title: Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy. CONTROLLED TRIAL OF HYPNOTHERAPY IN THE TREATMENT OF SEVERE REFRACTORY IRRITABLE-BOWEL SYNDROME The value of screening for psychiatric disorders prior to upper endoscopy. A controlled trial of psychological treatment for the irritable bowel syndrome. A randomized controlled trial of psychotherapy in patients with chronic functional dyspepsia. Long-term improvement in functional dyspepsia using hypnotherapy. Treating Nonulcer Dyspepsia Considering Both Functional Disorders of the Digestive System and Psychiatric Conditions Psychotherapy in functional dyspepsia. The Leeds Dyspepsia Questionnaire: a valid tool for measuring the presence and severity of dyspepsia
abstract: Abstract Objective : To examine the additional effect of cognitive behavioural therapy for patients with medically unexplained physical symptoms in comparison with optimised medical care . Design : R and omised controlled trial with follow up assessment s six and 12 months after the baseline evaluation . Setting : General medical outpatient clinic in a university hospital . Subjects : An intervention group of 39 patients and a control group of 40 patients . Interventions : The intervention group received between six and 16 sessions of cognitive behavioural therapy . Therapeutic techniques used included identification and modification of dysfunctional automatic thoughts and behavioural experiments aim ed at breaking the vicious cycles of the symptoms and their consequences . The control group received optimised medical care . Main outcome measures : The degree of change , frequency and intensity of the presenting symptoms , psychological distress , functional impairment , hypochondriacal beliefs and attitudes , and ( at 12 months of follow up ) number of visits to the general practitioner . Results : At six months of follow up the intervention group reported a higher recovery rate ( odds ratio 0.40 ; 95 % confidence interval 0.16 to 1.00 ) , a lower mean intensity of the physical symptoms ( difference −1.2 ; −2.0 to −0.3 ) , and less impairment of sleep ( odds ratio 0.38 ; 0.15 to 0.94 ) than the controls . After adjustment for coincidental baseline differences the intervention and control groups also differed with regard to frequency of the symptoms ( 0.32 ; 0.13 to 0.77 ) , limitations in social ( 0.35 ; 0.14 to 0.85 ) and leisure ( 0.36 ; 0.14 to 0.93 ) activities , and illness behaviour ( difference −2.5 ; −4.6 to −0.5 ) . At 12 months of follow up the differences between the groups were largely maintained . Conclusion : Cognitive behavioural therapy seems to be a feasible and effective treatment in general medical patients with unexplained physical symptoms A total of 117 depressed clients , stratified for severity , completed 8 or 16 sessions of manualized treatment , either cognitive-behavioral psychotherapy ( CB ) or psychodynamic-interpersonal psychotherapy ( PI ) . Each of 5 clinician-investigators treated clients in all 4 treatment conditions . On most measures , CB and PI were equally effective , irrespective of the severity of depression or the duration of treatment . However , there was evidence of some advantage to CB on the Beck Depression Inventory ( Beck , Ward , Mendelson , Mock , & Erbaugh , 1961 ) . There was no evidence that CB 's effects were more rapid than those of PI , nor did the effects of each treatment method vary according to the severity of depression . There was no overall advantage to 16-session treatment over 8-session treatment . However , those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions 30 patients with severe refractory irritable-bowel syndrome were r and omly allocated to treatment with either hypnotherapy or psychotherapy and placebo . The psychotherapy patients showed a small but significant improvement in abdominal pain , abdominal distension , and general well-being but not in bowel habit . The hypnotherapy patients showed a dramatic improvement in all features , the difference between the two groups being highly significant . In the hypnotherapy group no relapses were recorded during the 3-month follow-up period , and no substitution symptoms were observed Gastrointestinal ( GI ) complaints are among the most common symptoms in primary care yet are frequently unexplained and often lead to costly diagnostic testing . We sought to determine the prevalence of psychiatric disorders in patients with unexplained GI complaints undergoing upper endoscopy  , and the likelihood of endoscopic abnormalities in patients with and without psychiatric diagnoses . We prospect ively evaluated 116 adult patients who were undergoing upper endoscopy to evaluate GI complaints . All subjects received a structured psychiatric interview prior to endoscopy using PRIME-MD , and endoscopists were blinded to the PRIME-MD results . Psychiatric disorders were detected in 70 ( 60 % ) patients . Overall , there were 113 diagnoses ( some patients had multiple disorders ) with the most common being somatoform ( 44 % ) , depressive ( 29 % ) , and anxiety ( 19 % ) disorders . Only 29 patients had major endoscopic abnormalities , including esophageal disease ( 14 ) , peptic ulcer ( 9 ) , severe gastritis ( 4 ) , gastric cancer ( 1 ) , and esophageal cancer ( 1 ) . There was a much higher prevalence of psychiatric disorders in patients without major endoscopic abnormalities ( 74 % vs. 21 % , p < 0.0001 ) . Psychiatric disease was strongly predictive of endoscopic findings ( OR for major abnormality = 0.11 in women , and 0.40 in men ) , especially if somatoform disorder was present ( OR = 0.15 ) . We conclude that , with a simple question naire , psychiatric disorders can be diagnosed in a large proportion of patients with unexplained GI complaints who are referred for upper endoscopy . The presence of a psychiatric disorder , particularly if somatoform , makes it unlikely that endoscopy will reveal significant GI disease One hundred two patients with irritable bowel syndrome were studied in a controlled trial of psychological treatment involving psychotherapy , relaxation , and st and ard medical treatment compared with st and ard medical treatment alone .  Patients were only selected if their symptoms had not improved with st and ard medical treatment over the previous 6 months . At 3 months , the treatment group showed significantly greater improvement than the controls on both gastroenterologists ' and patients ' ratings of diarrhea and abdominal pain , but constipation changed little . Good prognostic factors included overt psychiatric symptoms and intermittent pain exacerbated by stress , whereas those with constant abdominal pain were helped little by this treatment . This study has demonstrated that psychological treatment is feasible and effective in two thirds of those patients with irritable bowel syndrome who do not respond to st and ard medical treatment BACKGROUND & AIMS This study aim ed to determine whether brief psychodynamic-interpersonal ( PI ) psychotherapy is more efficacious than a psychological control for patients with chronic , intractable functional dyspepsia ( FD ) , and whether patients with abnormal gastric function respond differently than those with normal gastric function . METHODS Ninety-five consecutive patients with chronic symptoms of FD who had failed to respond to conventional pharmacologic treatments were approached . Thirty-seven received  PI psychotherapy , and 36 the control condition ( supportive therapy ) . Patients completed self-report question naires before and after treatment and 12 months later . The patients ' gastroenterologists , who were blind to the study groups , conducted independent ratings before and after treatment . Forty-nine patients also underwent a radioisotope gastric emptying study . An intention-to-treat analysis was used with baseline scores as covariates . RESULTS At the end of treatment , there were significant advantages for PI psychotherapy compared with controls for the gastroenterologists ' ( P = 0.002 ) and patients ' total symptom score ( P = 0.015 ) . One year after treatment , the symptomatic scores were similar . However , a sub analysis showed that PI therapy was superior to the control condition at 1 year , when patients with severe heartburn were excluded . There was no difference in outcome between patients with normal and abnormal gastric emptying . CONCLUSIONS PI therapy may have both short- and long-term effects in patients with dyspepsia , but further evaluation is required . Its cost-effectiveness needs to be determined BACKGROUND & AIMS We have shown hypnotherapy ( HT ) to be effective in  irritable bowel syndrome  , with long-term improvements in symptomatology and quality of life ( QOL ) . This study aim ed to assess the efficacy of HT in functional dyspepsia ( FD ) . METHODS A total of 126 FD patients were r and omized to HT , supportive therapy plus placebo medication , or medical treatment for 16 weeks . Percentage change in symptomatology from baseline was assessed after the 16-week treatment phase ( short-term ) and after 56 weeks ( long-term ) with 26 HT , 24 supportive therapy , and 29 medical treatment patients completing all phases of the study . QOL was measured as a secondary outcome . RESULTS Short-term symptom scores improved more in the HT group ( median , 59 % ) than in the supportive ( 41 % ; P = 0.01 ) or medical treatment ( 33 % ; P = 0.057 ) groups . HT also benefited QOL ( 42 % ) compared with either supportive therapy ( 10 % [ P < 0.001 ] ) or medical treatment ( 11 % [ P < 0.001 ] ) . Long-term , HT significantly improved symptoms ( 73 % ) compared with supportive therapy ( 34 % [ P < 0.02 ] ) or medical treatment ( 43 % [ P < 0.01 ] ) . QOL improved significantly more with HT ( 44 % ) than with medical treatment ( 20 % [ P < 0.001 ] ) . QOL did improve in the supportive therapy ( 43 % ) group , but 5 of these patients commenced taking antidepressants during follow-up . A total of 90 % of the patients in the medical treatment group and 82 % of the patients in the supportive therapy group commenced medication during follow-up , whereas none in the HT group did so ( P < 0.001 ) . Those in the HT group visited their general practitioner or gastroenterologist significantly less ( median , 1 ) than did those in the supportive therapy ( median , 4 ) and medical treatment ( median , 4 ) groups during follow-up ( P < 0.001 ) . CONCLUSIONS HT is highly effective in the long-term management of FD . Furthermore , the dramatic reduction in medication use and consultation rate provide major economic advantages Nonulcer dyspepsia ( NUD ) is a common syndrome , but the optimal treatments have yet to be established . This study was performed to determine the most effectivetreatment for NUD . Subjects were recruited through the Department of General InternalMedicine at the Kyushu University Hospital because oftheir somatic symptoms . When no organic lesions werefound , the patients were directed to consult ourdepartment ( Psychosomatic Medicine ) ; 194 consecutive NUD patients were studied . All subjects were assessedpsychiatrically with the Structured Clinical Interviewfor DSM-III-R(SCID ) . Patients with serious NUD were hospitalized , and r and omly divided into control(N = 42 ) and experimental groups ( N = 86 ) . The controlswere treated with physical treatment alone . Theexperimental group received psychiatric treatment inaddition , based on the results of SCID . The experimentalgroup showed a significant improvement compared with thecontrols ( P < 0.0001 ) . The treatment for NUD takinginto consideration both the physical and psychiatric conditions is highly effective Patients with functional dyspepsia were assigned at r and om to cognitive psychotherapy ( 10 sessions of 50 min duration , n = 50 ) or to a control group ( no treatment , n = 50 ) . Before treatment all patients were assessed on psychological , somatic and lifestyle factors . If allocated to the therapy group all patients were also asked to define the main problems they wanted to discuss in therapy ( ' target complaints ' ) . The patients were evaluated at the end of therapy ( after 4 months ) and at 1 yr follow-up . Outcome measures were dyspeptic symptoms , scores on ' target complaints ' and psychological parameters . Both groups showed improvement in dyspeptic and psychological parameters after 1 yr . The improvement in the control group was attributed to a non- specific effect of increased interest and attention . The therapy group showed greater reduction than the control group on dyspeptic symptoms [ days of epigastric pain ( p = 0.050 ) , nausea ( p = 0.024 ) , heartburn ( p = 0.021 ) , diarrhoea ( p = 0.002 ) and constipation ( p = 0.047 ) ] ; and on scores on ' target complaints ' ( p = 0.001 ) There is currently no vali date d question naire that assesses both the presence and severity of dyspepsia
target: The studies highlighted problems with recruitment and compliance .
  CONCLUSIONS : There was insufficient evidence on the efficacy of psychological therapies in NUD .
background: OBJECTIVES : We conducted a systematic review to determine the effectiveness of psychological interventions including psychodrama , cognitive behavioral therapy , relaxation therapy , guided imagery , or hypnosis in the improvement of  dyspepsia symptoms in patients with nonulcer dyspepsia ( NUD ) .