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

This study conducted a systematic review to assess the quality of existing literature on psychological treatments for irritable bowel syndrome and to quantify the evidence for their efficacy. Three independent reviewers (2 from England, 1 from the United States) coded the quality of 32 studies, 17 of which provided data suitable for meta-analysis. Meta-analysis of efficacy data (50% reduction of symptoms) gave an odds ratio of 12 (95% confidence interval = 5.56-25.96) and a number needed to treat of 2. Psychological treatments are, as a class of interventions, effective in reducing symptoms compared with a pooled group of control conditions. Questions regarding the relative superiority of specific psychological treatments and influence of active versus nonspecific treatment effects remain unanswered.

[1]  B. Rounsaville,et al.  A Stage Model of Behavioral Therapies Research: Getting Started and Moving on From Stage I , 2006 .

[2]  Francis Creed,et al.  Psychosocial aspects of the functional gastrointestinal disorders. , 1999, Gastroenterology.

[3]  R JoséKlinger,et al.  Irritable Bowel Syndrome , 2006 .

[4]  W. Whitehead,et al.  Impact of irritable bowel syndrome on quality of life , 1996, Digestive Diseases and Sciences.

[5]  E. Blanchard,et al.  Beyond abuse: the association among parenting style, abdominal pain, and somatization in IBS patients. , 2004, Behaviour research and therapy.

[6]  G. Koch,et al.  Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. , 2003, Gastroenterology.

[7]  Michael P. Jones,et al.  A systematic review of alternative therapies in the irritable bowel syndrome. , 2003, Archives of internal medicine.

[8]  N. Read,et al.  The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. , 2003, Gastroenterology.

[9]  A. Haines,et al.  Systematic review of mental health interventions for patients with common somatic symptoms: can research evidence from secondary care be extrapolated to primary care? , 2002, BMJ : British Medical Journal.

[10]  P. Schoenfeld,et al.  Systematic review on the management of irritable bowel syndrome in North America. , 2002 .

[11]  C. Eccleston,et al.  Systematic review of randomised controlled trials of psychological therapy for chronic pain in children and adolescents, with a subset meta-analysis of pain relief , 2002, PAIN.

[12]  E. Blanchard,et al.  Psychosocial aspects of assessment and treatment of irritable bowel syndrome in adults and recurrent abdominal pain in children. , 2002, Journal of consulting and clinical psychology.

[13]  E. Blanchard,et al.  A one year follow-up of relaxation response meditation as a treatment for irritable bowel syndrome. , 2002, Behaviour research and therapy.

[14]  W. Whitehead,et al.  Costs of care for irritable bowel syndrome patients in a health maintenance organization , 2001, American Journal of Gastroenterology.

[15]  Rachel Churchill,et al.  Development of a quality assessment instrument for trials of treatments for depression and neurosis , 2001 .

[16]  E. Blanchard,et al.  The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: results of a controlled treatment study. , 2001, Behaviour research and therapy.

[17]  S. Derbyshire,et al.  Cerebral Activation in Patients With Irritable Bowel Syndrome and Control Subjects During Rectosigmoid Stimulation , 2001, Psychosomatic medicine.

[18]  B. Wampold The Great Psychotherapy Debate: Models, Methods, and Findings , 2001 .

[19]  T. Revenson,et al.  Handbook of Health Psychology , 2001 .

[20]  Ferrari,et al.  Guidelines for Controlled Trials of Drugs in Migraine: Second Edition , 2000, Cephalalgia : an international journal of headache.

[21]  T. Imperiale,et al.  Pharmacologic Treatment of the Irritable Bowel Syndrome , 2000, Annals of Internal Medicine.

[22]  David R. Jones,et al.  Empirical assessment of effect of publication bias on meta-analyses , 2000, BMJ : British Medical Journal.

[23]  N. Talley,et al.  Cognitive-Behaviour Therapy as a Treatment for Irritable Bowel Syndrome: A Pilot Study , 2000, The Australian and New Zealand journal of psychiatry.

[24]  H. Mönnikes,et al.  The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome , 2000, American Journal of Gastroenterology.

[25]  R. Lydiard,et al.  Experience with anxiety and depression treatment studies: implications for designing irritable bowel syndrome clinical trials. , 1999, The American journal of medicine.

[26]  M. Egger,et al.  The hazards of scoring the quality of clinical trials for meta-analysis. , 1999, JAMA.

[27]  A. Burns,et al.  Assessment scales in old age psychiatry , 1999 .

[28]  C. Eccleston,et al.  Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache , 1999, Pain.

[29]  Songkai Yan,et al.  Impact of Irritable Bowel Syndrome on Quality of Life and Resource Use in the United States and United Kingdom , 1999, Digestion.

[30]  D. Cook,et al.  Assessing the quality of reports of randomised trials: implications for the conduct of meta-analyses. , 1999, Health technology assessment.

[31]  R. Moore,et al.  An Evidence-Based Resource for Pain Relief , 1998 .

[32]  E. Blanchard,et al.  Controlled comparison of individual versus group cognitive therapy for irritable bowel syndrome , 1998 .

[33]  T. Galovski,et al.  The Treatment of Irritable Bowel Syndrome with Hypnotherapy , 1998, Applied psychophysiology and biofeedback.

[34]  A. Zinsmeister,et al.  Effects of an irritable bowel syndrome educational class on health-promoting behaviors and symptoms , 1998, American Journal of Gastroenterology.

[35]  D. Drossman Gastrointestinal Illness and the Biopsychosocial Model , 1998, Psychosomatic medicine.

[36]  Z. Segal,et al.  Cognitive-behavioral group therapy for patients with irritable bowel syndrome. , 1998, International journal of group psychotherapy.

[37]  C. Schwartz,et al.  The Control Group Dilemma in Clinical Research: Applications for Psychosocial and Behavioral Medicine Trials , 1997, Psychosomatic medicine.

[38]  M. Camilleri,et al.  Review article: irritable bowel syndrome , 1997, Alimentary pharmacology & therapeutics.

[39]  K. Olden,et al.  The functional gastrointestinal disorders , 1997 .

[40]  G. Bleijenberg,et al.  Cognitive-Behavioral Group Therapy for Irritable Bowel Syndrome: Effects and Long-Term Follow-Up , 1996, Psychosomatic medicine.

[41]  T. Schacker,et al.  Clinical and Epidemiologic Features of Primary HIV Infection , 1996, Annals of Internal Medicine.

[42]  P. Whorwell,et al.  Syuptomatology, quality of life and economic features of irritable bowel syndrome—the effect of hypnotherapy , 1996, Alimentary pharmacology & therapeutics.

[43]  N. Talley,et al.  Psychological treatments for irritable bowel syndrome: a critique of controlled treatment trials. , 1996, The American journal of gastroenterology.

[44]  A R Jadad,et al.  Assessing the quality of reports of randomized clinical trials: is blinding necessary? , 1996, Controlled clinical trials.

[45]  E. Blanchard,et al.  A controlled comparison of cognitive therapy and self-help support groups in the treatment of irritable bowel syndrome. , 1995, Journal of consulting and clinical psychology.

[46]  Sheldon Cohen,et al.  Pathways linking affective disturbances and physical disorders. , 1995, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[47]  A R Jadad,et al.  Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists. , 1995, Controlled clinical trials.

[48]  E. Blanchard,et al.  Cognitive therapy for irritable bowel syndrome. , 1994, Journal of consulting and clinical psychology.

[49]  D. Drossman Irritable bowel syndrome: The role of psychosocial factors. , 1994 .

[50]  E. Blanchard,et al.  Relaxation training as a treatment for irritable bowel syndrome , 1993, Biofeedback and self-regulation.

[51]  A. Taylor,et al.  Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome. , 1992, Behaviour research and therapy.

[52]  P. Tfelt-Hansen Guidelines for Controlled Trials of Drugs in Migraine. First Edition , 1991 .

[53]  E. Guthrie,et al.  A controlled trial of psychological treatment for the irritable bowel syndrome. , 1991, Gastroenterology.

[54]  R. Newell,et al.  Behavioural psychotherapy in the treatment of irritable bowel syndrome. , 1991, Journal of psychosomatic research.

[55]  G Shaw,et al.  Stress management for irritable bowel syndrome: a controlled trial. , 1991, Digestion.

[56]  D. Drossman,et al.  Sexual and physical abuse in women with functional or organic gastrointestinal disorders. , 1990, Annals of internal medicine.

[57]  R. Sandler Epidemiology of irritable bowel syndrome in the United States. , 1990, Gastroenterology.

[58]  J. Suls,et al.  The role of anxiety and depression in the irritable bowel syndrome. , 1990, Behaviour research and therapy.

[59]  T J Meyer,et al.  Development and validation of the Penn State Worry Questionnaire. , 1990, Behaviour research and therapy.

[60]  A. Taylor,et al.  Behaviorally treated irritable bowel syndrome patients: a four-year follow-up. , 1990, Behaviour research and therapy.

[61]  E. Zamble,et al.  A controlled behavioral treatment study of Irritable Bowel syndrome , 1989 .

[62]  G. Spollett Irritable bowel syndrome: diagnosis and treatment. , 1989, The Nurse practitioner.

[63]  R. E. Barry,et al.  INDIVIDUAL AND GROUP HYPNOTHERAPY IN TREATMENT OF REFRACTORY IRRITABLE BOWEL SYNDROME , 1989, The Lancet.

[64]  J. Norcross,et al.  The movement toward integrating the psychotherapies: an overview. , 1989, The American journal of psychiatry.

[65]  E. Blanchard,et al.  Two-year follow-up of behavioral treatment of irritable bowel syndrome , 1988 .

[66]  P. Costa,et al.  Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. , 1988, Gastroenterology.

[67]  K. Klein Controlled treatment trials in the irritable bowel syndrome: a critique. , 1988, Gastroenterology.

[68]  E. Blanchard,et al.  Bowel sound biofeedback as a treatment for irritable bowel syndrome , 1988, Biofeedback and self-regulation.

[69]  R. Snaith,et al.  The Hospital Anxiety And Depression Scale , 2003, Health and quality of life outcomes.

[70]  E. Blanchard,et al.  A multi-component treatment for irritable bowel syndrome , 1987 .

[71]  E. Blanchard,et al.  Psychological Assessment and Treatment of Irritable Bowel Syndrome , 1987, Behavior modification.

[72]  P. Whorwell,et al.  Hypnotherapy in severe irritable bowel syndrome: further experience. , 1987, Gut.

[73]  E. Blanchard,et al.  Adaptation of a multicomponent treatment for irritable bowel syndrome to a small-group format , 1987, Biofeedback and self-regulation.

[74]  E. Blanchard,et al.  Psychological changes associated with self-regulatory treatments of irritable bowel syndrome , 1987, Biofeedback and self-regulation.

[75]  L. Hedges,et al.  Statistical Methods for Meta-Analysis , 1987 .

[76]  P. Bennett,et al.  A comparison of psychological and medical treatment of the irritable bowel syndrome. , 1985, The British journal of clinical psychology.

[77]  P. Whorwell,et al.  CONTROLLED TRIAL OF HYPNOTHERAPY IN THE TREATMENT OF SEVERE REFRACTORY IRRITABLE-BOWEL SYNDROME , 1984, The Lancet.

[78]  J. Svedlund,et al.  CONTROLLED STUDY OF PSYCHOTHERAPY IN IRRITABLE BOWEL SYNDROME , 1983, The Lancet.

[79]  David C. Hoaglin,et al.  Applications, basics, and computing of exploratory data analysis , 1983 .

[80]  J. Fleiss,et al.  Intraclass correlations: uses in assessing rater reliability. , 1979, Psychological bulletin.

[81]  Niels Birbaumer,et al.  Biofeedback and self-regulation , 1979 .

[82]  M. Åsberg,et al.  A COMPREHENSIVE PSYCHOPATHOLOGICAL RATING SCALE , 1978, Acta psychiatrica Scandinavica. Supplementum.

[83]  J. Fleiss,et al.  Statistical methods for rates and proportions , 1973 .

[84]  C. Spielberger,et al.  Manual for the State-Trait Anxiety Inventory , 1970 .

[85]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.

[86]  Jacob Cohen A Coefficient of Agreement for Nominal Scales , 1960 .

[87]  M. Tulin,et al.  Alterations in colonic function in man under stress; experimental production of sigmoid spasm in healthy persons. , 1949, Gastroenterology.