Zhao Shi-Rui, Ni Xiao-Mei, Zhang Xin-An, Tian Hong
College of Kinesiology, Shenyang Sport University, Shenyang 110102, Liaoning Province, China.
Department of Psychotherapy and Counseling, Shenyang Mental Health Center, Shenyang 110168, Liaoning Province, China.
World J Clin Cases. 2019 Nov 6;7(21):3446-3462. doi: 10.12998/wjcc.v7.i21.3446.
Irritable bowel syndrome (IBS) is a common digestive system disease with a high incidence rate and is common in women. The cause of IBS remains unclear. Some studies have shown that mental and psychological diseases are independent risk factors for IBS. At present, the treatment of IBS is mainly symptomatic treatment. Clinically, doctors also use cognitive behavioral therapy to improve patients' cognitive ability to diseases and clinical symptoms. In recent years, exercise therapy has attracted more and more attention from scholars. Improving the symptoms of IBS patients through psychosomatic treatment strategy may be a good treatment method.
To explore the effects of an intervention of cognitive behavioral therapy combined with exercise (CBT+E) on the cognitive bias and coping styles of patients with diarrhea-predominant irritable bowel syndrome (IBS-D); and to provide a theoretical reference for the management of IBS.
Sixty IBS-D patients and thirty healthy subjects were selected. The 60 IBS-D patients were randomly divided into experimental and control groups. The experimental group was treated with the CBT+E intervention, while the control group was treated with conventional drugs without any additional intervention. The cognitive bias and coping styles of the participants were evaluated at baseline and after 6 wk, 12 wk and 24 wk using the Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale (DAS) and Pain Coping Style Questionnaire (CSQ) instruments, and the intervention effect was analyzed using SPSS 17.0 statistical software.
At baseline, the scores on the various scales showed that all subjects had cognitive bias and adverse coping styles. The IBS Symptom Severity Scale (IBS-SSS) scores, ATQ total scores, DAS scores and CSQ scores of the two groups were not significantly different ( > 0.05). Compared with baseline, after 6 wk of the CBT+E intervention, there were significant differences in the ATQ scores, the dependence and total scores on the DAS, and the catastrophization, distraction and prayer scores on the CSQ ( < 0.05). After 12 wk, there were significant differences in the scores for perfectionism on the DAS and in the scores for reinterpretation, neglect and pain behavior on the CSQ in the experimental group ( < 0.05). After 24 wk, there were significant differences in the vulnerability, dependence, perfectionism, and total scores on the DAS and in the catastrophization, distraction and prayer scores on the CSQ in the experimental group ( < 0.01). The IBS-SSS scores were negatively correlated with the ATQ and DAS total scores ( < 0.05) but were positively correlated with the CSQ total score ( < 0.05).
Intervention consisting of CBT+E can correct the cognitive bias of IBS-D patients and eliminate their adverse coping conditions. CBT+E should be promoted for IBS and psychosomatic diseases.
肠易激综合征（IBS）是一种常见的消化系统疾病，发病率高，在女性中较为常见。IBS的病因尚不清楚。一些研究表明，精神和心理疾病是IBS的独立危险因素。目前，IBS的治疗主要是对症治疗。临床上，医生也使用认知行为疗法来提高患者对疾病的认知能力和临床症状。近年来，运动疗法越来越受到学者的关注。通过身心治疗策略改善IBS患者的症状可能是一种很好的治疗方法。
探讨认知行为疗法联合运动干预（CBT+E）对腹泻型肠易激综合征（IBS-D）患者认知偏差和应对方式的影响；并为IBS的管理提供理论参考。
选取60例IBS-D患者和30例健康受试者。将60例IBS-D患者随机分为实验组和对照组。实验组采用CBT+E干预，对照组采用常规药物治疗，无任何额外干预。使用自动思维问卷（ATQ）、功能失调性态度量表（DAS）和疼痛应对方式问卷（CSQ）工具在基线以及6周、12周和24周后对参与者的认知偏差和应对方式进行评估，并使用SPSS 17.0统计软件分析干预效果。
在基线时，各量表得分显示所有受试者均存在认知偏差和不良应对方式。两组的肠易激综合征症状严重程度量表（IBS-SSS）得分、ATQ总分、DAS得分和CSQ得分无显著差异（>0.05）。与基线相比，CBT+E干预6周后，ATQ得分、DAS上的依赖和总分以及CSQ上的灾难化、分心和祈祷得分有显著差异（<0.05）。12周后，实验组DAS上的完美主义得分以及CSQ上的重新诠释、忽视和疼痛行为得分有显著差异（<0.05）。24周后，实验组DAS上的易损性、依赖、完美主义和总分以及CSQ上的灾难化、分心和祈祷得分有显著差异（<0.01）。IBS-SSS得分与ATQ和DAS总分呈负相关（<0.05），但与CSQ总分呈正相关（<0.05）。
CBT+E干预可纠正IBS-D患者的认知偏差，消除其不良应对状况。CBT+E应在IBS和身心疾病中推广。
