The Effect of a Self-Management Program on Psychological Distress as Measured on Daily Diary in Irritable Bowel Syndrome

Thursday, 15 July 2010

Wimon Deechakawan, MSN, MS, RN
Kevin C. Cain, PhD
Monica E. Jarrett, PhD, RN
Margaret M. Heitkemper, PhD, RN, FAAN
Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA

Learning Objective 1: The learner will be able to identify two strategies for measuring psychological distress in men and women with irritable bowel syndrome.

Learning Objective 2: The learner will be able to understand the impact of a comprehensive self-management program on psychological distress.

Purpose: Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal (GI) disorder in both sexes in many countries. Cognitive behavioral therapy (CBT) has been shown to decrease GI symptoms and psychological distress as measured by retrospective recall of last week. The purpose of the current analysis is to examine the impact of CBT on individual psychological distress symptoms (anger, anxiety, panic feelings, decreased desire to talk or move, depression, and stress) as measured prospectively by daily diary. 

Methods: The secondary analysis used data collected in a randomized controlled trial of patients with IBS age 18-70 years (men = 20 and women = 124) who met Rome II criteria for IBS. The treatment group received a comprehensive self-management program (CSM) including CBT and the control group received usual care (UC). The CSM program was either delivered in-person or predominantly by telephone. The daily health diary data were collected for four weeks during the baseline and 12 months follow-up assessment.  

Results: There were no gender differences in psychological distress measures on daily diary at baseline. Compared to UC, CSM demonstrated significant improvement in mean daily anxiety (p = .03), panic (p = .01), decreased desire to talk or move (p =.02), and stressed (p = .05) at 12 months, and had weaker non-significant effects on anger (p = .07) and depression (p = .11). There was no statistically significant evidence that effect of CSM was different in men than in women, but the small number of men in the sample meant there was poor power for this comparison.

Conclusion: CSM has a significant effect on reducing psychological distress symptoms measured by daily diary, congruent with the results from retrospective measures. This study highlights the importance of considering psychological measures in intervention for patients with IBS. (funded by NINR # NR004142).