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Cognitive-Behavioral Treatment of Irritable Bowel Syndrome

Published online by Cambridge University Press:  07 November 2014

Abstract

There is increasing evidence that supports the view that irritable bowel disorder (IBS) is a disorder of brain-gut function. Cognitive-behavioral therapy (CBT) has received increased attention in light of this recent shift in the conceptualization of IBS. This review has two main aims. The first is to provide a critical review of controlled trials on CBT for IBS. The second is to discuss ways of further developing CBT interventions that are more clinically relevant and meaningful to health care providers and individuals with a diagnosis of IBS. A theme from a CBT intervention will be presented to illustrate how CBT interventions can be incorporated within a larger social context. A review of CBT for IBS lends some limited support for improvement in some IBS symptoms and associated psychosocial distress. This conclusion needs to be expressed with some caution, however, in light of many methodological shortcomings including small sample sizes, inadequate control conditions and failure to identify primary versus secondary outcome measures. In addition, future studies will need to further develop more relevant CBT protocols that more fully integrate the patient's perspective and challenge social cognitions about this stigmatized disorder.

Type
Review Articles
Copyright
Copyright © Cambridge University Press 2005

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References

REFERENCES

1.Drossman, DA, Camilleri, M, Mayer, EA, Whitehead, WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:21082131.Google Scholar
2.Levy, RL, Drossman, DA, Francisconi, C, et al. Psychosocial aspects of the functional gastrointestinal diorders. Gastroenterology. In press.Google Scholar
3.Toner, BB, Segal, ZV, Emmott, S, et al. Cognitive-behavioral group therapy for patients with irritable bowel syndrome. Int J Group Psychother. 1998;48:215243.Google Scholar
4.Toner, B, Segal, Z, Emmott, S, Myran, D. Cognitive-Behavioral Treatment of Irritable Bowel Syndrome: The Brain-Gut Connection. New York, NY: Guilford Press; 2000.Google Scholar
5.Bennett, P, Wilkinson, S. A comparison of psychological and medical treatment of the irritable bowel syndrome.Br J Clin Psychol. 1985;24(pt 3):215216.Google Scholar
6.Lynch, PM, Zamble, E. A controlled behavioral treatment study of irritable bowel syndrome. Behav Ther. 1989;20:509523.Google Scholar
7.Shaw, G, Srivastava, ED, Sadlier, M, Swann, P, James, JY, Rhodes, J. Stress management for irritable bowel syndrome: a controlled trial. Digestion. 1991;50:3642.Google Scholar
8.Rumsey, N. Group stress management programmes vs. pharmacological treatment in the treatment of the irritable bowel syndrome. In: Regis, Lyme, ed. Current Approaches Towards Confident Management of Irritable Bowel Syndrome. London, England: Lyme Regis; 1991:3339.Google Scholar
9.Corney, RH, Stanton, R, Newell, R, Clare, A, Fairclough, P. Behavioural psychotherapy in the treatment of irritable bowel syndrome. J Psychosom Res. 1991;35:461469.Google Scholar
10.van Dulmen, AM, Fennis, JF, Bleijenberg, G. Cognitive-behavioral group therapy for irritable bowel syndrome: effects and long-term follow-up. Psychosom Med. 1996;58:508514.CrossRefGoogle ScholarPubMed
11.Boyce, PM, Talley, NJ, Balaam, B, Koloski, NA, Truman, G. A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol. 2003;98:22092218.Google Scholar
12.Neff, DF, Blanchard, EB. A multi-component treatment for irritable bowel syndrome. Behav Ther. 1987;18:7083.CrossRefGoogle Scholar
13.Blanchard, EB, Schwarz, SP. Adaptation of a multicomponent treatment for irritable bowel syndrome to a small-group format. Biofeedback Self Regul. 1987;12:6369.Google Scholar
14.Blanchard, EB, Schwarz, SP, Suls, JM, et al. Two controlled evaluations of multi-component psychological treatment of irritable bowel syndrome. Behav Res Ther. 1992;30:175189.Google Scholar
15.Greene, B, Blanchard, EB. Cognitive therapy for irritable bowel syndrome. J Consult Clin Psychol. 1994;62:576582.Google Scholar
16.Payne, A, Blanchard, EB. A controlled comparison of cognitive therapy and self-help support groups in the treatment of irritable bowel syndrome. J Consult Clin Psychol. 1995;63:779786.Google Scholar
17.Vollmer, A, Blanchard, EB. Controlled comparison of individual versus group cognitive therapy for irritable bowel syndrome. Behav Ther. 1998;29:1933.Google Scholar
18.Drossman, DA, Toner, BB, Whitehead, WE, et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology. 2003;125:1931.CrossRefGoogle ScholarPubMed
19.Creed, F, Bradley, L, Francisconi, C, Drossman, DA, Naliboff, B, Olden, K. Psychosocial aspects of functional gastrointestinal disorders. In: Drossman, DA, Corazziari, E, Talley, NJ, Thompson, WG, Whitehead, WE, eds. Encyclopedia of Gastroenterology. McLean, VA: Degnon Associates; In press.Google Scholar
20.Lydiard, RB, Falsetti, SA. Experience with anxiety and depression treatment studies: Implications for designing irritable bowel syndrome clinical trials. Am J Med. 1999;107:65S73S.CrossRefGoogle ScholarPubMed
21.Toner, BB, Stuckless, N, Ali, A, Downie, F, Emmott, S, Akman, D. The development of a cognitive scale for functional bowel disorders. Psychosom Med. 1998;60:492497.Google Scholar
22.Veldhuyzen van Zanten, SJ, Talley, NJ, Bytzer, P, Klein, K, Whorwell, PJ, Zinsmeister, AR. Design of treatment trials for the functional gastrointestinal disorders. In: Drossman, DA, Corazziari, E, Talley, NJ, Thompson, WG, Whitehead, WE, eds. Rome II: Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology, and Treatment. McLean, VA: Degnon Associates; 2000:577622.Google Scholar
23.Whitehead, WE, Corazziari, E, Prizont, R, et al. Definition of a responder in clincial trials for functional gastrointestinal disorders. In: Drossman, DA, Corazziari, E, Talley, NJ, et al. eds. Rome II: Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology, and Treatment. McLean, VA: Degnon Associates; 2000:623627.Google Scholar
24.Thase, ME, Greenhouse, JB, Frank, E, et al. Treatment of major depression with psychotherapy or psychotherapy-pharmacotherapy combinations. Arch Gen Psychiatry. 1997;54:10091015.CrossRefGoogle ScholarPubMed
25.Holroyd, KA, O'Donnell, FJ, Stensland, M, Lipchik, GL, Cordingley, GE, Carlson, BWManagement of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA. 2001;285:22082215.Google Scholar
26.Keller, MB, McCullough, JP, Klein, DN, et al. A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med. 2000;342:14621470.Google Scholar
27.Whitehead, WE, Palsson, O, Jones, KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:11401156.Google Scholar
28.Lydiard, RB, Fossey, MD, Marsh, W, Ballenger, JC. Prevalence of psychiatric disorders in patients with irritable bowel syndrome. Psychosomatics. 1993;34:229234.Google Scholar
29.Barlow, DH, Gorman, JM, Shear, MK, Woods, SW. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA. 2000;283:25292536.Google Scholar
30.Creed, FH, Ratcliffe, J, Fernandes, L, et al. Depressive, panic and neurasthenic disorders predict poor outcome in severe irritable bowel syndrome unless suitably treated. Br J Psychiatry. In press.Google Scholar
31.Sperber, AD, Carmel, S, Atzmon, Y, et al. Use of the Functional Bowel Disorder Severity Index (FBDSI) in a study of patients with the irritable bowel syndrome and fibromyalgia. Am J Gastroenterol. 2000;95:995998.CrossRefGoogle Scholar
32.Davis, D, Padesky, C. Ehancing Cognitive Therapy with Women. Comprehensive Handbook of Cognitive Therapy. New York, NY: Plenum Press; 1989:535557.Google Scholar
33.Toner, BB, Chang, L, Fukudo, S, et al. Gender, age, society, culture and the patient's perspective in the disorders of gastrointestinal function. Gastroenterology. In press.Google Scholar
34.Goodrich, T, Rampage, C, Ellman, B, Halstead, K. Feminist Family Therapy. New York, NY: W.W. Norton & Company; 1988.Google Scholar
35.Ali, A, Oatley, K, Toner, BB. Emotional abuse as a precipitating factor for depression in women. J Emotion Abuse. 1999;1:113.Google Scholar
36.Ali, A, Toner, BB. Gender differences in depressive response: the role of social support. Sex Roles. 1996;35:281293.Google Scholar
37.Williams, DR. Race/ethnicity and socioeconomic status: measurement and methodological issues. Int J Health Serv. 1996;26:483505.CrossRefGoogle Scholar
38.Pinhas, L, Toner, BB, Ali, A, Garfinkel, PE, Stuckless, N. The effects of the ideal of female beauty on mood and body satisfaction. Int J Eat Disord. 1999;25:223226.Google Scholar
39.Striegel-Moore, R. Psychological factors in the etiology of binge eating. Addict Behav. 1995;20:713723.Google Scholar
40.Surrey, J. Eating patterns as a reflection women's development. In: Jordan, J, Kaplan, A, Miller, JB, Stiver, I, Surrey, J, eds. Women's Growth in Connection: Writings from the Stone Center. New York, NY: Guildord Press; 1991:237249.Google Scholar
41.Fodor, IE. Sex role conflict and symptom formation in women. Psychotherapy. 1974;11:2229.Google Scholar
42.Franks, V, Rothblum, ED. The Stereotyping of Women: In Effects on Mental Health. New York, NY: Brunner-Mazel; 1983.Google Scholar
43.McHugh, MC. A feminist approach to agoraphobia: challenging traditional views of women at home. In: Chrisler, JC, Golden, C, Rozee, PD, eds. Lectures on the Psychology of Women. New York, NY: McGraw-Hill; 1996:339357.Google Scholar
44.Craig, TK, Brown, GW. Goal frustration and life events in the aetiology of painful gastrointestinal disorder. J Psychosom Res. 1984;28:411421.Google Scholar
45.DeMarco, C. For Women Only: Take Charge of Your Body. Winlaw, Canada: Well Women Press; 1992.Google Scholar
46.Ali, A, Richardson, DC, Toner, BB. Feminine gender role and illness behavior in irritable bowel syndrome. J Gender Cult Health. 1998;3:5965.Google Scholar
47.Ali, A, Toner, BB, Stuckless, N, et al. Emotional abuse, self-blame, and self-silencing in women with irritable bowel syndrome. Psychosom Med. 2000;62:7682.Google Scholar
48.Toner, B. Cognitive-behavioural treatment of functional somatic syndromes: Integrating gender issues. Cogn Behav Pract. 1994;1:157178.Google Scholar
49.Toner, BB, Akman, D. Gender role and irritable bowel syndrome: literature review and hypothesis. Am J Gastroenterol. 2000;95:1116.Google Scholar
50.Kennedy, A, Robinson, A, Rogers, A. Incorporating patients' views and experiences of life with IBS in the development of an evidence based self-help guidebook. Patient Educ Couns. 2003;50:303310.Google Scholar
51.International Foundation for Functional Gastrointestinal Disorders. IBS in the real world survey [pamphlet]. Milwaukee, Wise: International Foundation for Functional Gastrointestinal Disorders; 2002.Google Scholar
52.Bertram, S, Kurland, M, Lydick, E, Locke, GR III, Yawn, BP. The patient's perspective of irritable bowel syndrome. J Fam Pract. 2001;50:521525.Google Scholar
53.Worell, J, Remer, P. Feminist Perspectives in Therapy: An Empowerment Model for Women. Toronto, Canada: Wiley & Sons; 1992.Google Scholar
54.Toner, B, Chang, L, Fukudo, S, et al. Gender, age, society, culture and the patient's perspective in functional gastrointestinal disorders. In: Drossman, DA, Corazziari, E, Talley, NJ, Thompson, WG, Whitehead, WE, eds. Encyclopedia of Gastroenterology. McLean, VA: Degnon Associates. In press.Google Scholar
55.Fabrege, H Jr. Somatization in cultural-historical perspective. In: Kirmayer, , Robbins, JM, eds. Current Concepts of Somatization: Researach and Clinical Perspectives. Washington, DC: American Psychiatric Press; 1991:181199.Google Scholar
56.Kirmayer, LJ, Robbins, JM. Functional somatic syndromes. In: Kirmayber, LJ, Robbins, JM, eds. Current Concepts of Somatization. Washington, DC: American Psychiatric Association; 1991:79105.Google Scholar
57.Lips, H. Sex and Gender. Mountainview, Calif: Mayfield Publishing; 1997.Google Scholar
58.Toner, B, Casati, J. Diseases of the digestive system. In: Perry, N, Johnson, SB, Rozensky, R, eds. Medical Disorders and Behavioral Applications. Washington, DC: American Psychological Association; 2002:283305.Google Scholar