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Depression and Anxiety and the Effectiveness of Cognitive Behavioural Therapy in IBS Patients: A Randomized Controlled Trial

Document Type : Original Articles

Authors

1 Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran;

2 Department of Psychology, School of Psychology and Educational Sciences, Allameh Tabatabaei University, Yasuj, Iran;

3 Department of Education, Faculty of Psychology and Educational Sciences, Evaluation and Phallic, Allameh Tabatabaei University, Yasuj, Iran;

4 Department of Internal Medicine, School of Medicine, University of Medical Sciences Yasuj, Yasuj, Iran;

5 Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Backgrounds: Anxiety and depression are found to be the major contributors to irritable bowel syndrome (IBS). The present study aimed to measure the effect of a specifically designed cognitive behavioural therapy (CBT) program on the severity of the symptoms and quality of life of patients with chronic IBS, and also define whether anxiety and depression in patients with IBS at baseline affect their response to CBT. Methods: The participants were randomly allocated to conventional treatment only (n=25, control) or CBT plus conventional treatment (n=25, intervention) group. The intervention group attended an eight session group stress management training course conducted by a psychologist in a meeting room at a gastrointestinal clinic at Yasuj University of Medical Sciences. Pre- and post-interventions and 3-month follow-up visits were scheduled and conducted by an experienced healthcare worker to measure the primary outcomes and levels of depression and anxiety in the patients. The study was conducted on 2011. Results: The Raw Group Difference (RGD) and Standardised Mean Differences (SMD) for the post-treatment scores of the intervention group, when compared with those of the control group, indicated a considerable improvement in the severity of IBS symptoms (RGD=−10.48, SMD=−1.23), anxiety (RGD=−9.90, SMD=−0.725), d epression ( RGD=−9.57, SMD=−0.785) a nd patient’s quality of life (MD=−16.81, SMD=−0.469). No association (and interaction with CBT) was found between anxiety/depression at baseline and post-treatment or follow-up scores of the outcomes. Conclusion: Although CBT improved anxiety, depression, severity of IBS and quality of life of patients with IBS, its effect was independent of the initial level of anxiety and depression of the patients. Trial registration number: IRCT201102195868N1

Keywords

References
  1. Lovell RM, Ford AC. Global prevalence of and risk
  2. factors for irritable bowel syndrome: a meta-analysis.
  3. Clin Gastroenterol Hepatol 2012; 10(7): 712-21. e4.
  4. Drossman DA, Dumitrascu DL. Rome III: New
  5. standard for functional gastrointestinal disorders. J
  6. Gastrointestin Liver Dis 2006; 15(3): 237.
  7. Everitt H, Moss-Morris R, Sibelli A, Tapp L,
  8. Coleman N, Yardley L, et al. Management of irritable
  9. bowel syndrome in primary care: the results of an
  10. exploratory randomised controlled trial of mebeverine,
  11. methylcellulose, placebo and a self-management
  12. website. BMC Gastroenterology 2013; 13(1): 68.
  13. Hazlett-Stevens H, Craske MG, Mayer EA, Chang L,
  14. Naliboff BD. Prevalence of irritable bowel syndrome
  15. among university students: The roles of worry,
  16. neuroticism, anxiety sensitivity and visceral anxiety.
  17. J Psychosom Res 2003; 55(6): 501-5.
  18. Cremonini F, Talley NJ. Treatments targeting putative
  19. mechanisms in irritable bowel syndrome. Nat Clin
  20. Pract Gastroenterol Hepatol 2005; 2(2): 82-8.
  21. Dean C, Wheeler C. IBS for Dummies. Wiley
  22. publishing, inc; 2011.
  23. Drossman DA. Gastrointestinal Illness and the
  24. Biopsychosocial Model. Psychosom Med 1998; 60(3):
  25. -67.
  26. Konturek PC, Brzozowski T, Konturek SJ. Stress
  27. and the gut: pathophysiology, clinical consequences,
  28. diagnostic approach and treatment options. J Physiol
  29. Pharmacol 2011; 62(6): 591-9.
  30. Lackner JM. Irritable bowel syndrome CA: Sage.
  31. In: Collins F, Cohen L, editors. Handbook of health
  32. psychology: Thousand Oaks; 2003. p. 397-424.
  33. Chang L. The role of stress on physiological responses
  34. and clinical symptoms in irritable bowel syndrome.
  35. Gastroenterology 2011; 140(3): 761.
  36. Blanchard EB, Lackner JM, Jaccard J, Rowell D,
  37. Carosella AM, Powell C, et al. The role of stress
  38. in symptom exacerbation among IBS patients. J
  39. Psychosom Res 2008; 64(2): 119-28.
  40. Linehan M. Cognitive-behavioral treatment of
  41. borderline personality disorder. Guilford Press; 1993.
  42. Lamb SE, Hansen Z, Lall R, Castelnuovo E, Withers EJ,
  43. Nichols V, et al. Group cognitive behavioural treatment
  44. for low-back pain in primary care: a randomised
  45. controlled trial and cost-effectiveness analysis. Lancet
  46. ; 375(9718): 916-23.
  47. Ford AC, Quigley EMM, Lacy BE, Lembo AJ, Saito
  48. YA, Schiller LR, et al. Effect of Antidepressants and
  49. Psychological Therapies, Including Hypnotherapy, in
  50. Irritable Bowel Syndrome: Systematic Review and
  51. Meta-Analysis. Am J Gastroenterol 2014; 109(9):
  52. -65.
  53. Jones M, Koloski N, Boyce P, Talley NJ. Pathways
  54. connecting cognitive behavioral therapy and change
  55. in bowel symptoms of IBS. J Psychosom Res 2011;
  56. (3): 278-85.
  57. Lackner JM, Mesmer C, Morley S, Dowzer C, Hamilton S. Psychological treatments for irritable bowel
  58. syndrome: a systematic review and meta-analysis. J
  59. Consult Clin Psychol 2004; 72(6): 1100.
  60. Blanchard EB, Lackner JM, Gusmano R, Gudleski
  61. GD, Sanders K, Keefer L, et al. Prediction of treatment
  62. outcome among patients with irritable bowel syndrome
  63. treated with group cognitive therapy. Behav Res Ther
  64. ; 44(3): 317-37.
  65. Blanchard EB, Lackner JM, Sanders K, Krasner S,
  66. Keefer L, Payne A, et al. A controlled evaluation of
  67. group cognitive therapy in the treatment of irritable
  68. bowel syndrome. Behav Res Ther 2007; 45(4): 633-48.
  69. Reme SE, Kennedy T, Jones R, Darnley S, Chalder
  70. T. Predictors of treatment outcome after cognitive
  71. behavior therapy and antispasmodic treatment for
  72. patients with irritable bowel syndrome in primary
  73. care. J Psychosom Res 2010; 68(4): 385-8.
  74. Shahbazi K, Aghaei A, Mobasheri M, Solati-Dehkordi
  75. K. Effects of hypnotherapy joint with drug therapy
  76. and drug therapy on severity and frequency of the
  77. symptoms of patients with irritable bowel syndrome.
  78. J Shahrekord Univ Med Sci 2013; 14(6): 1-9.
  79. Dehkordy SK, Adibi P, Gharamaleky SN. Effects of
  80. relaxation and citalopram on severity and frequency
  81. of the symptoms of irritable bowel syndrome with
  82. diarrhea predominance. Pak J Med Sci 2010; 26(1):
  83. -91.
  84. Beck AT, Steer RA, Brown GK. Beck Depression
  85. Inventory. Manual, Swedish version. Sandviken:
  86. Psykologif Ãrlaget; 2005.
  87. Fata L, Birashk B, Atef-vahid KDK. Validation of the
  88. Farsi version of the depression Beck questionnaire.
  89. Iranian Journal of psychiatry and clinical psychology
  90. ; 42: 312-26.
  91. Haghayegh S, Kalantari M, Solati S, Molavi H, Adibi
  92. P. Study on Validity of Farsi Version of Irritable Bowel
  93. Syndrome Quality of Life Questionnaire (IBS-QOL-
  94. . Govaresh 2012; 13(2): 99-105.
  95. Keypour M, Arman S, Maracy MR. The effectiveness
  96. of cognitive behavioral stress management training
  97. on mental health, social interaction and family
  98. function in adolescents of families with one Human
  99. Immunodeficiency Virus (HIV) positive member*. J
  100. Res Med Sci 2011; 16(6): 741.
  101. Yazdani M, Rezaei S, Pahlavanzadeh S. The
  102. effectiveness of stress management training program on
  103. depression, anxiety and stress of the nursing students.
  104. Iran J Nurs Midwifery Res 2010; 15(4): 208.
  105. Foxx-Orenstein A. IBS-review and what’s new. Med
  106. Gen Med 2006; 8(3): 20.
  107. Berkel V. Psychological stress management therapies
  108. in Irritable Bowel Syndrome: Tilburg University; 2011.
  109. Riedl A, Schmidtmann M, Stengel A, Goebel M,
  110. Wisser A-S, Klapp BF, et al. Somatic comorbidities
  111. of irritable bowel syndrome: A systematic analysis. J
  112. Psychosom Res 2008; 64(6): 573-82.
  113. Chilcot J, Moss-Morris R. Changes in illness-related
  114. cognitions rather than distress mediate improvements
  115. in irritable bowel syndrome (IBS) symptoms and
  116. disability following a brief cognitive behavioural therapy
  117. intervention. Behav Res Ther 2013; 51(10): 690-5.
  118. Clark DM, Layard R, Smithies R, Richards DA, Suckling
  119. R, Wright B. Improving access to psychological
  120. therapy: Initial evaluation of two UK demonstration
  121. sites. Behav Res Ther 2009; 47(11): 910-20.
  122. Lackner JM, Lou Coad M, Mertz HR, Wack DS, Katz
  123. LA, Krasner SS, et al. Cognitive therapy for irritable
  124. bowel syndrome is associated with reduced limbic
  125. activity, GI symptoms, and anxiety. Behav Res Ther
  126. ; 44(5): 621-38.
Journal of Health Sciences & Surveillance System
Volume 3, Issue 2 - Serial Number 2
10
April 2015
Pages 76-82
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