VIENNA — Irritable bowel syndrome can be conceptualized as an anxiety disorder—and, as such, responsive to cognitive-behavioral therapy, according to Dr. Sergej Andreewitch.
“Core symptomatology of IBS is clearly physiological, but the cause of suffering and severe loss of function affecting many patients is better accounted for by the catastrophizing appraisal of symptoms and the related avoidance behavior,” Dr. Andreewitch said at the annual congress of the European College of Neuropsychopharmacology.
A program of cognitive-behavioral therapy (CBT) targeting the negative evaluation of GI symptoms and resultant dysfunctional avoidance behaviors associated with IBS brought substantial improvement to participants in his pilot study. Next, Dr. Andreewitch, who is affiliated with the Karolinska Institute, Stockholm, plans to develop the treatment program into an Internet-based intervention.
He reported on 13 consecutive women with a mean age of 32 years and an 11.5-year history of IBS who had been referred for CBT from Stockholm-area GI clinics. The treatment program involved a 2-hour session weekly for 10 weeks, with four or five patients per group. The therapeutic strategy was modeled on well-established CBT programs for a variety of anxiety disorders.
As is typical in IBS, psychiatric comorbidity was common in this cohort. Nine of the 13 patients met diagnostic criteria for a specific phobia, panic disorder, generalized anxiety disorder, or dysthymia.
The psychotherapeutic intervention showed substantial efficacy. Scores on the daily patient-rated GI Symptoms Checklist of abdominal pain, tenderness, bloating, diarrhea, and constipation dropped from a baseline mean of 31.4 to 17.2 at conclusion of the CBT program and remained there at reassessment 4 weeks later.
Similarly, mean scores on the Sheehan Disability Scale plummeted from 13.2 to 3.8, while Montgomery-Asberg Depression Rating Scale scores dropped from a baseline of 12.7 to 6.8, and Anxiety Sensitivity Index ratings went from 25.1 to 11.7. Meanwhile, mean scores on the IBS Quality of Life Index improved from a baseline of 53.1 to 83.0.
These outcomes compare quite favorably with conventional treatments, which typically are only moderately effective. These treatments include stool-modifying agents, analgesics, antidepressants, and dietary restriction, Dr. Andreewitch said.
The etiology of IBS is poorly understood. One current concept is that noxious stimuli in the gut activate the brain-gut axis, resulting in stimulation of fear and arousal centers in the central nervous system. It is second only to the common cold as a cause of work absences. Affected patients often have inordinately high rates of medical services utilization, he noted.