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Cited by 141Gastrointestinal motility and disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health Interventions

Provoking symptoms to relieve symptoms: a randomized controlled dismantling study of exposure therapy in irritable bowel syndrome

Ljótsson, Brjánn, Hesser, Hugo, Andersson, Erik, Lackner, Jeffrey M., El Alaoui, Samir, Falk, Lisa, Aspvall, Kristina, Fransson, Josefin +5 more·2014·Behaviour Research and Therapy
DOI 10.1016/j.brat.2014.01.007
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Abstract

An internet-delivered cognitive behavioral treatment (ICBT) based on systematic exposure exercises has previously shown beneficial effects for patients with irritable bowel syndrome (IBS). Exposure exercises may be perceived as difficult for patients to perform because of the elicited short-term distress and clinicians may be reluctant to use these interventions. The aim of this study was to compare ICBT with the same protocol without systematic exposure (ICBT-WE) to assess if exposure had any incremental value. This randomized controlled dismantling study included 309 participants diagnosed with IBS. The treatment interventions lasted for 10 weeks and included online therapist contact. ICBT-WE comprised mindfulness, work with life values, acceptance, and encouraged reduced avoidance behaviors, while ICBT also included systematic exposure to IBS symptoms and related situations. Severity of IBS symptoms was measured with the Gastrointestinal Symptom Rating Scale - IBS version (GSRS-IBS). The between-group Cohen's d on GSRS-IBS was 0.47 (95% CI: 0.23-0.70) at post-treatment and 0.48 (95% CI: 0.20-0.76) at 6-month follow-up, favoring ICBT. We conclude that the systematic exposure included in the ICBT protocol has incremental effects over the other components in the protocol. This study provides evidence for the utility of exposure exercises in psychological treatments for IBS.

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  • Studies focusing on internet-delivered therapy for patients with medical speciality functional somatic syndromes such as irritable bowel syndrome, fibromyalgia, chronic pain, non-cardiac chest pain, and somatic symptom distress have shown promising results compared with waiting list or active control conditions.

    “Studies focusing on internet-delivered therapy for patients with medical speciality FSSs such as irritable bowel syndrome [[24], [25], [26]], fibromyalgia [27], chronic pain [28,29] and non-cardiac chest pain [30], as well as somatic symptom distress [31] have shown promising results for internet-delivered treatments compared with waiting list or active control conditions.”

    From Internet-delivered treatment for patients suffering from severe functional somatic disorders: Protocol for a randomized controlled trial (2023) · cites this paper as [24]

  • In Ljótsson et al. (2014), ICBT improved IBS-QOL (ES 0.31).

    “IBS-QOL: (ES: 0.31)”

    From Third wave treatments for functional somatic syndromes and health anxiety across the age span: A narrative review (2019) · cites this paper as Ljótsson et al. (2014)

  • Acceptance-based exposure therapy for IBS combines acceptance-based techniques, mindfulness training, and strict exposure training to produce consistently large effects, and the exposure element adds considerable effect.

    “Especially noteworthy here are the studies on acceptance-based exposure-based therapy for IBS (Ljótsson et al., 2010; Ljótsson et al., 2011), where acceptance-based techniques, mindfulness training and strict exposure training are combined to produce consistently large effects, and where the exposure element has been shown to add considerable effect (Ljótsson et al., 2014).”

    From Third wave treatments for functional somatic syndromes and health anxiety across the age span: A narrative review (2019) · cites this paper as Ljótsson et al., 2014

  • In Ljótsson et al. (2014), ICBT improved IBS symptom severity (GSRS-IBS) (ES 0.44).

    “IBS symptom severity (GSRS-IBS): + (ES: 0.44)”

    From Third wave treatments for functional somatic syndromes and health anxiety across the age span: A narrative review (2019) · cites this paper as Ljótsson et al. (2014)

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Authors
Ljótsson, B., Hesser, H., Andersson, E., Lackner, J. M., El Alaoui, S., Falk, L., Aspvall, K., Fransson, J., Hammarlund, K., Löfström, A., Nowinski, S., Lindfors, P., & Hedman, E.
Affiliations
  • Karolinska Institutet (SE)
  • Linköping University (SE)
  • Karolinska University Hospital (SE)
  • Erie County Medical Center (US)
  • Sabbatsberg Hospital (SE)
Corresponding author
Ljótsson, Brjánn
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2014-04
Volume
55
Pages
27-39
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2014.01.007
OpenAlex
W2034003089
Cited by
141
References
71
Citations by year
2026: 7 · 2025: 13 · 2024: 12 · 2023: 11 · 2022: 15 · 2021: 14 · 2020: 12 · 2019: 11 · 2018: 11 · 2017: 15 · 2016: 7 · 2015: 9 · 2014: 4
FWCI
11.71
Type
journal article
Language
en
Open access
closed
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
irritable bowel syndrome, exposure therapy, symptom provocation, mindfulness, acceptance and commitment therapy, avoidance behavior, gastrointestinal symptom severity
MeSH terms
Adult, Combined Modality Therapy, Female, Humans, Implosive Therapy, Male, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Internet, Irritable Bowel Syndrome, Young Adult

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