Home-based cognitive-behavioral therapy aids irritable bowel syndrome

A 10-week program of home-based cognitive-behavioral therapy led to significantly better improvements in irritable bowel syndrome than did a control education program in a prospective, randomized, single-center trial with 436 patients.

Study data also showed that the improvements produced  by the home-based cognitive-behavioral therapy (CBT) program were durable, persisting in 63% of high responders out to 6 months after treatment,according  to  the World Congress of Gastroenterology at the ACG 2017.

The trial had a third treatment arm in which patients underwent a 10-week course of standard CBT. Comparison of this group with the patients in the home-based program showed that the home-based, “minimal contact” regimen, which involved 4 total hours of professional contact during six sessions that were spaced out over a period of 10 weeks, was “at least as effective” as standard CBT, said by a  professor of medicine and director of the behavioral medicine clinic at the State University of New York at Buffalo.

He suggested that the minimal contact, home-based approach actually enhanced the efficacy of the CBT training that the patients received.

“Patients are given tasks to carry out. Responsibility is placed on them. It changes the dynamic between the clinician and patient. Skills patients learned during the minimal contact sessions included self-monitoring, muscle relaxation, worry control, problem solving, and modification of core beliefs.

The study enrolled adults up to 70 years old with at least moderately severe IBS symptoms at least twice weekly who met the ROME III diagnostic criteria. When patients performed a self-assessment  2 weeks after  the end of the 10-week intervention, 61% of those in the home-based CBT program group rated themselves as much or very much improved, compared with 55% of patients who received standard CBT and 44% of patients in the control group, who attended generic education sessions. The differences between each of the two CBT groups and the controls were statistically significant. Patient assessments performed by blinded gastroenterologists rated 56% of the home-based CBT patients as much or very much improved, compared with 51% of those who received standard CBT and 40% of the controls.

When reassessed 3 and 6 months later, the edge that home-based CBT patients showed over the control patients persisted. After 6 months off treatment, 57% of those who received home-based CBT continued to say they were much or very much improved over their baseline status, compared with 47% of the controls.

This  analysis also examined whether patients treated with CBT, either standard or home based, went into remission. He defined remission as having no or only mild symptoms during an assessment 2 weeks after the end of the intervention and then maintaining this response out to 6 months. No or only mild symptoms were reported by 35% of all CBT patients soon after treatment , compared  with 23% of the controls. Six months later, 63% of the high-responding patients on CBT and 52% of the high-responders with education maintained their high response.

“CBT appears to have an enduring effect that protects against subsequent relapse and recurrence in a sizable subsample of patients,” he concluded. The findings “suggest possible  disease modification by CBT.”