Irritable bowel syndrome: Psychotherapy can improve GI symptoms and emotional health
Medical treatment alone has proven disappointing, but psychotherapeutic approaches are showing promise.
The same investigators then assigned 90 patients to 12 sessions of CBT, given over 8 weeks with or without meditation and biofeedback. Patients with axis I psychiatric diagnoses tended to respond poorly to CBT. The authors concluded that a careful pretreatment psychological workup is important to identify patients with IBS who would benefit most from CBT.9
As a follow-up, these investigators randomly assigned 20 patients to intensive individualized CBT (10 sessions over 8 weeks) or 8 weeks of daily GI symptom monitoring. Patients who received CBT had significantly fewer GI symptoms than did the symptom-monitoring group (p = 0.005). With CBT, 80% improved clinically, compared with only 10% in the control group. Improvements in the CBT group persisted at 3 months’ follow-up. Improved GI symptoms also were correlated with increased positive thoughts and reduced negative automatic thoughts (i.e., negative self-image).10
In the preceding 12 months, the patient has experienced at least 12 weeks or more (need not be consecutive) of abdominal discomfort or pain that has:
Two out of three features
- relieved with defecation, and/or
- onset associated with a change in frequency or stool, and/or
- onset associated with a change in form (appearance) of stool
Symptoms that cumulatively support the diagnosis
- Abnormal stool frequency (for research purposes, “abnormal” may be defined as >3 bowel movements per day and <3 bowel movements per week);
- abnormal stool form (lumpy/hard or loose/watery stool)
- abnormal stool passage (straining, urgency, or feeling of incomplete evacuation)
- passage of mucus
- bloating or abdominal distension.
* In the absence of structural or metabolic abnormalities to explain the symptoms
Source: Drossman DA, Corazziari E, Talley NJ, et al. Rome II: The functional gastrointestinal disorders (2nd ed). McLean, VA: Degnon Associates, 2000.
Group therapy. In a study of group rather than individualized CBT, 45 patients with severe IBS symptoms were randomly assigned to either a group CBT module (n = 25) or a waiting list control group (n = 20). Patients received eight 2-hour group CBT sessions over 3 months, then were followed an average of 2.25 years. Their abdominal pain, number of successful coping behavioral strategies, and avoidance of negative situations improved significantly—compared with the waiting list controls—and persisted during follow-up. The authors concluded that group CBT is effective for alleviating IBS symptoms and improving patients’ coping strategies.11
CBT vs. support groups. In a study comparing the effectiveness of CBT and an IBS self-help support group, 34 patients were randomly assigned to:
- individualized CBT (study group)
- a self-help support group
- or a symptom-monitoring waiting list (control group).
Each group was followed for 8 weeks. GI symptoms were reduced significantly in patients who received individualized CBT, compared with the support group or controls. Anxiety and depression in the CBT group also remained significantly improved 3 months later, compared with both other groups.12
Group psychotherapy
Group psychotherapy for IBS treatment can be more cost-effective than individual therapy, but its success depends on whether patients accept a group format. Data on the use of group psychotherapeutic approaches are largely favorable.
As described previously, one study demonstrated that group CBT reduced abdominal pain and diarrhea and improved symptoms overall.11 In another study, 20 patients with refractory IBS underwent 6 weeks of group behavioral and didactic psychotherapy. GI symptoms, dysphoria, and psychological distress improved significantly in all patients, and their interpersonal sensitivity and hostility were reduced. These improvements persisted 6 months later.12
A recent review suggests that cognitive-behavioral group psychotherapy may be highly effective in patients with IBS. These authors concluded that CBT can improve patients’ mood and other emotional symptoms, reduce their pain, and improve well-being and coping ability.14
Hypnotherapy
Researchers in Manchester, UK, have shown excellent results with hypnotherapy for patients with severe refractory IBS. Although their data seem to have established the ability of hypnotherapy to improve the GI and non-GI symptoms of IBS, corroborating evidence is needed from other centers. In this regard, some preliminary evidence is emerging.
Manchester group. In the first trial by the Manchester group, 30 patients received seven half-hour sessions of hypnotherapy (study group) or supportive psychotherapy and placebo (control group). Patients who received hypnotherapy also were given a tape for home autohypnosis after the third session.
Patients who received hypnotherapy improved dramatically in all GI symptoms— including abdominal pain, bloating, and bowel habits—and in their sense of well-being. This effect persisted 3 months later. The control patients’ abdominal pain, bloating, and well-being improved somewhat, but their bowel habits did not improve.15
The same investigators then studied 30 patients with IBS to assess the effect of hypnotherapy on rectal physiology. Fifteen patients received hypnotherapy, and 15 received relaxation exercises. Rectal sensitivity was measured using anorectal manometry at the start and finish of the intervention.
