Prediction of symptomatic improvement after exposure-based treatment for irritable bowel syndrome

BMC Gastroenterology

Erik Hedman¹  Hugo Hesser²  Timo Hursti⁷  Evelyn Andersson⁴  Karin Romberg⁷  Johanna Norén⁷  Katarina Molin⁷  Karin Grönberg⁷  Jeffrey M Lackner⁵  Perjohan Lindfors⁶  Erik Andersson⁴  Brjánn Ljótsson³ 

[1] Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden;Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden;Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, Stockholm 171 65, Sweden;Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden;Department of Medicine, University at Buffalo School of Medicine and Biomedical Science, ECMC, Buffalo, NY, USA;Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden;Department of Psychology, Uppsala University, Uppsala, Sweden

关键词: Prediction analysis;    Psychological treatment;    Cognitive behavior therapy;    Internet;    Exposure;    Irritable bowel syndrome;   

Others  :  857469
DOI  :  10.1186/1471-230X-13-160

 received in 2013-06-12, accepted in 2013-11-14,  发布年份 2013

【 摘 要 】

Background

Several studies show that psychological treatments relieve symptoms for patients suffering from irritable bowel syndrome (IBS). However, there are no consistent findings that show what patient characteristics make a psychological treatment more or less likely to result in improvement. We have previously conducted a study of a newly developed internet-delivered cognitive behavioral therapy (ICBT) that emphasized exposure to IBS symptoms and IBS-related situations and reduced symptom-related avoidance. The study showed that the treatment led to improvement in IBS symptoms compared to a waiting list and that treatment gains were maintained over a 15–18 month follow-up period. The aim of the present study was to investigate several possible predictors of short- and long-term treatment outcome in terms of symptom improvement, based on data collected in the previously conducted treatment trial.

Methods

Demographics, comorbid psychological distress, IBS-related fear and avoidance behaviors, and IBS-related disability were investigated as predictors of treatment outcome in the sample consisting of 79 participants diagnosed with IBS who had undergone 10 weeks of ICBT. Predictors that were significantly correlated with symptom levels at post-treatment and follow-up were entered into multiple regression analyses that controlled for pre-treatment symptom levels.

Results

There were measures within each domain, i.e., comorbid psychological distress, IBS-related fear and avoidance behaviors, and IBS-related disability, with the exception of demographic data, that were correlated with the symptom levels at post-treatment and follow-up. However, when these were entered into a multiple regression analyses that controlled for pre-treatment levels, none remained a significant predictor of the post-treatment and follow-up symptomatic status.

Conclusions

The study did not find any individual characteristics that made patients more or less likely to respond to the exposure-based ICBT. The finding that comorbid psychological distress did not predict outcome is in accordance with previous studies. Reliable predictors for response to any type of psychological treatment for IBS remain to be established.

【 授权许可】

   
2013 Ljótsson et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Lovell RM, Ford AC: Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012, 10:712-721. e4
• [2]Longstreth G, Thompson W, Chey W, Houghton L, Mearin F, Spiller RC: Functional bowel disorders. Gastroenterology 2006, 130:1480-1491.
• [3]Halder S, Locke G, Talley NJ, Fett S, Zinsmeister A, Melton L: Impact of functional gastrointestinal disorders on health-related quality of life: a population-based case–control study. Aliment Pharmacol Ther 2004, 19:233-242.
• [4]Talley NJ, Gabriel S, Harmsen W, Zinsmeister A, Evans R: Medical costs in community subjects with irritable bowel syndrome. Gastroenterology 1995, 109:1736-1741.
• [5]Ford A, Talley NJ, Schoenfeld P, Quigley E, Moayyedi P: Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut 2009, 58:367-378.
• [6]Ljótsson B, Hesser H, Andersson E, Lindfors P, Hursti T, Rück C, Lindefors N, Andersson G, Hedman E: Mechanisms of change in an exposure-based treatment for irritable bowel syndrome. J Consult Clin Psychol 2013. http://dx.doi.org/10.1037/a0033439 webcite
• [7]Kraemer H, Wilson G, Fairburn C, Agras W: Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 2002, 59:877-883.
• [8]Whitehead W, Palsson O, Jones K: Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology 2002, 122:1140-1156.
• [9]Drossman DA, Camilleri M, Mayer EA, Whitehead W: AGA technical review on irritable bowel syndrome. Gastroenterology 2002, 123:2108-2131.
• [10]Galovski T, Blanchard E: The treatment of irritable bowel syndrome with hypnotherapy. Appl Psychophysiol Biofeedback 1998, 23:219-232.
• [11]Guthrie E, Creed F, Dawson D, Tomenson B: A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology 1991, 100:450-457.
• [12]Carruthers HR, Morris J, Tarrier N, Whorwell PJ: Mood color choice helps to predict response to hypnotherapy in patients with irritable bowel syndrome. BMC Complement Altern Med 2010, 10:75. BioMed Central Full Text
• [13]Reme SE, Kennedy T, Jones R, Darnley S, Chalder T: Predictors of treatment outcome after cognitive behavior therapy and antispasmodic treatment for patients with irritable bowel syndrome in primary care. J Psychosom Res 2010, 68:385-388.
• [14]Drossman DA, Toner B, Whitehead W, Diamant N, Dalton C, Duncan S, Emmott S, Proffitt V, Akman D, Frusciante K, Le T, Meyer K, Bradshaw B, Mikula K, Morris C, Blackman C, Hu Y, Jia H, Li J, Koch G, Bangdiwala S: Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology 2003, 125:19-31.
• [15]Blanchard EB, Lackner JM, Gusmano R, Gudleski GD, Sanders K, Keefer L, Krasner S: Prediction of treatment outcome among patients with irritable bowel syndrome treated with group cognitive therapy. Behav Res Ther 2006, 44:317-337.
• [16]Blanchard EB, Schwarz SP, Neff DF, Gerardi MA: Prediction of outcome from the self-regulatory treatment of irritable bowel syndrome. Behav Res Ther 1988, 26:187-190.
• [17]Blanchard E, Scharff L, Payne A, Schwarz S, Suls J, Malamood H: Prediction of outcome from cognitive-behavioral treatment of irritable bowel syndrome. Behav Res Ther 1992, 30:647-650.
• [18]Whorwell PJ, Prior A, Colgan SM: Hypnotherapy in severe irritable bowel syndrome: further experience. Gut 1987, 28:423-425.
• [19]Harvey R, Hinton R, Gunary R, Barry R: Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1989, 1:424-425.
• [20]Gonsalkorale W, Houghton L, Whorwell P: Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol 2002, 97:954-961.
• [21]Creed F, Ratcliffe J, Fernandes L, Palmer S, Rigby C, Tomenson B, Guthrie E, Read N, Thompson D: Outcome in severe irritable bowel syndrome with and without accompanying depressive, panic and neurasthenic disorders. Br J Psychiatry 2005, 186:507-515.
• [22]Creed F, Guthrie E, Ratcliffe J, Fernandes L, Rigby C, Tomenson B, Read N, Thompson D: North of England I: does psychological treatment help only those patients with severe irritable bowel syndrome who also have a concurrent psychiatric disorder? Aust NZ J Psychiat 2005, 39:807-815.
• [23]Creed F, Tomenson B, Guthrie E, Ratcliffe J, Fernandes L, Read N, Palmer S, Thompson D: The relationship between somatisation and outcome in patients with severe irritable bowel syndrome. J Psychosom Res 2008, 64:613-620.
• [24]Lackner JM, Jaccard J, Krasner SS, Katz LA, Gudleski GD, Blanchard EB: How does cognitive behavior therapy for irritable bowel syndrome work? a mediational analysis of a randomized clinical trial. Gastroenterology 2007, 133:433-444.
• [25]Ljótsson B, Andersson G, Andersson E, Hedman E, Lindfors P, Andréewitch S, Rück C, Lindefors N: Acceptability, effectiveness, and cost-effectiveness of internet-based exposure treatment for irritable bowel syndrome in a clinical sample: a randomized controlled trial. BMC Gastroenterol 2011, 11:110. BioMed Central Full Text
• [26]Ljótsson B, Andréewitch S, Hedman E, Rück C, Andersson G, Lindefors N: Exposure and mindfulness based therapy for irritable bowel syndrome - an open pilot study. J Behav Ther Exp Psychiatry 2010, 41:185-190.
• [27]Ljótsson B, Falk L, Vesterlund AW, Hedman E, Lindfors P, Rück C, Hursti T, Andréewitch S, Jansson L, Lindefors N, Andersson G: Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome–a randomized controlled trial. Behav Res Ther 2010, 48:531-539.
• [28]Ljótsson B, Hedman E, Andersson E, Hesser H, Lindfors P, Hursti T, Rydh S, Rück C, Lindefors N, Andersson G: Internet-delivered exposure-based treatment vs. stress management for irritable bowel syndrome: a randomized trial. Am J Gastroenterol 2011, 106:1481-1491.
• [29]Craske MG, Wolitzky-Taylor KB, Labus J, Wu S, Frese M, Mayer EA, Naliboff BD: A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behav Res Ther 2011, 49:413-421.
• [30]Hunt M, Moshier S, Milonova M: Brief cognitive-behavioral internet therapy for irritable bowel syndrome. Behav Res Ther 2009, 47:797-802.
• [31]Labus J, Bolus R, Chang L, Wiklund I, Naesdal J, Mayer EA, Naliboff B: The visceral sensitivity index: development and validation of a gastrointestinal symptom-specific anxiety scale. Aliment Pharmacol Ther 2004, 20:89-97.
• [32]Jerndal P, Ringstrom G, Agerforz P, Karpefors M, Akkermans L, Bayati A, Simrén M: Gastrointestinal-specific anxiety: an important factor for severity of GI symptoms and quality of life in IBS. Neurogastroenterol Motil 2010, 22:646-e179.
• [33]Labus J, Mayer EA, Chang L, Bolus R, Naliboff B: The central role of gastrointestinal-specific anxiety in irritable bowel syndrome: further validation of the visceral sensitivity index. Psychosom Med 2007, 69:89-98.
• [34]Ljótsson B, Hedman E, Lindfors P, Hursti T, Lindefors N, Andersson G, Rück C: Long-term follow-up of internet-delivered exposure and mindfulness based treatment for irritable bowel syndrome. Behav Res Ther 2011, 49:58-61.
• [35]Hedman E, Ljótsson B, Rück C, Furmark T, Carlbring P, Lindefors N, Andersson G: Internet administration of self-report measures commonly used in research on social anxiety disorder: a psychometric evaluation. Comput Hum Behav 2010, 26:736-740.
• [36]Wiklund I, Fullerton S, Hawkey C, Jones R, Longstreth G, Mayer EA, Peacock R, Wilson I, Naesdal J: An irritable bowel syndrome-specific symptom questionnaire: development and validation. Scand J Gastroenterol 2003, 38:947-954.
• [37]Sheehan D, Lecrubier Y, Sheehan K, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar G: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998, 59(Suppl 20):22-33.
• [38]Svanborg P, Åsberg M: A new self-rating scale for depression and anxiety states based on the comprehensive psychopathological rating scale. Acta Psychiatr Scand 1994, 89:21-28.
• [39]Gustavsson JP, Bergman H, Edman G, Ekselius L, Von Knorring L, Linder J: Swedish universities scales of personality (SSP): construction, internal consistency and normative data. Acta Psychiatr Scand 2000, 102:217-225.
• [40]Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L: The Hopkins symptom checklist (HSCL) - A measure of primary symptom dimensions. In Psychological Measurements in Psychopharmacology. Edited by Pichot P. Basel: Karger; 1974.
• [41]Rosenstiel A, Keefe F: The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 1983, 17:33-44.
• [42]Reiss S, Peterson RA, Gursky DM, McNally RJ: Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther 1986, 24:1-8.
• [43]Patrick D, Drossman DA, Frederick I, DiCesare J, Puder K: Quality of life in persons with irritable bowel syndrome: development and validation of a new measure. Dig Dis Sci 1998, 43:400-411.
• [44]Sheehan D: The Sheehan Disability Scales. New York City, NY: Charles Scribner and Sons; 1983:151. [The Anxiety Disease and How to Overcome It]
• [45]Hedman E, Ljótsson B, Lindefors N: Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost–effectiveness. Expert Rev Pharmacoecon Outcomes Res 2012, 12:745-764.
• [46]Steketee G, Chambless D: Methodological issues in prediction of treatment outcome. Clin Psychol Rev 1992, 12:387-400.
• [47]MacCallum RC, Zhang S, Preacher KJ, Rucker DD: On the practice of dichotomization of quantitative variables. Psychol Methods 2002, 7:19-40.
• [48]Clark D, Ehlers A: An overview of the cognitive theory and treatment of panic disorder. App Prev Psychol 1993, 2:131-139.
• [49]Hayes SC, Wilson K, Gifford E, Follette V, Strosahl K: Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol 1996, 64:1152-1168.
• [50]Rief W, Broadbent E: Explaining medically unexplained symptoms-models and mechanisms. Clin Psychol Rev 2007, 27:821-841.
• [51]Dorn SD, Kaptchuk TJ BPJ, Nguyen LT, Canenguez K, Nam BH, Woods KB, Conboy LA, Stason WB, Lembo AJ: A meta-analysis of the placebo response in complementary and alternative medicine trials of irritable bowel syndrome. Neurogastroenterol Motil 2007, 19:630-637.
• [52]Spiller RC, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P: Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut 2007, 56:1770-1798.
• [53]Reme SE, Darnley S, Kennedy T, Chalder T: The development of the irritable bowel syndrome-behavioral responses questionnaire. J Psychosom Res 2010, 69:319-325.
• [54]Kennedy T, Jones R, Darnley S, Seed P, Wessely S, Chalder T: Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial. Br Med J 2005, 331:435.
• [55]Hedman E, Andersson E, Ljótsson B, Andersson G, Andersson E, Schalling M, Lindefors N, Rück C: Clinical and genetic outcome determinants of Internet- and group-based cognitive behavior therapy for social anxiety disorder. Acta Psychiatr Scand 2012, 126:126-136.
• [56]Hedman E, Lindefors N, Andersson G, Andersson E, Lekander M, Rück C, Ljótsson B: Predictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety. Behav Res Ther 2013, 51:711-717.
• [57]Ljótsson B, Atterlöf E, Lagerlöf M, Andersson E, Jernelöv S, Hedman E, Kemani M, Wicksell RK: Internet-delivered acceptance and values-based exposure treatment for fibromyalgia: a pilot study. Cogn Behav Ther 2013. http://dx.doi.org/10.1080/16506073.2013.846401 webcite
• [58]Lackner JM, Gudleski GD, Keefer L, Krasner SS, Powell C, Katz LA: Rapid response to cognitive behavior therapy predicts treatment outcome in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2010, 8:426-432.