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Cited by 212Gastrointestinal motility and disordersMindfulness and Compassion InterventionsPsychosomatic Disorders and Their Treatments

Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations.

Open access
Garland, Eric L., Gaylord, Susan A., Palsson, Olafur, Faurot, Keturah, Douglas Mann, J., Whitehead, William E.·2012·Journal of Behavioral Medicine
DOI 10.1007/s10865-011-9391-zPMC PMC3883954
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Abstract

Irritable bowel syndrome (IBS) is a prevalent functional disorder characterized by abdominal pain and hypervigilance to gastrointestinal sensations. We hypothesized that mindfulness training (MT), which promotes nonreactive awareness of emotional and sensory experience, may target underlying mechanisms of IBS including affective pain processing and catastrophic appraisals of gastrointestinal sensations. Seventy five female IBS patients were randomly assigned to participate in either 8 weeks of MT or a social support group. A theoretically grounded, multivariate path model tested therapeutic mediators of the effect of MT on IBS severity and quality of life. Results suggest that MT exerts significant therapeutic effects on IBS symptoms by promoting nonreactivity to gut-focused anxiety and catastrophic appraisals of the significance of abdominal sensations coupled with a refocusing of attention onto interoceptive data with less emotional interference. Hence, MT appears to target and ameliorate the underlying pathogenic mechanisms of IBS.

Integrity signals

Registry

Crossref · 10.1007/s10865-011-9391-z

Cites

59 of 59 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

18 of 51 cited sources checked · 9 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Selective attention to visceral sensations and heightened threat appraisals may maintain IBS symptoms even without present stressors.

    “Furthermore, selective attention to visceral sensations and heightened threat appraisals may maintain IBS symptoms in lieu of present stressors (Naliboff et al., 2008).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Naliboff et al., 2008 source

      The Introduction links hypervigilance to GI sensations and symptom-specific fears with visceral hypersensitivity, which it says may underlie IBS discomfort. The Discussion links hypersensitivity to symptom generation, but does not establish that these processes maintain symptoms without present stressors; the heightened response observed in this study occurred in a threat context after aversive stimulation. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation

    Reduced cognitive elaboration of the sensory experience of pain through meditation has been shown to decrease pain unpleasantness.

    “Indeed, reduced cognitive elaboration of the sensory experience of pain through meditation has been shown to decrease pain unpleasantness (Perlman et al., 2010).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Perlman et al., 2010 source

      The Discussion reports reduced pain-unpleasantness ratings in long-term meditators practicing open monitoring. It says the results “appear to support” reduced cognitive elaboration as an explanation; it does not establish that mechanism as the cause, as the citing sentence implies. No page number is available in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    IBS is especially tractable to psychological treatments such as cognitive behavior therapy, clinical hypnosis, and mindfulness-based therapy.

    “One such condition, irritable bowel syndrome (IBS), remains refractory for a substantial number of patients receiving usual medical care, yet seems to be especially tractable to psychological treatments like cognitive behavior therapy (CBT) (Lackner et al., 2007), clinical hypnosis (Whorwell et al., 1984), and mindfulness-based therapy (Gaylord et al., 2011; Ljotsson et al., 2010).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Lackner et al., 2007 source
    • cites Whorwell et al., 1984 source
    • cites Gaylord et al., 2011 source
  • Premisecitation

    Lackner et al. (2007) found no evidence that reductions in comorbid psychological distress mediate the therapeutic effect of CBT on IBS.

    “However, path analyses of CBT as a treatment for IBS conducted by Lackner and colleagues (2007) found no evidence for such a presumed meditational effect.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Lackner et al., 2007 source
  • Interpretationcitation

    One explanation for the discrepancy with CBT findings may be that CBT and mindfulness training operate through distinct therapeutic mechanisms, with CBT targeting distressing cognitive-emotional content and mindfulness training targeting a maladaptive cognitive-emotional process.

    “One explanation for this discrepancy may be that CBT and MT operate through distinct therapeutic mechanisms, where the former targets distressing cognitive-emotional content while the latter targets a maladaptive cognitive-emotional process (Hayes & Wilson, 2003), that is, conflating cognitive evaluations of sensory experience with the actual experience in and of itself.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hayes & Wilson, 2003 source
  • May combine two claims. 28
  • Classified as probably not a substantial claim. 31

  • May combine two claims.

    Interpretationcitation

    This pattern of activation suggests that MT promotes interoceptive recovery from emotional distress, a refocusing from affective to viscerosensory aspects of a distressing experience that allows the emotion to return to baseline rather than being perpetuated through rumination.

    “This pattern of activation suggests that MT promotes interoceptive recovery from emotional distress, that is, a refocusing from the affective to viscerosensory aspects of a distressing experience that allows for the emotion to follow its natural time course and return to baseline, rather than being perpetuated through rumination (Farb et al., 2010).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Farb et al., 2010 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Findings from our recent RCT demonstrate that MT results in statistically and clinically significant improvements in bowel symptoms, affective symptoms, and IBS-related quality of life.

    “Findings from our recent randomized controlled trial (RCT) demonstrate that MT results in statistically and clinically significant improvements in bowel symptoms, affective symptoms, and IBS-related quality-of-life (Gaylord et al., 2011).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Gaylord et al., 2011 source

      The Results (Outcomes; page unavailable) report statistically significant improvements in IBS severity, psychological symptoms, and IBS-related quality of life, with the latter two showing greater improvement than the control group at the three-month follow-up. The Discussion calls the reduction in IBS severity clinically significant, but our copy does not establish clinical significance for the affective-symptom or quality-of-life improvements. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    In this trial, patients receiving MT exhibited significantly larger reductions in IBS severity after treatment (average 38.2% reduction in symptom scores) and significantly greater improvements in quality of life than those in a support group.

    “In this trial, patients receiving MT exhibited significantly larger reductions in IBS severity after treatment (an average 38.2% reduction in symptom scores) and significantly greater improvements in quality of life than those participating in a support group.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Gaylord et al., 2011 source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Recent research suggests that MT attenuates activation in the medial prefrontal cortex, which instantiates self-referential linguistic processing during negative affective experience, while enhancing activation in the insula, a region subserving interoception.

    “Recent research suggests that MT attenuates activation in brain areas (i.e., medial prefrontal cortex) that instantiate self-referential, linguistic processing during negative affective experience while enhancing activation in brain regions subserving interoception (i.e., insula) (Farb et al., 2010).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Farb et al., 2010 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The VSI is a validated 15-item scale that assesses hypervigilance to visceral sensations and gut-focused anxiety.

    “Hypervigilance to visceral sensations and gut-focused anxiety were assessed with the Visceral Sensitivity Index (VSI), a validated 15-item scale (Labus et al., 2004).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Labus et al., 2004 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In Lackner's model, CBT was directly associated with improvement in GI symptoms, which in turn was associated with increased quality of life.

    “Instead, in their model CBT was directly associated with improvement in GI symptoms which, in turn, was associated with increased quality of life.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Lackner et al., 2007 source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Enhancements in quality of life were reciprocally linked with reductions in psychological distress, but no direct effect of CBT on psychological distress was found.

    “Enhancements in quality of life were reciprocally linked with reductions in psychological distress, but no evidence was found for a direct effect of CBT on psychological distress.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Lackner et al., 2007 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The VSI has been shown to be a strong predictor of symptom severity.

    “The VSI has been shown to be a strong predictor of symptom severity (Labus et al., 2004), and evidenced excellent internal consistency in this sample (α = 0.91).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Labus et al., 2004 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The FFMQ is a validated, 39-item Likert-type scale that assesses five internally consistent factors of mindfulness.

    “We examined the construct of dispositional mindfulness via the Five Facet Mindfulness Questionnaire (FFMQ; Baer et al., 2006), a validated, 39-item Likert-type scale that assesses five internally-consistent factors of mindfulness”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Baer et al., 2006 source

      Participants and Procedures (p. 10) identifies the FFMQ as a 39-item questionnaire using a five-point Likert-type scale. Deriving Mindfulness Facets (p. 10) reports adequate-to-good internal consistency for all five facet scales. But the General Discussion (p. 17) says the FFMQ requires extensive additional validation, so calling it a validated scale overstates the paper's conclusion. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    Mindfulness training substantially attenuates IBS symptoms and ameliorates the often severe impairments in quality of life that characterize IBS.

    “Our research suggests that MT substantially attenuates IBS symptoms and ameliorates the often severe impairments in quality of life that characterize this disorder (Gaylord et al., 2011).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Gaylord et al., 2011 source

      The Discussion reports substantial reductions in IBS symptom severity and quality-of-life benefits at the three-month follow-up. However, the trial included only women, and the Discussion explicitly says whether the benefits extend to men is unknown; the citing sentence does not retain that population limit. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Earlier work by the authors asserted that disengagement from negative appraisals of aversive stimuli in favor of attending to the raw sensorium of present-moment experience allows for the generation of new, more adaptive appraisals rather than reprocessing an existing cognitive set already tainted by negative emotional judgments.

    “Earlier, we (2007; Garland et al., 2009) asserted that disengagement from negative appraisals of aversive stimuli in favor of attending to the raw sensorium of present moment experience allows for the generation of new, more adaptive appraisals rather than reprocessing an existing cognitive set already tainted by negative emotional judgments.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [2007]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Garland et al., 2009 source

  • May combine two claims.

    Findingown data

    MT produces significant therapeutic effects on IBS symptoms by increasing nonreactivity to gut-focused anxiety and catastrophic appraisals of abdominal sensations, and by refocusing attention onto interoceptive data with less emotional interference.

    “Results suggest that MT exerts significant therapeutic effects on IBS symptoms by promoting nonreactivity to gut-focused anxiety and catastrophic appraisals of the significance of abdominal sensations coupled with a refocusing of attention onto interoceptive data with less emotional interference.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Increases in nonreactivity mediated reductions in pain catastrophizing, which along with reductions in visceral sensitivity and IBS severity mediated improvements in IBS-related quality of life.

    “Similarly, increases in nonreactivity mediated reductions in pain catastrophizing, which, along with reductions in visceral sensitivity and IBS severity, mediated improvements in IBS-related quality of life.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The causal ordering in the path model—treatment precedes mediators, which precede outcomes—is correct.

  • May combine two claims.

    Findingown data

    The therapeutic effect of mindfulness training on IBS severity was mediated by increased reinterpretation of pain sensations and decreased visceral sensitivity, with the latter mediated by improved nonreactivity.

    “Results indicated that the therapeutic effect of MT on IBS severity was mediated by increasing reinterpretation of pain sensations and decreasing visceral sensitivity, the latter being mediated, in turn, by improvements in nonreactivity.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The causal ordering in the path model—treatment precedes mediators, which precede outcomes—is correct.

  • May combine two claims.

    Findingown data

    A non-significant chi-square value of p = .31 indicated that additional direct effects of mindfulness training on IBS severity and quality of life should not be retained, and that a full mediation model was more parsimonious.

    “The non-significant chi-square value obtained (p = .31) indicated that the additional direct effects of MT on IBS severity and IBS-related quality of life should not be retained in the final model, and that a full mediation model with only indirect effects of MT on IBS severity and IBS-related quality of life was more parsimonious.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Models four and five did not fit the data as well as the final model: model four χ2/df = 2.69, p = .001, RMSEA = .13, CFI = .74, AIC = 78.28; model five χ2/df = 1.74, p = .05, RMSEA = .09, CFI = .89, AIC = 66.83.

    “Neither of the other two alternative models fit the data as well as the final model presented in Figure 3 (model four: χ2/df = 2.69, p = .001; RMSEA = .13 (.08, .19), CFI = .74, AIC = 78.28; model five: χ2/df = 1.74, p = .05; RMSEA = .09 (.00, .15), CFI = .89, AIC = 66.83)”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    The original trimmed hypothetical model was retained as the final model.

    “Given the presence of nonsignificant paths and decrements in model fit, our original (yet trimmed) hypothetical model was retained as the final model.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The parameter estimates from models four and five did not contradict the basic conclusions of the results and discussion.

    “nor did the parameter estimates derived contradict the basic conclusions made in the results and discussion sections of this paper.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Enhanced responsiveness to psychosocial stressors and perturbations of visceral homeostasis may produce exaggerated autonomic reactions, altered bowel habits, hyperalgesia, and hypervigilance to interoceptive signals from the gut.

    “Given the established physiological linkages between the enteric and central nervous systems, enhanced responsiveness to psychosocial stressors and perturbations of visceral homeostasis may result in exaggerated autonomic reactions, altered bowel habits, hyperalgesia, and hypervigilance towards interoceptive signals from the gut (Mayer, 1999).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Mayer, 1999 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    IBS is a functional gastrointestinal disorder characterized by abdominal pain, heightened visceral sensitivity, and sometimes altered gastrointestinal motility.

    “IBS is a functional gastrointestinal (GI) disorder characterized by abdominal pain, heightened visceral sensitivity, and in some cases, altered gastrointestinal motility”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Mayer & Tillisch, 2010

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency of the CSQ pain catastrophizing subscale in this sample was high (α = 0.92).

    “Internal consistency in this sample was high (α = 0.92).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In hypnosis studies, significant reductions in maladaptive IBS-related cognitions, affective symptoms, and somatization are frequently reported along with improvement in gastrointestinal symptoms.

    “In studies of hypnosis, significant reductions in maladaptive IBS-related cognitions, affective symptoms, and somatization are frequently reported along with improvement in gastrointestinal symptoms (Gonsalkorale et al., 2004; Palsson et al., 2002).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Gonsalkorale et al., 2004 source
    • cites Palsson et al., 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Nine subjects withdrew during the intervention, 5 in the MT group and 4 in the SG.

    “Nine subjects withdrew from the study during the intervention, 5 in the MT group and 4 in the SG (Figure 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The BSI-18 global severity index evidenced high internal consistency in this sample (α = 0.87).

    “Here, the global severity index, which evidenced high internal consistency (α = 0.87), was used as an overall measure of psychological distress.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the present sample, internal consistency of the IBS-QOL was high (α = 0.95).

    “In the present sample, internal consistency was high (α = 0.95).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    This evidence corroborates findings of decreased chronic pain in clinical research.

    “corroborating findings of decreased chronic pain in clinical research (Grossman et al., 2004; Rosenzweig et al., 2010).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Grossman et al., 2004 source
    • cites Rosenzweig et al., 2010 source

  • May combine two claims.

    Premisecitation

    Evidence from several laboratories suggests that both brief and long-term mindfulness meditation are associated with decreased pain and increased pain thresholds during experimental pain stimulation.

    “Evidence from a number of laboratories suggests that both brief (Zeidan et al., 2009) and long-term mindfulness meditation (Grant & Rainville, 2009; Zeidan et al., in press) are associated with decreased pain and increased pain thresholds during experimental pain stimulation”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Zeidan et al., 2009 source
    • cites Grant & Rainville, 2009 source
    • cites Zeidan et al., in press

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    There were no significant differences between the mindfulness training and support group participants on any demographic variable.

    “There were no significant differences between MT and SG participants on any of the demographic variables.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The support group was facilitated by clinical social workers to control for expectations of benefit and amount of group contact.

    “For the control intervention, clinical social workers facilitated a support group to control for expectations of benefit and amount of group contact.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The support group actually controls for expectations of benefit and amount of group contact.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The reinterpretation of pain sensations subscale of the CSQ demonstrated high internal consistency in this sample (α = 0.88).

    “In the present sample, the reinterpretation of pain sensations subscale demonstrated high internal consistency (α = 0.88).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency of the IBS-SS in our sample was acceptable (α = 0.72).

    “Internal consistency of the scale in our study sample was acceptable (α = 0.72).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The IBS-QOL scale is responsive to therapeutic change and has high test-retest reliability.

    “Changes in physical and psychosocial functioning as a result of IBS were measured with the IBS-Quality of Life (IBS-QOL) scale, a 34-item scale that is responsive to therapeutic change (Drossman et al., 2000), and has high test-retest reliability (Patrick et al., 1998).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Drossman et al., 2000 source
    • cites Patrick et al., 1998 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The VSI evidenced excellent internal consistency in this sample (α = 0.91).

    “The VSI has been shown to be a strong predictor of symptom severity (Labus et al., 2004), and evidenced excellent internal consistency in this sample (α = 0.91).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    These psychological changes may mediate the robust therapeutic effects of clinical hypnosis on IBS observed across multiple clinical trials.

    “These psychological changes may mediate the robust therapeutic effects of clinical hypnosis on IBS observed across multiple clinical trials (Miller & Whorwell, 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Miller & Whorwell, 2009 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A previous clinical trial of CBT for IBS used a similar support group as a control condition.

    “A previous clinical trial of CBT for IBS used a similar support group as a control condition (Payne & Blanchard, 1995).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Payne & Blanchard, 1995 source

  • Classified as probably not a substantial claim.

    Premisecitation

    A growing body of research demonstrates therapeutic effects of MT on stress and pain symptoms in chronic functional disorders such as fibromyalgia and depression.

    “Given the growing body of research demonstrating the therapeutic effects of MT on stress and pain symptoms (Grossman et al., 2004; Rosenzweig et al., 2010) in chronic functional disorders such as fibromyalgia and depression (Kaplan et al., 1993; Teasdale et al., 2000)”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Grossman et al., 2004 source
    • cites Rosenzweig et al., 2010 source
    • cites Kaplan et al., 1993 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The six-item pain catastrophizing subscale of the CSQ has been shown to correlate with measures of pain intensity and functional impairment.

    “Catastrophizing was assessed with the six-item pain catastrophizing subscale of the Coping Strategy Questionnaire (CSQ) (Rosenstiel & Keefe, 1983), which has been shown to correlate with measures of pain intensity and functional impairment (Robinson et al., 1997).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Rosenstiel & Keefe, 1983 source
    • cites Robinson et al., 1997 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Of 210 women assessed for eligibility, 97 were eligible, and 75 began treatment after randomization (39 in MT, 36 in SG).

    “Of the 210 women assessed for eligibility, 97 were found to be eligible, and were enrolled. Seventy-five (76.5%) began treatment after randomization - 39 in MT and 36 in the SG (see the CONSORT diagram in Figure 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Jones et al. (2011) identified an indirect effect of CBT on IBS symptoms, such that improvement in mood led to perceived improvement in IBS symptoms.

    “However, a study by Jones et al. (2011) identified an indirect effect of CBT on IBS symptoms, such that improvement in mood led to the perception of improved IBS symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Jones et al., 2011 source

  • May combine two claims.

    Interpretationreasoning

    Two key therapeutic mechanisms identified in the present investigation, nonreactivity and reinterpretation of pain sensations, are both process-level factors.

    “Indeed, two key therapeutic mechanisms identified in the present investigation, nonreactivity and reinterpretation of pain sensations, are both process-level factors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    By coping with abdominal pain mindfully, cognitive elaboration on the unpleasantness of pain is reduced while attention to interoceptive signals is increased.

    “By coping with abdominal pain in this manner, cognitive elaboration on the unpleasantness of pain is reduced while attention to interoceptive signals is increased.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    A shift from affective to sensory processing may result in interoceptive recovery from emotional distress stemming from abdominal pain.

    “Such a shift from affective to sensory processing may result in interoceptive recovery from experiences of emotional distress stemming from abdominal pain.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Although overall model fit was excellent, the specified pathways explained only a modest yet statistically significant amount of variance in IBS severity, implying that variables contributing to the therapeutic effect of mindfulness on IBS were omitted.

    “Second, although our overall model fit was excellent, the specified pathways explained only a modest (yet statistically significant) amount of variance in IBS severity, which implies that variables were omitted from the present investigation that may have contributed significantly to the therapeutic effect of mindfulness on IBS.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Lackner and colleagues (2007) identified a feedback loop between changes in psychological distress and IBS-related quality of life.

    “Lackner and colleagues (2007) identified a feedback loop between changes in psychological distress and IBS-related quality of life.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lackner and colleagues (2007)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    Mindfulness training appears to result in nonreactivity to gut-focused anxiety and catastrophic appraisals of abdominal sensations, coupled with refocusing attention onto interoceptive data with less affective interference.

    “MT appears to result in nonreactivity to gut-focused anxiety and catastrophic appraisals of the significance of abdominal sensations coupled with a refocusing of attention onto interoceptive data with less affective interference.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Results of path analysis are data driven, meaning they depend on the particular set of experimental observations to support the explanatory model.

    “The results of path analysis are “data driven,” that is, dependent on the particular set of experimental observations to support the explanatory model.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Cultivating nonreactivity may lead to less catastrophic primary appraisals of the threat value of painful gut sensations while increasing the veracity of secondary appraisals of one's ability to manage those sensations.

    “Cultivating nonreactivity may also lead to less catastrophic primary appraisals of the threat value of painful sensations in the gut while increasing veracity of secondary appraisals of one’s ability to manage those sensations.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study relied on self-report data.

    “A third primary limitation of the study relates to its reliance on self-report data.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Cultivating a nonreactive mindset toward distressing thoughts, affective states, and somatic symptoms appears to be a key process for both IBS severity and IBS-related quality of life.

    “With regard to both IBS severity and the effect of IBS on quality of life, cultivating a nonreactive mindset toward potentially distressing thoughts, affective states, and somatic symptoms appears to be a key process.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Jones et al. (2009) identified indirect effects of cognitive-behavioral therapy on IBS symptoms that were partially mediated by changes in anxiety and depression.

    “Jones et al. (2009) identified indirect effects of CBT on IBS symptoms that were partially mediated by changes in anxiety and depression.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Jones et al. (2009)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    As IBS patients learn through mindfulness training to let go of visceral sensations and worried thoughts and observe them dispassionately, anxiety over gastrointestinal distention decreases, leading to reductions in abdominal pain and IBS-related impairments in quality of life.

    “Based on our path analyses, it appears that as IBS patients learn through MT to let go of visceral sensations and their worried thoughts about such sensations and observe them with a dispassionate attentional stance, anxiety over sensations of gastrointestinal distention decreases, leading to reductions in abdominal pain and IBS-related impairments in quality of life.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study had strengths including simultaneous estimation of multiple causal pathways and outcomes within the same model and use of an active and credible control condition.

    “This study has substantial strengths, including the simultaneous estimation of multiple causal pathways and outcomes within the same model and the use of an active and credible control condition.”
    Quote in the paperNot a substantial claim
52 of 52

  • The paper relies on this without support.

    The support group actually controls for expectations of benefit and amount of group contact.

    “For the control intervention, clinical social workers facilitated a support group to control for expectations of benefit and amount of group contact.”

  • The authors state this as an assumption.

    The mindfulness intervention's explicit training in reinterpretation of pain sensations is a distinct technique from cultivating nonreactivity, so there is a direct pathway from treatment to change in reinterpretation of pain sensations.

    “we presumed a priori that because the mindfulness intervention offered explicit training in reinterpretation of pain sensations as a distinct technique from the cultivation of nonreactivity to thoughts and emotions, there would be a direct pathway from the treatment variable to change in reinterpretation of pain sensations.”

  • The authors state this as an assumption.

    Reductions in catastrophizing are more directly linked with IBS-related quality of life than with IBS severity.

    “A priori, we reasoned that reductions in catastrophizing would be more directly linked with IBS-related quality of life than IBS severity, given that catastrophizing has been robustly associated with quality of life among IBS patients (Seres et al., 2008).”

  • The paper relies on this without support.

    The causal ordering in the path model—treatment precedes mediators, which precede outcomes—is correct.

    “Pre-post changes in reinterpretation of pain sensations, nonreactivity, visceral sensitivity, IBS severity, and IBS-related quality of life were measured concurrently and thus true causal order of the hypothesized pathways cannot be ascertained.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Particularly well-supported change processes from newer forms of CBT include cognitive defusion and non-reactivity.

    “Particularly well-supported change processes from newer forms of CBT include cognitive defusion 74 (which is the ability to experience thoughts with a sense of distance from them, so as to diminish their automatic behavioral impact) and non-reactivity 75,76 (which is allowing cognitive or other experiences to come and go without reacting in an effort to change them).”

    From “Third-wave” cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry (2021) · cites this paper as [74]

    The Results (page not provided) associate mindfulness training with increased nonreactivity and link nonreactivity to reduced visceral sensitivity and pain catastrophizing in people with IBS. The Discussion calls nonreactivity a therapeutic mechanism, but also describes the analysis as exploratory and distinguishes mindfulness training from CBT. This supports the nonreactivity portion to which this citation is attached, not the broader characterization of it as a particularly well-supported process across newer forms of CBT. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Randomized trials indicate that mindfulness alleviates pain by facilitating a shift from affective to sensory processing of pain sensations.

    “Randomized trials indicate that mindfulness alleviates pain by facilitating a shift from affective to sensory processing of pain sensations 13”

    From Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting. (2017) · cites this paper as [13]

    The Discussion (page unavailable) reports that mindfulness treatment increased reinterpretation of pain sensations as sensory signals, which predicted reduced IBS severity in women with IBS. It describes a shift from affective to sensory processing as a possible mechanism, but cautions that the measurements cannot establish the causal order. The claim overstates this exploratory finding as an established explanation for pain relief across randomized trials. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Research indicates that mindfulness meditation substantially lowers pain in both laboratory and clinical contexts.

    “Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings.”

    From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [12]

  • Mindfulness reduces pain severity by fostering a shift from affective to sensory processing of pain as innocuous sensory information.

    “Following the first trial of MORE, it was found that mindfulness reduces pain severity by fostering a shift from affective to sensory processing of pain as innocuous sensory information [74].”

    From Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research (2018) · cites this paper as [74]

  • Our findings are aligned with a growing body of evidence showing that in patients with chronic pain, mindfulness and participation in mindfulness-based interventions are related to decreases in pain catastrophizing.

    “Furthermore, our findings are aligned with a growing body of evidence showing that in patients with chronic pain, mindfulness and participation in mindfulness-based interventions are related to decreases in pain catastrophizing (e.g., Schutze et al., 2010; Cassidy et al., 2012; Garland et al., 2012; Day et al., 2014) but see (de Boer et al., 2014).”

    From Effects of mindfulness-based cognitive therapy on body awareness in patients with chronic pain and comorbid depression (2016) · cites this paper as Garland et al., 2012

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Figure 2 is assigned two different subjects

    Minor

    The methods identify Figure 2 as the CONSORT diagram, but the results identify it as the trimmed path model.

1 of 1

Cites

Flagged first, then by citations

3 of the 62 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Derogatis, L. R. (2000). BSI-18: Administration, scoring, and procedures manual. Minneapolis, MN: National Computer Systems.

Cited by

Sorted by citations

Related

Authors
Garland, E. L., Gaylord, S. A., Palsson, O., Faurot, K., Douglas Mann, J., & Whitehead, W. E.
Affiliations
  • Florida State University (US)
  • University of North Carolina at Chapel Hill (US)
Corresponding author
Garland, Eric L.
ORCID
Venue
Journal of Behavioral Medicine
Publisher
Springer Science and Business Media LLC
Published
2011-12-08
Volume
35
Issue
6
Pages
591-602
ISSN
  • 0160-7715 (ISSN-L)
  • 1573-3521
DOI
10.1007/s10865-011-9391-z
PMC
PMC3883954
OpenAlex
W2058447512
Cited by
210
References
62
Citations by year
2026: 3 · 2025: 8 · 2024: 13 · 2023: 16 · 2022: 21 · 2021: 15 · 2020: 21 · 2019: 29 · 2018: 16 · 2017: 18 · 2016: 10 · 2015: 10 · 2014: 18 · 2013: 7 · 2012: 4
FWCI
9.50
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of Behavioral Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • UNC Libraries
Funders
  • National Institutes of Health
  • National Institute on Drug Abuse (R03DA032517)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK031369, R24DK067674)
  • National Center for Complementary and Alternative Medicine
  • National Center for Complementary and Integrative Health (R21AT003619, T32AT003378)
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords
irritable bowel syndrome, mindfulness training, visceral sensitivity, pain catastrophizing, interoception, quality of life, abdominal pain, functional gastrointestinal disorders
MeSH terms
Adolescent, Adult, Affect, Aged, Anxiety, Attention, Female, Humans, Middle Aged, Quality of Life, Severity of Illness Index, Irritable Bowel Syndrome, Young Adult, Catastrophization, Pain Management, Mindfulness

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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