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Cited by 135Gastrointestinal motility and disordersPsychosomatic Disorders and Their TreatmentsInfant Health and Development

Short-term and long-term efficacy of psychological therapies for irritable bowel syndrome: a systematic review and meta-analysis

Open access
Laird, Kelsey T., Tanner-Smith, Emily E., Russell, Alexandra C., Hollon, Steve D., Walker, Lynn S.·2016·Clinical Gastroenterology and Hepatology
DOI 10.1016/j.cgh.2015.11.020
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Abstract

BACKGROUND & AIMS: Several meta-analyses have demonstrated the efficacy of psychological therapies for reducing gastrointestinal (GI) symptoms in patients with irritable bowel syndrome (IBS). However, no meta-analysis has investigated the duration of these effects. We performed a meta-analysis to assess the immediate, short-term, and long-term efficacy of psychotherapy for reducing GI symptoms in adults with IBS. METHODS: We searched PubMed, PsycINFO, Science Direct, and ProQuest Dissertations and Theses through August 15, 2015 for randomized controlled trials that compared psychological therapy with an active or non-active comparison (control) condition for treatment of GI symptoms in adults with IBS. RESULTS: Forty-one trials were included in our meta-analysis, comprising data from 2290 individuals (1183 assigned to psychotherapy and 1107 assigned to a control condition). Compared with a mixed group of control conditions, psychological therapies had a medium effect on GI symptom severity (d¯ = 0.69) immediately after treatment. On average, individuals who received psychotherapy had a greater reduction in GI symptoms after treatment than 75% of individuals assigned to a control condition. After short-term follow-up periods (1-6 months after treatment) and long-term follow-up periods (6-12 months after treatment), this effect remained significant and medium in magnitude (d¯ = 0.76 and d¯ = 0.73, respectively). CONCLUSIONS: Psychological therapies reduce GI symptoms in adults with IBS. These effects remained significant and medium in magnitude after short-term and long-term follow-up periods.

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Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis found that psychological therapies produce a medium-sized reduction in GI symptoms in adults with IBS immediately after treatment, and these effects remain significant and medium-sized at short-term (1–6 months) and long-term (6–12 months) follow-up. The analysis included 41 RCTs and 2290 participants.

Key findings

  • Across 41 trials (1183 psychotherapy, 1107 control), psychological therapies reduced GI symptom severity immediately after treatment versus mixed controls: d=0.69, P<.001, 95% CI 0.52–0.86; the average psychotherapy participant improved more than 75% of controls.
  • Effects remained medium-sized at short-term follow-up (14 trials; d=0.76, P<.001, 95% CI 0.54–0.97) and long-term follow-up (10 trials; d=0.73, P<.001, 95% CI 0.43–1.03). In the 5 trials with all three intervals, effects were d=0.54 immediately, d=0.76 short-term, and d=0.73 long-term.
  • No significant moderator effects were found for therapeutic modality (cognitive d=0.73, hypnosis d=0.78, relaxation d=0.72; Q=0.08, P=.960), delivery method (online vs in-person; Q=1.98, P=.160), format (group vs individual; Q=0.19, P=.666), dose, control type (active vs non-active; Q=0.01, P=.929), or publication date. Country differed: Sweden d=1.14 vs US d=0.54 and UK d=0.32.
  • Attrition risk of bias moderated effects: high-risk studies showed d=−0.03 (P=.875), versus unclear d=0.83 and low d=0.73 (Q=13.15, P=.001). No significant publication bias was detected at immediate, short-term, or long-term follow-up by Egger and rank correlation tests.

Methods

  • Systematic review and meta-analysis conducted per PRISMA with an a priori protocol. Searched PubMed, PsycINFO, ScienceDirect, and ProQuest Dissertations and Theses through August 15, 2015 for RCTs comparing psychological therapy with active or non-active control for GI symptoms in adults with IBS.
  • Included 41 unique trials comprising 2290 individuals (1183 psychotherapy, 1107 control). Eligible trials assessed continuous GI symptom outcomes, were written in English, and excluded quasi-randomized allocation, support-group-only interventions, and dichotomous outcomes.
  • Standardized mean differences (SMDs) were computed and pooled with random-effects weights using Comprehensive Meta-Analysis v3.3.070. Heterogeneity was assessed with Q, τ², and I²; risk of bias used the Cochrane tool; pre-specified moderator analyses examined therapy type, delivery, format, dose, control type, country, and publication date.

Limitations

  • Stated: substantial between-trial variability in measures, inclusion criteria, and control conditions; effects may vary by individual patient characteristics, but this was impossible to assess because of inconsistent reporting and limited diversity (participants were mostly female and mostly white in trials reporting these data).
  • Stated: no trial was rated low risk of bias in every domain; after excluding blinding, only 9 trials were low risk in all remaining domains. Few studies collected short-term or long-term follow-up data, and only 3 online therapy trials were included.
  • Evident: heterogeneity was substantial (I²=70.56 immediate, 58.63 short-term, 74.86 long-term), and high attrition-bias studies showed no significant effect, which may limit confidence in pooled estimates.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.cgh.2015.11.020

Cites

68 of 68 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 17 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    There was a significant effect of risk of bias in the domain of attrition (Q=13.15, P=.001).

    “There was a significant effect of risk of bias in the domain of attrition (Q ¼ 13.15, P ¼ .001).”
    Quote in the paperSubstantial claim
  • Findingcitation

    In 2 of these trials, the treatment group improved more than the control group on a dichotomous outcome measure identified by the authors as the primary outcome.

    “In 2 of these trials, the treatment group improved more than the control group on a dichotomous outcome measure identified by the authors as the primary outcome.57,59”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [57] Shinozaki, 2010, Effect of autogenic training on general improvement in patients with irritable bowel syndrome: a randomized controlled trial, Appl Psychophysiol Biofeedback source

      Not checked in the free run.

    • cites [59] Tkachuk, 2003, Randomized controlled trial of cognitive-behavioral group therapy for irritable bowel syndrome in a medical setting, Journal of Clinical Psychology in Medical Settings source

      Not checked in the free run.

  • Findingown data

    There was significant heterogeneity among studies at this time point (Q=35.80, P<.001, tau^2=0.17, I^2=74.86).

    “(d ¼ 0.73, P < .001;95% CI, 0.43-1.03;Q ¼ 35.80,P < .001,s 2 ¼ 0.17, I 2 ¼ 74.86).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Within therapies administered in person, there was no significant difference in effect between group and individual format.

    “Within therapies administered in person, there was no significant difference in the effect of interventions administered in a group (d ¼ 0.56, P ¼ .004;95% CI, 0.18-0.94)vs individual format (d ¼ 0.66, P < .001;95% CI, 0.47-0.84;Q ¼ 0.19, P ¼ .666).”
    Quote in the paperNot a substantial claim
  • Findingown data

    There was no evidence of significant publication bias at the first post-treatment follow-up.

    “There was no evidence of significant publication bias at the first post-treatment follow-up, as indicated by the Egger test (b ¼ 0.57, P ¼ .583)and the rank correlation test (s ¼ 0.09, P ¼ .439).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 12
  • Classified as probably not a substantial claim. 14
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    The majority of studies used interventions that combined several different treatment modalities, making it difficult to sort studies into discrete categories.

    “However, the majority of studies used interventions that combined several different treatment modalities, making it difficult to sort studies into discrete categories.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    It was impossible to assess variation by individual patient characteristics because of inconsistent reporting and limited diversity, with participants mostly female and mostly white in trials that reported these data.

    “Unfortunately, this was impossible to assess in the current metaanalysis because of inconsistent reporting and limited diversity (participants were mostly female and mostly white in trials that reported these data).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The numbers of trials meeting low risk of bias criteria for allocation sequence, concealment, blinding, incomplete outcome data, and selective reporting were 21, 16, 1, 22, and 34, respectively.

    “The numbers of trials meeting criteria for low risk of bias that was due to (1) allocation sequence, (2) concealment of allocation sequence, (3) blinding, (4) incomplete outcome data, and (5) selective reporting were 21, 16, 1, 22, and 34, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Number of sessions, average session duration, therapy duration, and session frequency were not significantly correlated with effect size.

    “Number of sessions (b ¼ -0.02, P ¼ .527),average session duration (b < 0.01, P ¼ .491),therapy duration (b ¼ 0.01, P ¼ .886),and session frequency (b ¼ -0.04, P ¼.887) were not significantly correlated with effect size.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Few studies collected short-term or long-term follow-up data.

    “Finally, few studies collected short-term or long-term follow-up data.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The 41 trials comprised data from 2290 individuals, with 1183 assigned to psychotherapy and 1107 assigned to a control condition.

    “Forty-one trials were included in our meta-analysis, comprising data from 2290 individuals (1183 assigned to psychotherapy and 1107 assigned to a control condition).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    For the 5 studies that included data for all three follow-up intervals, psychological therapies had mean effects on GI symptoms compared with control conditions at each follow-up interval.

    “Figure 3 . Figure 3. Mean effects of psychological therapies on GI symptoms compared with control conditions for the 5 studies that included data for all 3 follow-up intervals by follow-up interval.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent meta-analysis of psychotherapy for depression found that number of treatment sessions was not significantly associated with effect size after controlling for other relevant study variables.

    “These results are comparable to findings from a recent meta-analysis of the efficacy of psychotherapy for depression, 65 in which number of treatment sessions was not significantly associated with effect size after controlling for other relevant study variables.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Cuijpers, 2013, How much psychotherapy is needed to treat depression? a metaregression analysis, J Affect Disord source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Psychological therapies are as effective as antidepressants in reducing GI symptoms in IBS immediately after treatment, with a number needed to treat between 2 and 4.

    “Meta-analyses suggest that psychological therapies are as effective as antidepressants in reducing GI symptoms in IBS immediately after treatment, with a number needed to treat between 2 and 4. [5][6][7]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] Ford, 2014, Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis, Am J Gastroenterol source

      Not checked in the free run.

    • cites [6] Ford, 2009, Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis, Gut source

      Not checked in the free run.

    • cites [7] Lackner, 2004, Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis, J Consult Clin Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The results were similar to a recently published meta-analysis that used binary outcome data to compare psychotherapy versus antidepressant medications for reducing GI symptoms in IBS.

    “Our results were similar to a recently published metaanalysis that used binary outcome data to compare the efficacy of psychotherapy vs antidepressant medications for reducing GI symptoms in IBS.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Ford, 2014, Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis, Am J Gastroenterol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The average post-treatment effect on GI symptoms in this analysis (d=0.69) was similar to that previously reported for bowel dysfunction (d=0.57) and considerably higher than that previously reported for abdominal pain (d=0.27).

    “The average effect on GI symptoms after treatment (d ¼ 0.69) in our analysis was similar to that reported previously for bowel dysfunction (d ¼ 0.57) and considerably higher than that reported previously for abdominal pain (d ¼ 0.27) in the only previously published meta-analysis on this topic using continuous outcomes.7”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Lackner, 2004, Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis, J Consult Clin Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The remaining trial used walking as a comparison condition, which could arguably be conceptualized as an active treatment rather than a control condition.

    “The remaining trial 56 used walking as a comparison condition, which could arguably be conceptualized as an active treatment rather than a control condition.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Shahabi, 2016, Self-regulation evaluation of therapeutic yoga and walking for patients with irritable bowel syndrome: a pilot study, Psychology, Health & Medicine source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    Several meta-analyses have demonstrated the efficacy of psychological therapies for reducing GI symptoms in patients with IBS.

    “Several meta-analyses have demonstrated the efficacy of psychological therapies for reducing gastrointestinal (GI) symptoms in patients with irritable bowel syndrome (IBS).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Study design and conductnone given

    Because of the nature of psychotherapy, it is impossible for patients to be blinded to intervention content.

    “Because of the nature of psychotherapy, it is impossible for patients to be blinded to intervention content.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The meta-analysis was conducted in accordance with the PRISMA statement and followed an a priori established protocol.

    “This meta-analysis was conducted in accordance with the PRISMA statement and followed an a priori established protocol.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Cochrane Collaboration risk of bias assessment tool for RCTs was used to assess possible sources of bias in included trials.

    “The risk of bias assessment tool developed by the Cochrane Collaboration 22 for RCTs was used to assess the following possible sources of bias in included trials”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Higgins J, Altman D. Assessing risk of bias in included studies. In: Higgins J, Green S, eds. The Cochrane Collaboration: Cochrane handbook for systematic reviews of interventions. Version 5.0.1. 2008. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Assessment of eligibility and data extraction were each performed independently by 2 authors.

    “Assessment of eligibility and data extraction were each performed independently by 2 authors, and ITT data were used wherever possible.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Group format may be an effective and economical method of delivering psychological therapies to adults with IBS.

    “Thus, group format may be an effective and economical method of delivering psychological therapies to adults with IBS.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    ITT data were used wherever possible.

    “ITT data were used wherever possible.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    In this systematic review, L.S.W. and S.D.H. were consulted in unclear cases during screening, and disagreement was resolved through discussion.

    “L.S.W. and S.D.H. were consulted in unclear cases; disagreement was resolved through discussion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    In this systematic review, the authors were aware of the names of the study authors, results, and other publication information during the review process.

    “Authors were aware of the names of the study authors, results, and other publication information.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    In this systematic review, effect size data were entered by the first author (K.T.L.) and checked by another author (A.C.R.).

    “Effect size data were entered by the first author (K.T.L.) and checked by another (A.C.R.).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In this systematic review, a single reviewer (K.T.L.) coded all variables other than effect size data.

    “A single reviewer (K.T.L.) coded all other variables.”
    Quote in the paperNot a substantial claim
23 of 23

  • The paper relies on this without support.

    No meta-analysis has investigated the duration of the effects of psychological therapies on GI symptoms in IBS.

    “However, no meta-analysis has investigated the duration of these effects.”

  • The authors state this as an assumption.

    Dichotomous outcome measures measure a different underlying construct than continuous measures.

    “Dichotomous outcome measures were ineligible because these were assumed to measure a different underlying construct than continuous measures.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Our study demonstrated that CBT via telephone appeared to be the most beneficial in the long-term.

    “In addition, although previous reviews have demonstrated the short and long-term efficacy of psychological therapies for IBS, [98] regardless of delivery method (in person or online), our study demonstrated that CBT via telephone appeared to be the most beneficial in the long-term.”

    From Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis (2020) · cites this paper as [98]

  • The same two reviewers independently appraised study quality using the ASHA level of evidence scheme.

    “The same two reviewers independently appraised included studies’ quality using indicators identified by the American Speech-Language Hearing Association (ASHA) level of evidence scheme.29,30”

    From Benchmarks of Significant Change After Aphasia Rehabilitation (2019) · cites this paper as [30]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Eligibility was not independently assessed by two authors

    Major

    The discussion says two authors independently assessed eligibility, but the methods say the first author assessed articles and consulted others only in unclear cases.

  • Svedlund's attrition rating conflicts with the stated rule

    Minor

    The stated rule requires ITT data for a low attrition-risk rating, but Table 2 marks Svedlund as not providing ITT data and nevertheless rates attrition risk low.

  • Data extraction was not independently performed by two authors

    Minor

    The discussion describes independent extraction by two authors. The methods instead describe one author entering effect-size data for another to check, while a single reviewer coded all other variables.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Siegel KM. The effects of emotional disclosure on physical symptoms, healthcare utilization, and psychosocial adjustment in patients with irritable bowel syndrome. PhD dissertation. Alliant International University, San Diego, CA, 2003.
  2. Ljotsson, 2011, Acceptability, effectiveness, and cost-effectiveness of internet-based exposure treatment for irritable bowel syndrome in a clinical sample: a randomized controlled trial, BMC Gastroenterol, 11, 110, 10.1186/1471-230x-11-110 · DOI · Paper page

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Related

Authors
Laird, K. T., Tanner-Smith, E. E., Russell, A. C., Hollon, S. D., & Walker, L. S.
Affiliations
Vanderbilt University (US)
Corresponding author
Laird, Kelsey T.
ORCID
Venue
Clinical Gastroenterology and Hepatology
Publisher
Elsevier BV
Published
2016-07
Volume
14
Issue
7
Pages
937-947.e4
ISSN
1542-3565 (ISSN-L)
DOI
10.1016/j.cgh.2015.11.020
OpenAlex
W2215411395
Semantic Scholar
83fd7c8ee686a4fe7eea24cefa1e1f714177bd42
Cited by
135
References
66
Citations by year
2026: 8 · 2025: 7 · 2024: 13 · 2023: 8 · 2022: 19 · 2021: 12 · 2020: 15 · 2019: 20 · 2018: 13 · 2017: 10 · 2016: 10
FWCI
1.93
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Gastroenterology and Hepatology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Health Professions › Pharmacy › Infant Health and Development
Keywords
irritable bowel syndrome, psychotherapy, gastrointestinal symptoms, symptom severity, long-term efficacy, short-term follow-up
MeSH terms
Humans, Psychotherapy, Time, Randomized Controlled Trials as Topic, Treatment Outcome, Irritable Bowel Syndrome

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