Thesis (Ph. D.)--University of Hong Kong, 2007. / Title proper from title frame. Also available in printed format.

Thesis (Ph. D.)--University of Sydney, 2009. / Includes tables and questionnaires. Title from title screen (viewed May 14, 2009) Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Behavioural and Community Health Sciences, Faculty of Health Sciences. Includes bibliography. Also available in print form.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2002. / The aim of this placebo-controlled\xB7 trial was to investigate the efficacy of action potential therapy (APT) versus placebo, and the relative effectiveness of abdominal versus paraspinal electrode placement, in the treatment of Irritable Bowel Syndrome (IBS). Convenience sampling was used to recruit sixty patients with IBS from the community. These patients were randomly divided into four groups (A, B, C and D). Each group consisted of 15 patients, aged between 20 and 69 years. Patients attended five consultations over three weeks. Treatment was given with either active or placebo APT during the first four consultations. The fifth consultation was for data collection only. Patients in group A and C both received active APT. In group A, the electrodes were placed over the abdomen, while in group C the electrodes were placed paraspinally. Patients in group Band 0 both received placebo APT using a placebo APT device. In group B, the electrodes were placed over the abdomen, while in group 0, the electrodes were placed paraspinally. The measures of efficacy were the IBS Quality of Life Questionnaire (IBS-QOl), the Shortform McGill Pain Questionnaire (SF-MPQ) and the life line Stress Questionnaire (ll-SQ). Using these questionnaires, data was collected at the 1st. 3rd and s' consultations for each participant. The data was then analysed using the SPSS package. Assessment of intragroup and inter-group change was performed using Friedman's T-test and the Mann-Whitney U-Tests respectively. Analysis was performed at the 95% confidence level. Patients in all four groups showed a,n improvement in quality of life (measured by the IBSQOl), as well as in the perceived quantity of pain experienced (measured by the SF-MPQ), between initial and final consultations. As regards the patients' levels of stress (measured by the ll-SQ), there was no statistically significant improvement in any of the four groups between initial and final consultations. Inter-group comparison of the data showed a higher perceived quantity of pain in the active, paraspinally placed APT group (group C) at the first consultation when compared to both the / M

M.Tech.

M.Tech. (Homoeopathy) / The aim of this study was to determine the effectiveness of Argentum nitricum 6CH and Lycopodium clavatum 6CH in the individualised treatment of patients suffering from Irritable bowel syndrome. These two homoeopathic remedies are well known for their effect on the gastrointestinal system, especially when the gastrointestinal symptoms are associated with emotional stress. 60 subjects participated in this single blind, placebo controlled study. Each subject underwent an initial evaluation in order to ascertain their symptoms prior to treatment. They were then given their appropriate remedy to be administered three times daily for one month. The subject's symptoms were monitored through questionnaires completed at two week intervals. The homoeopathic medication appeared to reduce the Irritable bowel syndrome symptoms, with the Lycopodium clavatum group achieving slightly better results than the Argentum nitricum group. It is, however, recommended that further similar studies using a larger sample group for a longer duration be conducted in order to verify these findings.

M.A. / The purpose of this study is to investigate the effects of an individualized holistic psychotherapy and synergistic stress management programme for the treatment of Irritable Bowel Syndrome (IBS) and stress, both of which are common disorders in this present day and age. IBS is a functional bowel disorder of the gastrointestinal tract that leads to change in bowel habits with the additional features of abdominal pain and distension (Drossman, 1994b). This functional disorder has been associated with stress since time immemorial and it is only recently that research has begun to examine how and by what mechanisms IBS and stress are related. A review of the literature suggests a resurgent interest in IBS and stress. Tantalizing questions like ‘IBS – irritable bowel, irritable body, irritable brain or irritable mind?’ gives one an idea of the genesis from which the disorder has come, the complications in which it has been mired and the directions in which it is aspiring to go (Farthing, 1995). Using both the historical context and the present level of understanding in the research literature, one becomes aware of the shifting paradigm from the dualistic Cartesian-Newtonian biomedical perspective, to the biopsychosocial and integrative mind-body approaches which reflect the move to a holistic and non-linear quantum scientific worldview. The ecosystemic paradigm on which the present study is based, represents this shift whereby systemic changes in cyclical rhythmic patterns within the psychophysiology of clients reflect new ways of conceptualizing psychosomatic (mind-body) ill-health (Weiner, 1992). Within the behavioural and medical health fields, both psychologists and physicians as well as a number of other disciplines are moving towards more integrative solutions which include the mind-body-spirit dimensions of the individual. Drossman, Whitehead and Camilleri (1997) have begun to consider the individualized expression of the illness in the patient and to situate him among his wider systems, as well as incorporating a referral team approach to the treatment of IBS. Salt (1997) extends the use of the biopsychosocial model to include the spiritual dimension in his treatment of IBS patients. Broom (1997) weaves the various internal systems of the person into the story of the client’s illness that integrates the mind and body. The psychologically based holistic intervention of this study was developed in response to the calls for more integrative approaches to treatment which incorporate whole-person care. The specific aim of this study is to compare a group of IBS participants who receive the holistic individualized psychotherapy and synergistic stress management intervention with a group of IBS participants who do not receive the treatment. The sample consisted of two groups, an experimental (N = 20) group and a control (N = 20) group. The IBS Client Questionnaire also known as the Functional Bowel Disorder Severity Index (FBDSI) (Drossman, Zhiming, Toner, Diamant, Creed, Thompson, Read, Babbs, Barreiro, Bank, Whitehead, Schuster & Guthrie 1995) was used to verify a diagnosis of IBS as well as a measure of the severity of symptoms. This index is based on the current international diagnostic criteria for IBS. The Occupational Stress Inventory was used as a measure of vocational stress and was developed to provide an integrated theoretical model linking sources of stress in the work environment, psychological strains experienced by individuals as a result of work stressors and the coping resources available to counterbalance the effect of stressors and alleviate strain. It consists of three scales, namely Occupational Roles, Personal Strain and Personal Resources scales respectively. Wilks’ Lambda was used for the between-groups comparisons between the intervention and non-intervention groups and Paired Samples t-test was used for the within-groups analysis. The comparisons were made in terms of improvement in symptoms, determined by the Functional Bowel Disorder Severity Index (FBDSI) and lowering of occupational stress, determined by two of the scales of the Occupational Stress Inventory, namely the Occupational Roles and Personal Strain scales and an increase in coping responses determined by the Personal Resources scale. Both of these were administered as pre- and post-test measures before and three months after the intervention was completed. The results of the study indicate that the experimental group of IBS participants who received the intervention improved in symptom severity, their occupational stress was lowered and they began utilizing more coping resources than the group of IBS participants who did not receive the intervention. Thus it is concluded that an individualized holistic approach for the treatment of IBS is indicated and that individuals with refractory IBS can be helped to manage their illness and their lives. In particular, this psychologically based study confirms a very definite and specific place for psychologists in the treatment of clients with IBS and stress. An invitation was extended to the control group to use the facilities for therapeutic intervention offered by the RAU Psychogastroenterology project once the post-tests had been completed, thus addressing any ethical questions that could have arisen. This was an initial investigation using an ecologically based meta-theoretical framework as well as specific stress techniques for the holistic treatment of clients. A number of recommendations arose from this particular intervention and are included for future studies.

M.A. / The disorder known as Irritable Bowel Syndrome (IBS) is a clinical conundrum. Of chronic magnitude, this disorder of the gastrointestinal system affects up to 20% of the population in developed countries. Yet, it remains elusive in terms of its accurate definition and diagnosis, while its origins and etiology are unknown. To date, clinical confirmation of this disorder is complex and uncertain, while medical intervention has proven to be largely unsuccessful. Symptomatology relating to IBS varies widely and is not confined to the gastrointestinal tract. Diagnoses are made on the grounds of the manifestation of certain physical symptoms such as constipation, diarrhoea, abdominal pain and distension and disordered bowel habits. The role of psychological factors in the manifestation of IBS is controversial, although many clinicians postulate IBS to be a psychosomatic disorder due to the presence of many concomitant psychological features such as anxiety and depression. By all appearances, one of the most dramatic psychosocial concomitants of IBS is stress. Research has indicated that factors such as income, social support, life stress, psychological status, coping styles and personality all play a role in terms of whether the disorder develops and how successfully or adaptively the sufferer copes with his/her disorder. In terms of a research project undertaken by the Counselling and Research Centre for Gastroenterology under the auspices of the Department of Counselling Psychology at the Rand Afrikaans University, an exhaustive investigation into the physiological and psychological concomitants of IBS was conducted. As part of this endeavour to bring IBS to the attention of the medical profession, the public at large, and the individuals who suffer from this disorder, a number of individual studies were undertaken by MA (Psychology) students as part of the larger project. These researchers attempted to highlight various essential aspects associated with IBS, the focus of which included psychopathological features, stress, abuse, coping styles and strategies, defence mechanisms, personality factors and eating disorders. A second phase of this research project is currently in operation in order to provide remediation in the form of psychotherapy and stress management to the subjects who participated in the initial research project. The focus of the present treatise aims to provide an all-encompassing integration of the various research studies referred to above. Thereafter, on the basis of the data obtained from these studies, attention turns to the identification of a psychological profile with respect to the typical patient suffering from IBS. In accordance with the scientific demands of psychosocial research, a thorough review of the literature and various theoretical explanations of IBS were conducted as part of the integrative process. A number of theoretical models were considered in terms of their application to IBS, including the Digestive Disease model; the Psychiatric model; the Psychophysiological model; a Behavioural iii model; a Biopsychosocial model and a relatively recent newcomer, the Salutogenic Orientation proposed by Antonovsky, that offers an unusual approach to health and disease. In terms of the psychological profile mentioned above, the data demonstrated interesting findings. It was ascertained that the large majority of IBS patients are women, a finding that has been internationally verified. These women tend to be married with children, well-educated and employed on a full-time basis. The emotional status of the typical IBS patient reflects varying degrees of psychopathological tendencies, while her interpersonal relationships are characteristically unstable. Demonstrating high stress levels, the IBS patient tends to utilize inadequate coping skills, while these women also report using a maladapative defence mechanism to cope with the difficulties of their lives. Furthermore, personality traits such as introversion and neuroticism have been observed in these women. Lastly, it has been noted that the typical IBS patient exhibits certain aberrant eating patterns that are characteristic of women who are diagnosed as anorexic and/or bulimic. The IBS patient experiences her physical symptoms as severely disruptive and debilitating. Living in a very stressful and demanding world, she is lonely and isolated and shows the tendency to somatize her problems in the form of a disorder that is neither life-threatening, nor results in other more serious diseases, but which causes major distress in her life.

Stress-related functional bowel disease is a common, often incapacitating, problem in humans; the symptomatology of stress-related intestinal dysfunction is: (1) impaired small intestinal transit and motility, and (2) increased large intestinal transit and, commonly, diarrhea. The etiology of stress-induced intestinal dysfunction is completely unresolved, and the lack of an appropriate animal model has hindered studies of causality. We compared a number of stressors and their resultant effects on intestinal transit, a measure of the propulsive motor activity of the gut, in the rat. We found that the response of the intestine to stress, and the neural systems activated by stress, were dependent on the type and duration of stress, as well as the animal strain, and gender. We developed a model, acute wrapping restraint stress, to fully characterize the effects of stress on intestinal transit. Wrap restraint stress is a nonulcerogenic model in which rats are subjected to acute restraint by wrapping them in a harness of paper tape to restrict, but not prevent movement of the upper body and forelimbs. Transit was evaluated by the geometric center method, in which a radiomarker (⁵¹Cr) is instilled directly into the proximal duodenum and proximal colon via a surgically placed intestinal cannula, in fasted, adult female Sprague Dawley rats (150-200g). Subjecting animals to 35 min. of wrap restraint stress resulted in (1) inhibition of small intestinal transit, and (2) increased large intestinal transit and increased fecal output. The effects of stress on intestinal transit in rats resembled symptoms associated with stress in humans, suggesting that wrap restraint stress may be suitable as a model of stress-induced intestinal dysfunction. We found a close correlation between stress-induced intestinal dysfunction and stress-activation of endocrine systems. Stress-induced changes in intestinal function was strongly influenced by circadian variations in endocrine levels, suggesting that stress-induced intestinal dysfunction may be hormonally mediated. However, neither pituitary nor adrenal factors mediated the effects of stress on the gut. To evaluate the role of corticotropin-releasing factor (CRF), the major hypothalamic factor released in response to stress, in stress-induced intestinal dysfunction, we studied the effects of exogenous CRF on intestinal transit. CRF resulted in (1) a potent, dose-dependent inhibition of small intestinal transit, (2) a dose-dependent increase in large intestinal transit, and (3) increased fecal excretion. The effects of exogenously administered CRF closely paralleled the effects of stress on intestinal transit and on ACTH secretion in the rat. Blockade of CRF receptors by means of an antagonist, α helical CRF (9-41), prevented the effects of stress on colonic transit and fecal excretion. These data strongly suggest that endogenous CRF may mediate the effects of wrap restraint stress on intestinal motor activity and coordination in the rat.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / The aim of this placebo-controlled clinical trial was to determine the role of spinal manipulation in the management of irritable bowel syndrome (IBS), in terms of the patients' subjective response to treatment. It was hypothesized that spinal manipulation would have a greater effect than placebo in reducing the intensity of the symptoms of IBS. Thirty subjects diagnosed with IBS were randomly divided into two groups. Each group consisted of 15 subjects, aged between 18 and 50. Patients were treated twice a week for three weeks and once in the fourth week. Thereafter, each patient returned approximately 1 month later to be assessed for any longer-term benefit to treatment. Patients in the experimental group received spinal manipulation directed at areas of spinal fixation, as determined by motion palpation. Patients in the control group were treated using a detuned ultrasound machine over areas of spinal fixation. Treatment was performed with the same degree of enthusiasm in both groups, where possible. / M

Thesis (Ph. D.)--UCLA, 2009. / Vita. Description based on print version record. Includes bibliographical references (leaves 244-259).