Psychological Treatments in Functional Gastrointestinal Disorders

A Primer for the Gastroenterologist

Olafur S. Palsson; William E. Whitehead

Disclosures

Clin Gastroenterol Hepatol. 2012;11(3):208-216. 

In This Article

Summary and Conclusions: Advantages and Limitations of Psychological Treatment

As our summary of individual treatments demonstrates, a substantial literature supports the value of psychological treatment for patients with FGIDs. Good improvement is often seen from such treatment in patients who have shown little or no response to usual medical care. These therapies have no adverse side effects and do not cause interactions with pharmacologic treatment, making them well suited as co-therapies with medical care. Apart from improvement in symptoms, these therapies often bring patients positive outcomes including better quality of life, enhanced emotional well-being and life functioning, improved coping with the illness, and lessened healthcare and medication needs. The prospects of such improved well-being and functional outcomes are sufficient benefits to warrant referrals for these therapies for some patients.

There are limitations and challenges to the use of psychological treatments in FGIDs, however. For good success, referrals for such treatment require good therapeutic alliances between doctor and patient, reassurance, and education. It may be hard to find therapists in some areas who are skilled in the particular therapy modalities with best evidence of effectiveness for particular FGIDs. Also, the amount of effort and motivation required of patients to make use of psychological treatments may make them unsuitable for some individuals. Insurance reimbursement for psychological therapies for FGIDs is variable and not available in all insurance plans, so cost may be an obstacle for some patients.

In addition to these limitations that are common to all the treatment modes, the various treatments also have different challenges. The idea of hypnosis treatment may cause wariness in some patients because of the common misconceptions about hypnosis in mass media and the general culture. CBT generally depends heavily on homework assignments and therefore requires diligent and self-motivated patients for the best results. Biofeedback is more invasive than the other forms of psychological treatment, and some patients may be uncomfortable with use of intrarectal sensors. Finally, the research to date has only identified effective psychological treatments for a few of the many FGIDs. Despite all of these limitations, the current state of knowledge clearly indicates that psychological treatment should be considered for the subgroup of FGID patients who do not gain satisfactory symptom relief from usual gastroenterology management and for whom it is likely to significantly improve their clinical outcomes.

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