Mindfulness-based stress reduction improves irritable bowel syndrome (IBS) symptoms via specific aspects of mindfulness.
irritable bowel syndrome
meditation
mindfulness
visceral sensitivity
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
15
07
2019
revised:
29
01
2020
accepted:
07
02
2020
pubmed:
9
4
2020
medline:
29
7
2021
entrez:
9
4
2020
Statut:
ppublish
Résumé
Irritable bowel syndrome (IBS) is a common and often debilitating chronic gastrointestinal disorder characterized by abdominal pain and altered bowel habits. Pharmacological treatments are often ineffective, leading to the development of a variety of behavioral interventions. Mindfulness-based stress reduction (MBSR) is one such program that has shown efficacy in reducing gastrointestinal (GI) symptoms and improving quality of life (QOL). This single-arm intervention study examines the association of clinical outcomes with changes in specific aspects of mindfulness. Adults with IBS (53 women, 15 men) participated in an 8-week MBSR class. Primary outcomes of GI symptom severity, quality of life, and GI-specific anxiety, as well as specific aspects of mindfulness using the Five Factor Mindfulness Questionnaire (FFMQ), were assessed at baseline, post-treatment, and 6-month follow-up. Gastrointestinal symptom responder rate was 71%, and there was a significant pre-post treatment change for three of the five FFMQ scales. Regression analysis indicated that change in the Act with Awareness (P = .02) facet of mindfulness was the strongest predictor of GI symptom and QOL improvement. Mindfulness-based stress reduction training was associated with robust improvements in GI symptoms and associated problems in participants with IBS. Although significant increases in 3 of the 5 measured facets of mindfulness were found, regression analyses suggest that increases in the ability to retain present moment focus and act with awareness may be particularly important for improving outcomes in individuals with IBS. These results may inform the refinement of mindfulness-based protocols specifically for treatment of IBS.
Sections du résumé
BACKGROUND
Irritable bowel syndrome (IBS) is a common and often debilitating chronic gastrointestinal disorder characterized by abdominal pain and altered bowel habits. Pharmacological treatments are often ineffective, leading to the development of a variety of behavioral interventions. Mindfulness-based stress reduction (MBSR) is one such program that has shown efficacy in reducing gastrointestinal (GI) symptoms and improving quality of life (QOL). This single-arm intervention study examines the association of clinical outcomes with changes in specific aspects of mindfulness.
METHODS
Adults with IBS (53 women, 15 men) participated in an 8-week MBSR class. Primary outcomes of GI symptom severity, quality of life, and GI-specific anxiety, as well as specific aspects of mindfulness using the Five Factor Mindfulness Questionnaire (FFMQ), were assessed at baseline, post-treatment, and 6-month follow-up.
KEY RESULTS
Gastrointestinal symptom responder rate was 71%, and there was a significant pre-post treatment change for three of the five FFMQ scales. Regression analysis indicated that change in the Act with Awareness (P = .02) facet of mindfulness was the strongest predictor of GI symptom and QOL improvement.
CONCLUSIONS & INFERENCES
Mindfulness-based stress reduction training was associated with robust improvements in GI symptoms and associated problems in participants with IBS. Although significant increases in 3 of the 5 measured facets of mindfulness were found, regression analyses suggest that increases in the ability to retain present moment focus and act with awareness may be particularly important for improving outcomes in individuals with IBS. These results may inform the refinement of mindfulness-based protocols specifically for treatment of IBS.
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13828Subventions
Organisme : NIDDK NIH HHS
ID : P50 DK64539
Pays : United States
Organisme : NCCIH NIH HHS
ID : R01 AT007137
Pays : United States
Organisme : NCCIH NIH HHS
ID : R01 AT007137
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology. 2016;150:1262-1279.
Ballou S, Keefer L. The impact of irritable bowel syndrome on daily functioning: Characterizing and understanding daily consequences of IBS. Neurogastroenterol Motil. 2016;29(4):e12982.
Maixner W, Fillingim RB, Williams DA, et al. Overlapping chronic pain conditions: implications for diagnosis and classification. J Pain. 2016;17:T93-T107.
Lea R, Whorwell PJ. Quality of life in irritable bowel syndrome. Pharmacoeconomics. 2001;19:643-653.
Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part I: overall and upper gastrointestinal diseases. Gastroenterology. 2009;136:376-386.
Inadomi JM, Fennerty MB, Bjorkman D. Systematic review: the economic impact of irritable bowel syndrome. Aliment Pharmacol Ther. 2003;18:671-682.
Enck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nat Rev Dis Primers. 2016;2:16014.
Laird KT, Tanner-Smith EE, Russell AC, et al. Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: a systematic review and meta-analysis. Clin Psychol Rev. 2017;51:142-152.
Kabat-Zinn J, Hanh TN. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delta, 2009.
Gotink RA, Chu P, Busschbach JJ, et al. Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs. PLoS ONE ONE. 2015;10:e0124344.
Zernicke KA, Campbell TS, Blustein PK, et al. Mindfulness-based stress reduction for the treatment of irritable bowel syndrome symptoms: a randomized wait-list controlled trial. Int J Behav Med. 2013;20:385-396.
Kearney DJ, McDermott K, Martinez M, et al. Association of participation in a mindfulness programme with bowel symptoms, gastrointestinal symptom-specific anxiety and quality of life. Aliment Pharmacol Ther. 2011;34:363-373.
Gaylord SA, Palsson OS, Garland EL, et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am J Gastroenterol. 2011;106(9):1678-1688.
Garland EL, Gaylord SA, Palsson O, et al. Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. J Behav Med. 2012;35:591-602.
Zeidan F, Martucci KT, Kraft RA, et al. Brain mechanisms supporting the modulation of pain by mindfulness meditation. J Neurosci. 2011;31:5540-5548.
Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10:712-721.
Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology. 2006;130:1480-1491.
Labus JS, Bolus R, Chang L, et al. The Visceral Sensitivity Index: development and validation of a gastrointestinal symptom-specific anxiety scale. Aliment Pharmacol Ther. 2004;20:89-97.
Gaylord SA, Whitehead WE, Coble RS, et al. Mindfulness for irritable bowel syndrome: protocol development for a controlled clinical trial. BMC Complement Altern Med. 2009;9:24.
Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther. 1997;11:395-402.
Patrick DL, Drossman DA, Frederick IO, et al. Quality of life in persons with irritable bowel syndrome: Development and validation of a new measure. Dig Dis Sci. 1998;43:400-411.
Baer RA, Smith GT, Lykins E, et al. Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. 2008;15:329-342.
Gu J, Strauss C, Crane C, et al. Examining the factor structure of the 39-item and 15-item versions of the Five Facet Mindfulness Questionnaire before and after mindfulness-based cognitive therapy for people with recurrent depression. Psychol Assess. 2016;28:791-802.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361-370.
Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64:258-266.
Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychological Assessment. 1995;7(4):524-532. https://doi.org/10.1037/1040-3590.7.4.524
Gaylord SA, Palsson OS, Garland EL, et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am J Gastroenterol. 2011;106(9):1678-1688.
Duan W, Li J. Distinguishing dispositional and cultivated forms of mindfulness: item-level factor analysis of five-facet mindfulness questionnaire and construction of short inventory of mindfulness capability. Front Psychol. 2016;7:1348.
Drossman DA, Chang L, Schneck S, et al. A focus group assessment of patient perspectives on irritable bowel syndrome and illness severity. Dig Dis Sci. 2009;54:1532-1541.
Craske MG, Wolitzky-Taylor KB, Labus J, et al. A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behav Res Ther. 2011;49:413-421.
Emerson L-M, Heapy C, Garcia-Soriano G. Which facets of mindfulness protect individuals from the negative experiences of obsessive intrusive thoughts? Mindfulness. 2018;9:1170-1180.
Nigol SH, Di Benedetto M. The relationship between mindfulness facets, depression, pain severity and pain interference. Psychol Health Med. 2019;1-11.
Wolitzky-Taylor K, Craske MG, Labus JS, et al. Visceral sensitivity as a mediator of outcome in the treatment of irritable bowel syndrome. Behav Res Ther. 2012;50:647-650.
Ljotsson B, Hesser H, Andersson E, et al. Mechanisms of change in an exposure-based treatment for irritable bowel syndrome. J Consult Clin Psychol. 2013;81(6):1113-1126.
Longarzo M, Quarantelli M, Aiello M, et al. The influence of interoceptive awareness on functional connectivity in patients with irritable bowel syndrome. Brain Imaging Behav. 2017;11:1117-1128.
Kano M, Muratsubaki T, Morishita J, et al. Influence of uncertain anticipation on brain responses to aversive rectal distension in patients with irritable bowel syndrome. Psychosom Med. 2017;79:988-999.
Creswell JD, Lindsay EK, Villalba DK, et al. Mindfulness training and physical health: mechanisms and outcomes. Psychosom Med. 2019;81:224-232.
Branstrom R, Kvillemo P, Brandberg Y, et al. Self-report mindfulness as a mediator of psychological well-being in a stress reduction intervention for cancer patients-a randomized study. Ann Behav Med. 2010;39:151-161.
Grossman P. On the porosity of subject and object in “mindfulness” scientific study: Challenges to “scientific” construction, operationalization and measurement of mindfulness. Curr Opin Psychol. 2018;28:102-107.
Goldberg SB, Wielgosz J, Dahl C, et al. Does the five facet mindfulness questionnaire measure what we think it does? Construct validity evidence from an active controlled randomized clinical trial. Psychol Assess. 2016;28:1009.