Treatment of Fear and Pain in Irritable Bowel Syndrome

描述：(申请人提供)肠易激综合征(IBS)是最常见的功能性胃肠道疾病，主要症状为慢性腹痛或与排便习惯改变相关的不适。IBS的特点是与应激相关的症状恶化，并与情感障碍，特别是焦虑，有很高的共患率。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应激和恐惧回路的增强反应和条件反射，以及相关的高度警惕、应激诱导的痛觉过敏和对内脏感觉的改变的自主神经反应。基于这一模型和目前用于焦虑症的非常成功的暴露治疗，我们设计并成功地试验了一种针对IBS的独特的认知行为治疗(CBT)。传统的CBT疗法侧重于降低一般应激反应和提高应对生活压力的技能，在IBS方面仅显示出适度的疗效。我们假设IBS症状可以通过减少感觉间条件反射来改变对内脏感觉的反应，并将注意力从内脏刺激转移出去，从而更有效地治疗IBS症状。如果我们的假设是正确的，我们预计在这种新的CBT方法之后，症状会有更大的改善，改变的生理反应也会正常化。我们建议解决以下具体目标：1)有或没有内感暴露和定向注意的两种认知行为干预和注意控制治疗的主观结果是否不同？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？以及3)不同的治疗反应是否伴随着对内脏刺激的改变的大脑区域激活的正常化？在单独的研究中，我们将使用功能磁共振成像(FMRI)比较CBT和感觉性暴露，并将注意力集中在传统CBT(和对照条件)的结果指标上，包括症状减轻、信念、内脏敏感性(对气球扩张的疼痛、不适和恐惧反应)以及对内脏刺激的中枢反应。

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).