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A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care

Published online by Cambridge University Press:  17 June 2009

R. Moss-Morris ,
L. McAlpine ,
L. P. Didsbury  and
M. J. Spence
R. Moss-Morris*
Affiliation:
School of Psychology, University of Southampton, UK
L. McAlpine
Affiliation:
ProCare Psychological Services, Auckland, New Zealand
L. P. Didsbury
Affiliation:
ProCare Psychological Services, Auckland, New Zealand
M. J. Spence
Affiliation:
Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
*
*Address for correspondence: Professor R. Moss-Morris, School of Psychology, University of Southampton, Highfield, SouthamptonSO17 1BJ, UK. (Email: remm@soton.ac.uk)
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Abstract

Background

Recent guidelines for the treatment of irritable bowel syndrome (IBS) emphasize the need for research to facilitate home-based self-management for these patients in primary care. The aim of the current study was to test the efficacy of a manualized cognitive behavioural therapy (CBT)-based self-management programme for IBS in a pilot randomized controlled trial (RCT).

Method

Sixty-four primary-care patients meeting Rome criteria for IBS were randomized into either self-management plus treatment as usual (TAU) (n=31) or a TAU control condition (n=33). The self-management condition included a structured 7-week manualized programme that was self-administered in conjunction with a 1-hour face-to-face therapy session and two 1-hour telephone sessions. The primary outcome measures were the Subject's Global Assessment (SGA) of Relief and the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) assessed at baseline, end of treatment (2 months), and 3 and 6 months post-treatment.

Results

Analysis was by intention-to-treat. Twenty-three (76.7%) of the self-management group rated themselves as experiencing symptom relief across all three time periods compared to seven (21.2%) of the TAU controls [odds ratio (OR) 12.2, 95% confidence interval (CI) 3.72–40.1]. At 8 months, 25 (83%) of the self-management group showed a clinically significant change on the IBS-SSS compared to 16 (49%) of the control group (OR 5.3, 95% CI 1.64–17.26).

Conclusions

This study provides preliminary evidence that CBT-based self-management in the form of a structured manual and minimal therapist contact is an effective and acceptable form of treatment for primary-care IBS patients.

Keywords

Cognitive behavioural therapy (CBT)irritable bowel syndrome (IBS)primary carerandomized controlled trial (RCT)self-management
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 1 , January 2010 , pp. 85 - 94
Copyright
Copyright © Cambridge University Press 2009

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