درمان مبتنی بر ذهن آگاهی و مواجهه برای سندرم روده تحریک پذیر با پیگیری بلندمدت با ارائه اینترنت
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|32308||2011||4 صفحه PDF||سفارش دهید||3485 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Behaviour Research and Therapy, Volume 49, Issue 1, January 2011, Pages 58–61
We conducted a follow-up of a previously reported study of internet-delivered cognitive behavior therapy (CBT) for IBS, based on exposure and mindfulness exercises (Ljótsson et al. (2010). Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome – a randomized controlled trial. Behaviour Research and Therapy, 48, 531–539). Seventy-five participants from the original sample of 85 (88%) reported follow-up data at 15–18 months (mean 16.4 months) after completing treatment. The follow-up sample included participants from both the original study’s treatment group and waiting list after it had been crossed over to treatment. Intention-to-treat analysis showed that treatment gains were maintained on all outcome measures, including IBS symptoms, quality of life, and anxiety related to gastrointestinal symptoms, with mainly large effect sizes (within-group Cohen’s d = 0.78–1.11). A total of fifty participants (59% of the total original sample; 52% of the original treatment group participants and 65% of the original waiting list participants) reported adequate relief of symptoms. Improvements at follow-up were more pronounced for the participants that had completed the full treatment and maintenance of improvement did not seem to be dependent on further treatment seeking. This study suggests that internet-delivered CBT based on exposure and mindfulness has long-term beneficial effects for IBS-patients.
Irritable bowel syndrome (IBS) affects 5–11% of the adult population (Spiller et al., 2007). It is characterized by recurring episodes of abdominal pain or discomfort combined with diarrhea, constipation, and bloating (Longstreth et al., 2006). Compared to normal controls IBS-patients have impaired quality of life (Halder et al., 2004), are more likely to be absent from work (Drossman et al., 1993), and utilize more health care (Talley, Gabriel, Harmsen, Zinsmeister, & Evans, 1995). Two meta-analyses have demonstrated that psychological therapies generally produce positive effects on IBS symptoms (Ford et al., 2009 and Lackner et al., 2004). Cognitive behavior therapy (CBT) is considered the most well studied of the psychological interventions (Mayer, 2008) but its availability is limited (Lackner et al., 2008). To increase the availability of treatment a number of recent trials have explored different methods to limit the amount of therapist time. This has been done by reducing the number of sessions or providing therapist contact through the internet or by telephone (Hunt et al., 2009, Lackner et al., 2008, Ljótsson et al., 2010 and Moss-Morris et al., 2010). These studies show effect sizes comparable with treatments with more intensive treatment contact but have only provided 3–6 month follow-up data. There is also a lack of studies that consistently demonstrate long-term effectiveness of CBT delivered in a traditional manner. We are aware of four studies of CBT for IBS that have included at least 12 month follow-up data. The first (Neff & Blanchard, 1987) was followed up after 2 and 4 years (Blanchard et al., 1988 and Schwarz et al., 1990) but studied a protocol that has been practically abandoned. The second (van Dulmen, Fennis, & Bleijenberg, 1996) had large variations in the length of the follow-up period (6–48 months) and provided follow-up data for less than 70% of the sample. The third (Boyce, Talley, Balaam, Koloski, & Truman, 2003) also suffered from large attrition with only a 62% response rate at the follow-up, furthermore the study failed to demonstrate meaningful differences between CBT and relaxation training. Finally, one study (Kennedy et al., 2005) failed to show maintenance of treatment gains beyond 3 month follow-up. In summary, the long-term beneficial effects of any kind of CBT for IBS remain undetermined at best and questionable at worst. To determine the long-term effects of minimal contact CBT for IBS, specifically delivered via internet, we conducted a follow-up on the sample from a previous study by our research group (Ljótsson, Falk, et al., 2010). The internet-delivered treatment in that study was based on exposure and mindfulness exercises and the participants randomized to treatment showed large improvements in IBS symptoms and quality of life compared to a waiting list.