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Self-administered cognitive behavior therapy improves IBS symptoms

Jeffrey Lackner, PsyD
Jeffrey Lackner

ORLANDO — Self-administered cognitive behavior therapy was significantly more effective than an education intervention, and comparable to more resource-intensive clinic-based cognitive behavior therapy for improving symptoms of irritable bowel syndrome, according to the results of a randomized controlled trial presented at the World Congress of Gastroenterology at ACG 2017.

Cognitive behavior therapy (CBT) “is a drug-free treatment that targets maintaining factors in IBS, particularly faulty ways of processing information which aggravate GI symptoms by dysregulating brain-gut interactions. The goal of CBT is to teach patients practical skills to reverse that cycle,” Jeffrey Lackner, PsyD, of the Jacobs School of Medicine at the University of Buffalo, told Healio Gastroenterology and Liver Disease. “The problem is that only a fraction of people receive CBT, and so there’s a demand for treatments that retain the efficacy profile of ‘gold standard’ therapies but are easier to adopt in routine clinical settings. One strategy is to decrease therapist contact time using primarily home-based treatments.”

To evaluate the efficacy of home-based CBT among patients with more severe IBS, Lackner and colleagues randomly assigned 436 adults with moderate-to-severe IBS (86% women; mean age, 41 years) from two academic centers, to receive standard cognitive behavior therapy (CBT; 10 sessions administered by a therapist), minimal contact CBT (four self-administered sessions), or IBS education (four sessions focused designed to exclude CBT techniques) over 10 weeks. moderate to substantial improvement of IBS symptoms served as the primary endpoint.

In the intent-to-treat analysis, significantly more patients reported global improvement of IBS symptoms with minimal contact CBT vs. IBS education at 2 weeks after the treatment period ended (61% vs. 43%; P < .01), as did patients who received standard CBT (55%; P < .05 vs. IBS education). Gastroenterologists masked to the assigned treatments rated IBS symptom improvements similarly to those reported by patients.

“For the most part symptom improvement is sustained from 3 months and 6 months in the minimal contact group,” Lackner said. “We do see some erosion at 6 months for the clinic based CBT condition.”

Both CBT groups also showed significant improvements over the IBS education group at 3 months, with 57% in the self-administered CBT group (P < .01) and 53% in the standard CBT group (P < .05) vs. 46% in the IBS education group. At 6 months, the proportions were 57%, 48% and 47%, respectively, and the gastroenterologist ratings showed significant improvements with minimal contact CBT vs. IBS education at 6 months (58.4% vs. 40.4%).

 

“Formal equivalence testing applied across multiple contrasts suggested that the minimal contact CBT is at least as efficacious as more time- and labor-intensive CBT delivered in clinical settings,” Lackner noted.

He added that among patients who had improved symptoms 2 weeks after the treatment phase, 35% of those treated with CBT vs. 23% with education met clinical remission criteria based on the CGI severity scale, with no symptoms or mild symptoms. Additionally, 63% of these patients treated with CBT vs. 52% with education maintained gains at 6 months, “suggesting that CBT appears to have an enduring effect that protects against subsequent relapse and recurrence … and raises question about whether there’s some disease modifying quality to CBT,” he said.

Lackner and colleagues also found symptom improvement was unrelated to concomitant use of IBS drugs.

He concluded that “the findings are unlikely due to placebo response which typically dissipates over time and is accompanied by dramatic return of symptoms after treatment withdrawal. This did not characterize CBT.” – by Adam Leitenberger

Reference:

Lackner J, et al. Abstract 49. Presented at: World Congress of Gastroenterology at American College of Gastroenterology Annual Scientific Meeting; Oct. 13-18, 2017; Orlando, FL.

Disclosures: The researchers report no relevant financial disclosures.

Editor's note: This article was updated on October 30 with clarifications from the study author.

Jeffrey Lackner, PsyD
Jeffrey Lackner

ORLANDO — Self-administered cognitive behavior therapy was significantly more effective than an education intervention, and comparable to more resource-intensive clinic-based cognitive behavior therapy for improving symptoms of irritable bowel syndrome, according to the results of a randomized controlled trial presented at the World Congress of Gastroenterology at ACG 2017.

Cognitive behavior therapy (CBT) “is a drug-free treatment that targets maintaining factors in IBS, particularly faulty ways of processing information which aggravate GI symptoms by dysregulating brain-gut interactions. The goal of CBT is to teach patients practical skills to reverse that cycle,” Jeffrey Lackner, PsyD, of the Jacobs School of Medicine at the University of Buffalo, told Healio Gastroenterology and Liver Disease. “The problem is that only a fraction of people receive CBT, and so there’s a demand for treatments that retain the efficacy profile of ‘gold standard’ therapies but are easier to adopt in routine clinical settings. One strategy is to decrease therapist contact time using primarily home-based treatments.”

To evaluate the efficacy of home-based CBT among patients with more severe IBS, Lackner and colleagues randomly assigned 436 adults with moderate-to-severe IBS (86% women; mean age, 41 years) from two academic centers, to receive standard cognitive behavior therapy (CBT; 10 sessions administered by a therapist), minimal contact CBT (four self-administered sessions), or IBS education (four sessions focused designed to exclude CBT techniques) over 10 weeks. moderate to substantial improvement of IBS symptoms served as the primary endpoint.

In the intent-to-treat analysis, significantly more patients reported global improvement of IBS symptoms with minimal contact CBT vs. IBS education at 2 weeks after the treatment period ended (61% vs. 43%; P < .01), as did patients who received standard CBT (55%; P < .05 vs. IBS education). Gastroenterologists masked to the assigned treatments rated IBS symptom improvements similarly to those reported by patients.

“For the most part symptom improvement is sustained from 3 months and 6 months in the minimal contact group,” Lackner said. “We do see some erosion at 6 months for the clinic based CBT condition.”

Both CBT groups also showed significant improvements over the IBS education group at 3 months, with 57% in the self-administered CBT group (P < .01) and 53% in the standard CBT group (P < .05) vs. 46% in the IBS education group. At 6 months, the proportions were 57%, 48% and 47%, respectively, and the gastroenterologist ratings showed significant improvements with minimal contact CBT vs. IBS education at 6 months (58.4% vs. 40.4%).

 

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“Formal equivalence testing applied across multiple contrasts suggested that the minimal contact CBT is at least as efficacious as more time- and labor-intensive CBT delivered in clinical settings,” Lackner noted.

He added that among patients who had improved symptoms 2 weeks after the treatment phase, 35% of those treated with CBT vs. 23% with education met clinical remission criteria based on the CGI severity scale, with no symptoms or mild symptoms. Additionally, 63% of these patients treated with CBT vs. 52% with education maintained gains at 6 months, “suggesting that CBT appears to have an enduring effect that protects against subsequent relapse and recurrence … and raises question about whether there’s some disease modifying quality to CBT,” he said.

Lackner and colleagues also found symptom improvement was unrelated to concomitant use of IBS drugs.

He concluded that “the findings are unlikely due to placebo response which typically dissipates over time and is accompanied by dramatic return of symptoms after treatment withdrawal. This did not characterize CBT.” – by Adam Leitenberger

Reference:

Lackner J, et al. Abstract 49. Presented at: World Congress of Gastroenterology at American College of Gastroenterology Annual Scientific Meeting; Oct. 13-18, 2017; Orlando, FL.

Disclosures: The researchers report no relevant financial disclosures.

Editor's note: This article was updated on October 30 with clarifications from the study author.

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