Irritable bowel syndrome (IBS) is a common gastrointestinal disorder affecting up to one in five people worldwide, researchers reported in April 2019 in the journal Gut. Abdominal pain, bloating, and unpredictable bowel function can negatively impact quality of life, work performance, and enjoyment of leisure activities. Face-to-face cognitive behavioral therapy (CBT) can ease symptoms and improve patients’ quality of life by helping them overcome worry and negative emotions about the illness and develop coping behaviors, the study team writes. But research to date hasn’t offered a clear picture of the ideal way to deliver CBT or the long-term outcomes from this treatment approach. For the current study, researchers randomly assigned 558 patients with IBS to one of three groups: only standard treatment for the condition — including diet changes and medications; or usual treatment combined with either phone-based or online CBT. After one year of follow-up, people who participated in one of the two CBT groups in addition to standard treatment reported a much bigger reduction in symptom severity than people who only received treatment as usual. “Sometimes with chronic diseases such as IBS, people get into unhelpful patterns of behavior and have unhelpful thoughts that exacerbate their symptoms and the impact of the symptoms on their ability to live their lives,” says the lead study author, Hazel Everitt, MBBS, PhD, a general practitioner and a researcher at the University of Southampton in the United Kingdom. “Our CBT programs enable patients to pinpoint things that they can do to reduce the impact of their IBS on their lives, and this helps them manage their IBS more effectively than current treatment as usual,” Dr. Everitt says.
How CBT Works to Treat Conditions Like IBS
To treat IBS, doctors typically recommend diet modifications like smaller meals and a low-fat diet as well as plenty of sleep and exercise. Doctors may also prescribe medications to slow digestion, prevent diarrhea, and ease the passage of stool. In the study, participants assigned to telephone CBT in addition to usual treatment received a detailed self-help book with homework assignments and had six hour-long phone sessions with therapists at weeks 1, 2, 3, 5, 7 and 9. They also received additional one-hour phone therapy sessions at four and eight months. People in the web-based CBT group received online access to an educational program for managing symptoms and feelings related to IBS, along with 30-minute telephone therapy sessions at weeks 1, 3, and 5 as well as at four and eight months. Participants assigned to receive only standard treatment did not receive any psychological support. At the start of the study, participants were 43 years old on average and had been living with IBS for a median of 7.4 years. They had average symptom severity scores of 265, indicating moderately severe symptoms. After one year, patients who received telephone CBT had symptom severity scores about 62 points lower than people who only had treatment as usual, and patients in the web therapy group had scores about 35 points lower than with usual care. Those declines are enough to leave some people with mild to moderate symptoms. One limitation of the study is that about 30 percent of the participants dropped out before 12 months. Another drawback is that the participants were all open to trying CBT, and it’s possible the success of this intervention might not be as pronounced for all IBS patients. It’s also not clear how many participants received care from a dietitian specializing in diets for IBS, which could affect symptom severity as well as quality of life, says Peter Gibson, a gastroenterology researcher at Monash University in Melbourne who wasn’t involved in the study. Still, the results underscore the potential for CBT to be an important part of IBS treatment, and for telephone and online therapy options to provide a convenient alternative to people who might not otherwise be able to access or afford in-person therapy, Gibson says. “Our own approach is to use CBT and other psychological approaches as part of a multidisciplinary strategy in the management of patients with IBS,” Gibson says. “Nondrug approaches like CBT and diet are effective and self-empowering for the patients in managing their own symptoms,” Gibson adds. “Both require skilled healthcare professional time, things that are not well funded in our current system, and the study in question offers a practical and inexpensive way of delivering CBT.”
