Mindfulness Training Targets Cognitive-Affective Mechanisms to Reduce Illness Severity and Improve Quality of Life Among Women with IBS: Results of a Randomized Controlled Trial

Background: Irritable bowel syndrome (IBS) is a stress-related health condition characterized by symptoms of abdominal pain that affects 10-15% of the U.S. population and results in significant disability, impaired quality of life, and health-care burden. Persons with IBS have high rates of psychosocial comorbidities such as anxiety, depression, and sexual trauma histories. Given evidence that the etiology of IBS may involve selective attention to intestinal sensations leading to anxiety and sensitivity to pain, mindfulness meditation, which involves nonjudgmental attention to body sensations and emotions, may be uniquely suited to treat the underlying causes of IBS. Data is presented from a NIH-funded, randomized controlled trial of mindfulness training (MT) for women with IBS. It was hypothesized that MT, relative to an active control condition, would result in significant reductions in IBS severity and improvements in IBS-related quality of life. Methods: 75 female IBS patients recruited from a community sample were randomly assigned to receive either 8 weeks of MT or a social support group (SG) led by a Master's-level social worker. Repeated measures analyses of variance were used to explore the differential effects of treatment on self-reported IBS severity/abdominal pain, IBS-related quality of life, psychiatric symptoms, and dispositional mindfulness. Path analysis was employed to examine mediators of change. Results: Women participating in MT showed greater baseline to post-treatment reduction in IBS symptom severity both at 2 weeks (26.4% vs. 6.2% reduction; p = .006) and 3 months follow-up (38.2% vs. 11.8% reduction; p = .001) relative to the SG. Changes in quality of life, psychological distress, and visceral anxiety were not significantly different between the two groups at the first post-treatment assessment, but MT participants evidenced significantly greater improvements in these variables than SG participants at the 3-month follow-up. MT led to significantly larger increases in dispositional mindfulness after treatment, confirming effective learning of mindfulness skills. Path analysis revealed that the therapeutic effect of MT on IBS-related factors was mediated by increased nonreactivity, a shift from emotional to sensory processing of pain sensations, attenuated visceral hypersensitivity, and decreased pain catastrophizing. Conclusions and Implications: MT exerts significant therapeutic effects on IBS symptoms by promoting nonreactive decentering from gut-focused anxiety and catastrophic appraisals of the significance of abdominal sensations coupled with a refocusing of attention onto interoceptive data with less bias due to emotional interference. Hence, MT appears to target and ameliorate the underlying pathogenic mechanisms of IBS. By disengaging from negative cognitive appraisals of visceral sensations and re-orienting attention to their sensory qualities, IBS patients may come to appraise such sensations as innocuous and eminently manageable. As such, it may behoove medical social workers to learn to implement this empirically-supported intervention as a means of providing effective services to women suffering from IBS.