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CompletedNCT03454386Updated Jun 1, 2020

SMART Program in Irritable Bowel Syndrome (IBS)

An interventional study of Stress Management and Resilience Training Program and Self-Management Stress Reduction Program in Irritable Bowel Syndrome, sponsored by University of California, Los Angeles. Completed at 1 site in United States. Open to participants aged 18 Years to 70 Years. Per ClinicalTrials.gov, last updated 2020-06-01.

Sponsored by University of California, Los Angeles · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
39
Allocation
Non-randomized
Ages
18 Years to 70 Years
Sex
All
01

Study summary

This is a pilot study to determine the efficacy of the Stress Management and Resilience Training (SMART) program in improving gastrointestinal and psychological symptoms, health-related quality of life, and satisfaction of care in patients with irritable bowel syndrome (IBS). Half of the participants will be enrolled in the SMART program initially. The other half will be placed in a self-management stress reduction program where they will read a popular stress reduction book over 12 weeks. Then they will have access to participate in the online SMART program.

Read the detailed description

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain related to defecation and associated with changes in stool frequency and/or form. IBS is a stress sensitive disorder and its severity has been shown to be moderated by both acute and chronic stress. Furthermore, resilience, which is defined as the ability to positively adapt and thrive in the presence of stressors and adversity, has been shown to be lower in those with IBS and associated with more severe symptoms. Therapies aimed at stress reduction in IBS have been found to be effective in the management of IBS. To our knowledge, there are no reports in the literature of a therapy to target resilience in the IBS patient population.

The Stress Management and Resilience Training (SMART) program was developed by Dr. A. Sood at the Mayo clinic to reduce stress, decrease symptoms related to stress and enhance resiliency. This is accomplished by targeting human attention and interpretation of events, people and the world. Furthermore, methods to strengthen the skills of gratitude, compassion, acceptance, forgiveness and understanding of a higher meaning are taught. Previous studies have demonstrated that this program can improve stress, anxiety, resilience and quality of life of participants.

02

Conditions studied

  • Irritable Bowel Syndrome

Keywords

  • Irritable Bowel Syndrome (IBS)
  • Stress
  • Resilience
  • Stress Management and Resilience Training Program (SMART)
03

Who can participate

Ages eligible
18 Years to 70 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Those with a diagnosis of IBS based on the Rome IV diagnostic criteria (recurrent abdominal pain at least once per week in the last 3 months associated with 2 of the following: related to defecation, associated with a change in stool frequency, associated with a change in stool form. Symptoms must have started 6 months prior to presentation)
  • Between the ages of 18 and 70
  • English speaking
  • Are able to provide written, informed consent
  • At least moderate IBS symptoms (based on an IBS symptom severity scale score [IBS-SSS] of 175 or higher)
  • At least moderate levels of perceived stress (based on a perceived stress score of 14 or higher
  • If receiving pharmacologic therapy for IBS, they must be on a stable dose for 30 days prior to enrollment

Exclusion criteria

Exclusion Criteria:

  • History of gastrointestinal disease including celiac disease, cirrhosis, gastrointestinal malignancy, inflammatory bowel disease
  • History of gastrointestinal surgery (except appendectomy and cholecystectomy or gallbladder removal >6 months ago)
  • Poorly controlled psychiatric disease such as severe depression (with or without suicidal ideation), severe anxiety, schizophrenia, dementia
  • Currently receiving, or have received in the last 6 months, other stress reduction therapies such as mindfulness based stress reduction, meditation
  • Excessive alcohol intake (up to 1 drink per day for females and 2 drinks per day for males)
  • Illicit substance use
  • High dose opiate use
  • Pregnancy
  • Non-English speaking
  • Inability to provide written informed consent
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
39 participants (actual)

Study arms

  • Active comparator
    Active Treatment

    Stress Management and Resilience Training Program This group will be initially enrolled in the program.

    Behavioral: Stress Management and Resilience Training Program

  • Other
    Control

    Self-Management Stress Reduction Program This group will be placed in a self-management stress reduction program. During this time these participants will be given a popular stress reduction book to read over 12 weeks. They will complete questionnaires at weeks 4 and 12. After the 12 weeks, this group will be enrolled in the online SMART program and complete assessments at week 24 (upon completion of the program.

    Behavioral: Self-Management Stress Reduction Program

Interventions

  • BehavioralStress Management and Resilience Training Program

    This program targets attention and interpretation of events, people and the world through the skills of gratitude, compassion, acceptance, forgiveness and understanding of a higher meaning. The program involves two phases. The 4 week "training phase" begins with a group session that discusses the practices that can be used to enhance awareness and engagement through the principles listed above. Participants will receive twice weekly emails with videos that described a different practice for participants to use in their daily lives. The second phase is the "sustain phase" that is 8 weeks in duration. Participants are expected to continue using the daily practices learned during the training phase. Weekly emails will be sent with ways to incorporate these practices into their daily lives.

    Also known as: SMART Program

  • BehavioralSelf-Management Stress Reduction Program

    Program participants will be given a popular stress reduction book to read over a 12 week period. Upon completion of this, they will be enrolled in the online SMART program for 12 weeks.

05

What researchers measure

Primary outcomes

  1. Change in perceived stress score from baseline

    Validated questionnaire with 10 questions regarding respondents stress levels

    Time frame: Week 12 (end of the SMART program)

Secondary outcomes

  1. Change in perceived stress score from baseline

    Validated questionnaire with 10 questions regarding respondents stress levels

    Time frame: Week 4

  2. IBS symptom severity responder rate

    IBS symptom severity will be measured using the validated IBS symptom severity score. A participant will be consider a responder if they have a 50 point reduction in their baseline score.

    Time frame: Week 4, week 12

  3. IBS related quality of life responder rate

    IBS related quality of life will be measure using a validated questionnaire. A participant is considered a responder if there is a 14 point improvement in their baseline score

    Time frame: Week 4, week 12

  4. Change from baseline in resilience scores as measured by the Brief Resilience scale

    The Brief Resilience scale is a 6 question validated questionnaire

    Time frame: Week 4, week 12

  5. Change from baseline in resilience score as measured by the Connor-Davidson Resilience Scale

    The Connor-Davidson Resilience Scale is a 25 question validated questionnaire

    Time frame: Week 4, week 12

  6. Change from baseline in adaptive resilience score

    A validated questionnaire to measure adaptive resilience will be used

    Time frame: Week 4, week 12

  7. Change in gratitude scores from baseline

    Gratitude will be measured using a validated questionnaire.

    Time frame: Week 4, week 12

  8. Change in mindfulness scores from baseline

    Mindfulness will be measured using the validated five factor mindfulness questionnaire

    Time frame: Week 4, week 12

  9. Change in patient satisfaction from baseline

    The measurement of patient satisfaction will be adapted from the patient global satisfaction scale from the Hospital Consumer Assessment of Healthcare Providers and Systems.

    Time frame: Week 4, week 12

  10. Change in anxiety symptoms from baseline

    Anxiety symptoms will be measured using the validated hospital anxiety and depression questionnaire

    Time frame: Week 4, week 12

  11. Change in gastrointestinal symptom related anxiety from baseline

    Gastrointestinal symptom related anxiety will be measured using the validated visceral sensitivity index

    Time frame: Week 4, week 12

  12. Change in somatic symptom severity from baseline

    Somatic symptom severity will be measured using the validated patient health questionnaire

    Time frame: Week 4, week 12

06

Study locations

1 site
  • UCLA
    Los Angeles, California 90095, United States
07

Registry details

Key details

Study ID
NCT03454386
Lead sponsor
University of California, Los Angeles
Responsible party
Lin Chang, MD (Co-Director, G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles) — Principal investigator
First posted
Mar 5, 2018
Start date
Jul 1, 2018
Primary completion
Nov 7, 2019
Completion
Feb 2, 2020
Last update
Jun 1, 2020

Study contacts

Lin Chang, MD
principal investigator · University of California, Los Angeles

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
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