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# Mind-Body Interventions for Gastrointestinal Conditions

*Evidence Reports/Technology Assessments, No. 40*

Ian D Coulter, Mary L Hardy, Joya T Favreau, Pamela D Elfenbaum, Sally C Morton, Elizabeth A Roth, Barbara J Genovese, and Paul G Shekelle.

Agency for Healthcare Research and Quality (US)2001 Jul
Report No.: 01-E0301-58763-054-0

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## Structured Abstract

#### Objectives:

 The objective of this evidence report was to conduct a search of the literature                    on the use of all mind-body therapies for the treatment of health conditions                    and, on the basis of that search, to choose either a condition or a mind-body                    modality for a comprehensive review. The health condition chosen, based on the                    results of an initial search, was gastrointestinal problems. The specific                    questions addressed in this project were: (1) What mind-body therapies have been                    used 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 problems?

#### Search strategy:

 A research librarian performed an initial database search of                    MEDLINE®, HealthSTAR, EMBASE®, Allied and Complementary                    Medicine™, MANTIS™, PsycINFO®, Social Science Citation                        Index®, two files of Science Citation Index®, and                        CINAHL®. We used “mind/body relations (metaphysics)” and “mind                    body therapies” as the MeSH term and a set of synonyms for mind-body. A more                    focused search was conducted for gastrointestinal health problems and                    mind-body.

#### Selection criteria:

 The literature search was confined to those mind-body therapies currently                    recognized as such by the National Center for Complementary and Alternative                    Medicine (NCCAM). In the initial search, all studies focusing on mind-body                    therapies were included. Those studies that focused on gastrointestinal (GI)                    problems were then identified. The mind-body therapies documented in the                    literature for treating GI problems included: behavioral therapy, biofeedback,                    cognitive therapy, guided imagery, hypnosis, placebo, relaxation therapy, and                    multimodal therapy.

#### Data collection and analysis:

 All titles, abstracts, or articles were reviewed by two independent reviewers                    and entered into a database. The titles/or abstracts/or articles were analyzed                    and synthesized into a descriptive report. Particular attention was paid to the                    mind-body modality used, the target body systems/conditions, the outcomes                    measured, and the type of study design used. An in-depth analysis was conducted                    on those studies that focused on GI conditions. We identified 53 GI studies that                    included a concurrent comparison group. Because of the clinical heterogeneity of                    these trials, however, we did not conduct a meta-analysis. Instead, a                    qualitative synthesis was conducted.

#### Main results:

 In the search of mind-body studies, the most common body systems/conditions for                    which mind-body therapy literature was found are: neuropsychiatric; head/ear,                    nose, and throat (head/ENT); gastrointestinal; circulatory; and musculoskeletal.                    Regarding therapies, the most common ones for which published studies were found                    were: biofeedback, hypnosis, relaxation, behavioral, and cognitive.For GI                    conditions, the most commonly studied mind-body therapy was biofeedback (n =                    22), and the most commonly studied conditions were irritable bowel syndrome (n =                    15), followed by fecal incontinence/encopresis (n = 11). Studies with a                    comparison group were reviewed for biofeedback (n = 17), hypnosis (n = 8),                    relaxation therapy (n = 8), behavioral therapy (n = 8), multimodal therapy (n =                    4), cognitive therapy (n = 4), guided imagery (n = 2), and placebo (n = 1).

Eleven of the biofeedback studies had a no biofeedback comparison group, and two                    reported a significant benefit from biofeedback. These studies were of adults                    with fecal incontinence and nausea/vomiting following chemotherapy. In the                    remaining nine biofeedback trials, seven of which were on children, biofeedback                    was not reported to have any benefit. There were seven studies of hypnosis that                    had a no hypnosis comparison group, six of which reported a significant benefit                    (for irritable bowel syndrome, two studies; nausea/vomiting, two studies;                    duodenal ulcer, one study; and ulcerative colitis, one study). Six of the eight                    relaxation-therapy controlled trials reported a significant benefit for                    irritable bowel syndrome (two studies), nausea/vomiting (two studies), ulcer                    (one study), and GI distress (one study). For the eight studies in behavioral                    therapy, six studies with a no behavioral therapy comparison group reported a                    significant benefit for encopresis (one study), nausea/vomiting (two studies),                    irritable bowel syndrome (two studies), and abdominal pain (one study). In                    cognitive therapy, four studies, all with a no cognitive therapy comparison                    group, reported a significant benefit. These were for irritable bowel (three                    studies) and ulcer (one study). In guided imagery therapy, one out of two                    studies with a no imagery comparison group reported a significant benefit. In                    placebo therapy there was only a single study. Four studies using a multimodal                    intervention, which does not enable a conclusion about individual therapies,                    were also reviewed.

#### Conclusions:

 There are limited data to support the efficacy of relaxation therapy, behavioral                    therapy, cognitive therapy and guided imagery as therapy for certain                    gastrointestinal conditions. There is no evidence to support the efficacy of                    biofeedback for children with gastrointestinal conditions, while for adults the                    evidence is mixed. The studies of hypnosis are limited by methodologic problems                    and no conclusions can be drawn.

## Contents

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                          - Collapse All

                        - Preface
                        - Summary
                        - 1. Introduction                           - Purpose
                          - Scope of Work
                          - Mind-Body Defined
                          - Review Scope
                          - Mind-Body Modalities
                        - 2. Methodology                           - Scope of Work
                          - Objectives
                          - Mind-Body Literature Search Design
                          - Mind-Body Study Review Strategy
                          - Focused Search
                          - The Review Process
                          - Data Extraction/Data Synthesis
                        - 3. Results                           - General Content of Mind-Body Literature
                          - Focused Search
                          - Synthesis of the Evidence
                        - 4. Conclusions and Future Research                           - Conclusions
                          - Limitations of the Review
                          - Future Research
                        - Evidence Tables
                        - Appendixes                           - Appendix A: Literature Search Strategies
                          - Appendix B: Short Screening Form
                          - Appendix C: Long Screening Form
                        - Acknowledgments
                        - References

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                          - Collapse All

Southern California Evidence-based Practice Center/RAND Director: Paul Shekelle,                    MD, PhD. Co-Director and Senior Statistician: Sally C Morton, PhD. Task Order                    Director: Ian D Coulter, PhD. Task Order Co-Director: Mary Hardy, MD. Expert                    Reviewers: Ian D Coulter, PhD; Joya T Favreau, MD; Pamela Elfenbaum, MPH. Senior                    Programmer/Analyst: Elizabeth A Roth, MA. Task Order Coordinator: Barbara                    Genovese, MA. Reference Librarian: Roberta Shanman, MLS. Editor: Elizabeth                    Maggio, BA. Research Associate: Swamy Venuturupalli, MD. Staff Assistants: Leigh                    Rohr; Louis R Ramirez, BA.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department                of Health and Human Services.1                 Contract No. 290-97-0001.                Prepared by: Southern California                    Evidence-based Practice Center/RAND.

#### Suggested citation:

Coulter ID, Hardy ML, Favreau JT, et al. Mind-Body                    Interventions for Gastrointestinal Conditions. Evidence Report/Technology                    Assessment No. 40 (Prepared by Southern California Evidence-based Practice                    Center/RAND under Contract No. 290-97-0001). AHRQ Publication No. 01-E030.                    Rockville (MD): Agency for Healthcare Research and Quality; July                    2001.

This report may be used, in whole or in part, as the basis for development of                clinical practice guidelines and other quality enhancement tools, or as a basis for                reimbursement and coverage policies. Endorsement by the Agency for Healthcare                Research and Quality (AHRQ) or the Department of Health and Human Services (DHHS) of                such derivative products may not be stated or implied.

The authors of this report are responsible for its content. Statements in the report                should not be construed as endorsement by the Agency for Healthcare Research and                Quality or the U.S. Department of Health and Human Services of a particular drug,                device, test, treatment, or other clinical service.

                        - 1
                        - 
2101 East Jefferson Street, Rockville, MD 20852. www​.ahrq.gov

Copyright Notice

Bookshelf ID: NBK33758

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