Pilot-RCT of an integrative group therapy for patients with refractory irritable bowel syndrome (ISRCTN02977330)

S Berens; E Stroe-Kunold; F Kraus; J Tesarz; A Gauss; B Niesler; W Herzog; R Schaefert

doi:10.1016/j.jpsychores.2017.12.002

Pilot-RCT of an integrative group therapy for patients with refractory irritable bowel syndrome (ISRCTN02977330)

J Psychosom Res. 2018 Feb:105:72-79. doi: 10.1016/j.jpsychores.2017.12.002. Epub 2017 Dec 5.

Authors

S Berens¹, E Stroe-Kunold², F Kraus³, J Tesarz⁴, A Gauss⁵, B Niesler⁶, W Herzog⁷, R Schaefert⁸

Affiliations

¹ Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany. Electronic address: Sabrina.Berens@med.uni-heidelberg.de.
² Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
³ Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany. Electronic address: Felicitas-Kraus@web.de.
⁴ Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany. Electronic address: Jonas.Tesarz@med.uni-heidelberg.de.
⁵ Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany. Electronic address: Annika.Gauss@med.uni-heidelberg.de.
⁶ Institute of Human Genetics, Department of Human Molecular Genetics, University Hospital Heidelberg, Im Neuenheimer Feld 366, D-69120 Heidelberg, Germany. Electronic address: Beate.Niesler@med.uni-heidelberg.de.
⁷ Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany. Electronic address: Wolfgang.Herzog@med.uni-heidelberg.de.
⁸ Division of Internal Medicine, Department of Psychosomatic Medicine, University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland. Electronic address: Rainer.Schaefert@usb.ch.

PMID: 29332637
DOI: 10.1016/j.jpsychores.2017.12.002

Abstract

Objective: Different forms of psychotherapeutic treatments have been proven effective in irritable bowel syndrome (IBS), but disorder-oriented and integrative concepts are still rare. Therefore, we implemented and evaluated an integrative group therapeutic concept within an interdisciplinary tertiary care clinic for functional gastrointestinal disorders (FGIDs).

Aims: present our integrative group concept, assess feasibility issues, and evaluate efficacy.

Methods: A pilot-RCT with a randomized controlled wait-listed group design was conducted. The treatment concept was a disorder-oriented multicomponent group therapy (12 90-min weekly sessions) integrating interactive psychoeducation, gut-directed hypnotherapy, and open group phases. All patients received enhanced medical care and completed a short online diary as an active wait-listed control condition.

Inclusion criteria: refractory IBS diagnosed as somatoform autonomic dysfunction of the lower gastrointestinal tract (SAD).

Primary outcome: IBS symptom severity (IBS-SSS).

Results: Of 294 patients, 220 had IBS (ROME III), 144 were diagnosed as SAD (ICD-10), 51 were eligible regarding inclusion/exclusion criteria, and 30 consented to participate (group intervention: n=16, wait-listed control condition: n=14). Only 1 patient dropped out. Intention-to-treat-analysis with repeated-measures mixed ANOVA showed that the group intervention was not significantly superior to the wait-listed control condition. Nevertheless, the calculated effect size for the between-group difference in IBS-SSS at the end of treatment (post) was moderate (d=0.539).

Conclusion: Our disorder-oriented integrative group intervention for IBS proved to be acceptable and feasible in an interdisciplinary tertiary care setting. There is promise in this intervention, but a larger RCT may be needed to investigate efficacy.

Keywords: Group therapy; Gut-directed hypnotherapy; Irritable bowel syndrome; Somatoform autonomic dysfunction of the lower gastrointestinal tract.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Combined Modality Therapy
Feasibility Studies
Female
Humans
Hypnosis / methods*
Integrative Medicine / methods*
Irritable Bowel Syndrome / psychology
Irritable Bowel Syndrome / therapy*
Male
Middle Aged
Patient Education as Topic / methods
Pilot Projects
Psychotherapy, Group / methods*
Somatoform Disorders / psychology
Somatoform Disorders / therapy*
Treatment Outcome
Waiting Lists