Cognitive therapy improves irritable bowel syndrome

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Four sessions of cognitive behavioral therapy, combined with a take-home workbook, result in a greater than 70 percent improvement in symptoms of irritable bowel syndrome (IBS) compared with patients relegated to a waiting list, according to a study presented at Digestive Disease Week 2006 here this week.

Dr. Jeffrey M. Lackner, of the State University of New York at Buffalo, and colleagues randomly assigned 59 patients with irritable bowel syndrome to one of three treatments.

Patients in the first group received 10 sessions of standard cognitive behavioral therapy. Patients in the second group received 4 sessions of minimal contact cognitive therapy but with minimal contact, and were given a self-help workbook to take home. Patients in the third group were placed on a waiting list.

The researchers conducted follow-up visits to evaluate symptoms after 4 and 10 weeks.

In general, cognitive behavioral therapy emphasizes the patient’s thought process and how it influences feelings and actions. The therapy is usually short-term, focusing on the development of coping skills using a structured, goal-oriented and individualized approach.

In the study, patients were taught how to manage fear, worry and anxiety, stressors that aggravate symptoms. “We’re not shrinking heads here,” Lackner told meeting attendees. “We gave patients practical tips on how to manage their symptoms, just as is done in cardiac rehab.”

At the end of the study period, symptoms of irritable bowel syndrome had improved by approximately 73 percent in patients who received cognitive therapy, while patients on the wait list had no improvements.

Pain relief was also reported in approximately 73 percent of patients in both cognitive therapy groups compared with 11.8 percent in wait-listed patients. Gastrointestinal symptoms improved by 63.6 percent and 68.4 percent in those on the 4-week and 10-week sessions, respectively.

Patients in the minimal contact cognitive therapy group reported significant improvements in quality of life, and unlike those who received 10 weeks of therapy, “they are continuing to improve,” Lackner said. Those who received the 10-week course have merely maintained their gains.

Minimal contact cognitive therapy was 2.5 times more efficient than the 10-week standard course and placed a 60-percent lower demand on therapists. Short-course therapy was also about 5.0 times as efficient in a cost-effectiveness analysis.

Lackner attributes the continued improvement to ongoing practice of the techniques the patients learned, assisted by the workbook.

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