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Primarily home-based cognitive behavior therapy as effective as standard therapy for treatment of irritable bowel syndrome

New research has shown that a mainly home-based behavior therapy regimen to treat irritable bowel syndrome (IBS) is just as effective as a similar, more expensive, strictly clinic-based therapy, and is more effective than an education-only approach. IBS is marked by a group of symptoms that occur together, including recurring pain in the abdomen and bowel movement issues, such as diarrhea, constipation, or both. Although the cause of IBS is not clear, its symptoms are often triggered by stress, so a significant portion of IBS research has focused on the gut’s intimate connection with the brain. This has led to interest in the use of a type of evidence-based, structured psychological treatment called cognitive behavior therapy (CBT), which typically consists of regular counseling sessions with a licensed psychotherapist. Although CBT has been shown to be an effective treatment for IBS, several barriers have prevented it from being widely adopted, including cost, time, therapist availability, and stigmas associated with IBS and psychosocial therapies.

To make CBT more accessible and less costly, a group of researchers recently developed a modified form of CBT for IBS that is primarily home-based, consisting of only four clinic visits over 10 weeks and relying more on home-study materials to strengthen skills that had been introduced in the clinical sessions. To test the new therapy’s effectiveness, 436 people with IBS underwent standard, clinic-based CBT (10 weekly counseling sessions), primarily home-based CBT (four weekly counseling sessions with home-study materials), or four education-only sessions that provided information on the roles of diet, stress, and exercise in IBS. In both the mainly home-based and standard CBT groups, counseling sessions involved education on the relationship between stress and IBS, along with coaching on relaxation exercises, methods for relieving stress and pain associated with the syndrome, and certain problem-solving strategies. About 80 percent of the participants were women, reflecting the fact that women are more likely than men to develop IBS. By the end of the treatments, 61 percent of the people who participated in the mainly home-based CBT reported moderate to substantial improvements in their symptoms, compared to about 55 percent for clinic-based CBT participants, suggesting that home-based CBT is as least as effective as standard CBT. In participants who received only educational sessions, about 44 percent reported symptom improvements. Assessment of participants by gastroenterologists after completion of study therapies supported these findings, and the general differences in symptom improvement scores among the three treatments persisted for at least 6 months. These results suggest that the primarily home-based CBT, with more limited therapist contact than standard CBT, is an effective method to treat IBS, providing a more low-cost, time-efficient, and accessible alternative to the standard clinic-based therapy.

References

Lackner JM, Jaccard J, Keefer L,…Sitrin MD. Improvement in gastrointestinal symptoms after cognitive behavior therapy for refractory irritable bowel syndrome. Gastroenterol. 155: 47-57, doi: 10.1053/j.gastro.2018.03.063, 2018.

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