Irritable bowel syndrome/relaxation-psychotherapy

Townsend Letter for Doctors and Patients,  Feb-March, 2007  by Robert A. Anderson

• E-mail
• Print
• Link

In this study, 102 patients with irritable bowel syndrome of over one year's duration and unimproved with six months of conventional medical treatment were randomly assigned to a medical treatment group (high fiber diet and antispasmodic drugs) or to a psychological treatment group including an initial two-hour interview, followed by regular therapeutic interviews using the conversational model of Hobson. Each patient received a relaxation tape to use at home on a regular basis. No psychotropic medication was used. At three months, the psychotherapy group was significantly more improved than the medical-only group. Therapist-observed improvement was significant for discomfort (p<.01) and diarrhea (p<.05), and in subjective observations of decreased pain (p<.001), distension (p<.01), and diarrhea (p<.05). At three months, there was also significant correlation with improvement in the Psychiatric Assessment Schedule, the Hamilton Rating Scale, the Clinical Anxiety Scale, and the degree of decrease in abdominal symptoms (p<.001). Symptom scores, improved overall, were highly significantly improved in women (p<.01 to .001) but not significant in men. In the following year, clinic visits were reduced 75% vs. the previous year (p<.001), and the psychiatric improvement on HRS and CAS scores was much better than controls (p<.001 and p<.01, respectively).

Guthrie E, Creed F, Dawson D, Tomenson B, et al. A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology. 1991 Feb; 100(2):450-57.

COMMENT: As a whole, the psychological treatment group at three months and one year compared to the conventional medical treatment group. Men did not fare nearly as well as did women. Again, these gains were the result of group work. Physicians themselves can organize such groups or refer to psychologists and/or hospitals, many of whom do offer or at least should be encouraged to organize outpatient groups for patients with given diagnostic labels. The leadership of such groups is critical and must be facilitated by persons with the requisite skills. Many studies have shown improved diabetic self-care and management of low back pain following attendance at such groups with a psychological emphasis.

COPYRIGHT 2007 The Townsend Letter Group
COPYRIGHT 2007 Gale Group