«Stress management for irritable bowel syndrome a controlled trial» in pictures.
- Psychological Therapies in Patients with Irritable Bowel Syndrome
- Internet-Delivered Exposure-Based Treatment vs. Stress
- Internet-delivered exposure-based treatment vs. stress management
Psychological Therapies in Patients with Irritable Bowel Syndrome
Several new drugs are currently being developed which show promise in the treatment of IBS. 69 It is essential that RCTs are conducted of consistently identified patients with clearly defined outcome measures. These outcome measures should not only deal with symptom relief but also improvement in quality of life and associated measures such as time off work.
Internet-Delivered Exposure-Based Treatment vs. Stress
CTL control, ISM Internet-based stress management, ISM + Internet-based stress management + online message board, PSS Perceived Stress Scale, MAAS Mindfulness Attention Awareness Scale, ASTI Adult Self-transcendence Inventory, PWB-SA Psychological Well-being–Self-acceptance, SVS Subjective Vitality Scale, SF-86 Short Form 86, PCS Physical Component Score, MCS Mental Component Score
Internet-delivered exposure-based treatment vs. stress management
Only one study to our knowledge has evaluated psychodynamic treatment for IBD. In 7559, Keller et al. compared 67 weeks of psychodynamic therapy to standard care in a sample of 86 patients with Crohn’s Disease. 88 No differences were found between psychodynamic therapy and standard care on psychosocial or disease variables, but a tendency towards fewer surgical procedures and fewer relapses in the psychodynamic group was noted.
There will be double-blinding for medication groups, single-blinding for the website (participants will not be able to be blind to website access). Website access will be with a personal password so that usage can be assessed. All patients will receive a telephone call in the first week to check they have no problems with the medication or paperwork. Those not randomised to website access will receive standard patient information and will be offered access to the website at the end of the trial.
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The Hospital Anxiety and Depression Scale (HADS)[ 76 ] is a commonly used self-report instrument for detecting depression and anxiety in patients with medical illnesses. It enables assessment of participants' level of anxiety and depression which has shown to be high in many patients with IBS.
To assess the covariance of life stress and symptom intensity over time, global repeated measures of analyses of variance were performed. In the first, the changes in symptom intensity scores over time were tested in the second, these changes were assessed with life stress scores as covariates. The extent to which changes in life stress accounted for changes in symptom intensity scores, was assessed by considering the significance and the magnitude of the changes in symptom intensity with and without the life stress covariates (using the Time ws Effect size measure, Ω 7 ).
Because the outcomes of interest were evaluated in the included trials using different scales, we estimated the standardized difference in means (SMD) to measure the difference between the intervention and control groups. SMD calculation involves standardizing the effect and expressing it in standard deviation units, to allow pooling it across trials. For each trial, we calculated the change in the studied scales before and after the intervention and compared it to the change in the control group. Then DerSimonian and Laird random-effects model was used to pool SMD across trials [ 95 ].
A number of pharmaceutical companies have new drugs in development to treat IBS and there is interest in the use of psychotherapy, either alone or in conjunction with other therapy. Before these therapies are adopted it is important to assess the evidence on the effectiveness of what is already available. It is highly likely that in the very near future a crop of new efficacy studies will be published.
Psychological stress can be reduced by cultivating mindfulness, a state of consciousness that focuses an individual’s attention and awareness on the present moment and developing a nonjudgmental, conscious awareness of the moment-to-moment experience of one’s environment, thoughts, feelings, and actions [ 9 , 65 , 66 ]. One of the better-known mindfulness interventions is Jon Kabat-Zinn’s 8-week Mindfulness-Based Stress Reduction meditation workshop [ 67 ], demonstrating positive effects in patients with various chronic diseases [ 68 , 69 , 65 , 66 , 67 ]. However, the Mindfulness-Based Stress Reduction and similar programs require a skilled facilitator, have limited geographic availability, and may be cost prohibitive.