STRESS AND CONTINGENCY MANAGEMENT IN THE TREATMENT OF IRRITABLE-BOWEL-SYNDROME

Ninety patients with irritable bowel syndrome (IBS) who did not respon d to medical treatment were randomly assigned to four treatment condit ions-two experimental groups: stress management and contingency manage ment; and two control groups: medical treatment and placebo. The subje cts underwent 12 individual sessions which were specific for each cond ition, All the subjects completed symptom-monitoring diaries. Thirty-t hree dropped out during the assessment or treatment. The subjects who received training in contingency management experienced significant re ductions in all the characteristic digestive symptoms: abdominal pain (p < 0.001), diarrhoea (p < 0.05), constipation (p < 0.05) and dyspeps ia (p < 0.001). At the end of the treatment, 50 per cent of the patien ts remained asymptomatic and 37.5 per cent reduced their symptoms by a t least 50 per cent. Among the patients assigned to the condition stre ss management, 33 per cent got rid of their symptomatology and the sub jects showed significant reductions in the following digestive symptom s: abdominal pain (p < 0.05), diarrhoea (p < 0.05) and dyspepsia (p < 0.05), The changes in the placebo group are not representative. The su bjects assigned to this condition showed a high dropout rate, Signific ant changes were not observed in symptomatology in the medical treatme nt group. The results are maintained after a year of follow-up. Possib le predictive parameters of the progress of the patients are explored. (C) 1998 John Wiley & Sons, Ltd.