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Remote CBT works better than treatment as usual in refractory IBS

11 Jul 2019

Cognitive behavioural therapy (CBT), delivered over the web or phone, yields superior improvements in irritable bowel syndrome (IBS) symptoms and more favourable effects on life and mood in comparison with treatment as usual (TAU), according to data from the ACTIB* trial.

Researchers conducted a three-arm randomized controlled trial, including 558 IBS patients (mean age, 43.1 years; 75.8 percent female) who were assigned to receive telephone-delivered CBT (TCBT; n=186), web-based CBT (WCBT) with minimal therapist support (n=185) or TAU (n=187). All patients had refractory IBS (clinically significant symptoms for ≥12 months despite first-line therapies).

Of the patients, 70.1 percent completed 12 months of follow-up. The primary outcomes of interest were IBS Symptom Severity Score (IBS-SSS) and Work and Social Adjustment Scale (WSAS) at 12 months.

Compared with TAU, both TCBT and WCBT significantly reduced IBS-SSS (mean differences, 61.6 and 35.2 points; p<0.001 and p=0.002, respectively). More patients in both CBT arms achieved a clinically significant change in IBS-SSS (50 points) from baseline to 12 months (72.8 percent in TCBT; 66.1 percent in WCBT; 44.3 percent in TAU).

Similar results were observed with respect to the effect of IBS symptoms on the ability to work and manage at home, participate in social and private leisure activities, and maintain relationships. Specifically, WSAS score was lower by 3.5 points (p<0.001) in the TCBT arm and by 3.0 points in the WCBT arm than in the TAU arm at 12 months (p<0.001 and p=0.001, respectively).

Furthermore, both CBT interventions produced significantly greater improvements on all secondary outcomes (IBS-SSS and WSAS at 3 and 6 months after randomization; mood, symptom relief and ability to cope with symptoms at 3, 6 and 12 months) compared with TAU.

No serious adverse reactions to treatment were seen.

The findings of the current trial reinforce NICE guidance, which currently relies on a limited evidence base of mostly face-to-face CBT, the researchers pointed out. Patients with refractory IBS can benefit from CBT for IBS and that telephone-delivered or web-delivered CBT can provide sustained improvements.

*Assessing Cognitive–behavioural Therapy in Irritable Bowel syndrome

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