Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder affecting 10 - 20 per cent of people. Abdominal pain, bloating and altered bowel habit significantly affect patients' quality of life and can force them to take days off work.
New research has shown that Cognitive Behavioural Therapy (CBT) tailored specifically for IBS and delivered over the telephone or through an interactive website is more effective in relieving the symptoms of IBS than current standard care. These results could make a real difference to patients with IBS who currently have very limited access to CBT in a resource constrained NHS.
The research was led by Dr Hazel Everitt, Associate Professor in General Practice at the University of Southampton. Dr Everitt comments: "We previously knew that face-to-face CBT sessions could be helpful for treating IBS and this type of treatment is recommended in the National Institute for Clinical Excellence's guidelines. However, in my experience as a GP, I have found that availability is extremely limited."
In the largest study of its kind, researchers at the University of Southampton and King's College London carried out a trial involving 558 patients who had ongoing significant IBS symptoms despite having tried other IBS treatments for at least a year. Rona Moss-Morris, Professor of Psychology as Applied to Medicine and Trudie Chalder, Professor of Cognitive Behavioural Therapy from King's College London, developed the IBS specific CBT programmes, which both involve 8 treatment sessions but differing amounts of therapist input.
The findings, published today in the journal GUT, show that those who received either form of CBT were more likely to report significant improvement in severity of symptoms and impact on their work and life after 12 months of treatment compared to those who only received current standard IBS treatments.
Dr Everitt added: "The fact that both telephone and web based CBT sessions were shown to be effective treatments is a really important and exciting discovery. Patients are able to undertake these treatments at a time convenient to them, without having to travel to clinics.''
Professor Moss-Morris said: "The most important next step is for these tailored CBT treatments to be made more widely available. Professor Trudie Chalder and I are currently training NHS therapists at pre-existing Improving Access to Psychological Therapy (IAPT) services, so that more people suffering from IBS can access these treatments quickly. We are also working with a commercial partner to bring web-based CBT to the NHS and other parts of the world."
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The study was funded by the National Institute for Health Research (NIHR). The research team is now working towards making the therapy widely available in the NHS.
Statements from patients who took part in the trial:
Laura Day:
"There's no other way of putting it: this trial has changed my life. I'd had symptoms for as long as I can remember, but was diagnosed officially around the age of 13. Everything used to revolve around my IBS, not by choice but through fear of being caught out by my symptoms. Now, at 31 years old, I barely think about it because I'm symptom-free 98% of the time. I admit I was sceptical at first, because I couldn't see how changing my mindset could have a direct affect on my bowel habits, but I was surprised to notice improvements within the first couple of weeks. I've spent my whole life avoiding certain foods, restaurants and situations thinking I was controlling my IBS when I was actually adding fuel to the flame. The CBT techniques I learned and the information I was given in this trial gave me real control in a healthy, manageable way. I can't thank the researchers enough for exploring the potential of this treatment for IBS. I hope many more people are given the opportunity to benefit from it."
Jill Durnell:
"IBS has a profound affect on my life for many years and medication had little or no effect. The urgent need to go to the toilet had a major impact on my life. My job entailed a considerable amount of driving and my route was planned to allow "loo stops". I was having to cancel events at the last minute and felt that I was letting friends down. Wherever I went I checked, subconsciously, where the nearest toilets were!
IBS affected my life and that of my family for decades.
"My involvement with the ACTIB trial has made me aware of the psychological effect of my IBS. I feel that, to a great extent, I can manage the condition and I have minimised the impact of IBS on my life, without the cost of medication or medical consultations.
IBS is not controlling my life."
Notes to Editors
1) For interviews with Dr Hazel Everitt, please contact Steve Bates, Media Relations, University of Southampton. Email: s.d.bates@southampton.ac.uk Tel 023 8059 3212
2) The paper Assessing telephone-delivered cognitive-behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial is published in the journal GUT (DOI: 10. 1136/gutjnl- 2018- 317805) and can be found here following the embargo lifting: https://gut.bmj.com/content/early/2019/04/11/gutjnl-2018-317805. Journalists can see an advanced copy by contacting Media Relations.
3) The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world's challenges. We are among the top 100 institutions globally (QS World University Rankings 2019). Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 24,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 200,000 alumni. http://www.southampton.ac.uk
4) About King's College London and the Institute of Psychiatry, Psychology & Neuroscience
King's College London is one of the top 25 universities in the world (2017/18 QS World University Rankings) and among the oldest in England. King's has more than 26,500 students (of whom nearly 10,400 are graduate students) from some 150 countries worldwide, and nearly 6,900 staff. The university is in the second phase of a £1 billion redevelopment programme which is transforming its estate. http://www.kcl.ac.uk
The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London is the premier centre for mental health and related neurosciences research in Europe. It produces more highly cited publications in psychiatry and mental health than any other university in the world (Scopus, 2016), with 12 of the most highly cited scientists in this field. World-leading research from the IoPPN has made, and continues to make, an impact on how we understand, prevent and treat mental illness and other conditions that affect the brain. http://www.kcl.ac.uk/ioppn
5) The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
- Funds, supports and delivers high quality research that benefits the NHS, public health and social care
- Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
- Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
- Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
- Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.
This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. http://www.nihr.ac.uk/patientdata
6) Professor Hywel Williams, Director of the NIHR's Health Technology Assessment (HTA) Programme, which funded the study, said: "The results of this study provide important new evidence of how CBT delivered over the telephone or online can provide an effective treatment for patients living with this chronic and common gastrointestinal disorder. The research also provides important information for health care professionals who plan and deliver NHS care for people with irritable bowel syndrome."
Journal
Gut