Mind-Body Interventions for Gastrointestinal Conditions

Which mind-body therapy works best for GI conditions? Behavioral therapy, biofeedback, CBT, hypnosis or another? Find out.

Summary

Under its Evidence-based Practice Program, the Agency for Healthcare Research and Quality (AHRQ) is developing scientific information for other agencies and organizations on which to base clinical guidelines, performance measures, and other quality improvement tools. Contractor institutions review all relevant scientific literature on assigned clinical care topics and produce evidence reports and technology assessments, conduct research on methodologies and the effectiveness of their implementation, and participate in technical assistance activities.

• Overview
• Reporting the Evidence
• Methodology
• Findings
• Future Research
• Availability of Full Report

Overview

The objective of this evidence report was to search the literature on the use of mind-body therapies for the treatment of health conditions and, on the basis of this search, to choose either a condition or mind-body modality for a comprehensive review.

A broad search of mind-body therapies showed that there were sufficient studies regarding their use for gastrointestinal (GI) conditions to warrant a detailed review. GI conditions pose a significant health problem, and they can be challenging to manage. They also have been the focus of mind-body interventions, including:

• Behavioral therapy.
• Biofeedback.
• Cognitive therapy.
• Guided imagery.
• Hypnosis.
• Meditation.
• Placebo therapy used as an intervention.
• Relaxation therapy.
• Multimodal therapy.

However, no studies of meditation were found that used a comparative treatment design. Therefore, this report reviews the use of behavioral therapy, biofeedback, cognitive therapy, guided imagery, hypnosis, placebo therapy, relaxation therapy, and multimodal therapy for the treatment of GI conditions.

Reporting the Evidence

The purpose of this work is to identify those mind-body therapies that have empirical support of efficacy. Such information can be used to help health care providers care for patients with GI conditions and to identify future research needs. The specific questions addressed in this report are:

1. What mind-body therapies have been reported in the literature, for which body systems/conditions, and using what kind of research design?

2. What is the efficacy of mind-body therapies for the treatment of gastrointestinal conditions?

An initial broad search of the mind-body literature yielded 2,460 titles, of which 690 were judged possibly relevant to our investigation based on the use of a short screening form. This form screened for:

• Source of the article.
• Subject.
• Language.
• Focus.
• Body system.
• Outcomes.
• Modalities used.
• Human/animal subjects.
• Study type.

To answer our first major research question and to describe the basic characteristics of the published mind-body literature, we assessed these accepted articles for their target body systems or health conditions, for the mind-body modalities used, and for the study design. To answer our second research question, we further assessed this abridged group of articles and identified 53 studies of GI conditions that included a mind-body therapy in a trial. These studies provided evidence regarding the efficacy of mind-body therapies for the treatment of GI conditions.

Methodology

A panel of technical experts representing diverse disciplines was established to advise us throughout the course of our research.

We searched the literature using the following online databases: MEDLINE®, HealthSTAR, EMBASE®, PsycINFO®, Allied and Complementary Medicine™, MANTIS™, Psychological Abstracts, Social Science Citation Index®, two files of Science Citation Index®, and CINAHL®.

We used the following ng MeSH terms: mind/body metaphysics, mind body therapies, mind/body medicine, mind/body wellness, bodymind medicine, mind/body therapies, psychosomatics/psychosomatic/psychosomatic medicine, wisdom of the body, self healing, placebo, healing force of nature, healing consciousness, biopsychosocial, psychoneuroimmunology (if article specified a mind-body therapy or diagnosis with psychoneuroimmunology), and wellness.

We further restricted the search by including terms for selected mind-body modalities as defined by the National Center for Complementary and Alternative Medicine (NCCAM) plus terms that would identify research reporting any outcomes.

There was no language restriction. Additional articles were identified from citations of articles, particularly review articles, and citations suggested by external reviewers. All titles, abstracts, and articles were reviewed by two reviewers, whose disagreements were resolved by consensus.

We collected data on the articles generated by this search regarding body system, mind-body modality, and study design with a screening form developed for this purpose. We used titles, abstracts, and/or articles to collect this information. We analyzed these data, reported on the general characteristics of the field of mind-body research, and used this analysis to inform our selection of a topic for a focused review.

We then conducted a focused literature search on mind-body therapies specifically for the treatment of GI conditions, searching the same databases used for the earlier search. In addition to the mind-body search terms, we also used the more general "outcomes" terms for GI conditions. We collected data for these new articles using the same review technique employed in the initial search.

We selected all studies identified in either the initial or the focused search that studied GI conditions using a controlled study design with a concurrent comparison group. This yielded 53 GI studies that were then reviewed in-depth. However, because of the clinical heterogeneity of these trials, we did not conduct a meta-analysis. Instead, a qualitative analysis was conducted on these studies.

Findings

• The five most common body systems/conditions for which mind-body therapy literature was found are: neuropsychiatric; head/ear, nose, and throat (head/ENT); GI; circulatory; and musculoskeletal.

• The trials that exist on GI conditions are seriously limited by methods problems (small sample sizes, lack of randomization, and clinical heterogeneity).

• The greatest number of trials of a mind-body therapy for GI conditions in trials was biofeedback (n=17).

• There are fewer controlled trials in the GI studies that assess other mind-body therapies: hypnosis (n=8), relaxation (n=8), behavioral therapy (n=8), multimodal therapy (n=4), cognitive therapy (n=4), imagery (n=2), and placebo (n=1).

• The most commonly studied GI conditions were irritable bowel syndrome (n=15), fecal incontinence/encopresis (n=11), constipation (n=10), vomiting (n=8), nausea (n=7), and abdominal pain (n = 5).

• There is no evidence to support the efficacy of biofeedback therapy for children.

• There is limited evidence (i.e., at least one trial whose quality score characterized it as "good" that reported statistically significant benefits and the majority of other studies also report statistically significant benefits) to support the efficacy of the following mind-body therapies:

  • Behavioral.

  • Cognitive.

  • Guided imagery.

  • Relaxation.

• The methodological shortcomings of studies reporting beneficial effects of hypnosis preclude drawing conclusions about its efficacy.

• Results are mixed regarding the use of biofeedback in adults.

Future Research

Future mind-body research needs to be better designed and implemented. Studies need to enroll adequate numbers of well-defined, clinically homogeneous populations, and they need to compare the mind-body therapy both to other potentially effective therapies and to a convincing control. They should employ randomization, use blinding where feasible, and measure outcomes that are meaningful to patients and that can be reliably assessed. Ultimately, only those studies with a control group for comparative analysis can address the question of the efficacy of mind-body therapies. A more focused research program might overcome the problem of too few studies found on too many GI conditions and variable patient populations.

Availability of the Full Report

The full evidence report from which this summary was taken was prepared for the Agency for Healthcare Research and Quality by the Southern California Evidence-based Practice Center under contract No. 290-97-0001. Printed copies may be obtained free of charge from the AHRQ Publications Clearinghouse by calling 1-800-358-9295. Requesters should ask for Evidence Report/Technology Assessment No. 40, Mind-Body Interventions for Gastrointestinal Conditions (AHRQ Publication No. 01-E027).

The Evidence Report is also online on the National Library of Medicine Bookshelf.

AHRQ Publication No. 01-E027 Current as of March 2001

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