Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist

Olafur S Palsson, William E Whitehead, Olafur S Palsson, William E Whitehead

Abstract

The functional gastrointestinal disorders (FGIDs) often show inadequate response to usual medical care. Psychological treatments can help improve functional gastrointestinal disorder patient outcomes, and such treatment should be considered for patients who have moderate or severe symptoms after 3-6 months of medical care and those whose symptoms are clearly exacerbated by stress or emotional symptoms. Effective psychological treatments, which are based on multiple randomized controlled trials, include cognitive behavioral therapy and hypnosis for irritable bowel syndrome and pediatric functional abdominal pain, cognitive behavioral therapy for functional chest pain, and biofeedback for dyssynergic constipation in adults. Successful referral by the gastroenterologist for psychological treatment is facilitated by educating the patient about the rationale for such treatment, reassurance about the diagnosis and continuation of medical care, firm doctor-patient therapeutic alliance, and identification of and communication with an appropriate psychological services provider.

Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

References

    1. Whitehead WE, Levy RL, Von Korff M, et al. The usual medical care for irritable bowel syndrome. Aliment Pharmacol Ther. 2004;20:1305–15.
    1. Brandt LJ, Chey WD, Foxx-Orenstein AE, et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009;104 (Suppl 1):S1–35.
    1. Drossman DA, Camilleri M, Mayer EA, et al. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:2108–31.
    1. Whitehead WE. Psychosocial aspects of functional gastrointestinal disorders. Gastroenterol Clin North Am. 1996;25:21–34.
    1. Chitkara DK, van Tilburg MA, Blois-Martin N, et al. Early life risk factors that contribute to irritable bowel syndrome in adults: a systematic review. Am J Gastroenterol. 2008;103:765–74. quiz 775.
    1. Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:1140–56.
    1. Drossman DA. Do psychosocial factors define symptom severity and patient status in irritable bowel syndrome? Am J Med. 1999;107:41S–50S.
    1. Van Oudenhove L, Vandenberghe J, Vos R, et al. Risk factors for impaired health-related quality of life in functional dyspepsia. Aliment Pharmacol Ther. 2011;33:261–74.
    1. Levy RL, Olden KW, Naliboff BD, et al. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology. 2006;130:1447–58.
    1. Van Oudenhove L, Vandenberghe J, Geeraerts B, et al. Relationship between anxiety and gastric sensorimotor function in functional dyspepsia. Psychosom Med. 2007;69:455–63.
    1. Clauwaert N, Jones MP, Holvoet L, et al. Associations between gastric sensorimotor function, depression, somatization, and symptom-based subgroups in functional gastroduodenal disorders: are all symptoms equal? Neurogastroenterol Motil. 2012
    1. Posserud I, Agerforz P, Ekman R, et al. Altered visceral perceptual and neuroendocrine response in patients with irritable bowel syndrome during mental stress. Gut. 2004;53:1102–8.
    1. Payne A, Blanchard EB. A controlled comparison of cognitive therapy and self-help support groups in the treatment of irritable bowel syndrome. J Consult Clin Psychol. 1995;63:779–86.
    1. Moss-Morris R, McAlpine L, Didsbury LP, et al. A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care. Psychol Med. 2010;40:85–94.
    1. Craske MG, Wolitzky-Taylor KB, Labus J, et al. A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behav Res Ther. 2011;49:413–21.
    1. van Dulmen AM, Fennis JF, Bleijenberg G. Cognitive-behavioral group therapy for irritable bowel syndrome: effects and long-term follow-up. Psychosom Med. 1996;58:508–14.
    1. Klimes I, Mayou RA, Pearce MJ, et al. Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Psychol Med. 1990;20:605–11.
    1. Mayou RA, Bryant BM, Sanders D, et al. A controlled trial of cognitive behavioural therapy for non-cardiac chest pain. Psychol Med. 1997;27:1021–31.
    1. Van Peski-Oosterbaan AS, Spinhoven P, Van der Does AJ, et al. Cognitive change following cognitive behavioural therapy for non-cardiac chest pain. Psychother Psychosom. 1999;68:214–20.
    1. Spinhoven P, Van der Does AJW, Van Dijk E, et al. Heart-focused anxiety as a mediating variable in the treatment of noncardiac chest pain by cognitive-behavioral therapy and paroxetine. J Psychosom Res. 2010;69:227–235.
    1. Jonsbu E, Dammen T, Morken G, et al. Short-term cognitive behavioral therapy for non-cardiac chest pain and benign palpitations: a randomized controlled trial. J Psychosom Res. 2011;70:117–23.
    1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), State University of New York at Buffalo. [Internet] Bethesda (MD): National Library of Medicine (US); 2000. Self Administered Cognitive Behavior Therapy for Irritable Bowel Syndrome. [cited 2012 Oct 8]. Available from: NLM Identifier: NCT00738920.
    1. Palsson OS, Turner MJ, Johnson DA, et al. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci. 2002;47:2605–14.
    1. Whorwell PJ, Prior A, Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut. 1987;28:423–5.
    1. Gonsalkorale WM, Miller V, Afzal A, et al. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003;52:1623–9.
    1. Vlieger AM, Menko-Frankenhuis C, Wolfkamp SC, et al. Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial. Gastroenterology. 2007;133:1430–6.
    1. Vlieger AM, Rutten JM, Govers AM, et al. Long-term follow-up of gut-directed hypnotherapy vs. standard care in children with functional abdominal pain or irritable bowel syndrome. Am J Gastroenterol. 2012;107:627–31.
    1. van Tilburg MA, Chitkara DK, Palsson OS, et al. Audio-recorded guided imagery treatment reduces functional abdominal pain in children: a pilot study. Pediatrics. 2009;124:e890–7.
    1. Jones H, Cooper P, Miller V, et al. Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy. Gut. 2006;55:1403–8.
    1. Miller V, Jones H, Whorwell PJ. Hypnotherapy for non-cardiac chest pain: long-term follow-up. Gut. 2007;56:1643.
    1. Calvert EL, Houghton LA, Cooper P, et al. Long-term improvement in functional dyspepsia using hypnotherapy. Gastroenterology. 2002;123:1778–85.
    1. Boyce PM, Talley NJ, Balaam B, et al. A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol. 2003;98:2209–18.
    1. van der Veek PP, van Rood YR, Masclee AA. Clinical trial: short- and long-term benefit of relaxation training for irritable bowel syndrome. Aliment Pharmacol Ther. 2007;26:943–52.
    1. Creed F, Fernandes L, Guthrie E, et al. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology. 2003;124:303–17.
    1. Koutsomanis D, Lennard-Jones JE, Roy AJ, et al. Controlled randomised trial of visual biofeedback versus muscle training without a visual display for intractable constipation. Gut. 1995;37:95–9.
    1. Chiarioni G, Salandini L, Whitehead WE. Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology. 2005;129:86–97.
    1. Farid M, El Monem HA, Omar W, et al. Comparative study between biofeedback retraining and botulinum neurotoxin in the treatment of anismus patients. Int J Colorectal Dis. 2009;24:115–20.
    1. Faried M, El Nakeeb A, Youssef M, et al. Comparative study between surgical and non-surgical treatment of anismus in patients with symptoms of obstructed defecation: a prospective randomized study. J Gastrointest Surg. 2010;14:1235–43.
    1. Rao SS, Seaton K, Miller M, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol. 2007;5:331–8.
    1. Heymen S, Scarlett Y, Jones K, et al. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum. 2007;50:428–41.
    1. Chiarioni G, Whitehead WE, Pezza V, et al. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006;130:657–64.
    1. Chiarioni G, Whitehead WE. The role of biofeedback in the treatment of gastrointestinal disorders. Nat Clin Pract Gastroenterol Hepatol. 2008;5:371–82.
    1. Engel BT, Nikoomanesh P, Schuster MM. Operant conditioning of rectosphincteric responses in the treatment of fecal incontinence. N Engl J Med. 1974;290:646–9.
    1. Wald A, Chandra R, Gabel S, et al. Evaluation of biofeedback in childhood encopresis. J Pediatr Gastroenterol Nutr. 1987;6:554–8.
    1. van der Plas RN, Benninga MA, Redekop WK, et al. Randomised trial of biofeedback training for encopresis. Arch Dis Child. 1996;75:367–74.
    1. Ilnyckyj A, Fachnie E, Tougas G. A randomized-controlled trial comparing an educational intervention alone vs education and biofeedback in the management of faecal incontinence in women. Neurogastroenterol Motil. 2005;17:58–63.
    1. Norton C, Chelvanayagam S, Wilson-Barnett J, et al. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology. 2003;125:1320–9.
    1. Solomon MJ, Pager CK, Rex J, et al. Randomized, controlled trial of biofeedback with anal manometry, transanal ultrasound, or pelvic floor retraining with digital guidance alone in the treatment of mild to moderate fecal incontinence. Dis Colon Rectum. 2003;46:703–10.
    1. Heymen S, Scarlett Y, Jones K, et al. Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Dis Colon Rectum. 2009;52:1730–7.
    1. Chiarioni G, Nardo A, Vantini I, et al. Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome. Gastroenterology. 2010;138:1321–9.
    1. Hjelland IE, Svebak S, Berstad A, et al. Breathing exercises with vagal biofeedback may benefit patients with functional dyspepsia. Scand J Gastroenterol. 2007;42:1054–62.
    1. Nieuwsma JA, Trivedi RB, McDuffie J, et al. Brief psychotherapy for depression: a systematic review and meta-analysis. Int J Psychiatry Med. 2012;43:129–51.
    1. Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008;69:621–32.
    1. Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol. 2002;97:954–61.
    1. Houghton LA, Heyman DJ, Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome--the effect of hypnotherapy. Aliment Pharmacol Ther. 1996;10:91–5.
    1. Grover M, Drossman DA. Psychotropic agents in functional gastrointestinal disorders. Curr Opin Pharmacol. 2008;8:715–23.
    1. Clouse RE, Lustman PJ. Use of psychopharmacological agents for functional gastrointestinal disorders. Gut. 2005;54:1332–41.
    1. Ford AC, Talley NJ, Schoenfeld PS, et al. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut. 2009;58:367–78.

Source: PubMed

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