Author: Helen Burton Murray1,2,3,4, Fengqing Zhang5,6, Christine C Call5,6, Ani Keshishian7, Rowan A Hunt5,6, Adrienne S Juarascio5,6, Jennifer J Thomas7,8
1 Department of Psychology, Drexel University, Philadelphia, PA, USA. firstname.lastname@example.org.
2 The WELL Center, Drexel University, Philadelphia, PA, USA. email@example.com.
3 Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA. firstname.lastname@example.org.
4 Harvard Medical School, Boston, MA, USA. email@example.com.
5 Department of Psychology, Drexel University, Philadelphia, PA, USA.
6 The WELL Center, Drexel University, Philadelphia, PA, USA.
7 Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.
8 Harvard Medical School, Boston, MA, USA.
Conference/Journal: Dig Dis Sci
Date published: 2020 Nov 11
Other: Special Notes: doi: 10.1007/s10620-020-06685-6. , Word Count: 264
Rumination syndrome (RS) is often treated in medical settings with 1-2 sessions of diaphragmatic breathing to target reflexive abdominal wall contraction in response to conditioned cues (e.g., food). However, many patients remain symptomatic and require additional behavioral interventions.
In an attempt to augment diaphragmatic breathing with additional interventions, we tested the proof-of-concept of a comprehensive Cognitive-Behavioral Therapy (CBT) for RS.
In an uncontrolled trial, adults with RS completed a 5-8 session CBT protocol, delivered by one of two psychology behavioral health providers. CBT included two main phases: awareness training and diaphragmatic breathing (Phase 1) and modularized interventions chosen by the therapist and patient to target secondary maintenance mechanisms (Phase 2). At pre-treatment, post-treatment, and 3-month follow-up, participants completed a semi-structured interview on RS symptoms with an independent evaluator.
Of 10 eligible individuals (ages 20-67 years, 50% female) offered treatment, all 10 initiated treatment and eight completed it. All participants endorsed high treatment credibility at Session 1. Permutation-based repeated measures ANOVA showed participants achieved large reductions in regurgitations across treatment [F(1,7) = 17.7, p = .007, ηp2 = .69]. Although participants reduced regurgitations with diaphragmatic breathing during Phase 1, addition of other CBT strategies in Phase 2 produced further large reductions [F(1,7) = 6.3, p = .04, ηp2 = .47]. Of eight treatment completers, treatment gains were maintained at 3-month follow-up for n = 6.
Findings provide evidence of feasibility, acceptability, and proof-of-concept for a comprehensive CBT for RS that includes interventions in addition to diaphragmatic breathing to target secondary maintenance mechanisms. Randomized controlled trials are needed.
Keywords: Disorders of gut-brain interaction; Feeding and eating disorders; Functional gastrointestinal disorder; Habit-reversal training; Rumination disorder; Rumination syndrome.
PMID: 33175346 DOI: 10.1007/s10620-020-06685-6