肠易激综合征的心理治疗:一项全面的系统评价和荟萃分析。

Psychological treatments for irritable bowel syndrome: a comprehensive systematic review and meta-analysis.

作者信息

Axelsson Erland, Kern Dorian, Hedman-Lagerlöf Erik, Lindfors Perjohan, Palmgren Josefin, Hesser Hugo, Andersson Erik, Johansson Robert, Olén Ola, Bonnert Marianne, Lalouni Maria, Ljótsson Brjánn

机构信息

Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.

Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden.

出版信息

Cogn Behav Ther. 2023 Nov;52(6):565-584. doi: 10.1080/16506073.2023.2225745. Epub 2023 Jun 21.

Abstract

A wide range of psychological treatments have been found to reduce the symptoms of irritable bowel syndrome (IBS) but their relative effects are unclear. In this systematic review and meta-analysis, we determined the effects of psychological treatments for IBS, including subtypes of cognitive behavior therapy, versus attention controls. We searched 11 databases (March 2022) for studies of psychological treatments for IBS, reported in journal articles, books, dissertations, and conference abstracts. The resulting database comprised 9 outcome domains from 118 studies published in 1983-2022. Using data from 62 studies and 6496 participants, we estimated the effect of treatment type on improvement in composite IBS severity using random-effects meta-regression. In comparison with the attention controls, there was a significant added effect of exposure therapy ( = 0.52, 95% CI = 0.17-0.88) and hypnotherapy ( = 0.36, 95% CI = 0.06-0.67) when controlling for the pre- to post-assessment duration. When additional potential confounders were included, exposure therapy but not hypnotherapy retained a significant added effect. Effects were also larger with a longer duration, individual treatment, questionnaire (non-diary) outcomes, and recruitment outside of routine care. Heterogeneity was substantial. Tentatively, exposure therapy appears to be a particularly promising treatment for IBS. More direct comparisons in randomized controlled trials are needed. OSF.io identifier: 5yh9a.

摘要

已发现多种心理治疗方法可减轻肠易激综合征(IBS)的症状,但其相对疗效尚不清楚。在这项系统评价和荟萃分析中,我们确定了针对IBS的心理治疗方法的效果,包括认知行为疗法的亚型,与注意力控制组相比。我们检索了11个数据库(截至2022年3月),以查找发表在期刊文章、书籍、论文和会议摘要中的IBS心理治疗研究。最终数据库包含1983 - 2022年发表的118项研究中的9个结局领域。使用来自62项研究和6496名参与者的数据,我们通过随机效应荟萃回归估计了治疗类型对综合IBS严重程度改善的影响。与注意力控制组相比,在控制评估前到评估后的持续时间时,暴露疗法(效应量 = 0.52,95%置信区间 = 0.17 - 0.88)和催眠疗法(效应量 = 0.36,95%置信区间 = 0.06 - 0.67)有显著的附加效应。当纳入其他潜在混杂因素时,暴露疗法仍保留显著的附加效应,而催眠疗法则不然。治疗持续时间更长、个体治疗、问卷(非日记)结局以及在常规护理之外招募时,效应也更大。异质性很大。初步来看,暴露疗法似乎是一种对IBS特别有前景的治疗方法。需要在随机对照试验中进行更多直接比较。OSF.io标识符:5yh9a。

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