAustralia
- University of Technology SydneyAustralian Research Centre for Complementary and Integrative MedicineSydneyAustralia
| | | | - Bradley C Johnston
- Dalhousie UniversityDepartment of Community Health and Epidemiology5790 University AvenueHalifaxNSCanadaB3H 1V7
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Tayama J, Saigo T, Ogawa S, Takeoka A, Hamaguchi T, Inoue K, Okamura H, Yajima J, Matsudaira K, Fukudo S, Shirabe S. Effect of attention bias modification on event-related potentials in patients with irritable bowel syndrome: A preliminary brain function and psycho-behavioral study. Neurogastroenterol Motil 2018; 30:e13402. [PMID: 30062816 DOI: 10.1111/nmo.13402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/28/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Attention bias modification normalizes electroencephalographic abnormalities in alpha and beta power percentages related to attention in patients with irritable bowel syndrome (IBS). Yet, it is unknown whether ABM contributes to the normalization of event-related potentials (ERP) in these patients. We hypothesized that ERP related to attention deficit would be normalized after ABM implementation in individuals with IBS. METHODS Thirteen patients with IBS and 10 control subjects completed a 2-month intervention that included five ABM sessions. Each session included 128 trials, resulting in a total of 640 trials during the study period. Event-related potentials were measured at the first and fifth sessions. As per the international 10-20 system for electroencephalographic electrode placement, right parietal P4 was evaluated to measure the attention component of facial expression processing. KEY RESULTS A group comparison of P100 latency at P4 revealed that latencies were significantly different between groups in session 1 (IBS vs control, 108 ± 8 vs 97 ± 14; t = -2.51, P = .0203). This difference was absent in session 5 (94 ± 11 vs 93 ± 11, respectively; t = -0.397, P = .6954, r = .09), indicating an effect of ABM in the IBS group. CONCLUSIONS AND INFERENCES Attention bias modification may have clinical utility for normalizing brain function and specifically attentional abnormalities in patients with IBS.
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Affiliation(s)
- J Tayama
- Graduate School of Education, Nagasaki University, Nagasaki, Japan
| | - T Saigo
- School of Psychological Science, Health Sciences University of Hokkaido, Sapporo, Japan
| | - S Ogawa
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
| | - A Takeoka
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
| | - T Hamaguchi
- Department of Occupational Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
| | - K Inoue
- Center for the Study of Higher Education and Global Admissions, Osaka University, Suita, Japan
| | - H Okamura
- Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Kurume, Japan
| | - J Yajima
- Faculty of Literature, Beppu University, Beppu, Japan
| | - K Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo-Hospital, Tokyo, Japan
| | - S Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Shirabe
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
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Thakur ER, Shapiro J, Chan J, Lumley MA, Cully JA, Bradford A, El-Serag HB. A Systematic Review of the Effectiveness of Psychological Treatments for IBS in Gastroenterology Settings: Promising but in Need of Further Study. Dig Dis Sci 2018; 63:2189-2201. [PMID: 29744772 DOI: 10.1007/s10620-018-5095-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 04/24/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psychological treatments are efficacious for irritable bowel syndrome (IBS) in clinical trials; however, their effectiveness when conducted in gastroenterology practice settings is unclear. AIM To perform a systematic review of the types and effects of psychological treatments for IBS conducted in gastroenterology clinics. METHODS We searched PubMed, EMBASE, and Cochrane central register. Studies conducted in gastroenterology clinic settings with IBS patients who were clinically referred from gastroenterology were included. RESULTS We identified 3078 citations, of which only eight studies were eligible. Seven studies compared psychological treatments (average n = 25.7; range 12-43) to controls (average n = 25.4 patients; range 12-47), whereas one study compared two active "bonafide" interventions. Psychological treatments varied (cognitive-behavioral therapy, guided affective imagery, mindfulness, hypnosis, biofeedback, emotional awareness training). However, across approaches, short-term benefits were seen. IBS symptoms improved significantly among patients in cognitive and behavioral therapies, mindfulness-based stress reduction, guided affective imagery, and emotional awareness training compared with controls; there was a similar trend for gut-directed hypnotherapy. Similarly, IBS symptoms improved in a study of two active biofeedback and hypnosis treatments. CONCLUSIONS Evidence for the effectiveness of psychological treatment in gastroenterology practice is promising but limited. Study designs that involve a blending of efficacy and effectiveness components are needed.
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Affiliation(s)
- Elyse R Thakur
- VA South Central Mental Illness Research, Education and Clinical Center, (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), Michel E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA.
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Jordan Shapiro
- Gastroenterology and Hepatology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Johanna Chan
- Gastroenterology and Hepatology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Rm. 7204, 5057 Woodward Ave., Detroit, MI, 48202, USA
| | - Jeffrey A Cully
- VA South Central Mental Illness Research, Education and Clinical Center, (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), Michel E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Andrea Bradford
- Gastroenterology and Hepatology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Hashem B El-Serag
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), Michel E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA
- Gastroenterology and Hepatology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
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[Brain-gut axis and gut-directed hypnosis - success of an integrated psychosomatic treatment in gastroenterology]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2017; 63:5-19. [PMID: 28245719 DOI: 10.13109/zptm.2017.63.1.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Moss D, Shaffer F. The Application of Heart Rate Variability Biofeedback to Medical and Mental Health Disorders. ACTA ACUST UNITED AC 2017. [DOI: 10.5298/1081-5937-45.1.03] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heart rate variability (HRV) is a medical index for morbidity and wellness. Lower HRV accompanies many illnesses; high HRV accompanies healthy states, resilience, and optimal functioning. Heart rate variability biofeedback (HRVB) uses real-time electronic feedback of the moment-to-moment changes in HRV to train patients to produce increases in HRV. Outcome studies on HRVB have shown therapeutic benefit for a wide variety of medical and mental health disorders. Lehrer and colleagues have published evidence-based protocols for HRV assessment and HRV treatment. Here, the authors review outcome studies on a sampling of common disorders: asthma, chronic muscle pain, depression, heart failure, hypertension, and posttraumatic stress disorder. HRVB offers promising therapeutic benefit for any medical or mental health disorder known to be accompanied by autonomic nervous system dysregulation.
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Affiliation(s)
- Donald Moss
- College of Integrative Medicine and Health Sciences, Saybrook University, Oakland, CA
| | - Fredric Shaffer
- Department of Psychology, Truman State University, Kirksville, MO
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Goldenberg JZ, Brignall M, Hamilton M, Beardsley J, Lichtenstein B. Biofeedback for treatment of irritable bowel syndrome. Hippokratia 2017. [DOI: 10.1002/14651858.cd012530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Matthew Brignall
- Bastyr University; Naturopathic Medicine; 14500 Juanita Dr. NE Kenmore WA USA
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Pellissier S, Bonaz B. The Place of Stress and Emotions in the Irritable Bowel Syndrome. VITAMINS AND HORMONES 2016; 103:327-354. [PMID: 28061975 DOI: 10.1016/bs.vh.2016.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Our emotional state can have many consequences on our somatic health and well-being. Negative emotions such as anxiety play a major role in gut functioning due to the bidirectional communications between gut and brain, namely, the brain-gut axis. The irritable bowel syndrome (IBS), characterized by an unusual visceral hypersensitivity, is the most common disorder encountered by gastroenterologists. Among the main symptoms, the presence of current or recurrent abdominal pain or discomfort associated with bloating and altered bowel habits characterizes this syndrome that could strongly alter the quality of life. This chapter will present the physiopathology of IBS and explain how stress influences gastrointestinal functions (permeability, motility, microbiota, sensitivity, secretion) and how it could be predominantly involved in IBS. This chapter will also describe the role of the autonomic nervous system and the hypothalamic-pituitary axis through vagal tone and cortisol homeostasis. An analysis is made about how emotions and feelings are involved in the disruption of homeostasis, and we will see to what extent the balance between vagal tone and cortisol may reflect dysfunctions of the brain-gut homeostasis. Finally, the interest of therapeutic treatments focused on stress reduction and vagal tone enforcement is discussed.
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Affiliation(s)
- S Pellissier
- Laboratoire Interuniversitaire de Psychologie, Personnalité, Cognition, Changement Social, Université Savoie Mont-Blanc, Chambéry, France.
| | - B Bonaz
- Clinique Universitaire d'Hépato-Gastroentérologie, CHU de Grenoble, Grenoble 09, France; Université Grenoble Alpes, Grenoble Institut des Neurosciences, Fonctions Cérébrales et Neuromodulation, INSERM, Grenoble 09, France
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Palsson OS. Hypnosis Treatment of Gastrointestinal Disorders: A Comprehensive Review of the Empirical Evidence. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2015; 58:134-58. [PMID: 26264539 DOI: 10.1080/00029157.2015.1039114] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hypnotherapy has been investigated for 30 years as a treatment for gastrointestinal (GI) disorders. There are presently 35 studies in the published empirical literature, including 17 randomized controlled trials (RCTs) that have assessed clinical outcomes of such treatment. This body of research is reviewed comprehensively in this article. Twenty-four of the studies have tested hypnotherapy for adult irritable bowel syndrome (IBS) and 5 have focused on IBS or abdominal pain in children. All IBS hypnotherapy studies have reported significant improvement in gastrointestinal symptoms, and 7 out of 10 RCTs in adults and all 3 RCTs in pediatric patient samples found superior outcomes for hypnosis compared to control groups. Collectively this body of research shows unequivocally that for both adults and children with IBS, hypnosis treatment is highly efficacious in reducing bowel symptoms and can offer lasting and substantial symptom relief for a large proportion of patients who do not respond adequately to usual medical treatment approaches. For other GI disorders the evidence is more limited, but preliminary indications of therapeutic potential can be seen in the single randomized controlled trials published to date on hypnotherapy for functional dyspepsia, functional chest pain, and ulcerative colitis. Further controlled hypnotherapy trials in those three disorders should be a high priority. The mechanisms underlying the impact of hypnosis on GI problems are still unclear, but findings from a number of studies suggest that they involve both modulation of gut functioning and changes in the brain's handling of sensory signals from the GI tract.
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HRV biofeedback for pediatric irritable bowel syndrome and functional abdominal pain: a clinical replication series. Appl Psychophysiol Biofeedback 2015; 39:287-91. [PMID: 25274501 DOI: 10.1007/s10484-014-9261-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Irritable bowel syndrome (IBS) and Functional Abdominal Pain (FAP) are among the most commonly reported Functional Gastrointestinal Disorders. Both have been associated with varying autonomic dysregulation. Heart Rate Variability Biofeedback (HRVB) has recently begun to show efficacy in the treatment of both IBS and FAP. The purpose of this multiple clinical replication series was to analyze the clinical outcomes of utilizing HRVB in a clinical setting. Archival data of twenty-seven consecutive pediatric outpatients diagnosed with IBS or FAP who received HRVB were analyzed. Clinical outcomes were self-report and categorized as full or remission with patient satisfaction, or no improvement. Qualitative reports of patient experiences were also noted. Full remission was achieved by 69.2 % and partial remission was achieved by 30.8 % of IBS patients. Full remission was achieved by 63.6 % and partial remission was achieved by 36.4 % of FAP patients. No patients in either group did not improve to a level of patient satisfaction or >50 %. Patient's commonly reported feeling validated in their discomfort as a result of psychophysiological education. Results suggest that HRVB is a promising intervention for pediatric outpatients with IBS or FAP. Randomized controlled trials are necessary to accurately determine clinical efficacy of HRVB in the treatment of IBS and FAP.
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Boltin D, Sahar N, Gil E, Aizic S, Hod K, Levi-Drummer R, Niv Y, Dickman R. Gut-directed guided affective imagery as an adjunct to dietary modification in irritable bowel syndrome. J Health Psychol 2015; 20:712-20. [DOI: 10.1177/1359105315573450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This work aimed to study the effect of guided affective imagery on the irritable bowel syndrome. A total of 15 irritable bowel syndrome patients received guided affective imagery and 19 patients served as controls. Symptom severity and irritable bowel syndrome quality of life were measured at baseline and 8 weeks. Symptom severity decreased following guided affective imagery compared to controls (−1.5 ± 1.9 vs 0.1 ± 1.6, p = 0.04). Irritable bowel syndrome quality of life increased following guided affective imagery compared to controls (12.1 ± 12.5 vs −0.7 ± 16.2, p < 0.01). Guided affective imagery predicted reduced symptom severity (odds ratio = 5.71, p = 0.02) and increased irritable bowel syndrome quality of life (odds ratio = 17.88, p = 0.01). Guided affective imagery combined with dietary modification may be beneficial in the management of irritable bowel syndrome, however larger studies are required.
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Affiliation(s)
- Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Nadav Sahar
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Efi Gil
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shoshana Aizic
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Keren Hod
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - Yaron Niv
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus and Sackler Faculty of Medicine, Tel Aviv University, Israel
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Efficacy, tolerability, and safety of hypnosis in adult irritable bowel syndrome: systematic review and meta-analysis. Psychosom Med 2014; 76:389-98. [PMID: 24901382 DOI: 10.1097/psy.0000000000000039] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the efficacy, tolerability, and safety of hypnosis in adult irritable bowel syndrome by a meta-analysis of randomized controlled trials. METHODS Studies were identified by a literature search of the databases Allied and Complementary Medicine Database, Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycINFO, and Scopus (from inception to June 30, 2013). Primary outcomes were adequate symptom relief, global gastrointestinal score, and safety. Summary relative risks (RRs) with number needed to treat (NNT) and standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were calculated using random-effects models. RESULTS Eight randomized controlled trials with a total of 464 patients and a median of 8.5 (7-12) hypnosis sessions over a median of 12 (5-12) weeks were included into the analysis. At the end of therapy, hypnosis was superior to control conditions in producing adequate symptom relief (RR, 1.69 [95% CI = 1.14-2.51]; NNT, 5 [3-10]) and in reducing global gastrointestinal score (SMD, 0.32 [95% CI = -0.56 to -0.08]). At long-term follow-up, hypnosis was superior to controls in adequate symptom relief (RR, 2.17 [95% CI = 1.22-3.87]; NNT, 3 [2-10]), but not in reducing global gastrointestinal score (SMD, -0.57 [-1.40 to 0.26]). One (0.4%) of 238 patients in the hypnosis group dropped out due to an adverse event (panic attack). CONCLUSION This meta-analysis demonstrated that hypnosis was safe and provided long-term adequate symptom relief in 54% of patients with irritable bowel syndrome refractory to conventional therapy.
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Abstract
Heart rate variability biofeedback has enjoyed increased popularity in recent years. In this review, empirical evidence from multiple sources is presented from the point of view of possible mechanisms of effect. While more research is clearly needed, the data thus far are certainly promising.
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