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Medically Unexplained Symptoms Irritable Bowel Syndrome
Definition ,[object Object],[object Object]
Co-morbidities with other symptoms ,[object Object],[object Object],[object Object],[object Object]
Early Trauma (IBS) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Common features of co-morbidities ,[object Object],[object Object],[object Object],[object Object]
Cognitive Bias ,[object Object],[object Object],[object Object]
Pain Processing Pathways increase in insular stimulation with anxious faces over neutral causing increased pain in normal individuals Visceral pain processing preferentially stimulates medial tract. When the “attention loop” is highly activated, the lowest stimulus intensity would maximally stimulate the affective-motivational pain system.  Hypnosis has been shown to increase or decrease the insular response to pain, and dissociates the cognitive and affective components of sensation
Guts vagus Spinal  cord Mind Body Loop – Fear pathway (after Ledoux)
IBS shows a combination of high cortisol (present in IBS) and amygdalar activity.  Due to dissociation there is a  focus on the attentional channels of the visceral and somatic channels
Hypervigilance Is whiplash a form of MUS?
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Psychological ,[object Object],[object Object],[object Object]
Hypnotherapy (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Major effect of hypnotherapy ,[object Object],[object Object],[object Object]
Karl Friston –  Thomas Bayes Gruzelier, J. (1998). A working model of the neurophysiology of hypnosis: a review of the evidence.  Contemporary Hypnosis , 15, 3-21
BES scale ,[object Object],[object Object],[object Object]
Emotional Regulation of Negative Emotions ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Further Work on Suppression ,[object Object],[object Object],[object Object]
Figure 1. Mean latency in seconds (error bars are ±1 SE) to retrieve autobiographical memories to positive and negative cue words on the recall task in the dysphoric and nondysphoric groups across the suppress and no-suppress conditions Basis of Rumination? Quicker response
Suppression ,[object Object],[object Object],[object Object],[object Object],[object Object]
Common themes in therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Benefits of Experiential Thinking Style ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reappraisal ,[object Object]
 
Reappraisal - Visualisation -Extinction – common pathway ,[object Object],[object Object],[object Object]
Karl Friston –  Thomas Bayes Gruzelier, J. (1998). A working model of the neurophysiology of hypnosis: a review of the evidence.  Contemporary Hypnosis , 15, 3-21 Reappraisal needs to be implicit: attentional distraction hypnosis or mindfulness
Reappraisal  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Mus 3

  • 1.  
  • 2. Medically Unexplained Symptoms Irritable Bowel Syndrome
  • 3.
  • 4.
  • 5.
  • 6.  
  • 7.
  • 8.
  • 9. Pain Processing Pathways increase in insular stimulation with anxious faces over neutral causing increased pain in normal individuals Visceral pain processing preferentially stimulates medial tract. When the “attention loop” is highly activated, the lowest stimulus intensity would maximally stimulate the affective-motivational pain system. Hypnosis has been shown to increase or decrease the insular response to pain, and dissociates the cognitive and affective components of sensation
  • 10. Guts vagus Spinal cord Mind Body Loop – Fear pathway (after Ledoux)
  • 11. IBS shows a combination of high cortisol (present in IBS) and amygdalar activity. Due to dissociation there is a focus on the attentional channels of the visceral and somatic channels
  • 12. Hypervigilance Is whiplash a form of MUS?
  • 13.
  • 14.
  • 15.
  • 16.
  • 17. Karl Friston – Thomas Bayes Gruzelier, J. (1998). A working model of the neurophysiology of hypnosis: a review of the evidence. Contemporary Hypnosis , 15, 3-21
  • 18.
  • 19.
  • 20.  
  • 21.  
  • 22.
  • 23. Figure 1. Mean latency in seconds (error bars are ±1 SE) to retrieve autobiographical memories to positive and negative cue words on the recall task in the dysphoric and nondysphoric groups across the suppress and no-suppress conditions Basis of Rumination? Quicker response
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.  
  • 29.
  • 30. Karl Friston – Thomas Bayes Gruzelier, J. (1998). A working model of the neurophysiology of hypnosis: a review of the evidence. Contemporary Hypnosis , 15, 3-21 Reappraisal needs to be implicit: attentional distraction hypnosis or mindfulness
  • 31.

Editor's Notes

  1. Roelofs K, Spinhoven P (2007) Trauma and Medically unexplained symptoms clinical psychology review 27:798-820 Myers B, Meerveld B (2009) Role of anxiety in the pathophysiology of irritable bowel syndrome: importance of the amygdala. Frontiers in Neuroscience 3:1-9
  2. Roelofs K, Spinhoven P (2007) Trauma and Medically unexplained symptoms clinical psychology review 27:798-820
  3. Riedl A, Schmidtmann M, Stengel A, Goebel M, Wisser A, Klapp B, Mönnikes H Somatic comorbidities of irritable bowel syndrome: A systematic analysis    Journal of Psychosomatic medicine 2007 Vol 64:573-582
  4. Journal of psychosomatic medicine 2007 vol 64 Irritable bowel syndrome: Does gender matter?   Review Article Pages 583-587 Margaret Heitkemper, Monica Jarrett
  5. (1) JE Gomborone, PA Dewsnap, GW Libby and MJG Farthing, Selective affective biasing in recognition memory in the irritable bowel syndrome, Gut 34 (1993), pp. 1230–1233. 2.M Phillips, LJ Gregory, S Cullen, S Coen, V Ng, C Andrew, V Giampietro, E Bullmore, F Zelaya, E Amaro, DG Thompson, AR Hobson, SC Williams, M Brammer and Q Aziz, The effect of negative emotional context on neural and behavioural responses to oesophageal stimulation, Brain 126 (2003), pp. 669–684. 3. Journal of affective disorders 2007 Psychophysiology of visceral pain in IBS and health   Review Article vol 64 Pages 589-597 Frauke Musial, Winfried Häuser, Jost Langhorst, Gustav Dobos, Paul Enck
  6. Psychophysiology of visceral pain in IBS and health   Review Article Pages 589-597 Frauke Musial, Winfried Häuser, Jost Langhorst, Gustav Dobos, Paul Enck
  7. showing fear linking into the body and the feedback from the body to the brain of emotion Peripheral adrenaline will increase learning through the vagal afferents feeding into the locus coerulus and on to the hippocampus. Brainstem nuclei are crucial in the process of the generation and maintenance of background emotions. All brain nuclei have feedforward/feedback abilities, and once specific situations have become associated with positive or negative primary emotions then a secondary emotion is established through this association. Antonio Damasio says that this creates secondary awareness of emotional states through an ‘as-if’ body loop. So the body can be bypassed, but the body will still be excited by the emotional correlates of the situation and it is essential for conciousness that the brain is able to compare the 2 states, the ‘as if’ state and the real body state, or Talk about how to switch off the amygdala Remember that part of the feedback is from muscle spindles saying how much tension is in the muscles. So if we feel tension in the uscles it alerts us to a state of danger.
  8. 1. Journal of affective disorders 2007 vol 64 Hypnotherapy for irritable bowel syndrome: The response of colonic and noncolonic symptoms   Review Article Pages 621-623 Peter J. Whorwell
  9. The p300 wave is larger when the subject subsequently learns from the ‘error’, so its absence means the ‘event’ has not been signalled as an error in need of correction. The error evaluation wave represents the ‘somatic marker’ from Damasio ‘Descartes Error, the emotion that drives choice decision and action, and represents the emotional impact driving learning and social interaction (multiple decisions in a highly complex environment). This wave is removed by attentional manipulation allowing the development of positive behaviours
  10. Volume 68 , Issue 3 , Pages 285-292 (March 2010) Journal of psychosomatic research The Beliefs about Emotions Scale: Validity, reliability and sensitivity to change Katharine A. Rimes , DPhil, Trudie Chalder , PhD
  11. Tell story of Dr Ds lady who unsupressed her feelings towards her daughter, and then daughter opened up. This slide emphasizes the detrimental effect that suppression within families may have.
  12. The Effects of Suppressing a Negative Autobiographical Memory on Concurrent Intrusions and Subsequent Autobiographical Recall in Dysphoria , By: Dalgleish, Tim, Yiend, Jenny, Journal of Abnormal Psychology, 2006, Vol. 115, Issue 3
  13. The Effects of Suppressing a Negative Autobiographical Memory on Concurrent Intrusions and Subsequent Autobiographical Recall in Dysphoria , By: Dalgleish, Tim, Yiend, Jenny, Journal of Abnormal Psychology, 2006, Vol. 115, Issue 3
  14. Wikipedia
  15. (Watkins & Teasdale, 2004), (Watkins & Baracaia, 2002), (Moberly & Watkins, 2006).
  16. The p300 wave is larger when the subject subsequently learns from the ‘error’, so its absence means the ‘event’ has not been signalled as an error in need of correction. The error evaluation wave represents the ‘somatic marker’ from Damasio ‘Descartes Error, the emotion that drives choice decision and action, and represents the emotional impact driving learning and social interaction (multiple decisions in a highly complex environment). This wave is removed by attentional manipulation allowing the development of positive behaviours