Related Experiment Video

Updated: Sep 9, 2025

E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

Published on: August 1, 2019

The Acceptance, Commitment and COgnitive RemeDiation (ACCORD) Study: Can a Brief Online Cognitive Intervention

Madison Simons¹, Sara H Marchese¹, Alyse Bedell²

¹Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Neurogastroenterology and Motility

|September 1, 2025

Abstract

Background:

Cognitive and psychological inflexibility are two mental processes that influence how a person interprets and responds to esophageal symptoms. Patients with greater mental inflexibility are at risk for poorer outcomes. Brain-gut behavioral therapies (BGBT) are effective adjunctive treatments in many digestive diseases, with potential to improve mental flexibility. We piloted a brief intervention targeting cognitive and psychological inflexibility in patients with esophageal disease. Secondary aims included improving symptoms, mood, and quality of life (QoL) and reducing hypervigilance and symptom anxiety.

Methods:

Eighty adults newly diagnosed with achalasia, eosinophilic esophagitis, gastroesophageal reflux, or functional dysphagia from an esophageal clinic participated in a non-randomized, open-label trial. Acceptance, Commitment and COgnitive RemeDiation (ACCORD) was a novel 4-week BGBT administered via telemedicine. Feasibility and acceptability were assessed. Evaluations of esophageal symptom severity, cognitive and psychological flexibility, hypervigilance, symptom anxiety, and QoL occurred at baseline and posttreatment. Last observation carried forward was used for patients with incomplete 6-month data. Bayes Factor evaluated strength of support for study hypotheses.

Key Results:

89.9% of participants completed ACCORD. Moderate to decisive gains occurred for some markers of cognitive flexibility and psychological flexibility, which may demonstrate a delayed but strong improvement. Participants demonstrated strong to decisive reductions in symptoms, symptom anxiety, and decisive increases in health-related quality of life (HRQoL).

Conclusions And Inferences:

A novel, four-session BGBT targeting cognitive and psychological flexibility in patients with esophageal disease was feasible, acceptable, and shows potential to improve symptom severity, symptom anxiety, and HRQoL. ACCORD's use of telemedicine may mitigate access issues related to BGBTs. Further study is warranted.

Keywords:

brain–gut behavioral therapy cognitive flexibility esophagus psychological flexibility

More Related Videos

The Dyspepsia Educational Tool As a Novel Aid in Dyspepsia Management

The Dyspepsia Educational Tool As a Novel Aid in Dyspepsia Management

Published on: June 29, 2019

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

Published on: April 17, 2020

Related Concept Videos

Barrett Esophagus-II: Clinical Manifestations and Management

Barrett Esophagus-II: Clinical Manifestations and Management

Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...

Gastroesophageal Reflux Disease II: Clinical Features and Management

Gastroesophageal Reflux Disease II: Clinical Features and Management

Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...

Esophageal Strictures-II: Clinical Features and Management

Esophageal Strictures-II: Clinical Features and Management

Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...

Esophageal Varices-II: Clinical Features and Management

Esophageal Varices-II: Clinical Features and Management

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...

Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies

Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies

Assessing and diagnosing Chronic Obstructive Pulmonary Disease (COPD) involves a detailed approach that includes a comprehensive review of medical history, physical examination, and a variety of diagnostic tests. This thorough evaluation is essential to ensure an accurate diagnosis and guide effective management strategies.
Medical History

Acute Coronary Syndrome IV: Interprofessional Care

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...

Articles linked to this work by shared authors, journal, and citation graph.

Interactive Panometry: Using Proximal Balloon Distension During Functional Lumen Imaging Probe Panometry to Enhance Motility Evaluation of Inhibitory Function.

Journal of neurogastroenterology and motility·2026

Rome V global epidemiology and validation survey: prevalence of disorders of gut-brain interaction and comparison with the Rome IV global epidemiology study.

Gut·2026

Multinational prevalence and burden of paediatric disorders of gut-brain interaction: results of the Rome Foundation paediatric global study.

Gut·2026

Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease: Interdisciplinary Considerations and Management.

Neurogastroenterology and motility·2026

Associations Between Physical Activity and Irritable Bowel Syndrome in the All of Us Research Program.

The American journal of gastroenterology·2026

Relative Contributions of Gastrointestinal-Specific Hypervigilance and Anxiety in Explaining Eating Disorder Symptoms.

Journal of clinical psychology·2026

See all related articles