Comprehensive Cognitive-Behavioral Interventions Augment Diaphragmatic Breathing for Rumination Syndrome: A Proof-of-Concept Trial

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
Author Information:
1 Department of Psychology, Drexel University, Philadelphia, PA, USA. hbmurray@mgh.harvard.edu.
2 The WELL Center, Drexel University, Philadelphia, PA, USA. hbmurray@mgh.harvard.edu.
3 Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA. hbmurray@mgh.harvard.edu.
4 Harvard Medical School, Boston, MA, USA. hbmurray@mgh.harvard.edu.
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


Background:
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.

Aims:
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.

Methods:
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.

Results:
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.

Conclusions:
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

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