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Telephone and web-based CBT for IBS more effective than standard care

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder affecting 10 – 20 per cent of people. Abdominal pain, bloating and altered bowel habit significantly affect a patient’s quality of life and can force them to take time off work.

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New research has shown that Cognitive Behavioural Therapy (CBT) tailored specifically for IBS and delivered over the telephone or through an interactive website is more effective in relieving the symptoms of IBS than current standard care. These results could make a real difference to patients with IBS who currently have very limited access to CBT in a resource constrained NHS.

In the largest study of its kind, researchers at King’s and the University of Southampton carried out a trial involving 558 patients who had ongoing significant IBS symptoms despite having tried other IBS treatments for at least a year. 

The findings, published today in the journal GUT, show that those who received either form of CBT (via telephone or interactive website) were more likely to report significant improvement in severity of symptoms and impact on their work and life after 12 months of treatment compared to those who only received current standard IBS treatments.

In 1998, Professor Trudie Chalder, Professor of Cognitive Behavioural Therapy at King's, developed a cognitive behavioural model and treatment specifically for IBS  and her first HTA funded trial found that CBT combined with medeverine hydrochlorie (anti-spasmodic) was superior to mebeverine alone when delivered by trained nurses.  

Professor Rona Moss-Morris, Professor of Psychology as Applied to Medicine at King's, then developed and piloted a self-management version of CBT for IBS at the University of Auckland partly based on this approach and, when later based at Southampton University, developed a web-based version. 

Professor Chalder said: 'When Professor Moss-Morris came to King's we joined forces to evaluate therapist delivered CBT alongside web-based CBT and compared them to treatment as usual.  We are delighted to have found two modes of delivery helpful in improving the lives of patients with IBS.'

The research was led by Dr Hazel Everitt, Associate Professor in General Practice at the University of Southampton. Dr Everitt comments: 'We previously knew that face-to-face CBT sessions could be helpful for treating IBS and this type of treatment is recommended in the National Institute for Clinical Excellence’s guidelines. However, in my experience as a GP, I have found that availability is extremely limited. 

'The fact that both telephone and web-based CBT sessions were shown to be effective treatments is a really important and exciting discovery. Patients are able to undertake these treatments at a time convenient to them, without having to travel to clinics.'

Professor Moss-Morris said: 'The most important next step is for these tailored CBT treatments to be made more widely available. Professor Trudie Chalder and I are currently training NHS therapists at pre-existing Improving Access to Psychological Therapy  services, so that more people suffering from IBS can access these treatments quickly. We are also working with a commercial partner to bring web-based CBT to the NHS and other parts of the world.'

The study was funded by the National Institute for Health Research . The research team is now working towards making the therapy widely available in the NHS.

'Assessing telephone-delivered cognitive–behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial' by Everitt et al is published in Gut: https://gut.bmj.com/content/early/2019/03/26/gutjnl-2018-317805