Stress and contingency management in the treatment of irritable bowel syndrome

Ninety patients with irritable bowel syndrome (IBS) who did not respond to medical treatment were randomly assigned to four treatment conditions—two experimental groups: stress management and contingency management; and two control groups: medical treatment and placebo. The subjects underwent 12 individual sessions which were specific for each condition. All the subjects completed symptom-monitoring diaries. Thirty-three dropped out during the assessment or treatment. The subjects who received training in contingency management experienced significant reductions in all the characteristic digestive symptoms: abdominal pain (p<0.001), diarrhoea (p<0.05), constipation (p<0.05) and dyspepsia (p<0.001). At the end of the treatment, 50 per cent of the patients remained asymptomatic and 37.5 per cent reduced their symptoms by at least 50 per cent. Among the patients assigned to the condition stress management, 33 per cent got rid of their symptomatology and the subjects showed significant reductions in the following digestive symptoms: abdominal pain (p<0.05), diarrhoea (p<0.05) and dyspepsia (p<0.05). The changes in the placebo group are not representative. The subjects assigned to this condition showed a high dropout rate. Significant changes were not observed in symptomatology in the medical treatment group. The results are maintained after a year of follow-up. Possible predictive parameters of the progress of the patients are explored.