A validation trial of the Mindovergut.com optimal health and resilience program for adults living with a gastrointestinal condition and low-to-moderate psychological distress

The online Mindovergut.com resilience program is based on a combination of Stress Management (SM), CBT, and Acceptance and Commitment Therapy (ACT). SM strategies (such as relaxed breathing) will be utilised to reduce stress and the physiological impact that stress has on the body (e.g., increased muscle tension around the gastrointestinal tract). CBT strategies such as cognitive flexibility (identify and challenge unhelpful thinking patterns that promote stress and gastrointestinal symptoms e.g., ‘My gastrointestinal is getting worse’) and exposure work (a planned activity where individuals confront a situation which they currently avoid due to unwanted distress). ACT strategies (e.g., Mindfulness and Cognitive defusion) aim to change the negative cycle of distress associated with illness. The Mindovergut.com resilience program consists of 7 modules, each targeting a specific set of areas and factors known to exacerbate or maintain gastrointestinal difficulties and associated psychological distress. The modules are designed in a step-like fashion, with each Module building upon the strategies that have been learnt previously. What this means is that as participants progress through the Program, the workload will increase as they continue to practice things already learnt, whilst also incorporating new skills and activities into the daily routine. However, with practice it is hoped that many of the exercises engaged with will become second nature, requiring less effort and energy as they become more familiar and effective. Importantly, participants are also recommended throughout the program to pace the work they undertake in a way that best suits them and their situation. Each module (1 per week) will take approximately 30 minutes to complete and homework activities taking around 20-40 minutes per day. The modules will include a combination of videos, text, handouts, and audio files (e.g. relaxation tracks). A summary of the modules and their focus of target around gastrointestinal-related processes are provided below: Introduction to the program: Provides an overview of the program including its structure aims, and time requirements. The introduction also outlines the psychosocial processes associated with optimal health and resilience for those living with a gastrointestinal condition, and in turn how they are the target of the intervention. Finally, information about the psychological strategies what form the basis for the transdiagnostic program is outlined. Module One, entitled “Promoting a Growth Mindset”, lays the foundation for the many skills and strategies participants will learn as part of this Program overall. Too often, resilience and optimal health is blocked by negative thinking. As part of this Module, participants will therefore learn how to develop a positive growth mindset and get their mind to start reorienting itself towards positive aspects of life and experiences and acknowledging them, even during times of physical and/or psychological distress. Importantly, this module will also talk about and ask participants to identify potential barriers to taking part in and completing this program. The practice activities will be to complete Handout 1.1 (Building a growth mindset and cultivating gratitude) and engage in 1 to 2 minutes each day completing a gratitude diary. Module Two, entitled “Moving Towards Your Vision for the Future”, is focused on identifying values-based goals to help participants move towards the life they want to live. A key aspect of building resilience and optimal health is to identify and engage in those activities in life that give meaning, that is, values. The practice activities will include the gratitude diary and completing Handout: 2.1 (Identifying a vision for the future consistent with your values). Module Three, entitled “Stress Management”, targets stress and psychological distress. As part of this Module, participants will learn how to not only reduce overall stress levels but also how to use slow, relaxed breathing to help calm the body during peak levels of distress. The practice activities will include the gratitude diary, engaging in slow relaxed breathing, and completing Handout: 3.1 (Relaxation diary). Module Four, entitled “How You Think Impacts How You Feel: Mindfulness, Acceptance and Cognitive Defusion” targets catastrophising and rumination about symptoms. This Module explores the role of emotions and thoughts, and how by being observant of one’s experiences, rather than getting caught up in them, participants can break the negative cycle of thoughts, feelings, and emotions which perpetuates distress. The practice activities will include the gratitude diary, engaging in slow relaxed breathing, and completing Handout: 3.1 (Relaxation diary), and engage in cognitive defusion strategies as described in Handout 4.4. Module Five, entitled “How You Think Impacts How You Feel: Cognitive Flexibility,” targets similar processes to Module 3 but is aimed at building cognitive flexibility. In other words, this Module helps participants identify and challenge the thoughts that facilitate distress and poor symptom management. The practice activities will include the gratitude diary, engaging in slow relaxed breathing, and completing Handout: 3.1 (Relaxation diary), and engage in cognitive defusion strategies as described in Handout 4.4, engage in and practice cognitive flexibility (Handout 5.2) and use the worry diary (Handout 5.3). Module Six, entitled “How You Act Can Impact How You Think and Feel: Exposure Work”, targets avoidance and safety behaviours, helping participants confront fears through planning and engaging with exposure work. The practice activities will include the gratitude diary, engaging in slow relaxed breathing, and completing Handout: 3.1 (Relaxation diary), and engage in cognitive defusion strategies as described in Handout 4.4, engage in and practice cognitive flexibility (Handout 5.2), use the worry diary (Handout 5.3), develop a exposure activity plan (Handout 6.1). Lastly, Module Seven, the final Module, is entitled “Reviewing and Overcoming Setbacks” and is aimed at consolidating all that has been learnt in the previous six Modules. This Module will help participants identify strategies which might be used to overcome future setbacks and challenges and provides other resources which may be found helpful on the journey towards optimal health and resilience. Monitoring of adherence to the intervention (including practice activities) will be attained by participants completing a self-report online questionnaire prior to starting the next module.