Mayer EA, Naliboff BD, Raeen H, Mayer M, Liu C, Bolus R.

Psychoeducational intervention in IBS patients improves symptoms, symptom-related anxieties, coping and health-related quality of life.

Departments of Medicine, Physiology, Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA; VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Building 115, Room 223, Los Angeles, CA 90073. emayer@ucla.edu

BACKGROUND: Improving cognitions about IBS symptoms and self-management may decrease symptom-related anxieties, thereby reducing IBS symptoms and improving health-related quality of life (HRQoL). The therapeutic effect of such an intervention may be related to strengthening of inhibitory corticolimbic interactions (Arch Gen Psychiatry 2004;61:34-41).

METHODS: 69 Rome+ IBS patients (mean age: 46.8±12.6 yrs; 73% female; 35% IBS-C, 41% IBS-D, 24% IBS-A), seen at a tertiary referral center on conventional therapy, were randomized to either IBS class (5-8 patients per class; n=34) or wait list control (n=35). The IBS class consisted of 5 weekly 2-hour sessions of education on a biological mind body disease model emphasizing self-efficacy (diet, medications, coping styles), and practical instructions in simple relaxation techniques. Outcomes measured at baseline, 12 weeks (1 week post class) and 3 months, included: IBS SYMPTOMS (BSQ, diary), COGNITIONS (CS-FBD), AFFECT (Visceral sensitivity index, VSI), and IBS-SPECIFIC HRQoL (DSQ-IBS). Outcome was assessed from group comparison of change in scores at 12 weeks and 3 months.

RESULTS: Treated and untreated subjects were found to be comparable in all reported measures at baseline; with treated patients significantly improved at the 12-week point on all key measures. Differences were maintained at 3 months. 12-week results: SYMPTOMS (% change vs. control): Global severity (-30% vs. -1%, p<0.05), Urgency (-22% vs. +5%; p<0.01);

COGNITIONS: CSFBD (-15% vs. +2%; p<0.001), Catastrophizing (-32% vs. +13%; p<0.001); AFFECT: VSI (-16% vs. +8%; p<0.001); HRQoL: Sleep (+11% vs. -2%; p<0.02), Diet (+18% vs. -11%; p<0.001), Role Physical (+33% vs. +5%; p<0.01). Improvement in VSI and cognitions was positively correlated with improvement in HRQoL measures (r=0.4 to 0.5; p<0.01).

CONCLUSIONS: In IBS patients seen at a tertiary referral center, a brief psychoeducational group therapy is able to change cognitions and fears about IBS symptoms, and these changes are associated with improvement in IBS symptoms and HRQoL.

 

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