***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this study was to investigate if cognitive behavior therapy ( CBT ) based on exposure and mindfulness exercises delivered via the Internet would be effective in treating participants with irritable bowel syndrome ( IBS ) . Participants were recruited through self-referral . Eighty-six participants were included in the study and r and omized to treatment or control condition  ( an online discussion forum ) . One participant was excluded after r and omization . The main outcome measure was IBS-symptom severity and secondary measures included IBS-related quality of life , GI-specific anxiety , depression and general functioning . Participants were assessed at pre-treatment , post-treatment and 3 month follow-up ( treatment condition only ) . Four participants ( 5 % of total sample ) in the treatment condition did not participate in post-treatment assessment . Participants in the treatment condition reported a 42 % decrease and participants in the control group reported a 12 % increase in primary IBS-symptoms . Compared to the control condition , participants in the treatment group improved on all secondary outcome measures with a large between group effect size on quality of life ( Cohen 's d = 1.21 ) . We conclude that CBT-based on exposure and mindfulness delivered via the Internet can be effective in treating  IBS- patients  , alleviating the total burden of symptoms and increasing quality of life Acceptance and commitment therapy ( ACT ) interventions for persons with chronic pain have recently received empirical support . ACT focuses on reducing the disabling influences of pain through targeting ineffective control strategies and teaches people to stay in contact with unpleasant emotions , sensations , and thoughts . The aim of the present study was to investigate the effect of a guided internet-delivered ACT intervention for persons with chronic pain . A total of 76 patients with chronic pain were included in the study and r and omized to either treatment for 7 weeks or to a control group that participated in a moderated online discussion forum . Intent-to-treat analyses showed significant increases regarding activity engagement and pain willingness . Measurements were provided with the primary outcome variable Chronic Pain Acceptance Question naire which was in favour of the treatment group . Reductions were found on other measures of pain-related distress , anxiety and depressive symptoms . A six month follow-up showed maintenance of improvements . We conclude that an acceptance based internet-delivered treatment can be effective for persons with chronic pain Background : Although mindfulness meditation interventions have recently shown benefits for reducing stress in various population s , little is known about their relative efficacy compared with relaxation interventions . Purpose : This r and omized controlled trial examines the effects of a 1-month mindfulness meditation versus somatic relaxation training as compared to a control group in 83 students ( M age=25 ; 16 men and 67 women ) reporting distress . Method : Psychological distress , positive states of mind , distractive and ruminative thoughts and behaviors , and spiritual experience were measured , while controlling for social desirability . Results : Hierarchical linear modeling reveals that both meditation and relaxation groups experienced significant decreases in distress as well as increases in positive mood states over time , compared with the control group ( p<.05 in all cases ) . There were no significant differences between meditation and relaxation on distress and positive mood states over time . Effect sizes for distress were large for both meditation and relaxation ( Cohen ’s d=1.36 and .91 , respectively ) , whereas the meditation group showed a larger effect size for positive states of mind than relaxation ( Cohen ’s d=.71 and .25 , respectively ) . The meditation group also demonstrated significant pre-post decreases in both distractive and ruminative thoughts/behaviors compared with the control group ( p<.04 in all cases ; Cohen ’s d=.57 for rumination and .25 for distraction for the meditation group ) , with mediation models suggesting that mindfulness meditation ’s effects on reducing distress were partially mediated by reducing rumination . No significant effects were found for spiritual experience . Conclusions : The data suggest that compared with a no-treatment control , brief training in mindfulness meditation or somatic relaxation reduces distress and improves positive mood states . However , mindfulness meditation may be specific in its ability to reduce distractive and ruminative thoughts and behaviors , and this ability may provide a unique mechanism by which mindfulness meditation reduces distress Background Internet-based cognitive behavior therapy ( ICBT ) has shown promising effects in the treatment of irritable bowel syndrome ( IBS ) . However , to date no study has used a design where participants have been sample d solely from a clinical population . We aim ed to investigate the acceptability , effectiveness , and cost-effectiveness of ICBT for IBS using a consecutively recruited sample from a gastroenterological clinic . Methods Sixty-one patients were r and omized to 10 weeks of ICBT ( n = 30 ) or a waiting list control ( n = 31 ) . The ICBT was guided by an online therapist and emphasized acceptance of symptoms through exposure and mindfulness training . Severity of IBS symptoms was measured with the Gastrointestinal symptom rating scale - IBS version ( GSRS-IBS ) . Patients in both groups were assessed at pre- and post-treatment while only the ICBT group was assessed 12 months after treatment completion . Health economic data were also gathered at all assessment points and analyzed using bootstrap sampling . Results Fifty of 61 patients ( 82 % ) completed the post-treatment assessment and 20 of 30 patients ( 67 % ) in the ICBT group were assessed at 12-month follow-up . The ICBT group demonstrated significantly ( p < .001 ) larger improvements on the IBS-related outcome scales than the waiting list group . The between group effect size on GSRS-IBS was Cohen 's d = 0.77 ( 95 % CI : 0.19 - 1.34 ) . Similar effects were noted on measures of quality of life and IBS-related fear and avoidance behaviors . Improvements in the ICBT group were maintained at 12-month follow-up . The ICBT condition was found to be more cost-effective than the waiting list , with an 87 % chance of leading to reduced societal costs combined with clinical effectiveness . The cost-effectiveness was sustained over the 12-month period . Conclusions ICBT proved to be a cost-effective treatment when delivered to a sample recruited from a gastroenterological clinic . However , many of the included patients dropped out of the study and the overall treatment effects were smaller than previous studies with referred and self-referred sample s. ICBT may therefore be acceptable and effective for only a subset of clinical patients . Study dropout seemed to be associated with severe symptoms and large impairment . Objective and empirically vali date d criteria to select which patients to offer ICBT should be developed . Trial Registration Clinical Trials.gov : Decentering has been proposed as a potential mechanism of mindfulness-based interventions but has received limited empirical examination to date in experimental studies comparing mindfulness meditation to active comparison conditions . In the present study , we compared the immediate effects of mindful breathing ( MB ) to two alternative stress-management techniques : progressive muscle relaxation ( PMR ) and loving-kindness meditation ( LKM ) to test whether decentering is unique to mindfulness meditation or common across approaches . Novice meditators ( 190 female undergraduates ) were r and omly assigned to complete one of three 15-min stress-management exercises ( MB , PMR , or LKM ) presented by audio recording . Immediately after the exercise , participants completed measures of decentering , frequency of repetitive thoughts during the exercise , and degree of negative reaction to thoughts . As predicted , participants in the MB condition reported greater decentering relative to the other two conditions . The association between frequency of repetitive thought and negative reactions to thoughts was relatively weaker in the MB condition than in the PMR and LKM conditions , in which these two variables were strongly and positively correlated . Consistent with the construct of decentering , the relative independence between these two variables in the MB condition suggests that mindful breathing may help to reduce reactivity to repetitive thoughts . Taken together , results help to provide further evidence of decentering as a potential mechanism that distinguishes mindfulness practice from other credible stress-management approaches Background Irritable Bowel Syndrome ( IBS ) is highly prevalent and is associated with a substantial economic burden . Cognitive behavior therapy ( CBT ) has been shown to be effective in treating IBS . The aim of this study was to evaluate the cost-effectiveness of a new treatment alternative , internet-delivered CBT based on exposure and mindfulness exercises . Methods Participants ( N = 85 ) with IBS were recruited through self-referral  and were assessed via a telephone interview and self-report measures on the internet . Participants were r and omized to internet-delivered CBT or to a discussion forum .  Economic data was assessed at pre- , post- and at 3-month and 1 year follow-up . Results Significant cost reductions were found for the treatment group at $ 16,806 per successfully treated case . The cost reductions were mainly driven by reduced work loss in the treatment group . Results were sustained at 3-month and 1 year follow-up . Conclusions Internet-delivered CBT appears to generate health gains in IBS treatment and is associated with cost-savings from a societal perspective Behavioral training ( BT ) is recommended as a supplementary preventive treatment for migraine .  Online interventions have been successful in promoting health behavior change , the evidence for online BT in migraine is limited , however . This r and omized controlled trial aim ed to determine the post-treatment effectiveness of  online BT ( n = 195 ) compared to a waitlist control group ( WLC ; n = 173 ) on migraine attack frequency ( primary outcome ) , headache self-efficacy and locus of control ( secondary outcomes ) . BT aims to counteract attacks in the prodromal stage through early detection of prodromal features and self-management via physical relaxation and cognitive behavioral regulation , and was offered with minimal e-mail support in eight online lessons . Results showed that 120 ( 62 % ) participants completed BT . A decrease of 20 - 25 % in migraine attack frequency was found in both conditions without a between-group difference ( ES = 0.02 , p = .71 ) . BT participants improved more than WLC participants on migraine related self-efficacy ( ES = 0.86 , p < .001 ) , developed more internal ( ES = 0.57 , p < .001 ) , and less external control ( ES = 0.78 , p < .001 ) . To conclude , results at post-training did not corroborate that improvements in migraine attack frequency were due to online BT , the waitlist control group improved accordingly . However , positive effects of BT on self-efficacy and locus of control were established . We have to await the long term effects to see if improvements in psychological variables translate to a reduction in migraine headache Mindfulness-based Cognitive Therapy ( MBCT ) has been shown to effectively prevent relapse and reduce residual depressive symptoms ( RDS ) , yet it faces barriers to dissemination . The present study examined Mindful Mood Balance ( MMB ) , the first web-based approach to deliver the core content of MBCT . Of the 107 recurrently depressed individuals screened , 100 elected to enroll in the study and received MMB in an 8-session open trial with 6-month follow-up . Outcomes included depressive symptom severity , rumination and mindful awareness , and program engagement . A quasi-experimental comparison between MMB participants and propensity matched case-controls receiving usual depression care ( UDC ) ( N = 100 ) also was conducted . The full sample and the subgroup with residual depressive symptoms ( N = 42 ) showed significantly reduced depressive severity , which was sustained over six months , and improvement on rumination and mindfulness . Examination of acceptability of MMB indicated that 42 % of participants within the full sample and 36 % of the RDS subgroup completed all 8 sessions and 53 % within the full sample and 50 % within the RDS subgroup completed at least 4 sessions , and that participants engaged with daily mindfulness practice . MMB also was associated with significant reduction in RDS severity as compared to quasi-experimental propensity matched controls . Although the use of a non-r and omized design , with potential unmeasured differences between groups , and short interval of clinical follow-up were limitations , findings from this study support the web-based delivery of MBCT and suggest clinical benefits for participants with histories of depression and with RDS , relative to those receiving usual care alone BACKGROUND AND AIMS In the past decade , a large body of research has demonstrated that internet-based interventions can have beneficial effects on depression . However , only a few clinical trials have compared internet-based depression therapy with an equivalent face-to-face treatment . The primary aim of this study was to compare treatment outcomes of an internet-based intervention with a face-to-face intervention for depression in a r and omized non-inferiority trial . METHOD A total of 62 participants suffering from depression were r and omly assigned to the  therapist-supported internet-based intervention group ( n=32 ) and to the face-to-face intervention ( n=30 ) . The 8 week interventions were based on cognitive-behavioral therapy principles . Patients in both groups received the same treatment modules in the same chronological order and time-frame . Primary outcome measure was the Beck Depression Inventory-II ( BDI-II ) ; secondary outcome variables were suicidal ideation , anxiety , hopelessness and automatic thoughts . RESULTS The intention-to-treat analysis yielded no significant between-group difference ( online vs. face-to-face group ) for any of the pre- to post-treatment measurements . At post-treatment both treatment conditions revealed significant symptom changes compared to before the intervention . Within group effect sizes for depression in the online group ( d=1.27 ) and the face-to-face group ( d=1.37 ) can be considered large . At 3-month follow-up , results in the online group remained stable . In contrast to this , participants in the face-to-face group showed significantly worsened depressive symptoms three months after termination of treatment ( 
    Output:
    
The studies indicate that mindfulness- and relaxation-based eHealth interventions can have positive effects on patients ’ general health and psychological well-being .
No effects were found for stress or mindfulness .
Conclusion There is some evidence that mindfulness- and relaxation-based eHealth interventions for medical conditions can have positive effects on health outcomes .
Therefore , such interventions might be a useful addition to st and ard medical care .