Self-help workbook helps ease IBS symptoms

By Megan Brooks

NEW YORK (Reuters Health) - Patients with irritable bowel syndrome (IBS) experience statistically and clinically significant improvement in quality of life and gastrointestinal symptoms after completing a self-help workbook, new research shows.

"This is the first study to show that a self-help book based on cognitive behavioral therapy (CBT) principles and treatment strategies actually works for many patients with IBS without any additional contact with a therapist. This could dramatically improve the accessibility of effective treatment," Dr. Melissa Hunt of the University of Pennsylvania in Philadelphia said in a statement.

"IBS is often co-morbid with depression and anxiety and CBT is often used for IBS by trained cognitive-behavioral therapists," she added in an email to Reuters Health. "However, prevalence rates of IBS are quite high (some estimate 10% of the population) and there aren't nearly enough qualified therapists to go around, so the vast majority of patients with IBS do not have access to CBT."

Dr. Hunt tested the efficacy of a stand-alone CBT self-help wordbook for IBS in 60 patients. The workbook, which patients complete at their own pace, covers psychoeducation, relaxation techniques, the basic cognitive model of stress reduction, de-catastrophizing the implications of experiencing GI symptoms, and encouraging behavioral experiments and graded exposure, including to feared foods.

She randomly allocated the patients to the workbook or a wait-list control group. Patients were evaluated six weeks after randomization at which point wait-list controls crossed over to the workbook. All participants were then evaluated three months after treatment.

According to Dr. Hunt, IBS patients who completed the workbook enjoyed marked improvement in health-related quality of life, GI symptom severity, visceral sensitivity, and catastrophic thoughts.

There was "moderate attrition, as is common in both internet-based and self-help intervention studies," Dr. Hunt notes. However, analyses accounting for attrition "replicated prior statistically significant improvement on all major outcome measures."

Dr. Hunt reported her results October 20 at the annual meeting of the American College of Gastroenterology in Philadelphia.

"Self-help workbooks to help patients manage the psychological aspects of functional bowel disorders can easily be added to medical management and may result in significantly better patient outcomes with no added burden on medical personnel," Dr. Hunt said.

"The workbook is not actually published yet, but I'm delighted" to make it available electronically," she told Reuters Health. Her email is mhunt@psych.upenn.edu.

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