Heart Rate Variability Biofeedback Therapy versus Cognitive Therapy for Irritable Bowel Syndrome: A study of attendance, compliance, and symptom improvement

The primary objective of this study was to compare patients' willingness to attend and comply with biofeedback treatment versus Cognitive Therapy (CT) for IBS. The second objective of the study was to determine if Heart Rate Variability (HRV) Biofeedback Therapy is as effective as CT in reducing symptoms of Irritable Bowel Syndrome. This study was performed at Kaiser Permanente Zion Hospital GI Department. Patients were recruited using three versions of a mailed letter. Different versions of the letter described either CT, Biofeedback or offered a general description of the study. No differences were observed in response rates to the different recruitment letters. After a brief phone screening, participants were randomly assigned to receive either Biofeedback or CT treatment. The treatments were administered individually in once-weekly, 50 minute sessions over 8 weeks. Both treatments followed published protocols tailored to patients suffering from IBS. Participants assigned to biofeedback treatment received HRV biofeedback training in session and were given a personal biofeedback device to use at home. Over the course of treatment, a similar number of participants dropped out of both treatment groups. Upon hearing an evidence based rationale for treatments, participants in both groups reported having high expectations for their respective treatments. Over eight weeks, participants in both treatment groups showed improvements in symptom frequency and severity, reduced maladaptive cognitions, and increases in quality of life as it relates to IBS. No significant differences were observed between the two treatment groups and the treatment effects seen for both treatments were similar. Heart rate variability biofeedback did not appear to increase heart rate variability in IBS patients. The findings from this study suggest IBS patients who are willing to seek investigational treatments have no preference for biofeedback over CT. In addition, HRV biofeedback showed non-inferiority to CT in decreasing symptoms of IBS. The low number of participants in this study limits the conclusions that can be drawn from these results. Further investigation is necessary to determine if the effects seen in this study are due to common factors of therapy or if greater differences would arise with a larger number of participants.