Hugo Hesser1, Erik Hedman-Lagerlöf2, Erik Andersson3, Perjohan Lindfors4, Brjánn Ljótsson3. 1. Department of Behavioural Sciences and Learning, Linköping University. 2. Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet. 3. Department of Clinical Neuroscience, Division of Psychology, Karolinska Institute. 4. Department of Medicine Huddinge, Karolinska Institutet.
Abstract
OBJECTIVE: Systematic exposure is potentially an effective treatment procedure for treating irritable bowel syndrome (IBS), but little is known about the processes by which it achieves its effect on outcome. The aim of this study was to identify mediators in a previously published randomized dismantling trial in which participants with IBS were randomized to Internet-delivered cognitive-behavioral treatment (ICBT) that incorporated systematic exposure or to the same treatment protocol without exposure (ICBT-WE). METHOD: Weekly measurements of gastrointestinal anxiety-specific process variables (behavioral avoidance, gastrointestinal-specific anxiety) based on the gastrointestinal symptom-specific anxiety model, generic process variables (self-efficacy and mindful nonreactivity), and treatment outcome (IBS symptoms) were obtained from 309 participants with IBS. Growth models and cross-lagged panel models, estimated within structural equation modeling, were employed to evaluate mediators of outcome. RESULTS: Parallel process growth modeling showed that behavioral avoidance, gastrointestinal-specific anxiety, self-efficacy mediated the incremental effect of ICBT compared to ICBT-WE. The mediated effect of avoidance was stronger for individuals scoring high on the avoidance variable at 1st measurement point. Cross-lagged regression analyses with random effects revealed that behavioral avoidance and gastrointestinal-specific anxiety had a stronger effect on subsequent symptom change rather than vice versa, whereas mindful nonreactivity and self-efficacy displayed the opposite pattern. CONCLUSIONS: The evidence collectively provided support for the hypothesis that exposure for IBS achieves its positive results by virtue of changing gastrointestinal anxiety-specific processes rather than generic processes. IBS-specific behavioral avoidance emerged as the most clear-cut mediator of the specific effect of exposure on outcome. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
RCT Entities:
OBJECTIVE: Systematic exposure is potentially an effective treatment procedure for treating irritable bowel syndrome (IBS), but little is known about the processes by which it achieves its effect on outcome. The aim of this study was to identify mediators in a previously published randomized dismantling trial in which participants with IBS were randomized to Internet-delivered cognitive-behavioral treatment (ICBT) that incorporated systematic exposure or to the same treatment protocol without exposure (ICBT-WE). METHOD: Weekly measurements of gastrointestinal anxiety-specific process variables (behavioral avoidance, gastrointestinal-specific anxiety) based on the gastrointestinal symptom-specific anxiety model, generic process variables (self-efficacy and mindful nonreactivity), and treatment outcome (IBS symptoms) were obtained from 309 participants with IBS. Growth models and cross-lagged panel models, estimated within structural equation modeling, were employed to evaluate mediators of outcome. RESULTS: Parallel process growth modeling showed that behavioral avoidance, gastrointestinal-specific anxiety, self-efficacy mediated the incremental effect of ICBT compared to ICBT-WE. The mediated effect of avoidance was stronger for individuals scoring high on the avoidance variable at 1st measurement point. Cross-lagged regression analyses with random effects revealed that behavioral avoidance and gastrointestinal-specific anxiety had a stronger effect on subsequent symptom change rather than vice versa, whereas mindful nonreactivity and self-efficacy displayed the opposite pattern. CONCLUSIONS: The evidence collectively provided support for the hypothesis that exposure for IBS achieves its positive results by virtue of changing gastrointestinal anxiety-specific processes rather than generic processes. IBS-specific behavioral avoidance emerged as the most clear-cut mediator of the specific effect of exposure on outcome. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Authors: Brjánn Ljótsson; Michael Jones; Nicholas J Talley; Lars Kjellström; Lars Agréus; Anna Andreasson Journal: United European Gastroenterol J Date: 2020-01-14 Impact factor: 4.623
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Authors: Jonna Hybelius; Anton Gustavsson; Sandra Af Winklerfelt Hammarberg; Eva Toth-Pal; Robert Johansson; Brjánn Ljótsson; Erland Axelsson Journal: Pilot Feasibility Stud Date: 2022-07-19
Authors: Maria Lalouni; Aleksandra Bujacz; Marianne Bonnert; Karin B Jensen; Anna Rosengren; Erik Hedman-Lagerlöf; Eva Serlachius; Ola Olén; Brjánn Ljótsson Journal: Front Pain Res (Lausanne) Date: 2022-10-03
Authors: Hugo Wallén; Perjohan Lindfors; Erik Andersson; Erik Hedman-Lagerlöf; Hugo Hesser; Nils Lindefors; Cecilia Svanborg; Brjánn Ljótsson Journal: BMC Gastroenterol Date: 2021-07-13 Impact factor: 3.067