The Effectiveness of Emotional Schema Therapy on the Emotional Schemas and Emotional Regulation in Irritable Bowel Syndrome: Single Subject Design

Erfan, Arefeh; Noorbala, Ahmad Ali; Amel, Saeed Karbasi; Mohammadi, Abolfazl; Adibi, Peyman

The Effectiveness of Emotional Schema Therapy on the Emotional Schemas and Emotional Regulation in Irritable Bowel Syndrome: Single Subject Design

Authors

¹ Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran

² Psychosomatic Medicine Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

³ Department of Education and Psychology, Khorasgan Branch, Islamic Azad University, Isfahan, Iran

⁴ Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Positive and negative emotional states are the most important factors in treatment and prevention process of psychosomatic diseases. This research aimed to investigate the effectiveness of emotional schemas' therapy on emotional schemas' modification and difficulties of emotion regulation in women with irritable bowel syndrome (IBS). Materials and Methods: This research was implemented in the framework of single-subject experimental design using step-wise multiple baselines plan. Five patients with IBS were selected as convenience sampling on the base of their willingness to participate and then they received emotional schema therapy (EST). Research tools included ROME III scale, SCID interview, emotional schemas questionnaire, and difficulties of emotional regulation. The analysis of data was done using visual analysis charts, recovery percentage, and reliable change index. Results: The results showed a decrease of scores in some maladaptive schemas and increase of some adaptive schemas than baseline in patients who received EST (P ≤ 0.05). Furthermore, this treatment decreased scores of some emotion regulation difficulty components (P ≤ 0.05). Conclusion: It seems that EST is an appropriate option for treatment of these patients because it is effective in improvement of emotional schemas and difficulties of emotional regulation.

Keywords

References

1.	Phillips K, Wright BJ, Kent S. Psychosocial predictors of irritable bowel syndrome diagnosis and symptom severity. J Psychosom Res 2013;75:467-74. [PUBMED]
2.	Almquist E, Törnblom H, Simrén M. Practical management of irritable bowel syndrome: A clinical review. Minerva Gastroenterol Dietol 2016;62:30-48.
3.	Wolitzky-Taylor K, Craske MG, Labus JS, Mayer EA, Naliboff BD. Visceral sensitivity as a mediator of outcome in the treatment of irritable bowel syndrome. Behav Res Ther 2012;50:647-50. [PUBMED]
4.	Burgell RE, Asthana AK, Gibson PR. Irritable bowel syndrome in quiescent inflammatory bowel disease: A review. Minerva Gastroenterol Dietol 2015;61:201-13. [PUBMED]
5.	Levy RL, Olden KW, Naliboff BD, Bradley LA, Francisconi C, Drossman DA, et al. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology 2006;130:1447-58. [PUBMED]
6.	Naliboff BD, Fresé MP, Rapgay L. Mind/Body psychological treatments for irritable bowel syndrome. Evid Based Complement Alternat Med 2008;5:41-50.
7.	Fond G, Loundou A, Hamdani N, Boukouaci W, Dargel A, Oliveira J, et al. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): A systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2014;264:651-60. [PUBMED]
8.	Lee SP, Sung IK, Kim JH, Lee SY, Park HS, Shim CS, et al. The effect of emotional stress and depression on the prevalence of digestive diseases. J Neurogastroenterol Motil 2015;21:273-82.
9.	Lacy BE, Chey WD, Lembo AJ. New and emerging treatment options for irritable bowel syndrome. Gastroenterol Hepatol (N Y) 2015;11:1-9.
10.	Lindfors P, Ljótsson B, Bjornsson E, Abrahamsson H, Simrén M. Patient satisfaction after gut-directed hypnotherapy in irritable bowel syndrome. Neurogastroenterol Motil 2013;25:169-e86.
11.	Lövdahl J, Ringström G, Agerforz P, Törnblom H, Simrén M. Nurse-administered, gut-directed hypnotherapy in IBS: Efficacy and factors predicting a positive response. Am J Clin Hypn 2015;58:100-14.
12.	Peters SL, Muir JG, Gibson PR. Review article: Gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease. Aliment Pharmacol Ther 2015;41:1104-15. [PUBMED]
13.	Lackner JM, Gudleski GD, Keefer L, Krasner SS, Powell C, Katz LA, et al. Rapid response to cognitive behavior therapy predicts treatment outcome in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2010;8:426-32.
14.	Ljótsson B, Hedman E, Lindfors P, Hursti T, Lindefors N, Andersson G, et al. Long-term follow-up of internet-delivered exposure and mindfulness based treatment for irritable bowel syndrome. Behav Res Ther 2011;49:58-61.
15.	Chilcot J, Moss-Morris R. Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention. Behav Res Ther 2013;51:690-5. [PUBMED]
16.	Tang QL, Lin GY, Zhang MQ. Cognitive-behavioral therapy for the management of irritable bowel syndrome. World J Gastroenterol 2013;19:8605-10. [PUBMED]
17.	Jang AL, Hwang SK, Kim DU. The effects of cognitive behavioral therapy in female nursing students with irritable bowel syndrome: A randomized trial. Eur J Gastroenterol Hepatol 2014;26:918-26. [PUBMED]
18.	Li L, Xiong L, Zhang S, Yu Q, Chen M. Cognitive-behavioral therapy for irritable bowel syndrome: A meta-analysis. J Psychosom Res 2014;77:1-2. [PUBMED]
19.	Lackner JM, Keefer L, Jaccard J, Firth R, Brenner D, Bratten J, et al. The irritable bowel syndrome outcome study (IBSOS): Rationale and design of a randomized, placebo-controlled trial with 12 month follow up of self- versus clinician-administered CBT for moderate to severe irritable bowel syndrome. Contemp Clin Trials 2012;33:1293-310. [PUBMED]
20.	Boersma K, Ljótsson B, Edebol-Carlman H, Schrooten M, Linton SJ, Brummer RJ, et al. Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects. Cogn Behav Ther 2016;45:415-30.
21.	Sayar K, Solmaz M, Trablus S, Ozturk M, Acar B. Alexithymia in irritable bowel syndrome. Turk J Psychiatry 2000;11:190-7.
22.	Porcelli P, De Carne M, Leandro G. Alexithymia and gastrointestinal-specific anxiety in moderate to severe irritable bowel syndrome. Compr Psychiatry 2014;55:1647-53. [PUBMED]
23.	Aliakbari-Dehkordi M, Alipoor A, Mohammadi N, Daghaghzadeh H. The structural model of difficulties in emotion regulation, psychological problems, somatization and gastrointestinal symptoms intensity in functional gastrointestinal disorders. J Isfahan Med Sch 2015;33:28-44.
24.	Leahy RL. Emotional Schema Therapy. New York: Guilford Press; 2015.
25.	Davoodi R. The effect of emotional schemas-based group therapy on emotion regulation in married women: A case study of Isfahan. Adv Environ Biol 2014;8;1458-65.
26.	Herbert JD, Forman EM. Emotional schema therapy: A bridge over troubled waters. In: Leahy RL, editor. Acceptance and Mindfulness in Cognitive Behavior Therapy: Understanding and Applying the New Therapies. New York: Wiley;2012.
27.	Leahy RL. Emotional schemas and resistance to change in anxiety disorders. Cogn Behav Pract 2007;14:36-45.
28.	Rezaee M, Rezaee M. Effectiveness of emotional schema therapy on emotional schemas in major depressive patients. 1^st International Conference on Psychology & Behavioral Sciences. Tehran; 2015.
29.	Daneshmandi S, Izadikhah Z, Kazemi H, Mehrabi HA. The effectiveness of emotional schema therapy on emotional schemas of female victims of child abuse and neglect. J Shahid Sadoughi Univ Med Sci 2014;22:1481-94.
30.	Zorn P, Roder V, Soravia L, Tschacher W. Evaluation of the “Schema-focused emotive behavioural therapy” (SET) for patients with personality disorders: Results of a randomised controlled trial. Psychother Psychosom Med Psychol 2008;58:371-8. [PUBMED]
31.	Khanzadah M, Edrisi F, Muhammadkhani S, Sa'idian M. Factor structure and psychometric properties of emotional schema scale. J Clin Psychol 2013;11:91-117.
32.	Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess 2004;26:41-54.
33.	Khanzadeh M, Saidian M, Hosseinchary M, Edressi F. Factor structure and psychometric properties of difficulties in emotional regulation scale. J Behav Sci 2012;6:87-96.
34.	Hamidpour H. The importance of methodology in studies of cognitive – Behavioral. Baztabe Danesh 2000;3:49-56.
35.	Jacobson NS, Truax P. Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991;59:12-9. [PUBMED]
36.	Leahy RL, Tirch D, Napolitano LA. Emotion Regulation in Psychotherapy: A Practitioner's Guide. Translated by Rad M. Tehran: Arjmand; 2014.
37.	Hawton K, Salkoovskis PM, Kirk J, Clark DM. Cognitive Behaviour Therapy for Psychiatric Problems (A Practical Guide). Translated by Ghassemzadeh H. Oxford: Oxford University Press; 1989.
38.	Izadi R, Abedi MR. Acceptance & Commitment Therapy. Tehran: Jungle; 2014.
39.	Smout M. Psychotherapy for methamphetamine dependence treatment manual. Drug and Alcohol Services South Australia; 2008.
40.	Kanter JW, Busch AM, Rusch LC. Behavioral Activation. Translated by Fereidouni M. Tehran: Arjmand; 2012.
41.	Mehrabi A, Taherifar Z. Emotion regulation therapy. The Introduction of the Third Generation Cognitive-Behavioral Therapies. Tehran: Arjmand; 2015.
42.	Rostami A, Shariatnia K, Khajehvand Khoshli A. The relationship between self-efficacy and mind fullness with rumination among students of Islamic Azad University, Shahrood Branch. Med Sci 2015;24:254-9.
43.	Ahmadvand Z, Heydarinasab L, Shairi MR. Prediction of psychological well – Being based on the components of mindfulness. Health Psychol 2012;1:60-9.
44.	Kafi SM. Diagnosis and Treatment Addiction. Mashhad: Qalamazinreza; 2014.

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