Psychological counseling delivered over the telephone or through an interactive website is more effective at relieving the symptoms of irritable bowel syndrome (IBS) than standard care with medications, according to a British study published this month in the journal Gut.
These findings are noteworthy, for the study was a large randomized controlled trial, which is considered the gold standard of research.
The findings are also promising for people whose IBS symptoms have been chronic and difficult to control. Most of the people who participated in the study were individuals whose symptoms had not been previously helped with medications.
“A lot of people in our trial had symptoms for 10 or 15 years. They’ve tried everything and nothing is helping them,” said Dr. Hazel Everitt, the study’s lead author and an associate professor of medicine at the University of Southampton, in an interview with The Independent.
A common condition
An estimated 12 percent of American adults have IBS, a gastrointestinal disorder that causes abdominal pain, bloating, diarrhea, constipation and excess gas. The symptoms can have a significant effect on people’s quality of life.
The direct cause of the condition is unknown, although some research has suggested it may have to do with abnormal hormonal, neurological or immune-system responses to stress and infection.
There is no cure for IBS, but treatment can help relieve the symptoms. Standard treatment includes medications, as well as lifestyle advice about diet, exercise and reducing stress. Cognitive behavioral therapy (CBT), which focuses on helping people change their thought and behavioral patterns, has also been found to be effective.
Many people with IBS find it difficult to complete CBT because of the demands such sessions make on their time — and that’s even if they can get access to a CTB-trained therapist. This new study was undertaken to see if receiving the therapy over the phone rather than in-person would also help reduce the symptoms and impact of IBS.
How the study was done
For the study, researchers at the University of Southampton and King’s College London, recruited 558 men and women who had been diagnosed with IBS and whose symptoms had persisted for at least 12 months, despite receiving standard treatment.
Those participants were then randomly assigned to one of three groups. One group continued taking IBS medications, along with follow-up sessions with their general practitioner. They did not, however, receive psychological therapy. Another group received the same care, but also six one-hour telephone sessions with a therapist over a period of nine weeks, as well as two “booster sessions” at four and eight months. The third group received, in addition to standard care, access to web-based therapy, which also included three 30-minute telephone therapy calls during the first five weeks, followed by two 30-minute booster sessions at four and eight months.
The participants filled out detailed questionnaires about their symptoms at the start of the study and then again at three, six and 12 months. They scored their symptoms on a scale of 0 (not affected) to 500 (severely affected). Using another scale, they indicated how much their symptoms disrupted their working and social life, from 0 (not affected) to 40 (severely affected).
The researchers also measured several secondary outcomes, including the participants’ perceptions about their ability to cope with their IBS and its symptoms and their overall mood.
The study found that both the telephone and web-based CBT interventions were more effective at relieving the symptoms of IBS than standard care without therapy.
The telephone program was about 30 percent more effective and the web-based program was about 20 percent more effective than the medications alone.
Specifically, the telephone CBT group scored their symptoms an average of 61.6 points lower at the end of the study — and the web-based CBT group scored them an average of 35.2 points lower at the end of the study than did the group that had received only medications for their IBS.
Improvements in quality-of-life were also greater, on average, among the telephone CBT and web-based CBT groups than among the medications-only group. The same was true for the secondary outcomes related to mood and perceptions of being able to cope with IBS symptoms.
“The fact that both telephone and web-based CBT sessions were shown to be effective treatments is a really important and exciting discovery,” said Everitt in a released statement. “Patients are able to undertake these treatments at a time convenient to them, without having to travel to clinics.”
The study comes with several important caveats. Its participants were all British, and most were white. It’s unclear if the CBT interventions would work for more diverse groups of patients with IBS, including here in the United States.
Also, people who were unwilling to be assigned to CBT for the treatment of their IBS were unlikely to have volunteered for the study. So the patients in the study may have been more receptive to psychological counseling than the average IBS patient — a factor that may have skewed the findings.
We also don’t know from the study what it was about the CBT (changes in diet? reduced stress? better sleep habits?) that enabled so many of the participants to report that their IBS symptoms had improved.
Still, the study was large and rigorous enough to merit attention — and further research.
FMI: You can read the study in full at the website for Gut. You can learn more about cognitive behavioral therapy at the website of the National Association of Cognitive-Behavioral Therapists.