Internet-Delivered Exposure-Based Cognitive Behavior Therapy for Irritable Bowel Syndrome: A Clinical Effectiveness Study

Abstract

Objectives: IBS is a common and debilitating disorder. When dietary and pharmacological interventions are not satisfactory, psychological treatment may produce good results. But the access to such treatment is scarce and therefore it is of importance to make use of technical solutions. In the present study we wanted to investigate the real-world effectiveness of an internet-delivered exposure based cognitive behavioral treatment (ECBT) for IBS and to replicate an earlier finding regarding the working mechanism of the treatment. Methods: 309 consecutively recruited patients from the Internet Psychiatry Clinic in Stockholm received ECBT for 12 weeks. The patients’ IBS symptoms, quality of life, avoidance behaviors and gastro-intestinal symptom-specific anxiety (GSA) were monitored and we used a bivariate cross-lagged panel model to investigate time-related change in symptoms and avoidance behaviors. Results: IBS symptoms, measured with The Gastrointestinal Symptom Rating Scale for IBS (GSRS-IBS) were reduced from 48.06 (SD = 11.26) pre-treatment to 33.06 (SD=10.81) 6 month after treatment (p<.001). The effect size was (Cohens d) 1.30 [1.08-1.51]. There was a significant (p<.001) cross-lagged effect from reduction in avoidance behavior to reduction in symptoms but not in the reversed direction, indicating that the treatment effect is mediated by behavioral change. Conclusions: We conclude that ECBT is effective under real world conditions, also when delivered via the internet, and that an important treatment mechanism is the reduction of avoidance behaviors.