Cognitive Behavioral Therapy May Bring Relief to a Significant Number of Patients With Irritable Bowel Syndrome

Nancy Fowler Larson

May 5, 2010 — Nearly 30% of patients with irritable bowel syndrome (IBS) reported considerable relief after 4 weeks of cognitive behavioral therapy (CBT), and the vast majority sustained these improvements for 3 months, according to a study published in the April issue of Clinical Gastroenterology and Hepatology.

"[CBT] is an empirically validated treatment for [IBS], yet it is unclear for whom and under what circumstances it is most effective," write Jeffrey Lackner, PsyD, Division of Gastroenterology, Department of Medicine, State University of New York at Buffalo, and colleagues.

The goal of the study was to determine whether participants who reported an early, positive response to CBT would maintain that level of wellness. To that end, the researchers randomly assigned 75 adults (age, 18 - 70 years) diagnosed with IBS into 3 groups: those who received an hour of CBT once a week for 10 weeks (standard CBT [S-CBT]), those who underwent 4 hour-long sessions during a 10-week period (minimal-contact CBT [MC-CBT]), and wait-list control patients. Week 4 was defined as clinic session 4 for those in the S-CBT faction and clinic session 2 for the MC-CBT unit. Data were available for 71 of the participants.

The subjects answered yes-no questionnaires gauging the severity of their diarrhea, constipation, and bloating. They also completed the Irritable Bowel Syndrome Severity Scale (IBSSS) and other tests.

During the study, treatment responders were designated as those who achieved adequate relief of pain and bowel symptoms and whose IBSSS scores dropped by at least 50 points from their baseline. Rapid responders (RRs) were those who met the criteria during week 4. Nonrapid responders (NRRs) had not reached both goals by week 12.

Key findings of the research are as follows:

The study authors predicted that their work could lead to individualized, more economical treatment.

"Patients who quickly achieve treatment gains — for example, IBS symptom relief — may be spared the cost and inconvenience of follow-up care of little therapeutic value," Dr. Lackner said in a press release. "Conversely, patients who do not respond within a set number of sessions early on could be immediately identified and triaged or 'stepped up' to potentially more powerful treatment(s) rather than bearing the cost, demoralization and frustration that comes with treatment failure."

There were 2 stated limitations to the study. First, the subjects were all volunteers, who may be more open to psychological intervention. Second, the findings may not generalize to a wider population because the study was not powered to discern differences among S-CBT, MC-CBT, and other therapies.

"Whether rapid response is more likely to occur in a brief, home-based or more intensive, clinic-based form of CBT and is unique to CBT (vs common ingredients of therapies including pharmacologic ones) is an important task of a larger randomized controlled trial," the authors write.

The National Institute of Diabetes and Digestive and Kidney Diseases supported the study. The study authors have disclosed no relevant financial relationships.

Clin Gastroenterol Hepatol . 2010;8:426-432. Abstract

Authors and Disclosures

Journalist

Nancy Fowler Larson

Nancy Fowler Larson is a freelance writer for Medscape.

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