Show simple item record Tkachuk, Gregg Allan en_US 2007-05-22T15:16:00Z 2007-05-22T15:16:00Z 2001-05-01T00:00:00Z en_US
dc.description.abstract 'Background'. Standard medical treatments have not been consistently effective for 113S patients. Psychological interventions, targeting symptom reduction and improved daily functioning, have empirical support as a viable treatment option, with individual cognitive behavioral therapy (CBT) emerging as efficacious in clinical trials. This study compared the efficacy of cost-efficient Group CBT with a home-based symptom monitoring with weekly telephone contact (SMTC) treatment, extending previous uncontrolled research in this area. 'Methods'. The study participants were refractory IBS patients recruited exclusively through gastroenterologists and family physicians. After receiving a diagnosis by GI specialists based on the Rome I criteria, they were assessed for psychiatric comorbidity, matched on Axis I diagnosis and IBS subtype, and randomly assigned to the treatment conditions. The 10-session Group CBT treatment protocol was based on components identified by Blanchard (1993) and Toner, Segal, et al. (1998)including education, relaxation, cognitive restructuring, and assertiveness training. In the comparison (SMTC) condition, participants monitored symptoms daily and were contacted weekly by phone to provide support and discussion of symptom patterns. Outcome measures included IBS symptom reduction scores (13 wks of daily monitoring; 4 wk global assessments), as well as psychological functioning (depression: BDI II; bowel-related cognitive-emotional distress: CSFBD; trait anxiety: STAI-T; discomfort with assertion: AQ, and quality of life: SF36), all assessed pre-, post- and, for Group CBT, at three month follow-up. 'Results'. Twenty-eight patients (96% female, mean age 39.5, range 18-68, mean symptom duration 9 yrs) took part. Data were analyzed based on change scores for matched pairs. Based on daily symptom measures, a third of patients had significant improvement (>=50% reduction) in pain from pre to post treatment, equally across treatment conditions. Group CBT participants reported significantly higher global ratings of pain relief and GI symptom improvement than SMrC participants. There was a significant reduction in daily pain scores for Group CBT at three-month follow-up. Based on MANOVA, there was significant improvement in psychological functioning and quality of life for the Group CBT participants in comparison to the SWC participants, with changes in bowel-related cognitive-emotional distress contributing the largest variance ('R'2 = 0.33). These improvements were maintained at the three-month follow-up. At post-treatment, Group CBT patients had significantly lower scores on the ' Precontemplation' scale, and significantly higher scores on the ' Action' and 'Maintenance' scales, of the Pain Stages of Change Questionnaire than SWC patients. Percentagecompletion of Group CBT homework exercises was significantly related to post-treatment GI symptom reduction. 'Conclusions'. Group CBT was more effective in reducing IBS-related psychological morbidity and enhancing quality of life, with improvements maintained three months later. Group CBT patients reported better overall relief of pain and general GI symptoms, and daily symptom tracking revealed that significant pain reduction was achieved at 3-month follow-up. Patients' motivational readiness for change and completion of homework assignments were significantly related to treatment outcome. Future research should include specific measures of behavioral avoidance and coping, as well as, data on health-care utilization as additional indices of outcome. en_US
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dc.title Controlled trial of a multicomponent cognitive-behavioral group treatment for irritable bowel syndrome en_US Psychology en_US Doctor of Philosophy (Ph.D.) en_US

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