The impact of behavioral interventions on gastrointestinal diseases

Background: There is strong evidence for gut‐directed hypnotherapy (HYP) and cognitive‐behavior therapy (CBT) in irritable bowel syndrome (IBS). These interventions succeed because they address centrally‐mediated symptom processes‐ catastrophizing, symptom anxiety and autonomic arousal. Research also suggests that these interventions can be translated to "organic" GI disorders, including inflammatory bowel diseases (IBD). We will demonstrate the potential for behavior therapies across the spectrum of GI diseases in the context of the Irritable Bowel Syndrome Outcome Study (IBSOS) and the Ulcerative Colitis Relapse Prevention Trial (UCRPT). Study 1: IBSOS is an ongoing, NIH‐funded trial of brief (4 session) CBT for IBS. The protocol was developed by Lackner and colleagues in response to research showing that IBS patients have better outcomes when CBT is delivered rapidly. Skills targeted in brief CBT map directly onto processes driving persistent symptoms including catastrophizing, worry and stress responsivity. The trial has 2 control arms‐education/support and standard CBT. 320 participants have been enrolled. While results will not yet be available, we will discuss the relevance of this research for the future of IBS management. Study 2: UCRPT is a recently completed NIH‐funded clinical trial of HYP for quiescent ulcerative colitis (UC). 54 patients were randomized to 7 sessions of HYP (n = 26) or attention control (CON; n = 29) and followed for 1 year to determine the impact of hypnotherapy on remission status/days to relapse. Hypnotherapy targeted factors influencing relapse rate‐immune function, heightened symptom awareness and stress. ANOVA comparing HYP and CON subjects on number of days to clinical relapse favored the HYP condition [F = 4.8 (1, 48), P = 0.03] by 78 days. Chi‐square comparing the groups on proportion maintaining remission at 1 year was also significant [X2(1) = 3.9,P = 0.04]‐68% of HYP vs 40% CON maintained remission for 1 year. Conclusion: Behavioral therapies show promise across a range of gastrointestinal diseases by targeting underlying disease processes, including cognitive‐affective dysregulation, stress and immune function.