Abstract

A Systematic Review of the Effectiveness of Psychological Treatments for IBS in Gastroenterology Settings: Promising but in Need of Further Study

Thakur ER1,2,3, Shapiro J4, Chan J4, Lumley MA5, Cully JA6,7,8, Bradford A4, El-Serag HB7,4. Dig Dis Sci. 2018 May 10. doi: 10.1007/s10620-018-5095-3. [Epub ahead of print]
 
     

Author information

1 VA South Central Mental Illness Research, Education and Clinical Center, (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA. Elyse.Thakur@bcm.edu.

2 VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), Michel E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA. Elyse.Thakur@bcm.edu.

3 Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA. Elyse.Thakur@bcm.edu.

4 Gastroenterology and Hepatology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.

5 Department of Psychology, Wayne State University, Rm. 7204, 5057 Woodward Ave., Detroit, MI, 48202, USA.

6 VA South Central Mental Illness Research, Education and Clinical Center, (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.

7 VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), Michel E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA.

8 Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.

Abstract

BACKGROUND: Psychological treatments are efficacious for irritable bowel syndrome (IBS) in clinical trials; however, their effectiveness when conducted in gastroenterology practice settings is unclear.

AIM: To perform a systematic review of the types and effects of psychological treatments for IBS conducted in gastroenterology clinics.

METHODS: We searched PubMed, EMBASE, and Cochrane central register. Studies conducted in gastroenterology clinic settings with IBS patients who were clinically referred from gastroenterology were included.

RESULTS: We identified 3078 citations, of which only eight studies were eligible. Seven studies compared psychological treatments (average n = 25.7; range 12-43) to controls (average n = 25.4 patients; range 12-47), whereas one study compared two active "bonafide" interventions. Psychological treatments varied (cognitive-behavioral therapy, guided affective imagery, mindfulness, hypnosis, biofeedback, emotional awareness training). However, across approaches, short-term benefits were seen. IBS symptoms improved significantly among patients in cognitive and behavioral therapies, mindfulness-based stress reduction, guided affective imagery, and emotional awareness training compared with controls; there was a similar trend for gut-directed hypnotherapy. Similarly, IBS symptoms improved in a study of two active biofeedback and hypnosis treatments.

CONCLUSIONS: Evidence for the effectiveness of psychological treatment in gastroenterology practice is promising but limited. Study designs that involve a blending of efficacy and effectiveness components are needed.

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