Psychotherapy Improves Symptoms, Daily Functioning in IBS
Psychological therapies can improve both mental health and daily functioning in irritable bowel syndrome, with cognitive behavior therapy (CBT) producing the greatest improvements to daily functioning, according to a new study.
“Researchers have known for some time that psychotherapy is helpful for improving gastrointestinal symptoms in IBS, with effects similar to those of pharmacological therapies,” said lead study author Kelsey T. Laird, MS, of the department of psychology and human development at Vanderbilt University in Nashville, TN. “Type of psychotherapy did not appear to matter in previous analyses. This is the first meta-analysis to investigate the effect of psychotherapy on daily functioning in this population. CBT appears to outperform other types of psychotherapy when looking at impact on daily functioning.”
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An extensive literature search located 28 eligible randomized controlled trials (RCTs) providing outcome data for mental health and 18 RCTs providing data for daily functioning. Compared to a mixed group of control conditions, psychotherapy produced significantly greater improvements to mental health and daily functioning. The investigators found CBT to be evaluated in the largest number of trials (21 trials), followed by hypnosis (4 trials), psychodynamic (3 trials), and relaxation (2 trials). The psychotherapeutic modalities were comparable with respect to their effect on mental health. CBT produced the greatest improvements to daily functioning, and this effect was significantly larger than that produced by relaxation therapy.
Although the investigators do not currently have plans to continue this line of work, Laird said it will be important for future research to identify specific elements of CBT that may make it more effective for improving daily functioning. The authors speculate that one such element may be a technique called “exposure,” in which people gradually expose themselves to uncomfortable situations.
“In someone with IBS, these could include traveling on long road trips, eating out at restaurants, and going places where bathrooms are not readily accessible,” she said. “Encouraging individuals to gradually confront such situations may increase their ability to participate in a wider range of activities.”
Laird KT, Tanner-Smith EE, Russell AC, et al. Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and meta-analysis [published online November 8, 2016]. Clin Psychol Rev. doi: 10.1016/j.cpr.2016.11.001.