Cognitive Behavioural Therapy in Irritable Bowel Syndrome

Abstract

Irritable bowel syndrome (IBS) is a chronic condition marked by abdominal pain associated with bowel dysfunction that affects about 15% of adults (Snyder, 2019). Safe interventions for irritable bowel syndrome (IBS) that improve symptoms and social and economic burden are urgently required, as stated by the above author. Cognitive Behaviour Therapy (CBT) isa form of psychotherapy to teach patients to modify their mental and behavioural skills (Rackner, 2016). The aim of this review is to study whether cognitive behavioural therapy (CBT) improves irritable bowel syndrome (IBS) patients’ bowel symptoms, quality of life (QOL) and assess its cost-effectiveness. To compile the data for this analysis, Pubmed journal articles were used with search terms “Cognitive Behaviour Therapy”, “Irritable Bowel Syndrome”, “symptoms”, “QOL”, “Cost-effectiveness”. All the studies selected were RCTs, which were relevant to the aim. An RCT conducted by Lackner et al., (2018) on 436 IBS patients in which one group received Cognitive behavioural therapy(CBT) and another group-IBS education, found that, based on immediate post treatment responses to the Client Satisfaction Questionnaire, patients appeared to be more content with CBT (P<0.05). In another RCT with 588 participants of CBT therapy and treatment as usual(TAU) found that, when compared to TAU, CBT group showed sustained improvements in IBS at 24-month follow-up (Everitt et al., 2019). In another multicentre RCT comparing CBT to TAU, the results of symptom improvement in the CBT group were significant (p><0.002) than in the TAU group. There were no significant side effects as a result of the procedure (Everitt et al., 2019). Based on data from an RCT on adolescent participants, Sampaio et al., (2019) determined whether exposure-based internet-delivered cognitive-behavioural therapy(internet-CBT) is a cost-effective> treatment for adolescents with IBS compared to a waitlist control group and found that offering internet-based CBT to adolescents with IBS increases health-related quality of life and results in modest quality-adjusted life-year(QALY) benefit than a waitlist control and Internet-CBT is likely to be cost-effective.In one of the RCTs contrasting therapist telephone-delivered CBT(TCBT) and web-based CBT (WCBT) with limited therapist assistance to treatment as compared to treatment as usual (TAU),revealed an improved capacity to cope with symptoms, negative feelings, and everyday difficulties (Everitt et al., 2019). Based on the articles reviewed, it can be concluded that IBS-related CBT has the ability to offer longterm relief from IBS. A specifically home-based version of CBT was found to produce significant and sustained gastrointestinal symptom improvement in patients with IBS. TCBT and WCBT interventions can both be preferred, but WCBT was less expensive.At a reasonable cost, sustained changes in IBS symptoms are possible. CBT delivered through the internet has been shown to boost health-related quality of life and quality-adjusted life-years; however, more research with larger sample is needed to confirm this aspect.