Two-year results show continued benefit of phone or web CBT for refractory IBS

Patients with irritable bowel syndrome (IBS) who had been randomized to receive remote cognitive behavioral therapy (CBT) had lower symptom severity scores than those who had received usual care, according to follow-up data from a British trial.


Patients who received cognitive behavioral therapy (CBT) for refractory irritable bowel syndrome (IBS) had reductions in symptoms at two years, a recent analysis found.

Researchers conducted a naturalistic follow-up of the Assessing Cognitive behavioural Therapy for IBS (ACTIB) trial, which randomized 558 English adults with refractory IBS to receive therapist-delivered telephone CBT, web-based CBT with minimal therapist support, or treatment as usual. The 12-month results were previously published in Gut and summarized in the April ACP Gastroenterology Monthly. These follow-up results were published by The Lancet Gastroenterology & Hepatology on Sept. 3.

At 24 months, data were available on 58% of the participants: 119 (64%) of 186 in the telephone-CBT group, 99 (54%) of 185 in the web-CBT group, and 105 (56%) of 187 in the usual care group. At that point, compared to the usual care patients, the mean IBS-Symptom Severity Score (IBS-SSS) was 40.5 points lower (95% CI, 15.0 to 66.0 points) in the telephone-CBT group (P=0.002) and 12.9 points lower (95% CI, –12.9 to 38.8 points) in the web-CBT group (P=0.33).

Both groups also had reduced mean scores on the other primary outcome, the Work and Social Adjustment Scale: 3.1 points lower (95% CI, 1.3 to 4.9 points) in the telephone-CBT group (P<0.001) and 1.9 points lower (95% CI, 0.1 to 3.7 points) in the web-CBT group (P=0.036) compared to usual care. A clinically significant change in IBS-SSS (≥50 points) from baseline to 24 months was found in 71% of the telephone-CBT group, 63% of the web-CBT group, and 46% of the usual care group.

Both versions of CBT were associated with sustained improvements at 24 months, although reduced in magnitude from those at 12 months, the study authors noted. In addition, both groups showed reductions in anxiety and depression and improvements in ability to cope with their illness at two years. A per protocol analysis indicated that adherence to the CBT interventions was associated with sustained improvements at 24 months, so some differences in outcomes may be explained by lower adherence in the web-CBT group than the telephone-CBT group, the authors said.

Limitations of the study include that people with IBS who are unwilling to consider CBT are unlikely to have participated and that missing data at 24 months may have affected the results. The authors are planning a future publication on the cost-effectiveness of the interventions, but in the meantime, the results show that both telephone and web-based CBT can provide long-term benefits for refractory IBS, they said.

In the September ACP Internist, conference coverage also focused on CBT as one of the two most evidence-based psychotherapies for IBS and other functional GI symptoms. Find out what the other effective therapy is here. While you're there, check out another story from Digestive Disease Week 2019, which helps explain the recent increase of eosinophilic esophagitis.