Objective: This study sought to characterize change mechanisms that underlie gastrointestinal (GI) symptom improvement in IBS patients undergoing two dosages of CBT for IBS as compared to a nondirective education/support (EDU) condition. Method: Data were collected in the context of a large clinical trial that randomized 436 Rome III-diagnosed IBS patients (Mage = 41, 80 % female) to standard, clinic-based CBT (S-CBT), a largely home-based version with minimal therapist contact (MC-CBT) or Education/Support that controlled for nonspecific effects. Outcome was measured with the IBS-version of the Clinical Global Improvement scale that was administered at Week 5 and 2-week posttreatment (Week 12). Potential mediators (IBS Self-efficacy (IBS-SE), pain catastrophizing, fear of GI symptoms, and treatment alliance were assessed at Weeks 3, 5, and 8 during treatment with the exception of treatment expectancy that was measured at the end of Session 1. Results: IBS-SE, a positive treatment expectancy for symptom improvement, and patient-therapist agreement on tasks for achieving goals mediated effects of CBT early in treatment (rapid response, RR) and at posttreatment. Notwithstanding their different intensities, both CBT conditions had comparable RR rates (43%-45%) and significantly greater than the EDU RR rate of 22%. While pain catastrophizing, fear of GI symptoms, and patient-therapist emotional bonding related to posttreatment symptom improvement, none of these hypothesized mediators explained differences between CBT and EDU, thereby lacking the mechanistic specificity of IBS-SE, task agreement, and treatment expectancy. Conclusion: Findings suggest that CBT-induced GI symptom improvement may be mediated by a constellation of CBT-specific (IBS-SE) and nonspecific (task agreement, treatment expectancy) processes that reciprocally influence each other in complex ways to catalyze, improve, and sustain IBS symptom relief. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

中文翻译：

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接受肠易激综合征教育/支持与认知行为治疗的患者胃肠道症状改善的具体和常见介质。


目的：本研究旨在描述与非指导性教育/支持 (EDU) 条件相比，接受两种剂量 CBT 治疗 IBS 的 IBS 患者胃肠道 (GI) 症状改善的变化机制。方法：在一项大型临床试验中收集数据，该试验将 436 名经罗马 III 诊断的 IBS 患者（Mage = 41，80% 女性）随机分配至标准的临床 CBT (S-CBT)，这是一种主要以家庭为基础的版本尽量减少治疗师接触 (MC-CBT) 或控制非特异性效应的教育/支持。结果采用 IBS 版本的临​​床整体改善量表进行测量，该量表在治疗后第 5 周和第 2 周（第 12 周）进行。在治疗期间的第 3、5 和 8 周评估潜在调节因素（IBS 自我效能 (IBS-SE)、疼痛灾难化、对胃肠道症状的恐惧和治疗联盟），但治疗预期除外（在疗程结束时测量） 1. 结果：IBS-SE、对症状​​改善的积极治疗期望以及患者与治疗师对实现目标的任务达成一致介导了治疗早期（快速反应，RR）和治疗后的 CBT 效果，尽管 CBT 的强度不同。虽然疼痛灾难性、对胃肠道症状的恐惧以及患者与治疗师的情感联系与治疗后症状改善相关，但这些假设的中介因素都没有。解释了 CBT 和 EDU 之间的差异，因此缺乏 IBS-SE、任务一致性和治疗预期的机制特异性。 结论：研究结果表明，CBT 诱导的胃肠道症状改善可能是由一系列 CBT 特异性 (IBS-SE) 和非特异性（任务一致性、治疗预期）过程介导的，这些过程以复杂的方式相互影响，以催化、改善和改善胃肠道症状。维持 IBS 症状缓解。 （PsycInfo 数据库记录 (c) 2021 APA，保留所有权利）。