Cognitive therapy for irritable bowel syndrome is associated with reduced limbic activity, GI symptoms, and anxiety.
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.
Lackner
Jeffrey M
JM
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
Lou Coad
Mary
M
Mertz
Howard R
HR
Wack
David S
DS
Katz
Leonard A
LA
Krasner
Susan S
SS
Firth
Rebecca
R
Mahl
Thomas C
TC
Lockwood
Alan H
AH
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