Management of irritable bowel syndrome (IBS) may be improved with dynamic motivation, clear definition of treatment expectancy, and social support. These findings were published in Journal of Clinical Gastroenterology.

Patients (N=436) with IBS were recruited from 2 centers in the United States for a National Institute of Health-funded clinical trial of 2 behavioral self-management treatment strategies. Prior to the trial start, patients underwent a battery of psychometrically validated assessments for characteristics which fall into 6 domains: motivation and treatment expectancy, cognitive, clinical, interpersonal and social, extra-intestinal medical comorbidities, and socio-demographics. All these variables were tested for whether or not they contributed to the 4 domains of the Working Alliance Inventory (alliance, goals, tasks, and bonding) after 1 treatment session.

Study participants were 80.3% women aged mean 41.39 (standard deviation [SD], 14.79) years. For demographic characteristics, sex was observed to have a significant effect on treatment alliance (b, 0.12; 95% CI, 0.05-0.54; P <.05), goals (b, 0.12; 95% CI, 0.06-0.55; P <.05), and tasks (b, 0.11; 95% CI, 0.04-0.53; P <.05).


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All of the extraintestinal components failed to reach significance for any part of treatment alliance.

For the interpersonal features, interpersonal support reached significance for alliance (b, 0.21; 95% CI, 0.10-0.33; P <.01), goals (b, 0.16; 95% CI, 0.04-0.27; P <.01), tasks (b, 0.19; 95% CI, 0.08-0.31; P <.01), and bonding (b, 0.21; 95% CI, 0.10-0.33; P <.01) components and interpersonal problems for tasks (b, 0.11; 95% CI, 0.01-0.21; P <.05).

The significant clinical characteristics were symptom severity for alliance (b, 0.14; 95% CI, 0.03-0.24; P <.05), tasks (b, 0.12; 95% CI, 0.01-0.23; P <.05), and bonding (b, 0.15; 95% CI, 0.04-0.26; P <.01) and average pain for goals (b, 0.14; 95% CI, 0.03-0.24; P <.05) and tasks (b, 0.11; 95% CI, 0.01-0.22; P <.05).

For cognitive factors, IBS self-efficacy was significant in relation to alliance (b, 0.11; 95% CI, 0.01-0.21; P <.05), goals (b, 0.11; 95% CI, 0.01-0.21; P <.05), and tasks (b, 0.13; 95% CI, 0.02-0.22; P <.05) components and visceral sensitivity for goals (b, 0.16; 95% CI, 0.04-0.27; P <.01).

The motivation factors which reached significance were expectancy of treatment success for alliance (b, 0.35; 95% CI, 0.25-0.44; P <.01), goals (b, 0.35; 95% CI, 0.26-0.45; P <.05), tasks (b, 0.37; 95% CI, 0.28-0.47; P <.01), and bonding (b, 0.18; 95% CI, 0.08-0.28; P <.01) and motivation to achieve treatment goals for alliance (b, 0.12; 95% CI, 0.02-0.21; P <.05), goals (b, 0.12; 95% CI, 0.02-0.21; P <.05), and bonding (b, 0.11; 95% CI, 0.01-0.21; P <.05).

This study was limited by its assessment of these characteristics early in the treatment course. It remains unclear whether long-term alliance and bonding are influenced by differing features.

These data indicated the quality of a working relationship between patients with IBS and their clinicians is multifaceted with several influencing factors. The success of a treatment program depends on multiple aspects from motivation and treatment expectancy, cognitive, clinical, interpersonal and social, and socio-demographic characteristics.

Reference

Lackner JM, Quigley BM, Radziwon CD, Vargovich AM. IBS patients’ treatment expectancy and motivation impacts quality of the therapeutic alliance with provider: results of the IBS outcome study. J Clin Gastroenterol. 2021;55(5):411-421. doi: 10.1097/MCG.0000000000001343