Home-based cognitive behavioral therapy improved IBS symptoms

Patients with irritable bowel syndrome (IBS) who received four sessions of primarily home-based cognitive behavioral therapy had similar symptom improvement to those who went to 10 standard therapy sessions.

A home-based cognitive behavioral therapy (CBT) program significantly improved symptoms among patients with irritable bowel syndrome (IBS), a recent study found.

The prospective study included 436 patients with IBS based on Rome III criteria who were treated at tertiary centers between August 23, 2010, and October 21, 2016. Their mean age was 41.4 years, 80.3% were female, and 89.4% were white. They were randomly assigned to one of three treatments: 10 weekly sessions of standard CBT covering brain-gut interactions, self-monitoring of symptoms, muscle relaxation, worry control, flexible problem-solving, and relapse prevention training (n=146); four sessions of primarily home-based CBT with minimal therapist contact and provision of home-study materials covering the same procedures as standard CBT (n=145); or four sessions of education that provided support and information about IBS and the role of lifestyle factors such as stress, diet, and exercise (n=145).

The study was published online by Gastroenterology on April 24.

Two weeks after the intervention was completed, a higher percentage of patients in the home-based group than the education group reported moderate to substantial improvement in their gastrointestinal symptoms, as measured by the IBS version of the Clinical Global Impressions (CGI)-Improvement Scale (61.0% in the home CBT group, 54.5% in the standard CBT group, 43.5% in the education group). The same was true when the patients' gastroenterologists rated them on the CGI (55.7%, 50.6%, and 40.4%, respectively). This difference in symptom improvement continued six months after the end of treatment (58.4%, 51.6%, and 44.8%, respectively; P=0.05 for difference between home CBT and education). Patients were also more satisfied with the home-based CBT than the education program (P<0.05).

“A 10-session, clinic-based version of CBT does not appear to confer incremental advantage over a 4-session, home-based version, even though the latter required 60% less clinician delivery time. Symptomatic improvement was achieved without risk of safety to patients which is notable given reported adverse effects of most medical therapies for IBS,” the study authors said. They noted that the observed rates of symptom improvement with home-based CBT compare favorably with those of FDA-approved pharmacological agents for IBS.

New systems are needed to deliver the benefits of CBT to a broader number of patients than can be reached by specially trained professionals, and the current study “is a step in this direction,” the authors said. However, they cautioned that the generalizability of the results is limited because the volunteer study population mostly involved white women.