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.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uj/uj:14643 |
| Date | 11 November 2008 |
| Source Sets | South African National ETD Portal |
| Detected Language | English |
| Type | Thesis |
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