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Empirical Support for a Self-help Treatment for IBS

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Abstract

Irritable Bowel Syndrome (IBS) is a chronic, functional gastrointestinal (GI) disorder. Cognitive behavioral therapy (CBT) has been shown to be efficacious for IBS; however, access to qualified CBT therapists is limited. This study was a randomized, controlled trial of a CBT self-help workbook for IBS. Sixty patients with IBS were randomly assigned to active treatment or waitlist control. Participants were evaluated 6 weeks post-randomization at which point waitlist controls crossed over to active treatment. Treatment completers (17 in the immediate treatment group vs 19 in the waitlist control) experienced statistically and clinically significant improvement in quality of life, GI symptom severity, visceral sensitivity and catastrophic cognitions immediately post-treatment. Treatment efficacy was partially mediated by reductions in catastrophic thinking and visceral sensitivity. Limitations of the study included a high attrition rate, as is common in both internet-based and self-help intervention studies. Multiple imputation of missing data for post-treatment was carried out to correct for attrition, and subsequent analyses replicated prior statistically significant improvement on all major outcome measures. This study represents a move towards wider dissemination of and access to empirically-supported treatments for IBS, as well as an effort to test a self-help book in a randomized, controlled trial prior to publication.

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References

  • Afari, N., Ahumada, S. M., Wright, L. J., Mostoufi, S., Golnari, G., Reis, V., et al. (2014). Psychological trauma and functional somatic syndromes: A systematic review and meta-analysis. Psychosomatic Medicine, 76(1), 2–11. doi:10.1097/PSY.0000000000000010.

    Article  PubMed Central  PubMed  Google Scholar 

  • American Gastroenterological Association. (2002). American Gastroenterological Association medical position statement: Irritable Bowel Syndrome. Gastroenterology, 123(6), 2105–2107. doi:10.1053/gast.2002.37095b.

    Article  Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. doi:10.1037/0022-3514.51.6.1173.

    Article  CAS  PubMed  Google Scholar 

  • Bergsma, A. (2008). Do self-help books help? Journal of Happiness Studies, 9(3), 341–360. doi:10.1007/s10902-006-9041-2.

    Article  Google Scholar 

  • Bradley-Bolen, B. (2000). Breaking the bonds of irritable bowel syndrome: A psychological approach to regaining control of your life. Oakland, CA: New Harbinger.

    Google Scholar 

  • Casiday, R. E., Hungin, A. P. S., Cornford, C. S., de Wit, N. J., & Blell, M. T. (2009). GPs’ explanatory models for irritable bowel syndrome: A mismatch with patient models? Family Practice, 26(1), 34–39. doi:10.1093/fampra/cmn088.

    Article  PubMed  Google Scholar 

  • Chapman, S., & Martin, M. (2011). Attention to pain words in irritable bowel syndrome: Increased orienting and speeded engagement. British Journal of Health Psychology, 16(1), 47–60. doi:10.1348/135910710X505887.

    Article  PubMed  Google Scholar 

  • Chilcot, J., & Moss-Morris, R. (2013). Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention. Behaviour Research and Therapy, 51(10), 690–695. doi:10.1016/j.brat.2013.07.007.

    Article  PubMed  Google Scholar 

  • Cho, H. S., Park, J. M., Lim, C. H., Cho, Y. K., Lee, I. S., Kim, S. W., et al. (2011). Anxiety, depression and quality of life in patients with irritable bowel syndrome. Gut and Liver, 5(1), 29–36. doi:10.5009/gnl.2011.5.1.29.

    Article  PubMed Central  PubMed  Google Scholar 

  • Craske, M. G., Wolitzky-Taylor, K. B., Labus, J., Wu, S., Frese, M., Mayer, E. A., et al. (2011). A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behaviour Research and Therapy, 49(6–7), 413–421. doi:10.1016/j.brat.2011.04.001.

    Article  PubMed Central  PubMed  Google Scholar 

  • Dancey, C. P., Hutton-Young, S. A., Moye, S., & Devins, G. M. (2002). Perceived stigma, illness intrusiveness and quality of life in men and women with irritable bowel syndrome. Psychology, Health, & Medicine, 7(4), 381–395. doi:10.1080/1354850021000015203.

    Article  Google Scholar 

  • Den Boer, P. C. A. M., Wiersma, D., & Van Den Bosch, R. J. (2004). Why is self-help neglected in the treatment of emotional disorders? A meta-analysis. Psychological Medicine, 34(6), 959–971. doi:10.1017/S003329170300179.

    Article  Google Scholar 

  • Drossman, D. A. (2006). The functional gastrointestinal disorders and the Rome III process. Gastroenterology, 130(5), 1377–1390. doi:10.1053/j.gastro.2006.03.008.

    Article  PubMed  Google Scholar 

  • Drossman, D. A., Chang, L., Bellamy, N., Gallo-Torres, H. E., Lembo, A., Mearin, F., et al. (2011). Severity in irritable bowel syndrome: A Rome foundation working team report. American Journal of Gastroenterology, 106(10), 1749–1759. doi:10.1038/ajg.2011.201.

    Article  PubMed  Google Scholar 

  • Fond, G., Loundou, A., Hamdani, N., Boukouaci, W., Dargel, A., Oliveira, J., & Boyer, L. (2014). Anxiety and depression comorbidities in irritable bowel syndrome (ibs): A systematic review and meta-analysis. European Archives of Psychiatry and Clinical Neuroscience. doi:10.1007/s00406-014-0502-z

  • Ford, A. C., Bercik, P., Morgan, D. G., Bolino, C., Pintos-Sanchez, M. I., & Moayyedi, P. (2013). Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gastroenterology, 145(6), 1262–1270.

    Article  PubMed  Google Scholar 

  • Ford, A. C., Brandt, L. J., Young, C., Chey, W. D., Foxx-Orenstein, A. E., & Moayyedi, P. (2009). Efficacy of 5-HT3 antagonists and 5-HT4 agonists in irritable bowel syndrome: Systematic review and meta-analysis. The American Journal of Gastroenterology, 104(7), 1831–1843. doi:10.1038/ajg.2009.223.

    Article  CAS  PubMed  Google Scholar 

  • Ford, A. C., Forman, D., Bailey, A. G., & Moayyedi, P. (2008). Irritable bowel syndrome: A 10 year natural history of symptoms, and factors that influence consultation behavior. American Journal of Gastroenterology, 103(5), 1229–1239. doi:10.1111/j.1572-0241.2007.01740.x.

    Article  PubMed  Google Scholar 

  • Gros, D. F., Antony, M. M., McCabe, R. E., & Swinson, R. P. (2009). Frequency and severity of the symptoms of irritable bowel syndrome across the anxiety disorders and depression. Journal of Anxiety Disorders, 23(2), 290–296. doi:10.1016/j.janxdis.2008.08.004.

    Article  PubMed  Google Scholar 

  • Halpert, A., & Drossman, D. (2005). Biopsychosocial issues in irritable bowel syndrome. Journal of Clinical Gastroenterology, 39(8), 665–669. Retrieved from http://journals.lww.com/jcge/pages/default.aspx

  • Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76(4), 408–420. doi:10.1080/03637750903310360.

    Article  Google Scholar 

  • Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analyses: A regression-based approach. New York: The Guilford Press.

    Google Scholar 

  • Hayes, A. F., & Scharkow, M. (2013). The relative trustworthiness of tests of indirect effects in statistical mediation analysis: Does method really matter? Psychological Science, 24(10), 1918–1927. doi:10.1177/0956797613480187.

    Article  PubMed  Google Scholar 

  • Hunt, M. G., Ertel, E., Coello, J. A., & Rodriguez, L. (2014). Development and validation of the GI-Cognitions Questionnaire. Cognitive Therapy and Research, 38(4), 472–482. http://www.springerlink.com/openurl.asp?genre=article&id=doi:10.1007/s10608-014-9607-y

  • Hunt, M. G., Milonova, M., & Moshier, S. (2009a). Catastrophizing the consequences of gastrointestinal symptoms in irritable bowel syndrome. Journal of Cognitive Psychotherapy, 23(2), 160–173. doi:10.1891/0889-8391.23.2.160.

    Article  Google Scholar 

  • Hunt, M. G., Moshier, S., & Milonova, M. (2009b). Brief cognitive-behavioral internet therapy for irritable bowel syndrome. Behaviour Research and Therapy, 47, 797–802. doi:10.1016/j.brat.2009.05.002.

    Article  PubMed  Google Scholar 

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. doi:10.1037/0022-006X.59.1.12.

    Article  CAS  PubMed  Google Scholar 

  • Jones, M., Koloski, N., Boyce, P., & Talley, N. J. (2011). Pathways connecting cognitive behavioral therapy and change in bowel symptoms of IBS. Journal of Psychosomatic Research, 70(3), 278–285. doi:10.1016/j.jpsychores.2010.10.004.

    Article  PubMed  Google Scholar 

  • Kaptchuk, T. J., Friedlander, E., Kelley, J. M., Sanchez, M. N., Kokkotou, E., Singer, J. P., et al. (2010). Placebos without deception: A randomized controlled trial in irritable bowel syndrome. PLoS One, 5(12), e15591. doi:10.10.1371/journal.pone.0015591.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Labus, J. S., Bolus, R., Chang, L., Wiklund, I., Naesdal, J., Mayer, E. A., et al. (2004). The visceral sensitivity index: Development and validation of a gastrointestinal symptom-specific anxiety scale. Alimentary Pharmacology & Therapeutics, 20(1), 89–97. doi:10.1111/j.1365-2036.2004.02007.x.

    Article  CAS  Google Scholar 

  • Labus, J. S., Mayer, E. A., Chang, L., Bolus, R., & Naliboff, B. D. (2007). The central role of gastrointestinal-specific anxiety in irritable bowel syndrome: Further validation of the visceral sensitivity index. Psychosomatic Medicine, 69(1), 89–98. doi:10.1097/PSY.0b013e31802e2f24.

    Article  PubMed  Google Scholar 

  • Lackner, J. M., & Quigley, B. M. (2005). Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome. Behavior Research and Therapy, 43(7), 943–957. doi:10.1016/j.brat.2004.06.018.

    Article  Google Scholar 

  • Lackner, J. M., Quigley, B. M., & Blanchard, E. B. (2004). Depression and abdominal pain in IBS patients: The mediating role of catastrophizing. Psychosomatic Medicine, 66(3), 435–441. doi:10.1097/01.psy.0000126195.82317.46.

    PubMed  Google Scholar 

  • Ljotsson, B., Falk, L., Vesterlund, A. W., Hedman, E., Lindfors, P., Ruck, C., et al. (2010). Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome: A randomized controlled trial. Behavior Research and Therapy, 48(6), 531–539. doi:10.1016/j.brat.2010.03.003.

    Article  Google Scholar 

  • Ljotsson, B., Hesser, J., Andersson, E., Lackner, J. M., El Alaoui, S., Falk, L., et al. (2014). Provoking symptoms to relieve symptoms: A randomized controlled dismantling study of exposure therapy in irritable bowel syndrome. Behaviour Research and Therapy, 55, 27–39. doi:10.1016/j.brat.2014.01.007.

    Article  PubMed  Google Scholar 

  • Longstreth, G. F., Thompson, W. G., Chey, W. D., Houghton, L. A., Mearin, F., & Spiller, R. C. (2006). Functional bowel disorders. Gastroenterology, 130(5), 1480–1491. doi:10.1053/j.gastro.2005.11.061.

    Article  PubMed  Google Scholar 

  • Luscombe, F. A. (2000). Health-related quality of life and associated psychosocial factors in irritable bowel syndrome: A review. Quality of Life Research, 9(2), 161–176. doi:10.1023/A:1008970312068.

    Article  CAS  PubMed  Google Scholar 

  • Mains, J. A., & Scogin, F. R. (2003). The effectiveness of self-administered treatments: A practice friendly review of the research. Journal of Clinical Psychology, 59(2), 237–246. doi:10.1002/jclp.10145.

    Article  PubMed  Google Scholar 

  • Mathieu, E., McGeechan, K., Barratt, A., & Herbert, R. (2013). Internet-based randomized controlled trials: A systematic review. Journal of the American Medical Informatics Association, 20(3), 568–576. doi:10.1136/amiajnl-2012-001175.

    Article  PubMed Central  PubMed  Google Scholar 

  • Moss-Morris, R., McAlpine, L., Didsbury, L. P., & Spence, M. J. (2010). A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care. Psychological Medicine, 40(1), 85–94. doi:10.1017/S0033291709990195.

    Article  CAS  PubMed  Google Scholar 

  • Naliboff, B. D., Derbyshire, W. G., Munakata, J., Berman, S., Mandelkern, M., & Mayer, E. A. (2001). Cerebral activation in patients with irritable bowel syndrome and control subjects during rectosigmoid stimulation. Psychosomatic Medicine, 63(3), 365–375. Retrieved from http://www.psychosomaticmedicine.org/

  • Norcross, J. C. (2006). Integrating self-help into psychotherapy: 16 practical suggestions. Professional Psychology: Research and Practice, 37(6), 683–693. doi:10.1037/0735-7028.37.6.683.

    Article  Google Scholar 

  • Patrick, D. L., Drossman, D. A., Frederick, I. O., DiCesare, J., & Puder, K. L. (1998). Quality of life in persons with irritable bowel syndrome: Development and validation of a new measure. Digestive Diseases and Sciences, 43(2), 400–411. doi:10.1023/A:1018831127942.

    Article  CAS  PubMed  Google Scholar 

  • Posserud, I., Svedlund, J., Wallin, J., & Simrén, M. (2009). Hypervigilance in irritable bowel syndrome compared with organic gastrointestinal disease. Journal of Psychosomatic Research, 66(5), 399–405. doi:10.1016/j.jpsychores.2008.09.020.

    Article  PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, and Computers, 36(4), 717–731. doi:10.3758/BF03206553.

    Article  PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing the indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. doi:10.3758/BRM.40.3.879.

    Article  PubMed  Google Scholar 

  • Reme, S. E., Darnley, S., Kennedy, T., & Chalder, T. (2010). The development of the irritable bowel syndrome-behavioral responses questionnaire. Journal of Psychosomatic Research, 69(3), 319–325. doi:10.1016/j.jpsychores.2010.01.025.

    Article  PubMed  Google Scholar 

  • Sainsbury, A., & Ford, A. C. (2011). Treatment of irritable bowel syndrome: Beyond fiber and antispasmodic agents. Therapeutic Advances in Gastroenterology, 4(2), 115–127. doi:10.1177/1756283X10387203.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Sanders, A. S., Blanchard, E. B., & Sykes, M. A. (2007). Preliminary study of a self-administered treatment for irritable bowel syndrome: Comparison to a wait list control group. Journal of Applied Psychophysiological Biofeedback, 32(2), 111–119. doi:10.1007/s10484-007-9037-7.

    Article  Google Scholar 

  • Spratt, M., Carpenter, J., Sterne, J. A. C., Carlin, J. B., Heron, J., Henderson, J., et al. (2010). Strategies for multiple imputation in longitudinal studies. American Journal of Epidemiology, 172(4), 478–487. doi:10.1093/aje/kwq137.

    Article  PubMed  Google Scholar 

  • van Dulmen, A. M., Fennis, J. F. M., & Bleijenberg, G. (1996). Cognitive-behavioral group therapy for irritable bowel syndrome: Effects and long-term follow-up. Psychosomatic Medicine, 58(5), 508–514. Retrieved from http://www.psychosomaticmedicine.org/

  • Whitehead, W. E., Palsson, O. S., Thiwan, S., Talley, N. J., Chey, W. D., Irvine, J., et al. (2006). Development and validation of the Rome III diagnostic questionnaire. In D. A. Drossman, E. Corazziari, R. C. Spiller, & W. G. Thompson (Eds.), Rome III: The functional gastrointestinal disorders (3rd ed., pp. 835–853). McLean, VA: Degnon Associates.

    Google Scholar 

  • Wiklund, I. K., Fullerton, S., Hawkey, C. J., Jones, R. H., Longstreth, G. F., Mayer, E. A., et al. (2003). An irritable bowel syndrome-specific symptom questionnaire: Development and validation. Scandinavian Journal of Gastroenterology, 38(9), 947–954. doi:10.1080/00365520310004209.

    Article  CAS  PubMed  Google Scholar 

  • Wolitzky-Taylor, K., Craske, M. G., Labus, J. S., Mayer, E. A., & Naliboff, B. D. (2012). Visceral sensitivity as a mediator of outcome in the treatment of irritable bowel syndrome. Behaviour Research and Therapy, 50(10), 647–650. doi:10.1016/j.brat.2012.05.010.

    Article  PubMed Central  PubMed  Google Scholar 

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Conflict of Interest

Melissa G. Hunt, Elisabeth Ertel, Jordan A. Coello and Lauren Rodriguez declare that they have no conflict of interest.

Informed Consent

All procedures followed were in accordance with the ethical standards of the Institutional Review Board of the University of Pennsylvania and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

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No animal studies were carried out by the authors for this article.

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Hunt, M.G., Ertel, E., Coello, J.A. et al. Empirical Support for a Self-help Treatment for IBS. Cogn Ther Res 39, 215–227 (2015). https://doi.org/10.1007/s10608-014-9647-3

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