Cognitive Behavioral Therapy May Lead to Better IBS Outcomes
Patients with IBS who don’t respond well to standard treatments know how hard day-to-day living can be. IBS affects 10 to 20 percent of adults worldwide, and many patients experience symptom relief with standard treatments.
However, some IBS patients only have a partial reduction of symptoms or little to no symptom relief. These people, known as refractory IBS patients, struggle to maintain their quality of life, loss of work time and decreased social interactions due to their continued IBS symptoms.
UK research on CBT
Researchers in the United Kingdom (UK) wanted to see if adding a specific behavioral health counseling known as cognitive behavioral therapy (CBT) to standard IBS therapies to see if there was an increase in symptom management for refractory IBS patients. While there has been some research suggesting that CBT could help people find better relief of their IBS symptoms, there was a shortage of study evidence to show this correlation. In addition, there is a shortage of approved, in-person, CBT providers in the UK to provide counseling for those with IBS.
Researchers studied a group of 558 refractory IBS patients who gave consent to participate in the research group. The people were split into three groups of approximately 185 patients; the first group received CBT through telephone calls with a counselor, the second group received CBT through web-based sessions, and the last group received treatment as usual (TAU). The web-based and telephone sessions were used as an alternative to in-person counseling, due to provider shortage.
CBT and timing
People receiving telephone call CBT had a total of eight telephone calls that were an hour each. These phone calls happened at one, two, three, five, seven, and nine weeks and then again at four and eight months. Along with the phone calls, patients detailed manuals with assignments, homework, and record sheets. Patients who received web-based therapy had three 30-minute sessions at weeks one, three and five. These 30-minute sessions were also repeated just once a week 4 and 8 months. The TAU group received no calls or web sessions but continued on the medical treatments that are considered to be standard of care for their symptoms.
After 12 and 24 months, all patients were surveyed on their current medical therapies, if they had CBT for any other condition besides their IBS, and their quality of life. The quality of life questions looked at the ability to work, social life and activities, and activities of daily living (cleaning, cooking, shopping, etc.), as well as symptom management issues such as anxiety and depression, ability to cope with illness and treatments and symptom relief.
People who received CBT either by phone or by web-based means had a significant improvement in the quality of life and symptom outcomes at both 12 and 24 months compared to the TAU group. While the CBT group’s improvement did decrease incrementally at 24 months, it was still significantly better than the TAU patient’s outcomes, with 71 percent of telephone-based patients and 63 percent% of web-based patients showing improvement, compared to 46% of TAU patients having improvement. This study helps to show a correlation between CBT and improved IBS patient outcomes and can help pave the way for other studies like it.
It is also important to note that while only approximately 60 percent of people responded at 12 and 24 months, more of the telephone (approximately 70 percent) and web-based (approximately 65 percent) patients responded as compared to the TAU patients (approximately 45 percent). This higher response could be because of the improved outcomes, but can also show some missing-data bias in the data analysis and may drive researchers to further study CBT in IBS patients for more and better data.
If you are interested in CBT for your IBS, you should discuss this with your care team. Your team should be able to refer you to a counselor who specializes in CBT for IBS or other health care issues and should be able to help you get an appointment. While this study isn’t perfect, it does show a link between physical and behavioral health and may help patients understand that holistic treatments may lead to better outcomes.
- Everitt H, Landau S, O'Reilly G et al. Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial. The Lancet Gastroenterology & Hepatology. 2019. DOI:10.1016/s2468-1253(19)30243-2. Accessed October 8, 2019.