uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Mechanisms of Change in an Exposure-Based Treatment for Irritable Bowel Syndrome
Show others and affiliations
2013 (English)In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 81, no 6, 1113-1126 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to identify mediators of change in a previously published randomized controlled trial that compared Internet-delivered cognitive behavioral treatment based on exposure exercises (ICBT) with Internet-delivered stress management (ISM) for irritable bowel syndrome (IBS). ICBT and ISM targeted distinct proposed mechanisms of illness maintenance and symptom exacerbation, gastrointestinal symptom-specific anxiety (GSA), and stress reactivity, respectively. The original study found that ICBT was more effective than ISM in improving IBS symptoms. Method: Weekly measurements of GSA and stress reactivity (putative mediators) and treatment outcome were obtained from 195 participants with IBS, who had been randomized to ICBT or ISM. Results: Parallel process growth mediational analyses revealed that the larger reduction of IBS symptoms from ICBT compared to ISM was mediated by changes in GSA, alpha beta = 0.42, 95% CIasymmetric [-0.71, -0.16]. In contrast, changes in stress reactivity did not mediate the difference in outcomes between treatments, alpha beta = 0.04, 95% CIasymmetric [-0.09, 0.20]. Analyses of the temporal sequence of week-to-week changes in process and outcome measures showed that only GSA displayed a pattern consistent with a causal model in which change in process preceded and contributed to symptom change. Furthermore, engagement in treatment specific activities was related to change in GSA but not to stress reactivity in the ICBT arm, whereas treatment specific activities were not related to change in any of the putative processes in the ISM arm. Conclusions: We conclude that ICBT works through directly targeting GSA, rather than by means of reducing stress reactivity.

Place, publisher, year, edition, pages
2013. Vol. 81, no 6, 1113-1126 p.
Keyword [en]
IBS, exposure, stress management, mediation, growth curve analysis
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-213912DOI: 10.1037/a0033439ISI: 000327856400016OAI: oai:DiVA.org:uu-213912DiVA: diva2:683714
Available from: 2014-01-06 Created: 2014-01-05 Last updated: 2014-01-06Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Hursti, Timo
By organisation
Department of Psychology
In the same journal
Journal of Consulting and Clinical Psychology
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 199 hits
ReferencesLink to record
Permanent link

Direct link