Psychosocial risk factors linked to brain–gut dysregulation are prevalent across the spectrum of gastrointestinal disorders and are associated with poor patient outcomes. Robust and reproducible data in the areas of behavioural intervention science and the brain–gut axis have led to major advances in patient care, including the routine use of brain–gut psychotherapies to manage digestive symptoms and optimize coping. The logical next step for the emerging field of psychogastroenterology is to develop a scientific framework that enables the identification of those individual characteristics and coping styles that buffer patients against the negative psychological effects of chronic gastrointestinal disorders. A shift towards a strength-based, positive psychological science of gastrointestinal disorders could facilitate the integration of early, effective psychological care into gastroenterology practice. In this Perspective, I discuss the potential role of three human strengths with relevance to gastrointestinal health — resilience, optimism and self-regulation — and how these three constructs can be cultivated through existing or emerging brain–gut psychotherapies.
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Peery, A. F. et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology 149, 1731–1741.e3 (2015).
Taft, T. H. & Keefer, L. A systematic review of disease-related stigmatization in patients living with inflammatory bowel disease. Clin. Exp. Gastroenterol. 9, 49–58 (2016).
Taft, T. H., Bedell, A., Naftaly, J. & Keefer, L. Stigmatization toward irritable bowel syndrome and inflammatory bowel disease in an online cohort. Neurogastroenterol. Motil. 29, e12921 (2017).
Guadagnoli, L., Taft, T. H. & Keefer, L. Stigma perceptions in patients with eosinophilic gastrointestinal disorders. Dis. Esophagus 30, 1–8 (2017).
Van Oudenhove, L. et al. Biopsychosocial aspects of functional gastrointestinal disorders. Gastroenterology 150, 1355–1367.e2 (2016).
McCombie, A., Gearry, R., Andrews, J., Mulder, R. & Mikocka-Walus, A. Does computerized cognitive behavioral therapy help people with inflammatory bowel disease? A randomized controlled trial. Inflamm. Bowel. Dis. 22, 171–181 (2016).
Szigethy, E. M. et al. White Paper AGA: the impact of mental and psychosocial factors on the care of patients with inflammatory bowel disease. Clin. Gastroenterol. Hepatol. 15, 986–997 (2017).
Keefer, L. & Kane, S. V. Considering the bidirectional pathways between depression and IBD: recommendations for comprehensive IBD care. Gastroenterol. Hepatol. (N Y) 13, 164–169 (2017).
Kiebles, J. L., Doerfler, B. & Keefer, L. Preliminary evidence supporting a framework of psychological adjustment to inflammatory bowel disease. Inflamm. Bowel. Dis. 16, 1685–1695 (2010).
Kinsinger, S. W., Ballou, S. & Keefer, L. Snapshot of an integrated psychosocial gastroenterology service. World. J. Gastroenterol. 21, 1893–1899 (2015).
Riehl, M. E., Kinsinger, S., Kahrilas, P. J., Pandolfino, J. E. & Keefer, L. Role of a health psychologist in the management of functional esophageal complaints. Dis. Esophagus 28, 428–436 (2015).
Seligman, M. E. & Csikszentmihalyi, M. Positive psychology. An introduction. Am. Psychol. 55, 5–14 (2000).
Seligman, M. E., Steen, T. A., Park, N. & Peterson, C. Positive psychology progress: empirical validation of interventions. Am. Psychol. 60, 410–421 (2005).
Quirin, M., Kent, M., Boksem, M. A. & Tops, M. Integration of negative experiences: a neuropsychological framework for human resilience. Behav. Brain. Sci. 38, e116 (2015).
Charney, D. S. Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am. J. Psychiatry 161, 195–216 (2004).
Drossman, D. A. Abuse, trauma, and GI illness: is there a link? Am. J. Gastroenterol. 106, 14–25 (2011).
Prusator, D. K., Andrews, A. & Greenwood-Van Meerveld, B. Neurobiology of early life stress and visceral pain: translational relevance from animal models to patient care. Neurogastroenterol. Motil. 28, 1290–1305 (2016).
Greenwood-Van Meerveld, B., Moloney, R. D., Johnson, A. C. & Vicario, M. Mechanisms of stress-induced visceral pain: implications in irritable bowel syndrome. J. Neuroendocrinol. https://doi.org/10.1111/jne.12361 (2016).
Carlsen, K. et al. Self-efficacy and resilience are useful predictors of transition readiness scores in adolescents with inflammatory bowel diseases. Inflamm. Bowel. Dis. 23, 341–346 (2017).
Sehgal, P., Abrahams, E., Ungaro, R. C., Dubinsky, M. & Keefer, L. Resilience is associated with lower rates of depression and anxiety, and higher quality of life in inflammatory bowel disease patients. Gastroenterology 152, S797–S798 (2017).
Russo, S. J., Murrough, J. W., Han, M. H., Charney, D. S. & Nestler, E. J. Neurobiology of resilience. Nat. Neurosci. 15, 1475–1484 (2012).
Smith, B. W. et al. The brief resilience scale: assessing the ability to bounce back. Int. J. Behav. Med. 15, 194–200 (2008).
Park, S. H. et al. Resilience is decreased in irritable bowel syndrome and associated with symptoms and cortisol response. Neurogastroenterol. Motil. 30, e13155 (2017).
Yehuda, R., Brand, S. R., Golier, J. A. & Yang, R. K. Clinical correlates of DHEA associated with post-traumatic stress disorder. Acta. Psychiatr. Scand. 114, 187–193 (2006).
Kautz, M., Charney, D. S. & Murrough, J. W. Neuropeptide Y, resilience, and PTSD therapeutics. Neurosci. Lett. 649, 164–169 (2017).
Keefer, L. et al. Centrally mediated disorders of gastrointestinal pain. Gastroenterology https://doi.org/10.1053/j.gastro.2016.02.034 (2016).
Andrews, J. M. & Holtmann, G. IBD: Stress causes flares of IBD — how much evidence is enough? Nat. Rev. Gastroenterol. Hepatol. 8, 13–14 (2011).
Bernstein, C. N. Psychological stress and depression: risk factors for IBD? Dig. Dis. 34, 58–63 (2016).
Keefer, L. & Blanchard, E. B. The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: results of a controlled treatment study. Behav. Res. Ther. 39, 801–811 (2001).
Kuo, B. et al. Genomic and clinical effects associated with a relaxation response mind-body intervention in patients with irritable bowel syndrome and inflammatory bowel disease. PLoS ONE 10, e0123861 (2015).
Gick, M. L. & Sirois, F. M. Insecure attachment moderates women’s adjustment to inflammatory bowel disease severity. Rehabil. Psychol. 55, 170–179 (2010).
Agostini, A. et al. Attachment and quality of life in patients with inflammatory bowel disease. Int. J. Colorectal. Dis. 29, 1291–1296 (2014).
Ercolani, M. et al. Gastroesophageal reflux disease (GERD) and inflammatory bowel disease (IBD): attachment styles and parental bonding. Percept. Mot. Skills. 111, 625–630 (2010).
Wood, J. D. et al. Evidence that colitis is initiated by environmental stress and sustained by fecal factors in the cotton-top tamarin (Saguinus oedipus). Dig. Dis. Sci. 45, 385–393 (2000).
Dusek, J. A. et al. Genomic counter-stress changes induced by the relaxation response. PLoS ONE 3, e2576 (2008).
Connor, K. M. & Davidson, J. R. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress. Anxiety 18, 76–82 (2003).
Scheier, M. F. & Carver, C. S. Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol. 4, 219–247 1985).
Smith, T. W., Ruiz, J. M., Cundiff, J. M., Baron, K. G. & Nealey-Moore, J. B. Optimism and pessimism in social context: an interpersonal perspective on resilience and risk. J. Res. Pers. 47, 553–562 (2013).
Nikcevic, A. V. & Nicolaides, K. H. Search for meaning, finding meaning and adjustment in women following miscarriage: a longitudinal study. Psychol. Health 29, 50–63 (2013).
Baker, C. & Stern, P. N. Finding meaning in chronic illness as the key to self-care. Can. J. Nurs. Res. 25, 23–36 (1993).
Boyraz, G., Horne, S. G. & Sayger, T. V. Finding meaning in loss: the mediating role of social support between personality and two construals of meaning. Death Stud. 36, 519–540 (2012).
Southwick, S. M. et al. Why are some individuals more resilient than others: the role of social support. World. Psychiatry 15, 77–79 (2016).
Ozbay, F., Fitterling, H., Charney, D. & Southwick, S. Social support and resilience to stress across the life span: a neurobiologic framework. Curr. Psychiatry Rep. 10, 304–310 (2008).
Katz, L. et al. Mechanisms of quality of life and social support in inflammatory bowel disease. J. Clin. Psychol. Med. Settings 23, 88–98 (2016).
Lackner, J. M. et al. The ties that bind: perceived social support, stress, and IBS in severely affected patients. Neurogastroenterol. Motil. 22, 893–900 (2010).
Kim, E. S. et al. Optimism and cause-specific mortality: a prospective cohort study. Am. J. Epidemiol. 185, 21–29 (2017).
Schiavon, C. C., Marchetti, E., Gurgel, L. G., Busnello, F. M. & Reppold, C. T. Optimism and hope in chronic disease: a systematic review. Front. Psychol. 7, 2022 (2016).
Rasmussen, H. N., Scheier, M. F. & Greenhouse, J. B. Optimism and physical health: a meta-analytic review. Ann. Behav. Med. 37, 239–256 (2009).
Kemp, A. H. & Quintana, D. S. The relationship between mental and physical health: insights from the study of heart rate variability. Int. J. Psychophysiol. 89, 288–296 (2013).
Liu, Q., Wang, E. M., Yan, X. J. & Chen, S. L. Autonomic functioning in irritable bowel syndrome measured by heart rate variability: a meta-analysis. J. Dig. Dis. 14, 638–646 (2013).
Mouzas, I. A. et al. Autonomic imbalance during the day in patients with inflammatory bowel disease in remission. Evidence from spectral analysis of heart rate variability over 24 h. Dig. Liver. Dis. 34, 775–780 (2002).
Jelenova, D. et al. Heart rate variability in children with inflammatory bowel diseases. Neuro. Endocrinol. Lett. 36, 72–79 (2015).
Dore, B. P. et al. Finding positive meaning in negative experiences engages ventral striatal and ventromedial prefrontal regions associated with reward valuation. J. Cogn. Neurosci. 29, 235–244 (2017).
Chang, E. C. & D’Zurilla, T. J. Relations between problem orientation and optimism, pessimism, and trait affectivity: a construct validation study. Behav. Res. Ther. 34, 185–194 (1996).
Cheng, C., Chan, A. O., Hui, W. M. & Lam, S. K. Coping strategies, illness perception, anxiety and depression of patients with idiopathic constipation: a population-based study. Aliment. Pharmacol. Ther. 18, 319–326 (2003).
Cheng, C., Hui, W. M. & Lam, S. K. Coping style of individuals with functional dyspepsia. Psychosom. Med. 61, 789–795 (1999).
Chan, A. O. et al. Differing coping mechanisms, stress level and anorectal physiology in patients with functional constipation. World. J. Gastroenterol. 11, 5362–5366 (2005).
Seligman, M. Learned Optimism: How to Change Your Mind and Your Life (Vintage, 2006).
Scheier, M. F., Carver, C. S. & Bridges, M. W. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. J. Pers. Soc. Psychol. 67, 1063–1078 (1994).
Terrill, D. R., Friedman, D. G., Gottschalk, L. A. & Haaga, D. A. Construct validity of the Life Orientation Test. J. Pers. Assess. 79, 550–563 (2002).
Chiesi, F., Galli, S., Primi, C., Innocenti Borgi, P. & Bonacchi, A. The accuracy of the Life Orientation Test-Revised (LOT-R) in measuring dispositional optimism: evidence from item response theory analyses. J. Pers. Assess. 95, 523–529 (2013).
Wichman, A. L., Reich, D. A. & Weary, G. Perceived likelihood as a measure of optimism and pessimism: support for the Future Events Scale. Psychol. Assess. 18, 215–219 (2006).
Baumeister, R. F. Self-regulation, ego depletion, and inhibition. Neuropsychologia. 65, 313–319 (2014).
Watson, D. & Tellegen, A. Toward a consensual structure of mood. Psychol. Bull. 98, 219–235 (1985).
Tangney, J. P., Baumeister, R. F. & Boone, A. L. High self-control predicts good adjustment, less pathology, better grades, and interpersonal success. J. Pers. 72, 271–324 (2004).
Eisenberg, N. et al. The relations of emotionality and regulation to preschoolers’ social skills and sociometric status. Child. Dev. 64, 1418–1438 (1993).
Bandura, A. Health promotion by social cognitive means. Health. Educ. Behav. 31, 143–164 (2004).
MacLeod, A. K., Coates, E. & Hetherton, J. Increasing well-being through teaching goal setting and planning skills: results of a brief intervention. J. Happiness Studies 9, 185–196 (2008).
Carter, N. T., Guan, L., Maples, J. L., Williamson, R. L. & Miller, J. D. The downsides of extreme conscientiousness for psychological well-being: the role of obsessive compulsive tendencies. J. Pers. 84, 510–522 (2016).
Halse, C., Honey, A. & Boughtwood, D. The paradox of virtue: (re)thinking deviance, anorexia and schooling. Gender Educ. 19, 219–235 (2007).
Letzring, T. D., Block, J. & Funder, D. C. Ego-control and ego-resiliency: generalization of self-report scales based on personality descriptions from acquaintances, clinicians, and the self. J. Res. Personal. 39, 395–422 (2005).
Lorig, K. Chronic disease self-management: from randomized trial to public policy. Eur. J. Public Health 20, 6–7 (2010).
Bandura, A. Self-efficacy: toward a unifying theory of behavioral change. Psychol. Rev. 84, 191–215 (1977).
Izaguirre, M. R., Taft, T. & Keefer, L. Preliminary development of a self-efficacy scale for adolescents and young adults with inflammatory bowel disease. Gastroenterology 146, S157–S158 (2014).
Keefer, L., Kiebles, J. L. & Taft, T. H. The role of self-efficacy in inflammatory bowel disease management: preliminary validation of a disease-specific measure. Inflamm. Bowel. Dis. 17, 614–620 (2011).
Graff, L. A. et al. Validating a measure of patient self-efficacy in disease self-management using a population-based IBD cohort: the IBD self-efficacy scale. Inflamm. Bowel. Dis. 22, 2165–2172 (2016).
Ballou, S., Taft, T. & Keefer, L. Disease-specific self-efficacy in the eosinophilic gastrointestinal disorders. J. Health. Psychol. 20, 1027–1036 (2015).
van den Brink, G. et al. Effectiveness of disease-specific cognitive-behavioural therapy on depression, anxiety, quality of life and the clinical course of disease in adolescents with inflammatory bowel disease: study protocol of a multicentre randomised controlled trial (HAPPY-IBD). BMJ Open Gastroenterol. 3, e000071 (2016).
Keefer, L., Doerfler, B. & Artz, C. Optimizing management of Crohn’s disease within a project management framework: results of a pilot study. Inflamm. Bowel. Dis. 18, 254–260 (2012).
Mikocka-Walus, A. et al. Cognitive-behavioural therapy for inflammatory bowel disease: 24-month data from a randomised controlled trial. Int. J. Behav. Med. 24, 127–135 (2017).
Keefer, L. et al. The potential role of a self-management intervention for ulcerative colitis: a brief report from the ulcerative colitis hypnotherapy trial. Biol. Res. Nurs. 14, 71–77 (2012).
Blair, C. et al. Salivary cortisol mediates effects of poverty and parenting on executive functions in early childhood. Child. Dev. 82, 1970–1984 (2011).
Bonaccorso, S. et al. Immunotherapy with interferon-alpha in patients affected by chronic hepatitis C induces an intercorrelated stimulation of the cytokine network and an increase in depressive and anxiety symptoms. Psychiatry Res. 105, 45–55 (2001).
Anisman, H., Kokkinidis, L. & Merali, Z. Further evidence for the depressive effects of cytokines: anhedonia and neurochemical changes. Brain. Behav. Immun. 16, 544–556 (2002).
Sakic, B., Gauldie, J., Denburg, J. A. & Szechtman, H. Behavioral effects of infection with IL-6 adenovector. Brain. Behav. Immun. 15, 25–42 (2001).
Regueiro, M. D. et al. The inflammatory bowel disease live interinstitutional and interdisciplinary videoconference education (IBD LIVE) series. Inflamm. Bowel. Dis. 20, 1687–1695 (2014).
Lackner, J. M. et al. Rapid response to cognitive behavior therapy predicts treatment outcome in patients with irritable bowel syndrome. Clin. Gastroenterol. Hepatol. 8, 426–432 (2010).
Blanchard, E. B. et al. A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome. Behav. Res. Ther. 45, 633–648 (2007).
Drossman, D. A. et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology 125, 19–31 (2003).
Craske, M. G. et al. A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behav. Res. Ther. 49, 413–421 (2011).
Palsson, O. S. Hypnosis treatment of gastrointestinal disorders: a comprehensive review of the empirical evidence. Am. J. Clin. Hypn. 58, 134–158 (2015).
Whorwell, P. J., Prior, A. & Faragher, E. B. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet. 2, 1232–1234 (1984).
Gaylord, S. A. et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am. J. Gastroenterol. 106, 1678–1688 (2011).
Guthrie, E., Creed, F., Dawson, D. & Tomenson, B. A randomised controlled trial of psychotherapy in patients with refractory irritable bowel syndrome. Br. J. Psychiatry 163, 315–321 (1993).
Ford, A. C. et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. Am. J. Gastroenterol. 109, 1350–1365 (2014).
Gracie, D. J. et al. Effect of psychological therapy on disease activity, psychological comorbidity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol. Hepatol 2, 189–199 (2017).
Creed, F. et al. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology 124, 303–317 (2003).
Hyphantis, T., Guthrie, E., Tomenson, B. & Creed, F. Psychodynamic interpersonal therapy and improvement in interpersonal difficulties in people with severe irritable bowel syndrome. Pain. 145, 196–203 (2009).
Creed, F. et al. Reported sexual abuse predicts impaired functioning but a good response to psychological treatments in patients with severe irritable bowel syndrome. Psychosom. Med. 67, 490–499 (2005).
Ljotsson, B. et al. Acceptability, effectiveness, and cost-effectiveness of internet-based exposure treatment for irritable bowel syndrome in a clinical sample: a randomized controlled trial. BMC. Gastroenterol. 11, 110 (2011).
Bonnert, M. et al. Internet-delivered cognitive behavior therapy for adolescents with irritable bowel syndrome: a randomized controlled trial. Am. J. Gastroenterol. 112, 152–162 (2017).
Ljotsson, B. et al. Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome — a randomized controlled trial. Behav. Res. Ther. 48, 531–539 (2010).
Lopez-Gomez, I., Chaves, C., Hervas, G. & Vazquez, C. Comparing the acceptability of a positive psychology intervention versus a cognitive behavioural therapy for clinical depression. Clin. Psychol. Psychother. 24, 1029–1039 (2017).
Garland, E. L. et al. Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. J. Behav. Med. 35, 591–602 (2012).
Berrill, J. W., Sadlier, M., Hood, K. & Green, J. T. Mindfulness-based therapy for inflammatory bowel disease patients with functional abdominal symptoms or high perceived stress levels. J. Crohns Colitis 8, 945–955 (2014).
Berkovich-Ohana, A., Glicksohn, J. & Goldstein, A. Studying the default mode and its mindfulness-induced changes using EEG functional connectivity. Soc. Cogn. Affect. Neurosci. 9, 1616–1624 (2014).
Holzel, B. K. et al. Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training. Neuroimage Clin. 2, 448–458 (2013).
Breckman, B. Mindfulness as a key resource for development and resilience. Nurs. Stand. 26, 32 (2012).
Hasenkamp, W., Wilson-Mendenhall, C. D., Duncan, E. & Barsalou, L. W. Mind wandering and attention during focused meditation: a fine-grained temporal analysis of fluctuating cognitive states. Neuroimage 59, 750–760 (2012).
Johnson, D. C. et al. Modifying resilience mechanisms in at-risk individuals: a controlled study of mindfulness training in Marines preparing for deployment. Am. J. Psychiatry 171, 844–853 (2014).
Hoge, E. A. et al. The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder. Psychiatry Res. 262, 328–332 (2018).
Black, D. S. et al. Mindfulness practice reduces cortisol blunting during chemotherapy: a randomized controlled study of colorectal cancer patients. Cancer 123, 3088–3096 (2017).
Ferreira, N. B., Gillanders, D., Morris, P. G. & Eugenicos, M. Pilot study of acceptance and commitment therapy for irritable bowel syndrome: a preliminary analysis of treatment outcomes and processes of change. Clin. Psychol. https://doi.org/10.1111/cp.12123 (2017).
Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L. & Pistorello, J. Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behav. Ther. 44, 180–198 (2013).
Sebastian Sanchez, B., Gil Roales-Nieto, J., Ferreira, N. B., Gil Luciano, B. & Sebastian Domingo, J. J. New psychological therapies for irritable bowel syndrome: mindfulness, acceptance and commitment therapy (ACT). Rev. Esp. Enferm. Dig. 109, 648–657 (2017).
Kiebles, J. L. & Keefer, L. M1056 assessing disease acceptance in a sample of patients with IBD: preliminary psychometrics of the Digestive Disease Acceptance Questionnaire (DDAQ) [abstract]. Gastroenterology 138, S–322 (2010).
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A. & Lillis, J. Acceptance and commitment therapy: model, processes and outcomes. Behav. Res. Ther. 44, 1–25 (2006).
Abramowitz, J. S., Tolin, D. F. & Street, G. P. Paradoxical effects of thought suppression: a meta-analysis of controlled studies. Clin. Psychol. Rev. 21, 683–703 (2001).
McCracken, L. M. & Vowles, K. E. Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. Am. Psychol. 69, 178–187 (2014).
McCracken, L. M., Gauntlett-Gilbert, J. & Vowles, K. E. The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability. Pain. 131, 63–69 (2007).
Hughes, L. S., Clark, J., Colclough, J. A., Dale, E. & McMillan, D. Acceptance and commitment therapy (ACT) for chronic pain: a systematic review and meta-analyses. Clin. J. Pain. 33, 552–568 (2017).
Low, J. et al. Acceptance and commitment therapy for adults with advanced cancer (CanACT): study protocol for a feasibility randomised controlled trial. Trials. 17, 77 (2016).
Keefer, L. Editorial: depression in the setting of inflammatory bowel disease means we have failed to provide early, effective, psychosocial care. Aliment. Pharmacol. Ther. 46, 553–554 (2017).
Cuijpers, P., van Straten, A. & Warmerdam, L. Behavioral activation treatments of depression: a meta-analysis. Clin. Psychol. Rev. 27, 318–326 (2007).
Dimidjian, S. & Davis, K. J. Newer variations of cognitive-behavioral therapy: behavioral activation and mindfulness-based cognitive therapy. Curr. Psychiatry Rep. 11, 453–458 (2009).
Linehan, M. M. & Wilks, C. R. The course and evolution of dialectical behavior therapy. Am. J. Psychother. 69, 97–110 (2015).
Torrado, J. C., Gomez, J. & Montoro, G. Emotional self-regulation of individuals with autism spectrum disorders: smartwatches for monitoring and interaction. Sensors (Basel) 17 (E1359 (2017).
Mercer, K., Li, M., Giangregorio, L., Burns, C. & Grindrod, K. Behavior change techniques present in wearable activity trackers: a critical analysis. JMIR Mhealth Uhealth 4, e40 (2016).
Halland, M., Parthasarathy, G., Bharucha, A. E. & Katzka, D. A. Diaphragmatic breathing for rumination syndrome: efficacy and mechanisms of action. Neurogastroenterol. Motil. 28, 384–391 (2016).
Stern, M. J., Guiles, R. A. & Gevirtz, R. HRV biofeedback for pediatric irritable bowel syndrome and functional abdominal pain: a clinical replication series. Appl. Psychophysiol. Biofeedback 39, 287–291 (2014).
Goessl, V. C., Curtiss, J. E. & Hofmann, S. G. The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis. Psychol. Med. 47, 2578–2586 (2017).
Lewis, G. F. et al. Relaxation training assisted by heart rate variability biofeedback: implication for a military predeployment stress inoculation protocol. Psychophysiology. 52, 1167–1174 (2015).
Neff, J. A., Amodei, N., Valescu, S. & Pomeroy, E. C. Psychological adaptation and distress among HIV+ Latina women: adaptation to HIV in a Mexican American cultural context. Soc. Work Health Care 37, 55–74 (2003).
Kemper, K. J., Powell, D., Helms, C. C. & Kim-Shapiro, D. B. Loving-kindness meditation’s effects on nitric oxide and perceived well-being: a pilot study in experienced and inexperienced meditators. Explore (NY). 11, 32–39 (2015).
Leary, M. R., Tate, E. B., Adams, C. E., Allen, A. B. & Hancock, J. Self-compassion and reactions to unpleasant self-relevant events: the implications of treating oneself kindly. J. Pers. Soc. Psychol. 92, 887–904 (2007).
Neff, J. A. & MacMaster, S. A. Applying behavior change models to understand spiritual mechanisms underlying change in substance abuse treatment. Am. J. Drug. Alcohol. Abuse. 31, 669–684 (2005).
Dundas, I., Binder, P. E., Hansen, T. G. B. & Stige, S. H. Does a short self-compassion intervention for students increase healthy self-regulation? A randomized control trial. Scand. J. Psychol. 58, 443–450 (2017).
Davies, N. J. Learning self-compassion. A tool for your diabetes management kit. Diabetes Self Management https://www.diabetesselfmanagement.com/managing-diabetes/emotional-health/learning-self-compassion/ (2012).
Ballou, S. & Keefer, L. Psychological interventions for irritable bowel syndrome and inflammatory bowel diseases. Clin. Transl. Gastroenterol. 8, e214 (2017).
Gaylord, S. A. et al. Mindfulness for irritable bowel syndrome: protocol development for a controlled clinical trial. BMC. Complement. Altern. Med. 9, 24 (2009).
Seligman, M. E. P., Rashid, T. & Parks, A. C. Positive psychotherapy. Am. Psychol. 61, 774–788 (2006).
Lampropoulos, G. K. Integrating psychopathology, positive psychology, and psychotherapy. Am. Psychol. 56, 87–88 (2001).
Sheldon, K. M. & King, L. Why positive psychology is necessary. Am. Psychol. 56, 216–217 (2001).
Krause, N. & Markides, K. Measuring social support among older adults. Int. J. Aging. Hum. Dev. 30, 37–53 (1990).
Cyranowski, J. M. et al. Assessing social support, companionship, and distress: National Institute of Health (NIH) Toolbox Adult Social Relationship Scales. Health. Psychol. 32, 293–301 (2013).
McCracken, L. M., Vowles, K. E. & Eccleston, C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain. 107, 159–166 (2004).
Moss-Morris, R. et al. The revised Illness Perception Questionnaire (IPQ-R). Psychol. Health. 17, 1–16 (2002).
Izaguirre, M. R., Taft, T. & Keefer, L. Validation of a self-efficacy scale for adolescents and young adults with inflammatory bowel disease. J. Pediatr. Gastroenterol. Nutr. 65, 546–550 (2017).
Carlson, L. E. & Brown, K. W. Validation of the Mindful Attention Awareness Scale in a cancer population. J. Psychosom. Res. 58, 29–33 (2005).
Diener, E., Emmons, R. A., Larsen, R. J. & Griffin, S. The Satisfaction With Life Scale. J. Pers. Assess. 49, 71–75 (1985).
Watson, D., Clark, L. A. & Tellegen, A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J. Pers. Soc. Psychol. 54, 1063–1070 (1988).
Salsman, J. M. et al. Assessing psychological well-being: self-report instruments for the NIH Toolbox. Qual. Life. Res. 23, 205–215 (2014).
Nature Reviews Gastroenterology & Hepatology thanks G. Clarke, L. Van Oudenhove and other anonymous reviewer(s) for their contribution to the peer review of this work.
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Keefer, L. Behavioural medicine and gastrointestinal disorders: the promise of positive psychology. Nat Rev Gastroenterol Hepatol 15, 378–386 (2018). https://doi.org/10.1038/s41575-018-0001-1
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