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      Psychological Interventions for Irritable Bowel Syndrome and Inflammatory Bowel Diseases

      systematic-review
      Author(s): 1 , * , 2
      Publication date (Electronic):
      Journal: Clinical and Translational Gastroenterology
      Publisher: Nature Publishing Group

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          Abstract

          Psychological interventions have been designed and implemented effectively in a wide range of medical conditions, including Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Diseases (IBD). The psychological treatments for IBS and IBD with the strongest evidence base include: cognitive behavioral therapy, hypnosis, and mindfulness-based therapies. The evidence for each of these therapies is reviewed here for both IBS and IBD. In general, there is a stronger and larger evidence base to support the use of psychological interventions in IBS compared with IBD. This is likely due to the high level of psychiatric comorbidity associated with IBS and the involvement of the stress-response in symptom presentation of IBS. Further research in psychosocial interventions for IBD is necessary. Finally, the importance of conceptualizing both IBS and IBD in a biopsychosocial model is discussed and several resources for accessing Clinical Health Psychology materials and referrals are provided.

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          Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis.

          Alberto Chiesa, Alessandro Serretti (2011)
          Mindfulness- based Cognitive Therapy (MBCT) is a meditation program based on an integration of Cognitive behavioural therapy and Mindfulness-based stress reduction. The aim of the present work is to review and conduct a meta-analysis of the current findings about the efficacy of MBCT for psychiatric patients. A literature search was undertaken using five electronic databases and references of retrieved articles. Main findings included the following: 1) MBCT in adjunct to usual care was significantly better than usual care alone for reducing major depression (MD) relapses in patients with three or more prior depressive episodes (4 studies), 2) MBCT plus gradual discontinuation of maintenance ADs was associated to similar relapse rates at 1year as compared with continuation of maintenance antidepressants (1 study), 3) the augmentation of MBCT could be useful for reducing residual depressive symptoms in patients with MD (2 studies) and for reducing anxiety symptoms in patients with bipolar disorder in remission (1 study) and in patients with some anxiety disorders (2 studies). However, several methodological shortcomings including small sample sizes, non-randomized design of some studies and the absence of studies comparing MBCT to control groups designed to distinguish specific from non-specific effects of such practice underscore the necessity for further research. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
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            Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis.

            T Quigley, Brian Schoenfeld, P Moayyedi … (2009)
            Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. Evidence for treatment of the condition with antidepressants and psychological therapies is conflicting. Systematic review and meta-analysis of randomised controlled trials (RCTs). MEDLINE, EMBASE and the Cochrane Controlled Trials Register were searched (up to May 2008). RCTs based in primary, secondary and tertiary care. Adults with IBS. Antidepressants versus placebo, and psychological therapies versus control therapy or "usual management". Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). The number needed to treat (NNT) was calculated from the reciprocal of the risk difference. The search strategy identified 571 citations. Thirty-two RCTs were eligible for inclusion: 19 compared psychological therapies with control therapy or "usual management", 12 compared antidepressants with placebo, and one compared both psychological therapy and antidepressants with placebo. Study quality was generally good for antidepressant but poor for psychological therapy trials. The RR of IBS symptoms persisting with antidepressants versus placebo was 0.66 (95% CI, 0.57 to 0.78), with similar treatment effects for both tricyclic antidepressants and selective serotonin reuptake inhibitors. The RR of symptoms persisting with psychological therapies was 0.67 (95% CI, 0.57 to 0.79). The NNT was 4 for both interventions. Antidepressants are effective in the treatment of IBS. There is less high-quality evidence for routine use of psychological therapies in IBS, but available data suggest these may be of comparable efficacy.
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              Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome--a randomized controlled trial.

              Brjánn Ljótsson, Lisa Falk, Amanda Vesterlund … (2010)
              The aim of this study was to investigate if cognitive behavior therapy (CBT) based on exposure and mindfulness exercises delivered via the Internet would be effective in treating participants with irritable bowel syndrome (IBS). Participants were recruited through self-referral. Eighty-six participants were included in the study and randomized to treatment or control condition (an online discussion forum). One participant was excluded after randomization. The main outcome measure was IBS-symptom severity and secondary measures included IBS-related quality of life, GI-specific anxiety, depression and general functioning. Participants were assessed at pre-treatment, post-treatment and 3 month follow-up (treatment condition only). Four participants (5% of total sample) in the treatment condition did not participate in post-treatment assessment. Participants in the treatment condition reported a 42% decrease and participants in the control group reported a 12% increase in primary IBS-symptoms. Compared to the control condition, participants in the treatment group improved on all secondary outcome measures with a large between group effect size on quality of life (Cohen's d = 1.21). We conclude that CBT-based on exposure and mindfulness delivered via the Internet can be effective in treating IBS-patients, alleviating the total burden of symptoms and increasing quality of life. Copyright (c) 2010 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Transl Gastroenterol
                Journal ID (iso-abbrev): Clin Transl Gastroenterol
                Title: Clinical and Translational Gastroenterology
                Publisher: Nature Publishing Group
                ISSN (Electronic): 2155-384X
                Publication date (Print): January 2017
                Publication date (Electronic): 19 January 2017
                Publication date PMC-release: 1 January 2017
                Volume: 8
                Issue: 1
                Page: e214
                Affiliations
                [1 ]Division of Gastroenterology, Beth Israel Deaconess Medical Center , Boston, Massachusetts, USA
                [2 ]Icahn School of Medicine at Mount Sinai, Division of Gastroenterology , New York, USA
                Author notes
                [* ]Division of Gastroenterology Beth Israel Deaconess Medical Center , Dana 501, Boston, Massachusetts 02215, USA. E-mail: sballou@ 123456bidmc.harvard.edu
                Article
                Publisher Item ID: ctg201669
                DOI: 10.1038/ctg.2016.69
                PMC ID: 5288603
                PubMed ID: 28102860
                SO-VID: 7b787349-de23-4307-bb45-16b6cabb1fdc
                Copyright © Copyright © 2017 The Author(s) the American College of Gastroenterology
                License:

                Clinical and Translational Gastroenterology is an open-access journal published by Nature Publishing Group. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                Date received : 19 October 2016
                Date revision received : 02 December 2016
                Date accepted : 06 December 2016
                Categories
                Subject: Clinical and Systematic Reviews

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology

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