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A Neurobiology of Sensitivity? New Study Suggests a Link
Between Environmental Sensitivity and Anomalous Perceptions
Vienna, Virginia (April 24, 2006) – People with a 'sensitive' personality type are far more likely to report apparitional experience, according to a paper in the current issue of the Journal of the Society for Psychical Research. Such persons commonly report longstanding allergies, chronic pain and fatigue, depression, migraine headaches, or sensitivity to light, sound, and smell. These individuals are also more likely to report that immediate family members suffered from the same conditions. The survey raises the question of whether a 'neurobiology of sensitivity' could underlie reports of apparitional experience occurring across societies and throughout history.
Sixty-two self-described 'sensitives' participated in the study, along with 50 individuals serving as controls who did not profess any outstanding forms of sensitivity. Persons in the former group were 3.5 times as likely, on average, to assert that they'd had an apparitional experience (defined as perceiving something that could not be verified as being physically present through normal means). Sensitive persons were also 2.5 times as likely to indicate that an immediate family member was affected by similar physical, mental or emotional conditions.
Overall, 8 of the 54 factors asked about in the survey were found to be significant in the makeup of a sensitive personality:
Being female
Being a first-born or only child
Being single
Being ambidextrous
Appraising oneself as imaginative
Appraising oneself as introverted
Recalling a plainly traumatic event (or events) in childhood
Maintaining that one affects - or is affected by – lights, computers, and other electrical appliances in an unusual way.
Additionally, synesthesia – the scientifically recognized condition of overlapping senses, such as hearing colors or tasting shapes – was reported by approximately 10% of the sensitive group but not at all among controls.
This finding gives added weight to the possibility that apparitional perceptions stem from an underlying neurobiology of sensitivity.
"It seems quite possible," writes study author Michael Jawer, "that certain individuals are, from birth onward, disposed to a number of conditions, illnesses, and perceptions that, in novelty as well as intensity, distinguish them from the general population. If so, apparitional experience might have a bona fide neurobiological basis that makes it accessible to scientific inquiry."
The paper is posted online at http://cogprints.org/4846/. The Society for Psychical Research, founded in 1882 by a distinguished group of Cambridge University scholars, is the foremost British organization for the scientific study of anomalous perceptions. Its website is http://www.spr.ac.uk/.
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Social Science & Medicine 62 (2006) 2838–2847
An international study of irritable bowel syndrome: Family
relationships and mind-body attributions
Mary-Joan Gersona,, Charles D. Gerson, Richard A. Awad, Christine Dancey, Pierre Poitrase, Piero Porcellif, Ami D. Sperberg
Irritable bowel syndrome (IBS) is a functional gastrointestinal illness, characterized by potentially debilitating symptoms without pathologic findings, often associated with psychological conditions. Little is known about the psychosocial aspects of this condition on an international scale. A total of 239 patients in eight countries were given a series of psychological and medical questionnaires, including IBS activity, relationships with significant others, beliefs regarding the etiology of symptoms, and assessment of quality of life. There were highly significant associations between IBS severity and all other measures. Symptoms were worse if relationship conflict was high and if attributions about illness were physiological rather than psychological. Symptoms were less severe if relationship depth and support were high, and illness was viewed as psychological. Implications for treatment are discussed.
r 2005 Elsevier Ltd. All rights reserved.
Full study is available in PDF format. Mind Body Survey
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From Alimentary Pharmacology & Therapeutics
The Effectiveness of Hypnotherapy in the Management of Irritable Bowel Syndrome
Posted 10/03/2006
S. Wilson; T. Maddison; L. Roberts; S. Greenfield; S. Singh
Aim: To systematically review the literature evaluating hypnotherapy in the management of irritable bowel syndrome (IBS).
Methods: Electronic databases were searched (Cochrane Library, Medline, CINAHL, AMED, Embase, PsycINFO, CISCOM, TRIP and the Social Science Citation index), bibliographic references scanned and main authors contacted. No restrictions were placed on language or publication year. Eligible studies involved adults with IBS using single-component hypnotherapy. All studies, except single case or expert opinion, were sought and all patient-related outcomes eligible.
Results: Out of 299 unique references identified, 20 studies (18 trials of which four were randomized, two controlled and 12 uncontrolled) and two case series were eligible. These tended to demonstrate hypnotherapy as being effective in the management of IBS. Numbers of patients included were small. Only one trial scored more than four out of eight on internal validity.
Conclusion: The published evidence suggests that hypnotherapy is effective in the management of IBS. Over half of the trials (10 of 18) indicated a significant benefit. A randomized placebo-controlled trial of high internal validity is necessary to establish the effectiveness of hypnotherapy in the management of IBS. Until such a trial is undertaken, this form of treatment should be restricted to specialist centres caring for the more severe forms of the disorder.
Introduction
Irritable bowel syndrome (IBS) is a chronic disorder affecting 10-20% of the population.[1,2] It is estimated that a general practitioner in the UK sees eight patients with IBS every week[3] and these patients constitute up to 50% of gastroenterology referrals.[4-7] The quality of life (QOL) of patients with IBS is surprisingly poor, particularly in the population seeking professional health care,[8] with over 40% of those referred to hospital out-patients reporting avoidance of some activities[9] and some studies have indicated that the impact of IBS on QOL is as great as that observed for congestive heart failure[10] and stroke.[11] Health service costs, both direct[12,13] and indirect,[14-16] are high.
Conventional therapy leaves up to 25% of sufferers without relief of symptoms[17] and many patients have been reported to turn to alternative therapies.[18]'Gut-directed hypnotherapy' (GDH), a type of hypnosis, is one of the alternative therapies most frequently reported to have a demonstrable beneficial therapeutic impact on IBS symptoms.[19,20] GDH is based on the use of hypnotic induction, using progressive relaxation and other techniques, followed by imagery directed towards control and normalization of gut function.[20] Therapy also aims to teach autohypnosis, to enable patients to manage their own symptoms without ongoing reliance on primary or secondary care, although occasional refresher sessions may be required.
The first paper to report an evaluation of GDH in the management of IBS was published 20 years ago[20] and indicated a significant benefit over placebo, in patients referred to a specialist centre for the management of refractory IBS. A more recent audit of patients treated in this hypnotherapy unit, reported that GDH may also confer longer term benefits and reduced health care costs as a result of lower consultation rates and medication use.[21] Such studies suggest benefits would be achieved by the more widespread use of GDH in the management of IBS.
Four reviews of the published evidence relating to the role of hypnotherapy in the management of IBS have been previously published with conflicting conclusions.[22-25] The first review[24] concluded that hypnotherapy was effective in the management of refractory IBS, with suggested models of implementation focusing on the training of primary and community care staff (nurses, physiotherapists and occupational therapists). However, this review limited searches to only one database (CISCOM) and no detail was provided with respect to the search strategy or years searched, how inclusion criteria were applied, how judgements of validity were made or the process of data extraction. Spanier's review aimed to determine the effectiveness of alternative therapies,[25] including hypnotherapy, for the treatment of IBS but was also limited to only one bibliographic database (Medline) and excluded all non-English language studies; language restrictions may compromise the validity of a systematic review, but potentially more so in the areas of alternative therapy where major developments have occurred outside of the English speaking world.[26] This review concluded that the studies identified (n = 3) were of poor quality and further research was necessary to determine the efficacy of hypnotherapy. Two recent reviews have included differing studies; Tan et al.[22] included six controlled trials and concluded that hypnosis consistently produces significant results, and, Whitehead[23] included five controlled studies and concluded that hypnosis has a substantial therapeutic impact on IBS.
The number of primary studies and reviews suggesting that GDH may have significant value in the management of IBS and the lack of a high quality systematic review, provided the impetus to conduct this systematic review, which addresses the question of whether hypnotherapy is effective in the management of IBS.
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Section 1 of 4 Next Page: Methods
S. Wilson*, T. Maddison*, L. Roberts*, S. Greenfield* & S. Singh† on Behalf of the Birmingham IBS Research Group
*Division of Primary Care, Public & Occupational Health, Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT, UK
†Good Hope NHS Trust, Birmingham B75 7RR, UK
Competing Interests: None of the authors have any competing interests to declare.
Aliment Pharmacol Ther. 2006;24(5):769-780. ©2006 Blackwell Publishing
http://www.medscape.com/viewarticle/543563
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Stress and the Emotional Motor System (EMS)
eCAM Advance Access published online on May 17, 2007
eCAM, doi:10.1093/ecam/nem046
Min/Body Psychological Treatments for Irritable Bowel Syndrome
Bruce D. Naliboff1,2,3, Michael P. Fresé1,2,3 and Lobsang Rapgay2
1UCLA Center for Neurovisceral Sciences and Women's Health, 2Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA and 3Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA
A variety of experimental and clinical studies support the model described above. In general, IBS patients show altered perception of visceral events that is characterized by hypervigilance, hypersensitivity and increased autonomic arousal (16,17). While peripheral GI factors may play a role in subsets of patients with IBS (e.g. post-infectious IBS), there is converging clinical and neurobiologic research to suggest that enhanced central stress responsiveness involving anxiety may provide a specific mechanism for enhanced visceral sensitivity found in these disorders (11). GI symptom-specific anxiety may be an especially important variable leading to increased pain sensitivity, hypervigilance and poor coping (18,19). Mild psychologic stress increases visceral perception in IBS patients but not in healthy controls (20) and IBS symptoms are exacerbated following stressful life events (21). We have also recently shown that visceral-specific anxiety appears to be particularly important in IBS and may be the primary element in mediating the impact between changes in symptom severity and changes in quality of life in IBS sufferers (18). Recent brain imaging findings have now begun to show the central circuitry that may underlie many of the observations described above (22). For example, patients with IBS during visceral stimulation show increased activation in the anterior cingulate cortex, a brain region involved in vigilance and discomfort during physical and social situations (23).
http://ecam.oxfordjournals.org/cgi/content/full/nem046v1#SEC3
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Gut 2007;56:1202-1209
Copyright © 2007 BMJ Publishing Group Ltd & British Society of Gastroenterology
Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity
Spencer D Dorn1, Olafur S Palsson1, Syed I M Thiwan1, Motoyori Kanazawa2, W Crawford Clark3, Miranda A L van Tilburg1, Douglas A Drossman1, Yolanda Scarlett1, Rona L Levy4, Yehuda Ringel1, Michael D Crowell5, Kevin W Olden6 and William E Whitehead1
1 Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
2 Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
3 Department of Psychiatry, Columbia University, New York, NY, USA
4 School of Social Work, University of Washington, Seattle, WA, USA
5 Mayo Clinic Scottsdale, Scottsdale, AZ, USA
6 Division of Gastroenterology, University of Arkansas, Little Rock, AR, USA
ABSTRACT
Objective: The aim was to determine whether lower visceral pain thresholds in irritable bowel syndrome (IBS) primarily reflect physiological or psychological factors.
Methods: Firstly, 121 IBS patients and 28 controls underwent balloon distensions in the descending colon using the ascending methods of limits (AML) to assess pain and urge thresholds. Secondly, sensory decision theory analysis was used to separate physiological from psychological components of perception: neurosensory sensitivity (p(A)) was measured by the ability to discriminate between 30 mm Hg vs 34 mm Hg distensions; psychological influences were measured by the report criterion—that is, the overall tendency to report pain, indexed by the median intensity rating for all distensions, independent of intensity. Psychological symptoms were assessed using the Brief Symptom Inventory (BSI).
Results: IBS patients had lower AML pain thresholds (median: 28 mm Hg vs 40 mm Hg; p<0.001), but similar neurosensory sensitivity (median p(A): 0.5 vs 0.5; p = 0.69; 42.6% vs 42.9% were able to discriminate between the stimuli better than chance) and a greater tendency to report pain (median report criterion: 4.0 ("mild" pain) vs 5.2 ("weak" pain); p = 0.003). AML pain thresholds were not correlated with neurosensory sensitivity (r = –0.13; p = 0.14), but were strongly correlated with report criterion (r = 0.67; p<0.0001). Report criterion was inversely correlated with BSI somatisation (r = –0.26; p = 0.001) and BSI global score (r = –0.18; p = 0.035). Similar results were seen for the non-painful sensation of urgency.
Conclusion: Increased colonic sensitivity in IBS is strongly influenced by a psychological tendency to report pain and urge rather than increased neurosensory sensitivity.
http://gut.bmj.com/cgi/content/abstract/56/9/1202?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Firstly%2C+it+underscores+the+importance+of+accounting+for+psychological+factors+w&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
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Nurs Res. 2007 Nov-Dec;56(6):399-406.
Daily stress and gastrointestinal symptoms in women with irritable bowel syndrome.Hertig VL, Cain KC, Jarrett ME, Burr RL, Heitkemper MM.
Department of Biobehavioral Nursing & Health Systems, University of Washington, Seattle, WA 98195, USA.
BACKGROUND: Stress has been implicated as contributing to the initiation and exacerbation of bowel and discomfort symptoms in patients with irritable bowel syndrome (IBS).
OBJECTIVE: To examine the relationships of daily self-reported stress to gastrointestinal (GI) and psychological distress symptoms both across women and within woman in a comparison group of women without IBS and among subgroups of women with IBS.
METHODS: Women with IBS (n = 181; age = 18-49 years) who were divided into subgroups based on bowel pattern (constipation, n = 52; diarrhea, n = 67; alternating, n = 62) were compared to a group of women without IBS (n = 48). Self-report stress measures; abdominal (abdominal pain, bloating, and intestinal gas), bowel pattern (constipation, diarrhea), and intestinal gas; and psychological (anxiety and depression) distress symptoms were obtained daily over 1 month. Across-women and within-woman analyses were used.
RESULTS: There were significant across-women correlations among mean daily stress, psychological distress, and GI symptoms in the total IBS group and the IBS bowel pattern subgroups. The across-women relationships between daily stress and GI symptoms were diminished when anxiety and depression were controlled in the analyses. Within-woman analyses showed little evidence of relationship between day-to-day variations in stress and day-to-day variations in GI symptoms; however, stress was strongly related to anxiety and depression.
DISCUSSION: Gastrointestinal symptom distress is associated with self-reported stress in women with IBS. Psychological distress moderates the effects of stress on GI symptoms. The IBS treatment protocols that incorporate strategies that decrease stress and psychological distress are likely to reduce GI symptoms.
PMID: 18004186 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=18004186&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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J Neurosci. 2008 Jan 9;28(2):349-59.
Reduced brainstem inhibition during anticipated pelvic visceral pain correlates with enhanced brain response to the visceral stimulus in women with irritable bowel syndrome.
Berman SM, Naliboff BD, Suyenobu B, Labus JS, Stains J, Ohning G, Kilpatrick L, Bueller JA, Ruby K, Jarcho J, Mayer EA.
Department of Medicine, University of California, Los Angeles Center for Neurovisceral Sciences and Women's Health, David Geffen School of Medicine at University of California, Los Angeles, 90073, USA.
Cognitive factors such as fear of pain and symptom-related anxiety play an important role in chronic pain states. The current study sought to characterize abnormalities in preparatory brain response before aversive pelvic visceral distention in irritable bowel syndrome (IBS) patients and their possible relationship to the consequences of distention. The brain functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) response to anticipated and delivered mild and moderate rectal distention was recorded from 14 female IBS patients and 12 healthy controls. During cued anticipation of distention, activity decreased in the insula, supragenual anterior cingulate cortex (sACC), amygdala, and dorsal brainstem (DBS) of controls.
IBS patients showed less anticipatory inactivation. Group differences were significant in the right posterior insula and bilateral DBS. Self-rated measures of negative affect during scanning were higher in patients than controls (p < 0.001), and the anticipatory BOLD decreases in DBS were inversely correlated with these ratings.
During subsequent distention, both groups showed activity increases in insula, dorsal ACC, and DBS and decreases in the infragenual ACC. The increases were more extensive in patients, producing significant group differences in dorsal ACC and DBS. The amplitude of the anticipatory decrease in the pontine portion of DBS was associated with greater activation during distention in right orbitofrontal cortex and bilateral sACC.
Both regions have been associated previously with corticolimbic inhibition and cognitive coping. Deficits in preparatory inhibition of DBS, including the locus ceruleus complex and parabrachial nuclei, may interfere with descending corticolimbic inhibition and contribute to enhanced brain responsiveness and perceptual sensitivity to visceral stimuli in IBS.
PMID: 18184777 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/18184777?ordinalpos=11&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Evid Based Complement Alternat Med. 2008 Mar;5(1):41-50.
Mind/Body psychological treatments for irritable bowel syndrome.
Naliboff BD, Fresé MP, Rapgay L.
UCLA Center for Neurovisceral Sciences and Women's Health, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA and Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Currently, the goal of treatment for those with irritable bowel syndrome (IBS) is to improve the quality of life through a reduction in symptoms. While the majority of treatment approaches involve the use of traditional medicine, more and more patients seek out a non-drug approach to managing their symptoms. Current forms of non-drug psychologic or mind/body treatment for IBS include hypnotherapy, cognitive behavioral therapy and brief psychodynamic psychotherapy, all of which have been proven efficacious in clinical trials. We propose that incorporating the constructs of mindfulness and acceptance into a mind/body psychologic treatment of IBS may be of added benefit due to the focus on changing awareness and acceptance of one's own state which is a strong component of traditional and Eastern healing philosophies.
PMID: 18317547 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/18317547?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Eur Arch Otorhinolaryngol. 2009 Dec 30.
Olfactory and gustatory function in irritable bowel syndrome.
Steinbach S, Reindl W, Kessel C, Ott R, Zahnert T, Hundt W, Heinrich P, Saur D, Huber W.
Department of Otorhinolaryngology, Philipps University, Deutschhausstrasse 3, 35037, Marburg, Germany,
Irritable bowel syndrome (IBS) is the most common, functional disorder diagnosed by gastroenterologists. It is still unclear whether IBS has a central etiology, e.g., hyperreactivity of the brain, or a peripheral etiology, e.g., stimulation of olfactory/gustatory receptors on enterochromaffin cells, followed by serotonin release and changed gut motility. Testing the odor identification (ID), odor discrimination (DIS) and odor threshold (THR) as well as the total taste and the taste qualities "sweet", "sour", "salty" and "bitter" should be of help for determining the etiology. To our knowledge, this is the first study investigating the olfactory/gustatory function in IBS patients. The olfactory/gustatory function of 43 patients (32 women, 11 men) suffering from IBS as defined by the ROME III criteria was investigated by means of validated tests (Sniffin' Sticks and taste strips). Compared to normative data, scores of THR were decreased and scores of ID and DIS were increased in IBS patients. Additionally, when compared to normative data, there was no difference in the taste function of IBS patients. Assuming that THR reflects more the peripheral olfactory function, whereas ID and DIS are influenced by central activity, and that taste did not differ in IBS patients compared to normative data, this supports the idea of a central etiology of IBS.
PMID: 20041259 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20041259
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Gastroenterol Clin Biol. 2009 Feb;33 Suppl 1:S48-58.
Brain-gut axis dysfunction
Bonaz B, Sabate JM.
Clinique Universitaire d'Hépato-Gastroentérologie et Stress et Interactions neuro-Digestives, Grenoble Institut des Neurosciences (GIN, Centre de Recherche INSERM U836-UJF-CEA-CHU), CHU de Grenoble, BP217, 38043 Grenoble cedex 09, France.
There is a bidirectional relation between the central nervous system and the digestive tract, i.e., the brain-gut axis. Numerous data argue for a dysfunction of the brain-gut axis in the pathophysiology of irritable bowel syndrome (IBS). Visceral hypersensitivity is a marker of IBS as well as of an abnormality of the brain-gut axis. This visceral hypersensitivity is peripheral and/or central in origin and may be the consequence of digestive inflammation or an anomaly of the nociceptive message treatment at the spinal and/or supraspinal level. Stress is involved in the genesis and maintenance of IBS. Disturbances of the autonomic nervous system are observed in IBS as a consequence of brain-gut axis dysfunction. The contribution of the neurosciences, in particular brain imaging techniques, has contributed to the better understanding of IBS physiopathology. The better knowledge of brain-gut axis dysfunction has therapeutic implications, either through drugs and/or cognitive and behavioral therapies.
PMID: 19303539 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/19303539
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