ReviewAre self-administered or minimal therapist contact psychotherapies an effective treatment for irritable bowel syndrome (IBS): A systematic review☆
Introduction
Functional gastrointestinal disorders (FGiDs) are highly prevalent gastrointestinal conditions, which are defined by their symptoms, as no entirely satisfactory or uniform biologic cause has yet been established. In some studies, FGiDs are associated with altered autonomic activity and thus sufferers experience heightened sensation in the gastrointestinal tract [1]. Whilst it is commonly accepted that there is a bidirectional pathway between the central nervous system and the enteric nervous system known as the brain-gut axis [2], currently no pathological cause can be found to explain FGiDs. As such, whilst FGiDs are positively diagnosed based on the presence of typical symptoms, other possible organic diseases also need to be considered and ruled out [3]. FGiDs are a significant public health concern, as no single treatment can fully resolve FGiD symptoms and health-related costs are high, due to repeated medical consultations and procedures, time lost from work, psychological distress and poor quality of life (QOL) [4].
Irritable bowel syndrome (IBS) is one type of FGiDs, estimated to be present in approximately 10% of the world population [5] and is a common reason for health care visits to physicians and gastroenterology outpatient clinics [4], [5], [6]. IBS patients are more likely to suffer from mood disorders, anxiety and neuroticism compared to healthy controls [6]. Whilst mild cases of IBS have been shown to improve with education, changes to lifestyle and diet, moderate to severe cases can benefit from psychological or pharmacological treatment, or a combination of both [7]. Research suggests that neither form of treatment is superior and instead the most important factors in successfully reducing IBS symptoms are that the patient accepts the need for treatment and is motivated to engage in it [8]. Antidepressants are commonly prescribed in IBS to target pain perception, as well as subsequent mood disturbances, and associated sleep problems [6]. However, since this line of treatment has been associated with side-effects, many patients are more open to try psychotherapy than commence a drug treatment [9]. Relaxation training, mindfulness meditation, hypnotherapy, and psychodynamic psychotherapy have all been found to be useful in treating IBS [7], [10]. However, cognitive behavioural therapy (CBT) has the most evidence of a treatment effect for symptom alleviation [6]. CBT helps patients to alter their beliefs about their symptoms, and experience of pain or discomfort so they are able to cope more effectively. CBT has been shown to primarily improve bowel symptoms which in turn decreases distress and increases quality of life [11].
Despite the benefits of psychotherapy as a treatment option, it can be costly, time consuming and not easily available, as it is usually conducted face-to-face over multiple sessions. One solution to this problem are ‘self-administered’ or ‘minimal therapist’ contact psychotherapy programs. Only one study on ‘self-administered’ CBT [12] was included in a recent comprehensive systematic review of IBS treatments, but it was decided that there was insufficient evidence from this study alone to determine a treatment effect [6]. To date, no review of the literature has been conducted on the efficacy of ‘self-administered’ and ‘minimal therapist’ contact psychotherapy and therefore this paper aims to address this question.
‘Self-administered’ programs were defined as referring to the use of a previously developed resource by a psychological practitioner such as a book without any assistance from the psychological practitioner throughout the program. ‘Minimal therapist’ contact programs referred to the use of a resource in conjunction with small amounts of support or feedback from, or contact with a psychological practitioner throughout the program.
Section snippets
Search locations
Electronic searches of PubMed, SCOPUS, Cochrane Library, and Ebscohost research databases were conducted in July 2012. These databases were chosen due to perceived relevance to the topic and were expected to provide coverage of the majority of relevant papers in the public domain.
Process
The key search phrases that were used in each of the databases were: “self-administered cognitive behavioural therapy AND functional gastrointestinal disorders”, “self-administered short therapy AND functional
Description of studies
The electronic database searches produced a total of 98 articles. After screening the articles to determine whether they met the inclusion criteria and were relevant, eight articles were included in this review and one was added from the hand search of reference lists (see Table 2 for a detailed description of the studies; see Fig. 1 for exclusion process). The nine articles included eight studies, as one study published its 18-month follow-up separately [13], [14]. All studies that met the
Discussion
This systematic literature review is the first summary evaluating the data to date which compares the effectiveness of no, and ‘minimal therapist’ contact psychotherapies for IBS. A summary of the effectiveness of these therapies was deemed important as clear, concise evidence would result in an increased trend to use this form of treatment in health-care settings where IBS is commonly seen. Moreover, there is the potential that the use of no or minimal contact psychotherapy (if effective)
Conclusion
This systematic review has shown that whilst ‘no therapist’ contact self-help programs are difficult to operationalize and may have poorer results due to lack of prompting, ‘minimal therapist’ contact psychotherapy programs appear to produce positive results in terms of physical symptom relief. However, more evidence is needed to be able to substantiate these conclusions as there is poor standardisation in study and outcome measurements. Future studies should use standardised and illness
Competing interests
All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf and declare that they have no competing interests to report. The study received no external funding.
Authorship statement
AMW is acting as the submission guarantor on this paper. All authors approved the final version of the article, including the authorship list. AA contributed to the design of the review, conducted the searches, contributed to the interpretation of findings, drafted the paper, and approved the final version. AMW contributed to the design of the review, checked the searches, confirmed the eligibility of the studies, contributed to the interpretation of findings, and approved the final version. AG
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Written expressive disclosure in adults with irritable bowel syndrome: A randomized controlled trial
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2020, Journal of Psychosomatic ResearchCitation Excerpt :The proposed intervention will further contribute to the enquiry into the role of expressive interventions in gastroenterology populations. Minimal contact therapies have not received much attention in gastroenterology, although the preliminary evidence is promising in terms of reducing healthcare seeking behaviour [35]. In IBD specifically, little research on low intensity or online psychotherapy is available [7].
Differential effects of behavioral interventions with a graded physical activity component in patients suffering from Chronic Fatigue (Syndrome): An updated systematic review and meta-analysis
2015, Clinical Psychology ReviewCitation Excerpt :Third, several interventions targeting CFS/ME patients present specific treatment characteristics that have not yet been taken into account as moderators: (1) flexibility in physical activity/exercise levels and goals, in accordance with patients' exercise tolerance (Nijs, Wallman, & Paul, 2011b); and (2) minimal contact interventions as compared to more intensive interventions. Based on recent systematic reviews on minimal contact and self-help treatments (Ahl, Mikocka-Walus, Gordon, & Andrews, 2013; Cuijpers, Donker, van Strale, Li, & Andersson, 2010; Haug, Nordgreen, Ost, & Havik, 2012; Pajak, Lackner, & Kamboj, 2013), we considered minimal-contact interventions as self-management interventions that consisted of a maximum of three initial face-to-face sessions followed by remote additional guidance and feedback during the treatment period (e.g. by email, telephone). Usually these interventions also provide patient manuals with information and assignments related to disease management.
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This work was conducted at the Schools of Psychology and Nursing and Midwifery, University of South Australia and Department of Gastroenterology and Hepatology, Royal Adelaide Hospital.