# the heavy hand of science and a ray of hope



## trbell (Nov 1, 2000)

I've recently come across 3 recent good overviews of some research that might be of interest (well maybe that's not true but they are of interest to me though). Taken as a whole they say that you can't really know if any treatment works until six months later and that really almost nothing has been shown to be true in the areas of ibs and psychological treatment for physical problems. The ray of hope though is that it does look like fairly soon there will be some answers that are 'good' scientifically.I'm not sure if this is the right place for this information but I'm going to put it here anyway. This should definitely not be taken as my saying that nothing works, as I know a lot of things work for a lot of people - it's a question of matching person and treatment.Now that I've said the dreary stuff I won't have to say it again, and I can be a participant in this forum.tom1. Brostoff, Jonathan and Linda Gamlin, _Food Allergies_, Rochester, VT,Healing Arts, 2000. "A characteristic feature of the placebo effect is thatit does not last all that long: usually only a matter of weeks, with two tosix months as about the most that can be expected." p. 201.2.. Gut 2001;48:272-282 ( February )Review: Treatment of irritable bowel syndrome: a review of randomisedcontrolled trials R AKEHURST, E KALTENTHALER3. Miller, Gregory E., and Sheldon Cohen, Psychological interventions andthe immune system: A meta-analytic review and critique. Health Psychology:2001, 20:2, 47 - 63.


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## eric (Jul 8, 1999)

Tom, I am not quite sure what your saying here. Can you be cured of IBS with therapies?We know there is no cure for IBS at this time and it is managing the condition that is important. Of course since IBS plays out the nervous system and the digestive system the importance of stress and anxiety reduction and relaxation is well known. I think when people are told how to do this and I use to be one of these people I did not know how to do it effectively. Actually, in the research these are some of the most effective techniques known and can have a major impact on your symptoms. In quite a few studies poeple seem to actually continue to get better after there treatments.I have been doing well for a year know after mine. I also believe some of this is continuing to use techniques to manage the condition.There is some other things I want to post here but I have to find them for you.------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com


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## Kathleen M. (Nov 16, 1999)

I looked over the Gut feb 2001 article.Of all the studies, only 6 were considered adequate by the authors. None of those was for therapy interventions.Although, when you do any sort of analysis of the literature for most anything the majority studies that have been done come up as inadequate, so IBS is not alone in that.The CBT trial I was in should meet the criteria for adequate (although you couldn't blind people to whether they got a drug or therapy).Generally in medicine there are quite a few intial studies that aren't as good as some of the later ones. In getting the funding (we're talking the big bucks here) to do a really good study, with enough people in it, with enough controls for a long enough treatment time, with a long enough follow up time...etc... You usually have to have some evidence that it is worth spending that much to do the big study. How do you do that. You do little studies that are more affordable, but usually end up being inadequate in one way or another until you can prove that the idea is worth spending millions on. K.


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## trbell (Nov 1, 2000)

i guess i wasn't clear enough in posting what i did. At this point there is not a lot that has been proven in terms of specific treatments for specific aspects of ibs.On the other hand I have been doing this for a long time and seen a lot of research. In general psychotherapy is an effective treatment (not necessarily a cure) for a lot of 'physical' problems, including ibs. It can also have some specific effects and some specific types of treatment such as CBT, hypnosis, biofeedback, and expressive treatments like poetry therapy have some research evidence to back their effectiveness. However, someone should be very cautious in making statements that one type of treatment works for ibs or that ony one specific techniques has a specific effect at this point in time. It was in that spirit that I posted the references - not a lot is known with scientific certainty about what ibs is and exactly what psychological treatment does. The best guide is a therapist's experience and credentials (including liscensure)and whether you like and trust him or her. Its also important that you be given some alternatives and feel good about your relationship with the therapist. I guess i was trying to separate some of the research issues from practice issues so i could participate here as a patient rather than as an expert.make sense?tom


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## Kathleen M. (Nov 16, 1999)

Tom, I understand alot where your coming from.I often have this battle between the anecdotal experience of mine with CBT and wanting to get others to see if it would help (or other mind-body therapies would help), and knowing that the study I was in is not complete, and I could just be an aberration in the data.I do suspect that my attitude played a big role in the sucess. Hey, since I was gonna get therapy and not have to pay for it I wanted to get as much as I could out of it. Since opportunity knocked I figured I'd invite it in and throw it a party. Of course I've got a brother who seems to prove that if you don't wanna get well, no amount of therapy, rehab, etc will do you any good. He may be my big brother, but he is not my role model (other than in the maybe his life is to serve as a warning for others kinda way).K.[This message has been edited by kmottus (edited 01-24-2001).]


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## kel1059 (Feb 28, 2003)

> quote: Hey, since I was gonna get therapy and not have to pay for it I wanted to get as much as I could out of it. Since opportunity knocked I figured I'd invite it in and throw it a party.


Some people would say that this is definitely the placebo effect. I on the other hand don't necessarily view it that way.The fact that you knew you were not in the control group could have added a measureable amount of joy to your life, and that joy could have been a boost to your immune system.Conversely, the people stuck in the silly 'reading up on IBS group' must have been pretty pissed off.I think it is nearly impossible to get a good DBPC study on something like this, but it does not rule out the possibility of getting useful information.


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## Kathleen M. (Nov 16, 1999)

You took me totally the wrong way.What game is this finding every old thread on this forum....Sigh...Please stop behaving like all you want to do is stir up trouble.Yep, I did participate as much as possible in the therapy to get everything I could out of it, after initial dissappointment because I hoped I was in the drug part of the trial. It is a lot like giving a drug a fair trial by TAKING IT AS DIRECTED.Go bother someone else on the internet on some other board...PLEASE!!!!!!!!!!!!K.K.


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## kel1059 (Feb 28, 2003)

What drug part? I thought the control was reading information on IBS.


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## Kathleen M. (Nov 16, 1999)

The Clinical Trial I was in compared CBT to desipramine as treatments for IBS.There were FOUR groups.PlaceboDrugCBTSham Therapy.Unfortunately you can't totally placebo the therapy as people notice those sorts of thing.The people in the reading info came in, got the same attention from the clinical staff trial people (other than they didn't get therapy), etc. Had the same tests run, etc. That way you normalize for the positive effect that sometimes just coming into the clinic where they want you to stay in the trial (they are very nice to you because they don't want you to drop the trial).K.


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