Comprehensive Cognitive-Behavioral Interventions Augment Diaphragmatic Breathing for Rumination Syndrome: A Proof-of-Concept Trial Author: Helen Burton Murray1,2,3,4, Fengqing Zhang5,6, Christine C Call5,6, Ani Keshishian7, Rowan A Hunt5,6, Adrienne S Juarascio5,6, Jennifer J Thomas7,8 Affiliation: <sup>1</sup> Department of Psychology, Drexel University, Philadelphia, PA, USA. hbmurray@mgh.harvard.edu. <sup>2</sup> The WELL Center, Drexel University, Philadelphia, PA, USA. hbmurray@mgh.harvard.edu. <sup>3</sup> Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA. hbmurray@mgh.harvard.edu. <sup>4</sup> Harvard Medical School, Boston, MA, USA. hbmurray@mgh.harvard.edu. <sup>5</sup> Department of Psychology, Drexel University, Philadelphia, PA, USA. <sup>6</sup> The WELL Center, Drexel University, Philadelphia, PA, USA. <sup>7</sup> Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA. <sup>8</sup> Harvard Medical School, Boston, MA, USA. Conference/Journal: Dig Dis Sci Date published: 2020 Nov 11 Other: Special Notes: doi: 10.1007/s10620-020-06685-6. , Word Count: 264 Background: Rumination syndrome (RS) is often treated in medical settings with 1-2 sessions of diaphragmatic breathing to target reflexive abdominal wall contraction in response to conditioned cues (e.g., food). However, many patients remain symptomatic and require additional behavioral interventions. Aims: In an attempt to augment diaphragmatic breathing with additional interventions, we tested the proof-of-concept of a comprehensive Cognitive-Behavioral Therapy (CBT) for RS. Methods: In an uncontrolled trial, adults with RS completed a 5-8 session CBT protocol, delivered by one of two psychology behavioral health providers. CBT included two main phases: awareness training and diaphragmatic breathing (Phase 1) and modularized interventions chosen by the therapist and patient to target secondary maintenance mechanisms (Phase 2). At pre-treatment, post-treatment, and 3-month follow-up, participants completed a semi-structured interview on RS symptoms with an independent evaluator. Results: Of 10 eligible individuals (ages 20-67 years, 50% female) offered treatment, all 10 initiated treatment and eight completed it. All participants endorsed high treatment credibility at Session 1. Permutation-based repeated measures ANOVA showed participants achieved large reductions in regurgitations across treatment [F(1,7) = 17.7, p = .007, ηp2 = .69]. Although participants reduced regurgitations with diaphragmatic breathing during Phase 1, addition of other CBT strategies in Phase 2 produced further large reductions [F(1,7) = 6.3, p = .04, ηp2 = .47]. Of eight treatment completers, treatment gains were maintained at 3-month follow-up for n = 6. Conclusions: Findings provide evidence of feasibility, acceptability, and proof-of-concept for a comprehensive CBT for RS that includes interventions in addition to diaphragmatic breathing to target secondary maintenance mechanisms. Randomized controlled trials are needed. Keywords: Disorders of gut-brain interaction; Feeding and eating disorders; Functional gastrointestinal disorder; Habit-reversal training; Rumination disorder; Rumination syndrome. PMID: 33175346 DOI: 10.1007/s10620-020-06685-6