Chasing the elusive cure for IBS

Cognitive behavioural therapy makes
"no change" in outcome

By Liliana Abruzzese

For the past six years Alison Brent has suffered from painful constipation, bloating and gas. After a slew of medical tests her family practitioner diagnosed her with irritable bowel syndrome (IBS). In order to ease the pain she was dealing with Ms Brent increased the fibre in her diet and on occasion used medication. Nothing alleviated her symptoms. She was irritable, often absent from work and depressed. Her doctor suggested she try to control the stress in her life.

Previous studies have shown that psychological interventions are helpful in reducing the symptoms of IBS. New Australian research compares the use of cognitive behavioural therapy (CBT) with relaxation training as adjuncts in the management of IBS.

IBS is reported to affect an estimated six million Canadians. Approximately 70% of those affected are women. Even though IBS does not lead to further serious disorders it has a detrimental affect on a patient's quality of life. Following the common cold, IBS is the second-leading cause of work or school absenteeism in Canada and is the most common intestinal disorder seen by gastroenterologists. The annual direct healthcare costs are estimated at $352 million.

Researchers led by Dr Phillip M Boyce, professor of psychiatry at the University of Sydney, Penrith, Australia, conducted a randomized, investigator-blinded trial to compare the effects of CBT with relaxation therapy and routine clinical care alone in people with IBS. The key outcome measured by the study was bowel symptom severity.

In their study, which appears in the October issue of the American Journal of Gastroenterology, a total of 105 subjects were recruited from ads and outpatient clinics. All participants met Rome I criteria for IBS and were screened to rule out those with resistant IBS.

The eight-week study consisted of routine clinical care (RCC) for all groups plus either CBT or relaxation training. RCC involved three sessions with a gastroenterologist that lasted about 15-30 minutes each. In the relaxation training arm participants received RCC and weekly 30-minute instructional sessions in a range of relaxation strategies. Those randomized to CBT had RCC plus weekly one-hour sessions of CBT conducted by a clinical psychologist.

Each group was assessed at one-year follow-ups, using the Bowel Symptom Severity Scale. This scale measures the frequency, disability and distress of intestinal symptoms associated with IBS. Symptoms include loose or hard stools, abdominal pain, more than three bowel movements daily, bloating, urgency, inability to have a bowel movement in the past week and abdominal discomfort.

All of the participants demonstrated significant improvement in their symptoms as well as reductions in anxiety and depression. There were no significant differences among the treatment groups or any of the measures, indicating that CBT does not have an advantage over relaxation training or routine clinical care.

Initially, it was anticipated that CBT would prove to be more effective than other treatments. However, in contrast to earlier studies of CBT for the treatment of IBS that did show some success with patients, results from this study indicate otherwise. According to the study, researchers conclude cognitive behavioural therapy is not superior to relaxation therapy or standard treatment alone for treating the symptoms of IBS.