Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial

Abstract

Objective To assess the efficacy of cognitive behaviour therapy delivered in primary care for treating irritable bowel syndrome. Design Randomised controlled trial. Setting 10 general practices in London. Participants 149 patients with moderate or severe irritable bowel syndrome resistant to the antispasmodic mebeverine. Interventions Cognitive behaviour therapy delivered by trained primary care nurses plus 270 mg mebeverine taken thrice daily compared with mebeverine treatment alone. Main outcome measures Primary measures were patients' scores on the irritable bowel syndrome symptom severity scale. Secondary measures were scores on the work and social adjustment scale and the hospital anxiety and depression scale. Results Of 334 referred patients, 72 were randomised to mebeverine plus cognitive behaviour therapy and 77 to mebeverine alone. Cognitive behaviour therapy had considerable initial benefit on symptom severity compared with mebeverine alone, with a mean reduction in score of 68 points (95% confidence interval 103 to 33), with the benefit persisting at three months and six months after therapy (mean reductions 71 points (109 to 32) and 11 points (20 to 3)) but not later. Cognitive behaviour therapy also showed significant benefit on the work and social adjustment scale that was still present 12 months after therapy (mean reduction 2.8 points (5.2 to 0.4)), but had an inconsistent effect on the hospital anxiety and depression scale. Conclusion Cognitive behaviour therapy delivered by primary care nurses offered additional benefit over mebeverine alone up to six months, although the effect had waned by 12 months. Such therapy may be useful for certain patients with irritable bowel syndrome in primary care.

Significant psychological morbidity occurs in irritable bowel syndrome: a case‐control study using a pharmacy reimbursement database

“…8,9 Cognitive behavioural therapy has also been employed in the treatment of IBS, with mixed results. 10,11 Psychological distress severely impairs response to IBS treatment. 12 A number of studies have examined the prevalence of depression and anxiety in IBS.…”

The current treatment landscape of irritable bowel syndrome in adults in Hong Kong: consensus statements

“…Psychological interventions such as counselling, cognitive behavioural therapy, and hypnotherapy are effective treatments for patients with mental morbidities and IBS. 17,18 Physicians should routinely counsel patients on the importance of mental health in the management of IBS.…”

“…A study of 149 patients with moderate or severe IBS resistant to the antispasmodic agent mebeverine found that the addition of cognitive behavioural therapy, delivered by primary care nurses, had a considerable initial benefit on symptom severity compared with mebeverine alone, with the benefit persisting after 3 and 5 months. 17 Cognitive behavioural therapy also showed a significant benefit on the work and social adjustment scale that persisted 12 months after therapy (mean reduction of 2.8 points). 17 19 Involvement of dieticians may improve accuracy and adherence to the low-FODMAP diet or other specific diets.…”

“…17 Cognitive behavioural therapy also showed a significant benefit on the work and social adjustment scale that persisted 12 months after therapy (mean reduction of 2.8 points). 17 19 Involvement of dieticians may improve accuracy and adherence to the low-FODMAP diet or other specific diets. 20 In a randomised, controlled, single-blind, crossover trial, a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet for 21 days led to a significant improvement in symptoms of IBS (including abdominal pain, bloating, passage of gas and dissatisfaction with stool consistency) and quality of life compared with a standard Australian diet.…”

How Should Functional Somatic Syndromes Be Diagnosed?

“…However, the field of behavioural medicine should take some pride in the fact that there are now effective treatments available for these debilitating conditions [32][33][34]. The current discussions around classifications and how to diagnose FSS are complex but important and have the potential to reduce the stigma, dualistic views and treatment delays.…”