Psychological treatments for irritable bowel syndrome: a critique of controlled treatment trials.
OBJECTIVE
We aimed to determine the efficacy of psychological treatments in irritable bowel syndrome.


METHODS
A systematic review of the literature on psychological treatments of IBS was performed using Medline (1966-1994) and Psychlit (1974-1994) and secondary references. Fully published studies in English were selected if they compared any type of "psychological" treatment of irritable bowel syndrome with a control group. Studies without any comparable control group, studies in which the subject group was not confined to irritable bowel syndrome sufferers, and those in which irritable bowel syndrome symptoms were not the primary outcome measures were excluded. Each study was reviewed using a structured format to examine methodological issues. A quality algorithm was developed a priori based on eight key requirements.


RESULTS
Eight studies (57%) reported that a psychological treatment was superior to control therapy; five failed to detect a significant effect, and one did not report if psychological treatment was superior. By the quality algorithm, only one study (a hypnotherapy trial) exceeded the preset cutoff score of 6, but this study was poorly generalizable due to sample selection.


CONCLUSIONS
The efficacy of psychological treatment for irritable bowel syndrome has not been established because of methodological inadequacies; future trials need to address these design limitations.
Talley
N J
NJ
University of Sydney, Australia.
Owen
B K
BK
Boyce
P
P
Paterson
K
K
D000465:Algorithms; D003109:Colonic Diseases, Functional / Q000188:drug therapy / Q000628:therapy*; D018849:Controlled Clinical Trials as Topic / Q000592:standards*; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D006801:Humans; D006990:Hypnosis; D010349:Patient Compliance; D010919:Placebos; D011613:Psychotherapy; D011897:Random Allocation; D013997:Time Factors
D010919:Placebos