Psychological Medicine

Original Articles

A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care

R. Moss-Morrisa1 c1, L. McAlpinea2, L. P. Didsburya2 and M. J. Spencea3

a1 School of Psychology, University of Southampton, UK

a2 ProCare Psychological Services, Auckland, New Zealand

a3 Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand

Abstract

Background Recent guidelines for the treatment of irritable bowel syndrome (IBS) emphasize the need for research to facilitate home-based self-management for these patients in primary care. The aim of the current study was to test the efficacy of a manualized cognitive behavioural therapy (CBT)-based self-management programme for IBS in a pilot randomized controlled trial (RCT).

Method Sixty-four primary-care patients meeting Rome criteria for IBS were randomized into either self-management plus treatment as usual (TAU) (n=31) or a TAU control condition (n=33). The self-management condition included a structured 7-week manualized programme that was self-administered in conjunction with a 1-hour face-to-face therapy session and two 1-hour telephone sessions. The primary outcome measures were the Subject's Global Assessment (SGA) of Relief and the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) assessed at baseline, end of treatment (2 months), and 3 and 6 months post-treatment.

Results Analysis was by intention-to-treat. Twenty-three (76.7%) of the self-management group rated themselves as experiencing symptom relief across all three time periods compared to seven (21.2%) of the TAU controls [odds ratio (OR) 12.2, 95% confidence interval (CI) 3.72–40.1]. At 8 months, 25 (83%) of the self-management group showed a clinically significant change on the IBS-SSS compared to 16 (49%) of the control group (OR 5.3, 95% CI 1.64–17.26).

Conclusions This study provides preliminary evidence that CBT-based self-management in the form of a structured manual and minimal therapist contact is an effective and acceptable form of treatment for primary-care IBS patients.

(Received February 12 2009)

(Revised April 22 2009)

(Accepted May 03 2009)

(Online publication June 17 2009)

Correspondence

c1 Address for correspondence: Professor R. Moss-Morris, School of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, UK. (Email: remm@soton.ac.uk)

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