"Mindfulness" may ease irritable bowel symptoms

NEW YORK Wed Jun 29, 2011 5:38pm EDT

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NEW YORK (Reuters Health) - A therapy that combines mindfulness meditation and gentle yoga may help soothe symptoms of irritable bowel syndrome, a small clinical trial suggests.

In a study of 75 women with the digestive disorder, researchers found that those assigned to "mindfulness training" saw a bigger improvement in their symptoms over three months than women who were assigned to a support group.

The findings, they say, suggest that the mindfulness technique should be an option for treating irritable bowel syndrome (IBS).

A doctor not involved in the study agreed.

"I think people with IBS should learn mindfulness skills," said Dr. Delia Chiaramonte, director of education for the University of Maryland's Center for Integrative Medicine in Baltimore.

Learning such skills, she said in an interview, is "100 percent safe," and it could offer people a way to help manage IBS symptoms on their own, long term.

People with IBS have repeated bouts of abdominal cramps, bloating, constipation and diarrhea. The typical treatment includes diet changes, as well as anti-diarrhea medication and, for constipation, laxatives or fiber supplements. There's also some evidence that regular, moderate exercise helps.

The exact cause of IBS is unknown, but anxiety and less-than-ideal coping strategies -- like avoiding going out because of your symptoms -- are thought to make IBS worse for many people.

Because of that, psychological counseling is sometimes used. The best-studied form is cognitive behavioral therapy, which tries to change the unhealthy thinking patterns and behaviors that contribute to people's health problems.

For the new study, Susan A. Gaylord and colleagues at the University of North Carolina, Chapel Hill, looked at a different approach to managing the "brain-gut" connection -- known as mindfulness-based stress reduction.

The researchers randomly assigned 75 women with IBS to either undergo the mindfulness training or attend an IBS support group once a week for eight weeks.

The training included lessons on meditation, gentle yoga postures and "body scanning," in which people focus their attention on one body area at a time to detect muscle tension and other sensations.

Gaylord's team found that three months after the therapy ended, women who'd undergone mindfulness training were faring better than the support group.

On average, their scores on a standard 500-point IBS symptom questionnaire fell by more than 100 points, with a 50-point drop considered a "clinically significant" improvement.

In contrast, women in the support group averaged a 30-point decline, according to results in the American Journal of Gastroenterology.

Chiaramonte said the trial was "tremendously well-designed," and set up to address the common criticisms of studies of mind-body therapies. Testing mindfulness training against a support group, for example, helps control for the fact that people involved in any form of therapy may simply expect to get better -- and, therefore, do.

In surveys, the researchers found that women in the support group were as likely to expect benefits as those in the mindfulness group.

"And still, the mindfulness group did better," Chiaramonte said. "So it's not just the contact with another human being, or not just that they expected to get better."

It also makes sense that mindfulness training would help people with IBS, according to Chiaramonte. "Part of the problem in IBS," she explained, "is the attention people give to the physical discomfort, and what the mind then does with that."

With mindfulness training, the goal is to help people become aware of what they are feeling, but then "let it go" instead of ruminating, and potentially making the physical symptoms worse.

There are still questions about the role of mindfulness in managing IBS, though.

Larger trials, including ones that recruit men as well, are needed, according to Chiaramonte.

There's also the fact that "mindfulness" can be learned in many different ways -- at your local yoga or meditation center, or through a book or CD, for example.

This study looked only at the specific technique of mindfulness-based stress reduction -- a program developed by researchers at the University of Massachusetts in 1979.

To best replicate the therapy given in the study, Chiaramonte noted, a person would have to take a Mindfulness-Based Stress Reduction (MBSR) course, which is widely available worldwide, including at some medical centers. It's usually given in the form of an eight-week program of classes, at a cost of between $300 and $500.

"This study doesn't tell us if learning mindfulness in other ways would work," Chiaramonte said.

On the other hand, she added, for people who are interested, buying a CD or taking a meditation class would be a low-cost, low-commitment way to give mindfulness a go.

SOURCE: bit.ly/lfYimf American Journal of Gastroenterology, online June 21, 2011.

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