Comprehensive Cognitive-Behavioral Interventions Augment Diaphragmatic Breathing for Rumination Syndrome: A Proof-of-Con
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ORIGINAL ARTICLE
Comprehensive Cognitive‑Behavioral Interventions Augment Diaphragmatic Breathing for Rumination Syndrome: A Proof‑of‑Concept Trial Helen Burton Murray1,2,3,4 · Fengqing Zhang1,2 · Christine C. Call1,2 · Ani Keshishian3 · Rowan A. Hunt1,2 · Adrienne S. Juarascio1,2 · Jennifer J. Thomas3,4 Received: 12 August 2020 / Accepted: 16 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Rumination syndrome (RS) is often treated in medical settings with 1–2 sessions of diaphragmatic breathing to target reflexive abdominal wall contraction in response to conditioned cues (e.g., food). However, many patients remain symptomatic and require additional behavioral interventions. Aims In an attempt to augment diaphragmatic breathing with additional interventions, we tested the proof-of-concept of a comprehensive Cognitive-Behavioral Therapy (CBT) for RS. Methods In an uncontrolled trial, adults with RS completed a 5–8 session CBT protocol, delivered by one of two psychology behavioral health providers. CBT included two main phases: awareness training and diaphragmatic breathing (Phase 1) and modularized interventions chosen by the therapist and patient to target secondary maintenance mechanisms (Phase 2). At pre-treatment, post-treatment, and 3-month follow-up, participants completed a semi-structured interview on RS symptoms with an independent evaluator. Results Of 10 eligible individuals (ages 20–67 years, 50% female) offered treatment, all 10 initiated treatment and eight completed it. All participants endorsed high treatment credibility at Session 1. Permutation-based repeated measures ANOVA showed participants achieved large reductions in regurgitations across treatment [F(1,7) = 17.7, p = .007, η2p = .69]. Although participants reduced regurgitations with diaphragmatic breathing during Phase 1, addition of other CBT strategies in Phase 2 produced further large reductions [F(1,7) = 6.3, p = .04, η2p = .47]. Of eight treatment completers, treatment gains were maintained at 3-month follow-up for n = 6. Conclusions Findings provide evidence of feasibility, acceptability, and proof-of-concept for a comprehensive CBT for RS that includes interventions in addition to diaphragmatic breathing to target secondary maintenance mechanisms. Randomized controlled trials are needed. Keywords Rumination disorder · Rumination syndrome · Disorders of gut-brain interaction · Habit-reversal training · Feeding and eating disorders · Functional gastrointestinal disorder
Adrienne S. Juarascio and Jennifer J. Thomas are co-senior authors. Guarantor of the article: Helen Burton Murray, PhD. * Helen Burton Murray [email protected]
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Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
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Harvard Medical School, Boston, MA, USA
Department of Psychology, Drexel University, Philadelphia, PA, USA
The WELL Center, Drexel University, Philadelphia, PA, USA
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Introduction Rumination sy
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