Thakur, Elyse R.; Chan, Johanna; Lumley, Mark; Cully, Jeffrey; El-Serag, Hashem.
Gastroenterology, suppl. Supplement 1152.5: S918. W.B. Saunders. (Apr 2017)
Background: There have been recent calls for delivering integrated multidisciplinary care including psychological treatment for patients with irritable bowel syndrome (IBS). However, most psychological treatment trials have been tested in community participants, or nongastroenterology (GI) settings. It remains unclear how psychological treatments perform in GI settings. Aims: To systematically examine the evidence for the effectiveness of psychological treatments for IBS patients recruited from and treated in GI settings. Methods: PubMed, EMBASE, and the Cochrane library were searched by two investigators (keywords: psychotherapy AND irritable bowel syndrome). Studies with IBS patients referred from GI providers and psychological treatments conducted face-to-face in GI practice settings were eligible. Studies with participants recruited from non-GI settings, or an unclear source, and studies involving self-management or psychoeducation were excluded. We calculated between-group effect size (ES) when possible: (follow-up minus baseline for treatment) minus (follow-up minus baseline for controls), divided by pooled SD of baseline scores. Negative ES indicate treatment had greater improvements than controls; positive ES mean the opposite. Results: 1,135 citations were identified, but only five studies (reportedly RCTs, conducted outside the US) comparing psychological treatments (n= 136) with controls (n = 132) fulfilled the eligibility criteria (range: 46- 90% women). Psychological treatments differed markedly (cognitive and behavioral therapy, mindfulness, hypnosis, emotional awareness training), but across approaches, post-treatment short-term benefits (0-3 months) were seen. IBS and pain symptoms significantly improved for patients in behavioral therapy, mindfulness-based stress reduction, and emotional awareness training compared with controls (Heymann-Monnikes et al., 2000; Farnam et al., 2014; Zernicke et al., 2013), whereas there was a similar but non-significant trend for gut-directed hypnotherapy (p = 0.17; Lindfors et al., 2012). Mindfulness-based stress reduction had a small effect for IBS symptom severity compared to controls (ES = -0.18). Depressive symptoms improved after cognitive-behavioral group therapy (ES = -0.47; Haghayegh et al., 2011), anxiety symptoms improved after gut-directed hypnotherapy (ES = -0.18; Lindfors et al., 2012), and quality of life improved after CBTbased treatments (ES = -0.62 & -0.94, Heymann-Monnikes et al., 2000; Haghayegh et al., 2011, respectively). Conclusions: When conducted in GI practice settings, psychological treatments appeared to have some benefits; however, the evidence for its effectiveness is limited, and best practices in the US are unclear. Research designs that involve efficacy, clinical effectiveness, and/or implementation components are warranted to advance clinical and research needs.