ABSTRACT
Patients with irritable bowel syndrome (IBS) (n = 121) were compared to 46 patients with inflammatory bowel disease (IBD), and to 45 nonpatient controls on a variety of psychological tests and on symptomatology. The most consistent finding was the ordering of group psychological test means such that, on 11 of 14 measures, IBS patients scored higher than IBD patients, who in turn scored higher than the nonpatient controls. The two patient groups differed significantly only on measures of anxiety with the IBS patients scoring significantly higher on all three measures. IBS patients also reported significantly more severity of abdominal pain than the IBD patients; while IBD patients reported more episodes of diarrhea, they did not rate them as significantly more severe than did the IBS patients. Various other parameters of the IBS population are also explored and implications for treatment and future study are discussed.
Subject(s)
Colonic Diseases, Functional/psychology , Inflammatory Bowel Diseases/psychology , Sick Role , Adaptation, Psychological , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Personality AssessmentABSTRACT
The presence of a diagnosable Axis I psychiatric disorder predicted significantly (P less than 0.001) lower likelihood of significant improvement among 90 irritable bowel syndrome patients given cognitive and behavioral treatments to help the disorder. Other psychological tests, including the MMPI, BDI, STAI, as well as demographic variables, failed to yield significant prediction.
Subject(s)
Cognitive Behavioral Therapy/methods , Colonic Diseases, Functional/therapy , Adolescent , Adult , Aged , Biofeedback, Psychology , Colonic Diseases, Functional/psychology , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Relaxation TherapyABSTRACT
Irritable Bowel Syndrome (IBS) patients were compared with Inflammatory Bowel Disease (IBD) patients and non-patient controls on four separate physiological measures (heart rate, finger-tip temperature, skin resistance level, and forehead EMG) for their physical reactivity to 'laboratory stressors'. It was predicted that the IBS patients would respond to these stressors with more physiological reactivity than the two other groups. There were initial basal differences among the groups on heart rate and finger-tip temperature: in general, the IBS patients had lower basal heart rates and the non-patient controls had lower finger-tip temperatures. These findings are contrary to the previous body of literature regarding possible sympathetic nervous system (SNS) arousal states in the IBS patient. The results also indicated IBS patients were not significantly different than the IBD patients or the non-patient controls in their reactivity to stressors. Previous literature has suggested that IBS in their reactivity to stressors. Previous literature has suggested that IBS patients have an enhanced SNS arousal or an SNS mediated reactivity to environmental stressors, our current study has not found these results.
Subject(s)
Inflammatory Bowel Diseases/physiopathology , Stress, Physiological/physiopathology , Adult , Arousal/physiology , Diagnosis, Differential , Electromyography , Facial Muscles/physiology , Female , Galvanic Skin Response/physiology , Heart Rate , Humans , Inflammatory Bowel Diseases/diagnosis , Male , Middle Aged , Multivariate Analysis , Muscle Contraction , Skin TemperatureABSTRACT
Results of 20 consecutive cases referred for post-traumatic headache (PT-HA) to a psychological practice were assessed for both psychiatric and neurological diagnoses. Nineteen of the 20 cases (95%) had a diagnosable psychiatric disorder, with 15 presenting with a post-traumatic stress disorder. Prior headache history was reported for only 25% of the referred patients, while a prior psychiatric disorder was found for 7 (35%) of the cases. Findings suggest that consideration of a psychiatric disorder should be made for PT-HA patients.
Subject(s)
Accidents, Traffic/psychology , Headache/psychology , Stress Disorders, Post-Traumatic/psychology , Female , Headache/etiology , Humans , Male , Psychiatric Status Rating Scales , Stress Disorders, Post-Traumatic/etiologyABSTRACT
We report two controlled comparisons of a previously validated multicomponent (relaxation, thermal biofeedback, and cognitive therapy) treatment for irritable bowel syndrome (IBS) to an ostensible attention-placebo control (pseudo-meditation and EEG alpha suppression biofeedback) and to a symptom-monitoring control. In Study 1 (n = 10 per condition) there were nonsignificant trends for the multicomponent treatment to be superior to the attention-placebo condition. In Study 2 (n = 30 per condition), we found no advantage for the multicomponent treatment over the attention-placebo condition. Subjects in both treatment conditions showed significant reductions in GI symptoms, as measured by daily symptom diaries, and significant reductions in trait anxiety and depression. The GI symptom reductions held up over a 6 month follow-up. Possible explanations for the results are explored.
Subject(s)
Behavior Therapy/methods , Colonic Diseases, Functional/therapy , Psychophysiologic Disorders/therapy , Adult , Attention , Awareness , Colonic Diseases, Functional/psychology , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Psychophysiologic Disorders/psychology , Sick RoleABSTRACT
Inflammatory bowel disease (IBD) encompasses two related gastrointestinal-tract diseases, ulcerative colitis (UC) and Crohn's Disease (CD). This study, a randomized controlled trial, compared the effectiveness of a multi-component behavioral treatment package (n = 11), which included IBD education, progressive muscle relaxation, thermal biofeedback, and training in use of cognitive coping strategies, to the effectiveness of symptom-monitoring (n = 10) as a control condition; 8 controls subsequently completed treatment. At posttreatment, the treatment group showed mean reductions on 5 symptoms, while the symptom monitoring controls showed mean reductions on all 8 symptoms. On a measure of Total Symptomatic change, the controls showed more improvement than the treated group; the treated controls at posttreatment, showed increases on all 8 symptoms. However, treated subjects perceived themselves as coping better with IBD, as feeling less IBD-related stress, and as experiencing less depression and anxiety. It is hypothesized that inherent differences may have existed between CD and UC subjects which could have led to the differences seen in treatment responses.
Subject(s)
Behavior Therapy/methods , Inflammatory Bowel Diseases/psychology , Adaptation, Psychological , Adult , Biofeedback, Psychology , Cognitive Behavioral Therapy , Female , Follow-Up Studies , Humans , Inflammatory Bowel Diseases/therapy , Male , Relaxation Therapy , Stress, Psychological/therapyABSTRACT
Nineteen of 27 patients suffering from Irritable Bowel Syndrome (IBS) who had completed a multicomponent treatment involving progressive muscle relaxation, thermal biofeedback, cognitive therapy and IBS education were located and evaluated 4 yr posttreatment. Seventeen of 19 (89.5, or 63% of the total original sample) rated themselves as more than 50% improved. Six of the 12 patients (50%) who submitted symptom monitoring diaries met our criteria for clinical improvement, i.e. achieving at least a 50% reduction in primary IBS symptom scores. The means on all measures at long-term follow-up were lower than those obtained prior to treatment. When follow-up symptom means were compared with pretreatment means, significant (P less than 0.05) reductions were obtained on abdominal pain/tenderness, diarrhea, nausea, and flatulence.
Subject(s)
Behavior Therapy/methods , Colonic Diseases, Functional/therapy , Adult , Colonic Diseases, Functional/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Sick RoleABSTRACT
Using a reliable and valid structured diagnostic interview scale (ADIS-R), and patients with careful medical characterization, we found significantly more diagnosable psychopathology, particularly anxiety disorders, among treatment seeking patients with irritable bowel syndrome than among comparable age and sex samples of treatment seeking patients with Inflammatory Bowel Disease. Significant differences were also found on the Hamilton Anxiety Rating Scale and Hamilton Rating Scale for Depression between IBS patients and the IBD patients and controls, who did not differ. Comparable levels of psychiatric disorder among parents of probands were found in all three groups. The results are consistent with Latimer's (1983) notion of IBS patients being a subclass of 'neurotics'.
Subject(s)
Anxiety Disorders/psychology , Colonic Diseases, Functional/psychology , Depressive Disorder/psychology , Adult , Colitis, Ulcerative/psychology , Crohn Disease/psychology , Female , Humans , Male , Neurotic Disorders/psychology , Risk FactorsABSTRACT
The psychological "side effects" of self-regulatory treatment (a combination of relaxation, thermal biofeedback, and cognitive therapy) for irritable bowel syndrome (IBS) were compared among 20 "successfully" treated patients, 12 "unsuccessfully" treated patients, and 9 patients who merely monitored symptoms for 12 weeks. Pretreatment and posttreatment scores on the Beck Depression Inventory, State-Trait Anxiety Inventory, and Psychosomatic Symptom Checklist were examined. "Successfully" treated patients had significant (p less than .01) reductions on all measures and significantly greater reductions on depression and state anxiety than the symptom monitoring group. Interestingly, the failures also showed a significant (p = .027) reduction in trait anxiety and no significant increases on other measures.
Subject(s)
Biofeedback, Psychology , Colonic Diseases, Functional/therapy , Relaxation , Adult , Aged , Anxiety/therapy , Body Temperature Regulation , Colonic Diseases, Functional/psychology , Combined Modality Therapy , Depression/therapy , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Psychological Tests , Psychophysiologic Disorders/therapyABSTRACT
We evaluated a multicomponent treatment program for IBS that had been adapted to a small-group format. Patient acceptance was satisfactory with 14 of 17 potential patients completing treatment. No reductions of GI symptoms were noted in a 12-week symptom-monitoring baseline phase; diarrhea became significantly worse. Treatment led to significant (p less than .05) reductions in abdominal pain and diarrhea. Nine of 14 (64.3%) patients were clinically improved.
Subject(s)
Colonic Diseases, Functional/therapy , Psychotherapy, Group/methods , Adult , Aged , Biofeedback, Psychology , Body Temperature Regulation , Combined Modality Therapy , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , RelaxationABSTRACT
Comparisons were made among patients with IBS (n = 55), tension headache (n = 69), or migraine headache (n = 68) and nonpatient controls (n = 64) on the MMPI and several other psychological tests, including BDI, STAI, Life Events, and Psychosomatic Symptom Checklist. With two nonsignificant exceptions (MMPI scale F and Life Events) the groups were consistently ordered, in terms of increasing psychological distress: Normals less than Migraine Headache less than Tension Headache less than IBS. The IBS patients were more like the tension headache patients than any other group. Subgroups of IBS patients, on the basis of presence or absence of diarrhea or constipation in addition to abdominal pain, were generally not significantly different on the psychological tests.
Subject(s)
Colonic Diseases, Functional/psychology , Headache/psychology , Migraine Disorders/psychology , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Muscle Contraction , Personality InventoryABSTRACT
Sixteen clients afflicted with irritable bowel syndrome (IBS) were reassessed 1 year following completion of a multicomponent treatment package incorporating progressive muscle relaxation, thermal biofeedback, cognitive therapy, and IBS education. For the 14 patients who kept a 2-week symptom diary, significant reductions in ratings of abdominal pain and tenderness, diarrhea, and flatulence were obtained comparing pretreatment and follow-up symptom-diary ratings. Eleven of 14 clients were improved over pretreatment levels, 57% met the criteria for clinical improvement of at least a 50% reduction in major symptom scores, and all but 1 of 16 rated themselves as subjectively improved.
