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CBT methods succeed against IBS

Monday 9 May 2011

Irritable bowel syndrome (IBS) is one of the most common chronic digestive disorders. Several trials have shown that cognitive behaviour therapy (CBT) can reduce symptoms in patients with the condition. New research from Institute of Psychiatry (IoP), at King’s has identified some of the underlying mechanisms of CBT that result in patient improvement. The results demonstrated that change in both cognitive and behavioural responses mediated change in symptoms, disability and anxiety in IBS sufferers.

Cognitive behavioural therapy is a form of psychotherapy in which patients receive both cognitive therapy to overcome unhelpful thinking, and behavioural therapy to help change unhelpful coping strategies. How, or why, CBT works currently remains unanswered. An understanding of what makes this form of therapy beneficial will allow the development of better optimised and effective treatments for patients.

The new research, lead by Professor Trudie Chalder, used data from a randomised controlled trial of 149 patients, half of who received a combination of CBT and the drug mebeverine, which is a common therapeutic drug for those who suffer IBS, and half who received only the drug. The combination therapy was shown to be more effective than drug therapy alone. During treatment the patients completed self-administered surveys which assessed the severity of their IBS, the impact it was having on their day-to-day lives and their cognitive and behavioural responses or coping strategies.

The team used ‘path analysis’ - a statistical method of identifying cause/effect relationships - to test whether their cognitive behavioural approach worked by changing unhelpful thoughts and coping behaviours, those that are thought to perpetuate symptoms and disability in people with IBS. The results suggest that while both behavioural and cognitive change are important, the behavioural aspect of CBT in this study was more important than the cognitive aspect.

This model reveals a complex interaction between cognition, symptoms and behaviour in IBS. Understanding which components of CBT are most important for bringing about change in symptoms and disability is vital for both the refinement of current treatments and the development of new ones. 

Professor Chalder said: ‘We now have a better understanding of how CBT works. We now want to refine our treatments so that more people can benefit.’

Mediators of change in cognitive behaviour therapy and mebeverine for irritable bowel syndrome’ is published in Psychological Medicine.

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