ARTICLE INFO

Article Type

Original Research

Authors

Soleymani   P. (*)
Abolghasemi   A. (1)
Vakilee Abasaliloo   S. (2)
Rahimi   A. (3)
Bayramzadeh   N. (4)






(*) Psychology Department, Science Faculty, Ardabil Branch, Islamic Azad University, Ardabil, Iran
(1) Psychology Department, Human Science & Literature Faculty, University of Guilan, Rasht, Iran
(2) Psychology Department, Humanity Faculty, Tabriz University, Tabriz, Iran
(3) Internal Department, Medical Faculty, Tehran University of Medical Science, Tehran, Iran
(4) Psychology Department, Science Faculty, Ardabil Branch, Islamic Azad University, Ardabil, Iran

Correspondence

Address: Andishe-ye-no Consulting and Psychological Office, Alghadir Building, Sarcheshmeh Square, Ardabil, Iran. Postal Code: 5614668149
Phone: +98 (45) 33256247
Fax: +98 (45) 33337677
p62.soleymani@gmail.com

Article History

Received:  December  18, 2015
Accepted:  July 19, 2016
ePublished:  October 1, 2016

BRIEF TEXT


Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal disorder. Patients experience abdominal pain and different bowel symptoms in the absence of any structural or biological abnormalities. Symptoms of this syndrome may be combined with diarrhea, constipation or both [1].

... [2-29]. stress management focuses on cognitive-behavioral approach. This treatment increases the people`s ability to reduce stress and to appropriately adjust to stressful situations. These interventions consist of elements such as awareness-raising about stress, relaxation techniques, identification of inefficient thoughts, cognitive restructuring, problem solving instruction, training skills of self-expression, anger management, self-management and planning for the activities which all have been reported to be effective as psychological treatments in reducing the symptoms and improving the psychological status of patients with IBS [30-34]. ... [35].

The aim of this study was to determine the effectiveness of the cognitive-behavioral stress management training on the severity of the symptoms and emotional welfare of patients with IBS.

This is a pilot study and a clinical trial in the form of pre-test and post-test with control group.

The statistical population of the study involves all patients with IBS who had referred to gastroenterologists of Ardabil in 2012 and had been diagnosed with Irritable Bowel Syndrome based on ROME III criteria by the gastroenterologists.

The sample consisted of 30 patients who were chosen availably and assigned randomly to experimental and control groups each with 15 people in simple method. The criteria for entering the study included; a diagnosis of irritable bowel syndrome by the physician based on ROME III diagnostic criteria, not having psychological illnesses, not receiving pharmaceutical and non- pharmaceutical treatments related to psychiatric and psychological fields in the last 6 months, lack of gastrointestinal or any other diseases, having a degree higher than Diploma and agreement of participation in the study.

The intervention included a treatment program of cognitive-behavioral stress management [36]. This treatment was held in ten 90-minute sessions in groups once a week (Table 1). At the end of all sessions, homework was assigned for the subjects to master the topics which had been taught and patients were required to practice the behavioral techniques 3 times a day using CDs that were given to them. The research tool was the questionnaire of IBS symptom severity based on the scales of ROME III, positive and negative trait affect and life satisfaction. In addition to considering ROME III diagnostic criteria, IBS symptom severity questionnaire was used by a gastroenterologist to assess the symptoms of Irritable Bowel Syndrome. This questionnaire contains questions evaluating the presence or absence of Irritable Bowel Syndrome symptoms. It includes 14 questions with multiple-choice various answers and for a specific option confirming Irritable Bowel Syndrome, the patient will receive one score. A higher score indicates the severity of the disease. In a pilot study, Cronbach's alpha coefficient and retest reliability coefficient (after a month) was obtained 0.89 and 0.95, respectively [37]. The scale of Positive and Negative Trait Affect is a 20-item self-assessment tool which has been designed to measure both the positive and negative affect. The items are ranked on a five-point scale (from very low to very high) by the subjects [38]. In domestic studies, internal consistency coefficient for the subscales of positive and negative affects has been reported 0.88 and 0.87, respectively [39]. Life satisfaction scale has 5 items which is responded based on a seven-point Likert scale from “I strongly agree” to “I strongly disagree”. The internal consistency coefficient of this scale has been reported between 0.79 and 0.89 as has the retest reliability, 0.84 [40]. The internal consistency and retest reliability in Iran has been obtained 0.85 and 0.77, respectively [24]. Evaluation of patients was performed in two stages of pre- test and post-test. It should be mentioned that the control group was only under medical treatment and received no psychological treatment. Data was analyzed using SPSS 20 software and multivariate analysis of covariance.

The mean age of all patients was 33.00 ± 8.30. 20, 10, 19 and 11of patients were female, male, married and single, respectively. In terms of occupation status, most of them in both experimental (53.3%) and control groups (66.7%) were employed. There was 1 to 4 and 1 to 6 years of history of Irritable Bowel Syndrome in the experimental and the control groups, with the mean of 2.50 ± 0.93 and 2.27 ± 1.50 years, respectively. There was a significant difference between the mean scores of positive affect, negative affect, life satisfaction and the symptom severity of Irritable Bowel Syndrome in both experimental and control groups at post-test stage (p <0.001). Therefore, the intervention based on cognitive-behavioral stress management training leaded to significant differences between the experimental and control groups; such that training cognitive-behavioral stress management could determine 51%, 55%, 89% and 57% of the variance of positive affect component, negative affect component, life satisfaction and symptoms severity of IBS, respectively (table 2).

The results of the study showed that cognitive-behavioral stress management therapy has been effective in reducing the severity of symptoms, and improving emotional states and life satisfaction in patients with IBS. Our results were in line with the findings of recent studies [29-34]. ... [40-44].

In future studies, it is suggested to separately evaluate the effects of treatment in Irritable Bowel Syndrome subgroups. Moreover, comparing the effectiveness of stress management training and other psychological treatments can be beneficial.

One of the limitations of the research was that no follow-up stage was performed after the treatment.

Cognitive-behavioral stress management therapy can be effective in reducing the severity of symptoms and improving emotional well-being of patients with Irritable Bowel Syndrome.

Sincere thanks are regarded to all patients who participated in this study.

Non-declared

This study was ethically approved by Islamic Azad University of Ardabil.

This article is taken from a Thesis of MA degree in the field of clinical psychology.

TABLES and CHARTS

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