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

Choosing Appropriate Psychological Treatment

What kind of psychological treatment is selected for each patient will be influenced to some degree by local availability of the different psychological services, patient preference, and the clinician's experience with referrals for the problems to be addressed. However, the following general guidelines can be given about the choices that are most likely to yield good results, on the basis of the literature to date.

Psychological Treatment to Improve Gastrointestinal Symptoms

If the goal of the referral is to achieve better improvement in gastrointestinal symptoms than has been possible with medical management, CBT and hypnosis offer excellent chances of improvement in IBS symptoms and pediatric abdominal pain. Relaxation training (especially progressive muscle relaxation) is also a suitable option for IBS treatment. Noncardiac chest pain shows a good response to CBT. For constipation caused by pelvic floor dyssynergia in adults, biofeedback is a good option. However, slow transit constipation without evidence of dyssynergic defecation is unresponsive to this therapy. Functional abdominal pain in children can be treated effectively with family CBT and hypnosis. There is insufficient empirical evidence to recommend particular therapies for other FGIDs, but single sizable and methodologically strong RCTs suggest that biofeedback might be worth consideration for levator ani syndrome (especially if patients have puborectalis tenderness on physical examination)[50] and hypnosis for functional dyspepsia.[31]

Psychological Treatment for Comorbid Affective Symptoms

If the primary goal of referral is reduction in comorbid emotional symptoms such as anxiety or depression, CBT is generally the best choice, because there is somewhat better evidence than for other forms of psychotherapy that CBT can reliably reduce these affective symptoms in a short course of treatment.[52,53] CBT is also particularly well suited for helping patients with maladaptive coping styles such as a tendency to catastrophize or excessive preoccupation with bowel symptoms, which can impair life functioning and quality of life in FGIDs. If life stress or stress-related symptoms are thought to be a key problem and the patient is able to recognize this, relaxation therapies are likely to be well received and effective. If somatization, ie, the psychological tendency to experience a multitude of nonspecific body symptoms, is a prominent problem, hypnosis treatment may be a suitable treatment option because it has more often been shown to reduce nongastrointestinal symptoms in FGIDs than other therapies.[23,54,55]

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