Long Term Benefits of Cognitive Behavioural Therapy for IBS

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This resource was made possible through an unrestricted educational grant from IBgard®.

 

Long term benefits of cognitive behavioural therapy for those with Irritable Bowel Syndrome (IBS).

Did you know Canada has one of the highest rates of Irritable Bowel Syndrome (IBS) in the world, estimated at 18% vs 11% globally?  1 With symptoms such as abdominal pain, bloating, recurring diarrhea or constipation, or a combination of both, among others, IBS can be disruptive, debilitating and embarrassing for many.

Patients with IBS suffer psychologically due to the chronic (long time or continuously recurring) nature of the condition.In the IBS Global Impact Report, they found that in 40–60% of cases, IBS is accompanied by psychological symptoms such as depression, anxiety disorders, and post-traumatic stress syndrome. Because anxiety and depression increase the chances of developing IBS symptoms and result from IBS, some people are caught in a vicious cycle of worsening physical and psychological symptoms 3

Due to this, psychological therapies as a whole have shown to be effective in reducing the severity of IBS symptoms. Cognitive-behavioural therapy (CBT) has been tested most rigorously in multiple randomized controlled trials and consistently demonstrates significant effects on IBS symptoms and quality of life, which is excellent news for our IBS friends! 4

Cognitive Behavioural Therapy (CBT)

For those who may not know, CBT is a form of psychotherapy that focuses on thinking, behaviour and problem-solving. CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them more effectively. 5

Although research had indicated that CBT is recommended for IBS, there was still uncertainty about the long term benefits.

In 2015, the largest clinical trial called Assessing Cognitive Behavioural Therapy in Irritable Bowel (the ACTIB trial for short), led by Professor Hazel Everitt at the University of Southampton in collaboration with researchers at King’s College in London began. The trial aimed to address the clinical-effectiveness and cost-effectiveness of cognitive behaviour therapy (CBT) for irritable bowel syndrome (IBS). 8

ACTIB was a randomised, controlled trial with 558 adults participants with IBS randomly allocated to three groups. Participants would either receive therapist-delivered telephone CBT (telephone-CBT group), web-based CBT with minimal therapist support (web-CBT group), or treatment as usual (TAU group) and were followed up for 12 months.7 The treatment as usual group would continue to take their current medications and usual doctor follow-up with no psychological therapy for IBS.

All the participants in this group received standard information known as the NICE guidelines on lifestyle and diet approaches to managing IBS. 7

The results of this trial showed that CBT tailored specifically for IBS and delivered over the telephone or through an interactive website was more effective in relieving the symptoms of IBS than current standard care one year after treatment! 7

To evaluate the long-term benefits of CBT, in 2019, 24 months after the trial, investigators followed up with ACTIB trial participants.  This 24 month follow up research published in Lancet Gastroenterology and Hepatology showed that benefits continued two years after treatment despite patients having no further therapy after the initial CBT course. 6 Interesting!

How can we use these findings to help IBS patients?

These results are important, as previously there was uncertainty whether the initial benefits of CBT could be continued in the long term. Increasing access to cognitive behavioural therapy for IBS patients could help provide them with long-term, effective relief of IBS symptoms. 6

Professor Everitt added: “the fact that both telephone and web-based CBT sessions were shown to be effective treatments is a really important and exciting discovery. Patients are able to undertake these treatments at a time convenient to them, without having to travel to clinics and we now know that the benefits can last long-term.”  6

During the current pandemic, this couldn’t be more relevant! With staying home, it’s good to know that cognitive behavioural therapy sessions can be done virtually, and benefits can still be seen. As more studies are done on CBT, we will be sure to update this article.


References:

1. Lovell RM and Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-21.e4.

2.Ballou S, Bedell A, Keefer L. Psychosocial impact of irritable bowel syndrome: A brief review. World J Gastrointest Pathophysiol. 2015;6(4):120-3.

3. Gastrointestinal Society. 2018. IBS Global Impact Report 2018. https://badgut-5q10xayth7t3zjokbv.netdna-ssl.com/wp-content/uploads/IBS-Global-Impact-Report.pdf 

4. Kinsinger S. W. (2017). Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insights. Psychology research and behavior management10, 231–237. https://doi.org/10.2147/PRBM.S120817

5. What is cognitive behavioral therapy? American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.

6. Hazel A Everitt, Sabine Landau, Gilly O’Reilly, Alice Sibelli, Stephanie Hughes, Sula Windgassen, Rachel Holland, Paul Little, Paul McCrone, Felicity L Bishop, Kim Goldsmith, Nicholas Coleman, Robert Logan, Trudie Chalder, Rona Moss-Morris. 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

7. Everitt H, Landau S, Little P, Bishop FL, McCrone P, O’Reilly G, Coleman N, Logan R, Chalder T, Moss-Morris R; ACTIB trial team. Assessing Cognitive behavioural Therapy in Irritable Bowel (ACTIB): protocol for a randomised controlled trial of clinical-effectiveness and cost-effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome in adults. BMJ Open. 2015 Jul 15;5(7):e008622. doi: 10.1136/bmjopen-2015-008622. PMID: 26179651; PMCID: PMC4513538.

8. Everitt H, Landau S, Little P, Bishop FL, McCrone P, O’Reilly G, Coleman N, Logan R, Chalder T, Moss-Morris R; ACTIB trial team. Assessing Cognitive behavioural Therapy in Irritable Bowel (ACTIB): protocol for a randomised controlled trial of clinical-effectiveness and cost-effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome in adults. BMJ Open. 2015 Jul 15;5(7):e008622. doi: 10.1136/bmjopen-2015-008622. PMID: 26179651; PMCID: PMC4513538.