PSYCHOLOGICAL TREATMENTS FOR IRRITABLE-BOWEL-SYNDROME - A CRITIQUE OFCONTROLLED TREATMENT TRIALS

Objective: We aimed to determine the efficacy of psychological treatme nts in irritable bowel syndrome, Methods: A systematic review of the l iterature on psychological treatments of IBS was performed using Medli ne (1966-1994) and Psychlit (1974-1994) and secondary references, Full y published studies in English were selected if they compared any type of ''psychological'' treatment of irritable bowel syndrome with a con trol group, Studies without any comparable control group, studies in w hich the subject group was not confined to irritable bowel syndrome su fferers, and those in which irritable bowel syndrome symptoms were not the primary outcome measures were excluded, Each study was reviewed u sing a structured format to examine methodological issues, A quality a lgorithm was developed a priori based on eight key requirements, Resul ts: Eight studies (57%) reported that a psychological treatment was su perior to control therapy; five failed to detect a significant effect, and one did not report if psychological treatment was superior, By th e quality algorithm, only one study (a hypnotherapy trial) exceeded th e preset cutoff score of 6, but this study was poorly generalizable du e to sample selection, Conclusion: The efficacy of psychological treat ment for irritable bowel syndrome has not been established because of methodological inadequacies; future trials need to address these desig n limitations.