title: Cognitive therapy for irritable bowel syndrome is associated with reduced limbic activity, GI symptoms, and anxiety.
abstract: This study sought to identify brain regions that underlie symptom changes in severely affected IBS patients undergoing cognitive therapy (CT). Five healthy controls and 6 Rome II diagnosed IBS patients underwent psychological testing followed by rectal balloon distention while brain neural activity was measured with O-15 water positron emission tomography (PET) before and after a brief regimen of CT. Pre-treatment resting state scans, without distention, were compared to post-treatment scans using statistical parametric mapping (SPM). Neural activity in the parahippocampal gyrus and inferior portion of the right cortex cingulate were reduced in the post-treatment scan, compared to pre-treatment (x, y, z coordinates in MNI standard space were -30, -12, -30, P=0.017; 6, 34, -8, P=0.023, respectively). Blood flow values at these two sites in the controls were intermediate between those in the pre- and post-treatment IBS patients. Limbic activity changes were accompanied by significant improvements in GI symptoms (e.g., pain, bowel dysfunction) and psychological functioning (e.g., anxiety, worry). The left pons (-2, -26, -28, P=0.04) showed decreased neural activity which was correlated with post-treatment anxiety scores. Changes in neural activity of cortical-limbic regions that subserve hypervigilance and emotion regulation may represent biologically oriented change mechanisms that mediate symptom improvement of CT for IBS.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Behavioral Medicine Clinic, University at Buffalo School of Medicine, SUNY, ECMC, 462 Grider Street, Buffalo, NY 14215, USA. lackner@buffalo.edu
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Lackner
authors.forename: Mary
authors.initials: M
authors.lastname: Lou Coad
authors.forename: Howard R
authors.initials: HR
authors.lastname: Mertz
authors.forename: David S
authors.initials: DS
authors.lastname: Wack
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Katz
authors.forename: Susan S
authors.initials: SS
authors.lastname: Krasner
authors.forename: Rebecca
authors.initials: R
authors.lastname: Firth
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Mahl
authors.forename: Alan H
authors.initials: AH
authors.lastname: Lockwood
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001007:Anxiety / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods; D002560:Cerebrovascular Circulation; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008032:Limbic System / Q000000981:diagnostic imaging / Q000503:physiopathology*; D049268:Positron-Emission Tomography; D011569:Psychiatric Status Rating Scales; D012107:Research Design