Title : The effects of cognitive behavioral therapy with biofeedback therapy on the quality of life, anxiety, depression and somatic symptoms in patients with dyssynergic defecation: A randomized controlled trial
Abstract:
Background and Objectives: Dyssynergic defecation (DD) is a major cause of chronic functional constipation. Patients with DD have greater psychological distress and an impaired health-related quality of life compared with the general population. This study aimed to evaluate the effectiveness of cognitive behavioral therapy (CBT) combined with biofeedback therapy (BFT) on the quality of life, anxiety, depression and physical symptoms in patients with DD.
Methods: This randomized Controlled trial (IRCT20141115019957N2) conducted on 45DD patients who referred to the Rehabilitation Clinic of Iran University of Medical Sciences in 2017. Convenience sampling method was used to select the participants and then they were randomly allocated into three equal groups using RANDBETWEEN function in Excel. The first group received a combination of BFT&CBT and also standard-of-care therapy (SoCT). The second group were treated by BFT and SoCT, and the third group received only SoCT. The patients were assessed by digital rectal examination and the Short Form-36, Spielberger Anxiety, Beck Depression and Constipation Scoring System questionnaires, before and after the treatment. The data were analyzed by SPSS-22, ANOVA, ANCOVA and Chi-Square tests.
Results: Patients who received both CBT&BFT had significant improvement in symptoms of constipation, depression and anxiety. Furthermore, BFT and CBT&BFT groups are valued equivalent only on the mental component of SF36 and the total SF36 questionnaire. But the physical component was significantly different, favoring CBT&BFT (P<?0.001). In CBT&BFT group,67%of patients reached the relaxed stage. While no patient reached the relaxed neither in BFT nor in SoCT.
Conclusion: According to our study, patients with unfavorable responses to BFT may become better if CBT is added to their treatment plan.
Keywords: Anxiety, Cognitive Behavioral Therapy, Depression, Dyssynergic Defecation
Audience Take Away Notes ;
- What is “already known” in this topic: Chronic constipation (CC) is one of the most common digestive system disorders, which can negatively affect quality of life (QoL). One-third of patients with CC are reported to have dyssynergic defecation (DD) which has both psychological and physiological causes.
- Dysfunction of muscle activity may be a result of sexual, physical, emotional abuse or due to uncoordinated mechanisms of defecation.
- Patients suffering from dyssynergia have dyssynergic pattern of defecation; during attempted defecation, there is a failure of the normal relaxation of pelvic floor muscle, and paradoxical contraction of the external sphincter, puborectalis, ineffective perineal descent, or impaired push effort and inability with stool expulsion or a combination.
- Because of the state of depression and anxiety in addicted individual, they can predispose for Dyssynergic defecation. On the other hand, up to a third of clinically depressed people engage in drug or alcohol abuse. Also one of the most problem in addicted individual is chronic constipation.
- Psychological aspect has become an important part of management of this patients. Therefore, behavioral techniques such as habit training and biofeedback therapy (BFT) And also, Cognitive-Behavioral Therapy (CBT) which is a psycho-social intervention for improving mental health, which either focuses on changing thought maladaptive and unhelpful patterns in cognitions or on developing and practicing healthy behavior patterns, are the main treatments.
- What this article adds: This study suggests the use of biofeedback therapy in combination with cognitive behavioural therapy, as an applicable effective therapeutic protocol, for patients with an unfavorable response to BFT alone. This combination can reconstruct the process of thought and cognition about the disease and improve the psychological state through increasing self-monitoring and self-awareness.
