Durability and Decay of Treatment Benefit of Cognitive Behavioral Therapy for Irritable Bowel Syndrome: 12-Month Follow-Up

There is a need for safe and effective IBS treatments that provide immediate and sustained improvement of IBS symptoms, particularly among more severe patients. The aim was to assess long-term clinical response of cognitive behavioral therapy (CBT) with reference to IBS education. A total of 436 Rom...

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Vydáno v:The American journal of gastroenterology Ročník 114; číslo 2; s. 330 - 338
Hlavní autoři: Lackner, Jeffrey M., Jaccard, James, Radziwon, Christopher D., Firth, Rebecca S., Gudleski, Gregory D., Hamilton, Frank, Katz, Leonard A., Keefer, Laurie, Krasner, Susan S., Ma, Chang-Xing, Sitrin, Michael D., Brenner, Darren M.
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.02.2019
Témata:
Abdomen
Adult
Clinical trials
Cognition & reasoning
Cognitive behavioral therapy
Cognitive Behavioral Therapy - methods
Design
Education
Exercise
Female
Follow-Up Studies
Humans
Irritable bowel syndrome
Irritable Bowel Syndrome - therapy
Male
Middle Aged
Pain
Patients
Psychotherapy
Treatment Outcome
ISSN:0002-9270, 1572-0241, 1572-0241
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Shrnutí:There is a need for safe and effective IBS treatments that provide immediate and sustained improvement of IBS symptoms, particularly among more severe patients. The aim was to assess long-term clinical response of cognitive behavioral therapy (CBT) with reference to IBS education. A total of 436 Rome III-diagnosed IBS patients (80% F, M age = 41 years) were randomized to: 4 session home-based CBT (minimal contact (MC-CBT)), 10 session clinic-based CBT (standard (S-CBT)), or 4 session IBS education (EDU). Follow-up occurred at 2 weeks and 3, 6, 9, and 12 months following treatment completion. Treatment response was based a priori on the Clinical Global Improvement Scale (global IBS symptom improvement) and IBS Symptom Severity Scale (IBS-SSS). Post-treatment CGI gains were generally maintained by MC-CBT patients at quarterly intervals through 12-month follow-up with negligible decay. For MC-CBT and S-CBT, 39 and 33% of respondents maintained treatment response at every follow-up assessment. The corresponding percent for EDU was 19%, which was significantly lower (p < 0.05) than for the CBT groups. On the IBS-SSS, therapeutic gains also showed a pattern of maintenance with trends towards increased efficacy over time in all conditions, with the mean unit reductions between baseline and follows-up being approximately -76 at immediate and approximately -94 at 12 months (-50 = clinically significant). For treatment-refractory IBS patients, home- and clinic-based CBT resulted in substantial and enduring relief of multiple IBS symptoms that generally extended to 12-month post treatment.
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Specific author contributions: JL and JJ had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: JL, RF, JJ, GDG, LAK, SSK, LK, DB, MDS, and FH; acquisition, analysis, or interpretation of data: all authors; drafting of the manuscript: JL and JJ; critical revision of the manuscript for important intellectual content: all authors; statistical analysis: JJ; obtained funding: JL, JJ, RF, LK, and MDS: administrative, technical, or material support: all authors; study supervision: JL, RF, JJ, LK, DB, FH, and C-XM.
ISSN:0002-9270
1572-0241
1572-0241
DOI:10.1038/s41395-018-0396-x