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Cited by 181Gastrointestinal motility and disordersInfant Health and DevelopmentPsychosomatic Disorders and Their Treatments

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Psychological treatments for the management of irritable bowel syndrome

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Zijdenbos, Ingeborg L, de Wit, Niek J, van der Heijden, Geert J, Rubin, Gregory, Quartero, A Otto·2009·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd006442.pub2
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Abstract

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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Research works printed but not linked: 11

  1. Blanchard, 1992, Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome, Behav Res Ther, 30, 175, 10.1016/0005-7967(92)90141-3 · DOI
  2. Bergeron CM A comparison of cognitive stress management, progressive muscle relaxation, and biofeedback in the treatment of irritable bowel syndrome Dissertation Abstracts International 1984
  3. Bogalo, 2006, The Effectiveness of Homework Tasks in an Irritable Bowel Syndrome Cognitive Behavioural Self-Management Programme, NZ J Psychol, 35, 120
  4. Brasio, 2006, Stress control training in the treatment of the irritable bowel syndrome, GED Gastrentologica Endosc Dig, 25, 135
  5. Magallan, 1997, Irritable bowel treatment with lidamidine and support psicotherapy, Revista de Gastroenterologia de Mexico, 62, 7
  6. Pavan, 1982, Brief dynamic psychotherapy in patients with irritable colon: Preliminary data, Med Psicosom, 27, 119
  7. Rumsey, 1991, Group Stress management programmes vs pharmacological treatment in the treatment of irritable bowel syndrome, 33
  8. Wang, 2005, Effects of psychological behavior interventions on the quality of life in patients with irritable bowel syndrome, Chinese Journal of Clinical Rehabilitation, 9, 70
  9. Beck, 1979, Cognitive therapy of depression: a treatment manual
  10. Ricci, 2002, Irritable bowel syndrome: a comparison of the economic (direct and indirect) burden in four European countries, Gut, 51
  11. Vandereycken, 2003, Psychotherapie; van theorie to praktijk

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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
DOI
10.1002/14651858.cd006442.pub2
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 › Medicine › Pediatrics, Perinatology and Child Health › 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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