Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome

Lackner, Jeffrey M.; Jaccard, James; Keefer, Laurie; Brenner, Darren M.; Firth, Rebecca; Gudleski, Gregory D.; Hamilton, Frank A.; Katz, Leonard; Krasner, Susan S.; Chang, Xing; Radziwon, Christopher; Sitrin, Michael D.

doi:10.1053/j.gastro.2018.03.063

Cited by 150 publications

(140 citation statements)

References 36 publications

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“…Cognitive behavioral therapy is a known therapy to treat neurological disorders such as mood disorders, anxiety, and depression . As IBS patients often report similar neurological disorders, the efficacy of CBT to improve the quality of life of IBS patients may not be surprising . Moreover, anecdotal clinical evidence suggests that CBT is an efficient intervention to treat visceral pain in IBS patients.…”

Section: Discussionsupporting

confidence: 55%

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Environmental enrichment prevents chronic stress‐induced brain‐gut axis dysfunction through a GR‐mediated mechanism in the central nucleus of the amygdala

Orock

Louwies

Tian

et al. 2020

Neurogastroenterology Motil

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The usefulness of psychotherapy, such as cognitive behavioral therapy (CBT) that encompasses cognitive and behavioral strategies that aim to improve the underlying thinking or behavioral patterns, extends far beyond the treatment of stress-related mood and psychological disorders such as anxiety and depression. 1-3 Nowadays, CBT is also being used to improve the quality of life in patients suffering from chronic pain, such as musculoskeletal pain, 4-6 pelvic pain, 7 and arthritic pain. 8 Clinical evidence suggests that CBT also improves in the overall symptomatology of patients with irritable bowel syndrome (IBS). 9 Irritable bowel syndrome a common gastrointestinal disorders characterized by chronic abdominal pain, due to increased visceral sensitivity, and abnormal bowel habits. These symptoms Abstract Background: Cognitive behavioral therapy (CBT) improves quality of life of patients with irritable bowel syndrome (IBS), a disorder characterized by chronic visceral pain and abnormal bowel habits. Whether CBT can actually improve visceral pain in IBS patients is still unknown. The aim of this study is to evaluate whether environment enrichment (EE), the animal analog of CBT, can prevent stress-induced viscerosomatic hypersensitivity through changes in glucocorticoid receptor (GR) signaling within the central nucleus of the amygdala (CeA).Methods: Rats were housed in either standard housing (SH) or EE for 7 days before and during daily water avoidance stress (WAS) exposure (1-h/d for 7 days). In the first cohort, visceral and somatic sensitivity were assessed via visceromotor response to colorectal distention and von Frey Anesthesiometer 24 hous and 21 days after WAS.In another cohort, the CeA was isolated for GR mRNA quantification.Key Results: Environment enrichment for 7 days before and during the 7 days of WAS persistently attenuated visceral and somatic hypersensitivity when compared to rats placed in SH. Environment enrichment exposure also prevented the WASinduced decrease in GR expression in the CeA. Conclusion & Inferences:Pre-exposure to short-term EE prevents the stress-induced downregulation of GR, and inhibits visceral and somatic hypersensitivity induced by chronic stress. These results suggest that a positive environment can ameliorate stress-induced pathology and provide a non-pharmacological therapeutic option for disorders such as IBS. K E Y W O R D Senvironmental enrichment, pain, rat, visceral hypersensitivity

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Section: Discussionsupporting

confidence: 55%

“…Clinical evidence suggests that CBT also improves in the overall symptomatology of patients with irritable bowel syndrome (IBS) . Irritable bowel syndrome a common gastrointestinal disorders characterized by chronic abdominal pain, due to increased visceral sensitivity, and abnormal bowel habits.…”

Section: Introductionmentioning

confidence: 99%

Environmental enrichment prevents chronic stress‐induced brain‐gut axis dysfunction through a GR‐mediated mechanism in the central nucleus of the amygdala

Orock

Louwies

Tian

et al. 2020

Neurogastroenterology Motil

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“…Due to the relative lack in therapist availability, clinical implementation of these therapies is still limited. Recent attempts to reduce resource use without compromising effectiveness may assist in making psychological treatment more widely available; for example, group hypnotherapy, Internet‐delivered exposure‐based CBT, and home‐based CBT . In that light, it will be interesting to explore whether these developments can affect long‐term quality of life and well‐being in patients with IBS.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to GI symptom severity, we found that quality of life did not improve over time in those that were Rome III-negative at Internet-delivered exposure-based CBT, 50 and home-based CBT. 51 In that light, it will be interesting to explore whether these developments can affect long-term quality of life and well-being in patients with IBS.…”

Section: Clevers Et Al Recently Evaluated Longitudinal Symptom Changementioning

confidence: 99%

Reduction in IBS symptom severity is not paralleled by improvement in quality of life in patients with irritable bowel syndrome

Weerts

Vork

Mujagic

et al. 2019

Neurogastroenterology Motil

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Background Irritable bowel syndrome (IBS) is a brain‐gut disorder, of which the natural course varies between patients and is difficult to predict. This study aimed to evaluate symptom evolution over a 5‐year follow‐up period and to identify baseline predictors for symptom severity and quality of life (QoL) at follow‐up. Methods Maastricht IBS cohort participants completed questionnaires upon inclusion regarding demographics and lifestyle, gastrointestinal (GI) symptoms, anxiety and depression, and QoL. The same questionnaires, in addition to others, were completed after 5 years. Rome criteria were confirmed face‐to‐face at initial enrollment and through telephonic interviews at follow‐up. Key Results At a mean follow‐up of 4.7 years, 379 patients were approached of whom 203 (53.7%) responded. Of these, 161 were reached by telephone and analyzed; 49 (30.4%) did not fulfill the Rome III criteria at follow‐up and had lower levels of GI symptoms and GI‐specific anxiety compared to those remaining Rome III‐positive (P < 0.001). However, Rome III‐negative patients had comparable levels of QoL and life satisfaction, comorbid anxiety and depression, work absenteeism, and impaired productivity. No baseline predictors were found for being Rome III‐positive or Rome III‐negative. However, greater age and lower baseline physical QoL predicted lower physical QoL at follow‐up (P < 0.005 and P < 0.01, respectively), while lower baseline mental QoL predicted lower mental QoL at follow‐up (P = 0.005). Additionally, higher anxiety and depression scores at follow‐up were associated with lower QoL and life satisfaction at follow‐up (P < 0.001). Conclusions and Inferences Long‐term QoL and general well‐being might depend on concurrent psychological symptoms, rather than GI symptom improvement.

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“…Cognitive behavioural therapy is considered to be safe, but AEs have not been well documented in clinical trials . However, a 2018 clinical study of cognitive behavioural therapy in patients with IBS (n = 436) reported one AE of suicide attempt, which was not considered to be related to treatment . The number needed to harm for cognitive behavioural therapy has not been published.…”

Section: Resultsmentioning

confidence: 99%

Review article: an analysis of safety profiles of treatments for diarrhoea‐predominant irritable bowel syndrome

Lacy

2018

Aliment Pharmacol Ther

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Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome

Abstract: In a randomized controlled trial, we found that a primarily home-based version of CBT produced significant and sustained gastrointestinal symptom improvement for patients with IBS compared with education. Clinicaltrials.gov no.: NCT00738920.

Cited by 150 publications

References 36 publications

Environmental enrichment prevents chronic stress‐induced brain‐gut axis dysfunction through a GR‐mediated mechanism in the central nucleus of the amygdala

Environmental enrichment prevents chronic stress‐induced brain‐gut axis dysfunction through a GR‐mediated mechanism in the central nucleus of the amygdala

Reduction in IBS symptom severity is not paralleled by improvement in quality of life in patients with irritable bowel syndrome

Review article: an analysis of safety profiles of treatments for diarrhoea‐predominant irritable bowel syndrome

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