Rutgers Robert Wood Johnson Medical School, USA.
Monmouth Medical Center, USA.
Behav Res Ther. 2020 May;128:103462. doi: 10.1016/j.brat.2019.103462. Epub 2019 Nov 12.
Irritable bowel syndrome (IBS) is a widespread chronic functional gastrointestinal (GI) disorder having bidirectional comorbidity with psychiatric disorders. This review focuses on psychological treatment of IBS, focusing on symptom severity rather than IBS diagnostic criteria. We chose this dimensional approach in order to assess mind-body effects as an alternative or complement to conventional medical treatment, which focuses on symptom relief. We calculated the effect sizes for various psychosocial-mind-body therapies (MBTs) for IBS symptoms in both children and adults. Therapies included meditation, relaxation, yoga, autogenic training, progressive relaxation, general training in stress coping, hypnotherapy, biofeedback, psycho-education, psychodynamic psychotherapy, and cognitive behavioral therapy. We performed a meta-regression analyses and mixed effects contrasts to find various outcome differences, and we analyzed their relative efficacy in both children and adults. We found 53 studies in 50 reports describing randomized controlled trials. Medium to high effect sizes were found across all methods compared with various controls, with possibly higher effects for children. We found no systematic differences among treatment methods. Meta-regression analyses showed no significant effect for the presence of psychophysiological training, meditation or explicit exposure procedures as treatment components, although most MBTs include exposure as a nonexplicit treatment characteristic, and many relaxation techniques have meditative characteristics. We conclude that there is considerable evidence that an array of mind-body and other psychological therapies can be effective complements to medical treatment for IBS symptom severity, with little evidence for relative superiority of any particular approach. We suggest that the various methods may operate through different mechanisms.
肠易激综合征（IBS）是一种广泛存在的慢性功能性胃肠道（GI）疾病，与精神障碍双向共病。本综述重点介绍了 IBS 的心理治疗，侧重于症状严重程度，而不是 IBS 的诊断标准。我们选择这种维度方法是为了评估身心影响，作为对传统医疗的替代或补充，传统医疗侧重于缓解症状。我们计算了各种心理社会身心治疗（MBTs）对儿童和成人 IBS 症状的效果大小。治疗包括冥想、放松、瑜伽、自生训练、渐进式放松、一般压力应对训练、催眠疗法、生物反馈、心理教育、心理动力学心理治疗和认知行为疗法。我们进行了元回归分析和混合效应对比，以发现各种结果差异，并分析了它们在儿童和成人中的相对疗效。我们在 50 份报告中发现了 53 项描述随机对照试验的研究。与各种对照相比，所有方法的效果大小均为中等到高，儿童的效果可能更高。我们没有发现治疗方法之间存在系统差异。元回归分析显示，作为治疗组成部分的心理生理训练、冥想或明确暴露程序的存在没有显著效果，尽管大多数 MBT 都将暴露作为非明确的治疗特征，许多放松技术都具有冥想的特点。我们的结论是，有相当多的证据表明，一系列身心和其他心理治疗方法可以作为 IBS 症状严重程度的医疗治疗的有效补充，几乎没有任何特定方法具有相对优势的证据。我们认为，各种方法可能通过不同的机制发挥作用。
