Research: LJOTSSON and COLLEAGUES,

Listed in Issue 201

Abstract

LJOTSSON and COLLEAGUES, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden. brjann.ljotsson@ki.se  compared internet-delivered cognitive behavioral treatment (ICBT) with internet-delivered stress management (ISM) for IBS to assess whether the effects of ICBT are specific.

Background

This research group has developed an internet-delivered cognitive behavioral treatment (ICBT) for irritable bowel syndrome (IBS). The authors compared ICBT with internet-delivered stress management (ISM) for IBS to assess whether the effects of ICBT are specific.

Methodology

This was a randomized controlled trial, including 195 self-referred participants diagnosed with IBS. The treatment interventions lasted for 10 weeks and included an online therapist contact. The ICBT emphasized acceptance of symptoms through exposure to IBS symptoms and related negative feelings. The ICBT also included mindfulness training. The ISM emphasized symptom control through relaxation techniques, dietary adjustments, and problem-solving skills. Severity of IBS symptoms was measured with the gastrointestinal symptom rating scale-IBS version (GSRS-IBS). Credibility of the treatments and expectancy of improvement were assessed with the treatment credibility scale. The participants' perceived therapeutic alliance with their online therapist was measured with the working alliance inventory.

Results

At post-treatment and 6-month follow-up, 192 (99%) and 169 (87%) participants returned data, respectively. At post-treatment and 6-month follow-up, we found significant differences on the GSRS-IBS, favouring ICBT. The difference on GSRS-IBS scores was 4.8 (95% confidence interval (CI): 1.2-8.4) at post-treatment and 5.9 (95% CI: 1.9-9.9) at 6-month follow-up. There were no significant differences on the treatment credibility scale or the working alliance inventory between the groups.

Conclusion

Internet-delivered CBT has specific effects that cannot be attributed only to treatment credibility, expectancy of improvement, therapeutic alliance, or attention. Furthermore, a treatment based on exposure exercises specifically tailored for IBS may be a better treatment option than general stress and symptom management for IBS patients. ICBT is a promising treatment modality for IBS as it can be offered to IBS patients in much larger scale than conventional psychological treatments.

References

Ljotsson B, Hedman E, Andersson E, Hesser H, Lindfors P, Hursti T, Rydh S, Ruck C, Lindefors N, Andersson G. Internet-delivered exposure-based treatment vs. stress management for irritable bowel syndrome: a randomized trial. American Journal of Gastroenterology. 106(8): 1481-91. Aug 2011.

Comment

The results of the above research indicating that internet-delivered CBT treatment for management of IBS symptoms may be superior to standard treatments provide hope for better treatment for long-suffering IBS patients.

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