A preliminary investigation of the effects of cognitive behavioral therapy for panic disorder on gastrointestinal distress in patients with comorbid panic disorder and irritable bowel syndrome

ArticleinDepression and Anxiety 28(11):1027-33 · November 2011with13 Reads
DOI: 10.1002/da.20863 · Source: PubMed
High comorbidity between panic disorder with/without agoraphobia (PD/A) and irritable bowel syndrome (IBS) has been identified in the literature. These findings have resulted in the recent development of neurobiological models to explain their overlapping symptoms and related origins. This study was a preliminary investigation of the influence of cognitive behavioral therapy (CBT) for PD/A on PD/A patients with and without comorbid IBS. All patients completed a thorough intake assessment, brief waitlist period, and a 12-week CBT group for PD/A. The results demonstrated significant reductions in the symptoms of anxiety, depression, and overall impairment in both patient groups (ts>2.3; Ps<.05). In addition, PD/A patients with comorbid IBS also experienced reductions in the disability and distress associated with their gastrointestinal symptoms of IBS (ts>1.9; Ps<.07). Although additional research still is needed, these preliminary findings suggest that CBT for PD/A can be used to simultaneously treat comorbid symptoms of PD/A and IBS. Implications for the neurobiological models for these comorbid conditions were discussed.
    • "Individuals with panic disorder – especially women – typically experience significantly low rates of remission and high rates of relapse for panic attack symptoms (Sibrava, Beard, Bjornsson, Moitra, Weisberg, & Keller, 2013; Yonkers, Bruce, Dyck, & Keller, 2003), calling attention to the need for improved treatment of patients facing panic disorder with agoraphobia. Evidence has suggested high rates of comorbidity of panic disorder with various medical conditions, including gastrointestinal disorders such as irritable bowel syndrome (Gros, Antony, McCabe, & Lydiard, 2011), asthma (Lavoie et al., 2013), cardiovascular and cerebrovascular disease (Morris, Baker, Devins, & Shapiro, 1997; Smoller, Pollack, Wassertheil-Smoller, Jackson, Oberman, & Wong, 2007), and migraines (Smitherman, Kolivas, & Bailey, 2013). Likewise, panic disorder can be comorbid with a variety of other mental health disorders, including bipolar disorder (Forty et al., 2009; Goes et al., 2012; Lee & Dunner, 2008), major depressive disorder (Forty et al., 2009; Goes et al., 2012; Sibrava et al., 2013), substance use disorders (Sibrava et al., 2013), and posttraumatic stress disorder (Cougle, Feldner, Keough, Hawkins, & Fitch, 2010; Gros, Frue, & Magruder, 2011). "
    [Show abstract] [Hide abstract] ABSTRACT: Despite limited attention in empirical and clinical literature, we propose that contextual therapy is a useful framework for intervening at both the individual and relational level, and we provide a detailed description of the process of multidirected partiality. A case study is provided to demonstrate multidirected partiality in individual and family therapy to treat a woman in her 60s with panic disorder. The client identified relational fears triggering her panic attacks and developed her coping skillset and support system, successfully managing her symptoms of panic and anxiety. Implications for expanding research and clinical practice based in contextual therapy are offered.
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    • "Agoraphobia is present in 20,2% of patient affected by PD [36,37]. High comorbidity between IBS and PD has been identified in the literature [3,17,38]. The prevalence of IBS symptoms characteristics in patients with PD varies between 25 to 44%, several symptoms being characteristic of the two disorders (nausea, diarrhea, abdominal discom- fort)39404142. "
    [Show abstract] [Hide abstract] ABSTRACT: Irritable bowel syndrome (IBS) is a functional syndrome characterized by chronic abdominal pain accompanied by altered bowel habits. Although generally considered a functional disorder, there is now substantial evidence that IBS is associated with a poor quality of life and significant negative impact on work and social domains. Neuroimaging studies documented changes in the prefrontal cortex, ventro-lateral and posterior parietal cortex and thalami, and implicate alteration of brain circuits involved in attention, emotion and pain modulation. Emerging data reveals the interaction between psychiatric disorders including generalized anxiety disorder, panic disorder, major depressive disorder, bipolar disorder, and schizophrenia and IBS, which suggests that this association should not be ignored when developing strategies for screening and treatment. Psychological, social and genetic factors appear to be important in the development of IBS symptomatology through several mechanisms: alteration of HPA axis modulation, enhanced perception of visceral stimuli or psychological vulnerability. Elucidating the molecular mechanisms of IBS with or without psychiatric comorbidities is crucial for elucidating the pathophysiology and for the identification of new therapeutical targets in IBS. Keywords: Irritable bowel syndrome; Psychiatric disorders; Comorbidities; Brain-gut axis; Psychosocial factors
    Full-text · Article · Jun 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Aim: To investigate the efficacy of tandospirone in patients with irritable bowel syndrome-diarrhea (IBS-D) and anxiety in a prospective, randomized, controlled study. Methods: Two hundred patients with IBS-D and moderate anxiety were randomized to receive pinaverium and tandospirone (arm A) or pinaverium and placebo (arm B). Tandospirone or placebo was given thrice daily at a fixed dose of 10 mg and pinaverium was given thrice daily at a fixed dose of 50 mg. The duration of treatment was 8 wk. Patients were assessed for abdominal pain and diarrhea. Anxiety was evaluated using the Hamilton Rating Scale for Anxiety (HAM-A). The primary study endpoints were response rates for abdominal pain and diarrhea. The secondary study endpoints were response rates for anxiety. Adverse events were also evaluated. Results: One hundred and seventy of 200 patients (82 patients in arm A and 88 patients in arm B) completed the study. Demographic and baseline characteristics of the 200 participants were comparable in the two arms. At week 8, the overall response rate for abdominal pain and diarrhea was 52.0% for arm A and 37.0% for arm B (P < 0.05). The HAM-A score showed that the response rate was 61.0% for arm A and 21.0% for arm B (P < 0.01). The treatments were well tolerated and no significant adverse events were reported. Conclusion: Tandospirone is effective and can be combined with pinaverium in IBS-D patients with anxiety.
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