Cognitive factors affect treatment response to medical and psychological treatments in functional bowel disorders.
OBJECTIVE
For clinical trials in functional bowel disorders (FBD), the definition of a responder, one who meets the predefined criteria for a clinical response, is needed. Factors that determine clinical response aside from treatment itself are unknown. The aim of this study was to determine what baseline and post-treatment factors affect treatment response.


METHODS
Females (n=397) with FBD entering a 12-week, four-arm, randomized NIH treatment trial (desipramine (DES), CBT, pill placebo, and education) were studied at baseline and after treatment. Demographic, clinical, psychosocial, and physiological variables were considered in the analysis. A responder was defined as a patient obtaining a score>3.5 on an averaged eight-item, five-point satisfaction-with-treatment questionnaire. Baseline and post-treatment logistic regressions were performed for each treatment condition to predict the responder outcome variable.


RESULTS
Similar cognitive features predisposed participants to treatment response across the treatment conditions: sense of control over the condition, positive relationship with therapist or study coordinator, confidence in treatment, improvement in maladaptive cognitions, and quality of life during treatment. Demographic and clinical variables studied were not predictive. Some treatment-specific effects predicting responder status were noted, including a reduction in stool frequency with DES treatment and lack of abuse history in the placebo group.


CONCLUSIONS
For medication, psychological, and placebo treatment in FBD, satisfaction with treatment depends on cognitive factors of confidence in treatments, perceived control over illness and symptoms, and reduction in negative cognitions related to symptom experience. Addressing these issues among patients with FBD may enhance treatment response to a variety of treatments.
Weinland
Stephan R
SR
Division of Gastroenterology and Hepatology, UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080, USA. stephan_weinland@med.unc.edu
Morris
Carolyn B
CB
Dalton
Christine
C
Hu
Yuming
Y
Whitehead
William E
WE
Toner
Brenda B
BB
Diamant
Nicholas
N
Leserman
Jane
J
Bangdiwala
Shrikant I
SI
Drossman
Douglas A
DA
D015746:Abdominal Pain; D000293:Adolescent; D000328:Adult; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D003109:Colonic Diseases, Functional / Q000523:psychology* / Q000628:therapy*; D003891:Desipramine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
D000929:Antidepressive Agents, Tricyclic; D003891:Desipramine