title: Provoking symptoms to relieve symptoms: a randomized controlled dismantling study of exposure therapy in irritable bowel syndrome.
abstract: An internet-delivered cognitive behavioral treatment (ICBT) based on systematic exposure exercises has previously shown beneficial effects for patients with irritable bowel syndrome (IBS). Exposure exercises may be perceived as difficult for patients to perform because of the elicited short-term distress and clinicians may be reluctant to use these interventions. The aim of this study was to compare ICBT with the same protocol without systematic exposure (ICBT-WE) to assess if exposure had any incremental value. This randomized controlled dismantling study included 309 participants diagnosed with IBS. The treatment interventions lasted for 10 weeks and included online therapist contact. ICBT-WE comprised mindfulness, work with life values, acceptance, and encouraged reduced avoidance behaviors, while ICBT also included systematic exposure to IBS symptoms and related situations. Severity of IBS symptoms was measured with the Gastrointestinal Symptom Rating Scale - IBS version (GSRS-IBS). The between-group Cohen's d on GSRS-IBS was 0.47 (95% CI: 0.23-0.70) at post-treatment and 0.48 (95% CI: 0.20-0.76) at 6-month follow-up, favoring ICBT. We conclude that the systematic exposure included in the ICBT protocol has incremental effects over the other components in the protocol. This study provides evidence for the utility of exposure exercises in psychological treatments for IBS.
authors.affiliation: Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden. Electronic address: brjann.ljotsson@ki.se.
authors.forename: Brjánn
authors.initials: B
authors.lastname: Ljótsson
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, Linköpings universitet, 581 83 Linköping, Sweden. Electronic address: hugo.hesser@liu.se.
authors.forename: Hugo
authors.initials: H
authors.lastname: Hesser
authors.affiliation: Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Karolinska Universitetssjukhuset Huddinge, M46, 141 86 Stockholm, Sweden. Electronic address: erik.m.andersson@ki.s.
authors.forename: Erik
authors.initials: E
authors.lastname: Andersson
authors.affiliation: Department of Medicine, University at Buffalo School of Medicine and Biomedical Science, ECMC, 462 Grider Street, Buffalo, NY 14215, USA. Electronic address: lackner@buffalo.edu.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Lackner
authors.affiliation: Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Karolinska Universitetssjukhuset Huddinge, M46, 141 86 Stockholm, Sweden. Electronic address: samir.el.alaoui@ki.se.
authors.forename: Samir
authors.initials: S
authors.lastname: El Alaoui
authors.affiliation: Department of Gastroenterology, Sabbatsbergs hospital, Olivecronas väg 1, 113 61 Stockholm, Sweden. Electronic address: lisa.falk@aleris.se.
authors.forename: Lisa
authors.initials: L
authors.lastname: Falk
authors.affiliation: Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden. Electronic address: kristina.aspvall@sll.se.
authors.forename: Kristina
authors.initials: K
authors.lastname: Aspvall
authors.affiliation: Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden. Electronic address: josefin.fransson@sll.se.
authors.forename: Josefin
authors.initials: J
authors.lastname: Fransson
authors.affiliation: Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden. Electronic address: klara.hammarlund@capio.se.
authors.forename: Klara
authors.initials: K
authors.lastname: Hammarlund
authors.affiliation: Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden. Electronic address: annalofstron@hotmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Löfström
authors.affiliation: Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden. Electronic address: sanna.nowinski@gmail.com.
authors.forename: Sanna
authors.initials: S
authors.lastname: Nowinski
authors.affiliation: Department of Gastroenterology, Sabbatsbergs hospital, Olivecronas väg 1, 113 61 Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, M54, Karolinska Universitetssjukhuset Huddinge, 141 86 Stockholm, Sweden. Electronic address: perjohan.lindfors@ki.se.
authors.forename: Perjohan
authors.initials: P
authors.lastname: Lindfors
authors.affiliation: Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden; Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Retzius väg 8 171 77 Stockholm, Sweden. Electronic address: kire.hedman@ki.se.
authors.forename: Erik
authors.initials: E
authors.lastname: Hedman
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D020407:Internet; D043183:Irritable Bowel Syndrome / Q000523:psychology* / Q000628:therapy*; D008297:Male; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome; D055815:Young Adult
keywords: Dismantling study; Exposure; Internet; Irritable bowel syndrome; Randomized controlled trial