Mindfulness-Based Stress Reduction for the Treatment of Irritable Bowel Syndrome Symptoms: A Randomized Wait-list Controlled Trial
Irritable bowel syndrome (IBS) is a functional disorder of the lower gastrointestinal (GI) tract affected by stress, which may benefit from a biopsychosocial treatment approach such as mindfulness-based stress reduction (MBSR).
A treatment as usual (TAU) wait-list controlled trial was conducted in Calgary, Canada to investigate the impact of MBSR on IBS symptoms. It was hypothesized that MBSR patients would experience greater reduction in overall IBS symptom severity and self-reported symptoms of stress relative to control patients.
Ninety patients diagnosed with IBS using the Rome III criteria were randomized to either an immediate MBSR program (n = 43) or to wait for the next available program (n = 47). Patients completed IBS symptom severity, stress, mood, quality of life (QOL), and spirituality scales pre- and post-intervention or waiting period and at 6-month follow-up. Intent-to-treat linear mixed model analyses for repeated measures were conducted, followed by completers analyses.
While both groups exhibited a decrease in IBS symptom severity scores over time, the improvement in the MBSR group was greater than the controls and was clinically meaningful, with symptom severity decreasing from constantly to occasionally present. Pre- to post-intervention dropout rates of 44 and 23 % for the MBSR and control groups, respectively, were observed. At 6-month follow-up, the MBSR group maintained a clinically meaningful improvement in overall IBS symptoms compared to the wait-list group, who also improved marginally, resulting in no statistically significant differences between groups at follow-up. Improvements in overall mood, QOL, and spirituality were observed for both groups over time.
The results of this trial provide preliminary evidence for the feasibility and efficacy of a mindfulness intervention for the reduction of IBS symptom severity and symptoms of stress and the maintenance of these improvements at 6 months post-intervention. Attention and self-monitoring and/or anticipation of MBSR participation may account for smaller improvements observed in TAU patients.
KeywordsMindfulness-based stress reduction Irritable bowel syndrome Stress Mood Meditation Yoga
Dr. Linda E. Carlson holds the Enbridge Research Chair in Psychosocial Oncology, co-funded by the Alberta Cancer Foundation and the Canadian Cancer Society Alberta/NWT Division. She is also an Alberta Heritage Foundation for Medical Research Health Scholar. This research was supported by a Calgary Health Region/Centre for the Advancement of Health Research Grant awarded to Dr. Carlson. Kristin Zernicke holds a Canadian Institute of Health Research—Frederick Banting and Charles Best Canada Graduate Scholarship, an Alberta Innovates—Health Solutions Studentship, and a Psychosocial Oncology Research Training Fellowship. We would like to thank our dedicated MBSR instructors, research assistants, and the patients who participated in this research. Without them, this research would not be possible.
Conflict of interest
- 2.Thompson WG, Creed F, Drossman DA, Heaton K, Mazzacca G. Functional bowel disorders and chronic functional abdominal pain. Gastroenterol Int. 1992;5:75–91.Google Scholar
- 6.Mearin F, Badia X, Balboa A, Baro E, Caldwell E, Cucala M, Diaz-Rubio M, Fueyo A, Ponce J, Roset M, Talley NJ. Irritable bowel syndrome prevalence varies enormously depending on the employed diagnostic criteria: comparison of Rome II versus previous criteria in a general population. Scand J Gastroenterol. 2001;36:1155–61.PubMedCrossRefGoogle Scholar
- 12.Burnett CK, Drossman DA. Irritable bowel syndrome and other functional gastrointestinal disorders. In: Haas L, editor. Handbook of primary care psychology. Oxford: Oxford University Press; 2005. p. 411–24.Google Scholar
- 13.Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130:1377–90.Google Scholar
- 16.Cumberland P, Sethi D, Roderick PJ, Wheeler JG, Cowden JM, Roberts JA, Rodrigues LC, Hudson MJ, Tompkins DS, IID Study Executive. The infectious intestinal disease study of England: a prospective evaluation of symptoms and health care use after and acute episode. Epidemiol Infect. 2003;130:453–60.PubMedGoogle Scholar
- 26.American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009;104 Suppl 1:S1-35.Google Scholar
- 27.Kabat-Zinn J. Full catastrophe living. New York: Bantam Dell; 1990.Google Scholar
- 29.Carlson LE, Speca M. Mindfulness-based cancer recovery: a step-by-step MBSR approach to help you cope with treatment and reclaim your life. Oakland: New Harbinger Publications; 2011.Google Scholar
- 37.McNair DD, Lorr M, Droppelman LF. Profile of mood states. San Diego: Educational and Industrial Testing Service; 1971.Google Scholar
- 38.Leckie MS, Thompson E. Symptoms of stress inventory. Seattle: University of Washington; 1979.Google Scholar
- 45.Kabat-Zinn J, Wheeler E, Light T, Skillings A, Scharf MJ, Cropley TG, Hosmer D, Bernhard JD. Influence of a mindfulness-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med. 1998;60:625–32.PubMedGoogle Scholar
- 51.Whitehead WE, Schuster MM. Gastrointestinal disorders: behavioral and physiological bases for treatment. New York: Academic Press; 1985.Google Scholar