Treatment of Fear and Pain in Irritable Bowel Syndrome

产品说明：肠易激综合征（IBS）是最常见的功能性胃肠道疾病，其主要症状为慢性腹痛或与改变的排便习惯相关的不适。 IBS的特征在于与压力相关的症状恶化和与情感障碍（特别是焦虑）的高共病率。 目前的建议是基于IBS的疾病模型，该模型强调中枢神经系统中的应激和恐惧回路的增强的反应性和调节，以及相关的过度警觉、应激诱导的痛觉过敏和对内脏感觉的自主反应的改变。 基于这个模型和现在用于焦虑症的非常成功的暴露治疗，我们设计并成功地试行了一种独特的IBS认知行为治疗（CBT）。 传统的CBT治疗侧重于减少一般压力反应和增加生活压力的应对技能，并且在IBS中仅显示出适度的疗效。 我们假设，IBS症状可以更有效地治疗，通过减少内感受性条件反射，特别是改变内脏感觉的反应，并将注意力从内脏刺激。 如果我们的假设是正确的，我们希望在这种新的CBT方法之后看到更大的症状改善以及改变的生理反应的正常化。 我们建议解决以下具体目标：1）主观结果之间的两个认知行为干预与不与内感受性暴露和定向注意，注意力控制治疗不同？ 2)不同的治疗反应是否伴随着对内脏刺激的知觉和自主反应的变化？3）不同的治疗反应是否伴随着对内脏刺激反应的局部脑激活的正常化？ 在单独的研究中，我们将使用功能性磁共振成像（fMRI）比较CBT与内感受性暴露和对传统CBT（和对照条件）的直接关注对症状减轻、信念、内脏敏感性（疼痛、不适和对球囊扩张的恐惧反应）和对内脏刺激的中枢反应的结果测量。

DESCRIPTION: (provided by applicant) Irritable Bowel Syndrome (IBS) is the most common of the functional gastrointestinal disorders with primary symptoms of chronic abdominal pain or discomfort associated with altered bowel habits. IBS is characterized by stress-related symptom exacerbations and a high co-morbidity with affective disorders, in particular, anxiety. The current proposal is based on a disease model of IBS that emphasizes enhanced responsiveness and conditioning of stress and fear circuits in the central nervous system, and associated hypervigilance, stress-induced hyperalgesia, and altered autonomic responses to visceral sensation. Based on this model and the highly successful exposure treatments now used for anxiety disorders, we have designed and successfully piloted a unique cognitive behavioral treatment (CBT) for IBS. Traditional CBT treatments focus on decreasing general stress responses and increasing coping skills for life stress, and have shown only modest efficacy in IBS. We hypothesize that IBS symptoms can be more effectively treated by specifically changing responses to visceral sensations through decreasing interoceptive conditioned responses, and directing attention away from visceral stimuli. If our hypotheses are correct, we expect to see greater symptom improvements as well as normalization of altered physiological responses following this new CBT approach. We propose to address the following specific aims: 1) Do subjective outcomes differ between the two cognitive behavioral interventions with and without interoceptive exposure and directed attention, and an attention control treatment? 2) Are differential treatment responses accompanied by changes in perceptual and autonomic responses to visceral stimuli? And 3) Are differential treatment responses accompanied by normalization of altered regional brain activation in response to visceral stimuli? In separate studies we will compare CBT with interoceptive exposure and directed attention to tradition CBT (and a control condition) on outcome measures of symptom reduction, beliefs, visceral sensitivity (pain, discomfort, and fear responses to balloon distension), and central responses to visceral stimulation using functional magnetic resonance imaging (fMRI).