Alimentary Pharmacology and Therapeutics

Invited Commentaries
Commentary: psychoeducation in the
irritable bowel syndrome - talking the talk
E. M. M. Quigley
Alimentary Pharmabiotic Centre, University College Cork, Cork,
Ireland.
E-mail: e.quigley@ucc.ie
doi:10.1111/apt.12220

Adopting our wise man/in my personal experience mode

we counsel our students and trainees on the critical value
of time spent with the irritable bowel syndrome (IBS) sufferer, emphasising the importance of explaining to them
the nature of their illness, and how stress and other environmental factors may inuence their symptomatology.
This approach seems to make sense and to be consistent with the traditional role of the wholistic, caring physician; but then so did blood-letting to the Victorians!
Demonstrating that this strategy is clinically valid is not
easy. Although a number of strands of evidence had suggested that time allocated to the IBS patient was well
spent, the randomised clinical trial from Labus and colleagues is, to my knowledge, the rst attempt to subject
what they describe as a psychoeducational intervention
to the rigours of modern clinical research methodology.1
In this study, those randomised to the active group
received 5 weekly 2 hour sessions with a gastroenterologist and a therapist, which included education about IBS
and its pathophysiology, instruction on the connection
between mood, stress and gastrointestinal symptoms,
relaxation training, and homework assignments. Subjects
were then evaluated at the end of the programme, and at
follow-up 3 months later. Symptom severity, depression
and visceral sensitivity were reduced, and quality of life
and coping skills enhanced at the end of the study, and
at the 3-month follow-up assessment in the group that
received the psychoeducation intervention.
These ndings support prior observations, such as
those of Owens and colleagues who noted that a positive

physician-patient interaction was associated, in the long

term, with fewer return visits to the clinic for IBS2 and
an uncontrolled study, also from the Mayo clinic, that
demonstrated, over a 6-month follow-up period, that an
education class reduced symptoms and enhanced some
health-promoting behaviours.3
Apart from such shortcomings as the location of the
study in a tertiary referral centre and relatively brief nature of the follow-up, what the Labus study cannot tell us
is why their approach worked and, specically, which of
the elements of the programme was most benecial.
Given that psychological approaches have been shown to
work in IBS4 and that one such approach, hypnotherapy,
has been shown to exert sustained effects,5 one could
postulate that it was the relaxation therapy that did the
trick.
Determining the operative element(s) of the strategy
employed by Labus and colleagues is of practical, as well
as academic, interest; this information will be critical when
one attempts to nd support for such a programme, be it
from a hospital, an academic institution or a payor.

ACKNOWLEDGEMENT
Declaration of personal and funding interests: None.
REFERENCES
1. 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: 30415.
2. Owens DM, Nelson DK, Talley NJ. The irritable bowel syndrome:
long-term prognosis and the physician-patient interaction. Ann
Intern Med 1995; 122: 10712.
3. Colwell LJ, Prather CM, Phillips SF, Zinsmeister AR. Effects of an
irritable bowel syndrome educational class on health-promoting
behaviors and symptoms. Am J Gastroenterol 1998; 93: 9015.
4. Ford AC, Talley NJ, Schoenfeld PS, Quigley EM, Moayyedi P.
Efcacy of antidepressants and psychological therapies in irritable
bowel syndrome: systematic review and meta-analysis. Gut 2009;
58: 36778.
5. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term
benets of hypnotherapy for irritable bowel syndrome. Gut 2003;
52: 16239.

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