Mechanisms of change in an exposure-based treatment for irritable bowel syndrome.
Abstract
Objective The aim of this study was to identify mediators of change in a previously published randomized controlled trial that compared Internet-delivered cognitive behavioral treatment based on exposure exercises (ICBT) with Internet-delivered stress management (ISM) for irritable bowel syndrome (IBS). ICBT and ISM targeted distinct proposed mechanisms of illness maintenance and symptom exacerbation, gastrointestinal symptom-specific anxiety (GSA), and stress reactivity, respectively. The original study found that ICBT was more effective than ISM in improving IBS symptoms. Method Weekly measurements of GSA and stress reactivity (putative mediators) and treatment outcome were obtained from 195 participants with IBS, who had been randomized to ICBT or ISM. Results Parallel process growth mediational analyses revealed that the larger reduction of IBS symptoms from ICBT compared to ISM was mediated by changes in GSA, αβ = -0.42, 95% CI asymmetric [-0.71, -0.16]. In contrast, changes in stress reactivity did not mediate the difference in outcomes between treatments, αβ = 0.04, 95% CI asymmetric [-0.09, 0.20]. Analyses of the temporal sequence of week-to-week changes in process and outcome measures showed that only GSA displayed a pattern consistent with a causal model in which change in process preceded and contributed to symptom change. Furthermore, engagement in treatment specific activities was related to change in GSA but not to stress reactivity in the ICBT arm, whereas trea…
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GI-specific anxiety has been identified as a mediator of treatment outcomes in investigations of new psychological therapies for IBS.
“Among investigations of new psychological therapies for IBS, GI-specific anxiety (GSA) has been identified as a mediator of treatment outcomes.37,38”
From Preliminary investigation of the associations between psychological flexibility, symptoms and daily functioning in people with chronic abdominal pain (2021) · cites this paper as [38]
Cites
Confidence Limits for the Indirect Effect: Distribution of the Product and Resampling Methods
MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004) · Multivariate Behavioral Research · doi:10.1207/s15327906mbr3901_4 · Cited by 7,806 · see citing works
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.64.6.1152 · Cited by 3,595 · see citing works
Mediators and Mechanisms of Change in Psychotherapy Research
Kazdin, A. E. (2007) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.3.022806.091432 · Cited by 2,504 · see citing works
Global Prevalence of and Risk Factors for Irritable Bowel Syndrome: A Meta-analysis
Lovell, R. M., & Ford, A. C. (2012) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2012.02.029 · Cited by 2,155 · see citing works
AGA technical review on irritable bowel syndrome.
Drossman, D. A., Camilleri, M., Mayer, E. A., & Whitehead, W. E. (2002) · Gastroenterology · doi:10.1053/gast.2002.37095 · Cited by 1,384 · see citing works
Whitehead, W. E., Palsson, O., & Jones, K. R. (2002) · Gastroenterology · doi:10.1053/gast.2002.32392 · Cited by 1,116 · see citing works
Feingold, A. (2009) · Psychological Methods · doi:10.1037/a0014699 · Cited by 851 · see citing works
Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032210-104449 · Cited by 800 · see citing works
Hedman, E., Ljótsson, B., & Lindefors, N. (2012) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/erp.12.67 · Cited by 672 · see citing works
Self-citationDrossman, D. A., Toner, B. B., Whitehead, W. E., Diamant, N. E., Dalton, C. B., Duncan, S., Emmott, S., Proffitt, V., Akman, D., Frusciante, K., et al. (2003) · Gastroenterology · doi:10.1016/s0016-5085(03)00669-3 · Cited by 614 · see citing works
Ford, A. C., Talley, N. J., Schoenfeld, P. S., Quigley, E. M. M., & Moayyedi, P. (2009) · Gut · doi:10.1136/gut.2008.163162 · Cited by 582 · see citing works
Using the Internet to provide cognitive behaviour therapy
Andersson, G. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.01.010 · Cited by 560 · see citing works
Self-citationAnxiety disorders: Why they persist and how to treat them
Clark, D. M. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00048-0 · Cited by 556 · see citing works
CONTROLLED TRIAL OF HYPNOTHERAPY IN THE TREATMENT OF SEVERE REFRACTORY IRRITABLE-BOWEL SYNDROME
Whorwell, P. J., Prior, A., & Faragher, E. B. (1984) · The Lancet · doi:10.1016/s0140-6736(84)92793-4 · Cited by 537 · see citing works
Medical costs in community subjects with irritable bowel syndrome
Talley, N. J., Gabriel, S. E., Harmsen, W. S., Zinsmeister, A. R., & Evans, R. W. (1995) · Gastroenterology · doi:10.1016/0016-5085(95)90738-6 · Cited by 460 · see citing works
Raudenbush, S. W., & Liu, X.-F. (2001) · Psychological Methods · doi:10.1037/1082-989x.6.4.387 · Cited by 455 · see citing works
The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome
Creed, F., Fernandes, L., Guthrie, E., Palmer, S., Ratcliffe, J., Read, N., Rigby, C., Thompson, D., & Tomenson, B. (2003) · Gastroenterology · doi:10.1053/gast.2003.50055 · Cited by 443 · see citing works
Physical Activity Improves Symptoms in Irritable Bowel Syndrome: A Randomized Controlled Trial
Johannesson, E., Simrén, M., Strid, H., Bajor, A., & Sadik, R. (2011) · American Journal of Gastroenterology · doi:10.1038/ajg.2010.480 · Cited by 431 · see citing works
V. Stress and irritable bowel syndrome
Mayer, E. A., Naliboff, B. D., Chang, L., & Coutinho, S. V. (2001) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.2001.280.4.g519 · Cited by 413 · see citing works
An irritable bowel syndrome-specific symptom questionnaire: development and validation
K., W. I., S., F., J., H. C., H., J. R., F., L. G., A., M. E., A., P. R., K., W. I., & J., N. (2003) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365520310004209 · Cited by 324 · see citing works
Gaylord, S. A., Palsson, O. S., Garland, E. L., Faurot, K. R., Coble, R. S., Mann, D. J., Frey, W., Leniek, K., & Whitehead, W. E. (2011) · American Journal of Gastroenterology · doi:10.1038/ajg.2011.184 · Cited by 281 · see citing works
Ljótsson, B., Falk, L., Vesterlund, A. W., Hedman, E., Lindfors, P., Rück, C., Hursti, T., Andréewitch, S., Jansson, L., Lindefors, N., et al. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.03.003 · Cited by 270 · see citing works
Self-citationCraske, M. G., Wolitzky-Taylor, K. B., Labus, J., Wu, S., Frese, M., Mayer, E. A., & Naliboff, B. D. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.04.001 · Cited by 243 · see citing works
Brinkborg, H., Michanek, J., Hesser, H., & Berglund, G. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.03.009 · Cited by 235 · see citing works
Self-citationHedman, E., Ljótsson, B., Rück, C., Furmark, T., Carlbring, P., Lindefors, N., & Andersson, G. (2010) · Computers in Human Behavior · doi:10.1016/j.chb.2010.01.010 · Cited by 220 · see citing works
Self-citationLjótsson, B., Hedman, E., Andersson, E., Hesser, H., Lindfors, P., Hursti, T., Rydh, S., Rück, C., Lindefors, N., & Andersson, G. (2011) · American Journal of Gastroenterology · doi:10.1038/ajg.2011.139 · Cited by 218 · see citing works
Self-citationGarland, E. L., Gaylord, S. A., Palsson, O., Faurot, K., Douglas Mann, J., & Whitehead, W. E. (2012) · Journal of Behavioral Medicine · doi:10.1007/s10865-011-9391-z · Cited by 210 · see citing works
Jerndal, P., Ringström, G., Agerforz, P., Karpefors, M., Akkermans, L. M., Bayati, A., & Simrén, M. (2010) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2010.01493.x · Cited by 192 · see citing works
Payne, A., & Blanchard, E. B. (1995) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.63.5.779 · Cited by 186 · see citing works
Zernicke, K. A., Campbell, T. S., Blustein, P. K., Fung, T. S., Johnson, J. A., Bacon, S. L., & Carlson, L. E. (2013) · International Journal of Behavioral Medicine · doi:10.1007/s12529-012-9241-6 · Cited by 178 · see citing works
Lackner, J. M., Jaccard, J., Krasner, S. S., Katz, L. A., Gudleski, G. D., & Holroyd, K. (2008) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2008.03.004 · Cited by 176 · see citing works
Boyce, P. M., Talley, N. J., Balaam, B., Koloski, N. A., & Truman, G. (2003) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2003.07716.x · Cited by 167 · see citing works
Randomized Controlled Trial of Internet-Based Stress Management
Zetterqvist, K., Maanmies, J., Ström, L., & Andersson, G. (2003) · Cognitive Behaviour Therapy · doi:10.1080/16506070302316 · Cited by 160 · see citing works
Self-citationBrief cognitive-behavioral internet therapy for irritable bowel syndrome
Hunt, M. G., Moshier, S., & Milonova, M. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.05.002 · Cited by 139 · see citing works
Ljótsson, B., Andersson, G., Andersson, E., Hedman, E., Lindfors, P., Andréewitch, S., Rück, C., & Lindefors, N. (2011) · BMC Gastroenterology · doi:10.1186/1471-230x-11-110 · Cited by 132 · see citing works
Self-citationA controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome
Blanchard, E. B., Lackner, J. M., Sanders, K., Krasner, S., Keefer, L., Payne, A., Gudleski, G. D., Katz, L., Rowell, D., Sykes, M., et al. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.07.003 · Cited by 121 · see citing works
Cognitive change in patients undergoing hypnotherapy for irritable bowel syndrome
Gonsalkorale, W. M., Toner, B. B., & Whorwell, P. J. (2004) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(03)00076-x · Cited by 110 · see citing works
Exposure and mindfulness based therapy for irritable bowel syndrome - An open pilot study
Ljótsson, B., Andréewitch, S., Hedman, E., Rück, C., Andersson, G., & Lindefors, N. (2010) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2010.01.001 · Cited by 76 · see citing works
Self-citationThe development of the irritable bowel syndrome-behavioral responses questionnaire
Reme, S. E., Darnley, S., Kennedy, T., & Chalder, T. (2010) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.01.025 · Cited by 64 · see citing works
Accuracy of estimates and statistical power for testing meditation in latent growth curve modeling
Cheong, J. (2011) · Structural Equation Modeling: A Multidisciplinary Journal · doi:10.1080/10705511.2011.557334 · Cited by 55 · see citing works
Pathways connecting cognitive behavioral therapy and change in bowel symptoms of IBS
Jones, M., Koloski, N., Boyce, P., & Talley, N. J. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.10.004 · Cited by 47 · see citing works
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Van Oudenhove, L., Levy, R. L., Crowell, M. D., Drossman, D. A., Halpert, A. D., Keefer, L., Lackner, J. M., Murphy, T. B., & Naliboff, B. D. (2016) · Gastroenterology · doi:10.1053/j.gastro.2016.02.027 · Cited by 512 · see citing works
Ebert, D. D., Van Daele, T., Nordgreen, T., Karekla, M., Compare, A., Zarbo, C., Brugnera, A., Øverland, S., Trebbi, G., Jensen, K. L., et al. (2018) · European Psychologist · doi:10.1027/1016-9040/a000318 · Cited by 437 · see citing works
“…2013; Ebert, Berking, Thiart, et al., 2015; Ebert, Lehr, et al.,2016; Graham et al., 2015; Hedman et al., 2013; Hesser et al., 2014; Lévesque et al., 2017; Ljótsson et al., 2013; Mogoașe et al., 2017; Morgan, Mackinnon, & Jorm, 2013; Warmerdam, van Straten, Jongsma, Twisk, & Cuijpers, 2010).”
Andersson, G., Carlbring, P., Titov, N., & Lindefors, N. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743719839381 · Cited by 324 · see citing works
Self-citationInternet interventions: Past, present and future
Andersson, G. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.03.008 · Cited by 315 · see citing works
“There are several good examples of research on mechanisms of change and how weekly measures can be used to investigate mediators of treatment outcome (Ljótsson et al., 2013).”
BackgroundSelf-citationKazantzis, N., Whittington, C., Zelencich, L., Kyrios, M., Norton, P. J., & Hofmann, S. G. (2016) · Behavior Therapy · doi:10.1016/j.beth.2016.05.002 · Cited by 280 · see citing works
Rogers, A. H., & Farris, S. G. (2022) · European Journal of Pain · doi:10.1002/ejp.1994 · Cited by 280 · see citing works
“…be partially explained by the myriad of studies across domains (i.e. yoga, CBT, physical activity) that show reductions in pain catastrophizing, providing evidence that this construct may, in fact, be a non- specific change factor associated with pain and function outcomes (Ljótsson et al., 2013).”
BackgroundHesser, H. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.02.003 · Cited by 192 · see citing works
“A good applied example of this parallel process mediator growth model can be found in a study that compared two forms of internet-delivered psychological treatments for irritable bowel syndrome using weekly measurements of potential mediators and primary outcome (Ljótsson et al., 2013).”
MethodSelf-citationLjótsson, B., Hesser, H., Andersson, E., Lackner, J. M., El Alaoui, S., Falk, L., Aspvall, K., Fransson, J., Hammarlund, K., Löfström, A., et al. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.01.007 · Cited by 141 · see citing works
“However, treatment effects are inconsistent across studies of the same treatment type andno single psychological treatment has emerged as the most effective treatment approach for IBS (Ljótsson et al., 2013).”
BackgroundSelf-citationFeingold, A. (2014) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0037721 · Cited by 126 · see citing works
“…efficacy, particularly in JCCP (e.g., Aderka, Gillihan, McLean, & Foa, 2013; Arch, Eifert, Davies, Vilardaga, Rose, & Craske, 2012; Chaffin, Funderburk, Bard, Valle, & Gurwitch, 2011; Kerr, DeGarmo, Leve, & Chamberlain, 2014; Ljótsson et al., 2013; Safren et al., 2012; Twohig et al., 2010).”
Bonnert, M., Olén, O., Lalouni, M., Benninga, M., Bottai, M., Engelbrektsson, J., Hedman, E., Lenhard, F., Bo, M.-L., Simrén, M., et al. (2017) · American Journal of Gastroenterology · doi:10.1038/ajg.2016.503 · Cited by 121 · see citing works
Self-citationChristensen, S. S., Frostholm, L., Ørnbøl, E., & Schröder, A. (2015) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.12.005 · Cited by 111 · see citing works
“org/ number of studies have examined mediators of change in FSS treatments, all of which emphasize the role of illness-related cognitions [11–20].”
BackgroundResultZaman, J., Vlaeyen, J. W. S., Oudenhove, L. V., Wiech, K., & Diest, I. V. (2015) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2015.01.009 · Cited by 116 · see citing works
Naliboff, B. D., Smith, S. R., Serpa, J. G., Laird, K. T., Stains, J., Connolly, L. S., Labus, J. S., & Tillisch, K. (2020) · Neurogastroenterology & Motility · doi:10.1111/nmo.13828 · Cited by 77 · see citing works
Ebert, D. D., Harrer, M., Apolinário-Hagen, J., & Baumeister, H. (2019) · Advances in Experimental Medicine and Biology · doi:10.1007/978-981-32-9721-0_29 · Cited by 76 · see citing works
Internet-Delivered Acceptance and Values-Based Exposure Treatment for Fibromyalgia: A Pilot Study
Ljótsson, B., Atterlöf, E., Lagerlöf, M., Andersson, E., Jernelöv, S., Hedman, E., Kemani, M., & Wicksell, R. K. (2014) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2013.846401 · Cited by 70 · see citing works
“IBS is an abdominal pain disorder characterized by fear-avoidance (Ljótsson et al., 2013) and substantial comorbidity with FM (Whitehead, Palsson, & Jones, 2002), suggesting that a similar treatment approach to the two disorders may be feasible.”
BackgroundResultInfluentialSelf-citationEhlers, A., Wild, J., Warnock-Parkes, E., Grey, N., Murray, H., Kerr, A., Rozental, A., Thew, G., Janecka, M., Beierl, E. T., et al. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(23)00181-5 · Cited by 68 · see citing works
“39 One could ask whether the small to medium effects matter.”
BackgroundSelf-citationWindgassen, S., Moss‐Morris, R., Chilcot, J., Sibelli, A., Goldsmith, K., & Chalder, T. (2017) · British Journal of Health Psychology · doi:10.1111/bjhp.12250 · Cited by 67 · see citing works
Murray, H. B., Kuo, B., Eddy, K. T., Breithaupt, L., Becker, K. R., Dreier, M. J., Thomas, J. J., & Staller, K. (2021) · International Journal of Eating Disorders · doi:10.1002/eat.23414 · Cited by 74 · see citing works
Weltens, N., Iven, J., Oudenhove, L. V., & Kano, M. (2018) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13969 · Cited by 67 · see citing works
Johansson, R., Hesslow, T., Ljótsson, B., Jansson, A., Jonsson, L., Färdig, S., Karlsson, J., Hesser, H., Frederick, R. J., Lilliengren, P., et al. (2017) · Psychotherapy · doi:10.1037/pst0000147 · Cited by 55 · see citing works
“Future comparative studies between IPDT and ICBT should include process measures that could be used to investigate mechanisms of change in Internet-based treatments (Hesser, Westin, & Andersson, 2014; Ljótsson et al., 2013).”
BackgroundSelf-citationBonnert, M., Olén, O., Bjureberg, J., Lalouni, M., Hedman-Lagerlöf, E., Serlachius, E., & Ljótsson, B. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.03.006 · Cited by 53 · see citing works
Self-citationInfluence of Interoceptive Fear Learning on Visceral Perception
Zaman, J., Weltens, N., Ly, H. G., Struyf, D., Vlaeyen, J. W. S., den Bergh, O. V., Wiech, K., Oudenhove, L. V., & Diest, I. V. (2015) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000257 · Cited by 53 · see citing works
“Ljótsson and colleagues (68) demonstrated that reductions in gastrointestinal-specific anxiety mediated the therapeutic effect of exposure on FGID symptoms.”
Hesser, H., Hedman-Lagerlöf, E., Andersson, E., Lindfors, P., & Ljótsson, B. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000273 · Cited by 50 · see citing works
“…fear responses have, in turn, been expected to break a vicious cycle of hypervigilance to gut sensations, pain sensitivity, and poor coping responses (e.g., avoidance, control behaviors, monitoring) contributing to symptom exacerbation and maintenance (Craske et al., 2011; Ljótsson et al., 2013).”
BackgroundMethodResultInfluentialSelf-citationHenrich, J. F., Gjelsvik, B., Surawy, C., Evans, E., & Martin, M. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000483 · Cited by 47 · see citing works
Ljótsson, B., Jones, M., Talley, N. J., Kjellström, L., Agréus, L., & Andreasson, A. (2020) · United European Gastroenterology Journal · doi:10.1177/2050640619900577 · Cited by 44 · see citing works
Self-citationInteroception, conditioning, and fear: The panic threesome
Van Diest, I. (2019) · Psychophysiology · doi:10.1111/psyp.13421 · Cited by 44 · see citing works
Murray, H., Flanagan, R., Banashefski, B., Silvernale, C. J., Kuo, B., & Staller, K. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2019.12.030 · Cited by 41 · see citing works
Lackner, J., Gudleski, G., Ma, C.-X., Dewanwala, A., & Naliboff, B. (2014) · American Journal of Gastroenterology · doi:10.1038/ajg.2014.241 · Cited by 41 · see citing works
Cassar, G. E., Knowles, S., Youssef, G. J., Moulding, R., Uiterwijk, D., Waters, L., & Austin, D. W. (2018) · Psychology, Health & Medicine · doi:10.1080/13548506.2018.1476722 · Cited by 40 · see citing works
“…and pain catastrophizing are able to both predict and mediate outcomes, which is concordant with previous research (Jerndal et al., 2010; Knowles et al., 2016; Lackner & Quigley, 2005; Ljotsson et al., 2013; van Tilburg et al., 2013; Wolitzky-Taylor, Craske, Labus, Mayer, & Naliboff, 2012).”
ResultCognitive Behavioral Therapy for IBS: How Useful, How Often, and How Does It Work?
Radziwon, C. D., & Lackner, J. M. (2017) · Current Gastroenterology Reports · doi:10.1007/s11894-017-0590-9 · Cited by 42 · see citing works
Grodzinsky, E., Walter, S., Viktorsson, L., Carlsson, A.-K., Jones, M. P., & Faresjö, Å. (2015) · BMC Family Practice · doi:10.1186/s12875-015-0225-x · Cited by 45 · see citing works
“Several studies of exposure-based CBT for IBS demonstrated that it is superior to attention control conditions [55,56] and that symptom improvements are mediated through change in symptom-related fear [57].”
BackgroundDevelopment of Irritable Bowel Syndrome Features Over a 5-year Period
Clevers, E., Tack, J., Törnblom, H., Ringström, G., Luyckx, K., Simrén, M., & Van Oudenhove, L. (2018) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2018.02.043 · Cited by 34 · see citing works
“02 Age, y 44 13 41 14 36 11 Female, n (%) 31 (53) 86 (72) 31 (86) IBS-C, n (%) 11 (19) 23 (20) 7 (20) IBS-D, n (%) 29 (50) 47 (40) 9 (26) IBS-A, n (%) 18 (31) 47 (40) 19 (54) PI-IBS, n (%) 7 (27) 6 (9) 1 (5) IBS duration, y 11 7 11 8 10 5 Rectal pain threshold, mm Hg 41 12 36 13 31 12 Accelerated transit, n (%) 6 (24)…”
Windgassen, S., Moss-Morris, R., Goldsmith, K., & Chalder, T. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.11.013 · Cited by 33 · see citing works
“Future studies should aim to include measurements at closer intervals for the purpose of assessing mediation [14] as has been conducted in previous mediation studies in IBS [17, 25].”
BackgroundInfluentialBonnert, M., Ljótsson, B., Hedman, E., Andersson, J., Arnell, H., Benninga, M., Simrén, M., Thulin, H., Thulin, U., Vigerland, S., et al. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.07.002 · Cited by 33 · see citing works
“for adultswith IBS showed that reduction in fear and avoidance of symptomswere associatedwith and preceded improvement in IBS symptoms (Ljótsson et al., 2013), indicating that the same mechanisms of change may have been active in this trial.”
BackgroundResultSelf-citationGrinsvall, C., Törnblom, H., Tack, J., Oudenhove, L. V., & Simrén, M. (2018) · United European Gastroenterology journal · doi:10.1177/2050640617715851 · Cited by 32 · see citing works
“Exposure-based cognitive behavioral therapy (CBT) has been shown to be effective in IBS, with its effects on GI symptoms being mediated by its effect on reducing GI-specific anxiety.(38) Based on these findings and our current finding of an association between GI symptom-specific anxiety and visceral sensitivity, this…”
BackgroundLalouni, M., Ljótsson, B., Bonnert, M., Hedman‐Lagerlöf, E., Högström, J., Serlachius, E., & Olén, O. (2017) · JMIR Mental Health · doi:10.2196/mental.7985 · Cited by 36 · see citing works
Self-citationOptimizing Long-term Outcomes of Exposure for Chronic Primary Pain from the Lens of Learning Theory
Gatzounis, R., den Hollander, M., & Meulders, A. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.04.012 · Cited by 29 · see citing works
Health-Related Quality of Life in Irritable Bowel Syndrome
Cassar, G. E., Youssef, G., Knowles, S., Moulding, R., & Austin, D. (2020) · Gastroenterology Nursing · doi:10.1097/sga.0000000000000530 · Cited by 27 · see citing works
Exposure-Based Therapy for Symptom Preoccupation in Atrial Fibrillation: An Uncontrolled Pilot Study
Särnholm, J., Skúladóttir, H., Rück, C., Pedersen, S. S., Braunschweig, F., & Ljótsson, B. (2017) · Behavior Therapy · doi:10.1016/j.beth.2017.06.001 · Cited by 29 · see citing works
Self-citationFeingold, J. H., Murray, H., & Keefer, L. (2019) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001234 · Cited by 24 · see citing works
Boersma, K., Ljótsson, B., Edebol, H., Schrooten, M. G. S., Linton, S. J., & Brummer, R. J. (2016) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2016.1194455 · Cited by 26 · see citing works
“…these studies compared the efficacy of treatment models focused on the assumption of the causal status of general stress sensitivity (summarized in Ljótsson et al., 2013) with treatment models focused on the causal status of specific gastrointestinal symptom-specific anxiety and found indications…”
BackgroundMethodInfluentialSelf-citationInternet-Based Cognitive Behavior Therapy
Andersson, G., Carlbring, P., & Hadjistavropoulos, H. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803457-6.00021-0 · Cited by 24 · see citing works
Self-citationSampaio, F., Bonnert, M., Olén, O., Hedman, E., Lalouni, M., Lenhard, F., Ljótsson, B., Ssegonja, R., Serlachius, E., & Feldman, I. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-023881 · Cited by 22 · see citing works
Self-citationBiesiekierski, J. R., Manning, L. P., Murray, H. B., Vlaeyen, J. W. S., Ljótsson, B., & Oudenhove, L. V. (2022) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17111 · Cited by 27 · see citing works
Self-citationRadu, M., Moldovan, R., Pintea, S., Băban, A., & Dumitrascu, D. (2018) · Journal of Gastrointestinal and Liver Diseases · doi:10.15403/jgld.2014.1121.273.bab · Cited by 20 · see citing works
“Chilcot& Moss- Morris, 2013 Christensen et al., 2014 Hunt et al., 2014 Hunt et al., 2009 Jones et al., 2011 Lackner et al., 2007 Ljotsson et al, 2013 Reme et al., 2011 Pederesen et al., 2016 WolitzkyTaylor et al., 2012 1.”
BackgroundHesser, H., Hedman-Lagerlöf, E., Lindfors, P., Andersson, E., & Ljótsson, B. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103862 · Cited by 19 · see citing works
Self-citationPrediction of symptomatic improvement after exposure-based treatment for irritable bowel syndrome
Ljótsson, B., Andersson, E., Lindfors, P., Lackner, J. M., Grönberg, K., Molin, K., Norén, J., Romberg, K., Andersson, E., Hursti, T. J., et al. (2013) · BMC Gastroenterology · doi:10.1186/1471-230x-13-160 · Cited by 25 · see citing works
“However, although most psychological treatments for IBS, in accordance with the common rationale, target comorbid psychological distress [6], there are also cognitive behavioral treatments that target disorder-specific behavioral patterns in IBS.”
BackgroundInfluentialSelf-citationGuadagnoli, L., Heathcote, L., Oudenhove, L. V., Elsenbruch, S., & Keefer, L. (2025) · The Lancet Gastroenterology and Hepatology · doi:10.1016/s2468-1253(25)00205-5 · Cited by 18 · see citing works
Future of Brain–Gut Behavior Therapies: Mediators and Moderators
Burton Murray, H., & Ljótsson, B. (2022) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2022.06.011 · Cited by 17 · see citing works
Self-citationYang, Y.-Y., & Jun, S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192114174 · Cited by 16 · see citing works
“intervention program, showed significant improvement in IBS symptoms [15,16].”
BackgroundSärnholm, J., Skúladóttir, H., Rück, C., Klavebäck, S., Ólafsdóttir, E., Pedersen, S. S., Braunschweig, F., & Ljótsson, B. (2021) · JMIR Cardio · doi:10.2196/24524 · Cited by 25 · see citing works
“These results are in line with the previous mediation analyses by our group of exposure-based CBT, where we have found that a reduction in avoidance behavior mediates improvement in other chronic health conditions [51-53].”
Self-citationTanner, S. E., Murray, H., Brown, T. A., Malik, Z., & Parkman, H. (2023) · Neurogastroenterology and Motility · doi:10.1111/nmo.14534 · Cited by 15 · see citing works
Johansson, R. (2013) · Linköping studies in behavioural science · doi:10.3384/diss.diva-100385 · Cited by 14 · see citing works
“An example of a psychotherapeutic approach where the entire evidence base is derived from Internet-based treatment studies is a series of trials testing the efficacy (and effectiveness) of exposure-based cognitive behavior therapy for irritable bowel syndrome (IBS; Ljótsson et al., 2010, 2011).”
BackgroundInfluentialImaging Brain Mechanisms of Functional Somatic Syndromes: Potential as a Biomarker?
Kano, M., Oudenhove, L. V., Dupont, P. J., Wager, T. D., & Fukudo, S. (2020) · The Tohoku Journal of Experimental Medicine · doi:10.1620/tjem.250.137 · Cited by 17 · see citing works
Melchior, C., Wilpart, K., Midenfjord, I., Trindade, I. A., Törnblom, H., Tack, J., Simrén, M., & Oudenhove, L. V. (2022) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001141 · Cited by 13 · see citing works
“The central role of GI-specific anxiety as a mediator of the effect of abuse on symptoms indicates that focusing on this factor as a treatment target might be beneficial for the subgroup of patients with a history of abuse, which would be in line with what has already been demonstrated for psychosocial treatment optio…”
ResultRoger, A. H., Gudleski, G., Quigley, B., Zvolensky, M. J., & Lackner, J. (2023) · The Behavior Therapist · doi:10.1016/j.beth.2023.01.004 · Cited by 12 · see citing works
Petrik, M. L., Palmer, B. E., Khoruts, A., & Vaughn, B. P. (2021) · Crohn's & Colitis 360 · doi:10.1093/crocol/otab061 · Cited by 12 · see citing works
Hesser, H., Hedman, E., Lindfors, P., Andersson, E., & Ljótsson, B. (2017) · Psychological Medicine · doi:10.1017/s0033291717001167 · Cited by 12 · see citing works
“Exposure has been proposed to be an integral component of effective psychological treatments in IBS by targeting potentially important maintaining factors, including increased anxiety and hypervigilance towards IBS symptoms and IBS-associated situations (Labus et al. 2007; Wolitzky-Taylor et al. 2012; Ljótsson et al.…”
BackgroundInfluentialSelf-citationEdebol, H., Ljótsson, B., Linton, S. J., Boersma, K., Schrooten, M. G. S., Repsilber, D., & Brummer, R. J. (2017) · Gastroenterology Research and Practice · doi:10.1155/2017/8915872 · Cited by 13 · see citing works
“Several mediational analyses have also suggested that the effect of exposure-based CBT on IBS symptom is mediated through reduced symptom fear [20, 39, 40].”
BackgroundSelf-citationHjärnan formas av psykologisk behandling
Månsson, K. N. T. (2016) · Linköping studies in behavioural science · doi:10.3384/diss.diva-132637 · Cited by 1 · see citing works
“CBT is a therapeutic approach consisting of numerous models using a broad set of techniques targeting different psychiatric (Cuijpers, Cristea, Karyotaki, Reijnders, & Huibers, 2016) and somatic (Ljótsson et al., 2013) disorders.”
Löwe, B., Nestoriuc, Y., Andresen, V., Vettorazzi, E., Zapf, A., Hübener, S., Maehder, K., Peters, L., & Lohse, A. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-059529 · Cited by 11 · see citing works
Lackner, J. M. (2020) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2020.1780118 · Cited by 15 · see citing works
“[83] who found that exposure works by reducing fear of GI symptoms.”
BackgroundEdebol, H., Schrooten, M. G. S., Ljótsson, B., Boersma, K., Linton, S. J., & Brummer, R. J. (2018) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2017-0153 · Cited by 12 · see citing works
Self-citationGendi, R., & Jahan, N. (2020) · Cureus · doi:10.7759/cureus.9324 · Cited by 10 · see citing works
Andersson, E., Ljótsson, B., Hedman‐Lagerlöf, E., Hesser, H., Enander, J., Kaldo, V., Andersson, G., Lindefors, N., & Rück, C. (2014) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1931 · Cited by 12 · see citing works
Self-citationWallén, H., Ljótsson, B., Svanborg, C., Rydh, S., Falk, L., & Lindfors, P. (2022) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2022.2047220 · Cited by 10 · see citing works
Self-citationWhat are the mechanisms of psychological treatments for irritable bowel syndrome?
Ljótsson, B. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.01.003 · Cited by 9 · see citing works
Self-citationComputer-Assisted Cognitive-Behavior Therapy in Medical Care Settings
Wright, J. H., McCray, L. W., Eells, T., Gopalraj, R., & Bishop, L. B. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0947-2 · Cited by 9 · see citing works
Yu, L., Inspector, Y., & McCracken, L. M. (2021) · British Journal of Pain · doi:10.1177/2049463720926559 · Cited by 8 · see citing works
Editorial : introducing Internet Interventions — A new Open Access Journal
Andersson, G., Riper, H., & Carlbring, P. (2014) · Internet Interventions · doi:10.1016/j.invent.2013.11.001 · Cited by 7 · see citing works
Self-citationAbber, S., Buchanan, K. L., Clukey, J., Joiner, T., Staller, K., & Burton-Murray, H. (2024) · Neurogastroenterology and Motility · doi:10.1111/nmo.14773 · Cited by 6
“35,36 Prior work also suggests that abdominal pain has stronger relations with quality of life than other GI symptoms in women with IBS.”
BackgroundMurray, H. B., Weeks, I., Thurler, A. H., Calabrese, S., Lapinel, M. K., Madva, E. N., Staller, K. D., Keefer, L., & Kuo, B. (2023) · Neurogastroenterology & Motility · doi:10.1111/nmo.14526 · Cited by 9 · see citing works
The role of arousal in maintaining the relationship between insomnia and gastrointestinal conditions
Rameshkumar, S., Arizmendi, B. J., & Salwen‐Deremer, J. K. (2024) · Translational Gastroenterology and Hepatology · doi:10.21037/tgh-23-126 · Cited by 6 · see citing works
“Arousal can take the form of hypervigilance of symptoms in certain GI conditions and can contribute to exacerbation of symptoms over time (19,37,39).”
Sobin, W. H. (2019) · Cambridge International Law Journal · doi:10.1007/978-3-030-18218-2 · Cited by 4 · see citing works
Ingeman, K., Frostholm, L., Wellnitz, K. B., Wright, K., Frydendal, D. H., Onghena, P., & Rask, C. U. (2023) · JMIR Research Protocols · doi:10.2196/46927 · Cited by 3 · see citing works
“…will have a positive effect on participants’ anxiety level; (2) there will be an increase in anxiety at the beginning of treatment, followed by a gradual decrease that becomes steeper after exposure is introduced in module 5; and (3) the effect will be permanent throughout follow-up [14,61,62].”
Exposure-based Interventions for Chronic Pain and Bodily Symptoms: A Special Interest Meeting Report
Schemer, L., Glogan, E., Sjouwerman, R., Ahm, R., Ashar, Y. K., Boddez, Y., Boersma, K., Cañeiro, J. P., Cima, R. F. F., den Hollander, M., et al. (2026) · Behaviour Research and Therapy · doi:10.1016/j.brat.2026.104998 · Cited by 3 · see citing works
Self-citationLackner, J. M. (2024) · Pain · doi:10.1097/j.pain.0000000000003186 · Cited by 3 · see citing works
Liliequist, B. E., Särnholm, J., Skúladóttir, H., Ólafsdóttir, E., Ljótsson, B., & Braunschweig, F. (2023) · JMIR Cardio · doi:10.2196/53815 · Cited by 3 · see citing works
“These results are consistent with previous results of AF-CBT [12,14] and of CBT for other somatic conditions [36-38].”
ResultSelf-citationPainful GI Conditions and Their Bidirectional Relationships with Sleep Disturbances
Salwen‐Deremer, J. K., & Ballou, S. (2022) · Current Sleep Medicine Reports · doi:10.1007/s40675-022-00230-9 · Cited by 4 · see citing works
Integrative Review on Cognitive Behavioral Therapy in Chronic Diseases: The Responses Predictors
Lukkahatai, N. (2019) · Iris Journal of Nursing & Care · doi:10.33552/ijnc.2019.01.000525 · Cited by 4 · see citing works
“[53] Randomized controlled crossed over design”
BackgroundMethodInfluentialCognitive-Behavioral Therapy for Irritable Bowel Syndrome
Hunt, M. G. (2019) · Springer eBooks · doi:10.1007/978-3-030-18218-2_5 · Cited by 8 · see citing works
Manning, L., Houte, M. V. D., Tuck, C., Oudenhove, L. V., & Biesiekierski, J. (2026) · United European Gastroenterology journal · doi:10.1002/ueg2.70204 · Cited by 1 · see citing works
Digital and Conventional Behavioral Therapies for Neurogastroenterology and Motility Disorders
Dave, P., & Kinsinger, S. (2025) · Current Gastroenterology Reports · doi:10.1007/s11894-025-01007-0 · Cited by 1 · see citing works
Wu, H., Liu, Q.-Q., Liu, J., & Liu, M. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1420970 · Cited by 1 · see citing works
Poovey, K. N., Walsh, B. E., Cunning, A., & Rancourt, D. (2026) · International Journal of Eating Disorders · doi:10.1002/eat.70157
Zvolensky, M. J., Smit, T., Wein, P. Y., Bakhshaie, J., Redmond, B. Y., Garey, L., Thai, J. M., & Lackner, J. M. (2025) · Journal of Behavioral Medicine · doi:10.1007/s10865-025-00576-9
“Higher levels of GI-specific anxi - ety are linked to more severe IBS symptoms, increased pain, poorer coping with interoceptive sensations, and reduced quality of life (Hazlett-Stevens et al., 2003; Labus et al., 2004, 2005, 2007; Ljótsson et al., 2013).”
Das Reizdarmsyndrom: kognitiv-behaviorale Faktoren und Interventionen
Stöckner, L., Külpmann, I., Icenhour, A., & Elsenbruch, S. (2024) · PiD - Psychotherapie im Dialog · doi:10.1055/a-2249-8252
Irritable Bowel Syndrome : Studies of central pathophysiological mechanisms and effects of treatment
Lowén, M. (2015) · Linköping University medical dissertations · doi:10.3384/diss.diva-122144
- Authors
- Ljótsson, B., Hesser, H., Andersson, E., Lindfors, P., Hursti, T., Rück, C., Lindefors, N., Andersson, G., & Hedman, E.
- Affiliations
- Karolinska Institutet (SE)
- Linköping University (SE)
- Sabbatsberg Hospital (SE)
- Uppsala University (SE)
- ORCID
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2013
- Volume
- 81
- Issue
- 6
- Pages
- 1113-1126
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W2075378461
- Cited by
- 94
- References
- 0
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 9 · 2021: 6 · 2020: 9 · 2019: 9 · 2018: 10 · 2017: 9 · 2016: 6 · 2015: 6 · 2014: 8 · 2013: 3
- FWCI
- 7.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Stockholm City Council
- Stockholm Centre for Psychiatry Research
- Karolinska Institutet
- Linköping University
- 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, stress management, stress reactivity, mediators of change, treatment engagement
- MeSH terms
- Adult, Anxiety Disorders, Arousal, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Implosive Therapy, Male, Middle Aged, Relaxation Therapy, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Internet, Irritable Bowel Syndrome
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