Studies find cognitive therapy benefits IBSLOS ANGELES (May 24, 2006) – Cognitive behavioral therapy and hypnotherapy have been successfully used in the treatment of a variety of chronic syndromes, including common functional disorders of the gastrointestinal tract, such as irritable bowel syndrome. New research presented today at Digestive Disease Week® 2006 (DDW) again asserts that these therapies may have a powerful impact on the digestive system including improving symptoms of lower GI tract disorders. DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
"These studies illustrate the intricate ties between the digestive tract and other major body systems," said Emeran Mayer, M.D., professor of medicine, physiology and psychiatry, University of California, Los Angeles. "Physicians must recognize these connections to help treat patients more effectively."
A Randomized Controlled Trial of Therapist-Administered vs Minimal-Therapist-Contact Cognitive Behavioral Treatment for Moderate to Severe IBS [Abstract 535]
Preliminary research funded by the National Institutes of Health shows that behavioral therapy may be quite effective in treating symptoms of irritable bowel syndrome (IBS) unresponsive to standard medications and dietary agents. However, it can be an expensive and time-consuming option. Study authors from the University at Buffalo, State University of New York condensed a behavioral treatment program into a four session patient-administered format with minimal therapist contact in an attempt to reduce the costs and time-commitment for patients. Researchers found that even though the four-session program required less therapist time, it was as effective as the 10-week, clinic-based program in relieving the range of GI symptoms of IBS.
Researchers randomly assigned 59 patients to receive a 10-week; clinic-based behavioral treatment (CBT); a four-session behavioral program (MC-CBT); or a wait list. The ultra-brief, four-session treatment covered the same range of procedures featured in CBT, but therapy was taught through a self-study workbook that patients worked through at home. The goal of behavioral treatment was to learn more adaptive thinking skills and coping behaviors. In total, the great majority of treated patients (74 percent of standard CBT vs. 73 percent of MC-CBT) reported moderate-to-substantial improvement in IBS symptoms at the end of treatment. Improvements were described as satisfactory in 73 percent of patients assigned to the brief behavioral treatment and accompanied by significant improvements in quality of life, emotional distress, IBS symptom severity and coping. Notably, the MC-CBT option was five times as cost efficient as the more time- and labor-intensive behavioral treatment
"This study shows great promise in showing that patients can control symptom often times resistant to medical treatments by learning relatively simple self-care skills and tools," said Jeffrey Lackner, Psy.D., University at Buffalo SUNY and lead study author. "Not only has this proven to be a cost-effective option, but it appears no less effective than the more time-consuming, therapist administered treatments that unfortunately are unavailable to most IBS patients. Most importantly, patients can use the skills they learn to relieve the severity of IBS symptoms including pain, constipation, bloating, urgency and diarrhea."
Effects of Hypnotherapy on IBS in Different Clinical Settings – Results from Two Randomized, Controlled Trials [Abstract 630]
Some physicians believe that the use of hypnotherapy can treat symptoms associated with irritable bowel syndrome (IBS), but there have been few trials to confirm this prediction. Moreover, hypnotherapy is conducted at highly specialized centers and is not readily available in most clinical practices. Scientists from the Sahlgrenska University Hospital in Sweden evaluated two trials of hypnotherapy in different clinical settings and found that it can be a useful treatment alternative, and can be successfully conducted to remedy IBS in a variety of clinical settings.
The first trial (study one) was conducted at a university hospital, which specializes in functional GI disorders while the second study (study two) was conducted at a local hospital. In both studies, patients received gut-directed hypnotherapy for one hour per week for 12 weeks with follow-up questionnaires on quality of life, anxiety and depression and GI symptoms after the treatment period and again after six and/or 12 months of treatment. Gut-directed hypnotherapy involves techniques such as deep relaxation with gut-specific treatments and suggestions (e.g. visualizing a fully functioning digestive tract).
In a large proportion of patients in both studies, a clinically significant improvement in the gastrointestinal symptom burden could be seen after hypnotherapy – an improvement that was clearly superior to the patients in the control group. After one year, the improvement for both groups was sustained, and in some cases, enhanced. In addition, the hypnotherapy patients in study two reported an improvement in anxiety and depression. Overall, both hypnotherapy groups reported significant improvements in GI symptoms including abdominal pain, distention and bloating in comparison to the control groups.
"The use of hypnotherapy is an exciting new option in treating IBS," said Magnus Simren, M.D., Sahlgrenska University Hospital and study co-author. "More studies should be conducted to adapt hypnotherapy techniques from highly specialized settings to standard clinical practices that can be regularly available to IBS patients."
Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 20-25, 2006 in Los Angeles, California. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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