Type of psychotherapy matters in treatment of irritable bowel syndrome
Worldwide, roughly one adult in 10 suffers from a painful and sometimes debilitating condition called irritable bowel syndrome, or IBS.
Previous studies have found that, on average, psychotherapy is just as effective as medications in reducing the severity of symptoms of this gastrointestinal disorder and the type of psychotherapy did not seem to matter.
Now, psychologists at Vanderbilt University have looked at different types of psychotherapy to determine which is best at improving the ability of IBS patients to participate in daily activities. They found that one form, called cognitive behavior therapy, was the most effective.
"Evaluating daily function is important because it distinguishes between someone who experiences physical symptoms but can fully engage in work, school and social activities and someone who cannot," said Kelsey Laird, a doctoral student in Vanderbilt's clinical psychology program.
Laird is the first author of the study "Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and meta-analysis" published online by the Clinical Psychology Review on Nov. 18.
Co-authors are Emily Tanner-Smith, research associate professor at Vanderbilt's Peabody Research Institute, Professor of Pediatrics Lynn S. Walker and Assistant Professor of Pediatrics Alexandra C. Russell at the Monroe Carrell Jr. Children's Hospital at Vanderbilt and Gertrude Conaway Vanderbilt Professor of Psychology Steven Hollon.
The authors analyzed 31 studies, which provided data for over 1,700 individuals who were randomly assigned to receive either psychotherapy or a control condition such as support groups, education or wait-lists.
Overall, those who received psychotherapy showed greater gains in daily functioning compared to those assigned to a control condition. However, individuals assigned to receive cognitive behavior therapy or CBT experienced larger improvements than those who received other types of therapy.
(CBT is an umbrella term for a number of different therapies, each of which is based on the idea that thoughts, feelings, physiology, and behavior are interrelated. Treatments are designed to help people develop alternative ways of thinking and behaving with the goal of reducing psychological distress and physiological arousal.)
The authors speculate that the greater improvement observed in patients who received CBT may be due to the fact that treatments often incorporate "exposure:" a technique in which individuals gradually expose themselves to uncomfortable situations. For someone with IBS, this could include long road trips, eating out at restaurants and going places where bathrooms are not readily accessible.
"Encouraging individuals to gradually confront such situations may increase their ability to participate in a wider range of activities," said Laird. "But more research is needed before we can say why CBT appears more effective for improving functioning in IBS compared to other therapy types."
David F Salisbury