Die Rolle Der Psychotherapie Beim Reizdarmsyndrom

Elena Weibert; Andreas Stengel

doi:10.1055/a-0829-6990

PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie, Table of Contents

Psychother Psychosom Med Psychol 2019; 69(09/10): 360-371
DOI: 10.1055/a-0829-6990

Übersicht

Die Rolle Der Psychotherapie Beim Reizdarmsyndrom

The Role of Psychotherapy in the Treatment of Irritable Bowel Syndrome

Elena Weibert

¹Medizinische Klinik mit Schwerpunkt Psychosomatik, Charité-Universitätsmedizin Berlin

,

Andreas Stengel

¹Medizinische Klinik mit Schwerpunkt Psychosomatik, Charité-Universitätsmedizin Berlin

²Innere Medizin VI, Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik, Tübingen

› Author Affiliations

Abstract

Zusammenfassung

Das Reizdarmsyndrom ist eine häufige funktionelle gastrointestinale Störung, die aufgrund wiederkehrender gastrointestinaler Beschwerden wie Bauchschmerzen oder Stuhlveränderungen die Lebensqualität erheblich beeinträchtigen kann. Basierend auf dem biopsychosozialen Krankheitsmodell wird die Ausprägung des Reizdarmsyndroms durch die Kombination von veränderten physiologischen Prozessen, sozialen Aspekten und psychischen Faktoren beeinflusst. Während der Fokus bisher auf der Linderung der Darmbeschwerden mittels Diät sowie medikamentöser Therapie lag, stellen Psychotherapieverfahren angesichts der starken Assoziation mit psychischen Komorbiditäten (u. a. Depression, Angststörung) zunehmend alternative oder ergänzende Behandlungsmethoden mit mittlerweile sehr guter Evidenz dar. Grundsätzlich können zusätzliche psychische Begleitsymptome die Wahrscheinlichkeit komplizierter Krankheitsverläufe erhöhen, wobei sich psychische Symptome und Darmbeschwerden maßgeblich gegenseitig beeinflussen. Mithilfe von kognitiver Verhaltenstherapie, psychodynamischer Psychotherapie, Hypnotherapie, achtsamkeitsbasierter Therapie und anderen psychotherapeutischen Verfahren sollen die Krankheitsbewältigung und -kontrolle gesteigert und fehlregulierte kognitive Prozesse umstrukturiert werden. In dieser Übersichtsarbeit fokussieren wir uns auf den psychosozialen Aspekt des Reizdarmsyndroms und diskutieren den Nutzen der psychotherapeutischen Verfahren.

Abstract

Irritable bowel syndrome is a common functional gastrointestinal disorder that greatly impacts on quality of life due to gastrointestinal complaints such as pain or altered stool habits. Based on the biopsychosocial model the severity of the disease is affected by the combination of physiological processes, social aspects and psychological factors. While treatment approaches mainly focused on the reduction of gut complaints by dietary means or medication, psychotherapy is becoming an alternative or additional approach with very good evidence, especially in light of associated psychiatric comorbidities (e. g. depression, anxiety disorder). Often psychiatric symptoms/comorbidities increase the probability of a complicated course of the disease with a reciprocal interaction of gut complaints and psychiatric symptoms. Behavioral therapy, psychodynamic psychotherapy, hypnotherapy, mindfulness interventions and other psychotherapeutic methods are used to increase coping as well as disease control and to restructure dysregulated cognitive processes. The current review focuses on psychosocial aspects of the irritable bowel syndrome and discusses the benefit of psychotherapeutic interventions.

Schlüsselwörter

Reizdarmsyndrom - Psychotherapie - Pathophysiologie - Behandlung - psychosoziale Faktoren

Key words

irritable bowel syndrome - psychotherapy - psychosocial factors - pathophysiology - treatment

Full Text

References

Literatur
1 Lacy BE, Mearin F, Chang L. et al. Bowel disorders. Gastroenterology 2016; 150: 1393-1407.e1395
2 Graubner B. ICD-10-GM 2018 Systematisches Verzeichnis: Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme. Berlin: Deutscher Ärzte-Verlag; 2017
3 WHO. ICD-11 for Mortality and Morbidity Statistics (2018). In 11th Revision of the International Classification of Diseases (ICD-11). 2018
4 Drossman DA. Irritable bowel syndrome. Gastroenterologist 1994; 2: 315-326
5 Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10: 712-721.e714
6 Whitehead WE, Palsson OS, Simrén M. Irritable bowel syndrome: what do the new Rome IV diagnostic guidelines mean for patient management?. Expert Rev Gastroenterol Hepatol 2017; 11: 281-283
7 Lacy BE, Patel NK. Rome criteria and a diagnostic approach to irritable bowel syndrome. J Clin Med 2017; 6: 99
8 Layer P, Andresen V, Pehl C. et al. Irritable bowel syndrome: German consensus guidelines on definition, pathophysiology and management. Z Gastroenterol 2011; 49: 237-293
9 Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology 2016; 150: 1262-1279.e1262
10 Gralnek IM, Hays RD, Kilbourne A. et al. The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology 2000; 119: 654-660
11 Drossman DA, Patrick DL, Whitehead WE. et al. Further validation of the IBS-QOL: a disease-specific quality-of-life questionnaire. Am J Gastroenterol 2000; 95: 999-1007
12 Enck P, Aziz Q, Barbara G. et al. Irritable bowel syndrome. Nat Rev Dis Primers 2016; 2: 16014
13 Hausteiner-Wiehle C, Henningsen P. Irritable bowel syndrome: relations with functional, mental, and somatoform disorders. World J Gastroenterol 2014; 20: 6024-6030
14 Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications?. Gastroenterology 2002; 122: 1140-1156
15 Lydiard RB. Irritable bowel syndrome, anxiety, and depression: what are the links?. J Clin Psychiatry 2001; 62 (Suppl. 08) 38-45
16 Janssens KA, Zijlema WL, Joustra ML. et al. Mood and anxiety disorders in chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome: results from the Life-Lines cohort study. Psychosom Med 2015; 77: 449-457
17 Jerndal P, Ringström G, Agerforz P. et al. Gastrointestinal-specific anxiety: an important factor for severity of GI symptoms and quality of life in IBS. Neurogastroenterol Motil 2010; 22: 646-e179
18 Creed F. The relationship between psychosocial parameters and outcome in irritable bowel syndrome. Am J Med 1999; 107: 74s-80s
19 Van Oudenhove L, Levy RL, Crowell MD. et al. Biopsychosocial aspects of functional gastrointestinal disorders: how central and environmental processes contribute to the development and expression of functional gastrointestinal disorders. Gastroenterology 2016; 150: 1355-1367.e1352
20 Mykletun A, Jacka F, Williams L. et al. Prevalence of mood and anxiety disorder in self reported irritable bowel syndrome (IBS). An epidemiological population based study of women. BMC Gastroenterol 2010; 10: 88
21 Fond G, Loundou A, Hamdani N. et al. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2014; 264: 651-660
22 Sibelli A, Chalder T, Everitt H. et al. A systematic review with meta-analysis of the role of anxiety and depression in irritable bowel syndrome onset. Psychol Med 2016; 46: 3065-3080
23 Vu J, Kushnir V, Cassell B. et al. The impact of psychiatric and extraintestinal comorbidity on quality of life and bowel symptom burden in functional GI disorders. Neurogastroenterol Motil 2014; 26: 1323-1332
24 Creed F, Ratcliffe J, Fernandes L. et al. Outcome in severe irritable bowel syndrome with and without accompanying depressive, panic and neurasthenic disorders. Br J Psychiatry 2005; 186: 507-515
25 Creed F, Ratcliffe J, Fernandez L. et al. Health-related quality of life and health care costs in severe, refractory irritable bowel syndrome. Ann Intern Med 2001; 134: 860-868
26 van Tilburg MA, Palsson OS, Whitehead WE. Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model. J Psychosom Res 2013; 74: 486-492
27 Drossman DA. Irritable bowel syndrome: a multifactorial disorder. Hosp Pract (Off Ed) 1988; 23: 119-124 126, 131–113
28 Whitehead WE, Bosmajian L, Zonderman AB. et al. Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. Gastroenterology 1988; 95: 709-714
29 Elsenbruch S, Rosenberger C, Enck P. et al. Affective disturbances modulate the neural processing of visceral pain stimuli in irritable bowel syndrome: an fMRI study. Gut 2010; 59: 489-495
30 Van Oudenhove L, Tornblom H, Störsrud S. et al. Depression and somatization are associated with increased postprandial symptoms in patients with irritable bowel syndrome. Gastroenterology 2016; 150: 866-874
31 Miller V, Hopkins L, Whorwell PJ. Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2004; 2: 1064-1068
32 Drossman DA, Hasler WL, Rome IV-Functional GI. disorders: disorders of gut-brain interaction. Gastroenterology 2016; 150: 1257-1261
33 Tanaka Y, Kanazawa M, Fukudo S. et al. Biopsychosocial model of irritable bowel syndrome. J Neurogastroenterol Motil 2011; 17: 131-139
34 Drossman DA. Presidential address: gastrointestinal illness and the biopsychosocial model. Psychosom Med 1998; 60: 258-267
35 Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry 1980; 137: 535-544
36 Levy RL, Whitehead WE, Von Korff MR. et al. Intergenerational transmission of gastrointestinal illness behavior. Am J Gastroenterol 2000; 95: 451-456
37 Levy RL, Jones KR, Whitehead WE. et al. Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology. Gastroenterology 2001; 121: 799-804
38 Drossman DA. Abuse, trauma, and GI illness: is there a link?. Am J Gastroenterol 2011; 106: 14-25
39 Mayer EA, Tillisch K. The brain-gut axis in abdominal pain syndromes. Annu Rev Med 2011; 62: 381-396
40 Blewett A, Allison M, Calcraft B. et al. Psychiatric disorder and outcome in irritable bowel syndrome. Psychosomatics 1996; 37: 155-160
41 Bennett EJ, Tennant CC, Piesse C. et al. Level of chronic life stress predicts clinical outcome in irritable bowel syndrome. Gut 1998; 43: 256-261
42 Pigrau M, Rodino-Janeiro BK, Casado-Bedmar M. et al. The joint power of sex and stress to modulate brain-gut-microbiota axis and intestinal barrier homeostasis: implications for irritable bowel syndrome. Neurogastroenterol Motil 2016; 28: 463-486
43 Mayer EA, Savidge T, Shulman RJ. Brain-gut microbiome interactions and functional bowel disorders. Gastroenterology 2014; 146: 1500-1512
44 Rajilic-Stojanovic M, Biagi E, Heilig HG. et al. Global and deep molecular analysis of microbiota signatures in fecal samples from patients with irritable bowel syndrome. Gastroenterology 2011; 141: 1792-1801
45 Jeffery IB, O'Toole PW, Ohman L. et al. An irritable bowel syndrome subtype defined by species-specific alterations in faecal microbiota. Gut 2012; 61: 997-1006
46 Tana C, Umesaki Y, Imaoka A. et al. Altered profiles of intestinal microbiota and organic acids may be the origin of symptoms in irritable bowel syndrome. Neurogastroenterol Motil 2010; 22: 512-519 e114-515
47 De Palma G, Lynch MD, Lu J. et al. Transplantation of fecal microbiota from patients with irritable bowel syndrome alters gut function and behavior in recipient mice. Sci Transl Med 2017; 9: eaaf6397
48 Peter J, Fournier C, Durdevic M. et al. A microbial signature of psychological distress in irritable bowel syndrome. Psychosom Med 2018; 80: 698-709
49 Owens DM, Nelson DK, Talley NJ. The irritable bowel syndrome: long-term prognosis and the physician-patient interaction. Ann Intern Med 1995; 122: 107-112
50 Di Palma JA, Herrera JL. The role of effective clinician-patient communication in the management of irritable bowel syndrome and chronic constipation. J Clin Gastroenterol 2012; 46: 748-751
51 Longstreth GF, Drossman DA. Severe irritable bowel and functional abdominal pain syndromes: managing the patient and health care costs. Clin Gastroenterol Hepatol 2005; 3: 397-400
52 Drossman DA, Talley NJ, Leserman J. et al. Sexual and physical abuse and gastrointestinal illness. Review and recommendations. Ann Intern Med 1995; 123: 782-794
53 Drossman DA, Li Z, Leserman J. et al. Health status by gastrointestinal diagnosis and abuse history. Gastroenterology 1996; 110: 999-1007
54 Drossman DA. 2012 David Sun lecture: helping your patient by helping yourself-how to improve the patient-physician relationship by optimizing communication skills. Am J Gastroenterol 2013; 108: 521-528
55 Staudacher HM, Lomer MCE, Farquharson FM. et al. A diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and a probiotic restores bifidobacterium species: a randomized controlled trial. Gastroenterology 2017; 153: 936-947
56 Ford AC, Quigley EM, Lacy BE. et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 1547-1561
57 Clarke G, Cryan JF, Dinan TG. et al. Review article: probiotics for the treatment of irritable bowel syndrome-focus on lactic acid bacteria. Aliment Pharmacol Ther 2012; 35: 403-413
58 Efskind PS, Bernklev T, Vatn MH. A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scand J Gastroenterol 1996; 31: 463-468
59 Chapman RW, Stanghellini V, Geraint M. et al. Randomized clinical trial: macrogol/PEG 3350 plus electrolytes for treatment of patients with constipation associated with irritable bowel syndrome. Am J Gastroenterol 2013; 108: 1508-1515
60 Camilleri M, Ford AC. Pharmacotherapy for irritable bowel syndrome. J Clin Med 2017; 6: 101
61 Sinagra E, Morreale GC, Mohammadian G. et al. New therapeutic perspectives in irritable bowel syndrome: targeting low-grade inflammation, immuno-neuroendocrine axis, motility, secretion and beyond. World J Gastroenterol 2017; 23: 6593-6627
62 Johnsen PH, Hilpusch F, Cavanagh JP. et al. Faecal microbiota transplantation versus placebo for moderate-to-severe irritable bowel syndrome: a double-blind, randomised, placebo-controlled, parallel-group, single-centre trial. Lancet Gastroenterol Hepatol 2018; 3: 17-24
63 Halkjaer SI, Christensen AH, Lo BZS. et al. Faecal microbiota transplantation alters gut microbiota in patients with irritable bowel syndrome: results from a randomised, double-blind placebo-controlled study. Gut 2018; 67: 2107-2115
64 Ford AC, Lacy BE, Harris LA et al. Effect of antidepressants and psychological therapies in irritable bowel syndrome: an updated systematic review and meta-analysis. Am J Gastroenterol 2018 Epub ahead of print
65 Drossman DA. Beyond tricyclics: new ideas for treating patients with painful and refractory functional gastrointestinal symptoms. Am J Gastroenterol 2009; 104: 2897-2902
66 Jones MP, Wessinger S, Crowell MD. Coping strategies and interpersonal support in patients with irritable bowel syndrome and inflammatory bowel disease. Clin Gastroenterol Hepatol 2006; 4: 474-481
67 Drossman DA, Chang L, Schneck S. et al. A focus group assessment of patient perspectives on irritable bowel syndrome and illness severity. Dig Dis Sci 2009; 54: 1532-1541
68 AWMF. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. S3 Leitlinie: Funktionelle Körperbeschwerden 2018
69 Guthrie E, Creed F, Dawson D. et al. A randomised controlled trial of psychotherapy in patients with refractory irritable bowel syndrome. Br J Psychiatry 1993; 163: 315-321
70 Lackner JM, Mesmer C, Morley S. et al. Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis. J Consult Clin Psychol 2004; 72: 1100-1113
71 Drossman DA, Toner BB, Whitehead WE. et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology 2003; 125: 19-31
72 Toner BB. Cognitive-behavioral treatment of irritable bowel syndrome. CNS Spectr 2005; 10: 883-890
73 Levy RL, Olden KW, Naliboff BD. et al. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology 2006; 130: 1447-1458
74 Ford AC, Talley NJ, Schoenfeld PS. et al. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut 2009; 58: 367-378
75 Zijdenbos IL, de Wit NJ, van der Heijden GJ. et al. Psychological treatments for the management of irritable bowel syndrome. Cochrane Database Syst Rev 2009; CD006442
76 Laird KT, Tanner-Smith EE, Russell AC. et al. Short-term and long-term efficacy of psychological therapies for irritable bowel syndrome: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 937-947.e934
77 Laird KT, Tanner-Smith EE, Russell AC. et al. Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: a systematic review and meta-analysis. Clin Psychol Rev 2017; 51: 142-152
78 Li L, Xiong L, Zhang S. et al. Cognitive-behavioral therapy for irritable bowel syndrome: a meta-analysis. J Psychosom Res 2014; 77: 1-12
79 Greene B, Blanchard EB. Cognitive therapy for irritable bowel syndrome. J Consult Clin Psychol 1994; 62: 576-582
80 Payne A, Blanchard EB. A controlled comparison of cognitive therapy and self-help support groups in the treatment of irritable bowel syndrome. J Consult Clin Psychol 1995; 63: 779-786
81 Blanchard EB, Schwarz SP. Adaptation of a multicomponent treatment for irritable bowel syndrome to a small-group format. Biofeedback Self Regul 1987; 12: 63-69
82 Heymann-Monnikes I, Arnold R, Florin I. et al. The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome. Am J Gastroenterol 2000; 95: 981-994
83 Ljótsson B, Falk L, Vesterlund AW. et al. Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome – a randomized controlled trial. Behav Res Ther 2010; 48: 531-539
84 Ljótsson B, Andréewitch S, Hedman E. et al. Exposure and mindfulness based therapy for irritable bowel syndrome – an open pilot study. J Behav Ther Exp Psychiatry 2010; 41: 185-190
85 Ljótsson B, Hedman E, Lindfors P. et al. Long-term follow-up of internet-delivered exposure and mindfulness based treatment for irritable bowel syndrome. Behav Res Ther 2011; 49: 58-61
86 Bonnert M, Olen O, Lalouni M. et al. Internet-delivered cognitive behavior therapy for adolescents with irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol 2017; 112: 152-162
87 Lackner JM, Jaccard J, Keefer L. et al. Improvement in gastrointestinal symptoms after cognitive behavior therapy for refractory irritable bowel syndrome. Gastroenterology 2018; 155: 47-57
88 Svedlund J, Sjodin I, Ottosson JO. et al. Controlled study of psychotherapy in irritable bowel syndrome. Lancet 1983; 2: 589-592
89 Hyphantis T, Guthrie E, Tomenson B. et al. Psychodynamic interpersonal therapy and improvement in interpersonal difficulties in people with severe irritable bowel syndrome. Pain 2009; 145: 196-203
90 Creed F, Fernandes L, Guthrie E. et al. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology 2003; 124: 303-317
91 Gonsalkorale WM, Toner BB, Whorwell PJ. Cognitive change in patients undergoing hypnotherapy for irritable bowel syndrome. J Psychosom Res 2004; 56: 271-278
92 Whorwell PJ, Prior A, Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet 1984; 2: 1232-1234
93 Whorwell PJ, Prior A, Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut 1987; 28: 423-425
94 Harvey RF, Hinton RA, Gunary RM. et al. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1989; 1: 424-425
95 Peters SL, Muir JG, Gibson PR. Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease. Aliment Pharmacol Ther 2015; 41: 1104-1115
96 Webb AN, Kukuruzovic RH, Catto-Smith AG. et al. Hypnotherapy for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2007; CD005110
97 Lee HH, Choi YY, Choi MG. The efficacy of hypnotherapy in the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Neurogastroenterol Motil 2014; 20: 152-162
98 Flik CE, Laan W, Zuithoff NPA. et al. Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 2018; S2468-1253 30310-30318
99 Rutten J, Vlieger AM, Frankenhuis C. et al. Home-based hypnotherapy self-exercises vs individual hypnotherapy with a therapist for treatment of pediatric irritable bowel syndrome, functional abdominal pain, or functional abdominal pain syndrome: a randomized clinical trial. JAMA Pediatr 2017; 171: 470-477
100 Gaylord SA, Palsson OS, Garland EL. et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am J Gastroenterol 2011; 106: 1678-1688
101 Zernicke KA, Campbell TS, Blustein PK. et al. Mindfulness-based stress reduction for the treatment of irritable bowel syndrome symptoms: a randomized wait-list controlled trial. Int J Behav Med 2013; 20: 385-396
102 Lakhan SE, Schofield KL. Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PLoS One 2013; 8: e71834
103 Kearney DJ, McDermott K, Martinez M. et al. Association of participation in a mindfulness programme with bowel symptoms, gastrointestinal symptom-specific anxiety and quality of life. Aliment Pharmacol Ther 2011; 34: 363-373
104 Garland EL, Gaylord SA, Palsson O. et al. Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. J Behav Med 2012; 35: 591-602
105 Thakur ER, Holmes HJ, Lockhart NA. et al. Emotional awareness and expression training improves irritable bowel syndrome: a randomized controlled trial. Neurogastroenterol Motil 2017; 29: e13143
106 Rokicki LA, Holroyd KA, France CR. et al. Change mechanisms associated with combined relaxation/EMG biofeedback training for chronic tension headache. Appl Psychophysiol Biofeedback 1997; 22: 21-41
107 Shaw G, Srivastava ED, Sadlier M. et al. Stress management for irritable bowel syndrome: a controlled trial. Digestion 1991; 50: 36-42
108 Bennett P, Wilkinson S. A comparison of psychological and medical treatment of the irritable bowel syndrome. Br J Clin Psychol 1985; 24 Pt 3 215-216
109 Blanchard EB, Greene B, Scharff L. et al. Relaxation training as a treatment for irritable bowel syndrome. Biofeedback Self Regul 1993; 18: 125-132
110 Kuttner L, Chambers CT, Hardial J. et al. A randomized trial of yoga for adolescents with irritable bowel syndrome. Pain Res Manag 2006; 11: 217-223
111 Schumann D, Langhorst J, Dobos G. et al. Randomised clinical trial: yoga vs a low-FODMAP diet in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2018; 47: 203-211
112 Ringström G, Störsrud S, Lundqvist S. et al. Development of an educational intervention for patients with irritable bowel syndrome (IBS): a pilot study. BMC Gastroenterol 2009; 9: 10
113 Labus J, Gupta A, Gill HK. et al. Randomised clinical trial: symptoms of the irritable bowel syndrome are improved by a psycho-education group intervention. Aliment Pharmacol Ther 2013; 37: 304-315
114 Ringström G, Störsrud S, Posserud I. et al. Structured patient education is superior to written information in the management of patients with irritable bowel syndrome: a randomized controlled study. Eur J Gastroenterol Hepatol 2010; 22: 420-428
115 Pincus T, Holt N, Vogel S. et al. Cognitive and affective reassurance and patient outcomes in primary care: a systematic review. Pain 2013; 154: 2407-2416
116 Kennedy A, Robinson A, Rogers A. Incorporating patients’ views and experiences of life with IBS in the development of an evidence based self-help guidebook. Patient Educ Couns 2003; 50: 303-310
117 Robinson A, Lee V, Kennedy A. et al. A randomised controlled trial of self-help interventions in patients with a primary care diagnosis of irritable bowel syndrome. Gut 2006; 55: 643-648
118 Schneider A, Rosenberger S, Bobardt J. et al. Self-help guidebook improved quality of life for patients with irritable bowel syndrome. PLoS One 2017; 12: e0181764
119 Liegl G, Plessen CY, Leitner A. et al. Guided self-help interventions for irritable bowel syndrome: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2015; 27: 1209-1221
120 Flik CE, Bakker L, Laan W. et al. Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome. World J Gastroenterol 2017; 23: 2223-2233
121 Thakur ER, Shapiro J, Chan J. et al. A systematic review of the effectiveness of psychological treatments for IBS in gastroenterology settings: promising but in need of further study. Dig Dis Sci 2018;

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