Empirical Support for a Self-help Treatment for IBS
Irritable Bowel Syndrome (IBS) is a chronic, functional gastrointestinal (GI) disorder. Cognitive behavioral therapy (CBT) has been shown to be efficacious for IBS; however, access to qualified CBT therapists is limited. This study was a randomized, controlled trial of a CBT self-help workbook for IBS. Sixty patients with IBS were randomly assigned to active treatment or waitlist control. Participants were evaluated 6 weeks post-randomization at which point waitlist controls crossed over to active treatment. Treatment completers (17 in the immediate treatment group vs 19 in the waitlist control) experienced statistically and clinically significant improvement in quality of life, GI symptom severity, visceral sensitivity and catastrophic cognitions immediately post-treatment. Treatment efficacy was partially mediated by reductions in catastrophic thinking and visceral sensitivity. Limitations of the study included a high attrition rate, as is common in both internet-based and self-help intervention studies. Multiple imputation of missing data for post-treatment was carried out to correct for attrition, and subsequent analyses replicated prior statistically significant improvement on all major outcome measures. This study represents a move towards wider dissemination of and access to empirically-supported treatments for IBS, as well as an effort to test a self-help book in a randomized, controlled trial prior to publication.
KeywordsIrritable Bowel Syndrome (IBS) Bibliotherapy Self-help intervention Cognitive-behavioral therapy Catastrophizing
Conflict of Interest
Melissa G. Hunt, Elisabeth Ertel, Jordan A. Coello and Lauren Rodriguez declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the Institutional Review Board of the University of Pennsylvania and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.
No animal studies were carried out by the authors for this article.
- Afari, N., Ahumada, S. M., Wright, L. J., Mostoufi, S., Golnari, G., Reis, V., et al. (2014). Psychological trauma and functional somatic syndromes: A systematic review and meta-analysis. Psychosomatic Medicine, 76(1), 2–11. doi: 10.1097/PSY.0000000000000010.CrossRefPubMedCentralPubMedGoogle Scholar
- Bradley-Bolen, B. (2000). Breaking the bonds of irritable bowel syndrome: A psychological approach to regaining control of your life. Oakland, CA: New Harbinger.Google Scholar
- Chilcot, J., & Moss-Morris, R. (2013). Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention. Behaviour Research and Therapy, 51(10), 690–695. doi: 10.1016/j.brat.2013.07.007.CrossRefPubMedGoogle Scholar
- Craske, M. G., Wolitzky-Taylor, K. B., Labus, J., Wu, S., Frese, M., Mayer, E. A., et al. (2011). A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behaviour Research and Therapy, 49(6–7), 413–421. doi: 10.1016/j.brat.2011.04.001.CrossRefPubMedCentralPubMedGoogle Scholar
- Fond, G., Loundou, A., Hamdani, N., Boukouaci, W., Dargel, A., Oliveira, J., & Boyer, L. (2014). Anxiety and depression comorbidities in irritable bowel syndrome (ibs): A systematic review and meta-analysis. European Archives of Psychiatry and Clinical Neuroscience. doi: 10.1007/s00406-014-0502-z
- Ford, A. C., Brandt, L. J., Young, C., Chey, W. D., Foxx-Orenstein, A. E., & Moayyedi, P. (2009). Efficacy of 5-HT3 antagonists and 5-HT4 agonists in irritable bowel syndrome: Systematic review and meta-analysis. The American Journal of Gastroenterology, 104(7), 1831–1843. doi: 10.1038/ajg.2009.223.CrossRefPubMedGoogle Scholar
- Ford, A. C., Forman, D., Bailey, A. G., & Moayyedi, P. (2008). Irritable bowel syndrome: A 10 year natural history of symptoms, and factors that influence consultation behavior. American Journal of Gastroenterology, 103(5), 1229–1239. doi: 10.1111/j.1572-0241.2007.01740.x.CrossRefPubMedGoogle Scholar
- Halpert, A., & Drossman, D. (2005). Biopsychosocial issues in irritable bowel syndrome. Journal of Clinical Gastroenterology, 39(8), 665–669. Retrieved from http://journals.lww.com/jcge/pages/default.aspx
- Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analyses: A regression-based approach. New York: The Guilford Press.Google Scholar
- Hunt, M. G., Ertel, E., Coello, J. A., & Rodriguez, L. (2014). Development and validation of the GI-Cognitions Questionnaire. Cognitive Therapy and Research, 38(4), 472–482. http://www.springerlink.com/openurl.asp?genre=article&id=doi:10.1007/s10608-014-9607-y
- Labus, J. S., Bolus, R., Chang, L., Wiklund, I., Naesdal, J., Mayer, E. A., et al. (2004). The visceral sensitivity index: Development and validation of a gastrointestinal symptom-specific anxiety scale. Alimentary Pharmacology & Therapeutics, 20(1), 89–97. doi: 10.1111/j.1365-2036.2004.02007.x.CrossRefGoogle Scholar
- Labus, J. S., Mayer, E. A., Chang, L., Bolus, R., & Naliboff, B. D. (2007). The central role of gastrointestinal-specific anxiety in irritable bowel syndrome: Further validation of the visceral sensitivity index. Psychosomatic Medicine, 69(1), 89–98. doi: 10.1097/PSY.0b013e31802e2f24.CrossRefPubMedGoogle Scholar
- Ljotsson, B., Falk, L., Vesterlund, A. W., Hedman, E., Lindfors, P., Ruck, C., et al. (2010). Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome: A randomized controlled trial. Behavior Research and Therapy, 48(6), 531–539. doi: 10.1016/j.brat.2010.03.003.CrossRefGoogle Scholar
- Ljotsson, B., Hesser, J., Andersson, E., Lackner, J. M., El Alaoui, S., Falk, L., et al. (2014). Provoking symptoms to relieve symptoms: A randomized controlled dismantling study of exposure therapy in irritable bowel syndrome. Behaviour Research and Therapy, 55, 27–39. doi: 10.1016/j.brat.2014.01.007.CrossRefPubMedGoogle Scholar
- Moss-Morris, R., McAlpine, L., Didsbury, L. P., & Spence, M. J. (2010). A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care. Psychological Medicine, 40(1), 85–94. doi: 10.1017/S0033291709990195.CrossRefPubMedGoogle Scholar
- Naliboff, B. D., Derbyshire, W. G., Munakata, J., Berman, S., Mandelkern, M., & Mayer, E. A. (2001). Cerebral activation in patients with irritable bowel syndrome and control subjects during rectosigmoid stimulation. Psychosomatic Medicine, 63(3), 365–375. Retrieved from http://www.psychosomaticmedicine.org/
- Sanders, A. S., Blanchard, E. B., & Sykes, M. A. (2007). Preliminary study of a self-administered treatment for irritable bowel syndrome: Comparison to a wait list control group. Journal of Applied Psychophysiological Biofeedback, 32(2), 111–119. doi: 10.1007/s10484-007-9037-7.CrossRefGoogle Scholar
- van Dulmen, A. M., Fennis, J. F. M., & Bleijenberg, G. (1996). Cognitive-behavioral group therapy for irritable bowel syndrome: Effects and long-term follow-up. Psychosomatic Medicine, 58(5), 508–514. Retrieved from http://www.psychosomaticmedicine.org/
- Whitehead, W. E., Palsson, O. S., Thiwan, S., Talley, N. J., Chey, W. D., Irvine, J., et al. (2006). Development and validation of the Rome III diagnostic questionnaire. In D. A. Drossman, E. Corazziari, R. C. Spiller, & W. G. Thompson (Eds.), Rome III: The functional gastrointestinal disorders (3rd ed., pp. 835–853). McLean, VA: Degnon Associates.Google Scholar
- Wiklund, I. K., Fullerton, S., Hawkey, C. J., Jones, R. H., Longstreth, G. F., Mayer, E. A., et al. (2003). An irritable bowel syndrome-specific symptom questionnaire: Development and validation. Scandinavian Journal of Gastroenterology, 38(9), 947–954. doi: 10.1080/00365520310004209.CrossRefPubMedGoogle Scholar
- Wolitzky-Taylor, K., Craske, M. G., Labus, J. S., Mayer, E. A., & Naliboff, B. D. (2012). Visceral sensitivity as a mediator of outcome in the treatment of irritable bowel syndrome. Behaviour Research and Therapy, 50(10), 647–650. doi: 10.1016/j.brat.2012.05.010.CrossRefPubMedCentralPubMedGoogle Scholar