Psychology, Health & Medicine

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Psychotherapy appears to improve symptoms

of functional dyspepsia and anxiety: systematic
review with meta-analysis

Antonina Mikocka-Walus, Subhadra Evans, Jake Linardon, Helen Wilding &

Simon R. Knowles

To cite this article: Antonina Mikocka-Walus, Subhadra Evans, Jake Linardon, Helen Wilding &
Simon R. Knowles (2023) Psychotherapy appears to improve symptoms of functional dyspepsia
and anxiety: systematic review with meta-analysis, Psychology, Health & Medicine, 28:5,
1309-1335, DOI: 10.1080/13548506.2022.2141278

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Published online: 02 Nov 2022.

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PSYCHOLOGY, HEALTH & MEDICINE
2023, VOL. 28, NO. 5, 1309–1335
https://doi.org/10.1080/13548506.2022.2141278

Psychotherapy appears to improve symptoms of functional

dyspepsia and anxiety: systematic review with meta-analysis
Antonina Mikocka-Walus a, Subhadra Evans a
, Jake Linardon a
, Helen Wildingb
and Simon R. Knowles c,d
a
School of Psychology, Deakin University, Melbourne, Australia; bLibrary Service, St Vincent’s Hospital
Melbourne, Fitzroy, Australia; cDepartment of Psychological Sciences, Faculty of Health, Arts and Design,
Swinburne University of Technology, Melbourne, Australia; dMental Health Unit, St Vincent’s Hospital,
Melbourne, Australia

ABSTRACT ARTICLE HISTORY

This systematic review and meta-analysis examined the efficacy of Received 8 December 2021
psychotherapy on symptoms of functional dyspepsia, anxiety, Accepted 25 October 2022
depression and quality of life. We searched Medline, Embase, KEYWORDS
PsycINFO, Emcare, Ovid Nursing, CINAHL, Cochrane Library, Anxiety; depression;
Informit Health Collection and ClinicalTrials.gov on 2 July 2021. functional dyspepsia;
Randomised controlled trials that compared psychotherapy to non- psychotherapy; quality of life
psychotherapy interventions in adults with functional dyspepsia
were included. Meta-analyses were conducted (using Hedges’s g)
under random effects models. Overall, 1,575 records were identified
after duplicates were removed, with nine randomised controlled
trials (n = 786) included. Preliminary meta-analyses showed that
psychotherapy outperformed control conditions at post-test and
follow-up on functional dyspepsia symptom severity and anxiety
symptoms, but no differences emerged for depressive symptoms.
The qualitative synthesis showed psychotherapy’s promise in
improving quality of life in functional dyspepsia. Psychotherapy
might have a small to moderate effect on functional dyspepsia
symptoms and anxiety at short- and long-term. However, conclu­
sions are limited by the small number of trials with a high risk of
bias.

Introduction
Functional dyspepsia (FD) affects approximately 20% of people (Ford et al., 2015). The
Rome IV criteria stipulate at least one of the following symptoms needs to be present for
the FD diagnosis: postprandial fullness, early satiation, epigastric pain, or epigastric
burning for at least 6 months, in the absence of evidence of organic, systemic, or
metabolic disease (Stanghellini et al., 2016).
FD has traditionally been thought of as a functional disorder, however, its conceptua­
lisation has recently shifted towards being a disorder of gut-brain interaction (DGBI;
Drossman, 2016), where the communication between the brain and the gut is impaired.
In particular, the aetiology of FD involves central nervous system dysregulation and gut

CONTACT Antonina Mikocka-Walus mikocka@deakin.edu.au School of Psychology, Deakin University, 221

Burwood Highway, Burwood 3125 VIC, Australia
© 2022 Informa UK Limited, trading as Taylor & Francis Group
1310 A. MIKOCKA-WALUS ET AL.

dysfunction. The changes in the gut-brain communication can be triggered by a variety

of factors including trauma, stress, anxiety, and depression (Grover & Drossman, 2011).
In fact, anxiety and depression are common in DGBI (Lee et al., 2017): in a recent
systematic review prevalence of depression and anxiety symptoms, respectively, in
patients with non-refractory FD was 20.9% and 23.3% versus 10% and 10% for healthy
controls (Esterita et al., 2021). A large prospective study (Koloski et al., 2016) showed that
anxiety and depression at baseline predicted the development of FD at one-year follow-
up. Conversely, when anxiety and depression are not present at baseline, those with
documented FD report significantly higher levels of these psychological symptoms at
one-year follow-up.
While research supports the efficacy of psychotherapy in managing symptoms of some
DGBI such as irritable bowel syndrome (IBS, N = 41; Black et al., 2020a), the evidence on
psychotherapy use in FD is unclear. The systematic reviews conducted to date are now
outdated, with new RCTs published (Batebi et al., 2020; Tavakoli et al., 2020; Teh et al.,
2020), and none has examined psychological outcomes such as anxiety and depression
(Moayyedi et al., 2017; Rodrigues et al., 2021; Soo et al., 2011). Therefore, the aim of this
study was to evaluate the effectiveness of psychotherapy on psychological symptoms as
well as symptom severity and quality of life (QOL) in FD.

Materials and methods

Study design
A systematic review and meta-analysis have been conducted. The study was registered in
PROSPERO [CRD42020167268].

Searches
Records were identified through searches of eight bibliographic databases and one trial
registry: Ovid MEDLINE(R) ALL 1946 to 30 June 2021; Embase 1974 to 30 June 2021
(Ovid); APA PsycInfo 1806 to June Week32021(Ovid); Ovid Emcare 1995 to
2021 Week 25; Ovid Nursing Database 1946 to June Week 4 2021; CINAHL
(EBSCOhost); Health Collection, Humanities & Social Sciences Collection (Informit);
Cochrane Library (Wiley) and Clinicaltrials.gov. All searches were updated on
2 July 2021 except for Informit Health Collection which was last searched on
13 February 2020 as it ceased to exist in the same format. An initial search was
developed for Ovid Medline (Figure 1) and then adapted for other databases adjusting
subject headings and syntax as appropriate (Appendix 1). Search results were exported
to EndNote and duplicates removed. Records were screened on publication type. All
remaining records were loaded into Covidence for further screening. Reference lists of
included studies were checked for additional records.

Selection criteria
English language.
 PSYCHOLOGY, HEALTH & MEDICINE 1311

Figure 1. Medline strategy.

Study design
Randomised controlled trials.
1312 A. MIKOCKA-WALUS ET AL.

Participants
Adults with functional dyspepsia, established using the Rome criteria or equivalent.

Intervention
Any psychological intervention (e.g., CBT) with any mode of delivery (e.g., face-to-face)
of any duration.

Comparator
Any comparator other than psychotherapy, i.e. standard care, wait list, antidepressants.
Exclusion: studies with other type of psychotherapy as the only comparator.

Outcomes
Primary. The efficacy of the intervention on symptoms of anxiety and depression.

Secondary. The efficacy of the intervention on symptoms of FD and QOL as well as

attrition.

Data extraction
Two independent reviewers screened records on title and abstract and then full text in
accordance with eligibility criteria. Any disagreements were resolved by the third
reviewer. Data were extracted by two independent reviewers using a pilot-tested form
and included: study country, year and setting, method of FD diagnosis, participants’
characteristics, sample size, design, intervention and control conditions, outcome mea­
sures, analysis, results, treatment compliance, attrition and risk of bias.

Risk of bias assessment

Two reviewers independently assessed study bias using the Cochrane Risk of Bias tool
(J. P. Higgins et al., 2011), previously used for risk of bias assessment in FD studies (Black
et al., 2020a; Ford et al., 2019). Any disagreements were discussed with the third reviewer.

Data synthesis and meta-analytic procedure

For the trials where meta-analysis was feasible, for each comparison the effect size was
calculated by dividing the difference between the two group means by the pooled
standard deviation at post-test (or follow-up; Lipsey & Wilson, 2001). The standardised
mean difference was converted to Hedge’s g to correct for small sample bias. If means and
standard deviations were not reported, effect sizes were calculated using conversion
equations from significance test (Borenstein et al., 2009). One trial reported medians
and interquartile ranges (Calvert et al., 2002). We used the Cochrane guidelines for
estimating an effect size based on these data (J. Higgins & Green, 2011). To calculate
a pooled effect size, each study’s effect size was weighted by its inverse variance.
A positive g indicated that the psychotherapy group produced more improvements on
the outcome variable than the control group. If a trial reported more than one follow-up
point, then data from the last reported follow-up were extracted and analysed. If a study
 PSYCHOLOGY, HEALTH & MEDICINE 1313

reported multiple measures for a particular outcome variable, then the mean of the effect
sizes from each measure within the study was calculated before the effect sizes were
pooled. Comprehensive Meta-Analysis Version 3.0 was used (Borenstein et al., 2009).
Since considerable heterogeneity was expected among the studies, random effects models
were used. Heterogeneity was examined by calculating the I2 statistic, which quantifies
heterogeneity revealed by the Q-statistic and reports how much overall variance (0–
100%) is attributed to between-study variance (J. Higgins & Thompson, 2002).
Publication bias was examined through the trim-and-fill procedure. This procedure
produces an estimate of the effect size after publication bias has been corrected for, by
computing adjusted values of the pooled effect sizes and 95% confidence intervals (Duval
& Tweedie, 2000). An effect size could not be calculated for one trial (Haug et al., 1994) as
insufficient data were reported.

Results
We identified 2,416 records. After removing duplicates and screening by publication
type, we examined 1,575 records against title and abstract, with 66 full text articles and
trial registrations screened. In total, nine studies (presented in 10 articles) met our
selection criteria and were included in the data synthesis, while 8 studies had useful
data available for meta-analysis (Figure 2).

Overview of included studies

All included studies were parallel randomised controlled trials. Overall, studies
included 786 participants with FD, with samples ranging from 28 to 158 (see,
Table 1). All studies except for one which did not specify the hospital type (Xiong
et al., 2019) recruited at teaching hospitals, with one additionally including patients
from a private gastroenterology service (Haug et al., 1994). Studies came from the
following countries: Iran (n = 3) and one from each: UK, Germany, Norway, Singapore,
Spain and China. One study did not report sample demographics (Calvert et al., 2002),
but all other studies included female-predominant samples. Mean age ranged from the
20s to 40s.
Interventions included CBT, dialectical behavioral therapy (DBT), relaxation, hyp­
notherapy, metacognitive therapy, mindfulness-based cognitive therapy (MBCT) and
psychoanalytical therapy. One study (Xiong et al., 2019) combined CBT with elements of
positive psychology. The most commonly used activities included challenging automatic
thoughts or metacognitive beliefs via cognitive restructuring, mindfulness and deep
relaxation, behavioural techniques targeting avoidance, and managing challenging emo­
tions by creating short-term positive experiences. Interventions were largely individual,
group-based (Teh et al., 2020; Xiong et al., 2019) or a mixture of individual and group-
based sessions (Orive et al., 2015). Sessions ran once a week, with common durations of
30, 45, 50 and 90 minutes. The duration of therapy ranged from 5 weeks of relaxation to
20 weeks of CBT. Seven studies used TAU as the main comparator, two used an
antidepressant and TAU, and one used active control. Follow up ranged from 8 to
56 weeks.
1314 A. MIKOCKA-WALUS ET AL.

Records identified through database

searching: Medline, Embase, APA Additional records identified
PsycINFO, Emcare, Ovid Nursing, through other sources:
CINAHL, Cochrane Library, Informit Trial registers: clinicaltrials.gov (n=28)
Identification

Health Collection (n=2387) Reference lists of included papers (n=1)

Records after duplicates

removed (n=1575)
Records excluded if publication type
was: case report, comment,
conference abstract or paper,
Records screened by dissertation, editorial, note ((n=252)
publication type (n=1575
Screening

Records screened against title Irrelevant records excluded (n=1257)

and abstract (n=1323)

Full-text articles/trial Full-text articles/trial registrations

Eligibility

registrations assessed for excluded (n=56 because:

eligibility (n=66)
Wrong intervention (n=18)
Wrong population (n=9)
Not in English (n=9)
Wrong design (n=6)
Studies included in qualitative No data reported (n=4)
synthesis (n= 10 articles Wrong comparator (n=3)
discussing 9 studies) A summary/registration of an
Included

already included article n=5

Study protocol n=2

Studies included in
quantitative synthesis
(meta-analysis) (n = 9 articles
discussing 8 studies)

Figure 2. PRISMA flow chart.

Risk of bias
Individual study quality assessments are shown in Table 3. Five studies were deemed
high risk of bias for Sequence Generation due to missing information such as lack
of clarity about who generated the sequence (Batebi et al., 2020; Calvert et al., 2002;
Haag et al., 2007; Haug et al., 1994; Tavakoli et al., 2020). For allocation conceal­
ment, there was insufficient information reported in five studies (Batebi et al., 2020;
Calvert et al., 2002; Haug et al., 1994; Tavakoli et al., 2020; Xiong et al., 2019). For
studies deemed at low risk of allocation concealment bias, strategies including using
researchers who did not know what groups participants were allocated to (Faramarzi
Table 1. Study characteristics.
Attrition
Authors, year, Participants and Duration of Outcomes at post-
country setting Intervention Comparator follow-up studied treatment
Batebi et al., 2020 65 patients with FD at Metacognitive therapy – 10 × 45 min Nortriptyline TAU – omeprazole 20 mg 3 months FD symptoms 26%
(Batebi et al., a gastroenterology sessions over 10 weeks 25 mg, once daily, daily and domperidone severity:
2020) clinic of over 10 weeks 10 mg daily over LDQ
Iran a university 10 weeks Anxiety: HAM-
hospital A
Intervention n = 20; Depression:
mean age 34.88 HDRS
(SD = 8.9); sex:
female n = 13
Comparator 1 n = 20;
mean age 38.31
(8.9); sex: female
n = 14
Comparator 2 n = 25
mean age 39.47
(8.6); sex: female
n = 14
Calvert et al., 2002 126 patients with FD Hypnotherapy – 12 x 30-minute visits Supportive therapy + TAU – ranitidine 150 mg 12 months FD symptoms 27%
(Calvert et al., at an endoscopy over 16 weeks placebo – supportive twice daily dispensed severity:
2002) unit of a university advice about FD and over 4 visits Symptom
UK hospital listening to patients’ Scoring
Intervention n = 32 concerns + placebo System
Comparator 1 n = 48 ranitidine tablet twice Anxiety: HADS
Comparator 2 n = 46 daily QOL: SBQOL
No demographics
reported.
PSYCHOLOGY, HEALTH & MEDICINE

(Continued)
1315
 1316

Table 1. (Continued).
Attrition
Authors, year, Participants and Duration of Outcomes at post-
country setting Intervention Comparator follow-up studied treatment
A. MIKOCKA-WALUS ET AL.

Faramarzi et al., 49 patients with FD at Psychoanalytic psychotherapy – 2 weeks TAU – Helicobacter pylori positive patients – bismuth 12 months FD symptoms 13%
2013 and gastroenterology of social interview + 16 × 50 min subcitrate (3 x 500 mg), metronidazole (3 x 250 mg), severity:
Faramarzi et al., services in two weekly sessions over 18 weeks amoxicillin (3 x 500 mg) and either omeprazole (2 PAGI-SYM
2015(Faramarzi teaching hospitals x 20 mg) or ranitidine (2 x 150 mg) for 2 weeks. After Anxiety and
et al., 2015; Intervention n = 24; 2 weeks, omeprazole (2 x 20 mg) or ranitidine (2 depression:
Faramarzi et al., mean age in x 150 mg) for four weeks. Helicobacter pylori negative SCL-90
2013) females 31.6 patients – omeprazole (2 x 20 mg) or ranitidine (2
Iran (SD = 7.0), age in x 150 mg) for six weeks
males 32.7
(SD = 7.6); sex:
female n = 17
Comparator n = 25;
mean age in
females 32.8
(SD = 5.7), age in
males 34.1
(SD = 4.5); sex:
female n = 17
(Continued)
Table 1. (Continued).
Attrition
Authors, year, Participants and Duration of Outcomes at post-
country setting Intervention Comparator follow-up studied treatment
Haag et al., 2007 100 patients with FD Intensive medical Intensive TAU – a prokinetic, Intensive TAU – 12 months FD symptoms 38%
(Haag et al., at an outpatient therapy plus medical antisecretory agent, information session on severity:
2007) gastroenterology progressive muscle therapy plus simethicone or herbal the bio-psychosocial Symptom
Germany service of relaxation – a group CBT – 1 h preparation in standard model of FD + Intensity
a university therapy 90-min session dose as clinically indicated a prokinetic or sensory- and Severity
hospital session weekly over weekly over modulating drugs as Scale
Intervention 1 n = 20; 5 weeks 20 weeks clinically indicated Anxiety and
median age: 45.2 depression:
(IQR: 39.4–51.0); HADS
sex: female QOL: SF-36
n = 65.0%
Intervention 2 n = 28;
median age: 48.5
(IQR: 43.5–53.6);
sex: female
n = 67.9%
Comparator 1 n = 24;
median age: 41.7
(IQR: 35.7–47.6);
sex: female
n = 58.3%
Comparator 2 n = 28;
median age: 44.4
(IQR: 38.4–50.4);
sex: female
n = 64.3%
PSYCHOLOGY, HEALTH & MEDICINE

(Continued)
1317
 1318

Table 1. (Continued).
Attrition
Authors, year, Participants and Duration of Outcomes at post-
country setting Intervention Comparator follow-up studied treatment
Haug et al., 1994 100 patients with FD CBT – 10 × 45–50 min sessions over Active control – a 5-min phone call by a therapist 12 months FD symptoms 12%
(Haug et al., at a university 4 months plus a booster session at every second month asking about FD symptoms severity:
1994) hospital and 6 months a series of
A. MIKOCKA-WALUS ET AL.

Norway a private Liker scales

gastroenterology for various
service symptoms
Intervention n = 50 Anxiety: STAI
Comparator n = 50 Depression:
Demographics for the BDI
whole sample: age:
40; female n = 59
Orive et al., 2015 158 patients with FD TAU + CBT – 8 group and 2 individual 50- TAU – 40 g of prokinetic a day, 1 mg of antisecretory 6 months FD symptoms 17%
(Orive et al., at min sessions over 10 weeks agent 3 times day or a combination of both severity:
2015) gastroenterology GDSS, DRHS
Spain services of 2 Anxiety and
university hospitals depression:
Intervention n = 76; HADS
mean age: 44.28
(SD = 14.06); sex:
female n = 64
Comparator n = 82;
mean age: 47.09
(SD = 15.19); sex:
female n = 66
(Continued)
Table 1. (Continued).
Attrition
Authors, year, Participants and Duration of Outcomes at post-
country setting Intervention Comparator follow-up studied treatment
Tavakoli et al., 2020 60 patients with FD at Dialectical behavioral therapy 8 x 90-min Sertraline 100 mg + TAU – pantoprazole 2 months FD symptoms N/A
(Tavakoli et al., a gastroenterology weekly sessions + pantoprazole pantoprazole 40 mg/daily 40 mg/daily for 2 months severity:
2020) clinic of 40 mg/daily for 2 months for 2 months GSSIQ
Iran a university Anxiety: BAI
hospital
Intervention n = 20;
mean age
25.7 ± 6.7; sex:
female n = 16
Comparator 1 n = 20;
mean age
29.1 ± 7.7; sex:
female n = 14
Comparator 2 n = 20;
mean age
29.4 ± 7.9; sex:
female n = 11
Teh et al., 2020(Teh 28 patients with FD at MBCT 8 x 2-hour sessions over 8 weeks + TAU – not defined over 8 weeks 2 months FD symptoms 18%
et al., 2020) a gastroenterology one half-day retreat after the sixth severity:
Singapore clinic in a tertiary session SCA-FD
hospital Anxiety and
Intervention n = 15; depression:
mean age: 49 DASS
(SD = 15.5); sex: QOL: SF-NDI,
female 40% EuroQol
Comparator n = 13; VAS
mean age: 48.2
(12.9); sex: female
PSYCHOLOGY, HEALTH & MEDICINE

n = 54%
(Continued)
1319
 1320

Table 1. (Continued).
Attrition
Authors, year, Participants and Duration of Outcomes at post-
country setting Intervention Comparator follow-up studied treatment
A. MIKOCKA-WALUS ET AL.

Xiong et al., 2019 100 patients with FD TAU + CBT and positive psychology over TAU – proton pump inhibitors, H2 receptor antagonists, 2 months FD symptoms 0%
(Xiong et al., treated at 8 weeks motility agents, digestive enzyme preparations, or severity:
2019) a hospital in China traditional Chinese medicines DSS
China Intervention n = 50; Anxiety and
mean age: 33.5 depression:
(SD = 4.1); sex: HADS
female n = 27
(54%)
Comparator n = 50;
mean age: 32.5
(SD = 3.1); sex:
female n = 30
Legend: BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; CBT = cognitive-behavioural therapy; DASS = Depression, Anxiety and Stress Scale–21; DRHS = Dyspepsia Related Health
Scale; DSS = dyspepsia symptom score; EuroQoL-VAS = EuroQoL-Visual Analog Scale; GDSS = The Glasgow Dyspepsia Severity Score; GSSIQ = Gastrointestinal Symptom Severity Index
Questionnaire; HADS = Hospital Anxiety and Depression Scale; HAM-A = Hamilton Anxiety Rating Scale; HDRS = Hamilton Depression Rating Scale; IQR = inter-quartile range; LDQ = Leeds
Dyspepsia Questionnaire; MBCT = Mindfulness-based cognitive therapy; PAGI-SYM = Patient Assessment of Upper Gastrointestinal Symptom Severity Index; QOL = quality of life;
SBQOL = SmithKline Beecham Quality of Life Scale; SCA-FD = subjective-clinical-assessment of FD symptoms; SD = standard deviation; SF-NDI = Short-form Nepean Dyspepsia Index;
STAI = State Trait Anxiety Inventory; TAU = treatment as usual
 PSYCHOLOGY, HEALTH & MEDICINE 1321

et al., 2015, 2013; Orive et al., 2015; Teh et al., 2020; Xiong et al., 2019), and
a computer generated random assignment sequence (Orive et al., 2015), a random
table (Faramarzi et al., 2015, 2013; Xiong et al., 2019), sealed envelopes (Teh et al.,
2020), were used. All studies were at high risk of bias due to Blinding of
Participants. Studies deemed high risk of bias for Blinding of Outcome Assessor
generally did not include sufficient information (Batebi et al., 2020; Faramarzi et al.,
2015, 2013; Haag et al., 2007; Haug et al., 1994; Orive et al., 2015; Tavakoli et al.,
2020; Teh et al., 2020). Studies deemed high risk of bias for Incomplete Outcome
Data had high rates of attrition; for example, 38% of participants were lost to post-
treatment analysis in one study (Haag et al., 2007).

Attrition
Attrition rates at post-treatment ranged from 0 to 38% (Table 1).

Post-treatment
Anxiety symptoms
The pooled effect size for the psychotherapy versus control conditions at post-test on
anxiety symptoms was significant and in favour of psychotherapy, with high heteroge­
neity (Table 2, Figure S1). Results were unstable (i.e., became non-significant) after
restricting the analyses to one effect per study.

Depression symptoms
The pooled effect size for the psychotherapy versus control conditions at post-test on
depressive symptoms was negative and non-significant, with high heterogeneity (Table 2,
Figure S1). Only one trial with a low risk of bias (Xiong et al., 2019) was included, and
results remained the same after including one comparison per study.

FD symptoms
All studies examined the effect of psychotherapy on FD symptom severity post-treatment.
The pooled effect size for the psychotherapy versus control conditions at post-test on
symptom severity was statistically significant and in favour of psychotherapy. There was
high heterogeneity (86%) and there was an indication of possible publication bias
(Table 3).
In this analysis, there was one trial in which two psychotherapy groups were compared
with the same control group (Haag et al., 2007). These comparisons were not indepen­
dent of each other, which may have artificially reduced the heterogeneity estimate and
affected the pooled effect size. To deal with this, we ran sensitivity analyses in which the
comparison with the smallest effect size was only included in the analysis, and then
repeated this again for the comparison with the largest effect size. These sensitivity
analyses ensured that only one comparison per study was included in the meta-
analysis, consistent with the approach adopted in several other meta-analyses (Cristea
et al., 2015; Cuijpers et al., 2008; Linardon et al., 2019). These sensitivity analyses yielded
a pooled effect size similar to the overall effect, although the effect size became statistically
 1322

Table 2. Results from the meta-analyses.

Symptom Severity Depressive Symptoms Anxiety Symptoms
A. MIKOCKA-WALUS ET AL.

Post-Treatment Analysis Ncomp g (95% CI) I2 Ncomp g (95% CI) I2 Ncomp g (95% CI) I2
Psychotherapy vs Control 8 0.56 (0.09, 1.03) 83% 7 0.17 (−1.05, 1.39) 96% 8 0.77 (0.18, 1.36) 89%
Adjusted for publication bias 7 0.44 (−0.01, 0.90) - 7 0.17 (−1.05, 1.39) 5 1.30 (0.55, 2.05) -
Low risk of bias trials only 1 0.78 (0.38, 1.19) 0% 1 0.76 (0.31, 1.11) 0% 1 0.73 (0.33, 1.13) 0%
One effect per study (smallest) 6 0.33 (−0.13, 0.81) 81% 6 0.45 (−0.89, 1.81) 96% 7 0.73 (0.07, 1.38) 90%
One effect per study (largest) 6 0.71 (0.10, 1.32) 86% 6 0.32 (−1.05, 1.70) 97% 7 0.94 (0.32, 1.55) 88%
CBT treatment 5 0.35 (−0.15, 0.85) 77% 5 −0.01 (−1.66, 1.65) 97% 5 0.91 (0.07, 1.74) 91%
Follow-Up Analysis
Psychotherapy vs Control 6 0.81 (0.01, 1.63) 90% 5 0.98 (−0.03, 1.99) 91% 3 1.67 (0.02, 3.34) 95%
Adjusted for publication bias 6 0.81 (0.01, 1.63) - 5 0.98 (−0.03, 1.99) - -
Low risk of bias trials only 0 - 0 - 0 -
One effect per study (smallest) 5 0.62 (−0.19, 1.44) 88% 4 1.14 (−0.15, 2.43) 93% 3 1.67 (0.02, 3.34) 95%
One effect per study (largest) 5 1.09 (0.20, 1.99) 89% 4 1.24 (0.04, 2.43) 93% 3 1.67 (0.02, 3.34) 95%
CBT treatment 3 0.67 (−0.32, 1.68) 84% 4 1.07 (−0.30, 2.45) 93% 2 1.95 (−1.27, 5.18) 97%
Note. Ncomp = number of comparisons.
Table 3. Risk of bias.
Blinding of participants/ Blinding of outcome Incomplete outcome Selective outcome
Sequence generation Allocation concealment personnel assessor data reporting
Batebi et al., High – no mention of how High – no detail provided High – not reported High – not reported High – It is not clear High – FD symptoms
2020 (Batebi done at what points were measured at
et al., 2020) participants were baseline, post, and
lost to the study follow-up, but the
results were not
reported
Calvert et al., High – no mention of High – not mentioned in High – participants weren’t Low – an independent High – fourteen Low – all seem
2002 (Calvert sequence generation the paper blinded but personnel was blind assessor was (11%) patients reported
et al., 2002) blinded used were lost during
the follow-up
phase. But 47 of
126 lost to the
long-term analysis
(37%)
Faramarzi et al., Low – a paper list (odd Low – an investigator High – not reported High – not reported High – did not Low – reported all
2013 & numbers were assigned to with no clinical undertake ITT or results apart from
Faramarzi the standard medication involvement in the trial undertake differences across
et al., 2015 therapy group and even randomly assigned the sensitivity analysis completer versus
(Faramarzi numbers to the CCRT patients (completer versus non completer
et al., 2015; psychotherapy group). non completer) groups
Faramarzi
et al., 2013)
Haag et al., 2007 High – no mention of how Low – concealed High – patients were blinded for High – researcher and High – 56 of 100 Low – all seem
(Haag et al., done allocation was assured randomization (whether they statistician did not initially reported
2007) by using randomization received SMT or IMT) but seem to be blinded. randomised
utilizing a computer patients receiving additional provided follow up
program and sealed psychotherapy were aware of data and missing
envelopes with the the intervention as blinding for data for several key
treatment allocation these therapies is hardly variables
possible. However, the
patients were not informed
that this was not part of the
PSYCHOLOGY, HEALTH & MEDICINE

normal management
Haug et al., 1994 High – no detail provided High – no detail provided High – not mentioned High – no detail Low – 12% attrition Low – all seem
(Haug et al., provided reported
1994)
1323

(Continued)
 1324

Table 3. (Continued).
Blinding of participants/ Blinding of outcome Incomplete outcome Selective outcome
Sequence generation Allocation concealment personnel assessor data reporting
Orive et al., 2015 Low – randomly allocated in Low – concealed High – physicians involved in the High – given the nature High – attrition 19% Low – Mixed model
(Orive et al., blocks of 4 according to allocation was assured recruitment and in the medical of the intervention, takes into account all
A. MIKOCKA-WALUS ET AL.

2015) a computer-generated by using randomization treatment were blinded to neither patients nor available data from
random assignment utilizing a computer patients’ randomization, but individuals collecting all randomized
sequence stratified by program, prepared in patients couldn’t be blinded the data were blinded participants, making
hospital site, prepared in advance by to the treatment it a full intention-to-
advance by a statistician a statistician assignment treat analysis
Tavakoli et al., High – no mention of how High – no detail provided High – no detail provided High – no detail High – attrition not Low – all seem
2020 (Tavakoli done provided discussed reported
et al., 2020)
Teh et al., 2020 Low – block randomization, Low – randomization with High – unblinded randomized High – no detail Low – attrition Low – all seem
(Teh et al., with assignment in sealed assignment in sealed trial provided numbers reported, reported
2020) envelopes envelopes prepared by with reasons
non-study team
members
Xiong et al., Low – randomisation High – little detail High – little detail provided Low – professionals who Low – no missing Low – all seem
2019 (Xiong according to a random provided but the table applied the scoring data, all reported
et al., 2019) number table was prepared by an scales and performed participants
independent the various tests were completed the
biostatistician all blinded to study
grouping
 PSYCHOLOGY, HEALTH & MEDICINE 1325

non-significant when including the comparison with the smallest effect size (Table 2,
Figure S1).

QOL
Only two studies examined the effect of psychotherapy on QOL post-treatment, and the
meta-analysis was not feasible. In the hypnotherapy trial (Calvert et al., 2002), median
QoL improved significantly in the experimental group from 5.3 (IQR: 4.6–6.1) at baseline
to 7.9 (IQR: 7–9.1) at the end of treatment as compared to TAU at baseline of 6.1 (IQR:
5.4–7.3) and post-treatment of 6.3 (IQR: 4.9–7.9) (p < 0.001). In a pilot of mindfulness-
based cognitive therapy (Teh et al., 2020), no significant group differences in QoL post-
treatment were observed, with the MBCT group’s mean of 57.6 (SD = 21) versus 65.4
(SD = 16) in TAU at baseline and both groups improving by 6.2 (SD = 18.6) and 6.7
(SD = 15.7) points, respectively.

Follow-up
Follow-up findings are presented in Table 2 and Figure S1, although fewer studies
contributed to these analyses (n = 6 symptom severity, n = 4 depressive symptoms,
n = 2 anxiety symptoms). Psychotherapy significantly outperformed control conditions
at follow-up on symptom severity and anxiety symptoms, but not depressive symptoms.
Qualitatively, the one trial (Faramarzi et al., 2015) that used a longer treatment program
that was not CBT-based produced a significantly larger effect size on anxiety symptoms at
follow-up than the one trial (Orive et al., 2015) that used a shorter treatment based on
CBT. Two trials examined the effect of psychotherapy on QOL long-term and the meta-
analysis was not feasible. In a hypnotherapy trial (Calvert et al., 2002), median QOL
improved significantly in the experimental group versus TAU (8.6, IQR: 6.7–9.1 versus
7.7, IQR: 6.9–8.1, p < 0.01) at 56 weeks of follow-up. In a trial comparing two experi­
mental groups (one receiving relaxation and another receiving CBT in addition to TAU)
to TAU (Haag et al., 2007), at 6 months there was no group difference in either mental or
physical QOL between each of the experimental groups and TAU. However, at 12-
months those receiving relaxation significantly improved physical QOL in comparison
to TAU (6.1± 2.4 vs. 1.2±1.0, p < 0.05).

Discussion
Psychotherapy does not appear to benefit depression symptoms in people with FD,
however, it tends to improve symptoms of short- and long-term anxiety, favouring
shorter CBT designs. It is unclear why psychotherapy does not offer improvements in
depressive symptoms and given the low number of trials in the present review, these
findings need to be confirmed in future studies. However, it is possible that the relation­
ship between anxiety and FD is causal while depression is the FD’s sequalae and therefore
a consequence rather than a cause of FD. This hypothesis is supported by longitudinal
studies documenting a high rate of anxiety, but not depression, prior to the onset of FD
(Aro et al., 2015), suggesting that those with anxiety might be prone to developing
symptoms of FD in time. CBT is the best evidenced psychotherapy to manage anxiety
and depression (APS, 2010) and larger trials of its usefulness in FD are urgently needed.
1326 A. MIKOCKA-WALUS ET AL.

Present findings also suggest that psychotherapy may lead to small-moderate improve­
ments in symptoms of FD at short- and long-term relative to non-psychological treat­
ments, with very preliminary evidence indicating that longer treatment programs may
produce the largest effects. In a recent IBS meta-analysis, while psychotherapy was
effective for bowel symptoms, no type of psychotherapy was superior (Black et al.,
2020a). However, therapy duration or intensity was not factored in this meta-analysis.
It is essential that future, high-quality trials of psychotherapy in FD address more than
FD symptoms and explore its impact on wellbeing given the bi-directional gut-brain
communication in FD (Koloski et al., 2016) and the need to manage FD biopsychoso­
cially using a person-focused approach (Black et al., 2020; Drossman et al., 1999).
Further, the optimal conditions in which the largest or smallest improvements are
made are unclear based on the available evidence because we could not conduct ade­
quately powered subgroup analyses. It is important to understand which type of psy­
chotherapy and duration should be delivered to ensure psychotherapy’s cost-
effectiveness.
While our conclusion regarding benefits for FD symptoms is consistent with the
previous meta-analysis (Moayyedi et al., 2017), our review is the first to document
preliminary evidence regarding benefits of psychotherapy on anxiety symptoms asso­
ciated with FD in long term. This is a novel finding as many reviews, and trials, focus on
short-term efficacy of psychotherapy. Its long-term efficacy is crucial when considering
the chronic and relapsing nature of FD and thus should be further investigated in
properly designed longitudinal trials. Clinically, what this finding means is that psy­
chotherapy is an emerging treatment for FD symptom severity and might improve
associated psychological symptoms and QOL. There is therefore potential for utilising
it more broadly in usual care (Keefer et al., 2022). In this context, it is important to note
that while the discipline of psycho-
gastroenterology is growing rapidly (van Tilburg et al. 2021), access to psychotherapy in
gastroenterology clinics worldwide remains limited. An Australian survey showed that
only 12% of patients with a chronic gastrointestinal condition had access to a mental
health practitioner as part of their gastroenterology service (Mikocka-Walus et al., 2020).
Strategies for a wider-scale implementation of psychological strategies to support people
with gastrointestinal conditions have been proposed (Feingold et al., 2019) and tested
with encouraging results (Lores et al., 2021). It is now time to put them into practice.

Limitations
We included publications in English which could have resulted in publication bias. We
only identified nine RCTs (n = 786), most of which were associated with a high risk of
bias. In light of prior meta-analyses showing that high risk of bias psychotherapy trials
tend to produce inflated effect sizes (Cuijpers et al., 2010), it is likely that our effects are
overestimated. All included trials did not properly mask patients which is a typical
feature of psychotherapy research. Further, intention-to-treat was not universally
applied, and attrition was problematic for all but one study. In addition, given the
number of outcome measures assessed in the present review, multiplicity caused by
having several secondary outcomes is possible. Further, the effects we examined were
unstable in sensitivity analyses due to small sample sizes and these analyses should be
 PSYCHOLOGY, HEALTH & MEDICINE 1327

repeated when more trials become available. Further, only eight studies could be included
in meta-analysis and heterogeneity was high due to wide ranging trial characteristics.
CBT was the only type of psychotherapy which was examined in more than one trial.

Disclosure statement
No potential conflict of interest was reported by the author(s).

Funding
The author(s) reported there is no funding associated with the work featured in this article.

ORCID
Antonina Mikocka-Walus http://orcid.org/0000-0003-4864-3956
Subhadra Evans http://orcid.org/0000-0002-1898-0030
Jake Linardon http://orcid.org/0000-0003-4475-7139
Simon R. Knowles http://orcid.org/0000-0001-8000-1000

Authors’ contributions
AMW, SE and SK conceived the study. AMW, SE, SK and HW collected data. AMW prepared
a qualitative synthesis while JL conducted meta-analysis and interpreted data. AMW drafted the
manuscript. All authors contributed to and approved the final draft of the manuscript. AMW is
accepting full responsibility for the conduct of the study. She has had access to the data and has
control of the decision to publish.

Data accessibility statement

The data that support the findings of this study are available publicly in the publications which
contributed to the present review.

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 PSYCHOLOGY, HEALTH & MEDICINE 1331

Appendix 1
Search strategy – databases other than Medline
Embase 1974 to 30 June 2021 (Ovid)
(1) dyspepsia/HT
(2) (dyspep* or epigastric or indigestion or impaired digestion or rome criter*).ti, ab.HT
(3) 1 or 2HT
(4) exp psychotherapy/ or psychoanalysis/ or exp counseling/HT
(5) (abreaction or “acceptance and commitment” or anger management therap* or animal
assisted therap* or animal therap* or aromatherap* or art therap* or autogenic training or
autosuggestion or aversive therap* or behavio?r analysis or behavio?r intervention* or
behavio?r therap* or behavio?ral or bibliotherap* or biofeedback).ti, ab.HT
(6) (catharsis or cbt or chronotherap* or cognitive behav* or cognitive remediat* or colo?r
therap* or counsel* or countertransference or couples therap* or crisis intervention* or
dance therap* or dbt or desensiti* or dialectical behavi* or emotion focused therap* or
equine assisted therap* or equine therap* or exposure therap*).ti, ab.HT
(7) (family therap* or gestalt therap* or free association or group therap* or guided imagery or
horticultural therap* or hypnosis or hypnotherap* or implosive therap* or interpersonal
support* or meditat* or mental health service* or milieu therap* or mindfulness or motiva­
tional or music therap* or narrative therap* or neurofeedback).ti, ab.HT
(8) (psychoanaly* or psychodrama or psychodynam* or psycholog* or psychosocial* or psy­
chotherap* or reality therap* or relax* or reprocessing or residential treatment* or sensitivity
training or sensory feedback or socioenvironmental therap* or sociotherap* or supportive
therap* or talk therap* or therapeutic alliance or therapeutic communit* or transactional
analysis or transference or validation therap*).ti, ab.HT
(9) exp mental health care/ or social work/HT
(10) (mental health service* or pastoral care or psychiat* or social work*).ti, ab.HT
(11) self care/ or self help/ or support group/HT
(12) (self care or self help or self manag* or support group*).ti, ab.HT
(13) 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12HT
(14) crossover-procedure/ or double-blind procedure/ or randomized controlled trial/ or single-
blind procedure/HT
(15) (random* or factorial* or crossover* or cross over* or placebo* or (doubl* adj blind*) or
(singl* adj blind*) or assign* or allocat* or volunteer*).tw.HT
(16) 14 or 15HT
(17) 3 and 13 and 16HT
(18) exp animal/ not human/HT
(19) (animal model* or rat or rats).ti.HT
(20) 18 or 19HT
(21) 17 not 20

APA PsycInfo 1806 to June Week32021(Ovid)

(1) dyspepsia/HT
(2) (dyspep* or epigastric or indigestion or impaired digestion or rome criter*).ti, ab.HT
(3) 1 or 2HT
(4) exp psychotherapy/ or exp psychology/ or exp counseling/ or exp counselors/ or anxiety
management/ or exp behavior modification/ or exp cognitive behavior therapy/ or exp
cognitive techniques/ or exp creative arts therapy/ or exp mental health programs/ or exp
mindfulness-based interventions/ or exp relaxation therapy/ or sociotherapy/ or exp ther­
apeutic processes/
(5) (abreaction or “acceptance and commitment” or anger management therap* or animal
assisted therap* or animal therap* or aromatherap* or art therap* or autogenic training or
1332 A. MIKOCKA-WALUS ET AL.

autosuggestion or aversive therap* or behavio?r analysis or behavio?r intervention* or

behavio?r therap* or behavio?ral or bibliotherap* or biofeedback).ti, ab.HT
(6) (catharsis or cbt or chronotherap* or cognitive behav* or cognitive remediat* or colo?r
therap* or counsel* or countertransference or couples therap* or crisis intervention* or
dance therap* or dbt or desensiti* or dialectical behavi* or emotion focused therap* or
equine assisted therap* or equine therap* or exposure therap*).ti, ab.HT
(7) (family therap* or gestalt therap* or free association or group therap* or guided imagery* or
horticultural therap* or hypnosis or hypnotherap* or implosive therap* or interpersonal
support* or meditat* or mental health service* or milieu therap* or mindfulness or motiva­
tional or music therap* or narrative therap* or neurofeedback).ti, ab.HT
(8) (psychoanaly* or psychodrama or psychodynam* or psycholog* or psychosocial* or psy­
chotherap* or reality therap* or relax* or reprocessing or residential treatment* or sensitivity
training or sensory feedback or socioenvironmental therap* or sociotherap* or supportive
therap* or talk therap* or therapeutic alliance or therapeutic communit* or transactional
analysis or transference or validation therap*).ti, ab.HT
(9) exp mental health services/ or exp social casework/ or exp psychiatry/HT
(10) (mental health service* or pastoral care or psychiat* or social work*).ti, ab.HT
(11) exp self-help techniques/ or exp support groups/HT
(12) (self care or self help or self manag* or support group*).ti, ab.HT
(13) 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12HT
(14) exp clinical trials/ or treatment effectiveness evaluation/HT
(15) (randomi?ed or randomly or placebo or trial or groups).ti, ab.HT
(16) 14 or 15HT
(17) 3 and 13 and 16HT
(18) animals/ not humans/HT
(19) 17 not 18

Ovid Emcare 1995 to 2021 Week 25

(1) dyspepsia/HT
(2) (dyspep* or epigastric or indigestion or impaired digestion or rome criter*).ti, ab.HT
(3) 1 or 2HT
(4) exp psychotherapy/ or psychoanalysis/ or exp counseling/HT
(5) (abreaction or “acceptance and commitment” or anger management therap* or animal
assisted therap* or animal therap* or aromatherap* or art therap* or autogenic training or
autosuggestion or aversive therap* or behavio?r analysis or behavio?r intervention* or
behavio?r therap* or behavio?ral or bibliotherap* or biofeedback).ti, ab.HT
(6) (catharsis or cbt or chronotherap* or cognitive behav* or cognitive remediat* or colo?r
therap* or counsel* or countertransference or couples therap* or crisis intervention* or
dance therap* or dbt or desensiti* or dialectical behavi* or emotion focused therap* or
equine assisted therap* or equine therap* or exposure therap*).ti, ab.HT
(7) (family therap* or gestalt therap* or free association or group therap* or guided imagery or
horticultural therap* or hypnosis or hypnotherap* or implosive therap* or interpersonal
support* or meditat* or mental health service* or milieu therap* or mindfulness or motiva­
tional or music therap* or narrative therap* or neurofeedback).ti, ab.HT
(8) (psychoanaly* or psychodrama or psychodynam* or psycholog* or psychosocial* or psy­
chotherap* or reality therap* or relax* or reprocessing or residential treatment* or sensitivity
training or sensory feedback or socioenvironmental therap* or sociotherap* or supportive
therap* or talk therap* or therapeutic alliance or therapeutic communit* or transactional
analysis or transference or validation therap*).ti, ab.HT
(9) exp mental health care/ or social work/HT
(10) (mental health service* or pastoral care or psychiat* or social work*).ti, ab.HT
(11) self care/ or self help/ or support group/HT
(12) (self care or self help or self manag* or support group*).ti, ab.HT
(13) 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12HT
 PSYCHOLOGY, HEALTH & MEDICINE 1333

(14) crossover-procedure/ or double-blind procedure/ or randomized controlled trial/ or single-

blind procedure/HT
(15) (random* or factorial* or crossover* or cross over* or placebo* or (doubl* adj blind*) or
(singl* adj blind*) or assign* or allocat* or volunteer*).tw.HT
(16) 14 or 15HT
(17) 3 and 13 and 16HT
(18) exp animal/ not human/HT
(19) (animal model* or rat or rats).ti.HT
(20) 18 or 19HT
(21) 17 not 20

Ovid Nursing Database 1946 to June Week 4 2021

(1) Dyspepsia/HT
(2) (dyspep* or epigastric or indigestion or impaired digestion or rome criter*).ti, ab.HT
(3) 1 or 2HT
(4) exp behavioral disciplines, tests, therapy, services/HT
(5) (abreaction or “acceptance and commitment” or anger management therap* or animal
assisted therap* or animal therap* or aromatherap* or art therap* or autogenic training or
autosuggestion or aversive therap* or behavio?r analysis or behavio?r intervention* or
behavio?r therap* or behavio?ral or bibliotherap* or biofeedback).ti, ab.HT
(6) (catharsis or cbt or chronotherap* or cognitive behav* or cognitive remediat* or colo?r
therap* or counsel* or countertransference or couples therap* or crisis intervention* or
dance therap* or dbt or desensiti* or dialectical behavi* or emotion focused therap* or
equine assisted therap* or equine therap* or exposure therap*).ti, ab.HT
(7) (family therap* or gestalt therap* or free association or group therap* or guided imagery* or
horticultural therap* or hypnosis or hypnotherap* or implosive therap* or interpersonal
support* or meditat* or mental health service* or milieu therap* or mindfulness or motiva­
tional or music therap* or narrative therap* or neurofeedback).ti, ab.HT
(8) (psychoanaly* or psychodrama or psychodynam* or psycholog* or psychosocial* or psy­
chotherap* or reality therap* or relax* or reprocessing or residential treatment* or sensitivity
training or sensory feedback or socioenvironmental therap* or sociotherap* or supportive
therap* or talk therap* or therapeutic alliance or therapeutic communit* or transactional
analysis or transference or validation therap*).ti, ab.HT
(9) (mental health service* or pastoral care or psychiat* or social work*).ti, ab.HT
(10) self-care/ or support groups/HT
(11) (self care or self help or self manag* or support group*).ti, ab.HT
(12) 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11HT
(13) (randomized controlled trial or controlled clinical trial).pt.HT
(14) exp clinical trials/HT
(15) drug therapy.fs.HT
(16) (randomi?ed or randomly or placebo or trial or groups).ti, ab.HT
(17) 13 or 14 or 15 or 16HT
(18) 3 and 12 and 17HT
(19) exp animals/HT
(20) (animal model* or rat or rats).ti.HT
(21) 19 or 20HT
(22) 18 not 21

CINAHL (EBSCOhost)
(S1) (MH “Dyspepsia”)
(S2) dyspep* OR epigastric OR indigestion OR “impaired digestion“ OR ”rome criter*”
(S3) S1 OR S2
(S4) (MH “Psychotherapy+“) OR (MH ”Mental Health Services+”)
(S5) (MH “Behavioral Sciences+”)
1334 A. MIKOCKA-WALUS ET AL.

(S6) abreaction or “acceptance and commitment” or anger management therap* or animal

assisted therap* or animal therap* or aromatherap* or art therap* or autogenic training or
autosuggestion or aversive therap* or behavio?r analysis or behavio?r intervention* or
behavio?r therap* or behavio?ral or bibliotherap* or biofeedback
(S7) catharsis OR cbt OR chronotherap* OR “cognitive behav*“ OR “cognitive remediat*“ OR
“colo?r therap*“ OR counsel* OR countertransference OR “couples therap*“ OR “crisis
intervention*“ OR “dance therap*” OR dbt OR desensiti* OR ”dialectical behavi*” OR
”emotion focused therap*” OR ”equine assisted therap*” OR ”equine therap*” OR ”exposure
therap*”
(S8) family therap* or gestalt therap* or free association or group therap* or guided imagery* or
horticultural therap* or hypnosis or hypnotherap* or implosive therap* or interpersonal
support* or meditat* or mental health service* or milieu therap* or mindfulness or motiva­
tional or music therap* or narrative therap* or neurofeedback
(S9) psychoanaly* OR psychodrama OR psychodynam* OR psycholog* OR psychosocial* OR
psychotherap* OR “reality therap*“ OR relax* OR reprocessing OR “residential treatment*“
OR “sensitivity training“ OR “sensory feedback“ OR “socioenvironmental therap*“ OR
sociotherap* OR “supportive therap*” OR ”talk therap*” OR ”therapeutic alliance” OR
”therapeutic communit*” OR ”transactional analysis” OR transference OR ”validation
therap*”
(S10) “mental health service*“ OR “pastoral care” OR psychiat* OR ”social work*”
(S11) (MH “Self Care“) OR (MH ”Self-Management”)
(S12) (MH “Support Groups”)
(S13) “self care“ OR “self help“ OR ”self manag*” OR ”support group*”
(S14) S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13
(S15) (MH “Randomized Controlled Trials+”)
(S16) randomi#ed OR randomly OR placebo OR trial OR groups
(S17) S15 OR S16
(S18) S3 AND S14 AND S17

Cochrane Library (Wiley)

(#1) [mh ^Dyspepsia]
(#2) (dyspep* OR epigastric OR indigestion OR “impaired digestion“ OR ”rome criter*”):ti, ab
(#3) #1 OR #2
(#4) [mh psychotherapy] OR [mh psychology] OR [mh ^“psychology, applied”] OR [mh
counseling]
(#5) (abreaction OR “acceptance and commitment“ OR “anger management therap*“ OR “animal
assisted therap*“ OR “animal therap*“ OR aromatherap* OR “art therap*“ OR ”autogenic
training” OR autosuggestion OR ”aversive therap*” OR ”behavio?r analysis” OR ”behavio?r
intervention*” OR ”behavio?r therap*” OR behavio?ral OR bibliotherap* OR biofeedback):
ti, ab
(#6) (catharsis OR cbt OR chronotherap* OR “cognitive behav*“ OR “cognitive remediat*“ OR
“colo?r therap*“ OR counsel* OR countertransference OR “couples therap*“ OR “crisis
intervention*“ OR “dance therap*” OR dbt OR desensiti* OR ”dialectical behavi*” OR
”emotion focused therap*” OR ”equine assisted therap*” OR ”equine therap*” OR ”exposure
therap*”):ti, ab
(#7) (“family therap*“ OR “gestalt therap*“ OR “free association“ OR “group therap*“ OR “guided
imagery*“ OR “horticultural therap*“ OR hypnosis OR hypnotherap* OR ”implosive
therap*” OR ”interpersonal support*” OR meditat* OR ”mental health service*” OR ”milieu
therap*” OR mindfulness OR motivational OR ”music therap*” OR ”narrative therap*” OR
neurofeedback):ti, ab
(#8) (psychoanaly* OR psychodrama OR psychodynam* OR psycholog* OR psychosocial* OR
psychotherap* OR “reality therap*“ OR relax* OR reprocessing OR “residential treatment*“
OR “sensitivity training“ OR “sensory feedback“ OR “socioenvironmental therap*“ OR
sociotherap* OR “supportive therap*” OR ”talk therap*” OR ”therapeutic alliance” OR
 PSYCHOLOGY, HEALTH & MEDICINE 1335

”therapeutic communit*” OR ”transactional analysis” OR transference OR ”validation

therap*”):ti, ab
(#9) [mh ^“mental health services“] OR [mh ^“community mental health services“] OR [mh
^“emergency services, psychiatric”] OR [mh ^”social work, psychiatric”] OR [mh ^”pastoral
care”] OR [mh psychiatry]
(#10) (“mental health service*“ OR “pastoral care” OR psychiat* OR ”social work*”):ti, ab
(#11) [mh ^“self care”]
(#12) [mh ^“self-help groups”]
(#13) (“self care“ OR “self help“ OR ”self manag*” OR ”support group*”):ti, ab
(#14) #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13
(#15) #3 AND #14

Health Collection, Humanities & Social Sciences Collection (Informit)

dyspep*

Clinicaltrials.gov
Dyspepsia AND behavioral