Cognitive behavioral therapy in irritable bowel syndrome

Digestion, Health & Nutrition                          Facebook Dr. Anil

By A. Minocha MD, author: Guide to Alternative Medicine and Digestive System

 

Cognitive behavioral therapy or CBT appears to have a direct effect on global manifestations of irritable bowel syndrome(IBS) or spastic colon. This may not correlate with resolution of psychological distress. Improvement in IBS symptoms is associated with improvements in the quality of life and the improvement in psychological distress may be a reason for, effect of or part of it.

Scientific basis

Cognitive therapy for irritable bowel syndrome results in decrease in limbic activity and improves digestive symtoms and anxiety. Thus CBT induced symptomatic improvement in IBS may be a biologically oriented change mediated by changes in neural activity of CNS foci that relate to hypervigilance and emotions.

• Drossman (2003) conducted a randomized, comparator-controlled, multicenter trial in 431 adults to examine the clinical efficacy and safety of cognitive-behavioral therapy versus education and tricyclic antideppressant (desipramine) versus t placebo in female patients with moderate to severe functional bowel disorders including IBS. Significantly higher number of patients responded in CBT group as compared to education (70% vs 37%). Desipramine was similar to placebo in intent to treat analysis.
• Kennedy conducted randomized controlled trial of the addition of nurse administered CBT to standard general practice management of IBS (antispasmodic agent mebeverine) in in primary care. The addition of CBT was significantly superior to mebeverine-only group at 3 months. Authors concluded that specially trained practice nurses can provide effective CBT to primary care patients with a clinical diagnosis of IBS, which although effective does not reduce service or social costs although the beneficial effects of the addition of CBT to antispasmodic therapy persist for up to 6 months.
• A randomized controlled trial (Ljotsson 2010) has documented that cognitive behavior therapy based on exposure and mindfulness exercises and conducted over the internet delivered via the Internet alleviating the total burden of symptoms and increasing IBS-related quality of life in patients with IBS. The treatment group reported a 42% decrease in primary IBS-symptoms as compared to 12% in controls.
• Another randomized controlled trial (Moss-Morris 2010) found that cognitive behavioral therapy based self-management in the form of a structured manual without much contact with the therapist contact is a effective for treatment of patients with IBS in primary care.
• In contrast to studies on CBT and IBS above, Boyce (2003) reported that cognitive behavior and relaxation therapy seem not to be superior to standard care alone in IBS.             

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