Cognitive behavioral therapy effective in treating irritable bowel syndrome

May 29 2006

According to the latest research behavioral therapy was more effective in treating the symptoms of irritable bowel syndrome (IBS) than being on a waiting list for treatment.

It seems that all it took for more than a 70 percent improvement rate to be seen was four sessions of cognitive behavioral therapy.

For the research 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 one group received 10 sessions of standard cognitive behavioral therapy, while another received 4 sessions of minimal contact cognitive therapy but with minimal contact, and a self-help workbook to take home.

The remaining patients were just placed on a waiting list.

Follow-up visits to evaluate symptoms were carried out after 4 and 10 weeks.

The researchers found that cognitive behavioral therapy emphasizes the patient's thought process and how it influences feelings and actions.

It is usually short-term and as a rule focuses on the development of coping skills using a structured, goal-oriented and individualized approach.

For the study patients were taught how to manage fear, worry and anxiety, stress factors that aggravate symptoms.

Lackner says the intention was to give patients practical tips on how to manage their symptoms.

At the end of the study period it was found that the 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 and gastrointestinal symptoms improved by 63.6 percent and 68.4 percent in those on the 4-week and 10-week sessions, respectively.

It is estimated that 15% of Americans, about 25 million people, have irritable bowel syndrome.

The condition manifests itself by constipation, bloating, diarrhea and gas which can make life miserable, and can limit activities.

There is little on the market at present which successfully treats the condition and researchers are now saying the best hope may be the most basic of treatments: lifestyle changes.

Experts are saying that behavior modification and dietary alterations can significantly ease symptoms of the complaint.

It appears that even a brief, self-help course of cognitive behavior therapy, in which people identify their symptoms' triggers and learn techniques, such as relaxation and thought processes, that can alter the response, significantly helped most patients.

Another government-sponsored behavior study found that 12 sessions of hypnotherapy reduced symptoms in many patients for at least one year.

The findings lend support to recent theories that irritable bowel syndrome involves a communications breakdown between the brain and gut but experts are in disagreement on whether drugs that act on the gastrointestinal tract or psychological therapies that alter thoughts and emotions will ultimately prove most beneficial.

The two views represent two different schools of thought.

The two medications currently approved for IBS has led to dissatisfaction and a resurgence of interest in how patients can help themselves.

Until recently many doctors doubted that IBS was a real disease; it affects mostly women and the disorder is characterized by chronic abdominal pain and discomfort, bloating, gas, constipation and diarrhea.

Yet there is no apparent injury, infection or inflammation in the gut, which raised the doubts about the true nature of the condition.

The nerve endings in the bowel wall that control muscle function and the sensations of the gut are thought to be hypersensitive in people with the disorder and there is an overreaction to normal events such as eating.

Although specific foods can set off symptoms in many patients, strong emotions and stress are considered the most powerful triggers.

Scientists now believe this hypersensitivity is caused by abnormal levels of certain chemicals that transmit messages between the brain and gut, such as serotonin.

The discovery of a potential biological explanation for the disorder has led to the development of two prescription drugs that focus on serotonin receptors, Lotronex and Zelnorm.

Both medications, however, have been tarnished with safety concerns.

Lotronex was withdrawn from the market shortly after it was approved in 2000 due to reports of life-threatening ischemic colitis, an inflammation caused by a disruption of blood flow to the large intestine.

The drug was re-approved with tighter restrictions in 2002 and is now recommended only for women with severe, diarrhea-predominant IBS who have not responded to other therapies.

Zelnorm was approved for women with constipation-predominant IBS in 2002 based on studies showing a modest improvement in symptoms.

But the drug was relabeled in 2004 to warn of a rare, serious side effect involving low blood pressure. Zelnorm, too, has been linked with rare cases of ischemic colitis, but there is little evidence that the medication causes the problem.

However as many as 70% of patients have tried the various medications and less than half are satisfied.

A third drug, lubiprostone (Amitiza), was granted approval in January for the treatment of chronic constipation in adults and it appears to be safe and effective.

But psychotherapies may work just as well, without side effects, to alter the communication between the brain and the gut.

Cognitive behavior therapy appears promising in helping IBS patients, but it is at present difficult to find therapists who offer it for IBS, and such therapy can be expensive and time-consuming.