Effect of a short-term cognitive behavioral group intervention on symptoms and quality of life (QOL) in patients with functional bowel disorders (FBD)

Abstract

BACKGROUND: Cognitive factors, such as ineffective coping styles and responses to psychosocial stressors, or inadequate disease concepts are common in many FBD patients and may contribute significantly to anxiety and healthcare utilization. While prolonged courses of individual cognitive behavioral therapy appear to be effective in decreasing FBD symptoms, such therapies are impractical in the majority of patients. AIMS: 1) Is a short course of group education combined with simple relaxation exercises effective in reducing FBD symptom severity and/or measures of psychological symptoms or quality of life? 2) What are the predictors for treatment outcomes? METHODS: 57 FBD patients, (34F, 23M), 35 with IBS or abdominal pain (30% Rome+), 11 with functional dyspepsia (FD) and I 1 with IBS+FD (100% Rome+) were referred by their gastroenterologist to 5 week courses of 2 hr/week sessions (6-8 patients per course). The course was led by a MD (total effort/course 2 hrs) and a therapist. Total cost to patient was $175. Education focused on a comprehensive FBD disease model, self-management, and correcting inappropriate coping styles. Patients were also instructed in simple relaxation techniques. Patients were assessed before start of the course, at the end of the course, and at 3-6 ms follow-up using the UCLA bowel symptom questionnaire, the SCL-90, and the SF-36 QOL questionnaire. RESULTS: At baseline 36% rated GI symptoms as mild to moderate, and 64% rated GI symptoms as severe to very severe. SCL-90 baseline scores indicated approximately 50% of the sample had elevated depression, and 56% had elevated anxiety. Comparisons from pre to postclass indicated a significant improvement in physical and social functioning on the SF-36, and an improvement in mood and quality of sleep (ps<.05). The subgroup of patients with FD and FD+IBS showed additional significant changes pre to post-class in overall GI symptom severity, upper abdominal symptoms, lower abdominal symptoms, bloating, pain, and the number of activities stopped by GI symptoms (ps<.05). Most post-class improvements were still evident at 3/6-month follow-up. Overall, patients with lower symptom levels and higher QOL scores at baseline showed the greatest improvement from the class. CONCLUSIONS: 1. Short term cognitivebehavioral intervention results primarily in enhanced QOL measures, including sleep, mood and physical and social functioning. These improvements are generally maintained at least over a period of 3-6 months. 2. FD patients and those meeting criteria for IBS may benefit more from this intervention than those with chronic abdominal pain. 3. Increased symptom severity and poor QOL at baseline are predictors of poorer treatment outcome.