https://doi.org/10.4081/ripppo.2020.448
A randomized clinical trial of metacognitive therapy and nortriptyline for anxiety, depression, and difficulties in emotion regulation of patients with functional dyspepsia
Submitted: December 31, 2019
Accepted: August 21, 2020
Published: September 17, 2020
Accepted: August 21, 2020
Abstract Views: 1110
PDF: 665
HTML: 91
HTML: 91
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Functional Dyspepsia (FD) as a psychosomatic disorder is an upper gastrointestinal tract disease without organic pathogenesis causes. The psychopathological nature of this disease and its high correlation with anxiety and depression implies the need for psychological interventions. The purpose of the present study is to compare the efficacy of Metacognitive Therapy (MCT) and medication for the symptoms of anxiety, depression, and difficulties in emotion regulation in patients with FD. In a randomized clinical trial, 65 patients with FD were recruited during their visit to gastroenterology clinics. These patients were randomly assigned to three groups to receive MCT, nortriptyline treatment, and controls. They were treated for 10 weeks and followed up three months later. The instruments used in this study were Hamilton anxiety and Depression Rating Scale (HAM-A and HDRS) and difficulties in emotion regulation scale. The results were analyzed using repeated measure analysis by SPSS (19- IBM). Data analysis showed statistically significant differences in the variables of depression, anxiety among MCT, nortriptyline treatment, and controls at pre-test, post-test and follow-up phases. Moreover, MCT had a better and more persistent effect on anxiety compared to nortriptyline treatment, as well as a better efficacy in treating anxiety and depression symptoms compared to the controls. MCT demonstrated better efficacy in treating anxiety symptoms compared to nortriptyline treatment and controls.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). Arlington, VA.
Aro, P., Talley, N. J., Ronkainen, J., Storskrubb, T., Vieth, M., Johansson, S. E., Boiling-sternevald, L., & Agréus, L. (2009). Anxiety is associated with uninvestigated and functional dyspepsia (Rome III criteria) in a Swedish population-based study. Gastroenterology, 137(1), 94-100.
DOI: https://doi.org/10.1053/j.gastro.2009.03.039
Bagherian, R., Pourkazem, T., Nouri, A., & Adibi, P. (2009). The effects of stress management training on symptoms of medical treatment-resistant functional dyspepsia. Govaresh, 14(1), 15-22.
Batebi, S., Masjedi Arani, A., Jafari, M., Sadeghi, A., Saberi Isfeedvajani, M., davazdahemami, M.H. (2019). Validity and Reliability of the Persian Version of Leeds Dyspepsia Questionnaire. Galen Medical Journal ;8: e1609. doi:10.31661/gmj. v8i0.1609.
DOI: https://doi.org/10.31661/gmj
Calvert, E. L., Houghton, L. A., Cooper, P., Morris, J., & Whorwell, P. J. (2002). Long-term improvement in functional dyspepsia using hypnotherapy. Gastroenterology, 123(6), 1778-1785.
DOI: https://doi.org/10.1053/gast.2002.37071
Chen, T. S., Luo, J. C., & Chang, F. Y. (2010). Psychosocial-spiritual factors in patients with functional dyspepsia: a comparative study with normal individuals having the same endoscopic features. European journal of gastroenterology & hepatology, 22(1), 75-80.
DOI: https://doi.org/10.1097/MEG.0b013e32832937ad
Cheng, C., Yang, F. C., Jun, S., & Hutton, J. M. (2007). Flexible coping psychotherapy for functional dyspeptic patients: a randomized, controlled trial. Psychosomatic Medicine, 69(1), 81-88.
DOI: https://doi.org/10.1097/01.psy.0000249734.99065.6f
Cusin, C., Yang, H., Yeung, A., & Fava, M. (2009). Rating scales for depression. In Handbook of clinical rating scales and assessment in psychiatry and mental health. Humana Press, Totowa, NJ. Springer. 7-35.
DOI: https://doi.org/10.1007/978-1-59745-387-5_2
Davis, R. N., & Valentiner, D. P. (2000). Does meta-cognitive theory enhance our understanding of pathological worry and anxiety? Personality and Individual Differences, 29(3), 513-526.
DOI: https://doi.org/10.1016/S0191-8869(99)00211-1
Dehghanizade, Z., Zargar, Y., Honarmand, M. M., Kadkhodaie, A., & Baygi, M. E. (2015). The effectiveness of cognitive behavior stress management on functional dyspepsia symptoms. Journal of Advances in Medical Education & Professionalism, 3(2), 45.
Drossman, D. A., Toner, B. B., Whitehead, W. E., Diamant, N. E., Dalton, C. B., Duncan, S., Emmott, S., Proffitt, V., Akman, D., Frusciante, K., Le, T., Meyer, K., Bradshaw, B., Mikula, K., Morris, C.B., Blackman, C.J., Hu, Y., Jia, H., Li, J.Z., Koch, G.G., Bangdiwala, S.I. (2003). Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology, 125(1), 19-31.
DOI: https://doi.org/10.1016/S0016-5085(03)00669-3
Ebrahimi, A., Kheyr, Z., Nasiri, H., & Barnamanesh, A. (2017). Reliability, validity, factor and discrimination power analysis of young mania rating scale among unipolar, bipolar depression and healthy people. Jundishapur scientific medical journal, 16(3):333-344.
Faramarzi, M., Azadfallah, P., Book, H. E., Tabatabaei, K. R., Taheri, H., & Shokri-shirvani, J. (2013). A randomized controlled trial of brief psychoanalytic psychotherapy in patients with functional dyspepsia. Asian Journal of psychiatry, 6(3), 228-234.
DOI: https://doi.org/10.1016/j.ajp.2012.12.012
Filipović, B. F., Randjelovic, T., Ille, T., Markovic, O., Milovanović, B., Kovacevic, N., & Filipović, B. R. (2013). Anxiety, personality traits and quality of life in functional dyspepsia‐suffering patients. European Journal of Internal Medicine, 24(1), 83-86.
DOI: https://doi.org/10.1016/j.ejim.2012.06.017
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of psychopathology and behavioral assessment, 26(1), 41-54.
DOI: https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Gross, J. J. (2001). Emotion regulation in adulthood: Timing is everything. Current directions in psychological science, 10(6), 214-219.
DOI: https://doi.org/10.1111/1467-8721.00152
Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations Handbook of emotion regulation. The Guilford Press, New York, NY, US.
Guendelman, S., Medeiros, S., & Rampes, H. (2017). Mindfulness and emotion regulation: Insights from neurobiological, psychological, and clinical studies. Frontiers in Psychology, 8, 220-243. doi: 10.3389/fpsyg.2017.00220.
DOI: https://doi.org/10.3389/fpsyg.2017.00220
Haug, T. T., Wilhelmsen, I., Svebak, S., Berstad, A., & Ursin, H. (1994). Psychotherapy in functional dyspepsia. Journal of Psychosomatic Research, 38(7), 735-744.
DOI: https://doi.org/10.1016/0022-3999(94)90026-4
Haug, T. T. (2002). Cognitive therapy in functional dyspepsia. In International Congress Series, 1241, 127-130.
DOI: https://doi.org/10.1016/S0531-5131(02)00633-7
Haag, S., Senf, W., Tagay, S., Langkafel, M., Braun‐Lang, U., Pietsch, A., Heuft, G., Talley, N.J., & Holtmann, G. (2007). Is there a benefit from intensified medical and psychological interventions in patients with functional dyspepsia not responding to conventional therapy? Alimentary pharmacology & therapeutics, 25(8), 973-986.
DOI: https://doi.org/10.1111/j.1365-2036.2007.03277.x
Hamilton, M. A. X. (1959). The assessment of anxiety states by rating. British journal of medical psychology.
DOI: https://doi.org/10.1111/j.2044-8341.1959.tb00467.x
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23:56-62.
DOI: https://doi.org/10.1136/jnnp.23.1.56
Hamilton, J., Guthrie, E., Creed, F., Thompson, D., Tomenson, B., Bennett, R., Moriarty, K., Stephens, W., & Liston, R. (2000). A randomized controlled trial of psychotherapy in patients with chronic functional dyspepsia. Gastroenterology, 119(3), 661-669.
DOI: https://doi.org/10.1053/gast.2000.16493
Jones, M. P., Dilley, J. B., Drossman, D., & Crowell, M. D. (2006). Brain–gut connections in functional GI disorders: anatomic and physiologic relationships. Neurogastroenterology & Motility, 18(2), 91-103.
DOI: https://doi.org/10.1111/j.1365-2982.2005.00730.x
Li, Y., Nie, Y., Sha, W., & Su, H. (2002). The link between psychosocial factors and functional dyspepsia: an epidemiological study. Chinese medical journal, 115(7), 1082-1084.
Mahadeva, S., & Goh, K. L. (2011). Anxiety, depression and quality of life differences between functional and organic dyspepsia. Journal of gastroenterology and hepatology, 26, 49-52.
DOI: https://doi.org/10.1111/j.1440-1746.2011.06656.x
Mahadeva, S., Chan, W. K., Mohazmi, M., Sujarita, R., & Goh, K. L. (2011). Validation study of the Leeds Dyspepsia Questionnaire in a multi‐ethnic Asian population. Journal of gastroenterology and hepatology, 26(11), 1669-1676.
DOI: https://doi.org/10.1111/j.1440-1746.2011.06806.x
Maier, W., Buller, R., Philipp, M., & Heuser, I. (1988). The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. Journal of affective disorders, 14(1), 61-68.
DOI: https://doi.org/10.1016/0165-0327(88)90072-9
Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9(1), 85-90.
DOI: https://doi.org/10.1093/clipsy.9.1.85
Mennin, D. S., Turk, C. L., & Heimberg, R. G. (2004). Clinical presentation and descriptive psychopathology of generalized anxiety disorder. Generalized anxiety disorder: advances in research and practice. New York: Guilford Press. p, 3-28.
Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour research and therapy, 43(10), 1281-1310.
DOI: https://doi.org/10.1016/j.brat.2004.08.008
Mennin, D. S., Holaway, R. M., Fresco, D. M., Moore, M. T., & Heimberg, R. G. (2007). Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behavior therapy, 38(3), 284-302.
DOI: https://doi.org/10.1016/j.beth.2006.09.001
Moayyedi, P., Duffett, S., Braunholtz, D., Mason, S., Richards, I. D., Dowell, A. C., & Axon, A. T. (1998). The Leeds Dyspepsia Questionnaire: a valid tool for measuring the presence and severity of dyspepsia. Alimentary pharmacology & therapeutics, 12(12), 1257-1262.
DOI: https://doi.org/10.1046/j.1365-2036.1998.00404.x
Mokhber, N., AzarPajooh, M. R., & Asghari, P. N. (2013). Effect of citalopram on depression and cognitive functions of stroke patients. Journal of Sabzevar University of Medical Sciences, 20(1): 6-14.
Molazadeh, J., & Yavari, A. H. (2016). Study of the mediating role of emotion regulation difficulties in the relationship between exposure to traumatic events and risky sexual behavior among substance abusers. Yafte, 18(3):78-87.
Orive, M., Barrio, I., Orive, V. M., Matellanes, B., Padierna, J. A., Cabriada, J., Orive, A., Escobar, A., & Quintana, J. M. (2015). A randomized controlled trial of a 10 week group psychotherapeutic treatment added to standard medical treatment in patients with functional dyspepsia. Journal of psychosomatic research, 78(6), 563-568.
DOI: https://doi.org/10.1016/j.jpsychores.2015.03.003
Sahan, H. E., Yildirim, E. A., Soylu, A., Tabakci, A. S., Cakmak, S., & Erkoc, S. N. (2018). Comparison of functional dyspepsia with organic dyspepsia in terms of attachment patterns. Comprehensive psychiatry, 83, 12-18.
DOI: https://doi.org/10.1016/j.comppsych.2018.02.007
Salmani, B., Hasani, J., Mohammad-Khani, S., & Karami, G. R. (2014). The efficacy of metacognitive therapy on metacognitive beliefs, metaworry and the signs and symptoms of patients with generalized anxiety disorder. KAUMS Journal (FEYZ), 18(5), 428-439.
Salters-Pedneault, K., Tull, M. T., & Roemer, L. (2004). The role of avoidance of emotional material in the anxiety disorders. Applied and Preventive Psychology, 11(2), 95-114.
DOI: https://doi.org/10.1016/j.appsy.2004.09.001
Salters-Pedneault, K., Roemer, L., Tull, M. T., Rucker, L., & Mennin, D. S. (2006). Evidence of broad deficits in emotion regulation associated with chronic worry and generalized anxiety disorder. Cognitive Therapy and Research, 30(4), 469-480.
DOI: https://doi.org/10.1007/s10608-006-9055-4
Schmulson, M. J., & Drossman, D. A. (2017). What is new in Rome IV. Journal of neurogastroenterology and motility, 23(2), 151.
DOI: https://doi.org/10.5056/jnm16214
Taché, Y., & Bonaz, B. (2007). Corticotropin-releasing factor receptors and stress-related alterations of gut motor function. The Journal of clinical investigation, 117(1), 33-40.
DOI: https://doi.org/10.1172/JCI30085
Talley, N. J., Ruff, K., Jiang, X., & Jung, H. K. (2008). The Rome III classification of dyspepsia: will it help research? Digestive Diseases, 26(3), 203-209.
DOI: https://doi.org/10.1159/000121347
Tanum, L., & Malt, U. F. (2001). Personality and physical symptoms in nonpsychiatric patients with functional gastrointestinal disorder. Journal of Psychosomatic Research, 50(3), 139-146.
DOI: https://doi.org/10.1016/S0022-3999(00)00219-1
Todorova, K. S., & Velikova, V. S. (2012). The validity of the Hamilton depression rating scale as a screening and diagnostic instrument for depression in patients with epilepsy. Journal of IMAB–Annual Proceeding Scientific Papers, 18(3), 305-307.
DOI: https://doi.org/10.5272/jimab.2012183.305
Turk, C. L., Heimberg, R. G., & Luterek, J. A. (2005). Delineating emotion regulation deficits in generalized anxiety disorder: A comparison with social anxiety disorder. Cognitive Therapy and Research, 29(1), 89-106.
DOI: https://doi.org/10.1007/s10608-005-1651-1
Van Oudenhove, L., Vandenberghe, J., Geeraerts, B., Vos, R., Persoons, P., Demyttenaere, K., Fischler, B., & Tack, J. (2007). Relationship between anxiety and gastric sensorimotor function in functional dyspepsia. Psychosomatic medicine, 69(5), 455-463.
DOI: https://doi.org/10.1097/PSY.0b013e3180600a4a
Wells, A. (1999). A metacognitive model and therapy for generalized anxiety disorder. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 6(2), 86-95.
DOI: https://doi.org/10.1002/(SICI)1099-0879(199905)6:2<86::AID-CPP189>3.0.CO;2-S
Wells, A. (2002). Emotional Disorders and Metacognition.: Innovative Cognitive Therapy. John Wiley & Sons. New York, NY, US.
DOI: https://doi.org/10.1002/9780470713662
Wells, A., & King, P. (2006). Metacognitive therapy for generalized anxiety disorder: An open trial. Journal of behavior therapy and experimental psychiatry, 37(3), 206-212.
DOI: https://doi.org/10.1016/j.jbtep.2005.07.002
Wells, A. (2007). Cognition about cognition: Metacognitive therapy and change in generalized anxiety disorder and social phobia. Cognitive and Behavioral Practice, 14(1), 18-25.
DOI: https://doi.org/10.1016/j.cbpra.2006.01.005
Wells, A., Welford, M., King, P., Papageorgiou, C., Wisely, J., & Mendel, E. (2010). A pilot randomized trial of metacognitive therapy vs applied relaxation in the treatment of adults with generalized anxiety disorder. Behaviour research and therapy, 48(5), 429-434.
DOI: https://doi.org/10.1016/j.brat.2009.11.013
Wells, A. (2011). Metacognitive therapy for anxiety and depression. Guilford press. New York, NY, US.
Wu, J. C. (2012). Psychological co-morbidity in functional gastrointestinal disorders: epidemiology, mechanisms and management. Journal of neurogastroenterology and motility, 18(1), 13-18.
DOI: https://doi.org/10.5056/jnm.2012.18.1.13
How to Cite
Batebi, S., Masjedi Arani, A., Jafari, M., Sadeghi, A., Saberi Isfeedvajani, M., & Davazdah Emami, M. H. (2020). A randomized clinical trial of metacognitive therapy and nortriptyline for anxiety, depression, and difficulties in emotion regulation of patients with functional dyspepsia. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(2). https://doi.org/10.4081/ripppo.2020.448
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Elham Qanbari Alaee, Omid Saed, Sahel Khakpoor, Reza Ahmadi, Mahsa Ali Mohammadi, Majid Yoosefi Afrashteh, Zekrolah Morovati, The efficacy of transdiagnostic cognitive behavioural therapy on reducing negative affect, anxiety sensitivity and improving perceived control in children with emotional disorders - a randomized controlled trial , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 25 No. 1 (2022)
- Samantha Reis, Emily L. Matthews, Brin F.S. Grenyer, Characteristics of effective online interventions: implications for adolescents with personality disorder during a global pandemic , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 23 No. 3 (2020)
- Osmano Oasi, Laura Buonarrivo, Alberto Codazzi, Margherita Passalacqua, Gio Matteo Risso Ricci, Francesca Straccamore, Roberto Bezzi, Assessing personality change with Blatt's anaclitic and introjective configurations and Shedler-Westen Assessment Procedure profiles: two case studies in psychodynamic treatment , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 20 No. 1 (2017)
- Irene Messina, Vincenzo Calvo, Alessandro Grecucci, Attachment orientations and emotion regulation: new insights from the study of interpersonal emotion regulation strategies , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 26 No. 3 (2023)
- Mahbobe Ghavidel Heydari, Mahmoud Shirazi, Gholam Reza Sanagouyemoharer, The effect of positive psychotherapy in test anxiety among Zahedan students with hemophilia , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 21 No. 1 (2018)
- Linnea Nissling, Sandra Weineland, Kristofer Vernmark, Ella Radvogin, Anna-Karin Engström, Sara Schmidt, Eva Nieto Granberg, Elin Larsson, Timo Hursti, Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 26 No. 2 (2023)
- Christopher B. Harte, Raymond C. Hawkins II, Impact of personality disorder comorbidity on cognitive-behavioral therapy outcome for mood and anxiety disorders: results from a university training clinic , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 19 No. 2 (2016)
- Violeta Stefania Rotărescu, Diana Bianca Matei, Ioana Alexandra Mircea, Andreea Maria Mirescu, Bogdan George Nedelescu, Daniela Georgiana Nedelea, Alexandra Nicoleta Raluca Neagu, Alexandru George Necșulescu, Gabriel Angelo Oteșanu, Lucian Constantin Tudor, How anxious did you feel during lockdown? The roles resilience, living environment, and gender play on the level of anxiety state during pandemic isolation , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 23 No. 3 (2020)
- Alvaro E. Carrasco, Acceptability of an adventure video game in the treatment of female adolescents with symptoms of depression , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 19 No. 1 (2016): Special issue on Qualitative and Quantitative Research in Child and Adolescent Psychotherapy: part 2
- Danijela Maras, Louise Balfour, Monique Lefebvre, Giorgio A. Tasca, Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 25 No. 3 (2022): SPECIAL ISSUE: "Group psychotherapy: between settled benchmarks and new horizons"
You may also start an advanced similarity search for this article.
