Provoking symptoms to relieve symptoms: a randomized controlled dismantling study of exposure therapy in irritable bowel syndrome

Brjánn Ljótsson; Hugo Hesser; Erik Andersson; Jeffrey M Lackner; Samir El Alaoui; Lisa Falk; Kristina Aspvall; Josefin Fransson; Klara Hammarlund; Anna Löfström; Sanna Nowinski; Perjohan Lindfors; Erik Hedman

doi:10.1016/j.brat.2014.01.007

Provoking symptoms to relieve symptoms: a randomized controlled dismantling study of exposure therapy in irritable bowel syndrome

Behav Res Ther. 2014 Apr:55:27-39. doi: 10.1016/j.brat.2014.01.007. Epub 2014 Feb 10.

Authors

Affiliations

¹ Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden. Electronic address: brjann.ljotsson@ki.se.
² Department of Behavioural Sciences and Learning, Linköping University, Linköpings universitet, 581 83 Linköping, Sweden. Electronic address: hugo.hesser@liu.se.
³ Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Karolinska Universitetssjukhuset Huddinge, M46, 141 86 Stockholm, Sweden. Electronic address: erik.m.andersson@ki.s.
⁴ Department of Medicine, University at Buffalo School of Medicine and Biomedical Science, ECMC, 462 Grider Street, Buffalo, NY 14215, USA. Electronic address: lackner@buffalo.edu.
⁵ Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Karolinska Universitetssjukhuset Huddinge, M46, 141 86 Stockholm, Sweden. Electronic address: samir.el.alaoui@ki.se.
⁶ Department of Gastroenterology, Sabbatsbergs hospital, Olivecronas väg 1, 113 61 Stockholm, Sweden. Electronic address: lisa.falk@aleris.se.
⁷ Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden. Electronic address: kristina.aspvall@sll.se.
⁸ Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden. Electronic address: josefin.fransson@sll.se.
⁹ Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden. Electronic address: klara.hammarlund@capio.se.
¹⁰ Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden. Electronic address: annalofstron@hotmail.com.
¹¹ Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden. Electronic address: sanna.nowinski@gmail.com.
¹² Department of Gastroenterology, Sabbatsbergs hospital, Olivecronas väg 1, 113 61 Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, M54, Karolinska Universitetssjukhuset Huddinge, 141 86 Stockholm, Sweden. Electronic address: perjohan.lindfors@ki.se.
¹³ Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden; Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Retzius väg 8 171 77 Stockholm, Sweden. Electronic address: kire.hedman@ki.se.

PMID: 24584055
DOI: 10.1016/j.brat.2014.01.007

Abstract

An internet-delivered cognitive behavioral treatment (ICBT) based on systematic exposure exercises has previously shown beneficial effects for patients with irritable bowel syndrome (IBS). Exposure exercises may be perceived as difficult for patients to perform because of the elicited short-term distress and clinicians may be reluctant to use these interventions. The aim of this study was to compare ICBT with the same protocol without systematic exposure (ICBT-WE) to assess if exposure had any incremental value. This randomized controlled dismantling study included 309 participants diagnosed with IBS. The treatment interventions lasted for 10 weeks and included online therapist contact. ICBT-WE comprised mindfulness, work with life values, acceptance, and encouraged reduced avoidance behaviors, while ICBT also included systematic exposure to IBS symptoms and related situations. Severity of IBS symptoms was measured with the Gastrointestinal Symptom Rating Scale - IBS version (GSRS-IBS). The between-group Cohen's d on GSRS-IBS was 0.47 (95% CI: 0.23-0.70) at post-treatment and 0.48 (95% CI: 0.20-0.76) at 6-month follow-up, favoring ICBT. We conclude that the systematic exposure included in the ICBT protocol has incremental effects over the other components in the protocol. This study provides evidence for the utility of exposure exercises in psychological treatments for IBS.

Keywords: Dismantling study; Exposure; Internet; Irritable bowel syndrome; Randomized controlled trial.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Cognitive Behavioral Therapy*
Combined Modality Therapy
Female
Humans
Implosive Therapy*
Internet
Irritable Bowel Syndrome / psychology*
Irritable Bowel Syndrome / therapy*
Male
Therapy, Computer-Assisted
Treatment Outcome
Young Adult