Psychological treatments for the management of irritable bowel syndrome
Open accessAbstract
BACKGROUND: No consensus exists on the optimal treatment for irritable bowel syndrome (IBS). Psychological treatments are increasingly advocated but their effectiveness is unclear. OBJECTIVES: To evaluate the efficacy of psychological interventions for the treatment of irritable bowel syndrome. SEARCH STRATEGY: A computer assisted search of MEDLINE, EMBASE, PsychInfo, CINAHL, Web of Science, The Cochrane Library and Google Scholar was performed for the years 1966-2008. Local databases were searched in Europe. SELECTION CRITERIA: Randomised trials comparing single psychological interventions with either usual care or mock interventions in patients over 16 years of age. No language criterion was applied. DATA COLLECTION AND ANALYSIS: The search identified 25 studies that fulfilled the inclusion criteria. The relative risk (RR), risk difference (RD), number needed to treat (NNT) and standardized mean difference (SMD) along with 95% confidence intervals were calculated using a random effects model for each outcome. MAIN RESULTS: Psychological interventions as a group The SMD for symptom score improvement at 2 and 3 months was 0.97 (95% CI 0.29 to 1.65) and 0.62 (95% CI 0.45 to 0.79) respectively compared to usual care. Against placebo, the SMDs were 0.71 (95% CI 0.08 to 1.33) and -0.17 (95% CI -0.45 to 0.11) respectively. For improvement of abdominal pain, the SMDs at 2 and 3 months were 0.54 (95%CI 0.10 to 0.98) and 0.26 (95% CI 0.07 to 0.45) compared to usual care. The SMD from placebo at 3 months was 0.31 (95% CI -0.16 to 0.79). For improvement in quality of life, the SMD from usual care at 2 and 3 months was 0.47 (95%CI 0.11 to 0.84) and 0.31 (95%CI -0.16 to 0.77) respectively. Cognitive behavioural therapy The SMD for symptom score improvement at 2 and 3 months was 0.75 (95% CI -0.20 to 1.70) and 0.58 (95% CI 0.36 to 0.79) respectively compared to usual care. Against placebo, the SMDs were 0.68 (95% CI -0.01 to 1.36) and -0.17 (95% CI -0.45 to 0.11) respectively. For improvement of abdominal pain, the SMDs at 2 and 3 months were 0.45 (95% CI 0.00 to 0.91) and 0.22 (95% CI -0.04 to -0.49) compared to usual care. Against placebo the SMD at 3 months was 0.33 (95% CI -0.16 to 0.82). For improvement in quality of life, the SMDs at 2 and 3 months compared to usual care were 0.44 (95% CI 0.04 to 0.85) and 0.92 (95% CI 0.07 to 1.77) respectively.Interpersonal psychotherapy The RR for adequate relief of symptoms was 2.02 (95% CI 1.13 to 3.62), RD 0.30 (95% CI 0.13 to 0.46), NNT 4 for comparison with care as usual. The SMD for improvement of symptom score was 0.35 (95% CI -0.75 to 0.05) compared with usual care. Relaxation/Stress management The SMD in symptom score improvement at 2 months was 0.50 (95%CI 0.02 to 0.98) compared with usual care. The SMD in improvement of abdominal pain at 3 months was 0.02 (95%CI -0.56 to 0.61) compared with usual care. Long term results Very few long term follow-up results were available. There was no convincing evidence that treatment effects were sustained following completion of treatment for any treatment modality. AUTHORS' CONCLUSIONS: Psychological interventions may be slightly superior to usual care or waiting list control conditions at the end of treatment although the clinical significance of this is debatable. Except for a single study, these therapies are not superior to placebo and the sustainability of their effect is questionable. The meta-analysis was significantly limited by issues of validity, heterogeneity, small sample size and outcome definition. Future research should adhere to current recommendations for IBS treatment trials and should focus on the long-term effects of treatment.
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CBT is presented as the best evidence-based psychological treatment for IBS.
“Although cognitive behaviour therapy (CBT) has been presented as the best evidence-based psychological treatment (Zijdenbos, Wit, Heijden, Rubin, & Quartero, 2009)for IBS”
From Pilot study of acceptance and commitment therapy for irritable bowel syndrome: A preliminary analysis of treatment outcomes and processes of change. (2018) · cites this paper as Zijdenbos, Wit, Heijden, Rubin, & Quartero, 2009
The trial's results align with two recent ACT-informed IBS studies and strengthen the evidence base for psychological IBS treatments.
“These results support the findings of two recent studies evaluating the efficacy of ACT informed interventions in improving IBS outcomes (Ljótsson, Andréewitch, et al., 2010;Ljótsson, Falk, et al., 2010) and also add to the evidence base of psychological approaches for IBS (Zijdenbos et al., 2009).”
From Pilot study of acceptance and commitment therapy for irritable bowel syndrome: A preliminary analysis of treatment outcomes and processes of change. (2018) · cites this paper as Zijdenbos et al., 2009
Evidence for psychological IBS interventions is growing, but economic costs have led to self-management approaches being proposed as viable alternatives.
“Empirical support for psychological interventions for IBS is growing (Zijdenbos, Wit, Heijden, Rubin, & Quartero, 2009), however, due to economic costs self-management approaches are being put forward as viable alternatives (Dorn, 2010).”
From Pilot study of acceptance and commitment therapy for irritable bowel syndrome: A preliminary analysis of treatment outcomes and processes of change. (2018) · cites this paper as Zijdenbos, Wit, Heijden, Rubin, & Quartero, 2009
In a meta-analysis of psychological treatments for IBS patients, 84% of studies investigated treatments implemented in secondary or tertiary care, and the remainder in primary care.
“In a meta-analysis of psychological treatments for IBS patients (Zijdenbos et al., 2009), 84% of studies investigated treatments implemented as part of secondary or tertiary care, and the remainder investigated those implemented as part of primary care.”
From Effectiveness of acceptance and commitment therapy for irritable bowel syndrome non-patients: A pilot randomized waiting list controlled trial (2020) · cites this paper as Zijdenbos et al., 2009
Cognitive-behavioural therapy (CBT) has been shown to reduce symptoms and increase functioning in adults with FSS.
“Cognitive–behavioural therapy (CBT) has been shown to reduce symptoms and increase functioning in adults with FSS,27–30”
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- Authors
- Zijdenbos, I. L., de Wit, N. J., van der Heijden, G. J., Rubin, G., & Quartero, A. O.
- Affiliations
- University Medical Center Utrecht (NL)
- University Medical Center Utrecht; Julius Center for General Practice and Patient Oriented Research; P.O. Box 85060 3508 AB Utrecht Netherlands
- University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care; Stratenum 6.131 P.O. Box 85500 Utrecht Netherlands 3508
- University of Sunderland; Benedict Building St George's Way Sunderland UK SR2 7BW
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2009-01-21
- Issue
- 1
- Pages
- CD006442-CD006442
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- OpenAlex
- W2125619655
- Cited by
- 180
- References
- 108
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 1 · 2021: 4 · 2020: 9 · 2019: 19 · 2018: 9 · 2017: 17 · 2016: 7 · 2015: 16 · 2014: 20 · 2013: 18 · 2012: 14
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- Licence
- cc-by
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed (publishedVersion)
- Durham Research Online (Durham University) (acceptedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Durham Research Online (Durham University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Health Professions › Pharmacy › Infant Health and Development
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- irritable bowel syndrome, psychological intervention, cognitive behavioral therapy, relaxation training, biofeedback, hypnotherapy, abdominal pain, symptom severity, quality of life, treatment efficacy, placebo comparison, usual care comparison, relapse after treatment withdrawal, medication adherence, patient satisfaction, patient self-management
- MeSH terms
- Humans, Psychotherapy, Psychotherapy, Group, Relaxation Therapy, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Irritable Bowel Syndrome
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