Abstract
M.A.
The purpose of this study is to investigate the effects of an individualized holistic
psychotherapy and synergistic stress management programme for the treatment
of Irritable Bowel Syndrome (IBS) and stress, both of which are common
disorders in this present day and age. IBS is a functional bowel disorder of the
gastrointestinal tract that leads to change in bowel habits with the additional
features of abdominal pain and distension (Drossman, 1994b). This functional
disorder has been associated with stress since time immemorial and it is only
recently that research has begun to examine how and by what mechanisms IBS
and stress are related.
A review of the literature suggests a resurgent interest in IBS and stress.
Tantalizing questions like ‘IBS – irritable bowel, irritable body, irritable brain or
irritable mind?’ gives one an idea of the genesis from which the disorder has
come, the complications in which it has been mired and the directions in which it
is aspiring to go (Farthing, 1995). Using both the historical context and the
present level of understanding in the research literature, one becomes aware of
the shifting paradigm from the dualistic Cartesian-Newtonian biomedical
perspective, to the biopsychosocial and integrative mind-body approaches which
reflect the move to a holistic and non-linear quantum scientific worldview. The
ecosystemic paradigm on which the present study is based, represents this shift
whereby systemic changes in cyclical rhythmic patterns within the
psychophysiology of clients reflect new ways of conceptualizing psychosomatic
(mind-body) ill-health (Weiner, 1992).
Within the behavioural and medical health fields, both psychologists and
physicians as well as a number of other disciplines are moving towards more
integrative solutions which include the mind-body-spirit dimensions of the
individual. Drossman, Whitehead and Camilleri (1997) have begun to consider
the individualized expression of the illness in the patient and to situate him
among his wider systems, as well as incorporating a referral team approach to
the treatment of IBS. Salt (1997) extends the use of the biopsychosocial model
to include the spiritual dimension in his treatment of IBS patients. Broom
(1997) weaves the various internal systems of the person into the story of the
client’s illness that integrates the mind and body. The psychologically based
holistic intervention of this study was developed in response to the calls for more
integrative approaches to treatment which incorporate whole-person care.
The specific aim of this study is to compare a group of IBS participants who
receive the holistic individualized psychotherapy and synergistic stress
management intervention with a group of IBS participants who do not receive the
treatment. The sample consisted of two groups, an experimental (N = 20) group
and a control (N = 20) group. The IBS Client Questionnaire also known as the
Functional Bowel Disorder Severity Index (FBDSI) (Drossman, Zhiming, Toner,
Diamant, Creed, Thompson, Read, Babbs, Barreiro, Bank, Whitehead, Schuster
& Guthrie 1995) was used to verify a diagnosis of IBS as well as a measure of
the severity of symptoms. This index is based on the current international
diagnostic criteria for IBS. The Occupational Stress Inventory was used as a
measure of vocational stress and was developed to provide an integrated
theoretical model linking sources of stress in the work environment,
psychological strains experienced by individuals as a result of work stressors and
the coping resources available to counterbalance the effect of stressors and
alleviate strain. It consists of three scales, namely Occupational Roles, Personal
Strain and Personal Resources scales respectively.
Wilks’ Lambda was used for the between-groups comparisons between the
intervention and non-intervention groups and Paired Samples t-test was used for
the within-groups analysis. The comparisons were made in terms of
improvement in symptoms, determined by the Functional Bowel Disorder
Severity Index (FBDSI) and lowering of occupational stress, determined by two of
the scales of the Occupational Stress Inventory, namely the Occupational Roles
and Personal Strain scales and an increase in coping responses determined by
the Personal Resources scale. Both of these were administered as pre- and
post-test measures before and three months after the intervention was
completed.
The results of the study indicate that the experimental group of IBS participants
who received the intervention improved in symptom severity, their occupational
stress was lowered and they began utilizing more coping resources than the
group of IBS participants who did not receive the intervention. Thus it is
concluded that an individualized holistic approach for the treatment of IBS is
indicated and that individuals with refractory IBS can be helped to manage their
illness and their lives. In particular, this psychologically based study confirms a
very definite and specific place for psychologists in the treatment of clients with
IBS and stress. An invitation was extended to the control group to use the
facilities for therapeutic intervention offered by the RAU Psychogastroenterology
project once the post-tests had been completed, thus addressing any ethical
questions that could have arisen.
This was an initial investigation using an ecologically based meta-theoretical
framework as well as specific stress techniques for the holistic treatment of
clients. A number of recommendations arose from this particular intervention
and are included for future studies.