King's College London.
University of Southampton.
Behav Ther. 2019 May;50(3):594-607. doi: 10.1016/j.beth.2018.09.006. Epub 2018 Sep 21.
Irritable bowel syndrome (IBS) is a functional gastrointestinal syndrome consisting of different bowel pattern subtypes: diarrhea predominant (IBS-D), constipation predominant (IBS-C), and alternating (IBS-A). This paper aimed to identify whether (a) psychological factors implicated in the cognitive behavioral model of IBS were differentially associated with bowel pattern subtypes, (b) whether there were differences in symptom severity and work and social adjustment across the IBS-subtypes. Analysis was conducted on baseline data of 557 individuals with refractory IBS recruited into the Assessing Cognitive Therapy in Irritable Bowel (ACTIB) randomized controlled trial. Correlations assessed the associations between psychological factors, stool patterns, symptom severity, and work and social adjustment. Hierarchical regressions identified whether cognitive and behavioral factors were significantly associated with frequency of loose/watery stools, hard/lumpy stools and symptom severity while controlling for affective (anxiety and depression) and demographic factors (age, gender, symptom duration). One-way ANOVAs were conducted to assess differences across Rome III classified subtypes (IBS-A, D and C) in cognitive, behavioral, affective, symptom severity, and adjustment measures. Psychological factors were significantly associated with symptom severity and work and social adjustment. Increased avoidance behavior and unhelpful gastrointestinal (GI) cognitions were significantly associated with higher frequency of loose/watery stools. Increased control behaviors were associated with higher frequency of hard/lumpy stools. Cognitive and behavioral differences were significant across the Rome III classified IBS subtypes. There were no differences in anxiety, depression, overall symptom severity, or work and social adjustment. The results are discussed in terms of their utility in tailoring cognitive behavioral treatments to IBS subtypes.
肠易激综合征（IBS）是一种功能性胃肠道综合征，由不同的肠型亚型组成：腹泻为主型（IBS-D）、便秘为主型（IBS-C）和交替型（IBS-A）。本文旨在确定（a）IBS 认知行为模型中涉及的心理因素是否与肠型亚型存在差异相关，（b）IBS 各亚型的症状严重程度和工作及社会适应是否存在差异。分析基于难治性 IBS 患者的基线数据，这些患者是纳入评估认知疗法治疗肠易激（ACTIB）随机对照试验的 557 名个体。相关性评估了心理因素、排便模式、症状严重程度和工作及社会适应之间的关联。分层回归确定了认知和行为因素在控制情感（焦虑和抑郁）和人口统计学因素（年龄、性别、症状持续时间）后，是否与稀便/水样便、硬便/块状便的频率以及症状严重程度显著相关。单向方差分析用于评估罗马 III 分类亚型（IBS-A、D 和 C）在认知、行为、情感、症状严重程度和适应措施方面的差异。心理因素与症状严重程度和工作及社会适应显著相关。回避行为和无益的胃肠道认知增加与稀便/水样便的频率增加显著相关。控制行为的增加与硬便/块状便的频率增加相关。在罗马 III 分类的 IBS 亚型中，认知和行为差异显著。焦虑、抑郁、总体症状严重程度或工作及社会适应方面没有差异。结果从为 IBS 亚型量身定制认知行为治疗的角度进行了讨论。
