Psychological Interventions for Irritable Bowel Syndrome

Abstract

Irritable bowel syndrome (IBS) patients often present psychoform symptoms or psychiatric disorders. Among the psychological factors studied in IBS patients, two seem to influence mostly its severity: catastrophizing and somatization. Somatization is an independent risk factor for IBS. In addition, somatization more than the severity of IBS influences the way the patients perceive their illness, the outcome and the efficacy of treatment. Irritable bowel syndrome patients demonstrate greater catastrophizing scores than controls, and pain catastrophizing is a significant predictor of gastrointestinal symptoms related to pain. In this context we analysed the data regarding the efficacy of two psychological treatments in IBS: cognitive behavioral therapy and hypnosis. Cognitive behavioral therapy is focused on replacing maladaptive coping strategies with more positive cognitions and behaviors. Several studies showed that cognitive behavioral therapy is effective in reducing bowel symptoms in IBS, both post-treatment and short-term follow-up. Gut-directed hypnotherapy has beneficial short-term effects in improving gastrointestinal symptoms of patients with IBS, and the results are maintained after one year in half of the patients. Psychological treatments are a suitable option for selected IBS patients. Abbreviations: CBT: Cognitive Behavioral Therapy; FGIDs: functional gastrointestinal disorders; GDH: Gut-Directed Hypnotherapy; GI: gastrointestinal; HRQoL: health related quality of liffe; IBS: irritable bowel syndrome; ICBT: Internet-delivered CBT; ISM: Internet-delivered Stress Management; NNT: number needed to treat; PROs: Patient-reported outcomes; QoL: Quality of Life; SD: Somatization Disorders; SMT: Supportive Medical Treatment.