Patient - Irritable Bowel Syndrome (IBS) Psychological Factors

• Guthrie E and Thompson D. "ABC of psychological medicine: Abdominal pain and functional gastrointestinal disorders." BMJ. 325:701-703, 2002.

  For patients who have not responded to initial management, four different kinds of psychological treatment have been evaluated in functional gastrointestinal disorders: cognitive therapies, behavioral therapies, interpersonal therapies and hypnosis. Each therapy has a different mechanism of action, but they have the common aims of reducing symptoms and improving function. Most treatments are delivered on a one to one basis, once weekly, over a period of two to four months. Although most studies indicated a positive outcome for psychological treatment, further studies are needed before definitive recommendations can be given. The most convincing evidence for the use of specific psychological treatments is for patients with chronic abdominal symptoms.

Hutton J. "Cognitive behaviour therapy for irritable bowel syndrome." European Journal of Gastroenterology & Hepatology. 17(1):11-4, 2005.
The UK Department of Health states that there is suggestive scientific evidence for the effectiveness of cognitive behavioral therapy (CBT) in IBS and recommends that CBT be considered as a treatment option for this disorder.
• Jarrett M, Heitkemper M, Cain KC, et al. "The relationship between psychological distress and gastrointestinal symptoms in women with irritable bowel syndrome." Nursing Research. 47(3):154-161, 1998.

  Psychological distress may contribute to GI symptoms in individuals with IBS. The study compared psychological distress in 97 women with IBS, women not diagnosed with IBS but with similar GI symptoms and women with no GI symptoms (the control group). The IBS group and the women with IBS symptoms had a higher percentage of lifetime psychological dysfunction and distress. At least 40% of the women in these two groups showed positive correlations between daily psychological distress and daily GI symptoms, confirming psychological distress as an important component of the IBS symptom experience.

• Jones M, Koloski N, Boyce P, Talley NJ. Pathways connecting cognitive behavioral therapy and change in bowel symptoms of IBS. Journal of Psychosomatic Research. 70(3):278-85, 2011.

  One hundred five people with IBS received individual CBT, relaxation therapy, or usual medical care. Data suggest indirect pathways of improvement that operate through change in mood, most clearly anxiety but to a lesser extent depression. Statistically significant pathways were identified that lead from CBT to change in mood state and then to change in bowel symptoms.

• Lackner JF, Quigley BM, Blanchard EB. "Depression and abdominal pain in IBS patients: the mediating role of catastrophizing." Psychosomatic Medicine. 66(3):435-441, 2004.

  This study explores the possibility that negatively skewed beliefs patients hold about abdominal pain (such as catastrophizing) effect the relationship between depression and pain severity. The study included 244 IBS patients who completed measures of pain severity, trait anxiety, catastrophizing, maladaptive beliefs and depression. Results indicated that pain catastrophizing partially caused a link between depression and abdominal pain severity. The finding that patients with IBS with greater depression reported greater pain severity can be explained in part by their tendency to engage in more catastrophic thinking specific to pain.

• Porcelli P. "Psychological abnormalities in patients with irritable bowel syndrome." Indian Journal of Gastroenterology. 23(2):63-69, 2003

  Persistent somatization (conversion of an emotional, mental, or psychosocial problem into a physical complaint) has been found as one of the main psychological factors contributing to persistent symptoms and poor treatment outcome in patients with IBS. From a psychological point of view, IBS can be conceived as an abnormal cognitive processing of emotional and gut stimuli, with a tendency to perceive bodily stimuli as evidence of symptoms of disease.

• Raine R, Sensky T, Hutchings A, et al. "Systematic review of mental health interventions for patients with common somatic symptoms: can research evidence from secondary care be extrapolated to primary care?" BMJ. 325:1082, 2002 November.

  A systematic review of randomized controlled trials for three common conditions for which no physical cause could be found was conducted (chronic fatigue syndrome, irritable bowel syndrome and chronic back pain). Results suggest that cognitive behavior therapy and behavior therapy are effective for chronic back pain and chronic fatigue syndrome and that antidepressants are effective for irritable bowel syndrome.

• Talley NJ, Owen BK, Boyce P, et al. "Psychological treatments for irritable bowel syndrome: a critique of controlled treatment trials." The American Journal of Gastroenterology. 91(2):277-286, 1996.

  A systematic review of the literature on psychological treatments for IBS was performed in order to determine their effectiveness. Eight studies reported that a psychological treatment was more effective than a control therapy and five failed to detect a significant effect (although three of these did report that symptoms were significantly reduced after psychological treatment compared with baseline measures).