The specific effect of systematic exposure in irritable bowel syndrome: complier average causal effect analysis using growth mixture modeling
We reanalyzed data from a previously published randomized component study that aimed to test the incremental effect of systematic exposure in an internet-delivered cognitive behavioral treatment (ICBT) for irritable bowel syndrome (IBS). Three hundred and nine individuals with IBS were randomly assi...
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| Veröffentlicht in: | Psychological medicine 2017-11, Vol.47 (15), p.2653-2662 |
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| creator | Hesser, H. Hedman, E. Lindfors, P. Andersson, E. Ljótsson, B. |
| description | We reanalyzed data from a previously published randomized component study that aimed to test the incremental effect of systematic exposure in an internet-delivered cognitive behavioral treatment (ICBT) for irritable bowel syndrome (IBS).
Three hundred and nine individuals with IBS were randomly assigned to either the full treatment protocol (experimental condition) or the same treatment protocol without systematic exposure (control). Participants were assessed weekly for IBS symptoms over the active treatment phase. We used a complier average causal effect (CACE) analysis, in the growth mixture modeling framework, to (1) examine the specific effect of exposure among those who received the intervention (i.e. compliers), and (2) explore the associations of pre-treatment patient characteristics with compliance status and outcome changes.
Fifty-five per cent of those assigned to the experimental condition were classified as compliers. The CACE analysis that took into account compliance status demonstrated that the magnitude of the incremental effect of systematic exposure on IBS symptoms was larger than the effect observed in an intention-to-treat analysis that ignored compliance status (d = 0.81 v. d = 0.44). Patients with university education showed more improvement during the exposure phase of the treatment. Pre-treatment patient characteristics did not predict compliance status.
The effect of systematic exposure on IBS symptoms is of substantial magnitude among those individuals who actually receive the intervention (CACE). Studying the subsample of individuals who discontinue treatment prematurely and tailoring interventions to improve compliance may increase overall improvement rates in ICBT for IBS. |
| doi_str_mv | 10.1017/S0033291717001167 |
| format | Article |
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Three hundred and nine individuals with IBS were randomly assigned to either the full treatment protocol (experimental condition) or the same treatment protocol without systematic exposure (control). Participants were assessed weekly for IBS symptoms over the active treatment phase. We used a complier average causal effect (CACE) analysis, in the growth mixture modeling framework, to (1) examine the specific effect of exposure among those who received the intervention (i.e. compliers), and (2) explore the associations of pre-treatment patient characteristics with compliance status and outcome changes.
Fifty-five per cent of those assigned to the experimental condition were classified as compliers. The CACE analysis that took into account compliance status demonstrated that the magnitude of the incremental effect of systematic exposure on IBS symptoms was larger than the effect observed in an intention-to-treat analysis that ignored compliance status (d = 0.81 v. d = 0.44). Patients with university education showed more improvement during the exposure phase of the treatment. Pre-treatment patient characteristics did not predict compliance status.
The effect of systematic exposure on IBS symptoms is of substantial magnitude among those individuals who actually receive the intervention (CACE). Studying the subsample of individuals who discontinue treatment prematurely and tailoring interventions to improve compliance may increase overall improvement rates in ICBT for IBS.</description><identifier>ISSN: 0033-2917</identifier><identifier>ISSN: 1469-8978</identifier><identifier>EISSN: 1469-8978</identifier><identifier>DOI: 10.1017/S0033291717001167</identifier><identifier>PMID: 28464975</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Adherence ; Adult ; Behavior modification ; Clinical psychology ; Cognition & reasoning ; Cognitive ability ; Cognitive behavioral therapy ; Cognitive Therapy - methods ; cognitive-behavior therapy ; Compliance ; dismantling ; Exposure ; Female ; Gastroenterologi ; Gastroenterology ; Gastroenterology and Hepatology ; growth mixture modeling ; Health psychology ; Humans ; iirritable bowel syndrome ; illness representation ; instrumental ; internet ; Intervention ; Intestine ; Irritable bowel syndrome ; Irritable Bowel Syndrome - therapy ; Male ; Medicin och hälsovetenskap ; metaanalysis ; Middle Aged ; Models, Statistical ; Motivation ; Neurosciences ; noncompliance ; Original Articles ; Outcome Assessment (Health Care) - methods ; Patient compliance ; Patient Compliance - statistics & numerical data ; Psychiatry ; psychological ; psychological treatment ; Psykiatri ; Quality of life ; randomized controlled-trial ; Studies ; syndrome ibs ; variables ; visceral sensitivity</subject><ispartof>Psychological medicine, 2017-11, Vol.47 (15), p.2653-2662</ispartof><rights>Copyright © Cambridge University Press 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c574t-33ac20a06e51ef5823ade9efc5ba4c806dfa1b240b0caf0581648dfe8f1de0ab3</citedby><cites>FETCH-LOGICAL-c574t-33ac20a06e51ef5823ade9efc5ba4c806dfa1b240b0caf0581648dfe8f1de0ab3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S0033291717001167/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>164,230,314,780,784,885,12846,27924,27925,30999,55628</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28464975$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-142832$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-78074$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://gup.ub.gu.se/publication/259694$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:136901333$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Hesser, H.</creatorcontrib><creatorcontrib>Hedman, E.</creatorcontrib><creatorcontrib>Lindfors, P.</creatorcontrib><creatorcontrib>Andersson, E.</creatorcontrib><creatorcontrib>Ljótsson, B.</creatorcontrib><title>The specific effect of systematic exposure in irritable bowel syndrome: complier average causal effect analysis using growth mixture modeling</title><title>Psychological medicine</title><addtitle>Psychol. Med</addtitle><description>We reanalyzed data from a previously published randomized component study that aimed to test the incremental effect of systematic exposure in an internet-delivered cognitive behavioral treatment (ICBT) for irritable bowel syndrome (IBS).
Three hundred and nine individuals with IBS were randomly assigned to either the full treatment protocol (experimental condition) or the same treatment protocol without systematic exposure (control). Participants were assessed weekly for IBS symptoms over the active treatment phase. We used a complier average causal effect (CACE) analysis, in the growth mixture modeling framework, to (1) examine the specific effect of exposure among those who received the intervention (i.e. compliers), and (2) explore the associations of pre-treatment patient characteristics with compliance status and outcome changes.
Fifty-five per cent of those assigned to the experimental condition were classified as compliers. The CACE analysis that took into account compliance status demonstrated that the magnitude of the incremental effect of systematic exposure on IBS symptoms was larger than the effect observed in an intention-to-treat analysis that ignored compliance status (d = 0.81 v. d = 0.44). Patients with university education showed more improvement during the exposure phase of the treatment. Pre-treatment patient characteristics did not predict compliance status.
The effect of systematic exposure on IBS symptoms is of substantial magnitude among those individuals who actually receive the intervention (CACE). Studying the subsample of individuals who discontinue treatment prematurely and tailoring interventions to improve compliance may increase overall improvement rates in ICBT for IBS.</description><subject>Adherence</subject><subject>Adult</subject><subject>Behavior modification</subject><subject>Clinical psychology</subject><subject>Cognition & reasoning</subject><subject>Cognitive ability</subject><subject>Cognitive behavioral therapy</subject><subject>Cognitive Therapy - methods</subject><subject>cognitive-behavior therapy</subject><subject>Compliance</subject><subject>dismantling</subject><subject>Exposure</subject><subject>Female</subject><subject>Gastroenterologi</subject><subject>Gastroenterology</subject><subject>Gastroenterology and Hepatology</subject><subject>growth mixture modeling</subject><subject>Health psychology</subject><subject>Humans</subject><subject>iirritable bowel syndrome</subject><subject>illness representation</subject><subject>instrumental</subject><subject>internet</subject><subject>Intervention</subject><subject>Intestine</subject><subject>Irritable bowel syndrome</subject><subject>Irritable Bowel Syndrome - therapy</subject><subject>Male</subject><subject>Medicin och hälsovetenskap</subject><subject>metaanalysis</subject><subject>Middle Aged</subject><subject>Models, Statistical</subject><subject>Motivation</subject><subject>Neurosciences</subject><subject>noncompliance</subject><subject>Original Articles</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Patient compliance</subject><subject>Patient Compliance - statistics & numerical data</subject><subject>Psychiatry</subject><subject>psychological</subject><subject>psychological treatment</subject><subject>Psykiatri</subject><subject>Quality of life</subject><subject>randomized controlled-trial</subject><subject>Studies</subject><subject>syndrome ibs</subject><subject>variables</subject><subject>visceral sensitivity</subject><issn>0033-2917</issn><issn>1469-8978</issn><issn>1469-8978</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kl2P1SAQhonRuMejP8AbQ-KNF1ahpS14t1k_k028cPWWUDp0WdtSoXj2_Aj_szTnQ6M5S0Igw_O-MxkGoaeUvKKE1q-_EFIUuaA1rQmhtKrvoRVllci4qPl9tFqes-X9DD0K4SYxBWX5Q3SWc1YxUZcr9OvqGnCYQFtjNQZjQM_YGRy2YYZBzUvwdnIhesB2xNZ7O6umB9y4DfQJG1vvBniDtRum3oLH6id41QHWKgbVHyzVqPptsAHHYMcOd95t5ms82Nt5cR5cC32KP0YPjOoDPNmfa_T1_buri4_Z5ecPny7OLzNd1mzOikLpnChSQUnBlDwvVAsCjC4bxTQnVWsUbXJGGqKVISWnFeOtAW5oC0Q1xRplO9-wgSk2cvJ2UH4rnbJyH_qebiBTkwgXiRcn-cm79o_oIKRFJVK707orVxcnmUJdXCR5KSrBEv_yJP_WfjuXzndpR1lzUrM77Y94b6NMP8-LPPEvdnyq-0eEMMvBBg19r0ZwMUjKBROUFWxBn_-D3rjo00cmSjDOqBBpwtaI7ijtXQgezLEESuQypvK_MU2aZ3vn2AzQHhWHuUxAsTdVQ-Nt28FfuU_a_ga4Zvei</recordid><startdate>20171101</startdate><enddate>20171101</enddate><creator>Hesser, H.</creator><creator>Hedman, E.</creator><creator>Lindfors, P.</creator><creator>Andersson, E.</creator><creator>Ljótsson, B.</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7QJ</scope><scope>7QP</scope><scope>7QR</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HEHIP</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2S</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>DG8</scope><scope>D91</scope><scope>F1U</scope></search><sort><creationdate>20171101</creationdate><title>The specific effect of systematic exposure in irritable bowel syndrome: complier average causal effect analysis using growth mixture modeling</title><author>Hesser, H. ; Hedman, E. ; Lindfors, P. ; Andersson, E. ; Ljótsson, B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c574t-33ac20a06e51ef5823ade9efc5ba4c806dfa1b240b0caf0581648dfe8f1de0ab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adherence</topic><topic>Adult</topic><topic>Behavior modification</topic><topic>Clinical psychology</topic><topic>Cognition & reasoning</topic><topic>Cognitive ability</topic><topic>Cognitive behavioral therapy</topic><topic>Cognitive Therapy - methods</topic><topic>cognitive-behavior therapy</topic><topic>Compliance</topic><topic>dismantling</topic><topic>Exposure</topic><topic>Female</topic><topic>Gastroenterologi</topic><topic>Gastroenterology</topic><topic>Gastroenterology and Hepatology</topic><topic>growth mixture modeling</topic><topic>Health psychology</topic><topic>Humans</topic><topic>iirritable bowel syndrome</topic><topic>illness representation</topic><topic>instrumental</topic><topic>internet</topic><topic>Intervention</topic><topic>Intestine</topic><topic>Irritable bowel syndrome</topic><topic>Irritable Bowel Syndrome - therapy</topic><topic>Male</topic><topic>Medicin och hälsovetenskap</topic><topic>metaanalysis</topic><topic>Middle Aged</topic><topic>Models, Statistical</topic><topic>Motivation</topic><topic>Neurosciences</topic><topic>noncompliance</topic><topic>Original Articles</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Patient compliance</topic><topic>Patient Compliance - statistics & numerical data</topic><topic>Psychiatry</topic><topic>psychological</topic><topic>psychological treatment</topic><topic>Psykiatri</topic><topic>Quality of life</topic><topic>randomized controlled-trial</topic><topic>Studies</topic><topic>syndrome ibs</topic><topic>variables</topic><topic>visceral sensitivity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hesser, H.</creatorcontrib><creatorcontrib>Hedman, E.</creatorcontrib><creatorcontrib>Lindfors, P.</creatorcontrib><creatorcontrib>Andersson, E.</creatorcontrib><creatorcontrib>Ljótsson, B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>Sociology Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Sociology Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Linköpings universitet</collection><collection>SWEPUB Örebro universitet</collection><collection>SWEPUB Göteborgs universitet</collection><jtitle>Psychological medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hesser, H.</au><au>Hedman, E.</au><au>Lindfors, P.</au><au>Andersson, E.</au><au>Ljótsson, B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The specific effect of systematic exposure in irritable bowel syndrome: complier average causal effect analysis using growth mixture modeling</atitle><jtitle>Psychological medicine</jtitle><addtitle>Psychol. Med</addtitle><date>2017-11-01</date><risdate>2017</risdate><volume>47</volume><issue>15</issue><spage>2653</spage><epage>2662</epage><pages>2653-2662</pages><issn>0033-2917</issn><issn>1469-8978</issn><eissn>1469-8978</eissn><abstract>We reanalyzed data from a previously published randomized component study that aimed to test the incremental effect of systematic exposure in an internet-delivered cognitive behavioral treatment (ICBT) for irritable bowel syndrome (IBS).
Three hundred and nine individuals with IBS were randomly assigned to either the full treatment protocol (experimental condition) or the same treatment protocol without systematic exposure (control). Participants were assessed weekly for IBS symptoms over the active treatment phase. We used a complier average causal effect (CACE) analysis, in the growth mixture modeling framework, to (1) examine the specific effect of exposure among those who received the intervention (i.e. compliers), and (2) explore the associations of pre-treatment patient characteristics with compliance status and outcome changes.
Fifty-five per cent of those assigned to the experimental condition were classified as compliers. The CACE analysis that took into account compliance status demonstrated that the magnitude of the incremental effect of systematic exposure on IBS symptoms was larger than the effect observed in an intention-to-treat analysis that ignored compliance status (d = 0.81 v. d = 0.44). Patients with university education showed more improvement during the exposure phase of the treatment. Pre-treatment patient characteristics did not predict compliance status.
The effect of systematic exposure on IBS symptoms is of substantial magnitude among those individuals who actually receive the intervention (CACE). Studying the subsample of individuals who discontinue treatment prematurely and tailoring interventions to improve compliance may increase overall improvement rates in ICBT for IBS.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>28464975</pmid><doi>10.1017/S0033291717001167</doi><tpages>10</tpages></addata></record> |
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| subjects | Adherence Adult Behavior modification Clinical psychology Cognition & reasoning Cognitive ability Cognitive behavioral therapy Cognitive Therapy - methods cognitive-behavior therapy Compliance dismantling Exposure Female Gastroenterologi Gastroenterology Gastroenterology and Hepatology growth mixture modeling Health psychology Humans iirritable bowel syndrome illness representation instrumental internet Intervention Intestine Irritable bowel syndrome Irritable Bowel Syndrome - therapy Male Medicin och hälsovetenskap metaanalysis Middle Aged Models, Statistical Motivation Neurosciences noncompliance Original Articles Outcome Assessment (Health Care) - methods Patient compliance Patient Compliance - statistics & numerical data Psychiatry psychological psychological treatment Psykiatri Quality of life randomized controlled-trial Studies syndrome ibs variables visceral sensitivity |
| title | The specific effect of systematic exposure in irritable bowel syndrome: complier average causal effect analysis using growth mixture modeling |
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