Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Perspective
  • Published:

OPINION

Behavioural medicine and gastrointestinal disorders: the promise of positive psychology

Abstract

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.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Synergy between traditional gastroenterology and positive gastroenterology approaches — a way forward.

Similar content being viewed by others

References

  1. Peery, A. F. et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology 149, 1731–1741.e3 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  2. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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).

    Article  Google Scholar 

  4. Guadagnoli, L., Taft, T. H. & Keefer, L. Stigma perceptions in patients with eosinophilic gastrointestinal disorders. Dis. Esophagus 30, 1–8 (2017).

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  5. Van Oudenhove, L. et al. Biopsychosocial aspects of functional gastrointestinal disorders. Gastroenterology 150, 1355–1367.e2 (2016).

    Article  Google Scholar 

  6. 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).

    Article  PubMed  Google Scholar 

  7. 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).

    Article  PubMed  Google Scholar 

  8. 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).

    Google Scholar 

  9. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kinsinger, S. W., Ballou, S. & Keefer, L. Snapshot of an integrated psychosocial gastroenterology service. World. J. Gastroenterol. 21, 1893–1899 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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).

    Article  PubMed  CAS  Google Scholar 

  12. Seligman, M. E. & Csikszentmihalyi, M. Positive psychology. An introduction. Am. Psychol. 55, 5–14 (2000).

    Article  PubMed  CAS  Google Scholar 

  13. Seligman, M. E., Steen, T. A., Park, N. & Peterson, C. Positive psychology progress: empirical validation of interventions. Am. Psychol. 60, 410–421 (2005).

    Article  PubMed  Google Scholar 

  14. 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).

    Article  PubMed  Google Scholar 

  15. Charney, D. S. Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am. J. Psychiatry 161, 195–216 (2004).

    Article  PubMed  Google Scholar 

  16. Drossman, D. A. Abuse, trauma, and GI illness: is there a link? Am. J. Gastroenterol. 106, 14–25 (2011).

    Article  PubMed  Google Scholar 

  17. 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).

    Article  PubMed  CAS  Google Scholar 

  18. 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).

  19. 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).

    Article  PubMed  Google Scholar 

  20. 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).

    Article  Google Scholar 

  21. Russo, S. J., Murrough, J. W., Han, M. H., Charney, D. S. & Nestler, E. J. Neurobiology of resilience. Nat. Neurosci. 15, 1475–1484 (2012).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Smith, B. W. et al. The brief resilience scale: assessing the ability to bounce back. Int. J. Behav. Med. 15, 194–200 (2008).

    Article  PubMed  Google Scholar 

  23. Park, S. H. et al. Resilience is decreased in irritable bowel syndrome and associated with symptoms and cortisol response. Neurogastroenterol. Motil. 30, e13155 (2017).

    Article  CAS  Google Scholar 

  24. 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).

    Article  PubMed  CAS  Google Scholar 

  25. Kautz, M., Charney, D. S. & Murrough, J. W. Neuropeptide Y, resilience, and PTSD therapeutics. Neurosci. Lett. 649, 164–169 (2017).

    Article  PubMed  CAS  Google Scholar 

  26. Keefer, L. et al. Centrally mediated disorders of gastrointestinal pain. Gastroenterology https://doi.org/10.1053/j.gastro.2016.02.034 (2016).

  27. Andrews, J. M. & Holtmann, G. IBD: Stress causes flares of IBD — how much evidence is enough? Nat. Rev. Gastroenterol. Hepatol. 8, 13–14 (2011).

    Article  PubMed  Google Scholar 

  28. Bernstein, C. N. Psychological stress and depression: risk factors for IBD? Dig. Dis. 34, 58–63 (2016).

    Article  PubMed  Google Scholar 

  29. 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).

    Article  PubMed  CAS  Google Scholar 

  30. 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).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Gick, M. L. & Sirois, F. M. Insecure attachment moderates women’s adjustment to inflammatory bowel disease severity. Rehabil. Psychol. 55, 170–179 (2010).

    Article  PubMed  Google Scholar 

  32. Agostini, A. et al. Attachment and quality of life in patients with inflammatory bowel disease. Int. J. Colorectal. Dis. 29, 1291–1296 (2014).

    Article  PubMed  Google Scholar 

  33. 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).

    Article  PubMed  Google Scholar 

  34. 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).

    Article  PubMed  CAS  Google Scholar 

  35. Dusek, J. A. et al. Genomic counter-stress changes induced by the relaxation response. PLoS ONE 3, e2576 (2008).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. 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).

    Article  PubMed  Google Scholar 

  37. Scheier, M. F. & Carver, C. S. Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol. 4, 219–247 1985).

    Article  PubMed  CAS  Google Scholar 

  38. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  39. 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).

    Article  PubMed  Google Scholar 

  40. Baker, C. & Stern, P. N. Finding meaning in chronic illness as the key to self-care. Can. J. Nurs. Res. 25, 23–36 (1993).

    PubMed  CAS  Google Scholar 

  41. 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).

    Article  PubMed  Google Scholar 

  42. Southwick, S. M. et al. Why are some individuals more resilient than others: the role of social support. World. Psychiatry 15, 77–79 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  43. 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).

    Article  PubMed  Google Scholar 

  44. 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).

    Article  PubMed  Google Scholar 

  45. 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).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  46. Kim, E. S. et al. Optimism and cause-specific mortality: a prospective cohort study. Am. J. Epidemiol. 185, 21–29 (2017).

    Article  PubMed  Google Scholar 

  47. 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).

    PubMed  Google Scholar 

  48. Rasmussen, H. N., Scheier, M. F. & Greenhouse, J. B. Optimism and physical health: a meta-analytic review. Ann. Behav. Med. 37, 239–256 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  49. 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).

    Article  PubMed  Google Scholar 

  50. 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).

    Article  PubMed  Google Scholar 

  51. 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).

    Article  PubMed  CAS  Google Scholar 

  52. Jelenova, D. et al. Heart rate variability in children with inflammatory bowel diseases. Neuro. Endocrinol. Lett. 36, 72–79 (2015).

    PubMed  Google Scholar 

  53. 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).

    Article  PubMed  Google Scholar 

  54. 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).

    Article  PubMed  CAS  Google Scholar 

  55. 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).

    Article  PubMed  CAS  Google Scholar 

  56. Cheng, C., Hui, W. M. & Lam, S. K. Coping style of individuals with functional dyspepsia. Psychosom. Med. 61, 789–795 (1999).

    Article  PubMed  CAS  Google Scholar 

  57. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  58. Seligman, M. Learned Optimism: How to Change Your Mind and Your Life (Vintage, 2006).

  59. 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).

    Article  PubMed  CAS  Google Scholar 

  60. 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).

    Article  PubMed  Google Scholar 

  61. 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).

    Article  PubMed  Google Scholar 

  62. 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).

    Article  PubMed  Google Scholar 

  63. Baumeister, R. F. Self-regulation, ego depletion, and inhibition. Neuropsychologia. 65, 313–319 (2014).

    Article  PubMed  Google Scholar 

  64. Watson, D. & Tellegen, A. Toward a consensual structure of mood. Psychol. Bull. 98, 219–235 (1985).

    Article  PubMed  CAS  Google Scholar 

  65. 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).

    Article  PubMed  Google Scholar 

  66. Eisenberg, N. et al. The relations of emotionality and regulation to preschoolers’ social skills and sociometric status. Child. Dev. 64, 1418–1438 (1993).

    Article  PubMed  CAS  Google Scholar 

  67. Bandura, A. Health promotion by social cognitive means. Health. Educ. Behav. 31, 143–164 (2004).

    Article  PubMed  Google Scholar 

  68. 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).

    Article  Google Scholar 

  69. 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).

    Article  PubMed  Google Scholar 

  70. Halse, C., Honey, A. & Boughtwood, D. The paradox of virtue: (re)thinking deviance, anorexia and schooling. Gender Educ. 19, 219–235 (2007).

    Article  Google Scholar 

  71. 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).

    Article  Google Scholar 

  72. Lorig, K. Chronic disease self-management: from randomized trial to public policy. Eur. J. Public Health 20, 6–7 (2010).

    Google Scholar 

  73. Bandura, A. Self-efficacy: toward a unifying theory of behavioral change. Psychol. Rev. 84, 191–215 (1977).

    Article  PubMed  CAS  Google Scholar 

  74. 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).

    Article  Google Scholar 

  75. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  76. 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).

    Article  PubMed  Google Scholar 

  77. Ballou, S., Taft, T. & Keefer, L. Disease-specific self-efficacy in the eosinophilic gastrointestinal disorders. J. Health. Psychol. 20, 1027–1036 (2015).

    Article  PubMed  Google Scholar 

  78. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  79. 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).

    Article  PubMed  Google Scholar 

  80. 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).

    Article  PubMed  Google Scholar 

  81. 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).

    Article  PubMed  Google Scholar 

  82. Blair, C. et al. Salivary cortisol mediates effects of poverty and parenting on executive functions in early childhood. Child. Dev. 82, 1970–1984 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  83. 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).

    Article  PubMed  CAS  Google Scholar 

  84. 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).

    Article  PubMed  CAS  Google Scholar 

  85. Sakic, B., Gauldie, J., Denburg, J. A. & Szechtman, H. Behavioral effects of infection with IL-6 adenovector. Brain. Behav. Immun. 15, 25–42 (2001).

    Article  PubMed  CAS  Google Scholar 

  86. 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).

    Article  PubMed  Google Scholar 

  87. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  88. 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).

    Article  PubMed  Google Scholar 

  89. 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).

    Article  PubMed  Google Scholar 

  90. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  91. Palsson, O. S. Hypnosis treatment of gastrointestinal disorders: a comprehensive review of the empirical evidence. Am. J. Clin. Hypn. 58, 134–158 (2015).

    Article  PubMed  Google Scholar 

  92. 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).

    Article  PubMed  CAS  Google Scholar 

  93. 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).

    Article  PubMed  Google Scholar 

  94. 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).

    Article  PubMed  CAS  Google Scholar 

  95. 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).

    Article  PubMed  CAS  Google Scholar 

  96. 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).

    Article  PubMed  Google Scholar 

  97. Creed, F. et al. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology 124, 303–317 (2003).

    Article  PubMed  Google Scholar 

  98. 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).

    Article  PubMed  Google Scholar 

  99. 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).

    Article  PubMed  Google Scholar 

  100. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  101. 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).

    Article  PubMed  Google Scholar 

  102. 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).

    Article  PubMed  Google Scholar 

  103. 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).

    Article  PubMed  Google Scholar 

  104. 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).

    Article  PubMed  Google Scholar 

  105. 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).

    Article  PubMed  Google Scholar 

  106. 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).

    Article  PubMed  Google Scholar 

  107. Holzel, B. K. et al. Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training. Neuroimage Clin. 2, 448–458 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  108. Breckman, B. Mindfulness as a key resource for development and resilience. Nurs. Stand. 26, 32 (2012).

    Article  PubMed  Google Scholar 

  109. 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).

    Article  PubMed  Google Scholar 

  110. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  111. 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).

  112. 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).

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  113. 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).

  114. 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).

    Article  PubMed  Google Scholar 

  115. 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).

    Article  PubMed  Google Scholar 

  116. 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).

    Google Scholar 

  117. 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).

    Article  PubMed  Google Scholar 

  118. 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).

    Article  PubMed  CAS  Google Scholar 

  119. 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).

    Article  PubMed  Google Scholar 

  120. 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).

    Article  PubMed  Google Scholar 

  121. 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).

    Article  PubMed  Google Scholar 

  122. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  123. 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).

    Article  PubMed  CAS  Google Scholar 

  124. Cuijpers, P., van Straten, A. & Warmerdam, L. Behavioral activation treatments of depression: a meta-analysis. Clin. Psychol. Rev. 27, 318–326 (2007).

    Article  PubMed  Google Scholar 

  125. 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).

    Article  PubMed  Google Scholar 

  126. Linehan, M. M. & Wilks, C. R. The course and evolution of dialectical behavior therapy. Am. J. Psychother. 69, 97–110 (2015).

    Article  PubMed  Google Scholar 

  127. 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).

    Google Scholar 

  128. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  129. 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).

    Article  PubMed  CAS  Google Scholar 

  130. 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).

    Article  PubMed  Google Scholar 

  131. 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).

    Article  PubMed  CAS  Google Scholar 

  132. 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).

    Article  PubMed  Google Scholar 

  133. 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).

    Article  PubMed  Google Scholar 

  134. 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).

    Article  PubMed  Google Scholar 

  135. 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).

    Article  PubMed  Google Scholar 

  136. 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).

    Article  PubMed  Google Scholar 

  137. 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).

    Article  PubMed  Google Scholar 

  138. 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).

  139. Ballou, S. & Keefer, L. Psychological interventions for irritable bowel syndrome and inflammatory bowel diseases. Clin. Transl. Gastroenterol. 8, e214 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  140. Gaylord, S. A. et al. Mindfulness for irritable bowel syndrome: protocol development for a controlled clinical trial. BMC. Complement. Altern. Med. 9, 24 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  141. Seligman, M. E. P., Rashid, T. & Parks, A. C. Positive psychotherapy. Am. Psychol. 61, 774–788 (2006).

    Article  PubMed  Google Scholar 

  142. Lampropoulos, G. K. Integrating psychopathology, positive psychology, and psychotherapy. Am. Psychol. 56, 87–88 (2001).

    Article  PubMed  CAS  Google Scholar 

  143. Sheldon, K. M. & King, L. Why positive psychology is necessary. Am. Psychol. 56, 216–217 (2001).

    Article  PubMed  CAS  Google Scholar 

  144. Krause, N. & Markides, K. Measuring social support among older adults. Int. J. Aging. Hum. Dev. 30, 37–53 (1990).

    Article  PubMed  CAS  Google Scholar 

  145. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  146. McCracken, L. M., Vowles, K. E. & Eccleston, C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain. 107, 159–166 (2004).

    Article  PubMed  Google Scholar 

  147. Moss-Morris, R. et al. The revised Illness Perception Questionnaire (IPQ-R). Psychol. Health. 17, 1–16 (2002).

    Article  Google Scholar 

  148. 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).

    Article  PubMed  Google Scholar 

  149. Carlson, L. E. & Brown, K. W. Validation of the Mindful Attention Awareness Scale in a cancer population. J. Psychosom. Res. 58, 29–33 (2005).

    Article  PubMed  Google Scholar 

  150. Diener, E., Emmons, R. A., Larsen, R. J. & Griffin, S. The Satisfaction With Life Scale. J. Pers. Assess. 49, 71–75 (1985).

    Article  PubMed  CAS  Google Scholar 

  151. 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).

    Article  PubMed  CAS  Google Scholar 

  152. Salsman, J. M. et al. Assessing psychological well-being: self-report instruments for the NIH Toolbox. Qual. Life. Res. 23, 205–215 (2014).

    Article  PubMed  Google Scholar 

Download references

Reviewer information

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Laurie Keefer.

Ethics declarations

Competing interests

The author declares no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41575-018-0001-1

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing