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Mediators of change in cognitive behaviour therapy and mebeverine for irritable bowel syndrome

Published online by Cambridge University Press:  11 April 2011

S. E. Reme ,
D. Stahl ,
T. Kennedy ,
R. Jones ,
S. Darnley  and
T. Chalder
S. E. Reme*
Affiliation:
Department of Psychological Medicine, and Department of Primary Care, King's College Hospital, London
D. Stahl
Affiliation:
Department of Psychological Medicine, and Department of Primary Care, King's College Hospital, London
T. Kennedy
Affiliation:
Department of Psychological Medicine, and Department of Primary Care, King's College Hospital, London
R. Jones
Affiliation:
Department of Psychological Medicine, and Department of Primary Care, King's College Hospital, London
S. Darnley
Affiliation:
Department of Psychological Medicine, and Department of Primary Care, King's College Hospital, London
T. Chalder
Affiliation:
Department of Psychological Medicine, and Department of Primary Care, King's College Hospital, London
*
*Address for correspondence: Dr S. E. Reme, Harvard School of Public Health, 450 Brookline Avenue, LW 731, Boston MA 02215, USA. (Email: silje.reme@uib.no)
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Abstract

Background

Cognitive behaviour therapies (CBTs) have through several trials been demonstrated to reduce symptoms and disability in irritable bowel syndrome (IBS) patients, but the mechanisms responsible for the changes are still unknown. The aim of this study was to test a theoretical model of CBT and investigate if cognitions and/or behaviour mediated the changes seen in CBT for IBS.

Method

To assess for possible mediating effects, we applied path analysis to the dataset of 149 diagnosed participants randomized to mebeverine hydrochloride plus CBT or mebeverine hydrochloride alone. Primary outcome was symptom severity, while secondary outcomes were work and social adjustment and anxiety.

Results

The path analyses supported mediational paths for all outcomes. Changes in behaviour and cognitions mediated all three outcomes, with models placing behaviour change ‘upstream’ of cognition change having best fit. The analyses of model fits revealed best fit for the anxiety model and hence provide increased confidence in the causal model of anxiety.

Conclusions

Changes in behaviour and cognitions mediate the change in CBT given to IBS patients. The results strengthen the validity of a theoretical model of CBT by confirming the interaction of cognitive, emotional and behavioural factors in IBS.

Keywords

Cognitive behaviour therapyirritable bowel syndromemediators of change
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 12 , December 2011 , pp. 2669 - 2679
Copyright
Copyright © Cambridge University Press 2011

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