To Örebro University

OBJECTIVES: Breast cancer (BC) remains the most diagnosed cancer among women worldwide and its growing survivorship population faces numerous long-term physical and psychological challenges. Cancer support groups emerge as promising interventions to promote comprehensive management of the disease and survivorship needs, emotional well-being and social connection. Accordingly, this study aimed to analyse the acceptability and perceived impact of the Mind Support Group (MSG), a professionally led support group intervention designed for women with BC.

DESIGN: A qualitative methodological approach was used to collect and analyse data.

METHODS: Participants' feedback data were collected through a guided feedback discussion during the MSG final session and analysed using content and thematic analysis.

RESULTS: The sample comprised 22 women diagnosed with BC (stages I-III). Findings showed high acceptability, with participants expressing satisfaction with several aspects of the intervention: interpersonal processes, content, group composition and perceived outcomes. Suggestions for improvement focused exclusively on the intervention dose (e.g., earlier access) and format (e.g., in-person delivery). Mechanisms of change and perceived outcomes also emerged from participants' feedback. Through social (e.g., shared information and experience), behavioural (e.g., self-disclosure) and psychological (e.g., emotional tension release) mechanisms, the MSG appeared to facilitate shifts toward more adaptive coping strategies, personal growth, a reduction in perceived isolation and alienation, and improved communication and self-management skills.

CONCLUSIONS: These findings suggest that the MSG may serve as a valuable complement to medical treatment or, at minimum, inform the design of more comprehensive cancer care interventions integrating psychosocial support across the illness trajectory.

TRIAL REGISTRATION: NCT05642897; NCT06212414.

INTRODUCTION: We aimed to investigate the prevalence of avoidant/restrictive eating in individuals with versus without bowel symptoms in the general population, and identify factors associated with avoidant/restrictive eating.

METHODS: In this Swedish population-based internet health survey, we included individuals with at least one bowel symptom used to diagnose a functional bowel disorder according to the Rome IV criteria, and an age- and sex-matched control group without bowel symptoms. Cutoffs for the Nine-Item avoidant/restrictive food intake disorder screen (NIAS) was used to determine the prevalence of avoidant/restrictive eating. Demographics and clinical characteristics were assessed using validated questionnaires, and independent factors associated with avoidant/restrictive eating were determined by hierarchical multiple regression analysis.

RESULTS: Avoidant/restrictive eating was more common in individuals with bowel symptoms (n=825) compared to controls (n=1806) (22.8% vs 18.2%, p<.001). Individuals with bowel symptoms with avoidant/restrictive eating were more often female, had lower body mass index, more likely to report overlapping functional dyspepsia, reported more severe bowel, psychological and somatic symptoms, shape/weight concerns, and a lower quality of life. Bowel symptom severity emerged as the strongest factor explaining the variability of avoidant/restrictive eating severity.

DISCUSSION: Avoidant/restrictive eating is common in individuals with bowel symptoms and associated with a more severe clinical profile, indicating a need to discuss eating behavior with patients. However, avoidant/restrictive eating is also common in individuals in the general population without bowel symptoms.

BACKGROUND AND AIMS: Bowel Disorders of Gut-Brain Interaction (DGBI) are a highly stigmatized group of disorders. Even though the link between stigma and shame is overall acknowledged, few studies focusing on health-related stigma mention shame, and research on shame in Bowel DGBI is non-existent. The aim of this study was to examine the implications of shame in Bowel DGBI.

METHODS: We included two Swedish population-based samples: a Bowel DGBI sample (n=537) and a matched comparative sample without bowel symptoms (n=1881). Participants completed an online survey with validated self-report scales. A cross-sectional mediation analysis via structural equation modelling, and a moderation analysis were conducted to analyze the role of shame in the associations between bowel symptom severity and psychosocial outcomes.

RESULTS: The Bowel DGBI sample reported significantly higher levels of shame than the comparative sample. The mediation model, conducted with the Bowel DGBI sample, showed that shame was a mediator of the associations of bowel symptoms with general anxiety, depressive symptoms, QoL, and activity impairment. Gastrointestinal (GI)-specific anxiety was not associated with any outcome of this model. Moderation results showed that shame was an exacerbator of the associations of bowel symptoms with higher severity of GI-specific anxiety and depressive symptoms, and poorer quality of life.

CONCLUSIONS: Shame appears to be a particularly important emotion deriving from the experience of GI symptoms in Bowel DGBI, influencing the associations between these symptoms and important patient reported outcomes. An empathetic doctor-patient relationship and psychological therapies may be helpful for individuals with Bowel DGBI experiencing high levels of shame.

Background: Patients with Irritable bowel syndrome (IBS) frequently suffer from comorbid psychiatric or somatic conditions, but the association with overall GI symptom severity and disease burden in IBS has not yet been established.

Objective: This pan‐European project, the DISCOvERIE project, aimed to characterize IBS patients with and without comorbid psychiatric (anxiety, depression) and/or somatic (fibromyalgia, chronic fatigue syndrome) conditions, and to compare them with disease (psychiatric and/or somatic condition without IBS) and healthy controls to further elucidate the effect of comorbid conditions on the disease burden in IBS.

Methods: Participants from nine different European centers were included: IBS patients (Rome IV criteria) with and without comorbid conditions, disease controls, and healthy controls. The presence of comorbidities was assessed through the Mini International Neuropsychiatric Interview (MINI) for anxiety or depression or through diagnostic criteria for fibromyalgia or chronic fatigue syndrome. Validated questionnaires on IBS (IBS‐SSS), depressive (PHQ‐9), anxiety (GAD‐7) and somatic symptom severity (PHQ‐12), fibromyalgia symptoms (FIQ) and fatigue (MFI) were completed.

Results: In total, 842 participants were recruited between March 2021 and January 2023, of which 607 had IBS, 161 were disease controls and 74 were healthy controls. IBS, anxiety, depression, somatic symptoms and fatigue were more severe in IBS patients with comorbidities compared with IBS patients without comorbidities. The severity of the abovementioned symptoms all increased gradually with increasing number of comorbidities (all p < 0.001).

Conclusion: This large pan‐European study highlights the significant impact of psychiatric and somatic comorbidities in IBS, and their strong link with outcomes and disease burden. 

Introduction: In the general population, many people are affected by both insomnia and irritable bowel syndrome (IBS). In this study, we aimed to explore the prevalence of insomnia in patients with IBS and its association with the severity of gastrointestinal and extra-intestinal symptoms.

Methods: Patients with IBS according to Rome IV criteria, referred to the Physiology Unit of Rouen University Hospital (France) between September 2022 and February 2025, who completed various validated questionnaires during their visit to assess insomnia (Insomnia Severity Index (ISI)), IBS severity (IBS-SSS), anxiety and depressive symptoms (HAD-S), quality of life (IBS-QOL), upper gastrointestinal symptom severity (PAGI-SYM), and somatic symptom severity (PHQ-15), were prospectively included in our study. Patients were considered insomniacs when their ISI score was >= 15.

Results: Among 700 patients with IBS included in our analysis, 270 (38.6%) were insomniac. The presence of insomnia was associated with more severe gastrointestinal symptoms (IBS severity, IBS-SSS, p < 0.001) and somatic symptom severity (PHQ-15, p < 0.001). The hierarchical linear regression analysis showed that the ISI score was associated with higher scores of anxiety and depressive symptoms, the presence of functional dyspepsia and fibromyalgia, and, to a lesser extent, older age and higher IBS severity scores (Adjusted R-2 = 0.265).

Discussion: Our findings suggest that in patients with IBS, insomnia is linked with psychological and somatic symptom burden, and the presence of comorbidities such as functional dyspepsia, but causality cannot be inferred. Future studies using objective sleep assessments, such as polysomnography, are needed to confirm these associations.

BACKGROUND: Adverse events (AEs) are unintentional patient outcomes expected in medicine, but their impact on physicians remains underexplored. OBJECTIVES: This study assessed the psychological state experienced by gastroenterologists following endoscopic AEs.

METHODS: A nationwide online survey was sent to all registered gastroenterologists (n = 709). Psychological state was assessed using validated scales assessing psychological distress (DASS-21), professional quality of life (ProQOL-5), self-compassion (SCS-12), and shame feelings (OAS2). Results are presented as mean and 95% confidence interval.

RESULTS: Seventy responded (9.87% response rate; median age 41; 41% female). Nearly all (99%) experienced AEs, most during polypectomy/mucosectomy (66%). None consulted psychological support. Stress (9.4 [7.3-11.5]), anxiety (5.1 [3.5-6.7]), and depression (5.2 [3.7-6.8]) were normal, while burnout (25.9 [24.5-27.2]) and traumatic stress (24.3 [23.0-25.5]) were moderate. Higher compassion satisfaction was associated with consultant status (41.5 vs. 37.7, p = 0.039), >10 years' experience (44.3 vs. 40.2, p = 0.032), age >50 years (41.9 vs. 39.3, p = 0.008) and those involved in legal actions (45.5 vs. 40.6; p = 0.023). Age >50 was also associated with higher stress (15.2 vs. 8.7, p = 0.023) and traumatic stress (26.3 vs. 23.8, p = 0.035). Stopping procedures after AEs was associated with higher anxiety (12.0 vs. 4.8, p = 0.026).

CONCLUSIONS: This is among the first studies to assess the psychological state of AEs on gastroenterologists. Participants showed moderate burnout and traumatic stress, but none consulted psychological support. Findings highlight the need for targeted healthcare support and further research on the emotional burden of AEs among endoscopists.

Background: Studies suggest that 40%-65% of stroke survivors develop chronic post-stroke pain (CPSP), which severely affects their quality of life and mental health. Empirical evidence suggests that existing treatments often fall short, underscoring the need for innovative, integrative interventions. Virtual Reality (VR) seems to provide valuable tools in stroke rehabilitation. Also, contextual-behavioural psychological approaches, such as Acceptance and Commitment Therapy (ACT), offer promising pain management and mental health resources, which seem to be feasible in VR formats. However, their combined application in CPSP remains unexplored.

Objective: This study protocol describes the VR-ACT study, which will test the feasibility and preliminary efficacy of an 8-week VR-ACT program for CPSP.

Methods: A pilot randomized controlled trial (N = 30) will compare a VR-based ACT intervention with a sham-VR control. The study will follow a mixed-methods approach. Quantitative outcomes include pain intensity, psychological symptoms, and quality of life (via self-report measures), and brain network connectivity of the Triple Network (via fMRI). Feasibility will be evaluated through adherence, engagement, and acceptability. Qualitative feedback will be collected post-intervention.

Results: The study expects that the VR-ACT program will be feasible, based on adherence, engagement, and acceptability. VR-ACT is expected to be significantly more effective than Sham VR in reducing pain, disability, and psychological symptoms, improving quality of life, and decreasing triple network brain connectivity (as measured by fMRI).

Conclusions: This trial is expected to corroborate the hypothesis that a VR-delivered ACT program is a feasible, acceptable, and potentially effective tool to support pain self-management and mental health in CPSP patients, laying the groundwork for larger, multicenter trials.

Trial Registration: ClinicalTrials.gov NCT06990646; https://clinicaltrials.gov/study/NCT06990646

Introduction: Irritable bowel syndrome (IBS) is a disorder of brain-gut interaction characterized by abdominal pain and altered bowel habits, often comorbid with anxiety, depression, chronic fatigue syndrome, and fibromyalgia. Psychosocial stress has been implicated in IBS, yet the underlying neural mechanisms and the role of comorbidities remain unclear. Therefore, we aimed to investigate (1) whether IBS patients exhibit in-creased self-reported negative affect (NA) and brain responses to stress, (2) the impact of comorbidities on these responses, and (3) the brain circuits mediating group differences in NA.

Methods: We analyzed data from 96 IBS patients in the European DISCOvERIE project, and 64 healthy controls (HCs). 54 (56.3%) patients met criteria of depression, anxiety, chronic atigue syndrome, and/or fibromyalgia. Psychological stress was induced using the Montreal Imaging Stress Test during functional magnetic resonance imaging scanning, while NA ratings were collected across time (Figure 1A). Group differences in NA were tested using mixed models (all IBS vs. HCs; IBS-comorbid vs. IBS-alone), and stress-related brain activity was compared using general linear models. Multivariate mediation models were applied to identify brain response patterns mediating group differences in NA.

Results: IBS patients reported more NA than HCs during stress (p < 0.01), driven by higher ratings from patients with comorbidities (p < 0.01; Fig 1B). The stress task induced higher brain activations in default mode network in IBS (Fig 1C), but no significant differences were found between comorbidity groups. Increased NA reporting in IBS patients vs HCs was mediated via heightened default mode network, salience network, and damp-ened central autonomic network responses (Fig 1D), and in IBS-comorbid vs. IBS-alone through altered responses in multiple somatosensory areas (Fig 1E).

Conclusions: IBS patients experienced more negative affect than HCs under stress, driven by the presence of comorbidities. The hyperactive default mode network and salience net-work, combined with hypoactive central autonomic network as mediators of case-control differences in negative affect, indicate dysregulated central stress processing in IBS patients. Comorbidities may further amplify negative affect through altered somatosensory processing.

BACKGROUND: Breast cancer is the most diagnosed cancer in women worldwide and carries a considerable psychosocial burden. Interventions based on Acceptance and Commitment Therapy (ACT) and compassion-based approaches show promise in improving adjustment and quality of life in people with cancer. The Mind programme is an integrative ACT and compassion-based intervention tailored for women with breast cancer, which aims to prepare women for survivorship by promoting psychological flexibility and self-compassion. A pilot study of the Mind programme has shown acceptability and preliminary efficacy in improving quality of life and psychological health. This paper presents the study protocol of two randomised controlled trials that aim to test the efficacy and cost-effectiveness of an optimised version of the Mind programme in women with breast cancer.

METHODS: Participants will be women diagnosed with breast cancer randomly assigned to the Mind programme or a support group intervention (active control) in a 1:1 ratio for study 1, while study 2 includes one more arm (treatment as usual; inactive control) and a 2:2:1 ratio. Both interventions will be delivered weekly via an 8-session face-to-face or online group format. Data will be collected at baseline, post-treatment and 6-month follow-up. The efficacy and cost-effectiveness of the two interventions will be assessed. Treatment outcomes will comprise cancer-specific quality of life (primary outcome), anxiety and depressive symptoms, psychological flexibility, self-compassion, health-related quality of life, resource use, and intervention's acceptability and feasibility. Study 1 will also include immunological and epigenetic markers associated with breast cancer prognosis and mental health. Outcome assessors will be blind to group allocation. Statistical analyses will be conducted using an intention-to-treat approach. Analyses of moderators and mediators of change will also be performed.

DISCUSSION: These trials examine the efficacy and cost-effectiveness of an integrative ACT and compassion-based intervention tailored for women with breast cancer. Greater improvements in psychosocial, biological and resource use are expected in the Mind group, when compared to the control group(s). Results will likely support the potential benefits of the Mind programme for breast cancer patients and highlight the clinical relevance of integrative and holistic interventions in oncology.

TRIALS REGISTRATION {2A, 2B}: ClinicalTrials.gov NCT05642897 and NCT06212414. Registered on December 8, 2022, and January 18, 2024.