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Mind-Body Digestive Center:
Original Research
Professional Bibliography
Gerson CD, Gerson M-J. A collaborative health care model for the treatment of irritable bowel syndrome. Clinical Gastroenterology and Hepatology. 1: 446-452, 2003.
Gerson M-J, Gerson CD. A collaborative family systemic approach to treating chronic illness: irritable bowel syndrome as exemplar. Contemporary Family Therapy 27: 37-49, 2005.
Gerson M-J, Gerson CD, Awad R, Dancey C, Poitras P, Porcelli P, Sperber A. An international study of irritable bowel syndrome: family relationships and mind-body attributions. Social Science & Medicine 62: 2838-2847, 2006.
Gerson M-J, Gerson CD. Relationship between pain beliefs, stress perception and symptom severity in irritable bowel syndrome. Gastroenterology 134, Suppl. 1, A-418, 2008.
Gerson CD, Gerson M-J, Awad R, Chowdhury A, Dancey C, Poitras P, Porcelli P, Sperber A, Wang W-A. Irritable bowel syndrome: an international study of symptoms in eight countries. In press, European Journal of Gastroenterology and Hepatology. 2008.
Periodical Bibliography and
Other Invited Presentations
Gerson CD, Gerson M-J. Irritable bowel syndrome: a cross-cultural perspective. FBG (Functional brain gut research group) newsletter, Spring, 2005.
Gerson CD, Gerson MJ. How physicians and psychologists can work together. Meet the Professor luncheon, Digestive Disease Week, Spring, 2006.
Gerson M-J, Gerson CD. Relationships and irritable bowel syndrome. Digestive Health Matters (IFFGD), Spring, 2007.
Gerson M-J, Gerson CD. Use your mind to soothe your stomach. Bottom Line/Health (Boardroom), November, 2007.
Articles Referenced Above
A Collaborative Health Care Model for Treatment of IBS
"A Collaborative Health Care Model for the Treatment of Irritable Bowel Syndrome." Gerson CD, Gerson M-J. Clinical Gastroenterology and Hepatology, November, 2003
BACKGROUND AND AIMS:
There have been few reports of successful treatment of chronically symptomatic patients with irritable bowel syndrome. We performed a single center study to evaluate a new collaborative treatment model that utilized both gastroenterologist and psychologist working together, compared to medical treatment or psychological treatment alone.
METHODS:
The method of treatment in collaborative and psychological sessions focused on the following: how is IBS embedded in life experience, including beliefs and reactions of significant others (lovers, spouses, friends, co-workers); what is the patient's personal life history of IBS; when did the symptoms begin; what is the current pattern. Forty-one irritable bowel syndrome patients, seen in a tertiary setting, were randomly assigned to the three treatment groups. The research design was weighted towards collaborative treatment, which consisted of 3 bi-weekly visits. A series of questionnaires, including a 2 week daily diary, as well as measures of quality of life, anxiety, depression and relationships, were administered before treatment, after treatment and again three months later. At termination of the study, patients completed a global assessment scale.
RESULTS:
16 patients completed the collaborative program, 8 completed medical treatment directed at gastrointestinal function, and 6 completed psychological therapy. protocol analyses showed that global self-assessment improved significantly at long-term follow-up in the collaborative group (p<.0002). Abdominal pain, diarrhea and constipation also improved significantly in the collaborative treatment group (p<.001). The psychological treatment group had 50% improvement in global score. There was no significant improvement in the medically treated group.
CONCLUSIONS:
We have demonstrated that short-term treatment, with gastroenterologist and psychologist working together, is more effective than medical treatment in relieving symptoms in chronic irritable bowel syndrome. Attributes of a collaborative approach are discussed. These pilot data suggest that collaborative treatment programs should be explored in further studies and they show the importance of dealing with both mind and body in these patients.
At the Mind-Body Digestive Center, Drs. Gerson have conducted an important research study comparing the treatment of chronic IBS patients by three different approaches. They documented statistically significant long-term improvement in patients seen by the two of them in a collaborative mind-body model, both by careful measurement of pain, diarrhea and constipation, and by the patient's self-assessment of improvement in their IBS condition. This was superior to medical treatment by Dr. Charles Gerson, alone. The third arm, psychological treatment by Dr. Mary-Joan Gerson appeared to be successful but there were too few patients to reach statistical significance.
This study has been published in a major gastroenterology journal, Clinical Gastroenterology and Hepatology. It is important for a number of reasons:
- By reading our article, gastroenterologists will learn about the importance of mind-body medicine, about thinking about their IBS patients in a more holistic manner. Western medical training does not adequately prepare them for this. The publication of this study indicates a readiness to begin a transition in thinking about chronic illness.
- IBS is not experienced by the patient in isolation. It occurs in an environment that includes intimate relationships, family members and work situations. We feel that it is imperative for the patient to look at these relationships: how do they affect IBS, how does IBS affect these relationships. This is an important aspect of our treatment model.
- Since we consider IBS to be a mind-body condition, we help patients to examine their own illness experience, to be their own investigator: when does the IBS flare up, what are the circumstances. Recognition can lead to insight and improved coping.
- Western medicine tends to look at illness as cause and effect. This can result in physicians who think stress is the cause of IBS saying to their patients: "it's all in your head." Our model is circular- there is no simple cause and effect. Both colonic function and emotions play a role; IBS symptoms can affect emotions and vice versa. This is one of our important messages: patients find it helpful.
- Chronic IBS sufferers have been found to continue to have symptoms over a number of years despite medical treatment. This publication underlines, in a very clear manner, that psychological issues are part of IBS and must be dealt with for long-term improvement. In our model, psychologist and gastroenterologist worked together in an extremely cost-effective manner (only three visits), with impressive results. In chronic illness such as IBS, it is important for physicians and psychologists to work together.
Finally, we would like to thank our IBS patients who participated in this study; without their willingness to help, our important message would not have reached the international gastroenterology community.
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Clinical article published in
Contemporary Family Therapy
Drs. Mary-Joan Gerson and Charles Gerson published "A collaborative family-systemic approach to treating chronic illness: irritable bowel syndrome as exemplar" in Contemporary Family Therapy (March 2005; 27: 37-49). In this article they describe the group program developed on the basis of their collaborative research. Groups of a maximum of 8 patients met for five sessions, two of which focused on medical issues, two on psychological issues and one on nutritional aspects of IBS, with at-home follow-up tasks prescribed. Drs. Gerson were present at one of each other's sessions. All meetings integrated mind and body linkages; active participation was encouraged. Patients often served as impressive resources for each other, and helped relieve the sense of isolation and shame often experienced by IBS patients. Long-term outcome results documented by questionnaires indicated significant reduction in IBS symptoms.[ TOP OF PAGE ]
2006 Global Study:
An International Study of Irritable Bowel Syndrome: Family Relationships and Mind-Body Attributions
An important research article has been published by an international team of IBS investigators, led by Drs. Mary-Joan and Charles Gerson: "An international study of irritable bowel syndrome: Family relationships and mind-body attributions" (Social Science & Medicine 2006; 62: 2838-2847), by M-J Gerson, C.D. Gerson, R.A. Awad, C. Dancey, P. Poitras, P. Porcelli, A.D. Sperber.
This article is the first global study of psycho-social aspects of irritable bowel syndrome. A total of 239 patients in eight countries (US, Mexico, Canada, United Kingdom, Italy, Israel, India and China) out a series of questionnaires. The two most important questionnaires were the Mind-Body IBS questionnaire and the Quality of Relationship Inventory. The MB/IBS score examines the degree to which patients attribute their illness to physical and emotional factors. The QRI looks at three measures of family relationships, depth, support and conflict.
The main findings were universal, suggesting that globalization and urbanization were more important variables than local cultural differences, though some geographic differences were noted.
MAJOR FINDINGS:
- If patients thought their symptoms were predominantly caused by physical factors (examples: food allergies or intestinal parasites), symptom severity was worse. If they recognized that IBS symptoms could be caused by emotional factors, symptoms were less severe. This suggests that a mind-body perspective may be beneficial to IBS patients.
- If family relationships were conflicted, symptom severity was high. If family relationship showed depth and support, severity was low. This suggests that family dynamics may have an effect on the IBS illness experience.
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Does attachment theory account for differences in Irritable Bowel Syndrome symptom severity?
Mary-Joan Gerson, Charles D. Gerson
Attachment theory is a psychological concept, rooted in childhood, that describes three styles of relationship, secure, avoidant and preoccupied/anxious. Secure attachment is marked by closeness, ability to depend on others and to be loved. Avoidant attachment is the converse of secure attachment. Preoccupied attachment is similar to avoidant but includes fear of abandonment. An attachment scale has been developed that measures three variables that reflect on attachment style, closeness, dependence and anxiety. Since relationships in childhood may affect patients with Irritable Bowel Syndrome (IBS), we studied whether an attachment scale predicts IBS symptom severity, directly or indirectly.
METHOD:
100 patients (72 females, 28 males) completed a series of questionnaires: IBS severity score (SS); the attachment scale, (closeness, dependence and anxiety had internal reliability of 86, .76, and .57); perceived stress scale; pain beliefs and perceptions inventory (PBAPI), with subscales: belief that pain will endure, pain is mysterious, and pain is due to self-blame; and quality of relationship inventory (QRI) with depth, support and conflict subscales.
RESULTS:
While attachment subscales did not directly predict SS, there were a number of significant indirect effects via perceived stress and pain beliefs. Attachment anxiety predicted perceived stress (p<.00) which predicted IBS SS (p<.01). Analysis of PBAPI results showed that higher close attachment scores predicted less belief that pain will endure (p<.07) while, conversely, belief that pain will endure predicted IBS SS (p<.00). Low close attachment scores predicted more belief that pain is mysterious (p<.05) while belief in pain as mystery predicted IBS SS (p<.07). Attachment anxiety predicted self-blame (p<.01) which predicted SS in males (p=.055). QRI results indicated that dependent attachment predicted QRI support (p<.01) and close attachment predicted QRI depth (p=.08). However QRI did not predict SS.
CONCLUSION:
While there was no direct predictive effect, attachment style predicts perceived stress which, in turn, predicts severity of IBS symptoms. Mediated through belief systems, close attachment is related to lower IBS symptom severity, while anxious attachment is related to higher IBS symptom severity in males. These results suggest that secure attachment enhances a positive response to IBS pain and symptoms, whereas avoidant and preoccupied attachment renders the patient vulnerable to a more negative response..
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Irritable Bowel Syndrome:
A Cross-Cultural Perspective in Our Research
IBS was originally described predominantly in the United States, Canada and western Europe. There are now articles documenting the presence of IBS in most countries of the world. There are many local factors that may influence a mind-body illness such as illness. These include cultural beliefs, psychological differences, family relationship issues, dietary habits, health care delivery systems and level of economic development.In this article, we introduce many of these ideas with the goal of stimulating interest in cross-cultural factors that may alter the way IBS is experienced and treated in different countries. Drs. Charles and Mary-Joan Gerson and international colleagues have recently completed a global survey of patients with IBS, investigating some of these issues, and a paper describing their findings will soon be published.
Click here to download the entire article.
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Relationships and Irritable Bowel Syndrome
In the Spring 2007 issue of Digestive Health Matters, the publication of the International Foundation for Functional Gastrointestinal Disorders (IFFGD), Drs. Mary-Joan and Charles Gerson wrote an article entitled Relationships and Irritable Bowel Syndrome. This article describes the importance of relationship effects on a patient's health. For example, married people usually have better health than single people (especially men) and unhappy marriages can be detrimental to health.
Relationship issues certainly apply to patients with IBS. A concerned relative can be overly solicitous. For example, asking a patient if she feels ready to take a long car ride can cause anxiety and worsen symptoms. Because of their own frustration, family members may blame an IBS patient for his/her illness, and accuse the patient of eating the wrong foods or being too tense. Family members may not sufficiently recognize the patient's coping strengths and strategies.
In a research study, we showed that IBS patients with a supportive family have milder symptoms than a patient who experiences conflict in the family.
In this relationship article, we conclude with a series of suggestions that may help the patient and his/her family. Examples are: reduce areas of conflict and distress with family members; let others know what kind of support you need; let people know that you need time and space to figure out what is best for you.
Click here to download the entire article.
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Use Your Mind to Soothe Your Stomach
Drs. Gerson wrote a column for the November 2007 issue of Boardroom's Bottom Line/Health magazine entitled "Use Your Mind to Soothe Your Stomach." Bottom Line has a wide corporate distribution so this article offered a chance to educate health consumers about MBDC's mind-body perspective on IBS. Click here to download the article.
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Group Hypnotherapy Study
The MBDC is conducting an outcome research study as part of our group hypnotherapy program. Based on impressive preliminary results, we were invited to give a presentation at the March 2008 national meeting of the American Hypnotherapy Society. Part of our study is a one-year follow-up measure of IBS symptom severity. We presented our initial results which showed improved scores in 90% of participants, an impressive finding. A reduction of 50 points in the IBS symptom severity scale indicates clinical improvement and this was found in about 70% of patients.
In addition to assessing improvement in IBS symptoms, we are attempting to determine whether we can predict which patients will respond to hypnotherapy depending on data from two questionnaires filled out before treatment begins, one addressing whether patients attribute their symptoms to emotional or physical cause and the other regarding intimate relationships. This will be evaluated at the termination of the study.
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