Whether web or telephone based, cognitive behavioral therapy (CBT) may be more effective than standard treatments for IBS — and the benefits last in the long term.

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Web based CBT relieves IBS symptoms and provides lasting benefits.

This is the main takeaway of a new study, which now appears in The Lancet Gastroenterology and Hepatology.

Prof. Hazel Everitt, from the University of Southampton in the United Kingdom, is the lead and corresponding author of the paper.

Previous research that Prof. Everitt spearheaded showed that CBT combined with standard care can alleviate the symptoms of irritable bowel syndrome (IBS).

At the time, the research — which Medical News Today reported on — focused on interactive web and telephone based CBT. It compared the benefits of CBT complementing standard therapy with those of standard treatment alone.

However, the new study has compared the benefits of web or telephone based CBT on their own with those of standard care, or "treatment as usual."

The researchers defined standard care as "continuation of current medications, which varied from patient to patient, and usual general practitioner or consultant follow-up with no psychological therapy."

Prof. Everitt and colleagues wanted to examine the long term effects of these therapies because although previous research has shown CBT to be effective, there is still "uncertainty" about whether or not these benefits last.

CBT better than standard care at 24 months

The researchers split 558 participants with refractory IBS — which occurs when a person continues to have significant symptoms after 12 months despite receiving first line treatment — into three groups:

  • One group received "therapist delivered telephone CBT."
  • One group received "web based CBT with minimal therapist support."
  • One group received "treatment as usual."

The team assessed the participants at 12 months and 24 months. They asked the participants to respond to questionnaires self-assessing their symptoms, either online or via post.

"At 24 month follow-up," the researchers explain, "sustained improvements in IBS were seen in both CBT groups compared with [treatment as usual], although some previous gains were reduced compared with the 12 month outcomes."

More specifically, at 24 months, 71% of the people in the telephone CBT group and 63% of those in the web based CBT group reported that IBS had been having a significantly lower impact on their lives.

By comparison, less than half (46%) of the participants in the "treatment as usual" group reported clinically significant changes in their IBS symptoms.

The researchers also saw a reduction in total anxiety and depression levels, as well as an increased ability to cope with the condition, in the CBT groups. Both of these benefits persisted after 2 years.

'A really important and exciting discovery'

The team notes the "well powered, rigorously conducted" nature of the randomized controlled trial and its "broad inclusion" as the main strengths of the research.

The fact that the therapists who ran the interventions were highly experienced also strengthened the findings, as did the long follow-up period.

Still, the researchers note some potential limitations. For instance, "people with IBS who are unwilling to consider undertaking CBT [...] are unlikely to have participated in the trial," they say, which limits the external validity of the results.

"However, we believe that the sample was broadly representative of people with IBS, as the age and gender was similar between those invited to participate in the [...] trial and those who were randomly allocated to trial groups, although there was little ethnic diversity," they add.

Prof. Everitt and her colleagues conclude: "IBS specific CBT has the potential to provide long term improvement in IBS, achievable within a usual clinical setting. Increasing access to CBT for IBS could achieve long term patient benefit."

"[T]he fact that both telephone and web based CBT sessions were shown to be effective treatments is a really important and exciting discovery."

Prof. Hazel Everitt

This, she explains, is because "[p]atients are able to undertake these treatments at a time convenient to them, without having to travel to clinics, and we now know that the benefits can last long term."

IBS affects around 10–15% of all adults in the United States.