PSYCHOL 7134 Health Psychology

PSYCHOL 7134 Health Psychology

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PSYCHOL 7134 Health Psychology

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PSYCHOL 7134 Health Psychology

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Course Code: PSYCHOL7134
University: The University Of Adelaide is not sponsored or endorsed by this college or university

Country: Australia


Produce a Written Rationale for your Shared Decision-Making Tool. This should demonstrate the alignment between your Shared Decision-Making Tool and current best evidence, such as clinical guidelines for the management of MUS, high quality systematic reviews, such as those produced by the Cochrane Collaboration and/or well-conducted single studies (remember the latter is only allowed in the absence of higher level evidence).
Your shared decision making tool should be suitable for patients with one of the following medically unexplained diagnoses

Irritable bowel syndrome,
Fibromyalgia, or
Non-epileptic seizures


Irritable bowel syndrome
Irritable bowel syndrome is an intestinal disorder that is manifested by abdominal cramps, bloating and changes in the bowel habit of the person. This can involve both diarrhoea or constipation or both. Some of the other names for this disorder are mucous colitis, irritable colon, spastic colitis or nervous stomach (Simrén et al., 2017).
The shared decision making tool has identified two options for the treatment of the irritable bowel syndrome- Cognitive behavioural therapy and medications or probiotics. The decision making tool have provided information regarding both the treatment in IBS. This study will provide the evidences to support the information provided in the decision making tool.
IBS is prevalent among 10-20 % of the general population and is associated with psycho-social factors as compared to the other intestinal disorders (Mahvi-Shirazi et al., 2012). Some of the standard medications prescribed by the physicians are Lopramide; for reducing the contraction of the muscles, Lomotil; for minimising the diarrhoea and Matoclopramide, for flexing the muscles (Mahvi-Shirazi et al., 2012).  
Furthermore, probiotics are now becoming an important part of the diet everyday due to their general and gastrointestinal benefits. In most of the cases the evidence regarding the efficacy of the probiotics treatment in IBS is grade B (Dai et al., 2013). This is due to the fact that most of the studies are not randomised controlled trials and not all probiotics have shown effectiveness (Kruis etal., 2016). In some of the studies where research has been done using lactobacilli and bifidobacteria, the trials have given promising findings and it appeared that probiotics are effective in patients with Irritable bowel syndrome. It is challenging to compare due to the variation in the study design dosage, the bacterial strain used and the formulation (Hosseini, Nikfar & Abdollahi, 2012). There is a still need for further researches for determining the most effective species, strains and the correct dosages.
A study conducted at the Centre of Stress and Anxiety reviewed all the psychological treatments applicable to the persons with IBS and have found that psycho-education, hypnotic therapy, Cognitive behavioural therapy had been efficient (Kinsinger, 2017).
According to the latest researches, brain and the gut axis plays a main role in the disorder (Van Oudenhove et al., 2016). The presence of the psychological factors and the central processing deficits contribute to the severity of the treatment. Psychosocial therapies as a whole have proven to be effective in reducing the effects of the IBS symptoms that have not responded to the initial pharmacological treatment (Simrén et al., 2017). There had been several researches in this field to find out the effectiveness of the treatment. There are 41 randomise control studies that have proven the efficacy of the psychological treatment. There are several meta-analyses that have concluded that psychological therapies such as CBT are moderately effective in relieving the symptoms of IBS (Li et al., 2014). CBT have not only helped to release the distress but have also improved the functioning of the bowel. CBT refers to a short term skill based therapy that focussed on the modifying behaviours and the altering thinking patterns. Some of the techniques that fall under the CBT treatment are psycho-education that involves educating the patient about IBS, the myths about IBS, about the gut-brain axis. It can help to improve the insight of the patient in the role of stress or the life style factors (Li et al., 2014).
Other techniques involve relaxation strategies, cognitive restructuring skills and problem solving skills. 2 of the studies have discussed about the progressive muscle relaxation and meditation (Park et al., 2014). Four meta-analyses have studied about anxiety after the relaxation exercise and based on the results, the average anxiety was found to have been reduced after the therapy. Four studies have also suggested that the frequency of the abdominal pain have decreased after the relaxation therapies (Park et al., 2014).  
Mahvi-Shirazi et al. (2012), have compared the effectiveness of cognitive behavioural therapy and medical and probiotic treatment in irritable bowel syndrome. As per the findings the mental wellbeing of those patient receiving CBT other than pharmacotherapeutics are much more compared to the ones getting only medications. Comparatively, while CBT and medications cured about 80 % of the patients, only those getting CBT have also shown a marked decrease of the symptoms (Kinsinger, 2017).
Although there are several RCT studies that have proven the efficacy of the CBT, medications and probiotics, it is essential to consider the perspective of the patients and patients should take up the treatments that best support their needs. This can be done by discussing the issue with the doctors and the peers.
Dai, C., Zheng, C. Q., Jiang, M., Ma, X. Y., & Jiang, L. J. (2013). Probiotics and irritable bowel syndrome. World Journal of Gastroenterology: WJG, 19(36), 5973.
Hosseini, A., Nikfar, S., & Abdollahi, M. (2012). Probiotics use to treat irritable bowel syndrome. Expert opinion on biological therapy, 12(10), 1323-1334.
Kinsinger, S. W. (2017). Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insights. Psychology research and behavior management, 10, 231.
Kruis, W., Chrubasik, S., Boehm, S., Stange, C., & Schulze, J. (2012). A double-blind placebo-controlled trial to study therapeutic effects of probiotic Escherichia coli Nissle 1917 in subgroups of patients with irritable bowel syndrome. International journal of colorectal disease, 27(4), 467-474.
Li, L., Xiong, L., Zhang, S., Yu, Q., & Chen, M. (2014). Cognitive–behavioral therapy for irritable bowel syndrome: A meta-analysis. Journal of psychosomatic research, 77(1), 1-12.
Mahvi-Shirazi, M., Fathi-Ashtiani, A., Rasoolzade-Tabatabaei, S. K., & Amini, M. (2012). Irritable bowel syndrome treatment: cognitive behavioral therapy versus medical treatment. Archives of medical science: AMS, 8(1), 123.
Park, S. H., Han, K. S., & Kang, C. B. (2014). Relaxation therapy for irritable bowel syndrome: a systematic review. Asian Nursing Research, 8(3), 182-192.
Simrén, M., Törnblom, H., Palsson, O. S., & Whitehead, W. E. (2017). Management of the multiple symptoms of irritable bowel syndrome. The Lancet Gastroenterology & Hepatology, 2(2), 112-122.
Van Oudenhove, L., Levy, R. L., Crowell, M. D., Drossman, D. A., Halpert, A. D., Keefer, L., … & Naliboff, B. D. (2016). Biopsychosocial aspects of functional gastrointestinal disorders: how central and environmental processes contribute to the development and expression of functional gastrointestinal disorders. Gastroenterology, 150(6), 1355-1367.

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