Irritable Bowel Syndrome

Improve the Symptoms of Central Pain Sensitization Syndromes with Mindfulness

psyjdc Leave a comment

Improve the Symptoms of Central Pain Sensitization Syndromes with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Central sensitization, in short, is a hypersensitivity to stimuli from things that are not typically painful. . . Stress can heighten pain even more, so various forms of stress management may be recommended to patients. This may include practices such as yoga, mindfulness, or meditation.” – Southern Pain

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. Central Pain Sensitization Syndromes such as fibromyalgia and Migraine headaches are particularly difficult to deal with as they have triggers that are not normally painful.

 

The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain. There is an accumulating volume of research findings that demonstrate that mindfulness practices, in general, are effective in treating pain.

 

A therapeutic technique that contains mindfulness training and Cognitive Behavioral Therapy (CBT) is Acceptance and Commitment Therapy (ACT). It focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

The research on the effectiveness of Acceptance and Commitment Therapy (ACT) for  Central Pain Sensitization Syndromes has been accumulating. So, it makes sense to pause and review what has been learned. In today’s Research News article “Effectiveness of Acceptance and Commitment Therapy in Central Pain Sensitization Syndromes: A Systematic Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8235706/ ) Galvez-Sánchez and colleagues review and summarize the published research evidence on the effectiveness of Acceptance and Commitment Therapy (ACT) for  Central Pain Sensitization Syndromes. They identified 21 published studies that included a total of 1090 adult participants.

 

They report that 8 studies found that Acceptance and Commitment Therapy (ACT) significantly improved the symptoms of fibromyalgia especially anxiety and depression and improved pain acceptance, self-efficacy, and psychological flexibility. Six studies found that ACT improved the patient’s acceptance of irritable bowel syndrome and the psychological distress produced by IBS. In 7 studies ACT was shown to significantly improve migraine pain and the affective distress resulting from the disease including anxiety and depression. These improvements were greater than those seen with pharmacological and psychoeducational interventions.

 

Mindfulness training has been shown to improve the symptoms of fibromyalgia, irritable bower syndrome, and migraine headache. The finding from the currently published research studies of the effectiveness of the mindfulness training of Acceptance and Commitment Therapy (ACT) suggests that it is similarly effective in treating the symptoms from Central Pain Sensitization Syndromes particularly the psychological distress produced by them and improve the patients’ health related quality of life.

 

So, improve the symptoms of Central Pain Sensitization Syndromes with mindfulness.

 

“The goal of meditation is not to eliminate pain or anxiety, but rather to get patients to focus on breathing and relaxation techniques. . . to reverse some of the negative central sensitization that can occur with chronic pain.” – Mel Pohl

 

MCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Galvez-Sánchez, C. M., Montoro, C. I., Moreno-Padilla, M., Reyes Del Paso, G. A., & de la Coba, P. (2021). Effectiveness of Acceptance and Commitment Therapy in Central Pain Sensitization Syndromes: A Systematic Review. Journal of clinical medicine, 10(12), 2706. https://doi.org/10.3390/jcm10122706

 

Abstract

Objectives: Acceptance and commitment therapy (ACT) is considered by the American Psychological Association as an evidence-based treatment for a variety of disorders, including chronic pain. The main objective of the present systematic review was to determine the effectiveness of ACT in patients with central pain sensitization syndromes (CPSS). Methods: This systematic review was conducted according to the guidelines of the Cochrane Collaboration and PRISMA statements. The protocol was registered in advance in the Prospective Register of Systematic Reviews (PROSPERO) international database. The selected articles were evaluated using the Cochrane risk of bias (ROB) assessment tool. The PubMed, Scopus, and Web of Science databases were searched. Results: The literature search identified 21 studies (including investigations of fibromyalgia syndrome, irritable bowel syndrome, and migraine) eligible for the systematic review. There were no studies regarding the effectiveness of ACT for chronic tension-type headache (CTTH), interstitial cystitis (IC), or temporomandibular disorder (TMD). The evaluation of ROB showed that 12 of the selected studies were of low quality, 5 were of moderate quality, and 4 were high quality. ACT reduces some clinical symptoms, such as anxiety, depression, and pain. This positive effect of ACT might be mediated by pain acceptance, psychological flexibility, optimism, self-efficacy, or adherence to values. ACT showed better results in comparison to non-intervention (e.g., “waiting list”) conditions, as well as pharmacological and psychoeducational interventions. It is not entirely clear whether extended ACT treatments are more advantageous than briefer interventions. Conclusions: There are few studies about the effectiveness of ACT on CPSS. However, ACT seems to reduce subjective CPSS symptoms and improve the health-related quality of life of these patients. The absence of studies on the effectiveness of ACT in CTTH, IC, and TMD, indicate the pressing need for further ACT studies in these CPSS.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8235706/

Improve Irritable Bowel Syndrome (IBS) with Mindfulness

psyjdc Leave a comment

Improve Irritable Bowel Syndrome (IBS) with Mindfulness

 

By John M. de Castro, Ph.D.

 

“IBS causes a huge public health and economic burden in the U.S. The standard of care currently has been diet changes along with medications. A mind-based . . . has the potential to minimize both the public health and economic burden of this debilitating disease,” – Saurabh Sethi

 

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal (GI) disorder with worldwide prevalence rates ranging from 9–23%. In the U.S. the rates generally in the area of 10–15% affecting between 25 and 45 million people. IBS is not life threatening but it is very uncomfortable producing changes in bowel movement patterns, bloating and excess gas, and pain in the lower belly. It is also a major source of absenteeism both at work and in school. IBS is also associated with a marked reduction in the individual’s health quality of life, with disruption of the physical, psychological and social routines of the individuals. At present, there are no known cures for IBS and treatments involve symptomatic relief, often with fairly radical dietary changes.

 

The cause(s) of IBS are not known. But emotion dysregulation is suspected to be involved. It is clear that psychological stress exacerbates the illnesses and anxiety amplifies the symptoms. This suggests that mindfulness or the lack thereof may be involved as mindfulness is known to be helpful in reducing the psychological and physical responses to stress and mindfulness is known to improve emotion regulation. In addition, It has been shown that meditation and yoga can help relieve IBS symptoms.  So, it would make sense to further investigate the effectiveness of mindfulness training and emotion regulation for Irritable Bowel Syndrome (IBS).

 

In today’s Research News article “Comparing the Efficacy of Mindfulness-Based Stress Reduction Therapy with Emotion Regulation Treatment on Quality of Life and Symptoms of Irritable Bowel Syndrome.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178327/ ), Ghandi and colleagues recruited patients with Irritable Bowel Syndrome (IBS) and randomly assigned them to receive either an 8-week, once a week for 90 minutes program of Mindfulness Based Stress Reduction (MBSR), Emotion Regulation group training, or a wait-list. The MBSR treatment consisted of body scan, meditation, and yoga practices and group discussion with homework. Emotion Regulation training consisted in training on “emotional awareness” and “acceptance”. The patients were measured before and after training and 2 months later for IBS severity and quality of life with IBS.

 

They found that both Mindfulness Based Stress Reduction (MBSR) and Emotion Regulation training produced significant improvements in IBS severity and the quality of life with IBS and that this effectiveness was maintained 2 months later. There were no significant differences in the effectiveness of MBSR and emotion regulation training. Hence, both MBSR and emotion regulation training produce large and lasting improvements in the symptoms of IBS and the quality of life of the patients.

 

Since MBSR training is known to improve emotion regulation, the fact that MBSR and emotion regulation training produced equivalent benefits suggests that MBSR may be effective for IBS because of its ability to improve emotion regulation, particularly improving the emotional responses to stress. It will require further research to examine this possibility.

 

So, improve Irritable Bowel Syndrome (IBS) with mindfulness.

 

“For a person who has IBS, mindfulness-based therapies are thought to help to reduce anxiety related to digestive symptoms. Due to our body’s natural stress response, such anxiety can actually exacerbate the very digestive symptoms that a person with IBS is most concerned about. The theory behind mindfulness-based therapies for IBS is that when you experience less reactivity to physical sensations related to your digestive system, you will experience less unwanted symptoms.” – Barbara Bolen

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

Abstract

 

Ghandi, F., Sadeghi, A., Bakhtyari, M., Imani, S., Abdi, S., & Banihashem, S. S. (2018). Comparing the Efficacy of Mindfulness-Based Stress Reduction Therapy with Emotion Regulation Treatment on Quality of Life and Symptoms of Irritable Bowel Syndrome. Iranian journal of psychiatry, 13(3), 175-183.

 

Objective: Irritable bowel syndrome is a common gastrointestinal disorder. The perception of stress and GI-specific anxiety play a key role in irritable bowel syndrome (IBS). The present study aims at comparing the efficacy of mindfulness-based stress reduction therapy with emotion regulation on the quality of life and severity in patients IBS.

Method : This randomized clinical trial was conducted in 3 phases: pretest, posttest, and follow-up. Follow-up was performed 2 months after the last intervention. The study population consisted of 24 IBS patients who were randomly selected according to Rome-IV Criteria and were then divided into 3 eight-member groups: (1) mindfulness-based stress reduction, (2) emotion regulation, and (3) control group. IBS-QOL34 and IBS-SSS were administered as assessment tools to all the 3 groups. The experimental groups were subjected to MBSR and ER psychotherapy, while the control group received no psychological intervention. After the 2-month follow-up, the 3 groups were evaluated again.

Results: The results revealed that MBSR improved the quality of life of IBS patients and dicreased severity of their condition. The findings of between and within subjects design revealed that the difference between MBSR and control groups was significant in IBS at follow-up (p = 0.01).

Conclusion: MBSR could be considered as a new, effective, and stable method in psychotherapy, in irritable bowel syndrome.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178327/

 

Improve Gastrointestinal Disorders with Mindfulness

psyjdc Leave a comment

By John M. de Castro, Ph.D.

 

 “The functional gastrointestinal disorders (FGIDs) are a group of more than 20 chronic and hard to treat medical conditions of the gastrointestinal tract that constitute a large proportion of the presenting problems seen in clinical gastroenterology.” – Jennifer Wolkin

 

Functional Gastrointestinal Disorders are the most common disorders of the gastrointestinal tract in the general population. The most common disorder in this group is Irritable Bowel Syndrome (IBS). Functional Gastrointestinal Disorders can involve the esophagus, stomach and/or intestines and are disorders of function (how these structures work), not structural or biochemical abnormalities. Estimates vary, but about 25% of people in the United States have one of these disorders. The conditions account for about 40% of GI problems seen by doctors and therapists.

 

The cause(s) of Functional Gastrointestinal Disorders are not known. But, emotion dysregulation is suspected to be involved. It is clear that psychological stress exacerbates the illnesses and anxiety amplifies the symptoms. This suggests that mindfulness or the lack thereof may be involved as mindfulness is known to be helpful in reducing the psychological and physical responses to stress and mindfulness is known to improve emotion regulation. In addition, contemplative practice has been shown to improve the symptoms of Irritable Bowel Syndrome. So, it would make sense to further investigate the relationship of mindfulness to emotion regulation, stress, and Functional Gastrointestinal Disorders.

 

In today’s Research News article “Difficulties in Emotion Regulation and Mindfulness in Psychological and Somatic Symptoms of Functional Gastrointestinal Disorders”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1178359818854609/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733315/

Mazaheri investigated the relationships between gastrointestinal symptoms, emotions, emotion regulation, and mindfulness in patients diagnosed with Functional Gastrointestinal Disorders. They found that the higher the levels of either depression, anxiety, or stress the greater the GI symptoms and that the lower the levels of emotion regulation the greater the symptoms. Significantly, they found that high levels of mindfulness were associated with lower levels of GI symptoms, depression, anxiety, and stress and with higher levels of emotion regulation.

 

The results support the contention that an inability to regulate emotions and stress are an important factor in Functional Gastrointestinal Disorders. In addition, they suggest that mindfulness is not only associated with lower levels of emotion and psychological stress but also with a greater ability to regulate these emotions. It should be noted that the results of this study are strictly observational and correlational and as such no conclusion about causation can be reached. But, the results give strong support to the need to perform a randomized controlled trial where mindfulness is trained and its effects on emotion regulation and Functional Gastrointestinal Disorders are measured.

 

With the caveat that causation hasn’t been established, it can be speculated that mindfulness training may be a safe and effective method for both the prevention and treatment of Functional Gastrointestinal Disorders. Mindfulness’ ability to improve emotion regulation may help the individual to be able to better experience emotions but respond to them in an effective and adaptive manner, lessening their impact. It remains for future research to investigate this exciting possibility.

 

So, improve gastrointestinal disorders with mindfulness.

 

“patients with heightened GI-specific anxiety may benefit from participation in a mindfulness programme as an adjunct to their usual clinical care.” – D. J. Kearney

 

CMCS – Center for Mindfulness and Contemplative Studies