title: A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome.
abstract: We randomized, at two sites, 210 patients with Rome II diagnosed irritable bowel syndrome (IBS), of at least moderate severity, to one of three conditions: group-based cognitive therapy (CT; n=120), psychoeducational support groups (n=46) as an active control, or intensive symptom and daily stress monitoring (n=44). One hundred eighty-eight participants completed the initial treatment. Those in symptom monitoring were then crossed over to CT. For an intent to treat analysis on a composite GI symptom measure derived from daily symptom diaries, both CT and the psychoeducational support groups were significantly more improved than those in the intensive symptom monitoring condition, but the CT and psychoeducational support group did not differ. Among treatment completers on the same composite measure of GI symptoms, again, both CT and psychoeducational support groups were statistically superior to symptom monitoring but did not differ on the symptom composite, or on any other measure. On individual IBS symptoms, both CT and psychoeducational support were statistically superior to symptom monitoring on reductions in abdominal pain and tenderness and for flatulence. Patient global ratings at the end of treatment showed the two active conditions statistically superior to symptom monitoring on change in Bowel Regularity, with CT superior to symptom monitoring on reduction in overall pain and in improvement in sense of well-being. Three-month follow-up data on 175 patients revealed maintenance of significant improvement or continued significant improvement on all IBS symptoms, including the McGill Pain Questionnaire. Group CT and psychoeducational support groups continued not to differ on any measure. We thus conclude that group CT is not superior to an attention placebo control condition.
authors.affiliation: Center for Stress and Anxiety Disorders, University at Albany, Albany, NY 12222, USA. ebblanchard@yahoo.com
authors.forename: Edward B
authors.initials: EB
authors.lastname: Blanchard
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Lackner
authors.forename: Kathryn
authors.initials: K
authors.lastname: Sanders
authors.forename: Susan
authors.initials: S
authors.lastname: Krasner
authors.forename: Laurie
authors.initials: L
authors.lastname: Keefer
authors.forename: Annette
authors.initials: A
authors.lastname: Payne
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Gudleski
authors.forename: Leonard
authors.initials: L
authors.lastname: Katz
authors.forename: Dianna
authors.initials: D
authors.lastname: Rowell
authors.forename: Mark
authors.initials: M
authors.lastname: Sykes
authors.forename: Eric
authors.initials: E
authors.lastname: Kuhn
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gusmano
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Carosella
authors.forename: Rebecca
authors.initials: R
authors.lastname: Firth
authors.forename: Lisa
authors.initials: L
authors.lastname: Dulgar-Tulloch
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018579:Patient Selection; D011615:Psychotherapy, Group / Q000379:methods*; D012657:Self-Help Groups; D012720:Severity of Illness Index; D016896:Treatment Outcome