Radu Mădălina, Moldovan Ramona, Pintea Sebastian, Băban Adriana, Dumitrascu Dan
Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania.
2nd Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
J Gastrointestin Liver Dis. 2018 Sep;27(3):257-263. doi: 10.15403/jgld.2014.1121.273.bab.
Cognitive behavioural therapy (CBT) has small to medium effects in alleviating emotional distress and psychosomatic symptoms in irritable bowel syndrome (IBS). However, the mechanism through which CBT exerts its effects is less studied. Mediation analysis examines the extent to which intermediate variables explain the effect of the intervention on outcomes. The meta-analysis aims to identify and assess the impact of CBT mediators identified in previous research on IBS.
An extensive search of studies investigating the effects of CBT for IBS published before January 2018 was conducted. A total of 699 studies were identified through database search and 6 studies including data from 638 patients were analysed. The selected studies had to clearly define the CBT intervention, include IBS patients, report sufficient data to allow calculation of effect sizes and provide a clear mediation analysis of one or several variables on the outcome.
The total effect of CBT was significant for both categories of outcomes (i.e. IBS symptom severity and psychosocial distress), with a low-to-moderate effect on psychosocial distress (r=0.222) and a medium-to-large effect on IBS symptom severity (r=0.413). In fact, the total effect of CBT on IBS symptom severity is significantly higher than the total effect on psychosocial distress Q(1)= 5.06, p= 0.024. Both behaviours and emotions (r=0.158) as well as cognitions (r=0.141) generated significant mediated effects on psychosocial distress, with no significant differences between them (Q(1)= 0.05, p=0.825). Behaviours and emotions mediated 71.1% of the total effect of CBT on psychosocial distress and cognitions mediated 63.5% of the total effect.
Although significant for both outcomes, the statistical analysis revealed CBT interventions have a greater effect on alleviating IBS symptoms severity rather than on reducing psychological distress. Of the mediators investigated, behaviours, emotions and cognitions seem to have a small to moderating effect in reducing IBS symptom and psychological distress.
认知行为疗法（CBT）在缓解肠易激综合征（IBS）的情绪困扰和心身症状方面具有小到中等程度的效果。然而，CBT发挥作用的机制尚未得到充分研究。中介分析考察中间变量在多大程度上解释了干预对结果的影响。本荟萃分析旨在识别和评估先前研究中确定的CBT中介因素对IBS的影响。
对2018年1月之前发表的关于CBT对IBS影响的研究进行了广泛检索。通过数据库搜索共识别出699项研究，并对其中6项包含638名患者数据的研究进行了分析。所选研究必须明确界定CBT干预措施，纳入IBS患者，报告足够的数据以计算效应量，并对一个或多个变量对结果进行清晰的中介分析。
CBT对两类结果（即IBS症状严重程度和心理社会困扰）的总体效应均显著，对心理社会困扰的影响为低到中等程度（r = 0.222），对IBS症状严重程度的影响为中等到大程度（r = 0.413）。事实上，CBT对IBS症状严重程度的总体效应显著高于对心理社会困扰的总体效应Q(1)= 5.06，p = 0.024。行为和情绪（r = 0.158）以及认知（r = 0.141）对心理社会困扰均产生了显著的中介效应，二者之间无显著差异（Q(1)= 0.05，p = 0.825）。行为和情绪介导了CBT对心理社会困扰总体效应的71.1%，认知介导了总体效应的63.5%。
尽管对两类结果均有显著影响，但统计分析表明CBT干预对缓解IBS症状严重程度的效果大于减轻心理困扰。在所研究的中介因素中，行为、情绪和认知在减轻IBS症状和心理困扰方面似乎具有小到中等程度的作用。
