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肠易激综合征的新型心理疗法:正念、接纳与承诺疗法(ACT)

New psychological therapies for irritable bowel syndrome: mindfulness, acceptance and commitment therapy (ACT).

作者信息

Sebastián Sánchez Beatriz, Gil Roales-Nieto Jesús, Ferreira Nuno Bravo, Gil Luciano Bárbara, Sebastián Domingo Juan José

机构信息

Psicología, Universidad de Almería.

Psychology, University of Edinburgh.

出版信息

Rev Esp Enferm Dig. 2017 Sep;109(9):648-657. doi: 10.17235/reed.2017.4660/2016.

Abstract

The current goal of treatment in irritable bowel syndrome (IBS) focuses primarily on symptom management and attempts to improve quality of life. Several treatments are at the disposal of physicians; lifestyle and dietary management, pharmacological treatments and psychological interventions are the most used and recommended. Psychological treatments have been proposed as viable alternatives or compliments to existing care models. Most forms of psychological therapies studied have been shown to be helpful in reducing symptoms and in improving the psychological component of anxiety/depression and health-related quality of life. According to current NICE/NHS guidelines, physicians should consider referral for psychological treatment in patients who do not respond to pharmacotherapy for a period of 12 months and develop a continuing symptom profile (described as refractory irritable bowel syndrome). Cognitive behavioral therapy (CBT) is the best studied treatment and seems to be the most promising therapeutic approach. However, some studies have challenged the effectiveness of this therapy for irritable bowel syndrome. One study concluded that cognitive behavioral therapy is no more effective than placebo attention control condition and another study showed that the beneficial effects wane after six months of follow-up. A review of mind/body approaches to irritable bowel syndrome has therefore suggested that alternate strategies targeting mechanisms other than thought content change might be helpful, specifically mindfulness and acceptance-based approaches. In this article we review these new psychological treatment approaches in an attempt to raise awareness of alternative treatments to gastroenterologists that treat this clinical syndrome.

摘要

肠易激综合征(IBS)目前的治疗目标主要集中在症状管理以及提高生活质量上。医生有多种治疗方法可供选择;生活方式和饮食管理、药物治疗以及心理干预是最常用且被推荐的方法。心理治疗已被提议作为现有护理模式的可行替代方案或补充。大多数已研究的心理治疗形式都已被证明有助于减轻症状,并改善焦虑/抑郁的心理成分以及与健康相关的生活质量。根据目前英国国家卫生与临床优化研究所(NICE)/英国国民医疗服务体系(NHS)的指南,对于那些在12个月内对药物治疗无反应且症状持续存在(被描述为难治性肠易激综合征)的患者,医生应考虑转介其接受心理治疗。认知行为疗法(CBT)是研究最多的治疗方法,似乎也是最有前景的治疗途径。然而,一些研究对这种疗法治疗肠易激综合征的有效性提出了质疑。一项研究得出结论,认知行为疗法并不比安慰剂对照更有效,另一项研究表明,随访6个月后其有益效果逐渐减弱。因此,一篇关于肠易激综合征身心治疗方法的综述建议,针对思维内容改变以外机制的替代策略可能会有所帮助,特别是正念和基于接纳的方法。在本文中,我们回顾这些新的心理治疗方法,旨在提高治疗这种临床综合征的胃肠病学家对替代治疗方法的认识。

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