The effect of eye movement desensitization and reprocessing (EMDR) on abdominal pain in patients with irritable bowel syndrome (IBS): a study protocol for a randomized controlled trial (EMDR4IBS)

BACKGROUND

Irritable bowel syndrome (IBS) is a highly prevalent disorder for which treatment options such as medication, diets, and hypnotherapy either have shown limited effect or relieve symptoms in only a limited subset of patients. Abdominal pain is the key criterion for the diagnosis and is deemed the most distressing IBS symptom, and the most disruptive of everyday life. A growing body of research demonstrates the effect of Eye Movement Desensitization and Reprocessing (EMDR) on chronic pain. EMDR is known as a safe and successful treatment for disorders in which unresolved traumatic memories play a role in the cause or maintenance of symptoms. In IBS, activated memories may increase pain through pain flashbacks and the stress generated by unresolved memories. The aim of this study is to ascertain whether applying EMDR to traumatic memories including pain memories will reduce abdominal pain in IBS patients.

METHODS

This study is a randomized controlled trial which will be conducted at a city hospital in the Netherlands. Adult patients with considerable IBS pain (pain intensity at least 60/100 during at least 5/10 days) will be randomly assigned to either EMDR therapy or the wait list. We aim to include 34 participants. The EMDR condition comprises seven sessions, around 90 min in length delivered weekly, the first of which is a case conceptualization session. All participants will be assessed at baseline, post-treatment, and at 3 months follow-up. The primary outcome measure is pain intensity on a Likert scale which is self-reported daily during a 2-week period. Secondary outcomes include similar daily ratings on other IBS symptoms and reported hindrance of valued activities, and also standardized questionnaires on IBS symptoms and Quality of Life. Data will be analyzed by a Linear Mixed Effects Model for repeated measures.

DISCUSSION

The results are expected to gain insight into the effectiveness of EMDR treatment on abdominal pain in IBS. As there are very few effective treatment options for IBS-related abdominal pain, this study could have important implications for clinical practice.

TRIAL REGISTRATION

Human ethics committee MEC-U NL71740.100.20. International Clinical Trial Registry Platform: NL8894. Prospectively registered on 28 January 2020.

Efficacy of eye movement desensitization and reprocessing therapy for fear of cancer recurrence among cancer survivors: a randomized single-case experimental design

Background: Fear of cancer recurrence (FCR) is one of the greatest problems with which cancer survivors have to deal. High levels of FCR are characterized by intrusive thoughts about cancer-related events and re-experiencing these events, avoidance of reminders of cancer, and hypervigilance, similar to post-traumatic stress disorder (PTSD). Eye movement desensitization and reprocessing (EMDR) therapy focuses on these images and memories. It is effective in reducing PTSD and may be effective in reducing high levels of FCR.Objective: The aim of the present study is to investigate the effectiveness of EMDR for severe FCR in breast and colorectal cancer survivors.Method: A multiple-baseline single-case experimental design (n = 8) was used. Daily repeated measurements for FCR were taken during the baseline phase and treatment phase, post-treatment, and at the 3 month follow-up. Participants answered the Cancer Worry Scale (CWS) and the Fear of Cancer Recurrence Inventory, Dutch version (FCRI-NL) five times, i.e. at the start and at the end of each phase (baseline, treatment, post-treatment, and follow-up). The study was prospectively registered at clinicaltrials.gov (NL8223).Results: Visual analysis and effect size calculation by Tau-U were executed for the daily questionnaire on FCR. The weighted average Tau-U score was .63 (p < .01) for baseline versus post-treatment, indicating large change, and .53 (p < .01) between baseline and follow-up, indicating moderate change. The scores on the CWS and FCRI-NL-SF decreased significantly from baseline to follow-up.Conclusion: The results seem promising for EMDR therapy as a potentially effective treatment for FCR. Further research is recommended.

Treatment course and its predictors in patients with somatoform disorders: A routine outcome monitoring study in secondary psychiatric care

AIM

Somatoform disorders are common and often chronic. It would be helpful to distinguish those patients who are likely to have a positive treatment course from those who are likely to follow a negative course. Such studies of different somatoform disorders are scarce, especially in secondary psychiatric care. This study examined the 6-month treatment course of psychological, physical symptoms, and functioning, and its predictors in a naturalistic sample of secondary psychiatric care outpatients with somatoform disorders.

METHOD

The present study used routine outcome monitoring data of patients with somatoform disorders regarding their 6-month treatment course of psychological and physical symptoms as well as functioning. The following patient groups were included: total group of somatoform disorders (N = 435), and undifferentiated somatoform disorder (N = 242), pain disorder (N = 102), body dysmorphic disorder (N = 51), and hypochondriasis (N = 40). Measures were Mini-International Neuropsychiatric Interview plus, Brief Symptom Inventory, Montgomery-Ǻsberg Depression Rating Scale, Brief Anxiety Scale, Short Form Health Survey 36, and Physical Symptom Checklist (PSC).

RESULTS

The study population generally showed high co-morbidity, especially with anxiety and mood disorders. The PSC total score, body dysmorphic disorder, and hypochondriasis were significant predictors for the treatment course of symptoms (Brief Symptom Inventory), whereas the PSC total score was the only significant predictor for the course of functioning (Short Form Health Survey 36).

CONCLUSION

Secondary psychiatric care outpatients with somatoform disorders showed high co-morbidity with anxiety and mood disorders, and an unfavourable 6-month course of both symptoms and functioning. Clinical implications are discussed, such as additional treatment of co-morbidity in somatoform disorders.

Pre-adult versus adult onset major depressive disorder in a naturalistic patient sample: the Leiden Routine Outcome Monitoring Study

BACKGROUND

Pre-adult onset of major depressive disorder (MDD) may predict a more severe phenotype of depression. As data from naturalistic psychiatric specialty care settings are scarce, we examined phenotypic differences between pre-adult and adult onset MDD in a large sample of consecutive out-patients.

METHOD

Altogether, 1552 out-patients, mean age 39.2 ± 11.6 years, were diagnosed with current MDD on the Mini-International Neuropsychiatric Interview Plus diagnostic interview as part of the usual diagnostic procedure. A total of 1105 patients (71.2%) had complete data on all variables of interest. Pre-adult onset of MDD was defined as having experienced the signs and symptoms of a first major depressive episode before the age of 18 years. Patients were stratified according to the age at interview (20-40/40-65 years). Correlates of pre-adult onset were analysed using logistic regression models adjusted for age, age squared and gender.

RESULTS

Univariate analyses showed that pre-adult onset of MDD had a distinct set of demographic (e.g. less frequently living alone) and clinical correlates (more co-morbid DSM-IV - Text Revision diagnoses, more social phobia, more suicidality). In the multivariate model, we found an independent association only for a history of suicide attempts [odds ratio (OR) 3.15, 95% confidence intervals (CI) 1.97-5.05] and current suicidal thoughts (OR 1.81, 95% CI 1.26-2.60) in patients with pre-adult versus adult onset MDD.

CONCLUSIONS

Pre-adult onset of MDD is associated with more suicidality than adult onset MDD. Age of onset of depression is an easy to ascertain characteristic that may help clinicians in weighing suicide risk.

[Prevalence and comorbidity of body dysmorphic disorder in psychiatric outpatients]

BACKGROUND

Body dysmorphic disorder (BDD) is a somatoform disorder, characterized by a patient's preoccupation with the belief that some aspect of his/her physical appearance is abnormal. The prevalence of BDD in the general population is 0.7 - 1.7%. The prevalence of BDD in patients attending a Dutch general outpatient clinic has never been examined.

AIM

Examine the prevalence of BDD in patients attending a Dutch general outpatient clinic.

METHOD

All patients aged 18 to 65 who were referred between September 2003 and July 2007 to six general outpatients clinics for treatment of a depressive disorder, an anxiety disorder, or a somatoform disorder were assessed with the Mini International Neuropsychiatric Interview (mini). Patients with BDD were also assessed by means of the Body Dysmorphic Disorder - Yale- Brown Obsessive Compulsive Scale (BDD-YBOCS). results BDD was diagnosed in 45 out of 5848 patients (0.8% (0.6-1.0%)). The average age of these patients was 31.1. years and 69% were female. A comorbid depressive disorder was present in 35 patients (78%) and a comorbid anxiety disorder in 26 patients (58%). Of the anxiety disorders, social phobia was the most common, with a prevalence of 27%. The average score on the BDD-YBOCS was 22.5 points. The BDD-YBOCS score was significantly higher in patients with a comorbid obsessive-compulsive disorder (35.7 points; p = 0.01).

CONCLUSION

The prevalence of BDD in psychiatric outpatients who were referred for treatment of a depressive disorder, an anxiety disorder, or a somatoform disorder was 0.8%. There was a high comorbidity of BDD with depressive and anxiety disorders.

Clinical trial: short- and long-term benefit of relaxation training for irritable bowel syndrome

BACKGROUND

Psychotherapy is effective in treating irritable bowel syndrome, but the effect of relaxation training, a brief psychological group intervention, is not known.

AIM

To determine the efficacy of relaxation training in a large cohort of irritable bowel syndrome patients.

METHODS

Ninety-eight irritable bowel syndrome patients were included in this randomized controlled trial. Forty-six patients received standard medical care (CON) and 52 received four 90-min sessions of relaxation training in small groups in addition to standard medical care. Irritable bowel syndrome symptom severity, medical consumption and quality of life were assessed at baseline in patients and in 38 healthy controls and evaluated in patients at 3, 6 and 12 months after intervention.

RESULTS

Irritable bowel syndrome symptom severity was significantly reduced in the relaxation training group compared to CON at 3, 6 and 12 months after treatment (time-by-treatment interaction, P = 0.002). The number needed to treat for long-term improvement was 5. Quality of life had improved (general health, P = 0.017; health change, P = 0.05). Frequency of doctor visits was reduced (P = 0.039).

CONCLUSIONS

Relaxation training is a brief group intervention that significantly improves symptom severity, general health perception and medical consumption in irritable bowel syndrome patients immediately after, as well as 6 and 12 months after intervention.

[Popularity of aesthetic dental treatments. Results of a national study in the Netherlands]

There are indications of a growing public interest in aesthetic dental treatments. For want of reliable data, a group of 907 randomly selected Dutch individuals was questioned in order to give this apparent tendency a foundation in figures. The results of this study show that about 25% of the respondents received aesthetic dental treatment at some time, about 8% was treated during the past year, and almost 8% intended to undergo aesthetic dental treatment in the coming year. In this respect, tooth whitening was found to be the most popular treatment. The results of this study suggest that there is a positive attitude towards aesthetic dentistry and that women take a greater interest in it than men. Whether this interest will lead to a rise in the number of actual aesthetic dental treatments is still unclear.

[Burning-mouth syndrome: consideration of maintenance factors]

Burning-mouth syndrome is characterised by a number of complaints of which the burning sensation in the mouth is the most important but cannot be explained by known medical causes. Although psychological factors can predispose for or trigger physical symptoms without a medical explanation, treatment directed at the proposed psychological causes has not proven to be very effective and is not acceptable for most patients. Treatment directed at reducing the consequences of the complaint that could play a role in maintaining the problem is, however, effective and is accepted by almost all patients. Consequences that could maintain the burning-mouth syndrome are anxiety, depression, selective attention, and measures taken to find relief but which can irritate the oral mucosa. The treating physician should inform the patient and help him to change his behaviour. If patients have become depressed or very anxious as a consequence of the complaints they should be referred to a cognitive-behaviour therapist specialised in the treatment of patients with physical symptoms without a medical explanation.