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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| Veröffentlicht in: | The American journal of gastroenterology Jg. 114; H. 2; S. 330 - 338 |
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| Format: | Journal Article |
| Sprache: | Englisch |
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United States
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
01.02.2019
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| ISSN: | 0002-9270, 1572-0241, 1572-0241 |
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| Abstract | 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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| AbstractList | BACKGROUND: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.METHODS: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).RESULTS: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).CONCLUSIONS: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. 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. 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.BACKGROUNDThere 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).METHODSA 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).RESULTSPost-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.CONCLUSIONSFor 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. |
| Author | Hamilton, Frank Jaccard, James Katz, Leonard A. Firth, Rebecca S. Krasner, Susan S. Sitrin, Michael D. Keefer, Laurie Lackner, Jeffrey M. Brenner, Darren M. Gudleski, Gregory D. Radziwon, Christopher D. Ma, Chang-Xing |
| AuthorAffiliation | 6 Department of Biostatistics, University at Buffalo SUNY, Buffalo, NY, USA 1 Department of Medicine, Jacobs School of Medicine, Divisions of Behavioral Medicine and Gastroenterology, University at Buffalo, Buffalo, NY, USA 3 Division of Digestive Disease and Nutrition, NIDDK, Bethesda, MD, USA 4 Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 5 Departments of Anesthesiology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA 2 School of Social Work, New York University,New York, NY,USA 7 Department of Medicine, Feinberg School of Medicine, Division of Gastroenterology, Northwestern University, Chicago, IL, USA |
| AuthorAffiliation_xml | – name: 1 Department of Medicine, Jacobs School of Medicine, Divisions of Behavioral Medicine and Gastroenterology, University at Buffalo, Buffalo, NY, USA – name: 7 Department of Medicine, Feinberg School of Medicine, Division of Gastroenterology, Northwestern University, Chicago, IL, USA – name: 4 Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA – name: 3 Division of Digestive Disease and Nutrition, NIDDK, Bethesda, MD, USA – name: 2 School of Social Work, New York University,New York, NY,USA – name: 5 Departments of Anesthesiology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA – name: 6 Department of Biostatistics, University at Buffalo SUNY, Buffalo, NY, USA |
| Author_xml | – sequence: 1 givenname: Jeffrey M. surname: Lackner fullname: Lackner, Jeffrey M. organization: Department of Medicine, Jacobs School of Medicine, Divisions of Behavioral Medicine and Gastroenterology, University at Buffalo, Buffalo, NY, USA – sequence: 2 givenname: James surname: Jaccard fullname: Jaccard, James organization: School of Social Work, New York University, New York, NY, USA – sequence: 3 givenname: Christopher D. surname: Radziwon fullname: Radziwon, Christopher D. organization: Department of Medicine, Jacobs School of Medicine, Divisions of Behavioral Medicine and Gastroenterology, University at Buffalo, Buffalo, NY, USA – sequence: 4 givenname: Rebecca S. surname: Firth fullname: Firth, Rebecca S. organization: Department of Medicine, Jacobs School of Medicine, Divisions of Behavioral Medicine and Gastroenterology, University at Buffalo, Buffalo, NY, USA – sequence: 5 givenname: Gregory D. surname: Gudleski fullname: Gudleski, Gregory D. organization: Department of Medicine, Jacobs School of Medicine, Divisions of Behavioral Medicine and Gastroenterology, University at Buffalo, Buffalo, NY, USA – sequence: 6 givenname: Frank surname: Hamilton fullname: Hamilton, Frank organization: Division of Digestive Disease and Nutrition, NIDDK, Bethesda, MD, USA – sequence: 7 givenname: Leonard A. surname: Katz fullname: Katz, Leonard A. organization: Department of Medicine, Jacobs School of Medicine, Divisions of Behavioral Medicine and Gastroenterology, University at Buffalo, Buffalo, NY, USA – sequence: 8 givenname: Laurie surname: Keefer fullname: Keefer, Laurie organization: Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA – sequence: 9 givenname: Susan S. surname: Krasner fullname: Krasner, Susan S. organization: Department of Medicine, Jacobs School of Medicine, Divisions of Behavioral Medicine and Gastroenterology, University at Buffalo, Buffalo, NY, USA;, Departments of Anesthesiology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA – sequence: 10 givenname: Chang-Xing surname: Ma fullname: Ma, Chang-Xing organization: Department of Biostatistics, University at Buffalo SUNY, Buffalo, NY, USA – sequence: 11 givenname: Michael D. surname: Sitrin fullname: Sitrin, Michael D. organization: Department of Medicine, Jacobs School of Medicine, Divisions of Behavioral Medicine and Gastroenterology, University at Buffalo, Buffalo, NY, USA – sequence: 12 givenname: Darren M. surname: Brenner fullname: Brenner, Darren M. organization: Department of Medicine, Feinberg School of Medicine, Division of Gastroenterology, Northwestern University, Chicago, IL, USA |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 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. |
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| SubjectTerms | 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 |
| Title | Durability and Decay of Treatment Benefit of Cognitive Behavioral Therapy for Irritable Bowel Syndrome: 12-Month Follow-Up |
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