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Mindfulness improved irritable bowel for a year

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Mindfulness therapy is worth the work

Mindfulness, an ancient Buddhist meditative practice, seeks to maintain awareness of the present moment by reducing attachment to thoughts or feelings about the past or future (for example, worry). Associated with reduced suffering in chronic pain and depression ( JAMA 2008;300:1350-2), mindfulness may potentially operate through top-down modulation of thalamocortical alpha-rhythms, facilitating more efficient filtering of sensory information in the brain ( Front. Hum. Neurosci. 2013;7:12). In IBS, mindfulness may "uncouple" the sensory experiences of abdominal pain (for example, visceral hypersensitivity) from its associated negative evaluative and emotional reactions (for example, catastrophizing, fear, avoidance). Mindfulness practice has been successfully incorporated into cognitive therapy for a host of psychological conditions ( Br. J. Psych. 2012;200:359-60).

Mindfulness-based stress reduction (MBSR), a stand-alone therapy (not just a skill) developed in 1979 by Dr. Jon Kabat-Zinn ( Gen. Hosp. Psych. 1982;4:33-47), has advantages over other therapies – it is a standardized, eight-session program that can be administered in groups to a heterogeneous patient population by a wide range of medical providers. MBSR features the skill of mindfulness but also incorporates yoga, acceptance, and stress management. In addition to intensive coursework and a weekend retreat, patients engage in home practice 45 minutes a day. In this study, MBSR may have been less feasible or acceptable to women of lower socioeconomic status or in certain ethnic/racial minority groups.

The long-term success of MBSR on IBS symptoms suggested that the acquisition of mindfulness skills and their incorporation into everyday life may not always alleviate symptoms immediately – in other words, we should not abandon its practice too soon. As mindfulness improved, so did symptoms. Despite limitations, these results suggest we could focus research on increasing adherence to the lifelong practice of mindfulness, include mindfulness as a skill in other IBS therapies, and increase its acceptability to a broader population of patients.

Dr. Laurie Keefer, AGAF, is with the departments of psychiatry and behavioral sciences at Northwestern University, Chicago, and director of the center for psychosocial research in GI, and director of clinical research, division of gastroenterology and hepatology. She has no financial disclosures.


 

AT DDW 2014

CHICAGO – An 8-week course in mindfulness-based stress reduction reduced the severity of irritable bowel syndrome symptoms 6 and 12 months later, compared with 8 weeks of participation in a control group, follow-up on 68 women found.

Scores for overall irritable bowel syndrome (IBS) severity on the IBS Severity Scale (IBS-SS) were similar between groups at baseline (284 in the intervention group and 288 in the control group) but had improved significantly more in the mindfulness training group at 6 months (scores decreased 151 and 108 points, respectively) and at 12 months (scores decreased 115 vs. 26 points, respectively) compared with baseline.

The investigators originally reported significant benefits from the mindfulness course, compared with the control group immediately after the group sessions and at 3 months of follow-up in the prospective, randomized, controlled trial involving 75 patients (Am. J. Gastroenterol. 2011;106:1678-88). The current follow-up to 6 and 12 months shows lasting symptomatic improvements from mindfulness training, Olafur S. Palsson, Psy.D., and his associates reported at the annual Digestive Disease Week.

Among the 68 patients who completed 1 year of follow-up in the current analysis, the 33 who got mindfulness training also showed significantly greater improvements in secondary outcomes, compared with the 35 patients in the support group, said Dr. Palsson, a professor of medicine at the University of North Carolina, Chapel Hill.

Scores on the IBS Quality of Life Instrument were similar between groups at baseline (65 in the mindfulness group and 67 in the control group) but improved significantly more in the mindfulness group by 12 months (by 15 vs. 3, respectively).

Scores for gut-focused anxiety on the Visceral Sensitivity Index – which were not significantly different between groups at baseline or immediately after the group sessions – improved significantly more in the mindfulness group than in the control group by 3 months and the gains remained significantly greater at 6 months (by 12 vs. 2, respectively) and at 12 months (by 9 vs. –1, respectively).

"To our knowledge, these follow-up findings demonstrate some of the longest-duration therapeutic effects of mindfulness training ever reported in a clinical trial," he said.

Both interventions consisted of eight weekly sessions and a half-day retreat. The control group attended a conventional support group. The mindfulness course was based on the Mindfulness-Based Stress Reduction Program of Jon Kabat-Zinn, Ph.D., and Saki F. Santorelli, Ed.D., both of the University of Massachusetts, Worcester.

The longitudinal study controlled for the effects of race and income (less than or at least $40,000/year). The results suggest that the impact of mindfulness training on bowel symptom severity and gut-focused anxiety are well maintained and that improvements in health-related quality of life develop gradually over many months after the training, Dr. Palsson said. General psychological well-being did not change significantly based on the training, he added.

Scores for mindfulness on the Five-Facet Mindfulness Questionnaire were higher at every follow-up in the mindfulness group, compared with the control group, but the differences were not statistically significant. Mindfulness scores peaked in the mindfulness group at around 6 months and were attenuated at 12 months.

Patients ranged in age from 19 to 71 years, with a mean age of 43 years. Most patients were white, and women who were minorities or had lower incomes were more likely to drop out of the trial over time.

The National Center for Complementary and Alternative Medicine funded the study. Dr. Palsson and his coinvestigators reported financial associations with Takeda Pharmaceuticals, Ono Pharmaceuticals, Ironwood Pharmaceuticals, Entera Health, and/or the Rome Foundation.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

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