Strictly Psychological Methods Not So Effective with IBS (Irritable Bowel Syndrome)

Research Topics

Sunday, 29 March 2009

Investigators from the Julius Center for Health Sciences and Primary Care at the University Medical Center Utrecht in the Netherlands, reviewed the research literature on efficacy of psychological interventions for the treatment of irritable bowel syndrome.

MEDLINE, EMBASE, PsychInfo, CINAHL, Web of Science, The Cochrane Library and Google Scholar identified 25 randomized trials comparing single psychological interventions with either usual care or placebo interventions in patients over 16 years of age, between the years 1966-2008.

Psychological interventions were found to be slightly superior to usual care or wait list control conditions at the end of treatment, although the clinical significance of this was debatable*. Except for a single study, psychological therapies were not superior to placebo and the sustainability of their effect was questionable. There was no convincing evidence that treatment effects were sustained following completion of treatment for any treatment modality.

Meta-analysis was significantly limited by issues of validity, heterogeneity, small sample size and outcome definition. The authors recommend that future research adhere to current recommendations for IBS treatment trials, and should focus on the long-term effects of treatment.

*[For those interested in some of the statistical details, the relative risk (RR), risk difference (RD), number needed to treat (NNT) and standardized mean difference (SMD) along with 95% confidence intervals were calculated using a random effects model for each outcome. Results for psychological interventions as a group: the SMD for symptom score improvement at 2 and 3 months was 0.97 (95% CI 0.29 to 1.65) and 0.62 (95% CI 0.45 to 0.79) respectively, compared to usual care. Against placebo, the SMDs were 0.71 (95% CI 0.08 to 1.33) and -0.17 (95% CI -0.45 to 0.11) respectively. For improvement of abdominal pain, the SMDs at 2 and 3 months were 0.54 (95%CI 0.10 to 0.98) and 0.26 (95% CI 0.07 to 0.45) compared to usual care. The SMD from placebo at 3 months was 0.31 (95% CI -0.16 to 0.79). For improvement in quality of life, the SMD from usual care at 2 and 3 months was 0.47 (95%CI 0.11 to 0.84) and 0.31 (95%CI -0.16 to 0.77) respectively.

Results for cognitive behavioral therapy: The SMD for symptom score improvement at 2 and 3 months was 0.75 (95% CI -0.20 to 1.70) and 0.58 (95% CI 0.36 to 0.79) respectively compared to usual care. Against placebo, the SMDs were 0.68 (95% CI -0.01 to 1.36) and -0.17 (95% CI -0.45 to 0.11) respectively. For improvement of abdominal pain, the SMDs at 2 and 3 months were 0.45 (95% CI 0.00 to 0.91) and 0.22 (95% CI -0.04 to -0.49) compared to usual care. Against placebo the SMD at 3 months was 0.33 (95% CI -0.16 to 0.82). For improvement in quality of life, the SMDs at 2 and 3 months compared to usual care were 0.44 (95% CI 0.04 to 0.85) and 0.92 (95% CI 0.07 to 1.77) respectively.

Results for interpersonal psychotherapy: The RR for adequate relief of symptoms was 2.02 (95% CI 1.13 to 3.62), RD 0.30 (95% CI 0.13 to 0.46), NNT 4 for comparison with care as usual. The SMD for improvement of symptom score was 0.35 (95% CI -0.75 to 0.05) compared with usual care. Relaxation/Stress management The SMD in symptom score improvement at 2 months was 0.50 (95%CI 0.02 to 0.98) compared with usual care. The SMD in improvement of abdominal pain at 3 months was 0.02 (95%CI -0.56 to 0.61) compared with usual care.]

There were very few long term follow-up results available.

Citation; Zijdenbos IL, de Wit NJ, van der Heijden GJ, Rubin G, Quartero AO. Psychological treatments for the management of irritable bowel syndrome. Cochrane Database Syst Rev.2009 Jan 21;(1): CD006442

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written by Rebecca H. Cratin, March 31, 2009

I find this report interesting because it validates my clinical experience. I have treated a patient with chronic IBS symptoms using a combination of psychotherapy and listening to Belleruth's CD. The patient was very compliant with listening and reported a decrease in symptoms in the first couple of weeks. She continued to listen on a daily basis, and then began to cut back to using the CD only when she anticipated being in stressful job situations. Over a period of a year, she has been almost symptom free, without medication, and using the CD prn when she sees fit to do so. The psychotherapy allows her to address the causes of her job stress, but the CD seems to be the intervention that made the difference. Thank you, Belleruth.

Rebecca Cratin

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written by Mike Miller, PhD, March 31, 2009

The way the stats were presented confused me.

Any research with guided imagery, hypnosis, etc?

Mike Miller, PhD
http://drmikemiller.com

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written by Belleruth, March 31, 2009

The problem is in the vast umbrella category that gets called "Cognitive Behavioral Therapy", which often but not always has a relaxation or imagery component to it.

But clearly this meta-analysis was primarily interested in comparing psychotherapy with CBT, and makes the point that therapy - either supportive, insight-based or process-oriented - doesn't seem to be so efficacious for reducing IBS symptoms. Perhaps the point to consider is that IBS isn't as much of a psychogenic condition as we are often led to believe. But I'm just surmising here. To get more information, you'd need to look up the complete article and perhaps even email the principle investigator.

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written by Sherryl Fall, April 05, 2009

While I am a big fan of cognitive behavioral therapy and use guided imagery often, it is not always the answer.

I have a long history with IBS (23 years) with no success in any method to control it. Quite by accident, I was diagnosed with Celiac Sprue a year ago. Celiac is a hidden disease that is often misdiagnosed. It is a genetic autoimmune disorder and I have found that many doctors know very little about it.

After many years of traumatic diagnosis's or being told it's all in my head, the simple change of my diet to exclude anything with gluten in it solved the IBS symptoms.

Part of my recovery this past year has included "cognitive behavioral therapy" and the other part is getting the word out about celiac disease.

I would recommend anyone with unresolved IBS get checked for Celiac disease. A biopsy of the small intestine can accurately diagnose the disease. There is also a blood test, but it is not always accurate.

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written by Belleruth, April 11, 2009

Thanks. That's a great recommendation. I suspect that the number of undiagnosed food allergies (mainly dairy or wheat) is huge.
BR

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