Table 2 Description of the treatment steps and number of patients reaching each step

1

Introduction to the treatment and two mindfulness exercises. 1. A 15-minute exercises during which the patient observes and labels inner and outer experiences (practiced once daily). 2. A 20 second exercise that brings the patient into immediate awareness of current thoughts, GI symptoms, feelings, and behavioral impulses (practiced several times daily).

7(23%)

2

Explanation of a psychological model of IBS. The learning of symptom-related fear through negative experiences of symptoms. The effect of anxiety on gastrointestinal functioning and how it increases awareness of threatening stimuli - specifically IBS-related stimuli.

6 (7%)

3

The role of negative thoughts in exacerbating IBS-related fear. A mindful and accepting stance towards negative thoughts and experiences is proposed as an alternative to attempts to control these experiences.

3 (10%)

4

Explanation of how IBS-related avoidance and control behaviors maintain the fear of awareness of IBS-symptoms. Patients record their own IBS-related behaviors.

5 (17%)

5

Behavior change and exposure, chiefly divided into three categories. 1) Reduction or removal of behaviors that serve to control symptoms, such as repeated toilet visits, distraction, eating certain foods, resting, and taking unprescribed medications. 2) Exposure to symptoms by engaging in activities that provoke symptoms, such as eating certain foods, physical activity, and stressful situations. 3) Exposure to situations where symptoms are unwanted, such as attending a meeting when experiencing abdominal pain or riding the bus with fear of losing control of the bowels. Instructions on how to use mindfulness during exposure. By observing and labeling their environment during exposure, i.e., aversive, neutral, and positive internal and external stimuli, patients will counter distraction from and suppression of thoughts and emotions. By attending to any impulses to flee the situation or decrease the intensity of symptoms they will also be less inclined to act on these impulses.

In the last week of treatment all patients got access to a text that discussed how to handle relapses into avoidance behaviors and how to maintain a widened behavioral repertoire.

13 (43%)