Abstract

Psychological treatments for irritable bowel syndrome: a comprehensive systematic review and meta-analysis

Cogn Behav Ther.?2023 Jun 21;1-20.?doi: 10.1080/16506073.2023.2225745.Online ahead of print. 

 

Erland Axelsson?1?2?3,?Dorian Kern?4?5,?Erik Hedman-Lagerlöf?4,?Perjohan Lindfors?4,?Josefin Palmgren?4,?Hugo Hesser?6?7,?Erik Andersson?4,?Robert Johansson?8,?Ola Olén?9?10?11,?Marianne Bonnert?5,?Maria Lalouni?12,?Brjánn Ljótsson?4 

 
     

Author information

1Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. 

2Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden. 

3Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden. 

4Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. 

5Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden. 

6Center for Health and Medical Psychology, School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden. 

7Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden. 

8Department of Psychology, Stockholm University, Stockholm, Sweden. 

9Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 

10Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. 

11Department of Pediatric Gastroenterology and Nutrition, Sachs' Children's Hospital, Stockholm, Sweden. 

12Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. 

Abstract

A wide range of psychological treatments have been found to reduce the symptoms of irritable bowel syndrome (IBS) but their relative effects are unclear. In this systematic review and meta-analysis, we determined the effects of psychological treatments for IBS, including subtypes of cognitive behavior therapy, versus attention controls. We searched 11 databases (March 2022) for studies of psychological treatments for IBS, reported in journal articles, books, dissertations, and conference abstracts. The resulting database comprised 9 outcome domains from 118 studies published in 1983-2022. Using data from 62 studies and 6496 participants, we estimated the effect of treatment type on improvement in composite IBS severity using random-effects meta-regression. In comparison with the attention controls, there was a significant added effect of exposure therapy (g?= 0.52, 95% CI = 0.17-0.88) and hypnotherapy (g?= 0.36, 95% CI = 0.06-0.67) when controlling for the pre- to post-assessment duration. When additional potential confounders were included, exposure therapy but not hypnotherapy retained a significant added effect. Effects were also larger with a longer duration, individual treatment, questionnaire (non-diary) outcomes, and recruitment outside of routine care. Heterogeneity was substantial. Tentatively, exposure therapy appears to be a particularly promising treatment for IBS. More direct comparisons in randomized controlled trials are needed. OSF.io identifier: 5yh9a. 

 

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