J Neurogastroenterol Motil  
Effects of Cognitive Behavior Therapy on Heart Rate Variability in Young Females with Constipation-predominant Irritable Bowel Syndrome: A Parallel-group Trial
Aelee Jang,1 Sun-Kyung Hwang,2* Nikhil S Padhye,1 and Janet C Meininger1
1School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, USA; and 2College of Nursing, Pusan National University, Yangsan, Gyeongsangnam-do, Korea
Correspondence to: Sun-Kyung Hwang, College of Nursing, Pusan National University, 49, Busandaehak-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do 626-870, Korea
Tel: +82-51-510-8340, Fax: +82-51-510-8308, E-mail: skhwang@pusan.ac.kr
Received: February 13, 2017; Revised: April 14, 2017; Accepted: April 28, 2017; Published online: May 8, 2017.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims
The relation between heart rate variability (HRV) as non-invasive biomarkers of autonomic function and cognitive behavior therapy (CBT) as non-pharmacological treatments has rarely been examined in patients with constipation-predominant irritable bowel syndrome (IBS-C). The purpose of this study was to evaluate the efficacy of an 8-week CBT intervention on HRV and IBS symptoms, and the correlation of changes in HRV with changes in IBS symptoms among young female nursing students with IBS-C.
Methods
This study consisted of an exploratory subgroup analysis of 43 participants with IBS-C who had been randomly assigned to receive either 8 weeks of CBT (n =
23) or general medical information (control, n = 20). At baseline and 8, 16, and 24 weeks, participants completed a questionnaire assessing their gastrointestinal (GI) symptoms, anxiety, depression, and stress, and their HRV was measured via electrocardiography.
Results
At the 8-week follow-up, the high-frequency (HF) power was significantly higher, and the low-frequency (LF)/HF ratio was lower in the CBT group than in the control group (P < 0.001 for both), and the severity of GI symptoms (P = 0.003), anxiety (P < 0.001), depression (P < 0.001), and stress (P < 0.001) was significantly lower in the CBT group than in the control group. Changes in the HF power were significantly associated with changes in GI symptoms, anxiety, depression, and stress at 16 and 24 weeks (P < 0.05 for all; range of r from -0.37 to -0.68). Changes in the LF/HF ratio were also significantly associated with changes in GI symptoms, anxiety, depression, and stress at 16 and 24 weeks (P < 0.05 for all; range of r from 0.38 to 0.60).
Conclusions
CBT was effective to manage the symptoms in young IBS-C patients and the change was sustained at 24 weeks following the completion of CBT. Furthermore, indirect measurement of autonomic function using HRV may be a useful objective parameter for assessing response to CBT in young IBS-C patients.
Keywords: Autonomic nervous system; Cognitive behavior therapy; Irritable bowel syndrome; Young female


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