Psychological Treatments in Functional Gastrointestinal Disorders

A Primer for the Gastroenterologist

Olafur S. Palsson; William E. Whitehead


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

In This Article

Empirically Tested Psychological Treatments for Functional Gastrointestinal Disorders

A number of different psychological therapies have been tested for FGIDs in the past 30 years. However, only 5 modes of treatment have been assessed in multiple RCTs. That is a necessary standard of evidence for any firm conclusions to be made about the value of interventions for FGIDs for multiple reasons. Without randomization, selection bias is likely to confound treatment outcomes; placebo rates are often high for psychological interventions, so placebo control or credible active treatments are necessary for outcome comparisons; and psychological treatments are generally carried out within the context of continued medical care, so observed therapeutic responses cannot be conclusively attributed to psychological treatment without control groups.

Although numerous systematic reviews have been published in the past on psychological treatments for various FGIDs, these are outdated. Some of the most important and strongest trials have appeared in the literature only after key reviews were published. We therefore searched the research literature via MEDLINE (1965–2012) for all RCTs on psychological treatments for FGIDs (by using terms for various common psychological treatments and the individual FGIDs) and reviewed articles cited in past systematic reviews as well as the reference sections of the articles found in our online search. Five psychological therapies— cognitive behavioral therapy (CBT), hypnosis, psychodynamic interpersonal therapy, relaxation training, and biofeedback—have been tested in multiple RCTs (Supplementary Tables 1–5), and our review will be limited to those 5 therapies. Because gastroenterologists may not have detailed knowledge of the nature of those therapies, we will describe each of them and then summarize the evidence for their value in FGID treatment. We will exclude from this overview several studies that combined multiple different psychological treatments, sometimes as many as 4 or more different interventions applied simultaneously, because this makes it impossible to judge the value of a particular therapy approach.