The usual treatment for irritable bowel syndrome consists of drugs and advice on lifestyle and diet. Now, a new study suggests that giving interactive web-based or telephone-based cognitive behavioral therapy on top of usual care can reduce symptoms more effectively than standard care alone for those whose IBS is not responding to drugs.
The study, which took the form of a randomized controlled trial, is the biggest so far to have tested these types of cognitive behavioral therapy (CBT) for the treatment of irritable bowel syndrome (IBS).
The trial took place in the United Kingdom under the direction of researchers from the University of Southampton and King's College London who detail the methods and findings in a paper that features in the journal Gut.
IBS is a common intestinal condition with persistent symptoms that can markedly affect a person's quality of life.
The new findings could help to widen access under the National Health Service (NHS) to effective psychological therapy for people with IBS.
The U.K. clinical guidelines recommend CBT for people with IBS whose ongoing symptoms remain unresponsive to drugs after 12 months.
The trial investigators state that while CBT can "reduce symptom scores and improve quality of life by targeting unhelpful beliefs and coping behaviors," scientists remain unclear about which methods of delivery are most effective.
Previous studies have suggested that face-to-face sessions of CBT can help to reduce symptoms of IBS.
"However," as first study author Dr. Hazel A. Everitt, who is an associate professor in general practice at the University of Southampton, explains, "in my experience as a G.P., I have found that availability [of face-to-face CBT] is extremely limited."
IBS and CBT
IBS is a persistent and distressing gastrointestinal condition that affects around 11 percent of people worldwide and "is a significant health care burden."
IBS is not the same as inflammatory bowel disease (IBD), although the two conditions have some similar symptoms.
CBT is a "talking therapy" that helps people to alter their thinking and behavior to manage problems in a positive, systematic way.
CBT focuses on the present; it encourages change through small, practical steps that individuals can implement in their daily lives straight away.
Comparing tailored CBT to standard care
For the trial, the investigators recruited 558 people with IBS who had been experiencing ongoing symptoms without relief from other treatments for at least 12 months.
They randomly assigned the participants to three groups. One group, the controls, received standard care, while the other two groups received two forms of CBT tailored for IBS in addition to standard care.
Standard care comprised "treatment as usual," which the researchers defined as "continuation of current medications and usual G.P. or consultant follow-up with no psychological therapy." It also included advice and a leaflet on lifestyle and diet.
The two forms of CBT – telephone- and web-based – had the same aims but different modes of delivery and varying amounts of input from therapists. The therapists also underwent the same training.
Both forms of CBT aimed to improve bowel habits and develop stable and healthful patterns of eating. They also sought to manage stress, challenge negative thinking, reduce the focus on symptoms, and prevent relapse.
Those on the telephone-based CBT program received a manual with detailed advice and homework. They also spoke for 1 hour on the telephone with a CBT therapist six times during the first 9 weeks. Then, they had two more 1-hour booster sessions with the therapist on the telephone at 4 months and 8 months after the start of the program.
The participants on the web-based CBT program could access an interactive self-help package based on materials that a previous trial of CBT for IBS had tested. They also received three 30-minute telephone sessions with a therapist in the first 5 weeks and then two 30-minute booster sessions after 4 and 8 months.
Results favored both modes of CBT
To assess the effectiveness of treatment in the three groups, the researchers analyzed a range of measures, including changes on symptom severity scores, level of disruption to work and social life, mood, and ability to manage symptoms.
They assessed some of these 3 and 6 months after the treatments started and then at the end of the study, which lasted for 12 months.
The results showed that, compared with participants who only received standard care for 12 months, those who received either telephone- or web-based CBT were more likely to report that their symptoms had lessened in severity and that their work and social lives had improved.
It is important to note that only people whose IBS had not responded to drugs took part in the trial, so the results do not necessarily apply to everyone with IBS.
The team is now working with the NHS so that more people with IBS can access these treatments. They are also working with a private company to make web-based CBT for IBS more accessible outside the NHS and in other countries.
"The fact that both telephone- and web-based CBT sessions were shown to be effective treatments is a really important and exciting discovery. Patients are able to undertake these treatments at a time convenient to them, without having to travel to clinics."
Dr. Hazel A. Everitt