Cognitive-Behavioral Therapy Approaches for Functional Dyspepsia: A Systematic Review of Monotherapy and Combination with Drugs
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Objectives: To evaluate the effectiveness and safety of cognitive-behavioral therapy (CBT) for functional dyspepsia (FD), including metacognitive therapy (MCT), dialectical behavior therapy (DBT), and mindfulness-based cognitive therapy (MBCT), applied either as monotherapy or in combination with pharmacological treatments. Methods: We systematically reviewed randomized controlled trials (RCTs) published since 2010 in English, Chinese, and Korean databases. Eligible studies included adults with FD and compared CBT alone or in combination with drugs against drug monotherapy or usual care. Meta-analysis was conducted when interventions and outcomes were comparable; otherwise, a narrative synthesis was performed. The risk of bias was assessed using the Cochrane tool. Results: Nine RCTs (n=831) were included. One trial of CBT alone demonstrated improvements in anxiety and dyspeptic symptoms compared to controls. Most trials investigated CBT approaches in conjunction with drugs, yielding greater reductions in anxiety and depression, improved gastrointestinal symptom scores, and enhanced disease-specific quality of life compared to drugs alone; one trial noted benefits lasting for six months. Across the various modalities, MBCT tended to enhance quality of life and mindfulness, MCT was effective in reducing anxiety, and DBT improved emotion regulation and gastrointestinal relief. Adverse events were rare and generally mild. Key limitations included incomplete reporting of allocation concealment and assessor blinding, small sample sizes, single-center designs, and variability in concomitant medications and outcomes. Conclusions: CBT approaches offer clinically meaningful benefits for FD, both as monotherapy and, more robustly, as adjuncts to pharmacotherapy, with an acceptable safety profile. However, concerns regarding risk of bias and heterogeneity limit certainty. Future research should involve larger, well-designed multicenter RCTs with standardized protocols and long-term follow-up.
Abstract
Objectives: To evaluate the effectiveness and safety of cognitive-behavioral therapy (CBT) for functional dyspepsia (FD), including metacognitive therapy (MCT), dialectical behavior therapy (DBT), and mindfulness-based cognitive therapy (MBCT), applied either as monotherapy or in combination with pharmacological treatments. Methods: We systematically reviewed randomized controlled trials (RCTs) published since 2010 in English, Chinese, and Korean databases. Eligible studies included adults with FD and compared CBT alone or in combination with drugs against drug monotherapy or usual care. Meta-analysis was conducted when interventions and outcomes were comparable; otherwise, a narrative synthesis was performed. The risk of bias was assessed using the Cochrane tool. Results: Nine RCTs (n=831) were included. One trial of CBT alone demonstrated improvements in anxiety and dyspeptic symptoms compared to controls. Most trials investigated CBT approaches in conjunction with drugs, yielding greater reductions in anxiety and depression, improved gastrointestinal symptom scores, and enhanced disease-specific quality of life compared to drugs alone; one trial noted benefits lasting for six months. Across the various modalities, MBCT tended to enhance quality of life and mindfulness, MCT was effective in reducing anxiety, and DBT improved emotion regulation and gastrointestinal relief. Adverse events were rare and generally mild. Key limitations included incomplete reporting of allocation concealment and assessor blinding, small sample sizes, single-center designs, and variability in concomitant medications and outcomes. Conclusions: CBT approaches offer clinically meaningful benefits for FD, both as monotherapy and, more robustly, as adjuncts to pharmacotherapy, with an acceptable safety profile. However, concerns regarding risk of bias and heterogeneity limit certainty. Future research should involve larger, well-designed multicenter RCTs with standardized protocols and long-term follow-up.