Cognitive-Behavioral Therapy Improved IBS Symptoms in Primary Care Setting

Use of cognitive-behavioral therapy (CBT) for the treatment of irritable bowel syndrome (IBS) – whether telephone- or web-based – resulted in significant improvements in IBS outcomes compared with treatment as usual (TAU), according to a randomized clinical trial.

The study, conducted by Hazel Everitt, of University of Southampton, United Kingdom, and colleagues, also found that the sustained improvements in IBS symptoms seen with CBT occurred at an acceptable cost.

“Currently, clinicians have few options to offer people with refractory IBS,” Everitt and colleagues wrote. “This study shows that providing CBT has the potential to provide significant improvement in symptoms.”

The study included 558 adults with refractory IBS recruited from 75 general practices and three gastroenterology centers in the United Kingdom between 2014 and 2016. Patients were randomly assigned to telephone-derived CBT, web-based CBT, or TAU.

The telephone-based CBT (n = 186) included receipt of a patient self-management manual, six 60-minute telephone sessions over nine weeks, and two 60-minute boost sessions at four and eight months (eight hours of therapist time). Web-based CBT (n = 185) was interactive, tailored, web-based therapy including three 30-minute telephone sessions over nine weeks and two 30-minute boosters at four and eight months (2.5 hours of therapist time).

The primary outcome of the study was IBS Symptom Severity Score (IBS SSS) and Work and Social Adjustment Scale (WSAS) at 12 months.

“Both the higher-intensity telephone CBT and the web-based self-management with minimal therapist support showed significant clinically important improvements in symptom severity,” the researchers wrote.

At baseline, the mean IBS SSS was 265.0. At 12 months, patients assigned to telephone-based CBT had a 61.6-point lower IBS SSS, and patients assigned to web-based CBT had a 35.2-point lower score, a significant improvement compared with the TAU arm (P < .001 and P = .002, respectively).

The average WSAS score at 12 months was 10.8 for patients assigned to TAU, but was 3.5 points lower in the telephone-based CBT arm (P < .001) and 3.0 points lower in the web-based arm (P = .001).

Adverse events were similar among all trial arms.

The incremental cost-effectiveness ratio (ICER) quality adjusted life year for telephone-based CBT compared with TAU was £22,284 (~$29,354), and £7,724 (~$10,174) for web-based CBT compared with TAU.

“Qualitative findings highlighted that, in the CBT arms, there was increased capacity to cope with symptoms,” the researchers noted.