The Effects of Cognitive Behavioral Therapy with Biofeedback Therapy on the Quality of Life, Anxiety, Depression and Somatic Symptoms in Patients with Dyssynergic Defecation: A Randomized Controlled Trial

.Afsaneh Nikjooy1* , Aniss Khoshlahjeh Sedgh2, Bahar Mahjoubi3, Rezvan Mirzaei4, Mahdyieh Naziri5, Parnian


Background: Dyssynergic defecation (DD) is a major cause of chronic functional constipation. Patients with DD have greater
psychological distress and impaired health-related quality of life compared with the general population. This study aimed to evaluate
the effectiveness of cognitive-behavioral therapy (CBT) combined with biofeedback therapy (BFT) on the quality of life, anxiety,
depression and physical symptoms in patients with DD.


This randomized controlled trial (IRCT20141115019957N2) was conducted on 45DD patients who were referred to the
Rehabilitation Clinic of Iran University of Medical Sciences in 2017. The convenience sampling method was used to select the
participants and then they were randomly allocated into three equal groups using RANDBETWEEN function in Excel. The first group
received a combination of BFT&CBT and also standard-of-care therapy (SoCT). The second group was treated with BFT and SoCT,
and the third group received only SoCT. The patients were assessed by digital rectal examination and the Short Form-36, Spielberger
Anxiety, Beck Depression and Constipation Scoring System questionnaires before and after the treatment.The data were analyzed by
SPSS-22, ANOVA, ANCOVA and Chi-Square tests.


Patients who received both CBT&BFT had significant improvement in symptoms of constipation, depression, and
anxiety.Furthermore, BFT and CBT&BFT groups are valued equivalent only on the mental component of SF36 and the total SF36
questionnaire. But the physical component was significantly different, favoring CBT&BFT (p< 0.001). In CBT&BFT group,67%of
patients reached the relaxed stage. In contrast, no patient reached the relaxed neither in BFT nor in SoCT.


According to our study, patients with unfavorable responses to BFT may become better if CBT is added to their