Mindfulness meditation for women with irritable bowel syndrome – evidence of benefit from a randomised controlled trial
- Correspondence to David J Kearney
Seattle VA Medical Centre, 111GI, 1660 S. Columbian Way, Seattle, WA 98108, USA;
Implications for Nursing Practice and Research
■ Participation in a 8-week course of Mindfulness-Based Stress Reduction (MBSR) may reduce irritable bowel syndrome (IBS) symptoms and improve quality of life for women with IBS.
■ Patient education for women with IBS should now include MBSR as a potential treatment option.
IBS is common with prevalence estimates ranging from 3.7% to 22% worldwide.1 IBS is characterised by recurrent abdominal pain or discomfort associated with two or more of the following: (1) symptom improvement with defecation, (2) change in stool frequency and (3) change in appearance of stool.2 A well-described phenomenon in IBS is gastrointestinal (GI)-specific anxiety, which includes hypervigilance to, fear, and avoidance of GI sensations and contexts.3 Examples of GI-specific anxiety might include worry about not knowing the location of bathroom facilities, or fear that GI sensations represent a serious underlying illness. GI-specific anxiety could have the potential to be modified by psychological interventions.
Mindfulness meditation is intended to foster the ability to bring non-judgmental attention to thoughts, emotions and bodily sensations, which may promote cognitive and behavioural change,4 and decrease rumination. A common clinical method of teaching mindfulness is a standardised class called MBSR.5
Two hundred and twenty-three women were screened for the study, of whom 97 were eligible and randomised. Twenty-two of 97 dropped out before either intervention began and 75 participated in study procedures. Exclusion criteria included mental illness with psychosis, prior psychiatric hospitalisation and inflammatory bowel disease. Subjects were randomised to 8 weekly 2-h sessions plus a half-day session of MBSR, or a support group (SG). Measures were collected at baseline, postintervention and at 3 months follow-up. Compensation was provided for completion of measures and good class attendance. Measures included IBS symptoms, IBS quality of life, GI-specific anxiety and mindfulness skills.
Women randomised to MBSR had greater reductions in IBS symptoms immediately postintervention (26.4% vs 6.2%; p=0.006) and at 3-month follow-up (38.2% vs 11.8%; p=0.001). Quality of life and GI-specific anxiety did not differ significantly between groups immediately postintervention, but were significantly improved at 3-month follow-up in the MBSR group. MBSR participants had significant improvement in mindfulness skills relative to the SG.
A strength of the study is that it employed an active control (a SG), which accounted for non-specific effects of group participation. Approximately 23% of women who were initially randomised dropped out before the interventions began, and subjects were paid for attendance, both of which raise questions about effectiveness and generalisability in clinical practice. Among participants who enrolled in MBSR, class attendance was excellent. These results support referral of women with IBS for MBSR, particularly if heightened GI-specific anxiety, depression or chronic stress appears to play a role. Overall, the study was well designed. Of note, significant improvement in IBS quality of life was not seen immediately postintervention, but was seen 3 months later, suggesting that some of the benefits of MBSR may take time to appear. Longer term follow-up studies are needed to assess if continued improvement occurs, or whether benefits wane over time. Of note, the MBSR curriculum in the study was modified slightly to emphasise the role of mindfulness in IBS-related symptoms and perceptions, whereas MBSR groups in most communities do not include this IBS-specific education. The importance of this supplementary component in symptom improvement is unclear. Patient education for women with IBS should now include MBSR as a potential treatment option.