Pilot-RCT of an integrative group therapy for patients with refractory irritable bowel syndrome (ISRCTN02977330)

Berens, Sabrina; Stroe-Kunold, Esther; Kraus, F; Tesarz, Jonas; Gauss, Annika; Niesler, Beate; Herzog, Wolfgang; Schaefert, Rainer

doi:10.1016/j.jpsychores.2017.12.002

Cited by 17 publications

(29 citation statements)

References 62 publications

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“…When we restricted the analysis to the 13 RCTs that stated that they only recruited patients with refractory IBS, [37,66,73,76,77,81,85,86,87,88,94,95] there was very little observed heterogeneity between studies ( 2 = 0.022). Group CBT was ranked first (RR of remaining symptomatic = 0.05; 95% CI 0.00 to 0.85, P-score 0.96) ( Supplementary Figure 5), but based on only one small RCT, and 95% CIs were again wide.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis

Black

Thakur

Houghton

et al. 2020

Gut

165

139

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ObjectivesNational guidelines for the management of irritable bowel syndrome (IBS) recommend that psychological therapies should be considered, but their relative efficacy is unknown, because there have been few head-to-head trials. We performed a systematic review and network meta-analysis to try to resolve this uncertainty.DesignWe searched the medical literature through January 2020 for randomised controlled trials (RCTs) assessing efficacy of psychological therapies for adults with IBS, compared with each other, or a control intervention. Trials reported a dichotomous assessment of symptom status after completion of therapy. We pooled data using a random effects model. Efficacy was reported as a pooled relative risk (RR) of remaining symptomatic, with a 95% CI to summarise efficacy of each comparison tested, and ranked by therapy according to P score.ResultsWe identified 41 eligible RCTs, containing 4072 participants. After completion of therapy, the psychological interventions with the largest numbers of trials, and patients recruited, demonstrating efficacy included self-administered or minimal contact cognitive behavioural therapy (CBT) (RR 0.61; 95% CI 0.45 to 0.83, P score 0.66), face-to-face CBT (RR 0.62; 95% CI 0.48 to 0.80, P score 0.65) and gut-directed hypnotherapy (RR 0.67; 95% CI 0.49 to 0.91, P score 0.57). After completion of therapy, among trials recruiting only patients with refractory symptoms, group CBT and gut-directed hypnotherapy were more efficacious than either education and/or support or routine care, and CBT via the telephone, contingency management, CBT via the internet and dynamic psychotherapy were all superior to routine care. Risk of bias of trials was high, with evidence of funnel plot asymmetry; the efficacy of psychological therapies is therefore likely to have been overestimated.ConclusionsSeveral psychological therapies are efficacious for IBS, although none were superior to another. CBT-based interventions and gut-directed hypnotherapy had the largest evidence base and were the most efficacious long term.Trial registration numberThe study protocol was published on the PROSPERO international prospective register of systematic reviews (registration number CRD 42020163246).

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Section: Resultsmentioning

confidence: 99%

“…provided dichotomous data for likelihood of remaining symptomatic at the first point of follow-up post-treatment [37,59,60,. 61,62, 63,64,65,66,67, 68,69, 70,71,72,73,74,75,76, 77,78,79,80,81,82,83, 84,85,86,87,88,89,90, 91,92,93,94,95,96] The network plot is provided in…”

mentioning

confidence: 99%

Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis

Black

Thakur

Houghton

et al. 2020

Gut

165

139

View full text Add to dashboard Cite

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“…The study was approved by the ethics committee of Heidelberg University (S-641/2015). [19,21,22], the model of care for our FGID clinic employs a simultaneous approach by considering somatic as well as psychosocial factors of illness in assessment and therapy [20,23]. Additionally, recommendations of phenotyping IBS patients for large-scale studies were picked up [24].…”

Section: Methodsmentioning

confidence: 99%

Patients with Multiple Functional Gastrointestinal Disorders (FGIDs) Show Increased Illness Severity: A Cross-Sectional Study in a Tertiary Care FGID Specialty Clinic

Berens

Engel

Gauss

et al. 2020

Gastroenterology Research and Practice

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Objectives. Overlaps between different functional gastrointestinal disorders (FGIDs) are common. However, little is known about the impact of this overlap on patients’ health status. This study is aimed at analyzing the differences between patients with multiple as compared to one single FGID. Methods. A retrospective, cross-sectional study was conducted with patients presenting to a tertiary care FGID specialty clinic between 06/2012 and 01/2015 (n=294). They were characterized primarily according to their GI symptom severity (IBS-SSS) and secondarily to their physical as well as psychosocial symptom burden, quality of life, health care utilization, and work-related impairment. Differences between patients with >1 vs. 1 FGID were analyzed. Results. Of the 294 patients, 92.2% fulfilled the Rome III criteria for any FGID, and 48.0% had >1 FGIDs. FGID patients had a median age of 38 [23.0] years; 72.0% were female. Median GI symptom severity (IBS-SSS) scores were 339 [126] and 232 [163] in patients with >1 and 1 FGID, respectively (p<.001). Furthermore, patients with >1 FGIDs had higher general somatic symptom severity, higher illness anxiety, lower quality of life, and more work-related impairment. Almost no differences were found regarding their somatic as well as mental comorbidities. Conclusions. Multiple FGIDs are associated with an increased risk for complicated courses of illness as reflected in higher GI and somatic symptom severity, as well as stronger psychosocial and diet- and work-related impairment. Stepped and interdisciplinary models of care including psychosocial expertise and dietary advice are needed, especially for patients with multiple FGIDs.

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“…The study was approved by the medical ethics committee of the University Hospital Heidelberg. The patient was recruited in the frame of a pilot intervention study, conducted between July, 2014 and June, 2015 [ 15 ]. During her waiting period—and before the beginning of the therapy group—the patient answered questions daily regarding somatic and psychological complaints as well as coping strategies with the use of an online diary.…”

Section: Case Presentationmentioning

confidence: 99%

Pain and psyche in a patient with irritable bowel syndrome: chicken or egg? A time series case report

et al. 2021

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Background Irritable bowel syndrome (IBS) appears to have a bidirectional interaction with both depressive and anxiety-related complaints. However, it remains unclear how exactly the psychological complaints, at the individual level, are related to somatic symptoms on a daily basis. This single case study investigates how somatic and psychological variables are temporally related in a patient with irritable bowel syndrome. Case report The patient was a woman in her mid-twenties with an IBS diagnosis. She reported frequent soft bowel movements (5–6 times per day), as well as flatulence and abdominal pain. She resembled a typical IBS patient; however, a marked feature of the patient was her high motivation for psychosomatic treatment as well as her willingness to try new strategies regarding the management of her symptoms. As an innovative approach this single case study used a longitudinal, observational, time series design. The patient answered questions regarding somatic and psychological variables daily over a period of twelve weeks with an online diary. The diary data was analysed using an autoregressive (VAR) modeling approach. Time series analyses showed that in most variables, strong same-day correlations between somatic (abdominal pain, daily impairment) and psychological time series (including coping strategies) were present. The day-lagged relationships indicated that higher values in abdominal pain on one day were predictive of higher values in the psychological variables on the following day (e.g. nervousness, tension, catastrophizing, hopelessness). The use of positive thinking as a coping strategy was helpful in reducing the pain on the following days. Conclusion In the presented case we found a high correlation between variables, with somatic symptoms temporally preceding psychological variables. In addition, for this patient, the use of positive thoughts as a coping strategy was helpful in reducing pain.

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Pilot-RCT of an integrative group therapy for patients with refractory irritable bowel syndrome (ISRCTN02977330)

Cited by 17 publications

References 62 publications

Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis

Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis

Patients with Multiple Functional Gastrointestinal Disorders (FGIDs) Show Increased Illness Severity: A Cross-Sectional Study in a Tertiary Care FGID Specialty Clinic

Pain and psyche in a patient with irritable bowel syndrome: chicken or egg? A time series case report

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