Last year I reported on a study that showed that psychotherapy was effective at reducing the physical pain of Irritable Bowel Syndrome (IBS) and that, at the same time, it was superior to medication at reducing healthcare costs associated with the illness. A new meta-analysis extends the work on psychological treatments for IBS and shows that talking therapies are also effective for improving the mental health and quality of life sufferers. Quality of Life is a psychological measure that looks at the wellbeing of an individual or group and can assess how much satisfaction they derive from their lives or from an aspect of it, such as work or relationships. IBS can reduce quality of life by getting in the way of normal daily activities like work or socialising and can create mental distress but, for example, increasing anxiety around eating and meal times, depression and, in severe cases, suicidal thoughts.

This new meta-analysis looked not only at the efficacy of psychotherapy on improving mental health in IBS sufferers but also at which type of therapy was most effective. The researchers collated 31 randomised controlled trials that provided data on overall mental health and daily functioning of nearly 2000 individuals from different countries. The researchers found that all kinds of psychotherapy were effective at improving psychological wellbeing, people felt better. When it came to daily function cognitive behaviour therapy (CBT) appeared to be the most effective, compared to psychodynamic, hypnosis or relaxation therapy.

Whilst this research is encouraging in relation to the value of therapy in treatment of IBS it does present with a number of problems. First, the researchers have been unable to distinguish between what types of CBT were being provided. For example, some ‘brands’ of CBT focus more on mindfulness, whilst others focus on acceptance and behaviour change. It may be that there is further variability within these groups. In addition, CBT was by far the most studied therapy. Looking at mental health, for example, there were 19 CBT trails compared to 3 psychodynamic. More research on other types of psychotherapy will be useful to add strength to the conclusions. Also, another paper published this year suggested that though CBT did lead to improvements in quality of life for IBS sufferers the results did not last long after the therapy ended.

What we can be surer of is that psychological therapy does improve the mental wellbeing of IBS patients and can be an important tool in helping improve their quality of life. Though there is further research required this meta-analysis adds to the body of research highlighting the powerful role that psychological therapies play in IBS treatment.

References

Laird, K. T., Tanner-Smith, E. E., Russell, A. C., Hollon, S. D. & Walker, L. S. (2017). Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and meta-analysis. Clinical Psychology Review, 51, 142-152. https://doi.org/10.1016/j.cpr.2016.11.001

Dehkordi AH, Solati K. The effects of cognitive behavioral therapy and drug therapy on quality of life and symptoms of patients with irritable bowel syndrome. Journal of Advanced Pharmaceutical Technology & Research. 2017;8(2):67-72. doi:10.4103/japtr.JAPTR_170_16.

Many people will have heard that there are mood benefits of exercise. This is often linked to the ‘runners high’; the body’s release of endorphins and other ‘feel good’ chemicals during and just after exercise. There are also other neurological benefits of exercise that are linked to improved mood and wellbeing. For example, aerobic exercise increases the production of a protein called Brain Derived Neurotrophic Factor (BDNF). BDNF promotes the growth of new brain cells and is associated with improved memory, executive function and mood. Several studies and meta-analyses have demonstrated a positive effect of exercise on the symptoms of depression that are comparable to psychotherapy and antidepressant medication, and a new meta-analysis published last month, looking specifically at Quality of Life (QoL) adds to this body of research. QoL differs from illness symptoms in that it relates to a more global sense of wellbeing or satisfaction with life including where one perceives oneself to be in relation to peers or cultural expectations.

In this review the researchers collated exercise trials that assessed QoL in people with a diagnosis of Major Depressive Disorder (MDD). All trials included in this review had to include a non-exercise control group so that the effect of exercise could be established (as opposed to some other factor). The results indicated that moderate aerobic exercise, performed three times per week (the average across the studies) was associated with improved overall QoL for people with MDD. In addition, there were specific improvements in the psychological domain. The psychological domain (compared to the physical and social domains) has been shown have the greatest effect on overall QoL in long-term illness. There was no change in QoL in the non-exercising (control) groups. The authors state that exercise can be used as an effective treatment strategy for depression especially since antidepressant medication alone tends not to improve QoL even when depressive symptoms improve.

The evidence for the benefits of exercise in treating depression is robust and established. Regular exercisers have up to 30% reduced risk of developing the illness. Of course, the experience of depression can make it difficult to find the motivation to exercise in the first place. For some people it may be important to start with smaller exercise goals such as a five minute walk three times a week to help build a sense of achievement and consistency. Walking with a friend or a group could potentially enhance the social domain of QoL as well as helping you to stay committed. Exercise can be a very effective, accessible, low-cost, low-risk (of side effects) weapon in the arsenal against depression.

Schuch, F. B., Vancampfort, D., Rosenbaum, S., Richards, J., Ward, P. B. & Stubbs, B. (2016). Exercise improves physical and psychological quality of life in people with depression: A meta-analysis including the evaluation of control group response. Psychiatry Research, 241, 47-54.

Arnold, R., Ranchor, A. V., Sanderman, R., Kempen, G. I., Ormel, J. & Suurmeijer, T. P. (2004). The relative contributions of domains of quality of life to overall quality of life for different chronic diseases. Quality of Life Research, 13, 883-896.

http://www.nhs.uk/Livewell/fitness/Pages/Whybeactive.aspx

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern. Speak to your GP or a trainer before making any significant changes to your exercise routine.

Psychotherapy Improves Mental Health and Daily Functioning in Irritable Bowel Syndrome: Meta-Analysis.

Mental Health Awareness Week – Special Focus on Depression (Exercise)