Self-led CBT as good as standard for improving IBS

Last Updated: 2018-05-04

By Anne Harding

NEW YORK (Reuters Health) - A shortened course of cognitive behavioral therapy (CBT) supplemented with home study is just as effective as 10 in-person sessions with a therapist for helping people with irritable bowel syndrome (IBS) manage their symptoms, new research shows.

"For most physicians, IBS is incredibly difficult to treat, in part because the drugs have an oftentimes unreliable and sometimes unsafe track record," said senior author Dr. Jeffrey Lackner, who directs the Behavioral Medicine Clinic at the University at Buffalo, SUNY, in New York.

"Patients can actually learn specific skills to regulate, to control and reduce their bowel symptoms, even when those bowel symptoms are very severe and disabling," he told Reuters Health by phone.

CBT has been shown to help patients with IBS, and several practice guidelines recommend it, Dr. Lackner and his team note in Gastroenterology, online April 25.

But "only a small fraction of people receive it in accordance with practice guidelines," they add. "Barriers to adoption include cost, limited therapist availability beyond select metropolitan areas, stigma, and logistical challenges such as transportation and time."

One approach for addressing these issues is "home-based" treatment, they add, which is largely self-administered, with minimal contact with a therapist.

In the new study, Dr. Lackner and his colleagues randomly assigned 436 IBS patients at two tertiary centers to receive standard CBT (S-CBT, 10 weekly 60-minute sessions with a therapist), minimal contact CBT (MC-CBT, four clinic sessions with a therapist over 10 weeks, with home study), or four sessions of education about IBS.

Two weeks after the end of treatment, 61% of patients who received MC-CBT and 55% of those who had S-CBT reported moderate to substantial symptom improvement in their symptoms; 56% and 51%, respectively, had this amount of improvement based on gastroenterologist ratings.

For the education arm, moderate to substantial symptom improvement based on patient and gastroenterologist ratings were 44% and 40%, respectively.

At six months, 58% of the MC-CBT group, 52% of the S-CBT group and 45% of the education group had moderate to substantial improvement in their IBS based on gastroenterologist ratings.

The abbreviated CBT seems to motivate patients, Dr. Lackner noted. "I think it has kind of a catalytic effect on change," he said. "We were concerned that a self-administered treatment would be a real problem from a compliance point of view. We did not find that."

The fact that the treatment's effects persisted over time, he added, "suggests that patients are not only learning skills, they are making it a part of their life that they can take with them over time and in other situations."

The findings are "exciting," and have "direct practical applications," Dr. Emeran A. Mayer, a professor of medicine, physiology and psychiatry at the David Geffen School of Medicine in UCLA, told Reuters Health by phone. Dr. Mayer studies the brain-gut connection and has collaborated with Dr. Lackner, but did not take part in the new study.

While short-form CBT is more accessible, Dr. Mayer added, it is still not available to all who need it. "Without too much difficulty, you could make a Web-based version of that program, and then it's available to everyone," he said.

SOURCE: https://bit.ly/2HQl06V

Gastroenterology 2018.