The Acceptance, Commitment and COgnitive RemeDiation (ACCORD) Study: Can a Brief Online Cognitive Intervention Improve Outcomes in Patients With Esophageal Disease?
Madison Simons, Sara H Marchese, Alyse Bedell, Livia Guadagnoli, Sonia Zavala, Dustin A Carlson, Josie McGarva, John Pandolfino, Tiffany Taft
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引用次数: 0
Abstract
Background: Cognitive and psychological inflexibility are two mental processes that influence how a person interprets and responds to esophageal symptoms. Patients with greater mental inflexibility are at risk for poorer outcomes. Brain-gut behavioral therapies (BGBT) are effective adjunctive treatments in many digestive diseases, with potential to improve mental flexibility. We piloted a brief intervention targeting cognitive and psychological inflexibility in patients with esophageal disease. Secondary aims included improving symptoms, mood, and quality of life (QoL) and reducing hypervigilance and symptom anxiety.
Methods: Eighty adults newly diagnosed with achalasia, eosinophilic esophagitis, gastroesophageal reflux, or functional dysphagia from an esophageal clinic participated in a non-randomized, open-label trial. Acceptance, Commitment and COgnitive RemeDiation (ACCORD) was a novel 4-week BGBT administered via telemedicine. Feasibility and acceptability were assessed. Evaluations of esophageal symptom severity, cognitive and psychological flexibility, hypervigilance, symptom anxiety, and QoL occurred at baseline and posttreatment. Last observation carried forward was used for patients with incomplete 6-month data. Bayes Factor evaluated strength of support for study hypotheses.
Key results: 89.9% of participants completed ACCORD. Moderate to decisive gains occurred for some markers of cognitive flexibility and psychological flexibility, which may demonstrate a delayed but strong improvement. Participants demonstrated strong to decisive reductions in symptoms, symptom anxiety, and decisive increases in health-related quality of life (HRQoL).
Conclusions and inferences: A novel, four-session BGBT targeting cognitive and psychological flexibility in patients with esophageal disease was feasible, acceptable, and shows potential to improve symptom severity, symptom anxiety, and HRQoL. ACCORD's use of telemedicine may mitigate access issues related to BGBTs. Further study is warranted.
期刊介绍：
Neurogastroenterology & Motility (NMO) is the official Journal of the European Society of Neurogastroenterology & Motility (ESNM) and the American Neurogastroenterology and Motility Society (ANMS). It is edited by James Galligan, Albert Bredenoord, and Stephen Vanner. The editorial and peer review process is independent of the societies affiliated to the journal and publisher: Neither the ANMS, the ESNM or the Publisher have editorial decision-making power. Whenever these are relevant to the content being considered or published, the editors, journal management committee and editorial board declare their interests and affiliations.
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