CBT and IBS

The journal Gut has very recently published a study evaluating the effectiveness of cognitive-behavioural therapy (CBT) as a treatment strategy for IBS. Let’s take a look at the results of this study and see if CBT can help with IBS.

What is cognitive-behavioural therapy (CBT)?

CBT is a type of therapy that aims to help you understand that your thoughts and behavior influence how you feel. It was originally developed to treat mental health disorders like depression and anxiety and has sparked interest for treating other disorders. It is based on the idea that our thoughts, emotions, and actions are closely linked with each other. The idea is to try to eliminate negative thoughts or behaviors, with the goal of improving your emotional well-being. CBT is a collaborative treatment typically led by a therapist, normally including both face-to-face office visits and at-home sessions.

How was the study structured?

The participants in this study were adults with refractory IBS (patients with long-term and ongoing symptoms >12 months, even after trying appropriate treatment options). CBT is recommended to these patients by NICE guidelines.

The participants were divided into three arms in this randomized controlled trial. One arm received CBT by telephone, one arm received web-based CBT and the final arm received standard care/ treatment as usual. The study assessed how the two CBT delivery methods compared to the standard care/ treatment as usual.

The participants and therapists were unable to be blinded, however, all others were blinded. These included the chief investigator, assessors and statisticians.

What did the study involve?

All arms received the standard treatment which included dietary advice and medications. Both CBT treatment arms were similar and based on a CBT model developed for IBS. There was a focus on improving bowel habits, developing healthy eating habits, reducing stress and negative thoughts – with the aim of preventing symptom relapse. The telephone-CBT group was given a range of self-help activities to complete at home and received eight hours of therapist support over the telephone. The web-based CBT group used a web-based service that guided them through a number of CBT-related tasks and had only two and a half hours of therapist support over the telephone. Participants were assessed for symptoms at 3, 6, and 12 months (the study ended at 12 months). The standard care/ treatment as a usual group received a continuation of current medications and standard GP/ consultant follow-ups, without any CBT-based therapy.

What were the results?

The researchers used two validated questionnaires to assess each participant. These included the IBS severity scoring system (IBS-SSS) and the Work and Social Adjustment Scale (WSAS). IBS-SSS is a simple method to track symptoms and WSAS is useful in assessing the impairment of daily functions, so by using the two the study really looked at how IBS can impact daily life. Both CBT groups had significant improvement in their IBS-SSS and WSAS results in comparison to the standard care arm, however, the telephone led group had the most significant results.

What is the mechanism?

The exact mechanism is not fully clear, but CBT appears to help patients develop coping strategies for day-to-day life, by identifying the behaviours and thoughts that can cause an issue for them. It is also likely linked with the regulation of the gut-brain axis, by allowing our brain and gut better communicate, perhaps through the release of important chemical messengers like serotonin.

Who can this help?

Patients with chronic, refractory IBS have limited treatment options and usually feel dissatisfied with the treatments offered to them by their GP/ primary care doctor. This study provides strong evidence that CBT could be a viable treatment strategy for patients with refractory IBS. It was interesting that both CBT strategies resulted in a reduction in IBS symptoms and had a positive impact on how their IBS affects their daily life and mood. This means that this therapy can be prescribed remotely by doctors, allowing a greater number of patients to receive adequate care but also providing them with the necessary education to self-manage their chronic condition.

What to do next?

You can read more about CBT online – the NHS (UK health service) website has lots of useful information as does the Mayo Clinic website. Talk with your doctor if you’re interested in a referral to a CBT therapist, or check out one of the many books available on the subject. One book that we’ve read and can recommend is “Mind Over Mood”.