Antonina Mikocka-Walus’s research while affiliated with Deakin University and other places

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Publications (39)


PRISMA flow diagram of included studies.
Forest plot of overall prevalence of disordered eating in gastrointestinal populations.
Forest plot of prevalence of disordered eating in non‐gastrointestinal populations.
Systematic Review and Meta‐Analysis: Examining the Psychometric Evaluations of Disordered Eating Scales in Adults Living With Gastrointestinal Conditions
  • Literature Review
  • Full-text available

February 2025

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2 Reads

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Antonina Mikocka‐Walus

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Molly M. Warner

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[...]

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Simon R. Knowles

Background The scales used to assess disordered eating are often not validated in adults living with gastrointestinal conditions (i.e., gastrointestinal populations). This systematic review and meta‐analysis aimed to examine the psychometric evaluations (i.e., assessments of reliability and validity) of disordered eating scales in adult gastrointestinal populations and quantify the prevalence of disordered eating in both gastrointestinal and non‐gastrointestinal populations. Methods We conducted a search of observational studies up to May 2024 that measured disordered eating using a scale in adults with a gastrointestinal condition. Psychometric evaluations of the scales were narratively reviewed. Prevalence rates of disordered eating were pooled using a random‐effects meta‐analysis, and risk of bias was assessed using an adapted Newcastle Ottawa Scale. Key Results Among 29 studies (overall medium risk of bias), 23 reported prevalences of disordered eating in gastrointestinal populations, and eight of these studies also reported prevalences in non‐gastrointestinal populations. Only one out of 10 scales was developed and psychometrically evaluated in gastrointestinal populations, and 11 studies reported internal consistency (range α = 0.63 to α = 0.95). The prevalence of disordered eating was 33.2% (p < 0.001; 95% confidence interval: 0.25–0.41; I² = 97.34%) in gastrointestinal populations and 21.0% (p < 0.001; 95% confidence interval: 0.09–0.32; I² = 97.41%) in non‐gastrointestinal populations. Subgroup analyses showed consistently high heterogeneity. Conclusions and Inferences The utilisation of current disordered eating scales for adults living with gastrointestinal conditions should be undertaken with caution, and there is a need for disordered eating scales to be developed and validated in this population.

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Nutrition Interventions in the Treatment of Endometriosis: A Scoping Review

February 2025

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6 Reads

Journal of Human Nutrition and Dietetics

Background: Pain, poor quality of life (QOL) and gastrointestinal (GI) symptoms are commonly experienced by individuals with endometriosis. Although diet and nutrition supplements are frequently used to manage endometriosis-related symptoms, there is limited understanding of the breadth and quality of research in this field. Our aim was to undertake a scoping review of diet and nutrition supplement intervention studies in people with endometriosis, diagnosed by ultrasound or surgery. Methods: MEDLINE Complete, Embase, CINAHL and PsycINFO databases were searched for articles published in English from database inception to November 2024. Quality was assessed by two reviewers independently using the Joanna Briggs Institute appraisal tools. In total, 5130 publications were screened and 13 were included. Results: Among these, five evaluated the effect of diet intervention, one evaluated the effect of a combined diet-supplement intervention and seven evaluated the effect of a nutrition supplement in endometriosis. Overall, there were seven randomised controlled trials (RCTs) (n = 1 diet intervention, n = 6 nutrition supplement), two nonrandomised controlled studies (n = 1 diet intervention, n = 1 combined diet-supplement) and four uncontrolled studies (n = 3 diet intervention, n = 1 nutrition supplement). On the basis of evidence from the RCTs, the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet improved QOL and GI symptoms, whereas garlic supplements and combination trace element supplements may be beneficial for improving reduced pain symptoms related to endometriosis. The quality of most included studies was poor. Adherence to the interventions was only measured in five studies and only one diet study measured baseline diet. Conclusions: High-quality RCTs of diet and nutrition supplement interventions are needed to progress the understanding of whether they should be integrated into the clinical management of endometriosis.


An online mindfulness-based intervention for adults with Inflammatory Bowel Disease & psychological distress: A feasibility randomized controlled trial of the Mind4IBD program

November 2024

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14 Reads

Journal of Psychosomatic Research

Objective The bidirectional relationship between disease activity and mental health in inflammatory bowel disease (IBD) has prompted investigations into the efficacy of psychotherapies, such as mindfulness-based interventions (MBI), for improving biopsychosocial outcomes. Therefore, the aim is to examine the feasibility, acceptability, and preliminary efficacy of an online-delivered, self-directed MBI, adapted to individuals with IBD and psychological distress, in comparison to wait-list control (WLC). Methods 50 adults with IBD were randomized to WLC (N = 25) or intervention (N = 25) groups. The intervention (MIND4IBD program) consisted of six, weekly, 15-min videos (with guided meditations). Feasibility was examined through recruitment and retention rates, while acceptability was examined through intervention satisfaction ratings and qualitative feedback. Preliminary efficacy was examined using linear mixed models for group differences in outcomes between baseline and post-intervention. Results Primary Outcomes. The retention rate for the WLC group was 92 %, while the retention rate for the intervention group was 48 %. However, 16 % of participants allocated to the intervention group never began the intervention, therefore this resulted in a retention rate of 71 % of participants who began the intervention. Acceptability was high with an average intervention satisfaction rating of 83/100. Secondary Outcomes. When compared with the WLC, the MIND4IBD program improved total mindfulness levels (b = 0.29, 95 %CI [0.11,0.47], p = 0.004) with a large effect size (β = 0.54, b = 0.19, 95 %CI [0.04,0.34], p = 0.014). Themes based on participants' intervention feedback included: 1) beginning of journey with mindfulness, 2) the beneficial impact of mindfulness, 3) why adapting the intervention to IBD is important, 4) views on program delivery, and 5) mixed reactions to AI generated presenters. Conclusion MIND4IBD is feasible and acceptable for individuals with IBD and psychological distress. Participants' total mindfulness levels increased significantly in the intervention group compared to WLC. Most participants provided positive intervention feedback. These findings warrant a full-scale RCT to determine MIND4IBD's efficacy for IBD.


The need for biopsychosocial menopause care: a narrative review

October 2024

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38 Reads

Menopause (New York, N.Y.)

Importance and Objective Menopause is a reproductive transition affecting half the world's population. Stigma and limited availability of evidence-based treatments that support biopsychosocial well-being mean that this life stage is often associated with challenging symptoms and reduced quality of life (QoL). The aim of this review was to examine the extent literature on psychological and mind-body interventions to manage perimenopausal and postmenopausal symptoms, and apply an interdisciplinary clinical, research, and cultural knowledge framework to guide recommendations for improving QoL and healthy aging in this population. We also aimed to understand the ideal delivery mode for such interventions. Methods Using Scopus, Medline, and PubMed, a review of systematic reviews, guidelines, and randomized controlled trials was undertaken to examine the use of psychological and mind-body interventions to improve menopause-related QoL and symptoms, including hot flushes, depression, anxiety, fatigue, pain, and sleep; conclusions were based on an analysis of this available evidence and linked to clinical and cultural considerations. Discussion and Conclusion Empirical support exists for a number of psychological and mind-body approaches to support QoL and symptoms during the menopause transition. The literature also identifies the need for menopause care that is culturally responsive. An online multimodal model of menopause care is thus recommended, incorporating evidence-based treatments (eg, cognitive behavioral therapy, yoga, hypnosis) and treatment techniques (eg, mindfulness, and education including nutrition support), as well as First Nations wisdom. We also recommend financial well-being approaches to support people undergoing menopause. Integrated, multimodal approaches should be available online to remove time, location, and healthcare access barriers, and be designed with diverse consumers to ensure equity for those underserved due to region, LGBTIQ+ assigned female at birth status, and for multicultural and First Nations people.


Major themes from focus group interviews demonstrating relationship between symptoms bothersomeness, interference, and need to seek care.
Symptom bothersomeness and life interference support Rome clinical criteria as clinically relevant indicators of DGBI

October 2024

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69 Reads

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1 Citation

Background Irritable bowel syndrome (IBS) and functional dyspepsia (FD) are common disorders of gut‐brain interaction (DGBI). The Rome IV criteria are the gold standard for research when diagnosing DGBI. However, bothersomeness, or the degree to which symptoms are distressing or disruptive to a person's daily life, is a potential treatment‐seeking motivator that is not assessed by the Rome criteria. The Rome Foundation developed and published diagnostic criteria for clinical practice that include bothersomeness. We aimed to evaluate these constructs via patient focus groups to determine what prompts healthcare‐seeking as a means to assess its value in the Rome clinical criteria. Methods Adults meeting Rome IV criteria for IBS, FD, or both participated in focus groups in Australia and the United States. Semi‐structured interview transcripts were analyzed using Template Thematic Analysis, with three a priori and other a posteriori themes refined iteratively through team discussion and consensus. Key Results Participants confirmed the frequency and duration of symptoms was not sufficient to reflect illness experience. Four major themes emerged: (1) Bothersomeness should be included in assessments of IBS and FD; (2) Patients find many DGBI symptoms bothersome; (3) Bothersomeness traverses multiple domains of quality of life; (4) Patients may hesitate to seek medical advice due to past negative experiences. Conclusions and Inferences These findings support the value of the Rome Clinical Criteria. They emphasize the importance of expanding assessments of patients with DGBI to include how bothersome they perceive symptoms to be, how much symptoms interfere with their daily life, and what may moderate their decisions to seek treatment.



Acceptance & Commitment Therapy for Adults Living With Inflammatory Bowel Disease & Distress: A Randomized Controlled Trial

August 2024

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21 Reads

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3 Citations

The American Journal of Gastroenterology

Background The bidirectional relationship between disease activity and mental health in inflammatory bowel disease (IBD) has prompted investigations into the efficacy of psychotherapeutic interventions such as Acceptance & Commitment Therapy (ACT) on biopsychosocial outcomes. We aimed t o examine the efficacy of an ACT Program (intervention) in comparison to a CBT-Informed Psychoeducation Program (active control) for individuals with IBD and co-existent psychological distress. Both programs were delivered online via a hybrid format (i.e. therapist led and participant-led sessions) . Methods 120 adults with IBD were randomized to either the intervention (N=61) or active control groups (N=59). Efficacy was determined using Linear Mixed Models for group differences, in rate of changes in study outcomes, between baseline, post intervention, and 3-month follow-up. Results The primary outcome HRQoL significantly improved in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to post intervention (t [190] = 2.15, p = 0.033) in favor of the intervention group with a medium effect size (β = 0.41, MD = 0.07, 95%CI [0.01, 0.12], p = 0.014). Similarly, the secondary outcome Crohn’s disease activity significantly reduced in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to 3-month follow-up (t [90] = -2.40, p = 0.018) in favor of the intervention group with a large effect size (β = -0.77, MD = -9.43, 95%CI [-13.72, -5.13], p < 0.001) p = 0.014). Further, when observing the rate of change in outcomes over time for the groups separately, anxiety symptoms and pain significantly improved in the intervention group only, and conversely, ulcerative colitis activity and stress symptoms significantly improved in the active control group only. All other outcomes (N=14) significantly improved over time in both groups including IBD activity, gastrointestinal unhelpful thinking patterns, visceral anxiety, fatigue interference, fatigue severity, fatigue frequency, psychological inflexibility, self-efficacy, resilience, current health status, depression symptoms, IBD control, and pain catastrophizing, however these changes were not significantly different between the groups. Conclusion Both programs were of benefit to people with IBD and distress. However, ACT offers a significant added benefit for HRQoL and self-reported Crohn’s disease activity and may be a useful adjuvant therapy in integrated IBD care.


Randomized e-Hypnotherapy for Chronic Pelvic Pain Study (REST): Comparing e-Hypnotherapy to Relaxation and Waitlist to Improve Pain, Cost Effectiveness and Biopsychosocial Outcomes (Preprint)

July 2024

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40 Reads

BACKGROUND Background: Chronic pelvic pain (CPP), defined as persistent pain in the structures of the pelvis, is a condition that significantly impacts the health-related quality of life (HRQoL) of up to one-third of people worldwide, with substantial associated costs to both the individual and healthcare system/s. OBJECTIVE The present trial aims to establish the efficacy of e-hypnotherapy over relaxation and waitlist controls on pain, HRQoL, and biopsychosocial outcomes, and to evaluate cost-effectiveness. METHODS Methods: A parallel-group, investigator-blinded, randomized control trial will be conducted. Eligible participants will be randomly allocated to either a 7-week online personalized e-hypnotherapy program (n = 44), a 7-week online personalized relaxation control (n = 44), or waitlist control (n = 44). The primary outcome will be self-reported pain level and secondary outcomes will include psychological distress, QoL, pain catastrophizing, self-efficacy, central sensitization, somatic symptoms, fatigue, and sleep. Cost-effectiveness will also be examined. Longitudinal qualitative interviews will be conducted with participants in the e-hypnotherapy (n = 20) and relaxation (n = 20) groups, to understand barriers/facilitators for ongoing use. RESULTS Data analyses will include mixed-effects regression models, cost-utility analysis from a health system and societal perspective, and thematic analysis. The e-hypnotherapy program will also be reviewed by a group of eligible healthcare providers who will consider potential barriers/facilitators for ‘real world’ implementation. CONCLUSIONS n/a CLINICALTRIAL This protocol has received ethics approval in Australia from Deakin University Research Ethics Committee (DUREC Ref.2024-080). The trial was prospectively registered in the Australian New Zealand Clinical Trials Registry on 13th April 2023 (ID: ACTRN12623000368639).


Fixed Effect Omnibus for Group, Time, and Group*Time (Excluding Covariates)
Signicant Post Hoc Comparisons Within and Between EndoOnly and Endo+IBS for T1 and T3
Exploring Biopsychosocial Health Outcomes in Endometriosis and Endometriosis with Co-occurring Irritable Bowel Syndrome – A Prospective Cohort Study

May 2024

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25 Reads

Endometriosis and irritable bowel syndrome (IBS) share common pathophysiological and risk factors, often leading to misdiagnosis, diagnostic delays, and treatment implications. Further, both conditions are associated with biopsychosocial comorbidities, resulting in compromised wellbeing and reduced health-related quality of life (HRQoL). This longitudinal prospective study consisting of 610 adult women with endometriosis (EndoOnly; n = 352), and with endometriosis and co-occurring IBS-type symptoms (Endo + IBS; n = 258) aimed to investigate the differences in biopsychosocial factors, specifically HRQoL, psychological distress, pain, fatigue and menstrual symptoms over a three-year period. Using linear mixed models, results demonstrated that individuals with Endo + IBS were more likely to experience lower HRQoL and higher functional pain disability, fatigue, and menstrual symptoms compared to individuals with EndoOnly over three years. Results showed significant linear declines in rumination, total pain catastrophising, pain severity and helplessness for both groups; however, the rate of change for the Endo + IBS group tended to diminish and change direction over time. Further individuals with Endo + IBS were inclined to exhibit more complex change trajectories in psychological distress, magnification, and fatigue over time, with a trend towards worse outcomes overall. The onset of the COVID-19 during the study appeared to produce unexpected and inconsistent patterns of change for both groups. Findings highlight important implications for the implementation of multidisciplinary psychosocial healthcare, to help improve diagnosis, clinical management and overall health outcomes for individuals living with endometriosis and co-occurring IBS-type symptoms.


‘Listen to women as if they were your most cherished person ’: Australian women’s perspectives on living with the pain of endometriosis: A mixed-methods study

May 2024

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14 Reads

This mixed-methods study used an online cross-sectional survey to explore perspectives of 533 adult Australian women living with endometriosis pain, and their relationship with biopsychosocial factors. Four themes were constructed: The primary theme, ‘Stigma and change’ reflected women’s experience of dismissal, and the wish to reverse the narrative of pain as normal. Some women emphasised self-education and self-advocacy to affect change, reflecting the theme ‘self-empowerment’. Participants described the ‘debilitating impact’ of endometriosis and the enduring difficulty of ‘inadequate healthcare’, reflecting themes three and four. Analysis indicated type of social support may impact perceived outcomes for endometriosis. Hierarchical regression analyses indicated too few significant relationships between biopsychosocial factors and themes to indicate meaningful patterns without risk of common method variance. Future research should explore the influence of social support and interventions which develop participant autonomy and practitioner competence and knowledge, using disease-specific measures over time.


Citations (20)


... However, these results differ somewhat from our previous single-center study which found that postmenopausal IBS women have a greater overall severity of symptoms than premenopausal IBS women, although there were no differences in the severity of individual symptoms [6]. Overall symptom severity is a multicomponent factor and the difference between pre-and postmenopausal women with IBS could have been more related to quality of life or bothersomeness of symptoms rather than frequency alone, although further study is needed [35]. Our finding of worse physical quality of life in older men and women across DGBI reflects the aforementioned study, and the trend towards better mental quality of life in older women and men reflects prior work by the RFGES [32]. ...

Reference:

Sex Differences, Menses‐Related Symptoms and Menopause in Disorders of Gut–Brain Interaction
Symptom bothersomeness and life interference support Rome clinical criteria as clinically relevant indicators of DGBI

... However, the precise mechanisms underlying these divergent relationships across different states of disease activity warrant further investigation. Recent consensus emphasizes the importance of mental health care and support in the management of IBD (Hinnant et al., 2024), and a recent randomized controlled trial has demonstrated that psychotherapeutic interventions can alleviate depressive symptoms and improve disease activity in IBD patients (Naude et al., 2024). Consequently, our findings may provide evidence that psychological therapy could exert beneficial effects on IBD through gut-brain interactions, potentially mediated by the left insula. ...

Acceptance & Commitment Therapy for Adults Living With Inflammatory Bowel Disease & Distress: A Randomized Controlled Trial
  • Citing Article
  • August 2024

The American Journal of Gastroenterology

... Despite the high prevalence of fatigue in IBD, there remains an incomplete understanding of its etiology and impact on individual lives and society. Further, while strategies have been proposed to screen for and treat fatigue, [12][13][14] the effects of these interventions remain uncertain. 6,15 With a better understanding of the impact, we hope this will drive urgency to find more effective interventions for fatigue. ...

People with Inflammatory Bowel Disease Prefer Cognitive Behavioral Therapy for Fatigue Management: A Conjoint Analysis

Digestive Diseases and Sciences

... [64] A recent study of over 55K patients with gastrointestinal diseases in 26 countries found that Patient Health Questionnaire-4 is a valid and reliable tool for assessing mental health symptomology in both gastrointestinal and nongastrointestinal cohorts. [65] HADS was shown to have good convergent validity in patients with cirrhosis who undergo liver transplantation (LT). [66] A study evaluating HADS as a screening instrument against the Mini International Neuropsychiatric Interview (MINI, a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5)based diagnostic instrument) in patients with cirrhosis, found that the prevalence of depression on HADS was 28% while on MINI was 18%; three items on HADS correlated with a diagnosis of MDD: "I have lost interest in my appearance," "I look forward with enjoyment to things," and "I feel cheerful" (the last 2 were reverse items). ...

Confirmatory validation of the patient health questionnaire - 4 (PHQ-4) for gastrointestinal disorders: A large-scale cross-sectional survey
  • Citing Article
  • March 2024

Journal of Psychosomatic Research

... While this has previously been documented, due to other considerations such as abnormal menstrual bleeding, infertility, urinary symptoms, and deep dyspareunia, further investigations are needed to assess causality [32][33][34] . Associations between other included conditions, such as endometriosis and PCOS, and sexual function have previously been suggested [35][36][37] . However, data from a recent systematic review suggest the association between PCOS and sexual dysfunction may be weaker than previously thought and warrants further investigation 38 . ...

An evaluation of sexual function and health-related quality of life following laparoscopic surgery in individuals living with endometriosis
  • Citing Article
  • April 2024

Human Reproduction

... Although there are rich insights in the reviewed studies, limitations remain. Most studies are cross-sectional, which may not establish causality between endometriosis and mental health outcomes (Dowding et al., 2024;Kessler and Bromet, 2013). Small sample sizes and heterogeneity in study designs make it challenging to generalize findings (Walker et al., 1989;Hansen et al., 2023). ...

Learning to cope with the reality of endometriosis: A mixed-methods analysis of psychological therapy in women with endometriosis

British Journal of Health Psychology

... Addressing comorbid mental health needs is essential as they have been found to be associated with higher disease burden and healthcare utilization (Fairbrass et al., 2023;Hill et al., 2022). The recent studies by Bennebroek Evertsz et al. (2024) and Wilkins et al. (2024) indicate that psychological treatments, including cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT), can be translated to address these needs in people with IBD. Timely and efficient assessment of patients with IBD is the first step to identify potential candidates for psychological treatment. ...

Moving Towards Acceptance and Values: A Qualitative Study of ACTforIBD Compared to IBD Psychoeducation

Journal of Clinical Psychology in Medical Settings

... The study found most posts on Facebook regarding endometriosis focused on emotional support, rather than on information. The third review of social media content used a similar approach to Towne et al. [36] but evaluated Instagram posts [37]. ...

Social Media, Endometriosis, and Evidence-Based Information: An Analysis of Instagram Content

Healthcare

... Furthermore, recent data suggests that medicinal cannabis as a dietary intervention may have effects in treating Endometriosis as it acts through various mechanisms such as suppressing inflammation, alleviating bloating, and acting as a painkiller. However, it has not fully been studied and additional research into this can be fruitful [96,97]. Herbal therapy can also be used to induce pregnancy in an individual who cannot conceive due to endometriosis and can be utilized as a safer approach compared to conventionally existing drugs with almost no harm to the individual or the fetus [98]. ...

“A glimmer of hope” - Perceptions, barriers, and drivers for medicinal cannabis use amongst Australian and New Zealand people with endometriosis

Reproduction and Fertility

... Timely and effective control of inflammation and symptoms is critical to preventing progression to moderate or severe activity and extending remission periods. A metaanalysis by Riggott et al. [46] revealed that most nursing interventions had no significant impact on disease activity. In alignment with the findings in Model A of this study, the effect of disease activity on self-management behavior was not significant, leading to the rejection of the original hypothesis H3(A). ...

Efficacy of psychological therapies in people with inflammatory bowel disease: a systematic review and meta-analysis
  • Citing Article
  • August 2023

The Lancet Gastroenterology & Hepatology