Access Type

Open Access Dissertation

Date of Award

January 2015

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Psychology

First Advisor

Mark A. Lumley

Abstract

ABSTRACT

THE EFFECTS OF EMOTIONAL AWARENESS AND EXPRESSION TRAINING AND RELAXATION TRAINING FOR PEOPLE WITH IRRITABLE BOWEL SYNDROME: A RANDOMIZED TRIAL

by

ELYSE R. THAKUR

August 2015

Advisor: Dr. Mark A. Lumley

Major: Psychology (Clinical)

Degree: Doctor of Philosophy

Irritable bowel syndrome has historically been considered a “functional” or “medically unexplained” disorder, characterized by abdominal discomfort and altered bowel habits. However, many facets of the disorder remain unclear and symptoms are often variable, which make it difficult to find successful treatments. A history of trauma, stressful life events, and intrapsychic conflict is common among people with IBS, as is the tendency to suppress the expression of their negative emotions. Over time, such stress and emotional suppression appears to contribute to IBS or exacerbate its symptoms. Thus, an intervention that enhances emotional awareness and expression may promote better adaptation for patients with IBS; however, most interventions for IBS are aimed at symptom management (e.g., relaxation training pharmacological treatments, diet, exercise) and do not address unresolved stress and emotional suppression. To improve health outcomes for people with IBS, these stress and emotional factors need to be targeted directly in therapy. This study tested how a novel 3-session intervention, emotional awareness and expression training (EAET), compared to a protocol that teaches the conceptually opposite approach – relaxation training (RT) – and how both of these interventions compared to a wait-list control condition.

In this study, 106 people with IBS were recruited from the community and local gastroenterological clinics. Participants completed self-report measures of IBS symptom severity, psychological functioning, and quality of life at baseline, and 4 and 12 following baseline / session 1. Then, participants were randomized to one of three conditions (emotional awareness and expression training, relaxation training, or a wait-list control). Participants in the active interventions met with a therapist weekly, for a 50-minute individual therapy session. At 4 weeks, EAET participants had greater reductions in IBS symptom severity as compared to the control condition. However, both of the active interventions reduced anxiety, hostility, and improved quality of life. At 12 weeks, participants in both of the interventions maintained their improvements; however, only quality of life remained significantly better than controls who, surprisingly, tended to improve on most other measures, eliminating the differences with the other two conditions. These findings provide preliminary evidence that emotional awareness and expression training is an efficacious treatment for IBS. Future research with greater methodological rigor is needed to confirm these findings and advance the understanding of emotional processing interventions for IBS. Research should also move towards translating best practices to front line care.

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