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World Congress of Gastroenterology 2017
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At-Home Cognitive Therapy Relieves IBS Symptoms
January 15, 2018
ORLANDO — A self-administered protocol for cognitive behavioral therapy that requires minimal clinician contact can be just as effective at relieving the symptoms of irritable bowel syndrome (IBS) as traditional therapy delivered in a clinical setting, new research shows.
With this protocol, "for the most part, symptom improvement is sustained out to 3 months and 6 months," said investigator Jeffrey Lackner, PsyD, from the University of Buffalo School of Medicine in New York.
These findings — which received an American College of Gastroenterology Governors Award for Excellence in Clinical Research — suggest that home-based treatments could be used to relieve chronic constipation, diarrhea, bloating, gas, and other IBS symptoms in more patients without increasing clinician time or the use of healthcare resources.
In April 2017, the National Institute for Health and Care Excellence (NICE) in the United Kingdom updated its guidelines on the diagnosis and treatment of IBS in adults. Patients who continue to experience IBS symptoms despite at least 12 months of pharmacologic treatment should be referred for cognitive behavioral therapy, hypnotherapy, or psychological therapy, the guidelines state.
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"The problem is that only a small fraction of people receive cognitive therapy in accordance with practice guidelines," said Dr Lackner. Therefore, "there is a demand for treatments that maintain efficacy but are more efficient to implement."
"One strategy is to decrease therapist contact time using home-based treatments," he said here at the World Congress of Gastroenterology.
For their study, Dr Lackner and his colleagues randomized 438 adults with moderate to severe IBS, diagnosed using Rome III criteria, to four 1-hour sessions of self-administered therapy, 10 sessions of standard psychiatrist- or psychologist-led therapy, or four sessions of education only. They assessed symptom relief at 12 weeks, 3 months, and 6 months.
A Durable Response
Significantly more patients in the self-administered therapy group than in the education-only group responded to the intervention — defined as moderate or substantial improvement — at 12 weeks (67.8% vs. 46.2%; P < .05) and at 3 months (63.8% vs. 49.2%; P < .05). At 6 months, the difference did not meet the threshold for significance (63.2% vs 50.5%; P < .07).
Patients' self-reported improvements closely mirrored the global assessments of gastroenterologists blinded to group assignment. At 12 weeks, the clinicians identified as responders 63% of the patients in the self-administered therapy group and 43% of the education-only group. They also identified 60% of patients in the standard therapy group as responders.
"Cognitive behavior therapy appears to have an enduring effect that protects against relapse and recurrence in a sizable sample," Dr Lackner reported.