Several psychological therapies found to be efficacious for IBS
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According to a systematic review and network analysis published in Gut, several psychological therapies were efficacious for treatment of irritable bowel syndrome; however, none were better compared with another.
“[Cognitive behavioral therapy] CBT-based interventions and gut-directed hypnotherapy had the largest evidence base and were the most efficacious long term,” Christopher J. Black, MD, from the Leeds Gastroenterology Institute at St. James’s University Hospital, and colleagues wrote. “Future [randomized controlled trials] RCTs should carefully select control conditions, consider the impact of adverse effects on outcomes, and examine the influence of psychological therapy earlier in the disease course to address clinical needs, before patients are refractory to medical management. Addressing these gaps in the current literature will help policy-makers refine clinical guidelines, so health care providers can more efficiently and effectively address patients’ needs in front-line practice settings.”
Black and colleagues searched medical literature for RTCs that evaluated the efficacy of psychological therapies for adults with irritable bowel syndrome, compared with each other or with a control intervention. Investigators identified 41 RCTs that included 4,072 patients. All trials included an evaluation of symptom status after completion of therapy. Black and colleagues used a random effects model to pool data. Efficacy was reported as a pooled relative risk for remaining symptomatic. Researchers ranked efficacy by therapy based on P score.
Results showed self-administered or minimal CBT (RR = 0.61; 95% CI, 0.45 to 0.83; P = .66), face-to- face CBT (RR = 0.62; 95% CI, 0.48 to 0.8; P = .65) and gut-directed hypnotherapy (RR = 0.67; 95% CI, 0.49 to 0.91; P = .57) were the psychological interventions with the largest number of trials and patients recruited that demonstrated efficacy after therapy completion. Group cognitive behavioral therapy and gut-directed hypnotherapy were more efficacious compared with education and or support or routine care among trials that only recruited patients with refractory symptoms. Additionally, CBT via telephone, contingency management, CBT via internet and dynamic psychotherapy were all greater compared with routine care.
Investigators noted the risk for bias of trials was high and there was evidence of funnel plot symmetry. This demonstrates the efficacy of psychological therapies may have been overestimated.
“Our study confirmed prior findings that psychological therapies are more efficacious than control interventions,” the investigators wrote. “Similar to our previous systematic review and trial-based meta-analysis, we found CBT and gut-directed hypnotherapy to have the largest evidence base. However, we found that CBT can be efficacious when administered in various forms, including via the telephone, group or self-administered/minimal contact, which differed from earlier findings.” – by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.
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Black CJ, et al. Gut. 2020;doi:10.1136/gutjnl-2020-321191.
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