| Objective: Irritable bowel syndrome(IBS)is a form of Functional gastrointestinal disorders(FGIDs),the incidence of IBS is associated with a variety of pathogenic factors,one of them is the interaction between the "brain-intestinal axis".Psychological and social factors can interfere with the communication between the "brain-intestinal system",thus affecting the expression of symptoms and prognosis of the disease.In this study,on the basic of psychosocial factors,endoscopic cognitive therapy(NCT)was applied to IBS patients for psychological intervention for the first time and its efficacy was evaluated,aiming to improve the quality of life and social function of IBS patients and provide a new way of IBS psychological treatment.Methods: This subject is divided into two parts.In the first study,98 patients with IBS who met the admission criteria were recruited from the digestive and anorectal outpatient department and inpatient department of Tianjin people’s hospital,and 98 healthy control patients were included.General situation questionnaire,self-rating anxiety scale(SAS),self-rating depression scale(SDS),symptom checklist 90(SCL-90),Pittsburgh sleep quality index(PSQI),life events scale(LES),family environment(FES),social support revalued scale(SSRS),Coping Style Questionnaire(CSQ),Attributional Style Questionnaire(ASQ),Short Form 36 Health Survey Questionnaire(SF-36)and Eysenck Personality Questionnaire(EPQ)were used for questionnaire survey.The t test of two independent-sample was used to compare the changes of each scale index between the two groups.In the second part of the study,98 patients with IBS who met the inclusion criteria in the first part of this study were randomly divided into NCT intervention group and control group,and a total of 90 patients completed the study.The NCT group(46 patients)was given 8weeks of dispersed NCT treatment on the basis of conventional IBS drug therapy,while the control group was only given conventional IBS drug therapy and health education.Hamilton anxiety rating scale-14(HAMA-14),Hamilton depression rating scale-17(HDMA-17),SCL-90,PSQI,IBS intestinal symptoms quantitative grading scale,IBS symptom severity scale(IBS-SSS),IBS quality of life(IBS-QOL)score were performed before intervention,4 weeks after treatment and 8 weeks after treatment.Repeated measures analysis of variance(ANOVA)was used to compare the differences in the scores of the above scales between the two groups with the extension of intervention time.The differences in CSQ and ASQ scores between the two groups were compared by independent and paired sample t tests before intervention and at the end of 8 weeks of treatment.Results: part 1:(1)There was no significant difference in the general demographics between the two groups(P>0.05).(2)There were statistically significant difference in SDS and SAS scores between the IBS group and the healthy control group(P<0.01).(3)There were statistically significant difference between the IBS group and the healthy control group in the SCL-90 factors and total score(P<0.01).(4)There were statistically significant difference between the IBS group and the healthy control group in PSQI factors and total score(P<0.01).(5)There was no significant difference between the IBS group and the healthy control group in LES positive sexual events score(P>0.05),but there was statistically significant difference in negative sexual events,family-related problems,work and learning scores(P<0.01),and there was statistical difference in social and other problems score(P<0.05).(6)IBS group and healthy control group in the FES in the degree of intimacy,conflict,entertainment,independence,control subscale scores were statistically significant difference(P<0.01).(7)The total score,subjective and objective support score and the utilization score of support in SSRS between the IBS group and the healthy control group had statistically significant difference(P<0.01).(8)The scores of solving problems,asking for help(score decreased),remorse,fantasy and avoidance(score increased)in the IBS group and the healthy control group were statistically significant difference in CSQ(P<0.01),and rationalization(increased score)showed significant difference(P<0.05).(9)In ASQ,positive events,achievement events,interpersonal events,internal and external dimensions,universal dimensions,stability dimensions(score decreased),hopelessness,negative events and fate dimensions(score increased)in the IBS group and the healthy control group,except for internal and external dimensions,the above scores were statistically significant difference(P<0.01).The scores of internal and external dimensions were statistically different(P<0.05).(10)The latitude scores of physiological function,physiological function,physical pain and general health status in sf-36 were statistically significant difference between the IBS group and the healthy control group(P<0.01).There were statistical differences in latitude scores of energy,social function,emotional function and mental health(P<0.05).(11)There were statistically significant difference in EPQ N score between the IBS group and the healthy control group(P<0.01).There was no significant difference in P,E and L scores(P>0.05).Part 2:(1)there was no significant difference between the two groups in general demographics and the score of each scale evaluation index before treatment(P>0.05).(2)With the extension of treatment time,compared with the control group,the HAMD and HAMA scores in the intervention group decreased obviously(P<0.01);Intra-group comparison before and after treatment,the score of the intervention group decreased(P<0.01),while the score of the control group not decreased(P>0.05).(3)with the prolonging of treatment time,compared with the control group,the scores of each factor in SCL-90 in the intervention group decreased(P<0.05);Intra-group comparison before and after treatment,the score of the intervention group decreased significantly(P<0.01),while the score in the control group was not decreased(P>0.05).(4)With the extension of treatment time,compared with the control group,the total score of PSQI and each item in the intervention group(except sleep drug P>0.05)score decreased,in additionally,the total score and the daytime function score had significant statistical difference(P<0.01),other items were statistically different(P<0.05).Intra-group comparison before and after treatment,the score of intervention group(except sleeping drug P>0.05)decreased significantly(P<0.01),while that of control group did not(P>0.05).(5)with the prolongation of treatment time,the severity and frequency scores of intestinal symptoms in the intervention group were significantly lower than those in the control group(P<0.05),and the total score decreased significantly(P<0.01).Intra-group comparison before and after treatment,the above scores in the two groups decreased significantly(P<0.01).(6)With the extension of treatment time,compared with the control group,the IBS-SSS score in the intervention group decreased significantly(P<0.01).Intra-group comparison before and after treatment,the score of the control group decreased(P<0.05),while the score of the intervention group decreased significantly(P<0.01).(7)with the extension of treatment time,the intervention group was significantly different from the control group in IBS-QOL in the 8 dimensions of the score increased(P<0.01);Intra-group comparison before and after treatment,the score of the intervention group increased significantly(P<0.01)(except sexual behavior P>0.05),while the score of the control group increased without statistical difference(P>0.05).(8)After 8 weeks of treatment,there was a statistically significant difference between the intervention group and the control group in the CSQ score of problem solving and help items(P<0.01);Self-accusation and fantasy scores decreased significantly(P<0.01),and withdrawal score decreased(P<0.05),but there was no significant difference in rationalization score(P>0.05).Intra-group comparison before and after treatment,the intervention group had significant statistical differences in problem solving,help(increased score),self-accusation,withdrawal,fantasy(decreased score)(P<0.01),while the rationalization score increased without statistical difference(P>0.05);In the control group,there were statistically significant differences in solving problems,asking for help(increased score)and self-accusation(decreased score)(P<0.01),and there were statistical differences in withdrawal score(P<0.05),while there were no significant differences in fantasy(decreased score)and rationalization(increased score)(P>0.05).(9)After 8 weeks of treatment,the intervention group was significantly different from the control group in ASQ positive events,interpersonal events,achievement events,internal and external dimensions,universal dimensions and stability dimensions(score increased),negative events,and fatalistic dimensions(score decreased)(P<0.01),and hopelessness score decreased(P<0.05).Intra-group comparison before and after treatment,in both control and intervention groups,the scores of positive events,interpersonal events,achievement events,internal and external dimensions,universal dimensions and stable dimensions were significantly increased(P<0.01),while the scores of negative events,hopelessness and fatalism were significantly decreased(P<0.01).Conclusion:(1)Most patients with IBS are associated with mental disorder(especially anxiety and depression),and have sleep problems.Psychosocial factors also play an important role in the pathogenesis,such as negative sexual events,family conflicts,lack of social support,poor coping ability and negative attribution style.Most patients have the personality characteristics of neuroticism.Therefore,positive coping strategies should be adopted to improve the quality of life of patients.(2)After combined with NCT treatment,patients with IBS showed significant improvement in emotional status,mental status,sleep status,clinical symptoms of IBS,quality of life,coping style and attribution style.NCT can be used as a new psychological therapy for IBS patients in clinical application. |
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