Pilot study of acceptance and commitment therapy for irritable bowel syndrome: A preliminary analysis of treatment outcomes and processes of change.

May combine two claims.

The IBSSSS has satisfactory reliability and is sensitive to change.

“This scale has been shown to have satisfactory reliability and to be sensitive to change (Gonsalkorale, Miller, Afzal, & Whorwell, 2003).”

• cites Gonsalkorale, Miller, Afzal, & Whorwell, 2003 sourcePartly supported

  The IBS symptoms section reports significant changes in overall IBS questionnaire scores after hypnotherapy, which supports the scale detecting change in this cohort. The Discussion’s statement about reliability concerns the separate subjective assessment questionnaire (SAQ), not the IBS severity scale. The paper does not establish satisfactory reliability for the IBSSSS. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

GSA is a key feature in IBS symptom maintenance, and higher GSA is related to higher symptom severity and lower quality of life.

“GSA is a key feature in IBS symptom maintenance, by acting as an endogenous stressor, and higher levels of GSA have consistently been shown to be related to higher symptom severity and lower quality of life (Jerndal et al., 2010;Labus et al., 2004Labus et al., , 2007)).”

• cites Jerndal et al., 2010 sourceNot checked — no full text of the source
• cites Labus et al., 2004 sourcePartly supported

  The Validity section reports that higher GSA, measured by the VSI, was associated with greater IBS symptom severity. The Introduction describes GSA as a possible endogenous stressor and a possible contributor to impaired quality of life, but the Proposed use section says its role in symptom maintenance had not been directly tested. This study does not establish a direct association between higher GSA scores and lower quality of life. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites Labus et al., 2007 sourceNot checked — no full text of the source

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

Symptom reduction is not a central ACT target, yet ACT studies commonly report such reductions.

“Although symptom reduction is not a key target in ACT, it is not uncommon for ACT studies to report these reductions (Hayes, Luoma, Bond, Masuda, & Lillis, 2006).”

• cites Hayes, Luoma, Bond, Masuda, & Lillis, 2006 sourceSupported

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

Evidence for psychological IBS interventions is growing, but economic costs have led to self-management approaches being proposed as viable alternatives.

“Empirical support for psychological interventions for IBS is growing (Zijdenbos, Wit, Heijden, Rubin, & Quartero, 2009), however, due to economic costs self-management approaches are being put forward as viable alternatives (Dorn, 2010).”

• cites Zijdenbos, Wit, Heijden, Rubin, & Quartero, 2009 sourceNot checked — no full text of the source
• cites Dorn, 2010 sourcePartly supported

  The Discussion (page unavailable) reports that self-management interventions can benefit patients with IBS, sometimes more than psychological interventions. It does not propose them as viable alternatives because of the economic cost of psychological treatment; instead, it questions whether many self-management interventions are feasible in routine practice. The Background’s cost figure concerns IBS overall, not psychological treatment. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Most background variables had no significant contribution to explained variance of any outcome, except education accounted for some variance in GSA change, which became non-significant when accounting for IBS acceptance.

“As shown in Table 3 most background variables had no significant contribution to the explained variance of any of the outcomes, except for education accounting some variance in the change score of GSA (however this became non-significant when accounting for IBS acceptance).”

May combine two claims.

Adding changes in acceptance as a final step significantly increased total variance explained, with an average total of 32% (range 17% for quality of life to 40% for avoidant behaviours).

“Adding the changes in the process measure of acceptance as a final step resulted in a significant (all p<.05) increment of the total variance explained by the equations with an average total of 32% (range 17% IBS impact on quality of life to 40% on use of avoidant behaviours).”

May combine two claims.

More frequent workbook use was significantly associated with greater reductions in GSA (r=.31, p=.03), but not with other outcome or process variables.

“Higher frequency of use of the workbook was significantly associated with greater reductions in GSA (r=.31; p=.03), but not with the remaining outcome or process variables.”

• AssumptionRests on an assumption: The statistical prediction of later outcome changes by earlier acceptance changes reflects the proposed treatment process rather than an artifact.

May combine two claims.

From before treatment to 6-month follow-up, IBS acceptance rose significantly, with a moderate effect size.

“There was also a significant increase in IBS acceptance, t(55)=6.38,p<.001 with a moderate effect size (d=.50).”

May combine two claims.

Outcome effect sizes were small to medium at post-treatment and rose to medium at follow-up.

“Effect-sizes were between small to medium at post-treatment but increased to medium at follow-up.”

May combine two claims.

Some improvements were clinically significant: nearly 20% of patients no longer met diagnostic criteria at follow-up, and 35% improved their symptom severity classification.

“Finally it is also important to highlight that improvements were also clinically significant in some cases, with almost 20% of patients not meeting criteria for diagnosis at follow-up and 35% of patients improving their symptom severity classification.”

May combine two claims.

IBS acceptance, the intervention's main target, had a small effect size initially and a medium effect size at 6 months.

“Regarding IBS acceptance which was the main target of the intervention, this initially had a small effect size change however 6 months after treatment it had increased to a medium level.”

May combine two claims.

At post-treatment and 6-month follow-up, significant improvements appeared in symptom severity, IBS quality-of-life impact, avoidant behaviours, and gastrointestinal-specific anxiety.

“Significant improvements in symptom severity, IBS impact on quality of life, use of avoidant behaviours and GSA were observed immediately at post-treatment and at 6 month follow-up.”

May combine two claims.

Gastrointestinal-specific anxiety showed a very large effect size immediately after treatment, which grew further at follow-up.

“The exception was GSA, for which a very large effect-size was immediately observed after treatment and that increased even further at follow-up.”

May combine two claims.

Patients maintained their initial post-treatment gains and continued improving at 6-month follow-up.

“Also important to note is patients held their initial posttreatment effects and continued to improve at 6 month follow-up.”

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

ACT proposes that unwillingness to contact aversive experiences leads to excessive control attempts and behavioural patterns away from valued activities.

“ACT proposes that an unwillingness to contact aversive physical, cognitive and emotional experiences (also called experiential avoidance) leads to excessive attempts to try and control, change or eliminate these experiences, promoting therefore behavioural patterns that lead people away from valued activities (Hayes, Strosahl & Wilson, 1999).”

• cites Hayes, Strosahl & Wilson, 1999Not matched

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

Classified as probably not a substantial claim.

CBT is presented as the best evidence-based psychological treatment for IBS.

“Although cognitive behaviour therapy (CBT) has been presented as the best evidence-based psychological treatment (Zijdenbos, Wit, Heijden, Rubin, & Quartero, 2009)for IBS”

• cites Zijdenbos, Wit, Heijden, Rubin, & Quartero, 2009 sourceNot checked — no full text of the source

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

The IBS36 has high internal consistency (α=0.95), high test-retest reliability, and is responsive to change.

“The scale has a high internal consistency (α = 0.95), high test-retest reliability and is responsive to change (Groll et al., 2002)”

• cites Groll et al., 2002 sourceNot checked — no full text of the source

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

The local ethics committee approved the study protocol and patients gave written informed consent.

“The local ethics committee approved the study protocol and patients gave written informed consent prior to enrolment (approval number 08/S1103/67).”

May combine two claims.

Completers and noncompleters differed only marginally on GSA, with noncompleters reporting higher GSA.

“Regarding the process and outcome variables there was only a marginally significant difference for GSA (t=2.05,p=0.46) with noncompleters reporting higher GSA.”

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

The IBS-BRQ has good internal consistency (α=.86) and validity.

“This scale has a good internal consistency (α=.86) and validity (Reme, Darnley, Kennedy, & Chalder, 2010).”

• cites Reme, Darnley, Kennedy, & Chalder, 2010Not matched

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

Classified as probably not a substantial claim.

Ferreira et al. (2011) propose that moving away from valued activities enhances suffering in IBS.

“Ferreira et al. (2011) propose that it is the movement away from activities that are important in one's life that enhances experiences of suffering in IBS as the patient becomes stuck in a set rigid behavioural patterns that allow for less diversity of experiences, therefore curtailing the possibility of experiencing events that would be likely to enhance Quality of Life or even the symptoms them”

• cites Ferreira et al. (2011)Not matched

  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). May combine two claims.

The VSI has good internal consistency (Cronbach's α=0.93) and validity.

“The scale has good internal consistency (Cronbach's α = 0.93) and validity (Labus et al., 2007).”

• cites Labus et al., 2007 sourceNot checked — no full text of the source

May combine two claims.

The findings support the efficacy of a brief ACT protocol for improving IBS outcomes and for maintaining effects at 6-month follow-up.

“Results support the efficacy of a brief ACT protocol in improving IBS outcomes and maintaining therapy effects at 6 month follow-up.”

• AssumptionRests on an assumption: Improvements in IBS outcomes from before treatment to after treatment and follow-up are attributable to the ACT intervention rather than to spontaneous symptom fluctuation, regression to the mean, or other non-treatment factors.
• AssumptionRests on an assumption: The 6-month follow-up period is sufficient to demonstrate maintenance of therapy effects.

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

Treatment fidelity was maintained by using a session protocol and producing a self-help manual.

“Treatment fidelity was maintained by using a session protocol and producing a self-help manual.”

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

The IBSAAQ has good reliability (α=.89) and good validity.

“This scale has shown to have good reliability (α = .89)and good validity ( Ferreira, Eugenicos, Morris, & Gillanders, 2012).”

• cites Ferreira, Eugenicos, Morris, & Gillanders, 2012Not matched

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

May combine two claims.

A baseline period similar in length to the intervention could serve as an adequate control, since post-treatment changes are unlikely to result from time passage or coincidental events in a population without prior standard care benefit.

“however using a baseline period similar to the intervention length could be seen as an adequate control as it is unlikely that changes post-treatment could be accounted by passage of time or coincidental events at the time of treatment in a population that had not benefitted from previous standard care approaches.”

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

Prior chronic pain research has shown similar increases in acceptance over time.

“Similar increases in acceptance over time have been previously observed in chronic pain (McCracken & Gutiérrez-Martínez, 2011).”

• cites McCracken & Gutiérrez-Martínez, 2011 sourceNot checked — no full text of the source

May combine two claims.

Two of the study authors delivered all interventions, raising potential bias in delivery and assessment.

“or the fact that two of the study authors conducted all the interventions.Therefore, potential issues of bias in the delivery and assessment of the intervention should be accounted for in future studies.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Implementing this intervention may require relatively low human and economic investment.

“Given that implementing this intervention will potentially involve a relatively low level of human and economic investment, it is suggested that it could be made available as part of the standard treatment for these patients.”

May combine two claims.

The rise in IBS acceptance over time fits ACT's proposition that acceptance is trainable and can increase with continued practice.

“This seems to be in line with ACT's proposal that acceptance is defined as a behaviour that is passable of being trained, therefore passable to grow with continuous use (Hayes et al., 1999).”

• cites Hayes et al., 1999Not matched

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

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

ACT may be indicated for patients whose improvements have plateaued or who did not improve with symptom-focused treatment.

“Alternatively this study suggests that ACT might be indicated for cases in which improvements either plateaued or were not obtained via the normal symptom focused approach.”

May combine two claims.

The study's self-selected sample-46% of those approached agreed, mostly female and higher educated-limits generalisation to the full IBS population.

“Some limitations include the fact that the study used a self-selected sample (only 46% of patients approached agreed to participate in the study) that was predominantly female and had attended higher education, therefore curtailing any generalization of the results to the whole population of IBS patients.”

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

ACT interventions are thought to reduce symptom reporting by disrupting the aversive experience-control behaviour-immediate relief cycle through acceptance, thereby lowering the functional importance of aversive symptoms.

“So it is thought that some of the aversive features of the symptoms might be removed by lowering their functional importance, therefore resulting in a lower reporting of symptoms.”

May combine two claims.

Avoidant coping in IBS is associated with poorer quality of life, high anxiety and depression, and predicts psychotherapeutic treatment success.

“Recent studies have shown the use of avoidant coping in IBS to be associated with poorer quality of life, high levels of anxiety and depression (Rutter & Rutter, 2007) and to be a good predictor of psychotherapeutic treatment success (Reme, Kennedy, Jones, Darnley, & Chalder, 2010).”

• cites Rutter & Rutter, 2007 sourceNot checked — no full text of the source
• cites Reme, Kennedy, Jones, Darnley, & Chalder, 2010Not matched

  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). May combine two claims.

The sampling method may be a strength because it was naturalistic and allowed comprehensive assessment using gold standard criteria.

“However this sampling method could be seen as a strength as it was done in a naturalistic context and allowed for a comprehensive assessment using gold standard criteria (Spiller et al., 2007).”

• cites Spiller et al., 2007 sourceNot checked — no full text of the source

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

The IBSAAQ measure includes elements of IBS willingness and engagement with important life activities.

“Although, as reported by Ferreira et al. (2012), the measure used (IBSAAQ) encompasses elements of IBS willingness and engagement with important life activities”

• cites Ferreira et al. (2012)Not matched

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

May combine two claims.

The data support the intervention's effectiveness and suggest it operated through the theoretically hypothesised processes.

“Regarding clinical applications, data seems to support the effectiveness of this intervention, but also suggested that it worked through the theoretically hypothesized processes.”

May combine two claims.

Symptom reduction need not always be the target for IBS interventions; targeting patients' relationship with their symptoms can effectively change physical and psychological outcomes.

“This study also implies that symptom reduction might not always have to be the target of interventions with IBS populations and that targeting the relation patients have with their symptoms can be an effective way to produce changes in both physical and psychological outcomes.”

May combine two claims.

This maintenance and further improvement is consistent with Ljótsson and colleagues' 3-month follow-up findings and with ACT behavioural principles.

“This is consistent with the findings of Ljótsson and colleagues (2010) at 3 month follow-up and with the behavioural tenets of ACT, in which it is reasonable to expect that a continuous engagement with accepting and valued behavioural patterns will lead to better outcomes therefore sustaining the effects of treatment by the positive consequences of these new behavioural patterns.”

• cites Ljótsson and colleagues (2010)Not matched

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

May combine two claims.

The trial's results align with two recent ACT-informed IBS studies and strengthen the evidence base for psychological IBS treatments.

“These results support the findings of two recent studies evaluating the efficacy of ACT informed interventions in improving IBS outcomes (Ljótsson, Andréewitch, et al., 2010;Ljótsson, Falk, et al., 2010) and also add to the evidence base of psychological approaches for IBS (Zijdenbos et al., 2009).”

• cites Ljótsson, Andréewitch, et al., 2010Not matched

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

• cites Ljótsson, Falk, et al., 2010 sourceNot checked — no full text of the source
• cites Zijdenbos et al., 2009 sourceNot checked — no full text of the source