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09/13/07 12:32 PM
Cognitive Behavior Therapy Improves Symptoms in Irritable Bowel Syndrome

Cognitive Behavior Therapy Improves Symptoms in Irritable Bowel Syndrome

By Michelle Rizzo

NEW YORK (Reuters Health) Sept 11 - Cognitive behavior therapy (CBT) has a direct effect on overall improvement of gastrointestinal symptoms in patients with irritable bowel syndrome (IBS), independent of its effects on distress, results of a study published in the August issue of Gastroenterology suggest. Improvement in IBS symptoms is linked to improvements in the quality of life, which may lower distress.

"Although multiple clinical trials support the efficacy of psychological treatments for reducing IBS symptoms, the mechanisms responsible for symptomatic improvement are unknown," Dr. Jeffrey M. Lackner, of the University at Buffalo, State University of New York, and colleagues write.

In the current study, the researchers examined 147 patients who were randomly assigned to CBT, psychoeducation, or placement on a wait list. The primary end point was the global improvement of GI symptoms. These were measured 2 weeks after a 10-week regimen. Secondary end points included distress and quality of life.

Results showed that CBT was associated with improvements in IBS symptoms. The therapeutic gains did not depend on changes in the patients' overall level of psychological distress. Treatment outcome was moderated by symptom severity, but not clinical status or sociodemographic factors.

"A non-drug behavioral self-management program (CBT) significantly improved primary symptoms of IBS (abdominal pain, diarrhea, and/or constipation), and...these improvements in gut symptoms did not occur because patients became less distressed," Dr. Lackner told Reuters Heath. "Instead, the reduction of distress was a result of their actual improvement in physical symptoms. These findings are impressive because they were found in some of the most challenging, complex patients who were severely affected by IBS symptoms and are more disrupted by them."

"We also found that there was a 'reciprocal' relationship between improvement in distress and quality of life such that as CBT improved IBS symptoms, patients felt less distressed and that this reduction of distress improved the quality of life," Dr. Lackner said.

"The immediate implication is that patients who fail to respond to simple lifestyle changes like eliminating foods or medications should not grow hopeless but have confidence their condition is treatable," the author said. "They can learn practical, concrete skills to take control and reduce symptoms that affect millions of Americans and are a source of considerable health care cost and personal suffering."

Dr. Lackner said that while the results of their study are encouraging, "they are based on a program that requires weekly doctor visits over 10 weeks."

"The challenge is to develop patient-administered behavioral treatments that can be used effectively and efficiently outside of a clinic setting," he said. "This will appeal to patients who live outside the range of the few specialty clinics where CBT is available."

Gastroenterology 2007;133:433-444.

http://www.medscape.com/viewarticle/562701



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