# The CBT study I was in abstract



## Kathleen M. (Nov 16, 1999)

http://www.ibsgroup.org/ubb/ultimatebb.php...c;f=10;t=000769 Went across to the library to do a quick read of the whole article.What I found most interesting and tends to argue against the "it's just fixing the mood" sort of arguements is that the CBT seemed to work better for people who were not depressed and not so well for those who were.They also referenced where the CBT information (what the proticol was) but I didn't write it down...I'll see about finding it out so It can be here for those who might want to see it.K.


----------



## trbell (Nov 1, 2000)

I think the idea that psychologists 'fix the mood' is a misconception that many have and I'm trying to change this but it's hard to do when even a lot of doctors don't understand this. Bada


----------



## Kathleen M. (Nov 16, 1999)

That is part of why I was so excited to see that in the paper!!I think that being able to show that in a large study will help change people's minds about it







K.


----------



## bonniei (Jan 25, 2001)

Wow! That was a large study. If there are that many IBS patients at UNC, you can form quite a support group with it, kmottus! Does such a group exist?


----------



## Guest (Jul 17, 2003)

Sounds very encouraging. Thanx for the post.Evie


----------



## eric (Jul 8, 1999)

Kmottus, I know you will understand this in regards to the above post also and even though this is a single case study.Dr Drossmans comments to me."For now I would suggest you look at the Marchissue of Gastroenterology which has the case report of a woman with severe IBS who responded to psychological treatment and antidepressant and this was evidenced by changes in brain imaging. What that suggests is that there are real physiological effects for people with IBS that relate to stress effecting their pain control symptoms and this can be treated with such treatments. It gets it away from the concept of "psychiatric" and looks more at changes in the functioning of the brain that can be treated." Gastroenterology 2003 Mar;124 3:754-761 Related Alterations of brain activity associated with resolution of emotional distress and pain in a case of severe irritable bowel syndrome.Drossman DA, Ringel Y, Vogt BA, Leserman J, Lin W, Smith JK, Whitehead W.UNC Center for Functional GI and Motility Disorders, Division of Digestive Diseases and Department of Radiology and Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina; and Cingulum NeuroSciences Institute and Department of Neuroscience and Physiology, SUNY Upstate Medical Center, Syracuse, New York.Background & Aims: The association of psychosocial disturbances with more severe irritable bowel syndrome IBS is well recognized. However, there is no evidence as to how these associations might be mediated. Functional magnetic resonance imaging fMRI offers an opportunity to study whether activation of the cingulate cortex, an area involved with the affective and pain intensity coding might be linked to poorer clinical status with IBS. In this case report, we found an association between the severity of a patient's clinical symptoms and psychosocial state, with activation of the cingulate cortex. We also found that clinical and psychosocial improvement was associated with reduced cingulate activation. METHODS: Observational case report of a young woman observed for 16 years with a history of sexual abuse, psychosocial distress, and functional GI complaints. Psychosocial, clinical, and fMRI assessment was performed when the patient experienced severe symptoms and again 8 months later when clinically improved. RESULTS: During severe illness, the patient had major psychosocial impairment, high life stress, a low visceral pain threshold, and activation of the midcingulate cortex MCC, prefrontal area 6/44, and the somatosensory cortex, areas associated with pain intensity encoding. When clinically improved, there was resolution in activation of these 3 areas, and this was associated with psychosocial improvement and an increased threshold to rectal distention. CONCLUSIONS: Activation of the MCC and related areas involved with visceral pain encoding are associated with poor clinical status in patients with severe IBS and psychosocial distress and appear to be responsive to clinical improvement.PMID: 12612913Physcial changes take place an hence make an improvement. http://www.ibsgroup.org/cgi-local/ubbcgi/u...c;f=10;t=000695


----------



## trbell (Nov 1, 2000)

K, you might want to check with Dr. P before sharing the protocol publically. just like any other psychological treatment like the CDs its not in the clients' best interest to get this information escept directly from qualified professional, i think.Bada


----------



## bonniei (Jan 25, 2001)

hey Bada- this is the internet age. I think if the info on how to make bombs is easily availablee on the internet, so should this be. I went to my library yesterday to look it up but the journal is not yet available. If k doesn't make it public, I intend to.


----------



## Kathleen M. (Nov 16, 1999)

The referenced a couple of books/papers, so that is public record which things the referenced.That is all I was looking to do...That is OK with you, isn't it??Once the article hits ISI which things that paper references will be on-line for anyone who accesses ISI.PubMed doesn't give the ref list for each paper, but ISI does, and gives you info on what papers referencec the abstract you are looking at.What I would hope is that since the # of professionals who have done this is pretty low if a patient knows the reference for the proticols there may be some change of finding a therapist who would be willing to look at those references before forging ahead on something they don't know that well.Just because you do CBT doesn't mean you can do CBT for IBS developing a proticol from scratch. Why ask a local therapist to re-invent a perfectly good wheel and most people do not have a CBT/IBS specialist handy.K.


----------



## trbell (Nov 1, 2000)

k.my concern was with the protocol and it would be appropriate to share this with liscensed professionals. I wasn't being critical of you, just reminding you that psychologists like Mike have professional rules for a reason. This is why Mike is appropriately uncomfortable sharing information that he's not published, I would think.sorry for the distraction from what you posted. I am glad to hear the study was posted.Bada


----------



## trbell (Nov 1, 2000)

k, no licensed professional would develop a protocol from scratch and I wish you would contribute to the effort to educate them. With your background I think you might have some insight into this.Bada


----------



## bonniei (Jan 25, 2001)

This is from the book k referenced from the paper. Irritable Bowel Syndrome: Psychosocial Assessment and ftreatments by Blanchardï¿½The cognitive therapy regimen consisted of 10 individual 1- hr sessions, twice per week for the 1st 2 weeks, then ob=nce per week for the next 6 weeks. Treatment started with a clear rationale for the treatment approach, describing IBS as an autonomic-nervous-system- mediated reaction to stress; the reaction was described as having three related components:cognitions, behaviors and physiological responses. Cognitions were emphasized as the determining factors in IBS symptomatology The therapy was an amalgamation of elements from the work of Meichenbaum(1985), Beck (1976) and Persons (1989). The intervention was structured and directive, yet it required the patients active collaboration. Therapy focused on increasing the patients awareness of the associations among stressors, thoughts and IBS symptoms. Next was emphasized training patients to identify and then modify their appraisals and interpretations of threatening stimuli. Intervention encompassed the use of both verbal and behavioral techniques to identify and modify underlying psychological mechanisms, fundamental beliefs, and assumptions.Self recording of automatic thoughts was emphasized. Patients were provided monitoring forms and asked to monitor daily, throughout treatment, automatic thoughtsas they occurred across daily situations that they found to be stressful. The therapist focused on the cognitive responses generated on the patientï¿½s monitoring sheets and working collaboaratively with the patient, identified control themes, or ï¿½working hypothesesï¿½, concerning the patientï¿½s underlying psychological mechanisms.Therapeutic work was directed at activating three change mechanisms:1)	ï¿½rational self analysisï¿½ or self understanding (in which the patient explores idiosyncratic beliefs and fears, their connection to the cognitive, behavioral, and affective components of their IBS, and in which they reach an understanding of their fundamental maladaptive orientation to self and world)2)	The second part of the therapeutic change mechanisms was ï¿½decentering,ï¿½. in which the patient gains distance from self by identifying his or her self talk and labeling it as self talk, thereby ï¿½explicitly ï¿½owningï¿½ automatic thoughts.3)	Lastly one begins to involve experential disconfirmation (admittedly focused) in which patients are led to challenge their maladaptive beliefs through strategically planned behavioral experiments and deliberately acting differently so as to experience the self in different ways.Clinical HintSome patients balk at step 1. They may claim to live a stress-free lifw and to find no connection between IBS symptoms and environmentalevents and their thoughts. The first step is to push the patient gently to reexamine his or her life. If that fails one can ask the patient to make a working hypothesis that there may be a connection. They are then asked to go along with the recording and analysis, even if ï¿½they knowï¿½ that it does not apply to them personally.If the latter fails then this may not be an approach which will work for this patient. We find this in about 10% of the cases, mostly menï¿½K were you aware of these 3 steps that I listed above during therapy or was that through osmosis on a subliminal level and could you tell us an irrational belief of yours and take us through the three steps which helped you get over it, please?


----------



## Kathleen M. (Nov 16, 1999)

Answered some of bonnei's questions on another thread she started.What concerns me about some professionals is that based on what people say there are a bunch of people who at least either try to "do it from scratch" or just do the "standard stress reduction" thing without any real focus towards what works for IBSers since they have no experience.Basically there seems to be a fair number of people who do a generalized program and the people do not get better (based on what a fair number of people say here) I think that when people chose a therapist, they need to find someone who either has been trained for IBS or if one is not readily available one who will look at the PUBLISHED materials (the refs in the paper are to other PUBLISHED work...basically if you use anything else in developing the proticol you HAVE to cite the other people's published work that you used. In the paper I was a guinea pig for at least 2 things were cited as the reference material for the proticol used in the study...I wouldn't even begin to know how to write up unpublished works, nor would I steal someone else's intellectual property and publish it here)The book quoted from above is one I BELIEVE is one of the cited reference works...the date is correct and the title sounds familiar but I need to get back to the library to recheck it is one of the ones they used.There are books (the one I think that is quoted above is one that Jeff has listed in the book section of this site...so I figure it is OK to let people know it exists) out there that educate people in the field as to what works, but they are also available to any lay person that wants it. After all that book is listed on amazon.com any yahoo can buy it whether it is good for them or not.AND I don't have a lot of access to professionals in the field to educate them. It is not my background and I am just a guinea pig. On the other hand, I feel that if there is patient demand for this, it might get at least a few people wanting to provide it and do it well, rather than doing just what they do for any random "I need to reduce stress" type proticol.K.


----------



## BQ (May 22, 2000)

bump


----------

