[Show abstract][Hide abstract] ABSTRACT: Completely scripted treatment courses for verbatim interventions are uncommon in the field of clinical hypnosis. This approach was adopted for by a North Carolina research team for treating gastrointestinal disorders 20 years ago and has been used in hypnosis treatment of irritable bowel syndrome and ulcerative colitis, as well as in guided imagery treatment for functional abdominal pain. Treatment with these scripted protocols is delivered in a fixed series of sessions over a 2- or 3-month period. They have been found efficacious for improving bowel symptoms in several clinical trials, even in patients who have been entirely unresponsive to medical treatment. Response rates in clinical trials have ranged from 53% to 94%, and the therapeutic benefits have been shown to be well maintained at 6-, 10-, or 12-month follow-ups in different studies. This article describes the development and research on these protocols and summarizes the advantages and limitations of this fully scripted treatment approach.
The American journal of clinical hypnosis 07/2015; 58(1). DOI:10.1080/00029157.2015.1012705 · 0.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Theory suggests that heightening state mindfulness in meditation practice over time increases trait mindfulness, which benefits psychological health. We prospectively examined individual trajectories of state mindfulness in meditation during a mindfulness-based intervention in relation to changes in trait mindfulness and psychological distress. Each week during the eight-week intervention, participants reported their state mindfulness in meditation after a brief mindfulness meditation. Participants also completed pre- and post-intervention measures of trait mindfulness and psychological symptoms. Tests of combined latent growth and path models suggested that individuals varied significantly in their rates of change in state mindfulness in meditation during the intervention, and that these individual trajectories predicted pre-post intervention changes in trait mindfulness and distress. These findings support that increasing state mindfulness over repeated meditation sessions may contribute to a more mindful and less distressed disposition. However, individuals' trajectories of change may vary and warrant further investigation.
Personality and Individual Differences 07/2015; DOI:10.1016/j.paid.2014.12.044 · 1.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Omega-3 and omega-6 fatty acids are precursors of bioactive lipid mediators posited to modulate both physical pain and psychological distress. In a randomized trial of 67 subjects with severe headaches, we recently demonstrated that targeted dietary manipulation-increasing omega-3 fatty acids with concurrent reduction in omega-6 linoleic acid (the H3-L6 intervention)-produced major reductions in headache compared with an omega-6 lowering (L6) intervention. Because chronic pain is often accompanied by psychological distress and impaired health-related quality of life (HRQOL), we used data from this trial to examine whether the H3-L6 intervention favorably impacted these domains. Additionally, we examined the effect of the interventions on the number of cases with substantial physical or mental impairments as defined by cutoff values in the Brief Symptom Inventory (BSI-18), Medical Outcomes Study Short Forms 12 (SF-12), Headache Impact Test (HIT-6), and the number of headache days per month. In the intention-to-treat analysis, participants in the H3-L6 group experienced statistically significant reductions in psychological distress (BSI-18 mean difference: -6.56; 95% confidence interval [CI]: -11.43 to -1.69) and improvements in SF-12 mental (mean difference: 6.01; 95% CI: 0.57 to 11.45) and physical (mean difference: 6.65; 95% CI: 2.14 to 11.16) health summary scores. At 12 weeks, the proportion of subjects experiencing substantial impairment according to cutoff values in the BSI-18, SF-12 physical, HIT-6, and headache days per month was significantly lower in the H3-L6 group. Dietary manipulation of n-3 and n-6 fatty acids, previously shown to produce major improvements in headache, was found to also reduce psychological distress and improve HRQOL and function.
[Show abstract][Hide abstract] ABSTRACT: Functional heartburn (FH) is a benign but burdensome condition characterized by painful, burning
epigastric sensations in the absence of acid reflux or symptom-reflux correlation. Esophageal hypersensitivity and its psychological counterpart, esophageal hypervigilance (EHv) drive symptom experience. Hypnotherapy (HYP) is an established and preferred intervention for refractory symptoms in functional gastrointestinal disorders (FGIDs) and could be applied to FH. The objective of this study was to determine the feasibility, acceptability, and clinical utility of 7 weekly sessions of esophageal-directed HYP (EHYP) on heartburn symptoms, quality of life, and EHv. Similar to other work in FGIDs and regardless of hypnotizability, there were consistent and significant changes in heartburn symptoms, visceral anxiety, and quality of life and a trend for improvement in catastrophizing. We would recommend EHYP in FH patients who are either non-responsive to medications or who would prefer a lifestyle intervention.
Diseases of the Esophagus 03/2015; 148(4). DOI:10.1111/dote.12353 · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES:The objectives of this study were to determine whether the symptoms of diarrhea (defined as loose or watery stools), constipation (hard or lumpy stools), abdominal pain, and bloating occur in episodes rather than sporadically in patients with irritable bowel syndrome (IBS); to identify rules for defining the onset and termination of symptom episodes; and to assess the overlap of these episodes.METHODS:IBS patients kept a symptom log in which they rated the consistency of each bowel movement (BM) on the Bristol Stool Scale for 3 months. Each night they transferred these data to an internet website and also rated abdominal pain and bloating for that day. Data were analyzed for 124 patients who completed at least 21 consecutive diary days (mean of 73 days) without taking laxative, antidiarrheal, or IBS-specific medications. For each symptom in each patient, we computed the correlation between consecutive observations (autocorrelations) in the diary to determine whether the symptom tended to occur in clusters of several instances, as would happen in episodes vs. happening randomly. Next, we compared different patterns by which diarrhea and nondiarrhea stools alternate to identify episode definitions that captured at least 75% of loose/watery stools. A similar pattern analysis was performed for constipation. Pain and bloating episodes were defined as days with an intensity rating >3 on a 0-10 scale. These patterns were converted into rules for defining the onset and termination of symptom episodes. Last, we used these episode definitions to examine the overlap of pain with episodes of diarrhea, constipation, and pain.RESULTS:Significant (P<0.05) autocorrelations were found in the Bristol Stool Scale ratings of 69.4% of patients and in the daily abdominal pain and bloating ratings of 52.4% and 68.5% of patients, respectively. Defining a diarrhea episode as two or more loose/watery stools never separated by >1 nonloose/watery stool or by a day without a BM captured 76% of all loose/water stools. Defining constipation episodes as two or more hard/lumpy stools never separated by >1 nonhard/lumpy stool captured 80% of hard/lumpy stools. Sequences of 3 or more days without a BM were also defined as constipation episodes because they were strongly associated with hard stools. Average episode durations were 2.1 days for diarrhea, 4.5 days for constipation, 3.1 days for pain, and 3.5 days for bloating. Overlap analysis showed that only 41.6% of constipation episode days and 67.0% of diarrhea episode days were pain episode days. Bloating and pain coexisted on 59.1% of days on which either type occurred.CONCLUSIONS:Loose/watery stools and hard/lumpy stools occur in well-defined episodes. Pain and bloating also occur in episodes, but contrary to the Rome criteria more than half of the pain episodes occur outside episodes of abnormal stool consistency.Am J Gastroenterol advance online publication, 1 July 2014; doi:10.1038/ajg.2014.181.
The American Journal of Gastroenterology 07/2014; 109(9). DOI:10.1038/ajg.2014.181 · 9.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
In a recent double-blinded clinical trial, the probiotic combination of Lactobacillus acidophilus NCFM (L-NCFM) and B-LBi07 reduced bloating symptoms in patients with functional bowel disorders; an effect more evident in those who reported abdominal pain. In mice, L-NCFM but not B-LBi07 induced colonic mu-opioid receptor (MOR) and cannabinoid receptor 2 (CB2) expression, and reduced visceral sensitivity.AimsTo determine if L-NCFM was the active component in the clinical trial and to investigate the mechanism of action in humans with mild to moderate abdominal pain.Methods
Caucasian women (n = 20) 18–70 years with mild to moderate abdominal pain were enrolled in a double-blind, two-armed, single-centre study. Patients were given either L-NCFM alone or in combination with B-LBi07 for 21 days at a total dose of 2×1010 CFU b.d. Colonic biopsies were collected during unsedated, unprepped flexible sigmoidoscopy before and at the end of probiotic consumption. mRNA and immunostaining were then performed on these biopsies. Patients kept symptom diaries for the 7 days prior to starting probiotic therapy and for the last 7 days of therapy.ResultsL-NCFM alone, but not with B-LBi07, induced colonic MOR mRNA and protein expression, as well as downstream signalling, as measured by enterocyte STAT3-phosphorylation. In contrast, CB2 expression was decreased. Both treatment groups trended towards improvement in symptoms, but the study was insufficiently powered to draw meaningful conclusions.Conclusions
Lactobacillus acidophilus NCFM modulates mu-opioid receptor expression and activity, while the combination of L-NCFM and B-LBi07 does not. This study provides a possible mechanism for action by which probiotics modulates pain sensation in humans (Clinical Trial Number: NCT01064661).