The present study indicates that the CBT combined with the medical treatment was more effective than the medical treatment alone in reducing IBS symptoms. The control group, which only received medical treatment, showed a reduction of symptoms but the level was not significant. In other words, patients receiving combination therapies (CBT plus medical treatment) gained lower scores in ROME-II clinical indices. This shows that IBS symptoms were reduced in these patients. The case group improved in ROME-II clinical indices compared not only to the control group but also to themselves at the pre-test level. The reduction of scores in the case group is in conformity with several studies [7
] which conclude that cognitive therapy, psychotherapy, short-term psychoanalysis and cognitive behavioural therapy have been the most effective treatments for IBS. In comparison, while the cognitive and medical treatment cured 80% of IBS patients, those receiving cognitive therapy alone showed extensive reduction of symptoms. In addition, the advantages of cognitive therapy remain for a longer time after the treatment [16
]. Pinto et al
. found that recognition and treatment of anxiety and depression in the subgroups of IBS patients with psychotropic drugs and cognitive therapy, for gaining more positive coping skills, may require special attention in the management of IBS [12
]. It is noteworthy that when IBS patients receive combined treatment, their symptoms seem to decrease significantly. As such, the study conducted by Guthrie et al
. shows that psychotherapy in IBS patients reduced stomach ache and diarrhoea, but did not affect constipation. At the same time, cognitive therapy has been proved to be useful for controlling IBS symptoms [17
]. Also, Blanchard et al
. stated that progressive muscle relaxation training for patients as well as training for reducing tension and relaxing could reduce IBS symptoms. When these methods are used for a longer period of over 4 years, some 50% of symptoms such as pain, nausea and bloating will be cured [18
]. These studies also showed that some IBS symptoms are affected by psychotherapy more than others. In the present study, patients’ scores decreased relatively after the psychotherapy. However, the ROME-II questions have not been analysed here one by one; hence, it cannot be stated which symptoms were reduced more or which ones did not change. This study is in contrast with some parts of the studies conducted by Boyce and Gilcharist, who believed that CBT reduces IBS-related distress and disabilities, but does not reduce intestinal symptoms. This shows that CBT probably increases organ sensitivity through changing the cognitive response [6
The current study has shown that in the case group different IBS symptoms were reduced when under medical treatment (when medicines were being administered to IBS patients) combined with cognitive behavioural therapy, compared to medical treatment alone, with the reason these two methods are performed through experimental methods. As such, it seems that the two methods of CBT and medical treatment show a better cure, especially in IBS treatment, when combined together. In other words, together, these two methods are complete treatment.
Furthermore, the results also show that the mental health level of subjects suffering from IBS improved consequently under CBT combined with medical treatment than those under medical treatment only. With regards to the results of t-test and Mann-Whitney U
-test after CBT, the case group enjoyed a higher health score than the control group. Mean scores showed that the mental health of the control group, who received only medical treatment, did not change, i.e. mean differences were not statistically significant; however, the case group enjoyed a better health score than the control group. The case group under CBT had a higher health score at the post-test level than at the pre-test. These results are in line with some previous studies [5
]. According to Boyce et al
], because of the biopsychosocial model of interaction between gut function and emotion in IBS, psychological therapies are intended to break the negative feedback loop between emotion and gut function, in order to reduce symptoms. According to them, attention must be paid to a number of elements in the psychological approaches including a detailed assessment, psycho-education, support, and reassurance. The results of cognitive therapy and hypnotherapy have been reviewed several times and thus it seems they were quite effective compared to placebo and their effect lasted for nearly 4 years [4
]. In one of his studies, Taylor compared patients suffering from IBS with marked concealed aggressiveness with those with mild concealed aggressiveness and concluded that the first group had a poorer prognosis when they received the medical treatment alone (without psychoterapy) [13
]. Boyce and Gilcharist also showed that patients’ depression and anxiety significantly decrease with the treatment [6
]. Overall it can be said that the increase in mental health of IBS patients was due to the effect of the cognitive behavioural therapy combined with the medical treatment. It is therefore necessary that patients follow psychologists’ advice all the time. Also, they have to take medication prescribed by gastroenterologists, as well. This is the only way one can be hopeful for a desired level of patients’ health.
In conclusion, to sum up, cognitive behavioural therapy combined with medical treatment can reduce IBS symptoms and improve patients’ mental health. Therefore, it is necessary that patients be referred to psychologists for psychotherapy while they are under medical treatment.