Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome

doi:10.1016/0005-7967(92)90141-3

Behaviour Research and Therapy

Volume 30, Issue 2, March 1992, Pages 175-189

https://doi.org/10.1016/0005-7967(92)90141-3 Get rights and content

Abstract

We report two controlled comparisons of a previously validated multicomponent (relaxation, thermal biofeedback, and cognitive therapy) treatment for irritable bowel syndrome (IBS) to an ostensible attention-placebo control (pseudo-meditation and EEG alpha suppression biofeedback) and to a symptom-monitoring control. In Study 1 (n = 10 per condition) there were nonsignificant trends for the multicomponent treatment to be superior to the attention-placebo condition. In Study 2 (n = 30 per condition), we found no advantage for the multicomponent treatment over the attention-placebo condition. Subjects in both treatment conditions showed significant reductions in GI symptoms, as measured by daily symptom diaries, and significant reductions in trait anxiety and depression. The GI symptom reductions held up over a 6 month follow-up. Possible explanations for the results are explored.

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Future of Brain–Gut Behavior Therapies: Mediators and Moderators
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Citation Excerpt :
Studies on the dosing of exposure techniques to adequately engage the targets of GI-specific anxiety and avoidance behaviors have not yet been conducted. Individuals with IBS have been shown to have increased trait anxiety, such as general tendencies to worry and overestimation of negative consequence.30,31 Facets of trait anxiety vary, some of which include cognitive inflexibility, neuroticism, and anxiety sensitivity, and measures of general anxiety typically are associated with trait anxiety.
Potential Benefit With Complementary and Alternative Medicine in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis
2021, Clinical Gastroenterology and Hepatology
Patients with irritable bowel syndrome (IBS) may pursue complementary and alternative medicine (CAM). We conducted a comprehensive systematic review and meta-analysis examining efficacy of CAM vs. placebo or sham in adults with IBS.
Publication databases were searched for randomized controlled trials of CAM therapies (herbal therapy, dietary supplements, mind-body based, body-based, and energy-healing) in adults with IBS. Data were extracted to obtain pooled estimates of mean improvement in abdominal pain (standardized mean difference [SMD]) and relative risk (RR) of overall response using random effects models. Sensitivity and subgroup analyses along with quality assessments were completed.
Among 2825 articles identified, 66 were included. Herbal therapy (SMD=0.47, 95% CI: 0.20 to 0.75, I²=82%) demonstrated significant benefit over placebo for abdominal pain (low confidence in estimates). Benefit with mind-body based therapy for abdominal pain was of borderline significance (SMD=0.29, 95% CI: -0.01 to 0.59, I²=78%). Herbal therapy (RR=1.57, 95% CI: 1.31 to 1.88, I²=77%), dietary supplements (RR=1.95, 95% CI: 1.02 to 3.73, I²=75%), and mind-body based therapy (RR=1.67, 95% CI: 1.13 to 2.49, I²=63%) showed benefit for overall response compared to placebo (low confidence in estimates). Body-based and energy healing therapies demonstrated no significant benefit over placebo or sham for abdominal pain or overall response.
CAM therapies such as herbal or dietary supplements and mind-body based approaches may be beneficial for abdominal pain and overall response in IBS. However, overall quality of evidence is low. Rigorous, high quality clinical trials are warranted to investigate CAM in IBS.
Mind-body treatments of irritable bowel syndrome symptoms: An updated meta-analysis
2020, Behaviour Research and Therapy
Irritable bowel syndrome (IBS) is a widespread chronic functional gastrointestinal (GI) disorder having bidirectional comorbidity with psychiatric disorders. This review focuses on psychological treatment of IBS, focusing on symptom severity rather than IBS diagnostic criteria. We chose this dimensional approach in order to assess mind-body effects as an alternative or complement to conventional medical treatment, which focuses on symptom relief. We calculated the effect sizes for various psychosocial-mind-body therapies (MBTs) for IBS symptoms in both children and adults. Therapies included meditation, relaxation, yoga, autogenic training, progressive relaxation, general training in stress coping, hypnotherapy, biofeedback, psycho-education, psychodynamic psychotherapy, and cognitive behavioral therapy. We performed a meta-regression analyses and mixed effects contrasts to find various outcome differences, and we analyzed their relative efficacy in both children and adults. We found 53 studies in 50 reports describing randomized controlled trials. Medium to high effect sizes were found across all methods compared with various controls, with possibly higher effects for children. We found no systematic differences among treatment methods. Meta-regression analyses showed no significant effect for the presence of psychophysiological training, meditation or explicit exposure procedures as treatment components, although most MBTs include exposure as a nonexplicit treatment characteristic, and many relaxation techniques have meditative characteristics. We conclude that there is considerable evidence that an array of mind-body and other psychological therapies can be effective complements to medical treatment for IBS symptom severity, with little evidence for relative superiority of any particular approach. We suggest that the various methods may operate through different mechanisms.
Irritable Bowel Syndrome
2020, Interventional Management of Chronic Visceral Pain Syndromes
IBS has a worldwide prevalence rate of 5%–20% and makes up ~25% of “functional gastrointestinal disorders” diagnoses. Functional abdominal pain is difficult to define, diffuse (not localized), and not associated with structural or biochemical changes. IBS is characterized by chronic abdominal pain, altered bowel habits (diarrhea or constipation), and the absence of any alarming findings. The chronic abdominal pain of IBS, like most chronic pain, is multifactorial, including changes in physiology at the peripheral and central level. There is currently no single treatment that has been proven to be effective. Pharmacologic treatment comprises central and peripherally acting modalities, and most agents take advantage of the deranged serotonin (5HT) levels found at the CNS and peripheral gut level in IBS. Agents to consider include antispasmodics, serotonin agonists, selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and atypical antipsychotics. Nonpharmacologic interventions play an important complementary role in the management of IBS pain. Recommended modalities include cognitive behavioral therapy, interpersonal psychodynamic therapy, hypnosis, stress reduction, and mindfulness meditation.
A Randomized Trial of a Group-Based Integrative Medicine Approach Compared to Waitlist Control on Irritable Bowel Syndrome Symptoms in Adults
2018, Explore
Irritable bowel syndrome (IBS) is a chronic debilitating functional gastrointestinal disorder that affects a large proportion of the general population. Dietary and mind-body approaches have shown some effectiveness in reducing IBS symptoms.
The purpose of this project was to test the feasibility of a low cost, group-oriented integrative medicine approach to IBS, and to explore whether such an approach improves participant outcomes.
This was a randomized-controlled trial involving a 4-week group-oriented treatment intervention combining dietary intervention and mind-body therapies followed by 8-weeks of telephonic health coaching. Differences between the intervention and control groups on IBS-specific measures were examined at baseline, 4, 8, and 12-week.
Fifty-two participants completed the study, 30 in the control group and 22 in the intervention group. On the IBS Symptom Severity Score, at 4 weeks the intervention group showed statistically significant improvement compared to the control group (p < .02), which was sustained at the 8 and 12-week data points as well, with the proportion of the intervention group experiencing moderate to severe symptoms decreasing from 81.3% at baseline to 45% at week 4 and 54.5% at week 12. A statistically significant improvement was also seen on the CES-D measure of depression between baseline and week 12 in the intervention group compared to controls. On the IBS Quality of Life measure we did not observe a statistically significant difference between the groups.
This low-cost, group-oriented intervention approach offers a strategy to address the challenge of access to this type of integrative approach for patients of low socioeconomic status or limited means.
Pilot-RCT of an integrative group therapy for patients with refractory irritable bowel syndrome (ISRCTN02977330)
2018, Journal of Psychosomatic Research
Different forms of psychotherapeutic treatments have been proven effective in irritable bowel syndrome (IBS), but disorder-oriented and integrative concepts are still rare. Therefore, we implemented and evaluated an integrative group therapeutic concept within an interdisciplinary tertiary care clinic for functional gastrointestinal disorders (FGIDs). Aims: present our integrative group concept, assess feasibility issues, and evaluate efficacy.
A pilot-RCT with a randomized controlled wait-listed group design was conducted. The treatment concept was a disorder-oriented multicomponent group therapy (12 90-min weekly sessions) integrating interactive psychoeducation, gut-directed hypnotherapy, and open group phases. All patients received enhanced medical care and completed a short online diary as an active wait-listed control condition. Inclusion criteria: refractory IBS diagnosed as somatoform autonomic dysfunction of the lower gastrointestinal tract (SAD). Primary outcome: IBS symptom severity (IBS-SSS).
Of 294 patients, 220 had IBS (ROME III), 144 were diagnosed as SAD (ICD-10), 51 were eligible regarding inclusion/exclusion criteria, and 30 consented to participate (group intervention: n = 16, wait-listed control condition: n = 14). Only 1 patient dropped out. Intention-to-treat-analysis with repeated-measures mixed ANOVA showed that the group intervention was not significantly superior to the wait-listed control condition. Nevertheless, the calculated effect size for the between-group difference in IBS-SSS at the end of treatment (post) was moderate (d = 0.539).
Our disorder-oriented integrative group intervention for IBS proved to be acceptable and feasible in an interdisciplinary tertiary care setting. There is promise in this intervention, but a larger RCT may be needed to investigate efficacy.

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Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome

Abstract

Behavior Therapy

Behaviour Research and Therapy

Gastroenterology

Lancet

Behavior Therapy

Behavior Therapy

Lancet

Psychometric properties of the SUNYA version of the Psychosomatic Symptom Checklist

Journal of Behavioral Medicine

Cognitive therapy of anxiety and phobic disorders

An inventory for measuring depression

Archives of General Psychiatry

Comparison of psychological and medical treatment of the irritable bowel syndrome

British Journal of Clinical Psychology

Progressive relaxation training

Adaptation of a multi-component treatment program for irritable bowel syndrome to a small group format

Biofeedback and Self-Regulation