Irritable Bowel Syndrome Clinical Trial
Official title:
Smartphone Stress Management Training for Irritable Bowel Syndrome
In the largest and most well-controlled randomized control trial of mindfulness-based interventions (MBIs) training in irritable bowel syndrome (IBS) to-date (N=325), the investigators will evaluate whether a smartphone MBI program (with attention monitoring and acceptance skills training; Monitor+Accept, MA-MBI) reduces daily life stress and IBS symptoms at post-treatment and two-month follow-up, relative to a matched MBI program with acceptance skills training removed (training in attention monitoring skills only; Monitor Only, MO-MBI) or to an active stress management training control group (Coping Control, CC). Participants will not only provide clinician and patient assessed measures of IBS symptoms at the three time points, but they will also provide sensitive experience sampling assessments (using Ecological Momentary Assessment) of their stress and symptoms in daily life at each time point. Finally, as an exploratory aim, participants will provide stool samples at baseline and post-intervention to provide the first ever test of whether MBIs can alter the gut microbiome in IBS. We will also conduct a sub-study that will include completion of a cold-water challenge performance task to test individuals' distress tolerance.
Status | Recruiting |
Enrollment | 325 |
Est. completion date | September 1, 2025 |
Est. primary completion date | September 1, 2025 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Rome IV IBS diagnosis - Indicate moderate to high levels of psychological distress over the past two weeks (composite score >5 on the Patient Health Questionnaire-4) - Willingness to provide assessments of bowel symptoms and complete study measures (including smartphone assessments) - Willingness/availability to be randomized and participate in all study activities Exclusion Criteria: - Non-English speaking - Report a new diagnosis of a (non-acute) medical or psychiatric condition requiring treatment within the last 3 months - Have a history of diagnosed IBD or gastrointestinal malignancies. - Begun any new treatments for IBS in the four weeks prior to baseline - Currently pregnant - Had a colonoscopy within 2 weeks of enrolling in the study or within the first 4 weeks of study procedures - CGI Interview Only: Is a patient of Dr. David Levinthal Cold Challenge Sub-study. Exclusion criteria: an existing pain condition, Reynaud's disease, history of heart/cardiovascular disease, high blood pressure, recent injuries, circulatory disorders, current or past frostbite, open cuts, or sores in both hands, a history of seizures, asthma, sickle cell disease or trait, cerebrovascular disease, a recent stroke or heart attack, or anxiolytic medication (e.g., Ativan, Xanax) or pain medication (e.g., aspirin) taken in the 2 hours prior to the study, pregnant or might be pregnant, and/or have a tendency/history of fainting after vaccines, shots, and/or blood draws. Participants will be excluded if they have taken anxiolytic medication (e.g., Ativan, Xanax) or pain medication (e.g., aspirin) taken in the 2 hours prior to the lab session. Participants who report viral illness (e.g., cold) and/or negative physical health symptoms (e.g., stomachache, nausea, fever, dehydration, hunger, sleep deprivation) before the start of the session will also be excluded. As they will be visiting our laboratory on campus, participants will now be required to show proof of COVID-19 vaccination to participate in the study. Participants must also show proof of a booster shot, if they do not have one, they will be asked to wear a mask at in-person sessions to participate. Moving forward, we will continue to follow CMU COVID protocols. |
Country | Name | City | State |
---|---|---|---|
United States | Carnegie Mellon University | Pittsburgh | Pennsylvania |
Lead Sponsor | Collaborator |
---|---|
Carnegie Mellon University | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) |
United States,
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* Note: There are 45 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Self-Reported Diet | Evaluated using a 7-day focused food frequency questionnaire based on established questionnaires used in previous NIH dietary trials with a special focus on FODMAP and probiotics consumption | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Other | Change in Self-Reported Treatment Expectancies | Evaluated using The 6-item Credibility-Expectancy Questionnaire, with a higher total score indicating greater treatment expectancy and credibility of the participant. | Change from baseline to 1-week post-intervention | |
Primary | Change in IBS Symptom Severity | The Irritable Bowel Syndrome Severity Scoring System (IBS-SSS), queries patients on the severity and occurrence of abdominal pain, bloating, tightness, and bowel habits, and IBS life interference over the previous ten days. Scores are totaled (0-500 range) to obtain a composite IBS severity score, with the scale demonstrating acceptable clinical sensitivity to change (50 point changes indicate clinical improvement). | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Primary | IBS Symptom Improvement | The Clinical Global Impressions Scale (CGI-I), a one-item 7-point measure, evaluates improvement in overall clinical condition (1= very much improved since the initiation of the treatment to 7=very much worse since the initiation of the treatment). | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Primary | Change in Self-Reported Symptom-Related Psychological Outcomes | The Brief Symptom Inventory 18-item is a self-report measure used to assess psychological problems in adults. The scale asks patients to rate how bothered they were by symptoms on a 5-point scale (1=not at all bothered to 5= extremely bothered). Therefore, total scores can range from 18 to 90, with a higher score indicating greater distress. | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Primary | Change in Self-Reported IBS Quality of Life | The Irritable Bowel Syndrome Quality of Life (IBS-QOL) is a 34-item scale that measures quality of life specific to IBS. The scores are transformed to a 0-100 scale, with higher scores corresponding to better IBS specific quality of life. | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Primary | Change in Microbiome Biology | Gut microbiome diversity evaluated using 16S rRNA gene sequencing for stool samples | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Primary | Change in Self-Reported Perceptions of Stress | Evaluated using Ecological Momentary Assessment using the items "Right now, how much stress are you experiencing or feeling?" (1=no stress to 7 = extremely severe stress); "Since the last survey, did you experience any feelings of stress?" (yes/no). | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Primary | Change in Self-Reported Perceptions of IBS Distress | Evaluated using Ecological Momentary Assessment using the items "Right now, how severe are your IBS symptoms right now? (1=no symptoms to 7=extremely severe symptoms); "Right now, how much are your IBS symptoms interfering with your life right now?" (1=not at all to 7=extremely); "Right now, my IBS symptoms are causing me distress" (1=no distress to 7= extremely severe distress). | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Primary | Change in Self-Reported Perceptions of IBS Distress During Bowel Movements | Evaluated using Event-Triggered Ecological Momentary Assessment. Measures their perceptions of distress in the minutes leading up to sitting on the toilet ("how distressed did you feel in the ten minutes leading up to sitting on the toilet? 1=not at all distressed to 7= extremely distressed) and during the bowel movement attempt ("how distressed did you feel while sitting on the toilet? 1=not at all distressed to 7= extremely distressed). | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Primary | Pain Tolerance following Cold Pressor Task | Evaluated by length of time (in minutes, seconds, and milliseconds) participant's hand is under water, where the maximum amount of time is 5 minutes, 0 seconds, 0 milliseconds. Measures the degree of pain/discomfort that can be withstood by the participants following completion of their assigned intervention condition. Differences will be analyzed across the three different arms (i.e., MA, MO, and CC) of the study. | Differences across all three conditions collected at post-intervention | |
Primary | Sensation Intensity Rating following Cold Pressor Task | Evaluated using a Likert-type scale on a single item ("how intense are the sensations for you at the moment?", 1=no sensations, 10=most intense sensations) every 30 seconds, measures the degree of intense sensations felt following completion of participant's assigned intervention condition. Differences will be analyzed across the three different arms (i.e., MA, MO, and CC) of the study. | Differences across all three conditions collected at post-intervention | |
Primary | Distress Rating following Cold Pressor Task | Evaluated using a Likert-type scale on a single item ("how distressed are you by the sensations at the moment?", 1=no distress, 10=worse distress) every 30 seconds, measures the degree of distress tolerance that can be withstood by participants following completion of participant's assigned intervention condition. Differences will be analyzed across the three different arms (i.e., MA, MO, and CC) of the study. | Differences across all three conditions collected at post-intervention | |
Secondary | Change in Self-Reported Perceived Stress | The 10-item Perceived Stress Scale is a self-reported assessment of perceptions of stress over the past month. Total scores range from 0 to 40, with higher scores indicating higher levels of perceived stress. | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Secondary | Change in Self-Reported Depressive Symptomatology | Evaluated using the 9-Item Patient Health Questionnaire (PHQ-9), which asks how often one has been bothered by 9 problems (0= not at all to 3= nearly every day), with a higher total score indicating more severe depressive symptomatology. | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Secondary | Change in Self-Reported Mindfulness | Evaluated using the The Five Facet Mindfulness Questionnaire, a 24-item scale measuring mindfulness. Each item is rated on a scale from 1=never or very rarely true to 5= very often or always true, with a higher total score indicating greater mindfulness tendencies. | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Secondary | Change in Self-Reported Loneliness | The UCLA Loneliness scale will be used to measure subjective feelings of loneliness and social isolation. A total score that ranges from 20 to 80 is calculated by summing the score of each item. A higher total score signifies increased feelings of loneliness. | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Secondary | Change in Self-Reported Distress Tolerance | Evaluated using the Distress Tolerance Scale (DTS), which asks participants to describe their beliefs about feeling distressed or upset in 15-item. Each item is scored as 1=strongly agree to 5= strongly disagree, and higher total scores correspond to greater distress tolerance. | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Secondary | Change in Self-Reported Perceived Partner Responsiveness | Change in perceived partner responsiveness will be measured using the Perceived Responsiveness and Insensitivity (PRI) Scale, a 4-item scale, in which each item is rated from 0= not at all to 5= completely, with a higher total score corresponding to more understanding and validation. | Change from baseline to 1-week post-intervention and 2-month follow-up | |
Secondary | Change in Self-Reported Sensitivity and Attention to Interoceptive Signals | Evaluated using the 17-item Interoceptive Sensitivity and Attention Questionnaire, in which each item is rated from 1= strongly disagree to 5= strongly agree, with a higher total score reflecting more sensitivity and attention to interoceptive signals. | Change from baseline to 1-week post-intervention | |
Secondary | Change in Gastrointestinal Symptom-Specific Anxiety | Evaluated using the 15-item Visceral Sensitivity Index, in which each item is rated from 1= strongly agree to 6= strongly disagree. | Change from baseline to 1-week post-intervention |
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