Effect of Self-Management Intervention on Cortisol and Daily Stress Levels in Irritable Bowel Syndrome

Abstract

Self-management programs that include cognitive behavioral strategies have been shown to improve gastrointestinal symptoms, psychological distress, and quality of life in persons with irritable bowel syndrome (IBS). However, less is known about the physiological impact of such a change. As part of a randomized controlled trial using a Comprehensive Self-Management (CSM) intervention (n = 126) compared to Usual Care (UC) (n = 62), cortisol levels were measured in four weekly first morning urine samples at baseline and at 3, 6, and 12 month follow-up. In addition, diary (28 days) ratings of stress were recorded at baseline, 3, 6, and 12 months. The omnibus test of all three outcome times showed no differences in urine cortisol levels between CSM and UC groups (p = .400); however, at 3 months the CSM group had significantly higher cortisol levels than the UC group (p = .012). The CSM group reported lower daily stress levels (p = .046 from omnibus test of all three time points) than UC, with the effect getting stronger over time. Despite marked improvements in reported stress and previously reported gastrointestinal and psychological distress symptoms at later follow-ups, the CSM program did not reduce urine cortisol levels in adults with IBS. These results suggest that the first void urine cortisol levels are not reflective of self reported daily stress in this patient population.

Effects of Cognitive Behavior Therapy on Heart Rate Variability in Young Females with Constipation-predominant Irritable Bowel Syndrome: A Parallel-group Trial

“…1,10 IBS has been attributed to GI sensory-motor dysfunction, such as intestinal dysmotility, visceral hypersensitivity, intestinal bacterial overgrowth, inflammation, food sensitivity or intolerance, genetic factors, and psychosocial dysfunction. 3,[11][12][13] Recent evidence suggests that alterations in the brain-gut axis play an important role in IBS, 14,15 including altered sympathetic and parasympathetic activities of the autonomic nervous system (ANS). 16 Similarly, patients with IBS are known to have a higher occurrence of mood disturbances, anxiety, depression, somatization disorders, and psychological distress, 15,17 and the central nervous system (CNS) is believed to be involved in the concomitance of these conditions.…”

“…3,[11][12][13] Recent evidence suggests that alterations in the brain-gut axis play an important role in IBS, 14,15 including altered sympathetic and parasympathetic activities of the autonomic nervous system (ANS). 16 Similarly, patients with IBS are known to have a higher occurrence of mood disturbances, anxiety, depression, somatization disorders, and psychological distress, 15,17 and the central nervous system (CNS) is believed to be involved in the concomitance of these conditions. 15,18,19 Heart rate variability (HRV) is a noninvasive measure of ANS activities.…”

“…16 Similarly, patients with IBS are known to have a higher occurrence of mood disturbances, anxiety, depression, somatization disorders, and psychological distress, 15,17 and the central nervous system (CNS) is believed to be involved in the concomitance of these conditions. 15,18,19 Heart rate variability (HRV) is a noninvasive measure of ANS activities. Power spectral analysis of HRV allows the assessment of predominance in sympathetic or parasympathetic activities.…”

“…3,5 Non-pharmacologic treatments, such as cognitive behavior therapy (CBT), have been effective in improving somatic symptoms of IBS. 15,22,23 The mechanism by which CBT improves somatic symptoms is related to the regulation of brain-gut axis function. 15,22,24 HRV is an objective, noninvasive biomarker that reflects current ANS function correlated with IBS symptoms.…”

“…15,22,23 The mechanism by which CBT improves somatic symptoms is related to the regulation of brain-gut axis function. 15,22,24 HRV is an objective, noninvasive biomarker that reflects current ANS function correlated with IBS symptoms. Thus, HRV may supplement clinical decisions in IBS patients who undergo CBT.…”