International Hypnosis Research Institute - Digestive Disorders

The Efficacy of Hypnotherapy in the Treatment of Functional Dyspepsia.

Thu, 19 Aug 2021 16:40:00 -0500

BACKGROUND: Functional dyspepsia (FD) is one of the most frequent functional gastrointestinal disorders and is defined using the Rome IV criteria as any combination of the following symptoms: postprandial fullness, early satiety, epigastric pain, and epigastric burning that are severe enough to interfere with the usual activities and occur at least 3 days per week over the past 3 months with an onset of at least 6 months before the presentation. The purpose of this systematic review is to analyze all the relevant studies in the literature that investigate the efficiency of hypnotherapy in FD. AREAS OF UNCERTAINTY: FD refractory to conservative treatment is a therapeutic challenge, and alternative treatment options are needed. Gut-oriented hypnotherapy has been reported an effective treatment for irritable bowel syndrome, but poorly tested in FD. DATA SOURCES: We performed a search in 6 bibliographic databases (PubMed, Embase, Cochrane Library, Web of Science, Scopus, and LILACS) using customized search strategies for each engine. The search strategy included the following terms: (hypnosis, hypnotherapy, hypnotherapies, hypnogenesis, hypnotism, hypnotist, hypnotical suggestion, suggestion, and mesmerism) and {[functional and (dyspepsia or dyspeptic)] or FD}. RESULTS: Taking the aforementioned criteria into account, the result was a review of 4 articles analyzing the efficacy of hypnotherapy in the treatment of FD, published in the past 20 years. The initial search identified 398 articles, of which 37 potentially appropriate articles were reviewed. Of these 37 articles, 4 articles were included in the review. The benefits observed by numerous studies go beyond the field of digestive pathology, patients describing a general improvement in physical and mental health. CONCLUSIONS: Current studies analyzing the efficacy of hypnotherapy in FD provide encouraging data, but additional randomized controlled trials are needed before a firm position on the effectiveness of hypnosis in FD. Am J Ther. 2019 Nov/Dec;26(6):e704-e713. doi: 10.1097/MJT.0000000000001033.

Psychotherapeutic Interventions in Irritable Bowel Syndrome.

Wed, 18 Aug 2021 16:39:00 -0500

Irritable bowel syndrome (IBS) is a frequent functional gastrointestinal disorder. The patients complain about various symptoms like change in bowel habits, constipation or diarrhea, abdominal pain, and meteorism leading to a great reduction in quality of life. The pathophysiology is complex and best explained using the biopsychosocial model encompassing biological, psychological as well as (psycho)social factors. In line with the multitude of underlying factors, the treatment is comprised of a multitude of components. Often, patients start with lifestyle changes and dietary advice followed by medical treatment. However, also psychotherapy is an important treatment option for patients with IBS and should not be restricted to those with psychiatric comorbidities. Several evidence-based psychotherapeutic treatment options exist such as psychoeducation, self-help, cognitive behavioral therapy, psychodynamic psychotherapy, hypnotherapy, mindfulness-based therapy, and relaxation therapy which will be discussed in the present review. Front Psychiatry. 2020 Apr 30;11:286. doi: 10.3389/fpsyt.2020.00286. eCollection 2020.

Effect of Lifestyle Factors on Outcomes in Patients With Inflammatory Bowel Diseases.

Mon, 09 Aug 2021 16:29:00 -0500

Various lifestyle factors including physical activity and obesity, stress, sleep, and smoking may modify the risk of developing inflammatory bowel diseases (IBDs). In patients with established IBD, these lifestyle factors may significantly impact the natural history and clinical outcomes. Recreational exercise decreases the risk of flare and fatigue in patients with IBD. In contrast, obesity increases the risk of relapse and is associated with higher anxiety, depression, fatigue, and pain and higher health care utilization. Obesity also modifies pharmacokinetics of biologic agents unfavorably and is associated with a higher risk of treatment failure. Sleep disturbance is highly prevalent in patients with IBD, independent of disease activity, and increases the risk of relapse and chronic fatigue. Similarly, stress, particularly perceived stress rather than major life events, may trigger symptomatic flare in patients with IBD, although its impact on inflammation is unclear. Cigarette smoking is associated with unfavorable outcomes including the risk of corticosteroid dependence, surgery, and disease progression in patients with Crohn's disease; in contrast, smoking does not significantly impact outcomes in patients with ulcerative colitis, although some studies suggest that it may be associated with a lower risk of flare. The effect of alcohol and cannabis use in patients with IBD is inconsistent, with some studies suggesting that cannabis may decrease chronic pain in patients with IBD, without a significant effect of biological remission. Although these lifestyle factors are potentially modifiable, only a few interventional studies have been conducted. Trials of structured exercise and psychological therapy including mindfulness-based therapies such as meditation and yoga and gut-directed hypnotherapy have not consistently demonstrated benefit in clinical and/or endoscopic disease activity in IBD, although may improve overall quality of life. Am J Gastroenterol. 2020 Jun;115(6):832-840. doi: 10.14309/ajg.0000000000000608.

Efficacy of psychological therapies for irritable bowel syndrome...

Sun, 08 Aug 2021 16:30:00 -0500

Full title: Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis. OBJECTIVES: National guidelines for the management of irritable bowel syndrome (IBS) recommend that psychological therapies should be considered, but their relative efficacy is unknown, because there have been few head-to-head trials. We performed a systematic review and network meta-analysis to try to resolve this uncertainty. DESIGN: We searched the medical literature through January 2020 for randomised controlled trials (RCTs) assessing efficacy of psychological therapies for adults with IBS, compared with each other, or a control intervention. Trials reported a dichotomous assessment of symptom status after completion of therapy. We pooled data using a random effects model. Efficacy was reported as a pooled relative risk (RR) of remaining symptomatic, with a 95% CI to summarise efficacy of each comparison tested, and ranked by therapy according to P score. RESULTS: We identified 41 eligible RCTs, containing 4072 participants. After completion of therapy, the psychological interventions with the largest numbers of trials, and patients recruited, demonstrating efficacy included self-administered or minimal contact cognitive behavioural therapy (CBT) (RR 0.61; 95%?CI 0.45 to 0.83, P score 0.66), face-to-face CBT (RR 0.62; 95%?CI 0.48 to 0.80, P score 0.65) and gut-directed hypnotherapy (RR 0.67; 95%?CI 0.49 to 0.91, P score 0.57). After completion of therapy, among trials recruiting only patients with refractory symptoms, group CBT and gut-directed hypnotherapy were more efficacious than either education and/or support or routine care, and CBT via the telephone, contingency management, CBT via the internet and dynamic psychotherapy were all superior to routine care. Risk of bias of trials was high, with evidence of funnel plot asymmetry; the efficacy of psychological therapies is therefore likely to have been overestimated. CONCLUSIONS: Several psychological therapies are efficacious for IBS, although none were superior to another. CBT-based interventions and gut-directed hypnotherapy had the largest evidence base and were the most efficacious long term. TRIAL REGISTRATION NUMBER: The study protocol was published on the PROSPERO international prospective register of systematic reviews (registration number CRD 42020163246). Gut. 2020 Aug;69(8):1441-1451. doi: 10.1136/gutjnl-2020-321191. Epub 2020 Apr 10.

Behavioral and Diet Therapies in Integrated Care for Patients With Irritable Bowel Syndrome.

Sat, 31 Jul 2021 16:19:00 -0500

Irritable bowel syndrome (IBS) is a common, symptom-based condition that has negative effects on quality of life and costs health care systems billions of dollars each year. Until recently, management of IBS has focused on over-the-counter and prescription medications that reduce symptoms in fewer than one-half of patients. Patients have increasingly sought natural solutions for their IBS symptoms. However, behavioral techniques and dietary modifications can be effective in treatment of IBS. Behavioral interventions include gastrointestinal-focused cognitive behavioral therapy and gut-directed hypnotherapy to modify interactions between the gut and the brain. In this pathway, benign sensations from the gut induce maladaptive cognitive or affective processes that amplify symptom perception. Symptoms occur in response to cognitive and affective factors that trigger fear of symptoms or lack of acceptance of disease, or from stressors in the external environment. Among the many dietary interventions used to treat patients with IBS, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols is the most commonly recommended by health care providers and has the most evidence for efficacy. Patient with IBS who choose to follow a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols should be aware of its 3 phases: restriction, reintroduction, and personalization. Management of IBS should include an integrated care model in which behavioral interventions, dietary modification, and medications are considered as equal partners. This approach offers the greatest likelihood for success in management of patients with IBS. Gastroenterology. 2021 Jan;160(1):47-62. doi: 10.1053/j.gastro.2020.06.099. Epub 2020 Oct 19.

Paediatric functional abdominal pain disorders.

Wed, 28 Jul 2021 16:17:00 -0500

Paediatric functional abdominal pain disorders, currently referred to as disorders of gut-brain interaction, comprise irritable bowel syndrome, functional dyspepsia, abdominal migraine and functional abdominal pain not otherwise specified, as defined by the Rome IV diagnostic criteria. Functional abdominal pain disorders are common disorders with a prevalence of 3-16% depending on country, age and sex. A greater understanding of aetiopathogenesis and pathophysiology is emerging and includes intestinal components (inflammation, motility and the microbiota), central factors (psychological aspects, sensitization and/or differences in connectivity or activity of certain brain regions) as well as extrinsic factors (infections). In particular, the timing of disruption of the microbiota-gut-brain axis seems to be important. Diagnosis is challenging but is primarily based on clinical symptoms and exclusion of other organic causes, with an emphasis on avoiding unnecessary invasive diagnostic procedures. The available pharmacological interventions are limited in children and, therefore, management has focused on combined approaches, including mind-targeted interventions (hypnotherapy and cognitive behavioural therapy), diet (probiotics) and percutaneous electrical nerve field stimulation. The evidence for their clinical efficacy, although limited, is favourable, with positive impacts on symptoms and overall quality of life. The coming decades hold promise for improved understanding and management of these enigmatic disorders. Nat Rev Dis Primers. 2020 Nov 5;6(1):89. doi: 10.1038/s41572-020-00222-5.

Practitioners' experiences of using Gut Directed Hypnosis for irritable bowel syndrome...

Tue, 27 Jul 2021 16:16:00 -0500

Full title: Practitioners' experiences of using Gut Directed Hypnosis for irritable bowel syndrome: Perceived impact upon client wellbeing: A qualitative study. Gut Directed Hypnosis (GDH) is a specialised form of hypnotherapy originally developed to reduce gastrointestinal (GI) symptoms in individuals with Irritable Bowel Syndrome (IBS). IBS is a condition characterised by symptoms including bloating, abdominal pain and diarrhoea and/or constipation as well as psychosocial symptoms such as depression and anxiety. Although the specific mechanism of action remains unclear, it is suggested that GDH works on the brain-gut axis to improve GI symptoms, psychological functioning and overall wellbeing. The present study aimed to expand upon the knowledge surrounding GDH by exploring practitioners' experiences of using GDH for IBS and their perceptions of how it impacts upon client wellbeing. Six practitioners trained in GDH participated in one hour semi-structured interviews. Thematic Analyses (TA) was used to analyse data. Three major themes emerged from data including: predisposing personality traits and vulnerabilities associated with IBS; GDH as evidence-based practice; and the future evolution of GDH. The findings from this study add to the growing body of literature exploring the use of GDH for IBS, by incorporating the perspective of practitioners working within this field. Complement Ther Med. 2020 Dec;55:102605. doi: 10.1016/j.ctim.2020.102605. Epub 2020 Nov 5.

Hypnotherapy for Irritable Bowel Syndrome...

Sat, 10 Jul 2021 15:59:00 -0500

Full title: Hypnotherapy for Irritable Bowel Syndrome-Type Symptoms in Patients with Quiescent Inflammatory Bowel Disease: A Randomized, Controlled Trial Background and aims: Many inflammatory bowel disease [IBD] patients in remission have persisting symptoms, compatible with irritable bowel syndrome [IBS-type symptoms]. We aimed to compare the effectiveness of gut-directed hypnotherapy vs standard medical treatment [SMT] for IBS-type symptoms in IBD patients. Methods: In this multicentre, randomized, controlled, open-label trial, patients aged 12-65 years with IBD in clinical remission [global assessment] and biochemical remission [faecal calprotectin ?100 µg/g, or ?200 µg/g without inflammation at endoscopy] with IBS according to Rome III criteria were randomized to hypnotherapy or SMT. Primary outcome was the proportion with ?50% reduction on a visual analog scale for symptom severity, as measured with the Irritable Bowel Syndrome Severity Scoring System [IBS-SSS] at week 40 [i.e. 6 months after finishing the intervention], compared to baseline. Secondary outcomes included total IBS-SSS score, quality of life, adequate relief, IBS-related cognitions, and depression and anxiety scores. Results: Eighty patients were included, of whom 70 received at least one session of the allocated treatment and were included in the modified intention-to-treat-population. Seven patients were excluded because of missing baseline data required for the primary outcome. The primary outcome was met in nine [27%] of 33 patients randomized to SMT and nine [30%] of 30 patients randomized to hypnotherapy [p = 0.81]. Adequate relief was reported in 60% and 40% of subjects, respectively. Exploratory analyses of secondary outcomes revealed no apparent differences between the two treatment groups. Conclusions: Hypnotherapy was not superior to SMT in the treatment of IBS-type symptoms in IBD patients. Both treatment strategies are reasonable options from a clinical perspective. J Psychosom Res. 2021 Jun 19;148:110553. doi: 10.1016/j.jpsychores.2021.110553.

Efficacy, Tolerability, and Safety of Hypnosis in Adult Irritable Bowel Syndrome: Systematic Review

Thu, 11 Sep 2014 13:54:00 -0500

OBJECTIVE: To assess the efficacy, tolerability, and safety of hypnosis in adult irritable bowel syndrome by a meta-analysis of randomized controlled trials. METHODS: Studies were identified by a literature search of the databases Allied and Complementary Medicine Database, Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycINFO, and Scopus (from inception to June 30, 2013). Primary outcomes were adequate symptom relief, global gastrointestinal score, and safety. Summary relative risks (RRs) with number needed to treat (NNT) and standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were calculated using random-effects models. RESULTS: Eight randomized controlled trials with a total of 464 patients and a median of 8.5 (7-12) hypnosis sessions over a median of 12 (5-12) weeks were included into the analysis. At the end of therapy, hypnosis was superior to control conditions in producing adequate symptom relief (RR, 1.69 [95% CI = 1.14-2.51]; NNT, 5 [3-10]) and in reducing global gastrointestinal score (SMD, 0.32 [95% CI = -0.56 to -0.08]). At long-term follow-up, hypnosis was superior to controls in adequate symptom relief (RR, 2.17 [95% CI = 1.22-3.87]; NNT, 3 [2-10]), but not in reducing global gastrointestinal score (SMD, -0.57 [-1.40 to 0.26]). One (0.4%) of 238 patients in the hypnosis group dropped out due to an adverse event (panic attack). CONCLUSION: This meta-analysis demonstrated that hypnosis was safe and provided long-term adequate symptom relief in 54% of patients with irritable bowel syndrome refractory to conventional therapy. Psychosom Med. 2014 Jun 4. Schaefert R(1), Klose P, Moser G, Häuser W. Author information: (1)From the Department of General Internal Medicine and Psychosomatics (R.S.), University of Heidelberg, Heidelberg, Germany; Department of Internal and Integrative Medicine (P.K.), Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany; Department of Internal Medicine III (G.M.), Medical University of Vienna, Vienna, Austria; Department of Internal Medicine I (W.H.), Klinikum Saarbrücken, Saarbrücken, Germany; and Department of Psychosomatic Medicine (W.H.), Technische Universität München, München, Germany.

The role of hypnotherapy for the treatment of inflammatory bowel diseases.

Tue, 26 Aug 2014 13:50:00 -0500

Inflammatory bowel diseases (IBD) are chronic disorders of unknown aetiology which are characterized by episodes of exacerbations and remissions. There is evidence that perceived distress contributes to IBD symptom flares; anxiety and depression are frequently found in patients with the active disease. Because there is no cure, treatment has to focus on prevention of complications, induction/maintenance of remission and improvement of quality of life. Gut-directed hypnotherapy (GHT) has been used successfully in functional gastrointestinal disorders. Few experimental studies and case reports have been published for IBD; GHT increases the health-related quality of life and reduces symptoms. Additionally, GHT seems to have an immune-modulating effect and is able to augment clinical remission in patients with quiescent ulcerative colitis. Expert Rev Gastroenterol Hepatol. 2014 May 12:1-6. Moser G. Author information: Abteilung für Gastroenterologie und Hepatologie, Univ. Klinik für Innere Medizin III, Währinger Gürtel 18-20, A-1090 Wien, Austria.

The Efficacy of Hypnotherapy in the Treatment of Irritable Bowel Syndrome...

Thu, 24 Jul 2014 13:18:00 -0500

Full title: The Efficacy of Hypnotherapy in the Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. Background/Aims: Hypnotherapy is considered as a promising intervention for irritable bowel syndrome (IBS), but the evidence is still limited. The aims of this study were to conduct a systematic review and meta-analysis to estimate the efficacy of hypnotherapy for the treatment of IBS. Methods: A literature search was performed using MEDLINE (PubMed), Embase, PsycINFO and the Cochrane Central Register of Controlled Trials (CENTRAL database). Only randomized controlled trials that compared hypnotherapy with any other conven-tional treatment or no treatment in patients with IBS were included. Studies had to report outcomes as IBS symptom score or quality of life. The mean change in outcome score was used to pool these outcomes for the meta-analysis. Data were syn-thesized using the standardized mean difference for continuous data. Results: Seven randomized controlled trials (6 papers) involving 374 patients with IBS were identified. Performance bias was high in all trials because it was impossible to blind participants and therapists in this type of intervention. The outcomes in this meta-anal-ysis were evaluated at 3 months for short-term effects and at 1 year for long-term effects. The change in abdominal pain score at 3 months was significant in the hypnotherapy group (standardized mean difference, -0.83; 95% CI, -1.65 to -0.01). Three of the 4 trials showed greater improvement in overall gastrointestinal symptoms in the hypnotherapy group. Conclusions: This study provides clearer evidence that hypnotherapy has beneficial short-term effects in improving gastrointestinal symptoms of patients with IBS. J Neurogastroenterol Motil. 2014 Apr 30;20(2):152-162. doi: 10.5056/jnm.2014.20.2.152. Lee HH(1), Choi YY(2), Choi MG(1). Author information: (1)Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. (2)Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

Efficacy of combined cognitive-behavior therapy and hypnotherapy in anorexia nervosa: a case study.

Thu, 03 Jul 2014 18:43:00 -0500

A 22-year-old female diagnosed with anorexia nervosa received brief psychotherapy within a span of 1.5 months. Detailed cognitive-behavioral assessment was done and eating attitude was rated. Intervention of eating behavior and cognitive restructuring were initiated along with regular practice of self-hypnosis with ego-strengthening suggestions. Age regression was done to identify conflicts. Significant improvement in eating attitude was noted after 8 sessions without relapse at 3 months. Details of the psychotherapy are discussed. Int J Clin Exp Hypn. 2014;62(2):224-30. doi: 10.1080/00207144.2014.869140. Roy PK. Author information: a Institute of Psychiatry , Kolkata , India.

Dynamic hypnosis, IBS, and the value of individualizing treatment: a clinical perspective.

Tue, 24 Jun 2014 18:40:00 -0500

Hypnosis has already been proven efficient in treatment of irritable bowel syndrome (IBS). The author was responsible for the hypnotherapy in a Swedish study and adds her clinical experience with IBS patients within and beyond that study. The hypnosis was labeled dynamic, and the treatment utilized the therapists' clinical competence and individually tailored techniques, including gut-oriented symptom relief and hypnoanalysis, separately or in combination. The author presents 2 cases, 1 with a focus on symptom relief and 1 on exploring traumatic causes. She illustrates her clinical rationale for technical flexibility from trauma resolving hypnoanalysis to symptom-alleviating suggestive hypnosis, including dynamics beyond the symptom when such are part of the case history. Int J Clin Exp Hypn. 2014;62(2):145-63. doi: 10.1080/00207144.2014.869127. Carolusson S. Author information: a Carolusson & Carolusson AB , Göteborg , Sweden.

The efficacy and methodological challenges of psychotherapy for adults...

Tue, 27 May 2014 18:26:00 -0500

Full title: The efficacy and methodological challenges of psychotherapy for adults with inflammatory bowel disease: a review. Adults with inflammatory bowel disease (IBD) are at a greater risk of anxiety and depression and impaired quality of life (QoL) compared with healthy controls and other chronic physical illness groups. Consequently, the development and evaluation of well-defined and theoretically robust psychotherapeutic interventions for adults with IBD are desirable. To date, interventions have, for the most part, used multiple cross-theoretical approaches. Published reviews are heterogeneous in terms both of categorization of psychotherapeutic approaches and also of conclusions relating to efficacy. A recent Cochrane meta-analysis of randomized controlled trials found no evidence for the efficacy of these interventions in adults, as in a number of previous reviews, ideologically disparate interventions (e.g., psychodynamic and cognitive behavioral) were grouped together. We aimed to extend the currently available literature on psychological intervention in IBD by: evaluating the efficacy of specific strategies (i.e., stress management, psychodynamic, cognitive behavioral therapy, or hypnosis) in improving psychological symptoms and QoL, including all controlled and noncontrolled studies, and explicating the methodological problems in published trials. Sixteen studies (5 stress management, 4 psychodynamic, 5 cognitive behavioral therapy, and 2 hypnosis) were evaluated. Interventions predominantly based on stress management showed only modest benefits for IBD or mental health symptoms or QoL. Cognitive behavioral therapy studies showed generally consistent benefits in terms of anxiety and depression symptoms, but inconsistent outcomes regarding IBD symptoms. Psychodynamically informed interventions reduced depressive and anxiety symptoms, but not IBD severity. Both hypnosis studies, albeit using different methods, seemed to have a more positive impact on disease severity than mental health symptoms or QoL. Our results suggest that while further well-designed and evaluated interventions are needed, psychological input can make a positive contribution to best practice multidisciplinary treatment of adults with IBD. Inflamm Bowel Dis. 2013 Nov;19(12):2704-15. Knowles SR, Monshat K, Castle DJ. *Department of Psychological Sciences and Statistics, Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Australia; Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia; and ‡Department of Psychiatry, The University of Melbourne, Melbourne, Australia.

Sensitivity and specificity of hypnosis effects on gastric myoelectrical activity.

Tue, 11 Feb 2014 18:13:00 -0500

OBJECTIVES: The effects of hypnosis on physiological (gastrointestinal) functions are incompletely understood, and it is unknown whether they are hypnosis-specific and gut-specific, or simply unspecific effects of relaxation. DESIGN: Sixty-two healthy female volunteers were randomly assigned to either a single session of hypnotic suggestion of ingesting an appetizing meal and an unappetizing meal, or to relax and concentrate on having an appetizing or unappetizing meal, while the electrogastrogram (EGG) was recorded. At the end of the session, participants drank water until they felt full, in order to detect EGG-signal changes after ingestion of a true gastric load. During both conditions participants reported their subjective well-being, hunger and disgust at several time points. RESULTS: Imagining eating food induced subjective feelings of hunger and disgust as well as changes in the EGG similar to, but more pronounced than those seen with a real gastric water load during both hypnosis and relaxation conditions. These effects were more pronounced when imagining an appetizing meal than with an unappetizing meal. There was no significant difference between the hypnosis and relaxation conditions. CONCLUSION: Imagination with and without hypnosis exhibits similar changes in subjective and objective measures in response to imagining an appetizing and an unappetizing food, indicating high sensitivity but low specificity. PLoS One. 2013 Dec 16;8(12):e83486. Enck P(1), Hefner J(2), Herbert BM(3), Mazurak N(4), Weimer K(1), Muth ER(5), Zipfel S(1), Martens U(1). (1)Department of Psychosomatic Medicine, University Hospital, Tübingen, Germany. (2)Department of Internal Medicine II, University Hospital, Würzburg, Germany. (3)Department of Health Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany. (4)Central Research Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine. (5)Department of Psychology, Clemson University, Clemson, South Carolina, United States of America.